bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatry and the Burden of Mental Illness
Authors: Bland Roger C 
Published: January 2017

Objective: To examine the morbidity produced by mental disorders, to project changes in morbidity likely to be produced by demographic and economic change, and to review the possible role of psychiatry in the health care system. Methods: Using prevalence data for psychiatric disorders and population projections, this paper presents the likely changes in morbidity over the next 20 years. A review of social and economic information indicates changes in social attitudes and their effects on mental health. This paper examines the determinants of health and how they are likely to change and explores some possible directions for changes in health care delivery. Results: Psychiatric disorders have been greatly underestimated as a cause of disability but account for 5 of the 10 leading causes of disability and 47.2% of all years lived with a disability (YLD) in developed countries. By 2016, there will be significant changes in the distribution and type of psychiatric disorders seen in the population, with cases of dementia almost doubling. Most of the population growth will be in the older age-groups, who will be well informed and will demand high standards of service. The gap between rich and poor will increase, and the results of childhood poverty and abuse will become more apparent. The disadvantaged, including many mentally ill, will suffer deprivation as disability payments decline, but youth unemployment will improve, possibly reducing crime rates. Forced early retirements will decline. Alternative medicine will make inroads into health care. A crisis in subsidized accommodation for the elderly can be anticipated, which perhaps will lead to reopening institutions that are currently being closed or to developing new forms of care. As the baby boomers pass 50 years of age and begin consuming health care services, governments will revise plans and eligibility for services; users will pay for services more directly. Conclusions: Psychiatry is very vulnerable to minor changes in health care schemes and will increasingly be called on to show economic arguments to justify its services. Pressure to support a primary care model by changing practice styles, developing new skills, and training practitioners will probably occur. The major growth area likely will be geriatric psychiatry.
Community Case Study: Suicide Cluster in a Small Manitoba Community
Authors: Wilkie Clarke , Macdonald Sharon , Hildahl Keith 
Published: January 2017

Objectives: To review a cluster of suicides and suicidal ideation in a First Nations community. Method: The medical records and autopsy reports of the victims are reviewed. Collateral information obtained in the community is presented. A series of psychiatric assessments conducted at the local health centre in a 3-day period is outlined. The dilemma of developing appropriate treatment plans is discussed. Results: In the period from February 3 to May 5, 1995, an isolated northern Manitoba First Nations community had 6 suicides in a population of less than 1500. Several other suicide attempts occurred. Community resources were strained. Alcohol was a factor in 4 of the suicides. Previous sexual assault was cited in 4 of 5 female cases presenting with suicidal ideation. Conclusions: Cluster suicide is a shared psychiatric and public health problem of major concern. Dreams of beckoning are common following a suicide. Communities should have a prepared plan to deal with a suicide. Resources should be provided quickly in an effort to prevent a cluster of suicides from occurring. High-risk individuals must be identified. Substance abuse must be addressed. Resources to assess and treat victims of sexual abuse must be available.
Group Treatment for Substance Abuse in Schizophrenia
Authors: Addington Jean , el-Guebaly Nady 
Published: January 2017

Objectives: A review of the relevant research suggests a need to develop an appropriate, effective, and replicable treatment to help individuals with schizophrenia and substance abuse problems. This pilot study describes a biweekly group specifically designed to help the individual with both schizophrenia and substance abuse. The components of the group were support, psychoeducation, and skills training. Attention was also paid to the stage of recovery. Method: Eighteen subjects attended the group and were assessed pregroup. Thirteen subjects completed a 1-year follow-up, and 5 subjects were assessed between 3 and 6 months. Results: At the follow-up assessment, 8 subjects (44%) were abstinent. Conclusions: This type of treatment appears to be effective for reducing substance abuse in this population.
Paraphrenia Redefined
Authors: Ravindran Arun V , Yatham Lakshmi N , Munro Alistair 
Published: January 2017

Background: Paraphrenia is a disorder similar to paranoid schizophrenia but with better-preserved affect and rapport and much less personality deterioration. It is now diagnosed relatively infrequently and is not listed in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or International Classification of Diseases (ICD-10). However, it appears that some psychiatrists recognize the illness but label it “atypical psychosis,” “schizoaffective disorder,” or “delusional disorder” for lack of a better diagnostic category. Virtually no systematic research on paraphrenia has been conducted in the past 60 years. Method: The authors distinguish paraphrenia from “late paraphrenia,” a diagnosis used mainly in the United Kingdom, and provide a neo-Kraepelinian description of paraphrenia that would be compatible with the formats of DSM-IV and ICD-10. Using a questionnaire adapted from this description, intake cases in 2 Canadian psychiatric centres (Ottawa [Ontario] and Dartmouth [Nova Scotia]) were surveyed. Cases of paraphrenia were distinguished from those of schizophrenia and delusional disorder and were examined at the time of intake and immediately prior to discharge. Results: For logistical reasons, collecting a totally consecutive series was not possible. However, during an 18-month period, investigators in both centres identified 33 cases closely fitting paraphrenia. The outstanding features of these cases are enumerated, and an outline description of paraphrenia is derived. Conclusion: It is possible to define and recognize paraphrenia; it is a viable diagnostic entity. Further research would benefit paraphrenia and schizophrenia patients. Cases in this study have been coded to permit follow-up investigations.
Identification of Childhood Psychiatric Disorder by Informant: Comparisons of Clinic and Community Samples
Authors: MacLeod Roderick J , McNamee Jane E , Boyle Michael H , Offord David R , Friedrich Marjorie 
Published: January 2017

Objective: To compare the identification of psychiatric disorder as informed by parents versus teachers in children aged 6–11 years and parents versus adolescents in youth aged 12–16 years in clinic versus community samples. Method: Study data come from parallel surveys in Hamilton, Ontario, of children aged 6–16 years. The surveys included consecutive referrals (N = 1150) between 1989 and 1991 to the region's 2 agencies providing outpatient child mental health services. Also, a simple random sample (N = 1689) was used, drawn in 1989 from students attending public schools. Conduct disorder, hyperactivity, emotional disorder, and somatization disorder were assessed by informants using the original Ontario Child Health Study scales. Results: The percentage of children identified with a disorder was markedly higher in the clinic sample, irrespective of the type of disorder, the age and sex of the child, and who provided the assessment. Also, there was a statistically significant differential shift between parents and teachers in the percentage of children identified with disorder. The ratio of children aged 6–11 years identified with conduct disorder or hyperactivity by parents versus teachers was higher in the clinic sample than in the community sample. Among youth aged 12–16 years, a similar pattern emerged for parents as informants versus the adolescents themselves, but it was statistically nonsignificant. Conclusions: The data suggest that the relative contribution of informants to the identification of childhood psychiatric disorder varies by sample type: clinic and community. If risk factors for child disorder are influenced by contextually specific factors wedded to informants, then studies conducted in clinic versus community samples may lead to discrepant information about the determinants of psychopathology. The extent of this problem needs to be assessed by comparing the results of parallel studies conducted in clinic versus community samples.
Long-Term Medical Conditions and Major Depression in the Canadian Population
Authors: Patten Scott B 
Published: January 2017

Objectives: To evaluate associations between long-term medical conditions and major depression in the Canadian population, and to examine the impact of these conditions on health care service use and disability. Methods: Data from the first wave of the Canadian National Population Health Survey (NPHS) were used. The NPHS used a probability sample of 17 626 Canadians and included questions about long-term medical conditions, health care service use, and disability and a brief predictor of major depression. Contingency tables and graphical techniques were used to evaluate associations between the variables of interest. Results: Various chronic medical conditions were associated with an elevated prevalence of major depression. There was no evidence that subjects with major depression and comorbid medical conditions were more likely to be admitted to hospital or to be high users of physician services. However, major depression comorbid with chronic medical conditions was associated with a greater than expected extent of activity limitations. Conclusions: Chronic illness may increase the risk of depression or the duration of depressive episodes; either effect could lead to an increased prevalence. Alternatively, major depression may predispose individuals to certain chronic illnesses. Comorbid major depression and chronic medical conditions are associated with a considerable burden of disability in the Canadian population but not excessive use of physician services.
Clinical Predictors of Short-Term Outcome in Electroconvulsive Therapy
Authors: Lam Raymond W , Bartley Simon , Yatham Lakshmi N , Tam Edwin M , Zis Athanasios P 
Published: January 2017

Objectives: Electroconvulsive therapy (ECT) remains one of the most effective biological treatments for major depression. However, there is little information on the clinical use of ECT, and most studies were conducted before the introduction of newer antidepressants and before improvements in ECT delivery. This study examined ECT use in a university teaching hospital to determine predictors of short-term ECT outcome. Methods: This was a retrospective chart review of ECT over the period 1994–1996. Data extracted from the chart included demographic information, clinical features of depression, and documented antidepressant trials. Outcome measures, based on the chart notes, included Clinical Global Impression (CGI) and cognitive side effects of ECT at 1 week post-ECT or at discharge if sooner. Results: Of 174 patients who received ECT, 130 had a diagnosis of unipolar major depressive disorder. Of these 130 patients, 92% were refractory to at least 1 antidepressant medication. After a clinical course of ECT, 87% were rated as “much” or “very much” improved on the CGI. Moderate side effects were noted in 16% of patients, while only 7% had marked side effects. Medication resistance was not related to ECT response. No significant clinical predictors (symptoms, chronicity, number of antidepressant trials) of ECT outcome were found on a stepwise multiple-regression analysis. Conclusions: These results support previous studies showing that ECT results in very good short-term response in major depressive disorder and that the cognitive side effects of ECT are reasonable. Despite the limitations of this study (retrospective, chart review, global measures), the results will inform clinicians who are recommending ECT for their patients.
A Comparison of Short-Term Group and Individual Therapy for Sexually Abused Women
Authors: Stalker Carol A , Fry Richard 
Published: January 2017

Objective: To compare the effectiveness of 10 sessions of group therapy with that of 10 sessions of individual therapy in a sample of 86 adult women seeking treatment for the effects of childhood sexual abuse. Method: Participants were randomly assigned to the 2 treatment modalities and tested at assessment, pretherapy following a 10-week wait condition, posttherapy, and 6-month and 12-month follow-up. Results: Participants had fewer symptoms and better psychosocial functioning posttherapy and were further improved at the 6- and 12-month follow-up. Neither treatment modality was superior to the other. Approximately one-half of the sample sought further treatment during the follow-up periods. Conclusions: Improvement in symptoms and functioning was associated with short-term treatment in both modalities, but many patients remained distressed and required further treatment. Future research should investigate whether sexually abused women who meet criteria for specific diagnoses require more focused and/or longer-term therapy.
Prenatal Factors and Adult Mental and Physical Health
Authors: Susser Ezra B , Brown Alan , Matte Thomas D 
Published: January 2017

Objective: To review research on prenatal influences on adult mental and physical health and draw implications for future directions in psychiatric research. Method: Schizophrenia is selected as an example from mental health and cardiovascular disease as an example from physical health. For each of these disorders, empirical findings on prenatal influences are reviewed, and the methods used to demonstrate them are critiqued. Results: Research on prenatal antecedents of these conditions has proceeded in parallel: intriguing findings have related fetal growth restriction or fetal insult to adult health; similar types of causal pathways have been proposed to explain the relationships; and research has been plagued by similar limitations, including lack of precise prenatal exposure data and difficulty of controlling confounding. The prevailing view of disease causation, which is not well-suited to investigation of prenatal antecedents, impedes research in both fields. Yet, there has been little interchange between researchers in the 2 fields. Conclusions: We propose a causal paradigm that could serve as a guide for future investigations on the prenatal antecedents of adult health and promote interchange between research on mental and physical health. The paradigm reflects current thinking in epidemiology by encompassing not only risk factors as traditionally conceived but also causal chains over time and causal influences at multiple levels of organization. Implications for the design of new research are illustrated with reference to an ongoing study.
Precursors to Schizophrenia: Do Biological Markers Have Specificity?
Authors: Tarrant C Jane , Jones Peter B 
Published: January 2017

This review addresses childhood antecedents and biological markers of schizophrenia within a neurodevelopmental framework. General-population birth-cohort studies illustrate delays in developmental milestones, abnormalities in social functioning, and cognitive deficits throughout childhood, adolescence, and early adulthood. Abnormal neurology and motor dysfunction have been measured in children prior to the onset of schizophrenia, at first onset of disease, and in those with chronic schizophrenia Minor physical anomalies, a static marker of developmental disturbance, are also increased in schizophrenia. None of these factors has high specificity for this disorder. This review examines the associations between these precursors and some etiological factors for schizophrenia, comments on their lack of complete specificity to this psychotic syndrome, and considers their usefulness as predictors of risk.
Des variations intersexuelles relatives aux traitements en psychiatrie
Authors: Godfroid Ivan O 
Published: January 2017

Objectif: L'auteur revoit la documentation abordant l'influence des facteurs sexuels sur l'efficacité des traitements les plus couramment utilisés en psychiatrie. Il propose d'optimaliser l'efficacité et la tolérance des thérapies en tenant compte du sexe du patient. Méthode: Une vue d'ensemble aborde successivement les traitements pharmacologiques, psychothérapeutiques et autres (psychochirurgie, électroconvulsivothérapie (ECT). Des conclusions intermédiaires sont tirées pour chaque chapitre. Résultats: Les publications sur le sujet sont rares et inégales. D'un point de vue pharmacologique, les différences intersexuelles sont marquées et touchent tant l'absorption, la distribution, le métabolisme, que l'excrétion des substances. Il en résulte des variations dans la biodisponibilité qui ont des répercussions sur l'efficacité et les effets secondaires; celles-ci touchent les antidépresseurs, les neuroleptiques, le lithium, et aussi les hypnotiques, sédatifs et anxiolytiques. Le cycle menstruel et la prise de contraceptifs oraux sont à l'origine d'interactions significatives. L'influence de l'effet sexospéciflque sur l'efficacité des psychothérapies a été peu étudiée. Certaines différences semblent toutefois possibles, mais un effort de recherche important devra être consenti avant de pouvoir tirer des conclusions reproductibles. Certains types de traitement «physiques», tels la psychochirurgie et l'ECT, semblent peu influencés par le sexe du patient. Conclusions: Il existe une influence certaine du sexe du patient sur l'efficacité du traitement qui lui est administré. Cette influence est toutefois souvent limitée, mais elle entre en ligne de compte dans l 'optimalisation de la réponse et de la tolérance à la thérapie. La recherche dans ce domaine de la psychiatrie devrait être encouragée.
A Comparison of Male and Female Adolescents Referred to an Eating Disorder Program
Authors: Geist Rose , Heinmaa Margus , Katzman Debra , Stephens Derek 
Published: January 2017

Objective: To compare gender-related psychopathology and psychiatric diagnoses in male and female adolescents referred to an adolescent eating disorder program. Method: All adolescents presenting at the Eating Disorder Program at our hospital completed the semistructured Diagnostic Interview for Children and Adolescents – Revised (DICA-R) and self-report scales, including the Children's Depression Inventory (CDI), the Brief Symptom Inventory (BSI), the Eating Disorder Inventory (EDI-2), and the Family Assessment Measure (FAM-III), during their initial assessment. The 157 subjects (21 male, 136 female) were classified into Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) eating disorder (ED) subtypes and then recombined into male and female restricters (R) and ED-related groups: showing eating-related concerns but not having a DSM-IV diagnosis. We compared the male and female restricter groups and ED-related group on 5 specific psychological dimensions to examine comorbid psychiatric diagnosis, ED-specific and nonspecific psychopathology, EDI clinical and provisional subscales, and family functioning using multivariate analyses of covariance (MANCOVAs). Results: Males endorsed statistically significant lower drive for thinness and body dissatisfaction than did females. However, there are no representative norms for adolescent males on these variables. The ED-related group also endorsed statistically significant lower drive for thinness and body dissatisfaction (specific ED psychopathology) than did the ED-restricter groups. The males in both groups endorsed fewer EDI items than did their female counterparts, but the differences were not statistically significant. Comorbid psychiatric diagnoses of depression and anxiety in male and female restricters were common but did not distinguish the groups. Conclusions: Our results suggest that male and female adolescents with EDs are clinically similar to each other and therefore resemble adults for lack of gender-specific effects on self-reported psychopathology, family functioning, and comorbid psychiatric disorders.
Family-of-Origin Characteristics in Bipolar Disorder: A Controlled Study
Authors: Cooke Robert G , Young L Trevor , Mohri Linda , Blake Pamela , Joffe Russell T 
Published: January 2017

Objective: To assess the family-of-origin characteristics of patients with bipolar disorder relative to those of control subjects. Method: Fifty-six euthymic patients meeting research diagnostic criteria for bipolar disorder and 21 control subjects completed the Family Environment Scale (FES) for the family they grew up with. Results: The 2 groups showed strikingly similar profiles on 10 indices of family functioning or structure. Conclusions: The results do not support the hypothesis that specific family attributes contribute to the development of bipolar disorder.
Elderly Suicide in Alberta: Difference by Gender
Authors: Quan Hude , Arboleda-Flórez Julio 
Published: January 2017

Objective: To determine differences by gender among elderly persons who commit suicide on demographic characteristics, place of suicide, suicide method, previous suicide behaviour, and precipitant stressor. Method: This study included completed suicides of individuals aged 55 years and over during 1984–1995 in Alberta (n = 920). Information was abstracted from suicide records of medical examiners. Results: Relative to elderly female suicides, elderly males who commit suicide characteristically use guns to commit suicide (43.8%), are single (12.5%), live in rural areas (46.7%), and have a lower frequency of previous suicide attempts (16.5%). Physical illness and financial difficulty as precipitant stressors of suicide are significantly more frequent among males (40.3% and 8.7% respectively) than females (29.9% and 1.8% respectively). Mental illness as a precipitant stressor is more common among females, 35.8% for women and 15.3% for men. Conclusions: Lethal methods of suicide and physical illness and financial difficulty as precipitant stressors of suicide are more common among elderly males than females who commit suicide.
Obsessive-Compulsive Spectrum Disorders: Effective Treatment with Paroxetine
Authors: Ravindran Arun V , Lapierre Yvon D , Anisman Hymie 
Published: January 2017

Objective: To examine whether, like pure obsessive-compulsive disorder, obsessive-compulsive spectrum disorders are treatable with a selective serotonin reuptake inhibitor (SSRI). Method: Case histories of patients prescribed paroxetine for compulsive collecting, skin-picking, and trichotillomania were reviewed. Results: All patients were successfully treated with paroxetine. Conclusions: Obsessive-compulsive spectrum disorders may share a serotonin-related dysfunction, and SSRIs may prove effective in their treatment.
Cost Savings Associated with Fitness-to-Stand-Trial Assessments in Detention Centres: A Pilot Program
Authors: Chaimowitz Gary A , Ferencz Joseph 
Published: January 2017

Objective: To determine whether fitness-to-stand-trial assessments “in detention” offer cost benefits over inpatient assessments. Method: The development of a pilot “fitness clinic” in a detention centre is described, and the results of 1 year of assessments are presented. The cost benefit of fitness assessments conducted in detention centres is outlined. Results: Significant cost savings were realized by operating fitness clinics in detention centres. Conclusion: Fitness clinics in detention centres offer important benefits and are recommended as an adjunct to forensic programs.