bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Estrogen in Schizophrenia: Implications for Schizophrenia Practice Guidelines for Women
Authors: Grigoriadis Sophie , Seeman Mary V 
Published: January 2017

Objective: The objective of this paper is to integrate what is known about estrogen effects on symptoms and treatment response into a global understanding of schizophrenia. The aim is to expand Canadian schizophrenia guidelines to include the specific needs of women. Method: We searched the Medline database; keywords included estrogen, estrogen replacement therapy, schizophrenia, psychosis, treatment, tardive dyskinesia (TD), and women. We examined reference lists from relevant articles to ensure that our review was complete. We review the evidence for the effects of estrogen in schizophrenia and we make recommendations for the next revision of official practice guidelines. Results: The epidemiologic evidence suggests that, relative to men, women show an initial delay in onset age of schizophrenia, with a second onset peak after age 44 years. This points to a protective effect of estrogen, confirming animal research that has documented both neurotrophic and neuromodulatory effects. Clinical research results indicate that symptoms in women frequently vary with the menstrual cycle, worsening during low estrogen phases. Pregnancy is often, though not always, a less symptomatic time for women, but relapses are frequent postpartum. Some work suggests that in the younger age groups women require lower antipsychotic dosages than men but that following menopause they require higher dosages. Estrogen has been used effectively as an adjunctive treatment in women with schizophrenia. Estrogen may also play a preventive role in TD. Conclusions: Symptom evaluation and diagnosis in women needs to take hormonal status into account. Consideration should be given to cycle-modulated neuroleptic dosing and to careful titration during pregnancy, postpartum, and at menopause. We recommend that discretionary use of newer neuroleptic medication and adjuvant estrogen therapy be considered.
Experiments in Change: Pretrial Diversion of Offenders with Mental Illness
Authors: Swaminath R S , Mendonca J D , Vidal C , Chapman P 
Published: January 2017

Objective: Our objective was to study the outcomes experienced by 2 communities after implementing pretrial diversion of offenders with mental illness. Method: The same method of diversion was implemented in a predominately urban and a predominantly rural county. We collected retrospective clinical and offence data from pretrial diversion assessments conducted in court. As well, we measured outcome for the diversion procedure in terms of actual vs expected rates of recidivism. Results: Prior psychiatric treatment was associated with the diverted group, and a criminal history was associated with the nondiverted group. In the larger, urban county the diversion option was offered more often to persons with psychoses, mood disorders, and minor offences. Conversely, in the smaller rural county diversion was offered most often to persons accused of serious offences. The recidivism found in urban and rural diverted groups after a year of supervised care was only 2% to 3%, but the rate of use of diversion in both counties was low, owing to selection biases. Conclusion: Pretrial diversion of offenders with mental illness accused of minor crimes is eminently feasible for both urban and rural settings, provided that police, crown, and treatment policies are coordinated to favour the treatment option rather than prosecution.
Prevalence and Correlates of Elder Abuse and Neglect in a Geriatric Psychiatry Service
Authors: Vida Stephen , Monks Richard C , Rosiers Pascale Des 
Published: January 2017

Objective: To determine the prevalence and correlates of 4 types of elder abuse and neglect in a geriatric psychiatry service. Method: We conducted a cross-sectional retrospective chart review of new in- and outpatients seen by the Montreal General Hospital Division of Geriatric Psychiatry in one calendar year. Results: Abuse or neglect was suspected or confirmed in 20 (16%) of 126 patients, comprising financial abuse in 16 (13%), neglect in 7 (6%), emotional abuse in 5 (4%), physical abuse in 3 (2%), and multiple abuse in 7 (6%). On bivariate analysis, patients living with nonspouse family, friends, or other persons were significantly more likely to have suffered abuse than were those living with their spouse or in a supervised setting (OR 10.5; 95%CI, 2.3 to 47.8); widowed, divorced, or separated patients were significantly more likely to have suffered abuse than were married patients (OR 4.7; 95%CI, 1.02 to 22.0). Nonsignificant trends included female sex (OR 4.1; 95%CI, 0.89 to 18.6); alcohol abuse (OR 2.1; 95%CI, 0.71 to 6.2); behaviour problems (OR 1.9; 95%CI, 0.71 to 5.2); and chronic cognitive impairment (OR 1.4; 95%CI, 0.55 to 3.8). Although living situation with nonspouse family, friends, or others and marital status of widowed, divorced, or separated were significantly associated with abuse when examined in separate logistic regression models, both were nonsignificant when examined together, suggesting collinearity. Both were retained in the model because they probably represent different aspects of vulnerability. The final model included living situation with nonspouse family, friends, or others (OR 6.1; 95%CI, 0.75 to 49.5) and widowed, divorced, or separated marital status (OR 2.4; 95%CI, 0.21 to 26.8). Nonsignificant trends included female sex (OR 2.6; 95%CI, 0.45 to 14.4); alcohol abuse (OR 2.2; 95%CI, 0.59 to 7.9); and lowest quartile on the Global Assessment of Functioning (GAF) scale (GAF < 35; OR 2.0; 95%CI, 0.64 to 6.0). Conclusions: The practical implications of our study are that elder abuse and neglect are common among patients referred to geriatric psychiatry services, that such services should have access to multidisciplinary expertise and resources to deal with abuse, and that certain situations may signal higher risk. In our setting, the situation of living with nonspouse family, friends, or other persons in a nonsupervised setting and a history of family disruption by widowhood, divorce, or separation were significant correlates of abuse. Suggestive but nonsignificant trends of potential importance (OR > 2.0) included female sex, alcohol abuse, and lowest quartile of functional status. Study limitations include a cross-sectional retrospective chart review design, a clinically derived sample, a small sample size, and a lack of structured instruments for several variables.
Prevalence and Outcomes of Pharmaceutical Industry—Sponsored Clinical Trials Involving Clozapine, Risperidone, or Olanzapine
Authors: Procyshyn Ric M , Chau Anthony , Fortin Patricia , Jenkins Willough 
Published: January 2017

Objective: The literature continues to highlight the debate on the ethics and merits of trials sponsored by the pharmaceutical industry. This study attempts to determine the prevalence and outcomes of industry-sponsored trials involving clozapine, risperidone, or olanzapine. Methods: We searched the literature from January 1, 1990, to December 31, 2001, to capture all eligible clinical trials involving clozapine, risperidone, or olanzapine. The primary outcome measured was the clinical outcome of industry-sponsored studies. Secondary outcome measures included the following parameters: disclosure of any sponsorship and financial support, author(s) employed by the industry, use of comparator drug(s) within the trial, sample size, blinding, and use of placebo. Results: The database comprised 372 articles. Of these trials, 124 (33.3%) were sponsored by the pharmaceutical industry. In general, trials sponsored by Eli Lilly or Janssen had better research design than trials not funded by the pharmaceutical industry. With regard to authorship, more trials funded by Eli Lilly (74.6%) were coauthored by an employee of the company, compared with trials funded by either Janssen (23.3%) or Novartis/Sandoz (5.6%). Further, more trials sponsored by Eli Lilly reported positive outcomes (92.1%), compared with Janssen-sponsored trials (88.4%) and Sandoz/Novartis-sponsored trials (72.2%). No negative results were reported in any of the industry-funded trials. Conclusions: One-third of the published clinical trials involving clozapine, risperidone, or olanzapine were funded by their respective manufacturer. The reported outcomes of the sponsored trials highly favour the manufacturer's product.
Patient Opinions on the Benefits of Treatment Programs in Residential Psychiatric Care
Authors: Biancosino Bruno , Barbui Corrado , Pera Valentina , Osti Michela , Rocchi Denis , Marmai Luciana , Grassi Luigi 
Published: January 2017

Objective: To assess patients' opinions on the perceived benefit of treatment delivered during their stay in a residential facility. Method: We administered the Opinions on Curative Factors Questionnaire (OCFQ), which was developed from previous studies and assesses several treatment modalities and therapeutic factors, to a sample of 157 severely ill psychiatric patients admitted to a residential facility. Results: All therapeutic factors tested by the OCFQ were considered helpful or very helpful by most of those sampled. The item with the highest score was “talking to doctor,” followed by “free pass,” “medication,” “visitors,” “nonhospital setting,” “making friends with patients,” “structure of daily life,” “support from team,” and “talking to nurses.” The least-valued item was “group activities.” Conclusion: Psychiatric patients consider several treatment factors to be helpful, especially those based on individual approaches or on a less restrictive therapeutic milieu that allows interactions with the outside world. These results may be a valuable contribution to improving treatment planning in residential facilities.
Hospitalization in the First Year of Treatment for Schizophrenia
Authors: Whitehorn David , Richard Julie C , Kopala Lili C 
Published: January 2017

Objective: To determine the rates of hospitalization during the first year of treatment for schizophrenia, using an epidemiologic sample. Method: We examined inpatient and outpatient administrative databases in the province of Nova Scotia for cases of schizophrenia (ICD-9 code 295 or 298) newly diagnosed during the years 1995 to 1998. We noted the diagnosis site (that is, inpatient or outpatient) and hospitalizations in the year following diagnosis. We also established links to the clinical database maintained by the Nova Scotia Early Psychosis Program (NSEPP). Results: Over the 4-year period, we identified 434 unique cases from an at-risk population of 320 000 (yielding a yearly average age-specific incidence rate of 3.3/10 000), of whom 119 had received care from the NSEPP. Of the cases, 54% were initially diagnosed while they were inpatients. In the year following diagnosis, the overall hospitalization rate, excluding initial hospitalizations, was 17%. Patients who were initially diagnosed while inpatients had a higher rate of hospitalization in the first year of treatment (25% vs 7%), compared with those initially diagnosed while outpatients. This relation was also present among patients who received care from the NSEPP. Conclusions: Of newly diagnosed patients with schizophrenia, 46% were not hospitalized at the time of initial diagnosis. Of all patients, 17% required hospitalization during the first year of treatment, excluding an initial hospitalization, if present. Hospitalization rates in the first year were higher among patients initially hospitalized and among those with a rural residence. Patients requiring hospitalization during the first year form an important target group for improved interventions.
Through a Glass Darkly: The Disutility of the DSM Nosology of Depressive Disorders
Authors: Parker Gordon 
Published: January 2017

Objective: To demonstrate that the dimension-weighted DSM-IV model for classifying the depressive disorders lacks utility. Method: The logical flaws in classifying the depressive disorders with any severity-based model (which underpin both the DSM-IV and ICD-10 systems) are noted. Integral definitional limitations to the DSM-IV definition of key depressive disorders are identified. It is argued that the DSM-IV classificatory system lacks utility for providing information on etiology and preferential management strategies. An alternative subtyping model is considered. Results: It is asserted that, in practice, the DSM-IV model and criteria lack explanatory power and compromise research and clinical practice. Conclusions: It is hoped that this article evokes wider debate about modelling and classifying the depressive disorders.
Impact of a Specialized Early Intervention Service for Psychotic Disorders on Patient Characteristics, Service Use, and Hospital Costs in a Defined Catchment Area
Authors: Goldberg Karen , Norman Ross , Hoch Jeff , Schmitz Norbert , Windell Deborah , Brown Nicole , Malla Ashok 
Published: January 2017

Objective: To evaluate the impact of a new early intervention service for first-episode psychosis on patient characteristics, service use, and hospital costs. Method: We examined clinical records of all first admissions to hospitals of patients diagnosed with first-episode psychoses (nonaffective) over a 3-year period before and after the introduction of an early intervention service, the Prevention and Early Intervention Program for Psychosis (PEPP), in a defined catchment area. We examined demographic, clinical, and service use indices covering a 2-year period subsequent to the index admission for each patient. Results: Patients in the post-PEPP phase were significantly younger ( P < 0.01), were more often male ( P < 0.05), and were less likely to be admitted to hospital with an involuntary status ( P < 0.05) or with injuries ( P < 0.05) at the time of their first hospital admission. Over the 2 years following the initial admission, post-PEPP patients had significantly fewer admissions to a regular psychiatric service ( P < 0.001) and made significantly fewer visits to the hospital emergency department ( P < 0.01). There was a significant mean reduction in costs per case of regular hospital bed use ($1028.49, SD 528.02, compared with $792. 28, SD 528.02; P < 0.01) and emergency visits ($519.18, SD 353.79, compared with $353.79, SD 345.0; P < 0.01). Time series analyses followed by Chow tests failed to confirm that these cost changes could be attributed specifically to the introduction of an early intervention service. Conclusion: Introduction of a specialized early intervention program may be beneficial to patients and to the health care system. To evaluate the cost–benefit ratio of early intervention services, longer term and more detailed data may be required.
The Epidemiology of Mental and Substance Use—Related Disorders among White, Chinese, and other Asian Populations in Canada
Authors: Tiwari Suresh K , Wang JianLi 
Published: January 2017

Objectives: The objectives of this study were to estimate and compare the lifetime and 12-month prevalence of mood disorders, anxiety disorders, and substance dependence in white, Chinese, and other Asian populations in Canada and to identify correlates of mental disorders in these ethnic groups. Methods: We used data from the Canadian Community Health Survey: Mental Health and Well-Being. The WHO's Composite International Diagnostic Interview was used to assess mental disorders diagnosed according to the DSM-IV criteria. We included subjects who were white ( n = 33 399), Chinese ( n = 733), or from other Asian populations ( n = 1113). The lifetime and 12-month prevalence of mental disorders was estimated according to ethnic group. Results: The lifetime and 12-month prevalence of mental disorders in Chinese participants was lower than the prevalence rates in white participants. Other Asian participants were less likely than white individuals to have had any mood and anxiety disorder in their lifetime. The 12-month prevalence of any mental disorder in Chinese participants was lower than in other Asian participants. However, the proportion of Chinese participants with perceived fair to poor mental health was higher than in the other Asian and white groups. Conclusions: The prevalence of mental disorders among Chinese individuals living in Canada resembles that in China's population. The prevalence of mental disorders in the Asian populations may vary by region. Studies are needed to examine subthreshold mental disorders in the Asian populations as well as ethnic differences in mental disorders in relation to sex, age, and clinical conditions.
Personality and Depression
Authors: Bagby R Michael , Quilty Lena C , Ryder Andrew C 
Published: January 2017

Objective: To examine the implications of the association between personality and depression for the understanding, assessment, and treatment of major depression. Method: A broad range of peer-reviewed manuscripts relevant to personality and depression was reviewed. Particular emphasis was placed on etiology, stability, diagnosis, and treatment implications. Results: Personality features in depressed samples reliably differ from those of healthy samples. The associations between personality and depression are consistent with a variety of causal models; these models can best be compared through longitudinal research. Research demonstrates that attention to personality features can be useful in diagnosis and treatment. Indeed, personality information has been on the forefront of recent efforts to advance the current diagnostic classification system. Moreover, personality dimensions have shown recent promise in the prediction of differential treatment outcome. For example, neuroticism is associated with preferential response to pharmacotherapy rather than psychotherapy. Conclusions: Consideration of personality features is crucial to the understanding and management of major depression.
Prevalence, Risk Factors, and Use of Health Care in Depression: A Survey in a Large Region of France between 1991 and 2005
Authors: Kovess-Masfety Viviane , Briffault Xavier , Sapinho David 
Published: January 2017

Objective: To compare the prevalence, risk factors, and use of care for depression between 2 periods, concerning changes in social factors and health care provision. Method: We compared data from 2 surveys carried out in a large urbanized French region (Île-de-France) 15 years apart (1991, n = 1192; 2005, n = 5308), using comparable methodology and tools. Results: The overall prevalence of depression has slightly increased over this period. In contrast, the tendency of people who claim they feel depressed has dramatically increased. At-risk populations have also changed during this period. The proportion of people consulting a psychiatrist for depression has not changed, while general practitioner (GP) consultations have decreased and psychologist consultations have increased 3-fold. Psychotropic use by people who are depressed has decreased significantly. Conclusion: The trend toward increased depressive symptoms does not correspond to an increase in depressed disorders. In a well-staffed urbanized French region, psychologists are playing a growing role in managing depression at the expense of GPs, when the use of a psychiatrist remains unchanged; decreased use of psychotropic drugs may be a consequence.
The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Trial: A Review
Authors: Sinyor Mark , Schaffer Ayal , Levitt Anthony 
Published: January 2017

Objective: The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial is the largest open-label, pragmatic trial that has been undertaken to examine the treatment of major depressive disorder. At a cost of US$35 million over 6 years, STAR*D sought to test the effectiveness both of pharmacotherapy and of cognitive therapy, and to ascertain whether certain treatments are more optimal after one or more failed trials. Method: Patients ( n = 2876) who presented to either a psychiatry or family practice setting seeking treatment for depression were included in the STAR*D analysis. In the 4 levels of STAR*D, patients were randomized to various treatment monotherapies, combinations, or augmentation strategies. The primary outcome was remission, based on the Hamilton Depression Rating Scale. Secondary outcomes were response, as measured by clinician and patient self-report as well as various measures of patients' level of function and (or) quality of life. Results: Remission rates for treatment levels 1 to 2 and 3 to 4 were 18% to 30% and 7% to 25%, respectively. There was no difference in effectiveness between any treatments at any treatment level. Patients with longer index episodes, more concurrent psychiatric or general medical disorders, and (or) lower measures of baseline function were less likely to achieve remission. There were no major differences between outcomes in patients treated in primary, compared with specialist care, nor were there significant differences between depression rating scores obtained through clinician ratings, compared with self-report. Conclusion: Results of the STAR*D trial have shed important light on the effectiveness of current treatment strategies for patients with depression.
Clinical and Sociodemographic Profiles of Male Inmates with Severe Mental Illness: A Comparison with Voluntarily and Involuntarily Hospitalized Patients
Authors: Dumais Alexandre , Côté Gilles , Lesage Alain 
Published: January 2017

Objective: To identify the clinical specificity of men with severe mental illness (aged 18 to 40 years) by legal status. Method: Our study compared 85 inmates with 66 involuntarily hospitalized patients (IHPs) and 50 voluntarily hospitalized patients (VHPs) with at least one Axis I diagnosis of psychosis or major affective disorder. Sociodemographics, medical information, and criminal history were drawn from interviews, medical records, and official criminal records. We used the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders to determine Axis I disorders and antisocial personality disorder (ASPD). Psychopathy was measured with the Psychopathy Checklist—Revised. Results: We found that inmates had a lower level of schooling ( P = 0.001), were more likely to have been in an intimate relationship ( P < 0.001), and were less likely to have a psychiatric hospitalization history ( P < 0.001), compared with hospitalized patients. Inmates were also more likely to meet criteria for delusional disorders or psychosis not otherwise specified ( P < 0.001) and major depression ( P = 0.001). IHPs were more likely to meet schizophrenia spectrum disorder criteria ( P < 0.001). Inmates had a higher level of comorbidity involving ASPD ( P < 0.001), psychopathy ( P < 0.001), and substance misuse ( P < 0.001). IHPs showed an intermediate level between inmates and VHPs for these comorbid disorders. VHPs had the lowest level of comorbidity with Axis I psychiatric diagnosis. Conclusion: Our clinical specificity hypothesis was supported: different psychopathological characteristics and social functioning profiles were identified by legal status. Specific integrated treatments should be considered for inmates and IHPs.