bluuebunny/crossref_metadata_2025_split huggingface dataset:
I. Downsizing Psychiatric Hospitals: Needs for Care and Services of Current and Discharged Long-Stay Inpatients
Authors: Lesage Alain D , Morissette Raymond , Fortier Linda , Reinharz Daniel , Contandriopoulos André-Pierre 
Published: January 2017

Background: With the psychiatric deinstitutionalization movement in its fourth decade, questions are being raised concerning its relevance for long-stay inpatients with severe disabilities and the risk that those discharged into the community may be abandoned. Methods A random sample taken in 1989 of long-stay inpatients at Louis-H Lafontaine Hospital made it possible to examine 96 pairs of patients. Each pair included 1 patient discharged between 1989 and 1998 and 1 patient hospitalized. Pairs were matched for sex, age, length of stay, and level of psychiatric care in 1989. Patients and staff were interviewed using standardized questionnaires, and case notes were reviewed to assess symptoms, daily living skills, residential status, quality of residential setting, and clinical and social problems and needs. Results The investigation revealed that discharged patients moved to highly supervised settings, which included professionally supervised group homes, supervised hostels, and foster families. About 20% went to nursing homes owing to loss of autonomy from physical disorders. Only 4 discharged patients were lost to follow-up, of whom 2 were probable vagrants. Both those discharged and those remaining as inpatients presented with major clinical problems and daily living skill deficits. The care needs of discharged patients were generally met, and placement in the community was considered appropriate. Of those who had remained hospitalized, over one-half could be moved to supervised settings immediately, or after 1 to 2 years' preparation in a discharge unit, while 13% could be moved to nursing homes. Over 25% required intensive, individualized rehabilitation treatment targeting engagement, psychotic symptoms, withdrawal, and dangerous and socially embarrassing behaviours. Conclusion Deinstitutionalization in the largest Canadian psychiatric hospital did not lead to patient abandonment in the community.
Who Uses Bibliotherapy and Why? A Survey from an Underserviced Area
Authors: Adams Susan J , Pitre Nancy L 
Published: January 2017

Objective: To assess which mental health therapists use bibliotherapy, their reasons for doing so, and rationale for recommending specific titles. To review the book selected most often in several categories, using prepublished criteria for reviewers of self-help books. Method We sent a survey to all therapists in a Northern Ontario community requesting information on therapist demographics, the respondent's practice, the use of bibliotherapy, and details of the book most often prescribed in various categories. Results Of 112 surveys, 62 were returned, for a response rate of 55%. Sixty-eight percent of respondents indicated that they used bibliotherapy. The most common reason for recommending books was to encourage self-help. There was a significant relation between greater counselling experience and increased use of bibliotherapy. Three of the 5 books reviewed were based on empirical theory; only 1 met all the guidelines. Conclusion Most therapists recommend books to their clients, but there is little empirical evidence of efficacy. Counsellors should review the books recommended and discuss them with the client. Client opinion should be solicited and effectiveness measured.
Child Maltreatment: What We Know in the Year 2000
Authors: MacMillan Harriet L 
Published: January 2017

This paper provides an overview of child maltreatment within a public health framework, based on the Closing Plenary Address presented at the 1999 Joint Meeting of the American Academy of Child and Adolescent Psychiatry and the Canadian Academy of Child Psychiatry. A brief historical perspective is followed by a discussion of the burden of suffering associated with child maltreatment. Evidence about the prevention and treatment of child abuse and neglect is reviewed. Evidence supports a program of nurse home visits as effective in preventing abuse and neglect among first-time, at-risk mothers. Sexual abuse education programs improve children's knowledge and prevention skills; whether such programs reduce the occurrence of child sexual abuse remains to be established. In the area of treatment, therapeutic daycare programs improve cognitive skills among physically abused and neglected children. Abuse-specific cognitive-behaviour therapy has been shown to be effective in reducing symptoms among sexually abused children in both preschool and older age groups. Further research is necessary across all subcategories of child maltreatment, particularly neglect and emotional abuse.
Symptoms of Posttraumatic Stress Disorder in Adolescents with Conduct Disorder: Sex Differences and Onset Patterns
Authors: Reebye Pratibha , Moretti Marlene M , Wiebe Vaneesa J , Lessard Jocelyne C 
Published: January 2017

Objective: To examine sex differences in the rate and symptoms of posttraumatic stress disorder (PTSD), trauma exposure, and onset patterns in youth with conduct disorder (CD). Method Youth admitted to a clinical facility for severe behaviour problems completed the Diagnostic Interview for Children and Adolescents – Revised (DICA-R) to assess the presence of CD and PTSD. Results Over one-half of CD youth reported exposure to trauma, yet only 17% met criteria for PTSD. PTSD was more frequent in CD girls (28%) than in boys (10%), and girls experienced greater symptom intensity and anhedonia, difficulty feeling love or affection, and disturbance of sleep and concentration. Girls more frequently reported sexual assault, while boys were more likely to report accidents, physical assaults, and witnessing the death of a loved one. Retrospective reports indicated that PTSD tended to develop subsequent to CD. Conclusions Exposure to trauma is common among CD youth; however, diagnostic procedures should be adapted for increased sensitivity to PTSD. The development of CD may increase the risk for PTSD, particularly in girls, by exposing youth to situations in which they are traumatized. The role of trauma in CD should be routinely examined by clinicians and warrants further research.
Impact of Risperidone on Seclusion and Restraint at a State Psychiatric Hospital
Authors: Chengappa KN Roy , Levine Joseph , Ulrich Richard , Parepally Haranath , Brar Jaspreet S , Atzert Rebecca , Brienzo Rick , Gopalani Aziz 
Published: January 2017

Objective: To evaluate the impact of risperidone on seclusion and restraint in patients at a state psychiatric facility, shortly after risperidone's release. Methods Patients who were in the hospital for at least 3 months prior to receiving risperidone and subsequently received risperidone for at least 3 months formed the cohort. A mirror-image design was used with duration to a maximum of 1 year before and 1 year after initiation of risperidone. The hospital population that did not receive either risperidone or clozapine during the same time period was used for comparison of trends of seclusion and restraint. Results Seventy-four patients (most with schizophrenia) met the inclusion criteria of the risperidone group. There were statistically significant decreases in the number of seclusion hours (2.2 [SD 5.5] to 0.26 [SD 0.06]) and of events (0.23 [SD 0.59] to 0.05 [SD 0.14]) per person per month during risperidone treatment, compared with the prerisperidone treatment period (P = 0.01). The comparison group also evidenced decreases on these measures during the same time period, but the risperidone-treated cohort achieved a proportionally greater reduction. There were similar trends toward reduction in the restraint measures during risperidone treatment compared with prerisperidone, but these did not achieve statistical significance. The comparison group also showed slightly decreased use of restraints over the study period. Conclusions Risperidone appears to have had a positive impact on seclusion in this state-hospital psychiatric population. These data support the positive impact of risperidone on violence found in other studies. Violence and aggression are major factors that affect morale among psychiatric patients and staff. So, any benefit in this regard as a result of antipsychotic drug treatment is salutary for patients, families, and health care providers.
Developmental Disability Training in Canadian Psychiatry Residency Programs
Authors: Lunsky Yona , Bradley Elspeth 
Published: January 2017

Objective: To examine current training in developmental disabilities in Canadian psychiatry residency programs and to determine, from the programs' perspectives, how provinces across Canada are responding to the needs of persons with developmental disabilities and comorbid mental health disturbances (persons with a “dual diagnosis”). Method: A survey was completed by residency directors, or their designate, for all 16 psychiatry residency programs in Canada. Results: Persons with developmental disabilities require psychiatric services throughout their lives, but inadequate training opportunities exist in many of the residency programs, particularly those involving adults and adolescents. While some didactic opportunities are usually available, supervised clinical opportunities are rare, and many of those reported are optional. Conclusions: Across Canada, there have been insufficient advances in clinical training and service developments to meet the needs of individuals with developmental disabilities and comorbid mental health disturbances.
Posttraumatic Stress Disorder, Trauma Exposure, and the Current Health of Canadian Bus Drivers
Authors: Vedantham Kumar , Brunet Alain , Boyer Richard , Weiss Daniel S , Metzler Thomas J , Marmar Charles R 
Published: January 2017

Objective: Previous studies of veterans have linked posttraumatic stress disorder (PTSD) after combat-related trauma to increased reports of health problems. It is unclear whether this association between PTSD and increased health problems generalizes to civilians who are exposed to a broader array of traumatic events. We also do not know whether trauma exposure is associated with increased health problems in individuals who do not develop PTSD. Using a non–treatment-seeking civilian sample, we examined whether lifetime PTSD or trauma exposure by itself was associated with current health problems. Methods: Using a cross-sectional design and self-report measures, we evaluated urban Canadian bus drivers (n = 342) on trauma exposure, lifetime PTSD, and current health problems. Based on their responses, we divided our sample into individuals who had never experienced trauma (n = 91), trauma-exposed individuals who had never developed PTSD (n = 218), and persons who developed PTSD at some point after trauma (n = 33). We compared these groups on health problems, treatment service use, and health assessment measures. Results: The PTSD group reported increased health complaints, more frequent use of health treatments, and poorer health self-ratings compared with the exposed non-PTSD and nonexposed groups. Trauma-exposed drivers without PTSD did not differ from unexposed drivers on any health measure. Controlling for sex and trauma frequency did not alter our findings. Conclusions: Trauma exposure that leads to PTSD is associated with increased health problems, while trauma exposure alone is not. Our results extend previous findings to a broader civilian context and clarify associations between trauma exposure and health.
Alcoholism: Beliefs and Attitudes among Canadian Alcoholism Treatment Practitioners
Authors: Meza Eduardo E , Cunningham John A , el-Guebaly Nady , Couper Linda 
Published: January 2017

Objectives: To explore differences in views concerning adjunctive medications and theoretical orientation among Canadian practitioners from different professional backgrounds who treat alcoholism. Methods: A survey of clinicians from different disciplines was conducted by mail. The response rate was 56%: 95 drug and alcohol counsellors, 46 social workers, 81 nonpsychiatrist addiction physicians, and 74 addiction psychiatrists. The number of items in the questionnaire was reduced using principal component analysis. Group differences were explored using analysis of variance with Bonferroni correction and Scheffé's posthoc comparisons. Results: Physicians and nonphysicians differed in their views on the utility of medications in treating alcohol problems, the disease concept of alcohol problems, and the classification of alcohol abuse or dependence as psychiatric conditions. No group differences emerged on views regarding cognitive-behavioural treatment, pharmacological-only interventions, combined treatment, and recovery without treatment. Psychopathology in the alcoholic was significantly more likely to be considered as secondary to the use of alcohol by nonpsychiatrist physicians. Nonphysician practitioners viewed alcoholic behaviour as self-medication. Conclusions: Groups differed on questionnaire items concerning medication use and the disease concept of alcoholism. Agreement on several areas may facilitate bridging the gap across disciplines. The implications of these results are discussed.
Canadian Geriatric Psychiatrists: Why Do They Do it? A Delphi Study
Authors: Lieff Susan , Clarke Diana 
Published: January 2017

Objective: To generate hypotheses regarding influential factors that have contributed to the practice of geriatric psychiatry by geriatric psychiatrists. Method: Using the Delphi technique, designed to generate ideas and consensus, a sample of members of the Canadian Academy of Geriatric Psychiatry (CAGP) were asked to provide ideas on what factors were influential in their decision to devote a significant part of their practice to geriatric patients. These items were then synthesized into a questionnaire and rated for their degree of influence by the same group of psychiatrists. Results: A total of 41 items were rated according to their degree of influence. The most influential items were related to geriatric psychiatry residency training experiences that were perceived to be positive or adequate. Supervision characteristics and interest in the medical psychiatric nature of the field were also deemed influential. Conclusions: This study generates the hypothesis that the nature of the educational experience during psychiatry residency has a significant influence on the practice of geriatric psychiatry.
Relation of Blood Counts during Clozapine Treatment to Serum Concentrations of Clozapine and Nor-Clozapine
Authors: Oyewumi L Kola , Cernovsky Zack Z , Freeman David J , Streiner David L 
Published: January 2017

Objective: To determine the relation between serum clozapine and nor-clozapine levels and blood cell counts during clozapine treatment. Method: We undertook a prospective longitudinal study of 37 consecutive patients with a diagnosis of schizophrenia treated with clozapine. We obtained informed consent and then determined serum concentrations of clozapine and nor-clozapine weekly. Clozapine was administered daily in divided doses given every 12 hours and adjusted according to clinical guidelines for its use. Samples for serum concentrations were taken at steady state, immediately before the next morning's dose, for 4 to 8 weeks. Complete blood counts (CBC), weight, and vital signs (that is, blood pressure, pulse, and temperature) were also monitored weekly before the morning's dose of clozapine was administered. Results: Analyses of variance showed no significant changes over the 8-week treatment course in the observed mean white blood count (WBC), red blood count (RBC), neutrophils, and lymphocytes counts, or in the hemoglobin and hematocrit. Only a few weak correlations (r < 0.21) were found between these hematological parameters and the measures of serum clozapine and nor-clozapine. Conclusions: The mechanism of clozapine-induced hematotoxicity at the therapeutic dosage range is probably not by direct toxicity of clozapine or nor-clozapine to the blood cells or their precursors. The formation of the cytotoxic nitrenium compound from clozapine by neutrophils may be necessary.
Behaviour in Children with Language Development Disorders
Authors: Willinger Ulrike , Brunner Esther , Diendorfer-Radner Gabriele , Sams Judith , Sirsch Ulrike , Eisenwort Brigitte 
Published: January 2017

Objective: The objective of the study was to explore the univariate and multivariate differences in behavioural problems among children with disorders in expressive or mixed receptive–expressive language development and children with unimpaired language development. Method: Ninety-four children with language development disorders (LDD) between the ages of 4 and 6 years and 94 children (matched by age and sex) without disorders of language development were compared concerning behavioural problems, as measured by the German version of the Child Behavior Checklist/4–18. Results: Thirty-two children (34%) with LDD showed behavioural problems in the clinical range, whereas only 6 control subjects (6%) had scores in this range. Univariate group comparisons between patients and control subjects showed significant differences in all 8 syndromes and the scale “other problems,” with patients having higher scores. Multivariate stepwise discriminant analysis showed a significant discriminant function by the scales “other problems,” “social problems,” “anxious–depressed,” “thought problems,” “attention problems,” and “delinquent problems.” Conclusions: In general, our results agree with several studies that report that children with speech and language disorders are at special risk for developing behavioural problems. Neurodevelopmental immaturity may be one factor underlying both the disorder in language development and the behavioural problems.
Pilot Study: Access to Fitness Facility and Exercise Levels in Olanzapine-Treated Patients
Authors: Archie Suzanne , Wilson Jane Hamilton , Osborne Shelley , Hobbs Heather , McNiven Jean 
Published: January 2017

Background: Increasingly alarmed by the health risks (that is, weight gain, elevated lipids, and poor glucose tolerance) posed by novel antipsychotic medications, clinicians who treat schizophrenia are attempting to help patients improve lifestyle factors. Unfortunately, schizophrenia research has neglected exercise as a legitimate adjunctive treatment for schizophrenia. Objective: To assess the extent to which stable patients with schizophrenia would adhere to an exercise program if offered access to a fitness facility. Methods: Ten of 20 stable patients with schizophrenia or schizoaffective disorder who were treated with olanzapine for at least 4 weeks had the opportunity to receive access to a Young Men's Christian Association (YMCA) fitness facility, based on random allocation. The intervention included a free membership to the YMCA for 6 months, with access to all the fitness amenities and equipment. The mean dosage of olanzapine was 11.5 mg daily for the YMCA group. Results: Of the 10 subjects, 2 did not attend at all. One subject met criteria for full attendance for each of the 6 months and lost 15 kg. Dropout rates were as follows: 90% at 6 months, 70% at 5 months, and 40% at 4 months. The main reason they gave for poor attendance was lack of motivation. The mean weight gain was 2 kg in the YMCA group. Conclusion: Most subjects did not regularly exercise or attend. They cited poor motivation as the main reason. The subject who exercised regularly lost a significant amount of weight.
Influence of Family Therapy on Bullying Behaviour, Cortisol Secretion, Anger, and Quality of Life in Bullying Male Adolescents: A Randomized, Prospective, Controlled Study
Authors: Nickel Marius K , Muehlbacher Moritz , Kaplan Patrick , Krawczyk Jakub , Buschmann Wiebke , Kettler Christian , Rother Nadine , Egger Christoph , Rother Wolfhardt K , Loew Thomas K , Nickel Cerstin 
Published: January 2017

Objective: To determine the influence of brief strategic family therapy (BSFT) on salivary cortisol, anger, and health-related quality of life (QoL) in adolescent boys with bullying behaviour. Method: We selected a sample of 72 boys demonstrating bullying behaviour from the general population and treated 36 with BSFT for 12 weeks. The other 36 boys formed the control group. Primary outcome measures were salivary cortisol concentration 15 to 30 minutes after awakening and changes on the subscales of the State-Trait Anger Expression Inventory (STAXI) and the Health Survey (SF-36). Results: After 12 weeks' treatment, we observed a significant reduction in bullying behaviour in the BSFT group ( P = 0.017) and in the mean values (according to the intent-to-treat principle) for salivary cortisol concentration ( P < 0.001). The BSFT group also showed significantly greater change on the STAXI subscales State-Anger ( P < 0.001), Trait-Anger ( P < 0.001), Anger-Out ( P < 0.001), and Anger-Control ( P < 0.001). Treatment with BSFT also resulted in significant improvement on the SF-36 subscales for Vitality ( P < 0.001), Social Functioning ( P < 0.001), Role-Emotional ( P < 0.001), and Mental Health ( P < 0.001). Conclusions: BSFT effectively influenced bullying behaviour, salivary cortisol concentration, anger, and health-related QoL in adolescent bullying boys.
Characterization and Treatment Response of Anxious Children with Asthma
Authors: Papneja Tripti , Manassis Katharina 
Published: January 2017

Objectives: To compare children with Axis I anxiety disorders and asthma with a matched group of anxious children without asthma on questionnaire measures and response to cognitive-behavioural treatment (CBT) for anxiety. Method: A sample of 36 children with comorbid anxiety and asthma, aged 8 to 12 years, were matched for age, sex, and specific anxiety disorder with 36 children with an Axis I anxiety disorder but no asthma. Parents and children completed standardized questionnaires. Results: Children with comorbid anxiety and asthma had significantly more perinatal complications ( P = 0.001), and higher total ( P = 0.000) and psychological stressors ( P = 0.02), especially parent–child problems ( P = 0.01), but lower levels of depression ( P = 0.03) and anxiety ( P = 0.05), compared with anxious, nonasthmatic children. All children reported decreased anxiety ( P = 0.001) and depression ( P = 0.000) posttreatment, with a trend toward less improvement in anxiety in anxious children with asthma. Conclusions: Although replication is needed, addressing psychosocial stress and parent–child problems may increase CBT efficacy in children with comorbid anxiety and asthma.