bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacological Treatment of Alzheimer Disease
Authors: Massoud Fadi , Léger Gabriel C 
Published: January 2017

Objective: To review the different pharmacological approaches to the cognitive, functional, and behavioural manifestations of Alzheimer disease (AD). Methods: We searched and critically analyzed the most recent relevant literature on pharmacological treatment of AD. Results: The current pharmacological approach to AD treatment is based on vascular prevention and symptomatic therapy with cholinesterase inhibitors (ChEIs) and memantine, an N-methyl-d-aspartic acid antagonist. Clinical trials of 6– to 12–month duration have shown statistically significant benefits with ChEIs and memantine on cognitive, global, functional, and behavioural outcome measures. In general, these benefits are modest. However, they are dose-dependent and reproducible across studies. Most importantly, these benefits are symptomatic as they do not alter disease course. According to the third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, these agents are considered standard treatment options in AD. We will discuss practical issues related to current pharmacological management, such as setting realistic expectations, management of side effects, switching ChEIs, and the decision to discontinue treatment. The results of clinical trials studying potentially disease-modifying approaches in AD will also be reviewed. Unfortunately, although there remains much promise and enthusiasm, none of these agents has shown consistent benefits, and none are available for use in clinical practice. Conclusion: Pharmacological options are presently available for the symptomatic treatment of AD. These treatments provide mild but sustained benefits. Before disease-modifying approaches become available, optimizing the use of the available treatment options is crucial.
Suicide Attempts: Prevention of Repetition
Authors: Daigle Marc S , Pouliot Louise , Chagnon François , Greenfield Brian , Mishara Brian 
Published: January 2017

Objective: To present an overview of promising strategies to prevent repetition of suicidal behaviours. Method: This literature review on tertiary preventive interventions of suicide attempts was produced using the computerized databases PubMed and PsycINFO from January 1966 to September 2010, using French- and English-language limits and the key words: suicid* or deliberate self-harm and treatment* or therapy or intervention* or management. Results: Thirteen of the 35 included studies showed statistically significant effects of fewer repeated attempts or suicides in the experimental condition. Overall, 22 studies focused on more traditional approaches, that is, pharmacological or psychological approaches. Only 2 of the 6 pharmacological treatments proved significantly superior to a placebo—a study of lithium with depression and flupenthixol with personality disorders. Eight out of 16 psychological treatments proved superior to treatment as usual or another approach: cognitive-behavioural therapy (CBT) ( n = 4), (including dialectical behaviour therapy [ n = 2]); psychodynamic therapy ( n = 2); mixed (CBT plus psychodynamic therapy [ n = 1]); and motivational approach and change in therapist ( n = 1). Among the 8 studies using visit, postal, or telephone contact or green-token emergency card provision, 2 were significant: one involving telephone follow-up and the other telephone follow-up or visits. Hospitalization was not related to fewer attempts, and 1 of the 4 outreach approaches had significant results: a program involving individualized biweekly treatment. The rationale behind these single or multiple approaches still needs to be clarified. There were methodological flaws in many studies and some had very specific limited samples. Conclusions: There is a need for more research addressing the problem in definitions of outcomes and measurement of the dependent variables, gender-specific effects, and inclusion of high-risk groups. There is a need for the development and evaluation of new approaches that support collaboration with community resources and more careful assessment and comparisons of existing treatments with different populations.
The Judicious Judicial Dispositions Juggle: Characteristics of Police Interventions Involving People with a Mental Illness
Authors: Charette Yanick , Crocker Anne G , Billette Isabelle 
Published: January 2017

Objective: The number of police interventions with people presenting a mental health problem has been increasing during the past 30 years, and police services are becoming increasingly aware of the human resources and skills these interventions require. Our study addresses the characteristics explaining police time used and outcomes of interventions as police officers interact with people with mental illness. Method: Using a police service administrative database from a large Canadian city, and an identification algorithm method, police interventions with people with mental illness were identified on 3 randomly selected days in 1 year. A content analysis of intervention logs was carried out to identify characteristics of those interventions: the call initiator, the location, and the final outcome of the intervention. Results: Interventions with people with mental illness represent a small proportion (3%; n = 272) of all police interventions ( n = 8485). General linear models show that the type of outcome is the most important factor in estimating the time required by police interventions. Arrests and hospitalizations are the least time-efficient outcomes, consuming 2.0 and 3.2 times, respectively, more time than informal dispositions. A multiple correspondence analysis shows that police interventions can be depicted in 2 dimensions, representing their main roles concerning people with mental illness, namely, to ensure the public safety and to protect the most vulnerable citizens. The more these services are required, the more police time will be required. Conclusion: Education and partnerships between police services and mental health services are essential to a proper management of outcomes.
Smoking, but Not Malnutrition, Influences Promoter-Specific DNA Methylation of the Proopiomelanocortin Gene in Patients with and without Anorexia Nervosa
Authors: Ehrlich Stefan , Walton Esther , Roffman Joshua L , Weiss Deike , Puls Imke , Doehler Nico , Burghardt Roland , Lehmkuhl Ulrike , Hillemacher Thomas , Muschler Marc , Frieling Helge 
Published: January 2017

Objective: Our pilot study evaluates the impact of environmental factors, such as nutrition and smoking status, on epigenetic patterns in a disease-associated gene. Method: We measured the effects of malnutrition and cigarette smoking on proopiomelanocortin (POMC) promoter-specific DNA methylation in female patients with and without anorexia nervosa (AN). POMC and its derived peptides (alpha melanocyte stimulating hormone and adrenocorticotropic hormone) are implicated in stress and feeding response. Promoter-specific DNA methylation of the POMC gene was determined in peripheral blood mononuclear cells of 54 healthy female control subjects, 40 underweight patients with AN, and 21 weight-restored patients with AN using bisulfite sequencing. Malnutrition was characterized by plasma leptin. Results: POMC promoter-specific DNA methylation was not affected by diagnosis or nutritional status but significantly negatively associated with cigarette smoking. Conclusions: Although malnutrition may be expected to reduce DNA methylation through its effects on one-carbon metabolism, our negative results are in line with several in vitro and clinical studies that did not show a direct relation between gene-specific DNA methylation and folate levels. In contrast, smoking has been repeatedly reported to alter DNA methylation of specific genes and should be controlled for in future epigenetic studies.
Disgust Recognition in Obsessive-Compulsive Disorder: Diagnostic Comparisons and Posttreatment Effects
Authors: Rector Neil A , Daros Alexander R , Bradbury Cheryl L , Richter Margaret A 
Published: January 2017

Objective: To examine whether disgust recognition deficits are present and specific to obsessive-compulsive disorder (OCD), and the extent to which this deficit, if present, can be reduced in cognitive-behavioural therapy (CBT). Method: Responses to the Pictures of Facial Affect (POFA) were examined in patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosed OCD ( n = 20), panic disorder with agoraphobia (PDA; n = 15), and generalized social phobia (GSP; n = 15) and a second, independent OCD sample of treatment responders to CBT ( n = 11). Results: There were signifcant and statistically large disgust recognition differences between the OCD group and comparison PDA and GSP groups. However, patients with OCD treated with CBT showed disgust recognition scores that were equivalent to the PDA and GSP groups, significantly better than the untreated OCD sample, and equivalent to scores from the original POFA nonaffected standardization sample. Conclusions: These results provide support for the presence of disgust recognition impairment in OCD, and provide preliminary evidence that disgust recognition impairments may improve with treatment.
Real-World Evaluation of the Resident Assessment Instrument-Mental Health Assessment System
Authors: Urbanoski Karen A , Mulsant Benoit H , Willett Peggie , Ehtesham Sahar , Rush Brian 
Published: January 2017

Objective: We evaluated the Resident Assessment Instrument—Mental Health (RAI-MH) assessment platform at a large psychiatric hospital in Ontario during the 3 years following its provincially mandated implementation in 2005. Our objectives were to document and consider changes over time in front-line coding practices and in indicators of data quality. Method: Structured interviews with program staff were used for preliminary information-gathering on front-line coding practices. A retrospective data review of assessments conducted from 2005 to 2007 examined 5 quantitative indicators of data quality. Results: There is evidence of improved data quality over time; however, low scores on the outcome scales highlight potential shortcomings in the assessment system's ability to support outcome monitoring. There was variability in implementation and performance across clinical programs. Conclusions: This evaluation suggests that the RAI-MH-based assessment platform may be better suited to longer-term services for severely impaired clients than to short-term, highly specialized services. In particular, the suitability of the RAI-MH for hospital-based addictions care should be re-examined. Issues of staff compliance and motivation and problems with assessment system performance would be highly entwined, making it inappropriate to attempt to allocate responsibility for areas of less than optimal performance to one or the other. The ability of the RAI-MH to perform well on clinical front lines is, in any case, essential for it to meet its objectives. Continued evaluation of this assessment platform should be a priority for future research.
A Case for Reprising and Redefining Melancholia
Authors: Parker Gordon 
Published: January 2017

Objective: To identify limitations to severity-based classifications of depression, and to argue for positioning melancholia as a distinct melancholic subtype. Method: An overview of relevant literature was conducted. Results: First, dimensionalizing depressive disorders effectively aggregates multiple heterogeneous depressive types and syndromes, and thus limits, if not prevents, identification of differential causes and treatments. Second, the melancholic depressive subtype can be defined with some relative precision, and that as it shows quite distinct differential treatment responsiveness, identification should be a clinical priority. Conclusion: Melancholia can be positioned and classified as a distinct depressive subtype.
Psychiatric Symptoms Associated with Brief Detention of Adult Asylum Seekers in Canada
Authors: Cleveland Janet , Rousseau Cécile 
Published: January 2017

Objectives: To examine the association between brief detention and psychiatric symptom levels among adult asylum seekers. Method: The Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist-25 were used to assess psychiatric symptoms and premigration trauma exposure in 122 detained and 66 nondetained adult asylum seekers in Montreal and Toronto. Results: After a mean detention of 31 days, the proportion of asylum seekers scoring above clinical cutpoints was significantly higher in the detained than the nondetained group for posttraumatic stress (X2 = 4.117, df = 1, P = 0.04), depression (X2 = 13.813, df = 1, P < 0.001), and anxiety (X 2 = 4.567, df = 1, P = 0.03) symptoms. Hierarchical multiple regression models showed that posttraumatic stress, depression, and anxiety symptom levels were significantly higher among detained asylum seekers than among the nondetained comparison group, taking into account previous trauma and demographics. Incremental F was significant for the addition of detention status for all 3 models, indicating that detention contributed to increased symptom levels. Conclusions: For asylum seekers, even brief detention is associated with increased psychiatric symptoms. Governments should consider the many viable alternatives to incarceration of asylum seekers, such as temporary placement in a supervised residential facility, to minimize the risks of psychological harm to this vulnerable population.
Symptoms of Posttraumatic Stress Disorder and Depression in Relation to Alcohol-Use and Alcohol-Related Problems among Canadian Forces Veterans
Authors: Fetzner Mathew G , Abrams Murray P , Asmundson Gordon J G 
Published: January 2017

Objective: Alcohol misuse is common among military veterans affected by posttraumatic stress disorder (PTSD) and depression; however, research to date has provided mixed evidence concerning differential associations among PTSD and depressive symptoms in relation to alcohol misuse. Further, most available studies have examined primarily male samples or have dichotomously grouped participants as either having or not having an alcohol use disorder. Our study sought to explore relations among 2 aspects of alcohol misuse (that is, alcohol-related problems, and quantity or frequency of alcohol use) and symptoms of PTSD and depression in independent samples of female and male military veterans. Method: Canadian military veterans (1271 men and 72 women) completed a battery of self-report questionnaires as part of a broader health status assessment conducted by Veterans Affairs Canada. Results: Linear regression analyses suggested depressive symptoms accounted for unique variance in reported alcohol-related problems and quantity or frequency of alcohol use among male veterans. Additionally, PTSD hyperarousal symptoms accounted for unique variance in reported alcohol-related problems. In contrast, among female veterans neither PTSD nor depressive symptoms were found to account for significant variance in measures of alcohol-related problems or quantity or frequency of alcohol use. Conclusions: Findings suggest differing mechanisms are involved in influencing alcohol misuse among male and female veterans. Accordingly, female veterans may benefit from specialized assessment and intervention approaches to prevent and treat alcohol-related disorders, rather than applying the same strategies commonly used with male veterans. Comprehensive results, implications, and directions for future research are discussed.
Sense of Belonging and Suicide: A Systematic Review
Authors: Hatcher Simon , Stubbersfield Olivia 
Published: January 2017

Objective: To systematically review the research on the association between sense of belonging and suicide. Method: We systematically reviewed electronic databases for studies that included assessments of suicidality and belonging. Results: We found 16 studies that met our eligibility criteria. They all found an association between belonging and suicidality but nearly all of the studies were in nonclinical populations, and the association was weak and could be taken into account by confounding factors. Conclusions: Low sense of belonging has a weak association with suicidality. However, current concepts make it hard to distinguish from loneliness or other measures of social support. An alternative view of belongingness, as a sense of connectedness to things other than people and in the past as well as the present, may generate alternative ideas about useful clinical interventions that may be especially relevant to indigenous populations.
Depression Screening in Primary Care: Why the Canadian Task Force on Preventive Health Care Did the Right Thing
Authors: Thombs Brett D , Ziegelstein Roy C 
Published: January 2017

Objective: To review the recent recommendation against routinely screening adults for depression in primary care settings by the Canadian Task Force on Preventive Health Care (CTFPHC). Methods: We reviewed the CTFPHC recommendation and discussed it in the context of relevant evidence. Results: Depression screening, which involves using depression symptom questionnaires to attempt to identify patients who have unrecognized depression, was previously recommended by the CTFPHC in primary care settings with staff-assisted depression care programs in place to ensure accurate diagnosis, effective treatment, and follow-up, but not in the absence of such programs. The CTFPHC recently updated this guideline and recommended against routinely screening adults for depression in primary care because there have not been any randomized controlled trials (RCTs) that have shown depression screening to be beneficial and because of a concern about the potentially high number of false-positive screens that would occur. Without evidence from RCTs of better health outcomes from screening, there are numerous factors that suggest that depression screening, even with collaborative depression care, may not be beneficial for patients, including the high rate of patients already treated, uncertainty about the ability of depression screening tools to accurately identify previously unrecognized patients, and relatively small treatment effects among patients with less severe depression who would be most likely to be identified through screening. Routine screening would expose some patients to avoidable risks and would pose a significant cost burden. Conclusion: The CTFPHC recommendation to not screen for depression in primary care is consistent with available evidence. Clinicians in primary care settings should be alert to signs of depression and attend to symptoms through assessment and, as appropriate, referral or management, as recommended by the CTFPHC.
Risk Indicators of Depressed Mood among Sex-Trade Workers and Implications for HIV Risk Behaviour
Authors: Rogers Marla Rochelle , Lemstra Mark Edgar , Moraros John Simeon 
Published: January 2017

Objectives: To determine the prevalence of depressed mood among people who have traded sex for money in the Saskatoon Health Region (SHR), the adjusted risk factors for depressed mood among this sample, and if depressed mood was associated with decreased self-efficacy for safe sexual practices and injection drug use. Methods: Two-hundred ninety-nine people who have traded sex for money were surveyed with validated instruments for measuring risk behaviours, depressed mood, and self-efficacy for safe sexual practices. Results: The sample consisted primarily of low-income, poorly educated Aboriginal women, many of whom also indicated using injection drugs. Using the 16-point score cut-off for the Center for Epidemiologic Studies Depression Scale, 84.6% of participants had depressed mood. When the cut-off score was 23 points or higher, 65.9% had depressed mood. After multivariate analysis, covariates that had an independent association with depressed mood included injecting a drug in the past 4 weeks (OR 1.59; 95% CI 1.2 to 1.8), suffering the death or permanent separation from a parent before the age of 18 (OR 2.09; 95% CI 1.05 to 4.15), and physical assault or abuse by a partner in adult life (OR 2.79; 95% CI 1.38 to 5.64). Depressed mood was associated with lower self-efficacy scores for safe sexual behaviours. Conclusions: Our study suggests that high rates of depressed mood among people who have traded sex for money is associated with injection drug use and low self-efficacy for safe sexual health practices. These findings are important and may help explain the high rates of human immunodeficiency virus within the SHR.
A Canadian Primary Care Sentinel Surveillance Network Study Evaluating Antidepressant Prescribing in Canada from 2006 to 2012
Authors: Morkem Rachael , Barber David , Williamson Tyler , Patten Scott B 
Published: January 2017

Objective: To evaluate the prescribing patterns of antidepressants (ADs) by primary care providers to youth, adults, and seniors, from 2006 to 2012, using data from electronic medical records (EMRs). Method: This was a retrospective cross-sectional database study that used primary care data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Data on more than 600 000 Canadian primary care patients were used to determine the prevalence and incidence of AD prescribing to patients 15 years and older who had an encounter in the years of study (from 2006 to 2012). Each study year was evaluated independently. Results: The study population consisted of 86 927 patients in 2006 (mean age 48.1 years [SD 18.7], 38% male) and grew to 273 529 (mean age 49.6 years [SD 19.3], 40% male) in 2012. The prevalence of AD prescribing increased from 9.20% in 2006 to 12.80% in 2012 ( P < 0.001). While the incidence rate of AD prescribing dropped from 3.54% in 2006 to 2.72% in 2008 ( P < 0.001) the rate started to significantly rise again, reaching an incidence of 3.07% by 2012 ( P < 0.001). Conclusions: The prevalence of AD prescribing by primary care providers in Canada continued to rise from 2006 to 2012. Conversely, incidence has remained stable or declined during the 6-year study period. While many complex factors likely contribute to the observed prevalence and incidence rates, our findings suggest that the guidelines indicating the efficacy of long-term AD therapy for patients with highly recurrent or severe depression are being followed.
Effects of Nonparental Child Care on Child Development: An Update
Authors: Lamb Michael E 
Published: January 2017

Objective: To review the published literature on the effects of nonparental and out-of-home care on infants, toddlers, and preschoolers. Method: Narrative literature review. Results: Although substantial controversy persists, the accumulated evidence suggests that nonparental care does not necessarily have either beneficial or detrimental effects on infants and children, although it can have such effects. In some circumstances, careproviders establish relationships with children that have significant effects on development, and this increases the importance of ensuring that careproviders are well trained, behave sensitively, and are stable rather than ephemeral figures in children's lives. Nonparental care is associated with behaviour problems (including aggression and noncompliance) when the care is of poor quality and opportunities for meaningful relationships with stable careproviders are not available, however. Conclusion: The effects of out-of-home care vary depending on the quality of care as well as the characteristics of individual children, including their age, temperaments, and individual backgrounds.