bluuebunny/crossref_metadata_2025_split huggingface dataset:
Judicial Case Management and the Custody and Access Assessment: Melding the Approaches
Authors: Leverette John , Crowe Trish , Wenglensky Rose , Dunbar Justice Mary 
Published: January 2017

Background: The presence of the Unified Family Court, with procedures emphasizing judicial case management and settlement in custody disputes, provided an opportunity to combine these practices with those of a university hospital-based family court clinic experienced in the provision of custody assessments. Specifically, a process integrating the clinical custody assessment with the work of counsel and court procedures was developed. This format, incorporating the preparation of a clinical settlement conference brief, was then evaluated with emphasis on time management, outcome in relation to settlement or trial, and the effect of clinical assessment at critical points in the combined endeavour. Method: Seventy-two judicial referrals conducted using this format were reviewed. To assess efficiency, we determined time intervals to various points in the process and compared them to previous local practice. Settlement rates, recorded incrementally to mark each component's contribution, were compared with rates noted in the literature. Assessment functions were identified according to the point of resolution of the dispute and in a manner to facilitate comparison with previously published work. Results: The format resulted in 50% of cases settling without trial in under 5 months, a minimum settlement rate of 50%, and confirmed the ability of clinical assessment to contribute flexibly to dispute resolution in several conciliation venues and at trial. Conclusions: Combining legal and mental health efforts can result in more efficient use of resources and a substantial diversion of cases from continuing litigation. While altering the process of clinical assessments enhances such findings, further work is required to assure appropriate selection criteria for various intervention formats.
Mental Health Treatment in Ontario: Selected Comparisons between the Primary Care and Specialty Sectors
Authors: Parikh Sagar V , Lin Elizabeth , Lesage Alain D 
Published: January 2017

Objective: Epidemiologic research has demonstrated that the majority of mental illness in the community is not treated. Primary care physicians and the specialty mental health sector each have an important role in the provision of mental health services. Our goal is to clarify the extent of undertreatment of selected mental illnesses in Ontario and to examine how treatment is divided between the primary care and specialty sectors. In particular, we are interested in both the relative numbers and the types—based on sociodemographic and severity indicators—of patients found in each sector, as well as in confirming the key role of primary care in the provision of mental health services. Method: Data were taken from the Mental Health Supplement to the Ontario Health Survey, a community survey of 9953 individuals. All subjects who met DSM-III-R criteria for a past year diagnosis of mood, anxiety, substance abuse, bulimic, or antisocial personality disorders were categorized by their use of mental health services in the preceding year—into nonusers, primary care only patients, specialty only patients, and both sector patients. The 3 groups utilizing services were then compared by demographic, clinical, and disability characteristics. Results: Only 20.8% of subjects with a psychiatric diagnosis reported use of mental health services, but 82.9% of these same individuals used primary care physicians for general health problems. Among those who used mental health services, 38.2% used family physicians only for psychiatric treatment, compared with 35.8% who used only specialty mental health providers, and 26.0% who used both sectors. The 3 groups of users showed only modest differences on sociodemographic characteristics. Patients in the specialty only sector reported significantly higher rates of sexual and physical abuse. On specific disability measures, all 3 groups were similar. Conclusion: The vast majority of individuals with an untreated psychiatric disorder are using the primary care sector for general health treatment, allowing an opportunity for identification and intervention. Primary care physicians also treat the majority of those seeking mental health services, and individuals seen only by these primary care physicians are probably as ill as those seen exclusively in the specialty mental health sector. From a public health perspective, future policy interventions should aim to improve collaboration between the 2 sectors and enhance the ability of primary care physicians to deliver psychiatric services.
Mental Health Practices of Ontario Family Physicians: A Study Using Qualitative Methodology
Authors: Craven MA , Cohen M , Campbell D , Williams J , Kates Nick 
Published: January 2017

Objective: To obtain descriptions of how family physicians detect and manage mental health problems commonly encountered in their practices and how they function in their role as mental health care providers. Also, to elicit their perceptions of barriers to the delivery of optimal mental health care. Method: Focus groups with standardized questions were used to elicit descriptive data, opinions, attitudes, and terminology. Convenience samples of 10 to 12 physicians were chosen in each of Ontario's 7 health care planning regions, with a mixture of rural, urban, and university settings. Discussions were audiotaped, transcribed, analyzed, and recurring themes were extracted. Results: Family physicians' descriptions of the range of problems commonly encountered and their detection and management highlight the unique nature of mental health care in the primary care setting. The realities of family medicine, the undifferentiated nature of presenting problems, the long-term physician–patient relationship, and the frequent overlap of physical and mental health problems dictate an approach to diagnosis and treatment that differs from mental health care delivery in other settings. Difficulties in the relationship with local psychiatric services—accessing psychiatric care (especially for emergencies), poor communication with mental health care providers, and cumbersome intake procedures of many mental health services—were consistently identified as barriers to the delivery of optimal mental health care. Conclusions: This study confirms the importance of the family physician in the detection and management of mental health problems. It offers insights into how family physicians function in their role as mental health care providers and how they deal with diagnostic and management challenges that are specific to primary care. It also identifies barriers to the optimal delivery of mental health care in the primary care setting, including difficulties at the clinical interface between psychiatry and family medicine. Further studies are needed to explore these issues in greater depth.
47,XYY Karyotypes and Pervasive Developmental Disorders
Authors: Nicolson Rob , Bhalerao Shree , Sloman Leon 
Published: January 2017

Objective: The presence of a 47,XYY karyotype in boys with pervasive developmental disorders (PDDs) has rarely been described in the past. Herein, 2 boys with PDDs and a supernumerary Y chromosome are presented. Methods: The case histories of the 2 patients are described along with the results of associated testing. The literature on psychosocial development as well as brain morphology and physiology in males with 47,XYY karyotypes is reviewed. Results: Both boys had presentations typical of PDDs, one with autistic disorder and the other with PDD not otherwise specified. Conclusions: The finding that, in a clinic for children with developmental disorders, 2 of 40 male referrals had 47,XYY karyotypes suggests that the rate of this sex chromosome anomaly may be increased in PDDs. An extra Y chromosome may be related to abnormal brain development, which may, in turn, predispose vulnerable males to PDDs.
Suicide and Suicidal Behaviours: Implications for Mental Health Services
Authors: Rhodes Anne E , Links Paul S 
Published: January 2017

Objective: To examine what is known about engaging and maintaining suicidal individuals in treatment and what can be learned from the randomized, controlled trials of psychosocial interventions concerning the reduction of suicidal behaviours. Method: Review of the relevant literature. Results: Treatment follow-through is low among those who attempt suicide. The evidence to date is inconclusive as to whether psychosocial interventions can reduce the repetition of suicidal behaviour. Conclusions: Certain groups may benefit from psychosocial interventions. Future research must overcome several methodological issues. As treatment relies on adequate follow-through, changes in the delivery of care may enhance treatment effectiveness.
Attempted Suicide among Inuit Youth: Psychosocial Correlates and Implications for Prevention
Authors: Kirmayer Laurence J , Boothroyd Lucy J , Hodgins Stephen 
Published: January 2017

Objective: To identify potential risk and protective factors associated with attempted suicide among Inuit youth, a population known to have a high rate of both attempted and completed suicide in recent years. Method: A secondary analysis of data on 203 Inuit youth (aged 15 to 24 years) from a random community survey conducted by Santé Québec in 1992. Factors previously identified in the literature and in clinical consultation and ethnographic research were tested with bivariate statistics and logistic regression models for each gender. Results: At the bivariate level, positive correlates included substance use (solvents, cannabis, cocaine), recent alcohol abuse, evidence of a psychiatric problem, and a greater number of life events in the last year. Regular church attendance was negatively associated with attempted suicide. Multivariate analysis indicated that a psychiatric problem, recent alcohol abuse, and cocaine or crack use were the strongest correlates of attempted suicide for females, while solvent use and number of recent life events were the strongest correlates for males. Conclusions: Suicide prevention programs can be targeted at youth who are using substances, particularly solvents, cocaine, and alcohol, have psychiatric illness, and have experienced recent negative life events. Involvement in church or other community activities may reduce the risk for suicide. Consideration of gender differences may allow more precise identification of those at risk for attempted suicide.
Risk and Protective Factors Scale: Reliability and Validity in Preadolescents
Authors: Looper Karl , Grizenko Natalie 
Published: January 2017

Objective: To describe the reliability and validity of a novel scale, the Risk and Protective Factors Scale (RPFS), in preadolescents. The RPFS is designed to predict the development of disruptive behaviour disorders (DBDs). Method: A controlled study of 120 children aged 6–12 years in DBD and normal groups. Measures include the RPFS and the Revised Child Behaviour Profile (RCBP). Results: Cohen κ for interrater reliability is 0.81, 92% agreement. Pearson correlation for test-retest reliability is 0.76, 94% agreement. Cronbach α for internal consistency is 0.89. Pearson correlation between the RPFS and RCBP is 0.82. The total scores and subscores of the RPFS discriminate significantly between DBD and control groups by student t-test. Conclusion: The RPFS has good internal consistency and interrater and test-retest reliability. It has concurrent validity to the RCBP and discriminant validity between DBD and normal groups. This scale may help identify children at risk for DBD, which would allow early intervention, but requires a longitudinal study to establish its predictive power.
Psychiatrie Residents' Views on Their Training and Experience regarding Issues Related to Child Abuse
Authors: Barnard-Thompson Kathleen , Leichner Pierre 
Published: January 2017

Objective: To explore the views of psychiatric residents regarding the prevalence and impact of child physical, sexual, and emotional abuse; the adequacy of their training in these areas; and the sufficiency of treatment resources for abused children and their abusers. Method: A 97-item survey questionnaire was distributed to 189 psychiatric residents as a section of the 1997 Coordinators of Postgraduate Education (COPE) self-assessment examination. Results: Estimations of prevalence of child sexual, physical, and emotional abuse among men and women in both general and psychiatric populations were generally accurate according to the literature. Residents appeared to be aware of the multifactorial nature of child abuse and identified the particular importance of social-environmental factors such as parental drug abuse and a violent social environment. Residents also recognized the significant association of posttraumatic stress disorder, borderline personality disorder, and dissociative disorders with child sexual abuse. Seventy-five percent of respondents felt that instruction on the topic of child abuse during their psychiatric residency was insufficient. Sixty-four percent of respondents felt that resources for the treatment of effects of child abuse were insufficient; 83% felt that treatment resources for child abusers were insufficient. Conclusion: Although psychiatric residents appear to be aware of the prevalence of child abuse and its varied effects on the victims' mental health, the majority felt that their medical training in this area had been insufficient. For this reason, medical school curricula and training experiences might require reevaluation. Increasing the profile of child abuse and its impact on mental health might also result in enhanced prevention programs and treatment resources available to abused children and their abusers.
Physicians Who Commit Sexual Offences: Are They Different from other Sex Offenders?
Authors: Langevin Ron , Glancy Graham D , Curnoe S , Bain J 
Published: January 2017

Objective: To determine if physician sex offenders differ significantly from other sex offenders by using a control group and assessing both groups with reliable and valid instruments. Method: Nineteen male physician sex offenders were compared with 19 male sex offender control subjects, matched on offence type, age, education, and marital status. Both groups were compared with a general sample of sex offenders (n = 2125). The 3 groups were compared on sexual history and preference, substance abuse, mental illness, personality, history of crime and violence, neuropsychological impairment, and endocrine abnormalities. Results: Physicians in this study were highly educated and older, forming a statistically significant subgroup of sex offenders. The majority of physician sex offenders suffered from a sexual disorder (68.4%), as did the other 2 groups. Physicians showed more neuropsychological impairment and endocrine abnormalities and less antisocial behaviour than did the general sample of sex offenders but did not differ from the matched control group. Physician offenders who sexually assaulted their patients did not differ from those who had nonpatient victims. Conclusions: Despite differences in age, education, and occupation between physician sex offenders and sex offenders in general, the same assessment procedures can be recommended for examining both groups. Although the sample size is small, results suggest that physicians who commit sexual offences should be scrutinized by phallometric assessment of sexual deviance and especially for neurological and endocrine abnormalities.
L'implantation du suivi intensif dans la communauté: Des leçons à tirer du passé
Authors: Benoit Frédéric , Lesage Alain D 
Published: January 2017

Objectif: Analyser différents enjeux de l'implantation d'un programme de Suivi intensif dans le milieu (SIM). Méthode: Des entrevues en profondeur ont été menées auprès de protagonistes d'un projet d'implantation du SIM qui s'est déroulé dans les années 1970. Une analyse qualitative a été effectuée qui évaluait les enjeux ayant empêché la généralisation de ce type d'approche ainsi que les aspects à observer lors d'implantations futures du SIM. Résultats: Des aspects sociaux, culturels, organisationnels, professionnels et économiques semblent avoir eu et auront une place déterminante dans l'intégration de ce type de programme. À l'époque, le projet d'implantation du SIM s'est développé en parallèle au mouvement de psychiatrie communautaire, sans jamais s'y arrimer. Actuellement, sur le plan social, des groupes d'entraide et de parents favorisent l'implantation de ce type de programme. L'aspect organisationnel décrit l'importance du type d'arrimage ainsi que la modification du SIM selon les services de soins en place. L'affiliation de ce type de projet à une équipe de recherche n'a pas été garante d'une implantation réussie. Un troisième théme aborde la formation ainsi que la motivation du psychiatre quant à la pratique de cette approche. Finalement, l'aspect économique se révèle de plus en plus comme étant un levier qui impose ce type d'approche. Conclusion: Cette étude nous renseigne sur différents enjeux de l'implantation d'un programme de suivi intensif dans la communauté. Ces résultats représentent autant d'hypothèses à vérifier en ce qui concerne l'implantation du SIM autant au Québec qu'ailleurs au Canada.
Child Psychiatry Practice Patterns in Ontario
Authors: Steele Margaret M , Wolfe Vicky Veitch 
Published: January 2017

Objectives: To examine the demographics, training, distribution, venues of practice, remuneration patterns, and professional affiliations of child psychiatrists in Ontario. Method: In July 1997, questionnaires were sent to 229 Ontario psychiatrists. A second mailing was sent to nonresponders in the fall of 1997. The overall response rate was 66.8%. Results: Compared with other research regarding the ratio of child psychiatrists to children with mental health problems, Ontario fares relatively well (1:6148). Generally, Ontario child psychiatrists report having received formalized training in the speciality. Child psychiatrists are disproportionately concentrated in Toronto and in midsize cities with medical schools compared with rural regions. Outreach services to smaller communities are provided by 30% of child psychiatrists, but it is not clear whether the services are sufficient and equitably available. Approximately 50% of current psychiatrists will be aged 65 years or older in 15 years, and it is unclear whether sufficient numbers will replace them. The profession appears to be reaching an equitable gender representation. Most child psychiatrists belong to the professional organizations that support the profession; however, they are least likely to belong to the Ontario Psychiatric Association (OPA). Conclusions: An optimal ratio of child psychiatrists per population served still needs to be determined, with special consideration given to the needs of rural communities. The small ratio of child psychiatrists to the population of children with mental health needs highlights the importance of collaborating with other medical and mental health professionals. Recruiting and retaining child psychiatrists will need to be monitored. Child psychiatrists in Ontario need a unified voice to address these issues.
Imaging of Autism: Lessons from the Past to Guide Studies in the Future
Authors: Goldberg Jeremy , Szatmari Peter , Nahmias Claude 
Published: January 2017

Objective: To review the scientific literature on the imaging of autism with a view to understanding how imaging can contribute to future studies. Methods: Medline was searched, and bibliographies from retrieved articles were reviewed. Inclusion criteria were a diagnosis of autism according to Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, third edition or later, and a control group without autism. Results: The field suffers from a lack of replication studies and poor methodology in terms of not controlling for confounding variables. Enlarged brain size, particularly in the temporoparietal brain region, and decreased size of the posterior corpus callosum are the only findings that have been independently replicated. Conclusion: Future imaging studies should attempt to investigate more homogeneous subgroups of patients such as those with “the lesser variant of PDD” and high-functioning patients with PDD who do not have comorbid medical conditions. A different approach, examining the individual behaviours that constitute the PDD spectrum and exploring these separately along with other associated variables such as neuropsychological deficits, structural and functional brain abnormalities, and genetic information could help identify biological mechanisms that do not follow diagnostic boundaries.
Comprehensive Glabellar Anatomy for the Cosmetic Surgeon
Authors: Burkat Cat N. , Lucarelli Mark J. , Lemke Bradley N. 
Published: January 2017

Introduction: The purpose of this study was to clarify controversies in motor innervation to the glabellar muscles in order to create a comprehensive guide of anatomic relationships within the glabella for the cosmetic surgeon performing surgery or injections in this aesthetic region. Methods: Microdissection was performed on 28 sides of 14 preserved cadaver heads and 10 sides of 5 fresh-frozen cadaver heads. Dissection proceeded anterograde from the main trunk of the facial nerve to its terminal branches in the glabellar muscles. Measurements were made with calipers to record the locations of the motor nerve entry into the corresponding muscle and the locations of the sensory nerves, vessels, and orbital landmarks. Results: The temporal branch of the facial nerve did not terminate after supplying the posterolateral transverse corrugator muscle but continued medially to innervate the oblique head of the corrugator muscle, entering 4 mm inferior to the superior edge (range 2–6.5 mm). This pattern was identified in 26 of 38 dissections (68.4%). In 74% of specimens, a small artery coursed with the nerve toward the corrugator muscle that should be anticipated to avoid bleeding. In 4 specimens (10.5%), the temporal facial nerve supplied a branch to the depressor supercilii, which continued to enter the posterior surface of the procerus muscle. In the remaining specimens, the small terminal branches were lost after entering the oblique corrugator muscle. The supratrochlear nerve exited between, rather than lateral to, the 2 heads of the corrugator supercilii muscle near the muscle origin before dividing into 2–3 branches and measured 17 mm from midline. A sensory branch entered the procerus muscle 5 mm inferior to the motor nerve entering the muscle. The supraorbital notch and foramen was 26 mm from midline. Prominent angular vessels were located between the heads of the corrugator supercilii muscle and between the heads of the depressor supercilii muscle. Conclusions: With a thorough understanding of the anatomic relationships of the muscles to their associated innervation and vascular supply, complications such as prolonged paresthesia or dysesthesia from sensory nerve injury, eyebrow asymmetry from motor nerve damage, traumatic neuromas, and visual loss from vascular emboli from cosmetic injections may be avoided.