bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cognitive Pharmacotherapy of Alzheimer's Disease and other Dementias
Authors: Herrmann Nathan 
Published: July 2017

Objective: The objective of this paper is to review the randomized controlled trials (RCTs) on the pharmacotherapy of Alzheimer's disease and other dementias and to provide evidence-based recommendations for treatment of the cognitive impairment associated with these disorders. Method: A Medline search was conducted for RCTs, using the following key words: Alzheimer's disease, dementia, therapy, cholinesterase inhibitor, donepezil, rivastigmine, and galantamine. Studies were critically appraised, followed by a review of published major clinical practice guidelines. Recommendations for treatment were made based on best available evidence. Results: The pharmacotherapy of Alzheimer's disease should include the meticulous management of vascular risk factors (for example, hypertension, diabetes, cholesterol, and stroke prophylaxis) and consideration for supplementation with folate, vitamin B complex, and vitamin E. Patients should be offered at least 1 trial of a cholinesterase inhibitor, with the possibility of another trial if the first is poorly tolerated or ineffective. Patients with vascular dementia and dementia with Lewy bodies should also be offered treatment with cholinesterase inhibitors. At this time, we lack sufficient data to recommend the use of hormone replacement or antiinflammatory therapy for treatment of dementia as the primary indication. Conclusion: Reasonable evidence exists to provide recommendations for the pharmacotherapy of dementia. Treatment will likely result in modest but important benefits to patients, caregivers, and society.
Are Leptin and Cytokines Involved in Body Weight Gain during Treatment with Antipsychotic Drugs?
Authors: Baptista Trino , Beaulieu Serge 
Published: July 2017

Objective: To critically review published literature on the causal association between leptin, cytokines, and excessive body weight gain (BWG) induced by antipsychotic drugs (APs). Methods: We completed a Medline search using the words leptin, cytokines, antipsychotic drugs, neuroleptics, psychotropic drugs, weight gain, and obesity. We also included our empirical research on this topic in the discussion. We examined the relation between leptin, cytokines (mainly tumour necrosis factor alpha [TNF-α] and its soluble receptors), and AP-induced BWG, using the biological sciences' current theories of causality. Results: In the general field of weight regulation, there is scarce experimental evidence that leptin or TNF-α by themselves can induce obesity. Serum levels of leptin and TNF-α rather increase simultaneously as BWG occurs. This has also been reported during AP-induced BWG, with the equivocal exception of a study with clozapine. Some researchers have suggested that the absence of the expected correlation between leptin and body mass index (BMI) or serum insulin levels, and the lack of sex-related differences in leptin levels in AP-treated patients, may point to a causal relation. This contention requires more experimental support. In addition, future clinical studies must carefully control for sex and BMI. Conclusions: No conclusive evidence has been provided that leptin or TNF-α may induce obesity either in drug-free subjects or in AP-treated patients. In most cases, the elevated serum levels of these hormones appear to be a consequence rather than a cause of obesity. That does not mean that such an elevation is innocuous, since it may impair blood pressure and also carbohydrate and lipid metabolism regulation. Hence, all efforts should be made to prevent or attenuate BWG during treatment with APs.
Progress against Major Depression in Canada
Authors: Patten Scott B 
Published: July 2017

Background: Generally, public health strategies for major depression have focused on case-finding, public and professional education, and disease-management strategies. In principle, increased rates of treatment utilization and improved treatment outcomes should lead to improved mental health at the population level. Progress of this sort, however, has been difficult to confirm. Methods: The National Population Health Survey (NPHS) is a large-scale longitudinal study of a representative sample drawn from the Canadian population. To date, Statistics Canada has released data from 3 NPHS cycles: 1994–1995, 1996–1997, and 1998–1999. Treatment utilization and major depression measures were employed in the NPHS survey, providing a unique source of longitudinal Canadian data. In this study, major depression point prevalence (defined using a predictive instrument for annual major depressive episode [MDE] prevalence and responses from a distress scale) and associated treatment utilization were evaluated over time. Results: Between 1994–1995 and 1995–1996, the proportion of persons with depression receiving antidepressant treatment increased dramatically, from 18.2% (12.3% to 22.1%) in 1994–1995 to 32.6% (23.0% to 42.2%) in 1998–1999. Point prevalence of major depression was 2.4%, 1.8%, and 1.9% in the 3 NPHS iterations. Conclusions: Data from the NPHS suggest public health progress against major depression in Canada. More people with major depression in Canada are receiving treatment, and these changes may have been associated with improved population health status. However, both random variation and extraneous societal factors could account for the observed trends in prevalence. It is impossible to relate changes in utilization directly to population health status using the NPHS data.
Antidepressants and the Risk of Breast Cancer
Authors: Kurdyak Paul A , Gnam William H , Streiner David L 
Published: July 2017

Background: A recent national newspaper article highlighted 2 published research papers that suggest an association between antidepressants and an increased risk of breast cancer. The authors of the 2 papers recommend switching or avoiding the antidepressants implicated in their studies. Method: We critically review these papers and, based on our review, consider what clinical practices, if any, should be modified as a result of their findings. Results: Both articles are based upon case–control studies. In the first paper, the authors examine the relation between tricyclic antidepressants (TCAs) and an increased risk of breast cancer. The study upon which the paper is based has several design strengths, and the paper presents findings that have biological plausibility. However, the conclusions are weakened by the lack of accounting for potential confounding factors and multiple statistical comparisons. In the second paper, the authors combined survey and administrative data to examine the association between antidepressant use and breast cancer risk. The press article notwithstanding, the second paper does not find a significant association between specific antidepressants and an increased risk of breast cancer, after adjusting for potential confounders. There are significant methodological limitations to the research upon which the paper is based. Conclusions: The finding of an association between TCA use and increased risk of breast cancer merits further testing using stronger research designs. However, because of the methodological concerns described, the 2 papers we review provide insufficient evidence to guide practitioners to change clinical practice.
Are There Cognitive and Behavioural Approaches Specific to the Treatment of Pathological Gambling?
Authors: Tavares Hermano , Zilberman Monica L , el-Guebaly Nady 
Published: July 2017

Objective: Treatment approaches for pathological gambling have been modelled after preexisting substance addiction models. This paper reviews cognitive-behavioural models in a search for original insights that are specific to gambling treatment. Method: A computerized search of major health care databases (Medline and PsycINFO) was performed. Results: New cognitive-behavioural approaches to the treatment of pathological gambling provide 3 original additions to the traditional multimodal treatment of addictions: cognitive restructuring, in vivo exposure, and imaginal desensitization. Other cognitive-behavioural techniques, such as relapse prevention, problem solving, and social skill training, are shared by gambling treatment and addictions treatment. Conclusions: When treating pathological gamblers, clinicians must consider introducing techniques to address cognitive distortions related to gambling. Also, cue exposure—whether in vivo or imaginal—may help deal with urges prompted by such cues. The blending of these new techniques into a multimodal addiction treatment potentially balances the rational and external orientation of the cognitive-behavioural approach with interpersonal and introspective components of the traditional addiction treatment.
The Thought Disorder Questionnaire
Authors: Waring Edward M , Neufeld RWJ , Schaefer B 
Published: July 2017

Objective: To describe the development of the Thought Disorder Questionnaire (TDQ), including data on reliability and validity, and to explain the questionnaire's feasibility and diagnostic accuracy. Methods: The TDQ has 6 scales, each with 10 items (on a scale from 0 [for never] to 4 [for always]). The 6 scales measure content of thought, control of thought, orientation, perception, fantasy, and symptoms. Results: The TDQ is a reliable 60-item, self-report questionnaire that measures the quantity and quality of disordered thinking in patients with mental disorders. It has established reliability and validity. Conclusion: The TDQ's clinical and research utility remains to be determined.
Phenomenology and Comorbidity of Dysthymic Disorder in 100 Consecutively Referred Children and Adolescents: Beyond DSM-IV
Authors: Masi Gabriele , Millepiedi Stefania , Mucci Maria , Pascale Rosa Rita , Perugi Giulio , Akiskal Hagop S 
Published: July 2017

Objective: Diagnostic criteria and nosological boundaries of juvenile dysthymic disorder (DD) are underresearched. Two different sets of diagnostic criteria are still discussed in the DSM-IV, the first giving major weight to somatic and vegetative symptoms and the second, included in the appendix, to more affective and cognitive symptoms. The aim of this study was to describe prototypical symptomatology and comorbidity of DD, according to DSM-IV criteria, in a consecutive series of referred children and adolescents, as a function of age and sex. Method: One hundred inpatients and outpatients (36 children and 64 adolescents, 57 males, 43 females, age range 7 to 18 years, mean age 13.3 years) received a diagnosis of DD without comorbid major depressive disorder (MDD), using historical information, the Diagnostic Interview for Children and Adolescents-Revised (DICA-R), and symptoms ratings according to the DSM-IV criteria. Results: Irritability, low self-esteem, fatigue or loss of energy, depressed mood, guilt, concentration difficulties, anhedonia, and hopelessness were present in more than 50% of subjects. Differences in symptomatic profile between male and female patients were not significant. Anxiety disorders were commonly comorbid with DD, mainly generalized anxiety disorder, simple phobias, and in prepuberal children, separation anxiety disorder. Externalizing disorders were reported in 35% of the patients, with higher prevalence in male patients. Adolescents showed more suicidal thoughts and anhedonia than children. Conclusions: The clinical picture of early-onset DD we found, based entirely on a pure sample without current and past MDD, is not totally congruent with the diagnostic criteria according to DSM-IV. A more precise definition of the clinical picture may help early diagnosis and prevention of superimposed mental disorders.
The Effect of Peer Support on Postpartum Depression: A Pilot Randomized Controlled Trial
Authors: Dennis Cindy-Lee 
Published: July 2017

Objective: To evaluate the effect of peer support (mother-to-mother) on depressive symptomatology among mothers identified as high-risk for postpartum depression (PPD). Method: Forty-two mothers in British Columbia were identified as high-risk for PPD according to the Edinburgh Postnatal Depression Scale (EPDS) and randomly assigned to either a control group (that is, to standard community postpartum care) or an experimental group. The experimental group received standard care plus telephone-based peer support, initiated within 48 to 72 hours of randomization, from a mother who previously experienced PPD and attended a 4-hour training session. Research assistants blind to group allocation conducted follow-up assessments on diverse outcomes, including depressive symptomatology, at 4 and 8 weeks postrandomization. Results: Significant group differences were found in probable major depressive symptomatology (EPDS > 12) at the 4-week (χ2 = 5.18, df = 1; P = 0.02) and 8-week (χ2 = 6.37, df = 1; P = 0.01) assessments. Specifically, at the 4-week assessment 40.9% ( n = 9) of mothers in the control group scored > 12 on the EPDS, compared with only 10% ( n = 2) in the experimental group. Similar findings were found at the 8-week assessment, when 52.4% ( n = 11) of mothers in the control group scored > 12 on the EPDS, compared with 15% ( n = 3) of mothers in the experimental group. Of the 16 mothers in the experimental group who evaluated the intervention, 87.5% were satisfied with their peer-support experience. Conclusions: Telephone-based peer support may effectively decrease depressive symptomatology among new mothers. The high maternal satisfaction with, and acceptance of, the intervention suggests that a larger trial is feasible.
Are Mental Health Services for Children Distributed According to Needs?
Authors: Blais Régis , Breton Jean-Jacques , Fournier Mylène , St-Georges Marie , Berthiaume Claude 
Published: July 2017

Objectives: The purpose of this study was twofold: 1) to determine whether publicly funded mental health services and resources available in 4 large regions in the province of Quebec were distributed according to the mental health needs of children aged 6 to 14 years and 2) to assess whether the variations in mental health services and resources across the 4 regions had changed over a 5-year period. Methods: Indicators of need according to the child's parent (presence of mental disorder, measure of adaptation, and perception of need for help) from an epidemiologic survey of 2400 noninstitutionalized children were compared with both in-school and community professional resources and with physician and hospital services in 1992–1993. Resource and service data were also collected for 1997–1998. Resource and service data came from professional colleges and government administrative databases. Results: No significant regional differences were found for need indicators, but there were large discrepancies in mental health resources and services in 1992–1993. Differences in professional resources were largest for special education teachers in the school system and for psychiatrists in the community. The regional differences in resources and services were as large in 1997–1998 as they were in 1992–1993. Conclusions: Despite universal health care in Quebec and a government mental health policy stressing equity of access, the available mental health resources for children aged 6 to 14 years are not distributed across regions according to needs. More evidence-based planning is required, specifically using epidemiologic survey data, to match resources to needs and to monitor changes over time.
Patient Characteristics Associated with Nonprescription Drug Use in Intentional Overdose
Authors: Lo Andre , Shalansky Stephen , Leung Marianna , Hollander Yitzchak , Raboud Janet 
Published: July 2017

Objective: Over-the-counter (OTC) medications remain freely available to suicidal patients, despite their potential lethality and common use in suicide. The study's main objective was to identify patient characteristics, particularly psychiatric diagnosis associated with the use of OTC medications in intentional overdose. Methods: We retrospectively reviewed 95 charts from patients who presented to St Paul's Hospital from August 1, 1997, to July 31, 1998, with a discharge diagnosis of intentional drug overdose. Univariate analysis was carried out to identify potential risk markers for OTC medication use, and logistic regression was performed using these variables. Results: When the variables age, sex, and concurrent psychiatric diagnoses were controlled, use of OTC medications in overdose was significantly lower in patients with a DSM-IV diagnosis of substance abuse (OR 0.11, P = 0.005) and in those who possessed prescription medications at the time of overdose (OR 0.18, P = 0.007). Most patients in this cohort (82%) had at least 1 of these 2 traits. Although not statistically significant, younger patients appeared more likely to choose OTC medications for overdose. Conclusion: Suicide-prone patients with a diagnosis of substance abuse and who possess prescription medications are unlikely to use OTC medications in overdose. For this cohort, this represents a relatively small proportion of patients whom clinicians should consider to be at greater risk for attempting suicide when using OTC medication, especially acetaminophen.
The Canadian Psychiatric Association Practice Profile Survey: II. General Description of Results
Authors: Woodside D Blake , Lin Elizabeth 
Published: July 2017

Objective: To provide an overview of the results of the Canadian Psychiatric Association (CPA) practice profile survey (PPS), a national survey of psychiatrists and psychiatric practice. Method: Mail-in interviews were sent to all Canadian psychiatrists listed in their provincial registers and to all active CPA members (total = 3628). Respondents provided general information about their professional activities for one 24-hour day and detailed information for 1 randomly selected hour. Patient information—including sociodemographics, diagnostic profiles, functioning levels, risk of harm to self or others, and disposition—was elicited for 1 patient seen during the random hour as well as for the most seriously ill patient receiving clinical services that day. Results: Psychiatrists work 10 hours daily on average and take calls for 5 hours. Sixty percent of the overall work time is in the provision of direct patient care, and fee-for-service payments account for 55% of hours worked. Forty percent of the clinical work is provided in a hospital setting, and 34% is in a private office. Agency work accounted for only 6% of clinical hours worked. Relatively few practitioners provide services to children, older, or forensic patients. The average patient seen is female, aged 40 years, unmarried or with a marital disruption, significantly impaired in multiple areas of functioning, and likely to suffer from depression (21%), schizophrenia (14%), an anxiety disorder (13%), or bipolar disorder (12%). Comorbid Axis I and Axis II disorders are common (each over 30%) and fairly high rates of suicidal (15% to 30%) and homicidal (10% to 20%) risk are present. Conclusions: This paper suggests a wide diversity of practice in psychiatry in Canada, with services being provided to a wide range of individuals with many different conditions.
Acceptability and Disintegration Rates of Orally Disintegrating Risperidone Tablets in Patients with Schizophrenia or Schizoaffective Disorder
Authors: Chue Pierre , Welch Ron , Binder Carin 
Published: July 2017

Objective: To investigate the disintegration profile, acceptability, and tolerability of orally disintegrating risperidone tablets in patients with schizophrenia or schizoaffective disorder. Method: Ten patients stable for at least 10 days on monotherapy with oral risperidone 2 mg to 4 mg taken once daily were switched for 7 days to an equivalent dosage of orally disintegrating risperidone. Visual assessments for time to initial and complete disintegration were collected at each visit. Clinical Global Impression of Severity scores were collected at baseline and at the last visit. Patient acceptance of the new formulation, rated according to a visual analog scale, was obtained at the last visit. Results: All patients maintained stable clinical status. Mean time to initial disintegration was 5.1 seconds, SD 0.8, and mean time to complete disintegration was 29.4 seconds, SD 18.4. The formulation was rated as very acceptable. Adverse events were reported by 5 patients; all were mild. Conclusion: The orally disintegrating risperidone tablets were well tolerated and rated as very acceptable by all patients.
Neurobiological Findings in Bipolar II Disorder Compared with Findings in Bipolar I Disorder
Authors: McGrath Brent M , Wessels Phillip H , Bell Emily C , Ulrich Michele , Silverstone Peter H 
Published: July 2017

Objective: To determine there are consistent neurobiological differences between patients with bipolar I disorder (BD I) and those with bipolar II disorder (BD II). Method: We reviewed the literature in areas where the most consistent neurobiological findings have been reported for bipolar disorder, specifically, neuroimaging and brain metabolism. The imaging studies reviewed, examined structure, using magnetic resonance imaging (MRI), and function, using functional MRI, positron emission tomography, and single photon emission computed tomography. We used magnetic resonance spectroscopy to examine brain chemistry. We reviewed those metabolic studies that examined cell calcium, 3-methoxy-4-hydroxyphenylglycol, and protein kinase C. Results: Some genetic studies suggest that there may be differences between BD II and BD I patients. However, our review of the imaging and metabolic studies identified few studies directly comparing these 2 groups. In those studies, there were few differences, if any, and these were not consistent. Conclusions: While genetic data suggest there may be differences between BD II patients and BD I patients, the neurobiological findings to date do not provide support. However, this may be owing to the small number of studies directly comparing the 2 groups and also to the fact that those carried out have not been adequately powered to detect possible small true differences. This is an important issue because, if there are no neurobiological differences, it would be anticipated that similar treatments would be similarly effective in both groups. Given the importance of understanding whether there are neurochemical differences between these groups, further research in this area is clearly needed.
Development and Reliability of a Pictorial Mental Disorders Screen for Young Adolescents
Authors: Smolla Nicole , Valla Jean-Pierre , Bergeron Lise , Berthiaume Claude , St-Georges Ma rie 
Published: July 2017

Objective: To report psychometric data from preliminary studies of the Adolescent Dominic (AD), a pictorial screen for the most frequent Axis I youth mental disorders. Methods: We created 113 picture items based on DSM-III-R diagnostic criteria and assessed them for comprehension (sample 1, n = 114; sample 2, n = 40) and reliability (sample 3, n = 128) in a group of adolescents aged 12 to 16 years living in the community. We used the kappa statistic to estimate test–retest reliability of symptoms, criteria and diagnoses, and intraclass correlation coefficients (ICCs) for symptom and criterion scores. We assessed internal consistency of symptom scores with the alpha coefficient. Results: For symptoms, 54.4% of kappas were higher than 0.60, while only 2% were poor. ICCs for symptom scores yielded higher values (0.81 to 0.89) than for criterion scores (0.51 to 0.86). Internal consistency of symptom scores ranged from 0.52 to 0.83. Kappas for diagnoses ranged from 0.52 to 0.76. Conclusions: Symptom reliability compared favourably with data from other assessment interviews of youth mental disorders. Following these positive results, a computerized DSM-IV version of the AD has focused on the assessment of symptoms and is currently being tested for reliability and criterion validity.