bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying Narcissistic Personality Disorders in Preadolescents
Authors: Guilé Jean-Marc 
Published: January 2017

Objective: To establish whether consensus exists among 3 diagnostic systems that outline criteria for narcissistic personality disorders (NPDs) in children (Kernberg), in adolescents (Bleiberg), and in adults primarily (DSM-IV) and to identify age-related criteria for preadolescents. Method: A comparative analysis was used to determine the rate of concordance for the 9 DSM-IV criteria for NPD. Results: There is a high concordance among the 3 systems for DSM criteria, suggesting that NPD can be identified among preadolescents. Conclusion: Preliminary ways of adapting DSM-IV criteria for NPD in this age group are discussed.
The Mental Health of Children in Foster Care: A Comparison with Community and Clinical Samples
Authors: Stein Eleanor , Evans Barrie , Mazumdar Rupak , Rae-Grant Naomi 
Published: January 2017

Objective: To determine whether the psychiatric profile of children in foster care is more similar to clinical or community profiles. Method: Caregiver and teacher ratings of DSM-III-R externalizing and internalizing symptoms were collected for 3 groups of children: children in foster care, children assessed at a children's mental health centre, and a community sample. Results: Children in foster care approximated the numbers and types of symptoms of the clinical sample. Coming from a family on social assistance, having a parent with a criminal history, and being of the male gender were correlated with higher externalizing and internalizing symptom scores independent of group membership. Group membership accounted for less than 5% of the variance in psychiatric symptom scores. Conclusions: The high symptom burden of children in care is substantially attributable to their high-risk histories, and treatment should be designed with this in mind.
The Effect of Risperidone on Cognition in Patients with Schizophrenia
Authors: Stip Emmanuel , Lussier Isabelle 
Published: January 2017

Objective: To evaluate the effect of risperidone on cognitive functions after both 6 weeks and 6 months of treatment and to determine whether any improvement on neuropsychological function relates to improvement in psychopathology. Method: Patients' psychiatric and extrapyramidal symptoms were assessed while they were receiving classical neuroleptic treatment and adjunctive medications. Patients were then reassessed after changing to a new treatment of risperidone. Results: During treatment with risperidone, schizophrenic patients displayed improved performance mainly on attentional components, specifically, selective attention and alertness. Conclusion: In patients who were given risperidone, there was a positive correlation between improvement in psychopathology and improvement in cognitive tests of explicit memory and alertness.
A Demographic Study of Polydipsia in an Institution for the Intellectually Disabled
Authors: Hayfron-Benjamin Jonathan , Peters Claudia A , Woodhouse Rosamund A 
Published: January 2017

Objective: To measure the prevalence of primary polydipsia in an Ontario institution for residents with developmental disabilities and to explore the associations of polydipsia with age, sex, and level of mental retardation. Method: All 798 residents were screened for polydipsia using a behavioural questionnaire completed by caregivers. Results: Thirty-three cases were detected: the prevalence among the mobile resident population (n = 660) was 5%. We found no association of polydipsia with age, sex, or level of mental retardation. Conclusions: Physicians should be aware of polydipsia because it is common among residents with moderate, severe, and profound mental disability. Unless screened for specifically, polydipsia may go unrecognized and may place the residents with mental handicap at risk for serious acute and chronic complications.
The Nature and Characteristics of Psychiatric Comorbidity in Incarcerated Adolescents
Authors: Ulzen Thaddeus PM , Psych Dip Child , Hamilton Hayley 
Published: January 2017

Objectives: To determine the prevalence of psychiatric disorders, the degree of psychiatric comorbidity, and the relationship between these and sociodemographic variables in a sample of incarcerated adolescents. A comparison with an age- and sex-matched community sample was conducted. Method: Age- and sex-matched samples of 49 incarcerated adolescents and 49 nondelinquents were compared for psychiatric morbidity and psychosocial characteristics. Psychiatric diagnoses were determined using the Diagnostic Interview for Children and Adolescents-Revised (DICA-R). Additional information on psychosocial, family, and offence characteristics was obtained using a semistructured interview designed specifically for this study. The prevalence of single and comorbid psychiatric disorders was determined. Results: Approximately 63.3% of incarcerated adolescents had 2 or more psychiatric disorders. The degree of psychiatric morbidity was directly related to indicators of family adversity, physical abuse, other psychosocial variables, or polysubstance abuse. Psychiatric comorbidity was more frequent in females. Incarcerated adolescents were more likely to endorse symptoms of thought disorder. Conclusions: Findings identify preventive intervention foci for policy makers and planners in the area of adolescent corrections. Implications for education and training of nonclinical custodial staff are discussed as is the need for a more therapeutic orientation in correctional facilities.
Efficacy of Divalproex Sodium in Patients with Panic Disorder and Mood Instability Who Have Not Responded to Conventional Therapy
Authors: Baetz Marilyn , Bowen Rudradeo C 
Published: January 2017

Objective: To determine the efficacy of divalproex sodium in the treatment of psychiatric outpatients with treatment refractory panic disorder and comorbid mood instability. Method: This was an 8-week, open-trial, flexible-dose outcome study conducted at a tertiary care referral centre. Individuals with panic disorder who failed to respond to a cognitive behavioural treatment program and standard antipanic medication, who also suffered from mood instability, were chosen to participate in the study. Divalproex sodium was administered at a flexible dose to reach serum levels of 300 to 600 umol/L (45 to 90 ug/ml) unless limited by tolerance. Patients were rated by self- and rater-administered questionnaires that measured the number of panic attacks, the degree of agoraphobic avoidance, the levels of depression, anxiety, and mood swings, and the perceived sense of well being. Results: Thirteen subjects were enrolled in the study, and 10 subjects completed it. Two dropped out early because of the medication's side effects, and 1 was lost within the first month of follow-up. All 10 subjects showed significant improvement in depressive and anxiety symptoms and mood instability. There was also a statistically and clinically significant improvement in panic attacks and measures of quality of life. Conclusions: These findings suggest that divalproex sodium is useful in the treatment of patients with panic disorder and concomitant mood instability, who are refractory to conventional treatment. Double-blind trials will be required to verify these findings.
Prospective Follow-up Study of Borderline Personality Disorder: Prognosis, Prediction of Outcome, and Axis II Comorbidity
Authors: Links Paul S , Heslegrave Ronald , van Reekum Robert 
Published: January 2017

Objective: To examine the rate of persistence of borderline personality disorder (BPD), the existence of concomitant personality disorders on follow-up, and the predictors of outcome in patients who met criteria for BPD compared with patients with borderline features who failed to meet all of the criteria. Method: This prospective cohort study reassessed subjects for BPD diagnosis and cooccurring personality pathology at 7 years follow-up. Initial measures of borderline and comorbid personality psychopathology were used to predict levels of borderline or other personality disorder psychopathology at follow-up. Results: Of the 5 7 subjects who initially met the criteria for BPD, 30 (52.6%) were found to have remitted BPD, and 27 (47.4%) were characterized as having persistent BPD. The remitted group met significantly fewer comorbid personality disorder diagnoses than the persistent group (mean = 0.8, mean = 3.5 respectively; P < 0.05). Results also indicated that the initial level of borderline psychopathology was predictive of borderline psychopathology at follow-up, which explained 17% of the variance. Conclusions: This prospective follow-up study found that almost 50% of former inpatients with BPD continue to test positive for BPD at 7 years follow-up, and these persistent BPD patients also had significantly more comorbid personality psychopathology. Borderline psychopathology at follow-up was primarily predicted by the level of borderline psychopathology recorded at the initial assessment.
Neuroendocrine Responses to Inhibitors of Steroid Biosynthesis in Patients with Major Depression Resistant to Antidepressant Therapy
Authors: Murphy Beverley E Pearson , Ghadirian A Missagh , Dhar Veena 
Published: January 2017

Objective: Patients with major depression frequently have high Cortisol levels and resistance to dexamethasone. We sought to determine to what extent major depression might be influenced by inhibitors of steroid biosynthesis and to study the endocrine changes produced. Method: After drug washout, 20 treatment-resistant patients with major depression were given aminoglutethimide, metyrapone, and/or ketoconazole, along with a small dose of cortisol for 8 weeks. Hamilton Depression Rating Scale (HDRS) ratings, 8:00 AM Cortisol, dehydroepiandrosterone sulfate (DHAS), adrenocorticotropin (ACTH), and testosterone levels were followed weekly or offener. A dexamethasone suppression test (DST) was conducted before and after treatment. Results: Seventeen patients (85%) completed the course of treatment, and a significant mean drop (P ≤ 0.0001) of 50% in the HDRS score occurred by 7 weeks of treatment. Cortisol levels fluctuated widely and were often still high after the patient had improved clinically. Dehydroepiandrosterone sulfate levels fell more uniformly and were found to be a useful indicator of compliance and, to some extent, efficacy with aminoglutethimide and ketoconazole therapy. The correlation between DHAS and HDRS (r = 0.94) was significant (P = 0.02). Testosterone levels in men fell with ketoconazole but returned promptly to normal at the end of treatment. Adrenocorticotropin levels were normal or elevated, depending on the assay used, and rose (P = 0.07; n = 13) in most subjects during therapy. Of the 6 responders who had nonsuppressor DSTs before starting therapy, 5 had reverted to normal 1 to 2 weeks following cessation of therapy (P = 0.0006). Conclusions: Abnormal metabolism of adrenocortical steroids may perpetuate depression, and alterations of synthesis or metabolism of these steroids may lead to a remission.
Sexual Recidivism in Sex Offenders
Authors: Greenberg David M 
Published: January 2017

Objective: To examine the recidivism rates of the various types of adult sex offenders including incest offenders, extrafamilial child molesters, exhibitionists, and rapists. Method: An examination of the literature over the past 4 decades and the data from our own study group. Results: Methodological shortfalls and differences across the studies make statistical appraisal of the results difficult. Nevertheless, there is a consensus that incest offenders are less likely to reoffend compared with extrafamilial child molesters. Rapists and exhibitionists are thought to be at a higher risk for recidivism. Conclusion: A combined actuarial predictive approach in conjunction with empirically guided clinical assessment is probably the best method to predict recidivism of sex offenders.
Fitness, Responsibility, and Judicially Ordered Assessments
Authors: Ohayon Maurice M , Crocker Anne , St-Onge Bernard , Caulet M 
Published: January 2017

Objective: To compare the characteristics of individuals assessed for fitness to stand trial (FST) with those assessed for criminal responsibility (CR). Method: This study examines all the consecutive requests of FST or CR addressed to the only forensic psychiatric hospital in the province of Quebec and 2 prisons in the Montreal area over a 1-year period. Results: In all, 170 FST, 52 CR, and 29 both FST and CR assessment requests were received (251 subjects). Psychiatrists' recommendations and court verdicts of unfitness to stand trial or not criminally responsible on account of mental disorders were mostly related to the presence of a psychotic-spectrum disorder. There is generally a good agreement between psychiatric recommendations and verdicts of the court, with the exception of unfitness recommendations. Conclusions: Defendants referred for a FST or a CR assessment displayed similar characteristics. However, although subjects with psychotic disorders represented more than one-half of the unfit or not criminally responsible verdicts, most of the subjects with psychoses were found competent to stand trial or responsible.
Alcohol Consumption and Major Depression in the Canadian Population
Authors: Patten Scott B , Charney Dara A 
Published: January 2017

Objective: Various clinical studies have documented associations between alcohol consumption and depressive disorders. In some circumstances, alcohol ingestion may cause or worsen depression, whereas in other circumstances the direction of causal effect may be reversed. The objective of this study was to evaluate associations between alcohol consumption and major depression in the Canadian population. Method: Data from the Canadian National Population Health Survey (NPHS) were analyzed. This survey, conducted by Statistics Canada in 1994, used a probability sample of 17 626 subjects. The NPHS included measures of alcohol ingestion and a diagnostic screen for major depression (Composite International Diagnostic Interview [CIDI] Short Form). Results: Subjects reporting any drinking in the year preceding the interview were more likely to have experienced an episode of major depression during that time than subjects reporting no drinking. Subjects reporting maximal ingestions of 5 or more drinks (and especially 10 or more drinks) on at least 1 occasion during the preceding year were also at greater risk of major depression than nondrinking subjects or subjects reporting smaller maximal ingestions. Neither the average amount consumed daily nor the frequency of drinking was associated with major depression. Conclusions: In the general population, there is no simple relationship between the quantity or frequency of alcohol consumption and the prevalence of major depression. Any drinking and maximal consumption on I occasion, however, are related to the prevalence of major depression. Further research is needed to delineate causal mechanisms so that clinical and public-health interventions can be formulated.
Confidentiality in Crisis: Part I—The Duty to Inform
Authors: Glancy Graham D , Regehr Cheryl , Bryant Anthony G 
Published: January 2017

Objective: To discuss the ethical and legal imperatives to protect third parties from harm in circumstances often believed to be protected by doctor-patient confidentiality. Method: A review of recent legislative changes and legal decisions pertaining to a psychiatrist's duty to warn. Conclusion: The current legislative and legal climate presents many risks to the concept of doctor-patient confidentiality. Psychiatrists must carefully consider any guarantees of confidentiality made to patients and must discuss the limits of confidentiality when obtaining consent for treatment.
Confidentiality in Crisis: Part II—Confidentiality of Treatment Records
Authors: Glancy Graham D , Regehr Cheryl , Bryant Anthony G 
Published: January 2017

Objective: To discuss the implications of recent legislative changes and court decisions in Canada that have placed the privacy of psychiatric records information at risk. New areas of exposure include client access to clinical information provided by family members, parental access to children's records, and court access to clinical records in civil, criminal, and family law matters. Method: A review of recent legislative changes and court decisions pertaining to access to psychiatric records. Conclusion: At present, psychiatric records can no longer be regarded as confidential. Recent changes in the concept of privilege of treatment records necessitates several changes in psychiatric practice regarding informed consent to treatment, content of clinical records, and responses to demands for information.
Phase-IV Multicentre Clinical Study of Risperidone in the Treatment of Outpatients with Schizophrenia
Authors: Chouinard Guy , Kopala Lili , Labelle Alain , Beauclair Linda , Johnson Sunny V , Singh Kulbir I ,   The RIS-CAN-3 Study Group
Published: January 2017

Objective: Since most clinical trials of atypical antipsychotics have been conducted in hospitalized patients, a Phase-IV, multicentre, 8-week, open-label, flexible-dose study was performed to assess the efficacy and safety of risperidone in outpatients with schizophrenia. Method: Three hundred and thirty patients with a Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) diagnosis of schizophrenia were enrolled at 61 Canadian sites. Upon trial entry, the patients had their neuroleptic and antiparkinsonian drugs discontinued, and treatment with risperidone was initiated at a dose of 2 mg daily, then increased by 2 mg daily on each of the 2 following days until the initial target dose of 6 mg daily was reached on day 3. No further titration was allowed until day 14, after which the dose could be increased or decreased. Results: During the stabilization phase (days 14–56), the dose was unchanged in 44% of the patients, increased in 24%, decreased in 23%, and titrated both up and down in 9% of the patients. In the efficacy-evaluable population (n = 292), treatment with risperidone produced substantial (−26.4) and significant (P = 0.0001) improvement in the total Positive and Negative Syndrome Scale (PANSS) score. At the end of the study (week 8), 85% of patients were classified as clinically improved according to an a priori definition (that is, 20% or more decrease from baseline in total PANSS score). On their last study visit, 75% of patients reported their experience with risperidone as better than their previous neuroleptic therapy. Risperidone was generally well tolerated. The adverse events reported by more than 5% of the patients were insomnia, nausea, headache, somnolence, dizziness, fatigue, anxiety, vomiting, and ejaculation disorder. Seventy-four percent of the reported treatment-related adverse events were recorded during the first 2 weeks of the trial, possibly because of the discontinuation of prior neuroleptic and antiparkinsonian drugs followed by immediate upward titration of risperidone. However, only 8.5% of adverse events were reported to have occurred during week 3, and only 0.8% of adverse events were reported for week 8. Risperidone treatment produced significant improvements over baseline in the incidence and severity of extrapyramidal symptoms (EPS). A slight but statistically significant increase in body weight was observed. Conclusions: The results of this open-label, Phase-IV trial in a large population of outpatients with schizophrenia found that risperidone was superior to the neuroleptics that patients had previously taken in terms of efficacy and severity of EPS. Our results suggest the use of risperidone at lower doses in outpatients with schizophrenia.
The Adequacy of Reporting Randomized, Controlled Trials in the Evaluation of Antidepressants
Authors: Streiner David L , Joffe Russell 
Published: January 2017

Objective: To evaluate the adequacy of the reports of methodological and statistical aspects of randomized, controlled trials that evaluate antidepressant medications and the degree to which their results can be used in subsequent metaanalyses. Data Sources: Randomized, controlled trials published in English that compared 2 antidepressant drugs with a placebo were reviewed. Papers were located using Medline and reference lists. Data Extraction: Each paper was evaluated using a checklist, and 3 summary criteria scores were derived: minimal, ideal, and overall. Results: Only 9 of the 69 papers met the minimal criteria to be included in a metaanalysis (which would report the final sample size and an estimate of the mean and of the standard deviation); and 0 met all of the ideal criteria for reporting clinical trials. Out of a possible 100 points, the mean score for the articles was 51, and the highest score was 80. Scores were not related to the citation impact factor of the journal in which they appeared. Conclusions: Researchers must become more aware of the criteria for reporting clinical trials, and editors must insist more strenuously that these criteria be satisfied.
The Relationship of Catatonia Symptoms to Symptoms of Schizophrenia
Authors: Cernovsky Zack Z , Landmark Johan A , Merskey Harold , O'Reilly Richard L 
Published: January 2017

Objective: To evaluate the relationships of symptoms of catatonic schizophrenia to 77 symptoms relevant for diagnosing schizophrenia and to socioanamnestic variables. Method: Data from a sample of 112 Canadian patients diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) were evaluated via φ correlation coefficients. Results: Forty-five (40.2%) of our 112 patients had catatonic symptoms, either at the time of this study or in the past. However, only weak correlations (φ < 0.31) to other symptoms relevant for diagnosing schizophrenia were found, and no significant correlations to socioanamnestic variables were found. Conclusion: Symptoms of catatonia appear to be independent of the key symptoms of schizophrenia.
The Endogenous Healing Process in Black Women
Authors: Hibdon Sharon L. Scandrett 
Published: January 2017

Healing is a term utilized in health care; however, understanding of this inherent process has been minimal. Knowledge of the client's own process of healing is important to advance nursing science and to alter health care approaches used to enhance the client's own innate processes. The art of nursing has long utilized the concept of healing; now, the science of nursing needs to systematically identify recurring elements of healing. The purpose of this paper is to identify the existence and characteristics of an endogenous healing process. Two qualitative strategies, audiotaped semistructured interviews and a daily health diary, were utilized to obtain information about the women's healing process. The sample consisted of forty–two southern Black adult women between the ages of 22 and 58. Thirty women were asymptomatic and twelve were symptomatic. Taped interviews were transcribed and examined in a cross–comparative method. Results show that several aspects of the endogenous healing process emerged and achieved theoretical clarification: awareness, appraisal and alignment. Two additional concepts emerged which need further clarification.