bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Financial Incentives to Promote Shared Mental Health Care
Authors: Dewa Carolyn S , Hoch Jeffrey S , Goering Paula 
Published: January 2017

Objectives: To consider the most common primary care reimbursement structures, to identify incentives inherent in each, and to discuss how each could be used to encourage a shared-care approach to treating mental disorders at the primary care level. Method: Three major financial reimbursement models—fee-for-service, capitation, and blended payment mechanisms—are examined. Each is considered in terms of its risk-sharing elements and the consequent incentives. We offer several scenarios to illustrate how the shared-care practice model might be encouraged under each financing mechanism. Results: The current fee-for-service system does not encourage shared care. For wide adoption of the shared-care practice model, there must be a change in the reimbursement system's incentives. While none of the financing mechanisms offers a perfect solution, each has potential. Each, however, must be carefully tailored to its environment. Conclusions: Financial considerations are just one aspect to achieving shared care. Nevertheless, in designing a system to encourage collaborative, coordinated care for those suffering from mental illness, decision makers should be wary of creating or maintaining obstacles (financial or otherwise) to provision of accessible, high-quality care. Objectifs: Examiner les structures de remboursement les plus répandues dans les soins primaires, trouver les incitatifs inhérents à chacune et présenter comment chacune pourrait servir à stimuler une approche de soins partagés pour le traitement des troubles mentaux dans les soins primaires. Méthode: Trois principaux modèles — rémunération à l'acte, capitation et mécanismes de versements confondus — sont examinés, chacun en fonction des éléments de partage des risques et des incitatifs qui s'ensuivent. Nous présentons plusieurs scénarios pour illustrer comment le modèle de la pratique des soins partagés peut être favorisé par chaque mécanisme de financement. Résultats: Le système actuel de rémunération à l'acte n'incite pas aux soins partagés. Pour que le modèle de la pratique des soins partagés soit largement adopté, il faut modifier les incitatifs du système de remboursement. Bien qu'aucun mécanisme de financement n'offre de solution parfaite, chacun offre des possibilités, mais doit être soigneusement adapté à son milieu. Conclusions: Les considérations financières ne sont qu'un aspect de la réalisation des soins partagés. Néanmoins, en concevant un système qui incite à des soins coopératifs et coordonnés dispensés aux personnes souffrant de maladie mentale, les décideurs doivent prendre garde de créer ou de maintenir des obstacles (financiers ou autres) à la prestation de soins accessibles de grande qualité.
Mild Dementia or Cognitive Impairment: The Modified Mini-Mental State Examination (3MS) as a Screen for Dementia
Authors: Bland Roger C , Newman Stephen C 
Published: January 2017

Objective: To examine the Modified Mini-Mental State Examination (3MS) as a screen for dementia. Method: A group of 1092 elderly Edmonton community residents completed the 3MS and the Geriatric Mental State Examination (GMS). 3MS sensitivity and specificity were determined by comparing positive 3MS screens (score ≤77) with those classified as GMS “organic” (severity level 3, equivalent to a clinical diagnosis). In the Canadian Study of Health and Aging (CSHA), 2914 subjects received the 3MS and a clinical examination. A group described as having “cognitive impairment but no dementia (CIND)” was identified. Results: In Edmonton, the 3MS showed 88% sensitivity, 90% specificity, 29% positive predictive value (PPV), and 99% negative predictive value (NPV). In the CSHA, 30% of subjects receiving both the 3MS and a clinical examination were classified as CIND. One-half of these were classified as having “age associated memory impairment (AAMI)” or as “unspecified.” Conclusions: The 3MS with a cutting score of 77/78 proved a reasonable screening instrument; 1 case in 3 screening “positive” has dementia, but few (0.64%) will be missed by screening “negative.” CIND, accounting for 2 out of 3 cases screened positive by the 3MS in the Edmonton study, is a substantial, heterogeneous group that is not necessarily “predementia” but that in many cases merits further investigation.
Polydipsia, Psychosis, and Familial Psychopathology
Authors: Ahmed AG , Heigh Liana M , Ramachandran KV 
Published: January 2017

Objective: To compare the demographic and clinical factors and familial psychopathology of chronic psychiatric inpatients with, and without, polydipsia. Method: We undertook a case-control study of chronic psychiatric inpatients both with, and without, polydipsia. Clinical and demographic data were gathered using a predesigned questionnaire, the Positive and Negative Syndrome Scale (PANSS), the Abnormal Involuntary Movement Scale (AIMS), the Mini-Mental State Examination Scale (MMSE), and the Family History–Research Diagnostic Criteria (FH-RDC). Results: The prevalence rate of polydipsia was 20.2%. The group with polydipsia was significantly younger, both at the time of their first-ever psychiatric and current psychiatric admissions, compared with the group without polydipsia. The 2 groups were similar in terms of their illness characteristics and psychiatric diagnoses. In the group with polydipsia, alcohol abuse predated the psychotic illness by a mean of 10.5 (SD 4.4) years, compared with 4.8 (SD 1.6) years for the same period in the unaffected group. The 2 groups did not differ significantly regarding the antipsychotic medication dosage, the proportion on concomitant anticholinergic medicaton, the documented previous response to antipsychotic medication, or past treatment with electroconvulsive therapy (ECT). First-degree relatives of patients with polydipsia were found to have significantly higher rates of alcohol dependence. Conclusion: This study provides further evidence for the higher rate of polydipsia among chronic psychiatric patient populations and for high rates of alcohol-related problems among their first-degree relatives.
Alternative Medicine Use by Individuals with Major Depression
Authors: Wang JianLi , Patten Scott B , Russell Margaret L 
Published: January 2017

Objective: To describe the use of alternative medicine (AM) by persons with major depression and to examine the factors associated with AM use among these individuals. Methods: We used data from the 1994–1995 and 1996–1997 National Population Health Surveys. We selected subjects who had major depression according to the Composite International Diagnostic Interview Short Form for Major Depression (CIDI-SFMD). The prevalence of AM and conventional health service use by the subjects was calculated for each survey and was stratified by province. We employed logistic regression to examine the factors associated with AM use. Results: There was a temporal trend toward increasing use of AM among persons with major depression. The prevalence of AM use among subjects with major depression was 7.8% in 1994–1995 and 12.9% in 1996–1997. Female sex, having more than 12 years' education, and having 1 or more long-term medical conditions were associated with an increased likelihood of using AM. The sex difference in AM use depended on subjects' age in 1996–1997. Conclusion: General practitioners, mental health specialists, and AM providers should be aware of their patients' use of both conventional medical services and AM because there may be interactions between conventional and alternative treatments. Communication and, if possible, cooperation may lead to improved outcomes in the management of depressive disorders.
Assessing and Treating Problem Gambling: Empirical Status and Promising Trends
Authors: Toneatto Tony , Millar Goldie 
Published: January 2017

Objective: Ways to clinically assess and treat problem gambling evolve as our knowledge about this disorder increases. This paper summarizes current knowledge about treating problem gambling and describes developments in the assessment, psychology, and biology of problem gambling that may be important for treatment. Methods: We reviewed recent published literature reporting advances in the assessment, psychology, and biology of problem gambling. We retained for review only controlled clinical trials in which subjects were randomized to either psychological or pharmacologic treatment. Results: Although several gambling treatments were found to be efficacious, support for any specific treatment modality is still limited. Cognitive-behavioural treatments were most effective. Although diagnostic assessment has improved, there are still very few measures of gambling-related variables. The contribution to gambling of sex, concurrent psychiatric disorders, cognitive distortions, and impulsivity has been described. Evidence implicating decision-making areas of the cortex and disturbances in serotonin and dopamine functioning has been reviewed. Available evidence for a genetic contribution to problem gambling is weak. Conclusions: Improvements in the methodology of gambling-treatment research were discussed to advance the clinical approach to this disorder. Developments in the area of assessment, psychology, and biology of gambling should inform clinical approaches to a greater degree than they currently do. We identified the need to study different types of gambling separately, rather than combining them, as an important goal.
The Boundary between Borderline Personality Disorder and Bipolar Disorder: Current Concepts and Challenges
Authors: Magill Chandra A 
Published: January 2017

Objective: The boundary between borderline personality disorder (BPD) and bipolar disorder (BD) is a controversial subject. Clinically, it can be difficult to diagnose patients who present with both affective instability and impulsivity. This paper reviews concepts and challenges related to the overlap of these disorders. Methods: A Medline search was conducted, using the key words borderline personality disorder, bipolar disorder, affective disorder, and personality disorder. Reference lists from articles generated were also used. Publications from the last 20 years were considered. Results: Studies demonstrate a greater cooccurrence between these 2 disorders than between BPD and other Axis I disorders or between BD and other Axis II disorders. Some authors suggest that many patients diagnosed with BPD are better described as having BD, that the bipolar classification is too narrow, or that BPD should be considered a variant of affective disorders. Others present evidence supporting BPD as a valid construct. Hypotheses about the relation between the 2 disorders and suggestions for clinical practice are offered. Conclusions: There appears to be sufficient evidence to consider BPD to be a valid diagnosis. Both disorders apply to heterogeneous populations, and their characteristics require further clarification. In diagnostically challenging situations, careful consideration of a patient's longitudinal history is essential. Future research will be important to ensure that our diagnostic classifications reflect clinically useful entities.
Twenty-Year Course of Schizophrenia: The Madras Longitudinal Study
Authors: Thara R 
Published: January 2017

Objective: To follow up 90 first-episode schizophrenia patients after 20 years and to study the course of symptomatology, work, social functioning, and pattern of illness during this period. Methods: The Present State Examination and the Psychiatric and Personal History Schedule were administered at fixed points during follow-up. The measures adopted to ensure a good follow-up rate (67%) after 20 years under adverse conditions are described. Results: Complete data were obtained from 61 subjects; 16 had died, and 13 could not be traced. After 20 years, 5 patients had recovered completely, and another 5 were continuously ill. Most of the cohort had multiple relapses with or without complete remission between them. The Global Assessment of Functioning Scale showed that symptoms and social functioning in this sample approximated results from developing countries and were much better than those of developed nations. There were not many sex differences. Marriage and occupational rates were higher than those observed in many published reports. Conclusions: This is one of the few long-term follow-up studies from the developing world. It reveals a pattern of course and functioning distinctly better than that found in many such studies from the developed nations.
Determinants of Coprescription of Anxiolytics with Antidepressants in General Practice
Authors: Verger Pierre , Saliba Bérengère , Rouillon Frédéric , Kovess-Masféty Viviane , Villani Patrick , Bouvenot Gilles , Lovell Anne 
Published: January 2017

Objectives: Anxiolytics are the most frequently prescribed psychotropic drugs in France. General practitioners (GPs) tend to prescribe anxiolytics and other benzodiazepines to patients with major depressive disorders (MDD). However, the extent to and reasons for which they prescribe these medications together are not well documented. This article assesses how often and why GPs coprescribe an anxiolytic when starting patients on antidepressant (AD) treatment, and which patient- and GP-related factors are associated with this coprescription. Methods: We used a survey of 131 GPs practising in southeastern France and of patients seen consecutively during June to October 2004 to whom they prescribed an AD. Data were collected from GPs (consultation-questionnaires focusing on their prescription, diagnosis, and symptom detection) and patients (self-administered questionnaires, including the Hospital Anxiety and Depression scale, and social and demographic characteristics). Factors associated with anxiolytic coprescription were analyzed with a multilevel logistic regression. Results: GPs completed 438 consultation-questionnaires for patients; 258 patients (58.9%) returned their questionnaires. Sixty percent of the patients received anxiolytics with ADs. Anxiolytics were prescribed more frequently by male GPs who reported feeling ill at ease treating MDD, or detected suicidal ideation or anxiety in their patients, and finally to patients with stable jobs. Conclusions: Although some practice guidelines and authors acknowledge that there might be some justification for zcoprescribing anxiolytics with ADs at the beginning of MDD treatment in specific situations, the high percentage of coprescriptions for anxiolytics observed in our study suggests that training and knowledge of GPs about MDD treatment are not optimal.
The Social Epidemiology of Affective and Anxiety Disorders in Later Life in Canada
Authors: Cairney John , Corna Laurie M , Veldhuizen Scott , Kurdyak Paul , Streiner David L 
Published: January 2017

Objective: To examine the association between markers of social position and psychiatric disorder among older adults, and test whether social support mediates the association between social position and psychiatric disorder in this population. Methods: We used data from the Canadian Community Health Survey: Mental Health and Well-Being to examine the social patterning of disorder. Using a series of logistic regression analyses, we regressed indicators of mood, anxiety, and any disorder on markers of social position and social support. Results: A negative association between age and disorder was evident across all models, and the likelihood of reporting disorder was elevated among separated–divorced and widowed respondents relative to their married counterparts. Social support was statistically significant in all models, and mediated a considerable amount of the effect of marital status on disorder. Conclusions: Many of the markers of social position associated with disorder among younger adults continue to be important predictors among older adults, and these variables are mediated to varying degrees by social support. The results support the general notion that social circumstances are important to psychological well-being. We discuss potential explanations for findings related to sex, age, marital status, and education as predictors of disorder in later life.
Three-Year Physician Treated Prevalence Rate of Mental Disorders in Alberta
Authors: Slomp Mel , Bland Roger , Patterson Sandy , Whittaker Lindsay 
Published: January 2017

Objective: To examine the rate at which adults seek services for mental disorders from different categories of physicians. Method: The study used billing data from all physicians during a 3-year period for the total adult population of the province of Alberta. Results: During the 3-year period, 35% of adults consulted a physician and were given a mental disorder diagnosis. The highest rates of consultation were for anxiety disorders (21%), followed by mood disorders (depression) (16%). Among patients, 84% were seen by primary care physicians only, and 3% were seen solely by psychiatrists. The more serious the diagnosing (for example, psychosis) the more likely patients were to be seen by psychiatrists. Conclusions: These results show that the 3-year prevalence rate includes more than one-third of the entire adult population. These figures differ considerably from those derived from population surveys in showing markedly higher prevalence (and treatment) rates. The number of people treated in primary care far exceeds those treated in the specialist sector.
Incidence of Diabetes in Patients with Schizophrenia: A Population-Based Study
Authors: Hsu Jer-Hwa , Chien I-Chia , Lin Ching-Heng , Chou Yiing-Jenq , Chou Pesus 
Published: January 2017

Objective: To detect the incidence of diabetes in patients with schizophrenia in Taiwan. Methods: The National Health Research Institute provided a database of 1 million random subjects for study, from which we drew a random sample of 617 068 subjects aged 18 years and older in the year 2000. Subjects who had at least one service claim during this year, with a primary diagnosis of schizophrenia, diabetes, or with a prescription for treatment of diabetes, were identified. We compared initial diagnosis of diabetes between patients with schizophrenia and the general population in 2000. We also followed a cohort of subjects with schizophrenia from 2000 to 2005. Results: The incidence of diabetes was higher in patients with schizophrenia than in the general population (1.46% and 1.12%, respectively; OR 1.47; 95% CI 1.09 to 1.97) in 2000. Compared with the general population, patients with schizophrenia showed a higher incidence of diabetes in the group aged 18 to 29 years; among females; among those with insurance of more than US$1281; among those living in the northern region; and among those residing in urban areas. The average annual incidence of diabetes in patients with schizophrenia was 1.84% from 2000 to 2005. Higher incidence of diabetes in patients with schizophrenia was associated with increased age, females, hypertension, and hyperlipidemia. Conclusions: Patients with schizophrenia had a higher incidence of diabetes for the youngest adult age group and for females than for the general population. Increased age, females, hypertension, and hyperlipidemia were risk factors of diabetes in patients with schizophrenia.
Sexual Orientation and its Relation to Mental Disorders and Suicide Attempts: Findings from a Nationally Representative Sample
Authors: Bolton Shay-Lee , Sareen Jitender 
Published: January 2017

Objective: To compare the rates of all Axis I and II mental disorders and suicide attempts in sexual orientation minorities with rates in heterosexuals using a nationally representative sample. Method: Data used were from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 ( n = 34 653, response rate = 70.2%). Cross-tabulations and multivariate logistic regression analyses were performed to determine differences in rates of mental disorders and suicide attempts by sexual orientation. All analyses were stratified by sex. Results: Compared with their heterosexual counterparts, lesbians and bisexual women demonstrated a 3-fold increased likelihood of substance use disorders, and gay and bisexual men showed twice the rate of anxiety disorders and schizophrenia and (or) psychotic illness, even after accounting for mental disorder comorbidity. Suicide attempts were independently associated with bisexuality, with odds 3 times higher than in heterosexuals. Conclusion: Findings from our study emphasize the fact that sexual orientation minorities are vulnerable to poor mental health outcomes, including suicide attempts. Clinicians need to be aware of these specific negative mental health consequences when assessing sexual orientation minorities.
Psychiatric Disorder in Detained Male Adolescents as Risk Factor for Serious Recidivism
Authors: Colins Olivier , Vermeiren Robert , Vahl Pauline , Markus Monica , Broekaert Eric , Doreleijers Theo 
Published: January 2017

Objective: A growing body of research consistently shows that detained minors bear substantial mental health needs. However, the relation between mental disorder and criminal recidivism has largely remained unexplored. Our study examines whether psychiatric disorders increase the likelihood of recidivism after controlling for time at risk, criminal history, and the presence of other disorders. Method: Participants ( n = 232) were detained male adolescents from all 3 youth detention centres in Flanders, Belgium, who were interviewed with the Diagnostic Interview Schedule for Children, Version IV. Two to 4 years later, information on serious recidivism was retrieved from the official judicial registration system. Serious recidivism was defined as having at least one arrest charge for violent, severe property crime, or substance-related offences. Results: Serious recidivism was high, with 81% ( n = 191) of the participants being rearrested. Psychiatric disorders predicted neither serious recidivism in general nor violent and severe property recidivism. However, other drug use disorder (OR 2.41; 95% CI 1.22 to 4.75) and general comorbidity (OR 2.64; 95% CI 1.40 to 4.99) were significantly predictive of substance-related recidivism. Conclusion: Common psychiatric disorders in detained male adolescents do not significantly increase the likelihood of subsequent arrests, with the exception that substance use disorders appear to increase the risk of later substance-related recidivism. Effective treatment of these disorders may prevent detained juveniles to experience the detrimental outcomes associated with substance-related crimes as adults (for example, mental illness).
Predicting Response to Day Treatment for Personality Disorder
Authors: Ogrodniczuk John S , Lynd Larry D , Joyce Anthony S , Grubisic Maja , Piper William E , Steinberg Paul I 
Published: January 2017

Objective: Efforts to improve the effectiveness of day treatment should attend to factors that influence treatment response. Our prospective study identified predictors of response to day treatment for personality disorder (PD). Method: Patients with a PD, consecutively admitted to a day treatment program, were assessed with self-report and interview measures. Predictors included personality characteristic, demographic, initial disturbance, and PD variables. Patients' overall response to treatment was classified as better, same, or worse, based on change in multiple outcome measures. A comprehensive approach to multivariate modelling was used. Results: The likelihood of being classified as better significantly increased if the patient was more psychologically minded, used avoidance-oriented coping strategies, and had a high level of baseline symptom severity. Probability of being classified as better decreased if the patient had a substance use disorder and a history of high service use. Conclusions: Identifying factors that affect response to day treatment can help clinicians make better selection decisions or take measures to modify treatment.