bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Index Manic Episode in Juvenile-Onset Bipolar Disorder: The Pattern of Recovery
Authors: Rajeev J , Srinath Shoba , Reddy YCJ , Shashikiran MG , Girimaji Satish Chandra , Seshadri Shekhar P , Subbakrishna DK 
Published: July 2017

Objective: Recent studies of patients with juvenile bipolar disorder report low rates of recovery and high rates of chronicity. However, we lack data on the short-term outcome. This study examines the pattern of recovery from the index episode in an aggressively treated juvenile sample. Method: We assessed 25 subjects (< 16 years) with a diagnosis of mania, using the Diagnostic Interview for Children and Adolescents-Revised) (DICA-R), Young Mania Rating Scale (YMRS), and Children's Global Assessment Scale (CGAS) at intake and at 3 and 6 months. We studied the time taken to recover from the index episode, the level of functioning, and the factors predicting them. Results: After 6 months, 24 (96%) subjects had recovered from the index manic episode. The median time to recovery was 27 days. Total episode length was significantly longer among those with previous affective episodes. Conclusions: The findings suggest that juvenile-onset mania has high rates of recovery and low rates of chronicity. These differences from the existing literature need further exploration.
A Pilot Study of a Parent-Education Group for Families Affected by Depression
Authors: Sanford Mark , Byrne Carolyn , Williams Susan , Atley Sandy , Ridley Ted , Miller Jennifer , Allin Heather 
Published: July 2017

Objective: This study assessed the feasibility and efficacy of a parent-education group for families with young children and a parent with depression. We designed the program to be readily disseminated if shown to be effective. Method: We recruited 44 parents with depression from clinics and family doctors in Hamilton, Ontario, and randomly assigned them to receive the parenting program or to a wait-list control group. The outcomes measured included knowledge of depression, parenting, family relationships, depression symptoms, child depressive symptoms, and functioning. We used analysis of covariance to test for posttreatment differences between experimental and control groups. Results: Of the treatment group, 27% dropped out at posttreatment, and 43% by follow-up. Those who dropped out had more severe depression at baseline than did those who completed the program, and there was selective loss of parents with more severe depression in the experimental group. In intention-to-treat analyses at posttreatment, probands in the experimental group reported more improvements on family functioning, parenting sense of competence, and family and parent conflict than did control subjects. Standardized effect sizes (ES) were medium (0.4 to 0.6). When baseline depressive symptom scores were controlled in the analyses, the between-group differences were reduced, showing that selective loss of participants may have influenced the findings. Conclusions: On balance, the results are encouraging and support the further development and evaluation of the group intervention. However, the study does not provide unequivocal evidence in support of the program. Before it is transferred to other settings, the program needs further modification to improve participation by parents with more severe depression and further evaluation of its effectiveness.
Cultural Consultation: A Model of Mental Health Service for Multicultural Societies
Authors: Kirmayer Laurence J , Groleau Danielle , Guzder Jaswant , Blake Caminee , Jarvis Eric 
Published: July 2017

Objectives: This paper reports results from the evaluation of a cultural consultation service (CCS) for mental health practitioners and primary care clinicians. The service was designed to improve the delivery of mental health services in mainstream settings for a culturally diverse urban population including immigrants, refugees, and ethnocultural minority groups. Cultural consultations were based on an expanded version of the DSM-IV cultural formulation and made use of cultural consultants and culture brokers. Methods: We documented the service development process through participant observation. We systematically evaluated the first 100 cases referred to the service to establish the reasons for consultation, the types of cultural formulations and recommendations, and the consultation outcome in terms of the referring clinician's satisfaction and recommendation concordance. Results: Cases seen by the CCS clearly demonstrated the impact of cultural misunderstandings: incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment, and failed treatment alliances. Clinicians referring patients to the service reported high rates of satisfaction with the consultations, but many indicated a need for long-term follow-up. Conclusion: The cultural consultation model effectively supplements existing services to improve diagnostic assessment and treatment for a culturally diverse urban population. Clinicians need training in working with interpreters and culture brokers.
A Random-Assignment, Double-Blind, Clinical Trial of Once- vs Twice-Daily Administration of Quetiapine Fumarate in Patients with Schizophrenia or Schizoaffective Disorder: A Pilot Study
Authors: Chengappa KN Roy , Parepally Haranath , Brar Jaspreet S , Mullen Jamie , Shilling Ann , Goldstein Jeffrey M 
Published: July 2017

Objective: To evaluate the efficacy and safety of administering quetiapine once vs twice daily. Method: Utilizing a double-blind design, 21 hospitalized adult men or women with DSM-IV schizophrenia or schizoaffective disorder, who had received unchanged doses (for 2 weeks) of either 400 or 600 mg daily of quetiapine administered in 2 doses, were randomly assigned to once- or twice-daily administration for 4 weeks and then crossed over to the opposite dosing regimen for an additional 4 weeks. Standard psychopathology and safety measures were used in the study. Results: Nearly 70% (15/21) of the subjects met the a priori efficacy responder criteria with no statistical differences in response between those assigned to once- or twice-daily quetiapine administration. Statistical analyses confirmed that most subjects maintained efficacy during the switch to once- or twice-daily administration with quetiapine. A minority (15%) did experience worsening of symptoms or orthostatic hypotension during the crossover. Quetiapine was generally well tolerated at either twice- or once-daily administration. Conclusions: These pilot data suggest that it is clinically feasible to switch most quetiapine-treated subjects receiving a therapeutic twice-daily dosing schedule to a once-daily regimen. A minority may experience worsening of symptoms or orthostatic hypotension during the switch. This strategy of administering quetiapine entirely at bedtime may promote improved adherence to treatment.
Effect of Depression on Stroke Morbidity and Mortality
Authors: Ramasubbu Rajamannar , Patten Scott B 
Published: July 2017

Objectives: This narrative review examines the evidence and discusses the clinical relevance of depression as a risk factor for stroke morbidity and mortality. It also proposes recommendations for future research. Methods: We used the Medline computer database to search the relevant original studies published in English from January 1966 to December 2001. Our key words were as follows: depressive disorder, cerebrovascular disease, stroke, vascular risk factors, and mortality. Articles that investigated the relation between antecedent depression and subsequent stroke morbidity and mortality were collected and reviewed. Results: Since 1990, 8 prospective studies have been published. Among these 8 studies, 6 addressed depression and stroke morbidity, 1 investigated the association of depression with stroke morbidity and stroke mortality, and 1 investigated the association with stroke mortality only. Of 7 studies examining the independent effect of depression on stroke morbidity, 6 were positive. With regard to stroke mortality, 2 studies found an independent association between depression and specific stroke mortality. The contributions and methodological limitations of these studies are discussed. Conclusions: Emerging data suggest an association between depressive symptoms and increased risk for stroke morbidity and mortality. More methodologically sound studies are needed to elucidate causal pathways that link depression and cerebrovascular disease. They are also needed to determine the effect of depression intervention on reducing the risk of cerebrovascular events.
Switch to Mania upon Discontinuation of Antidepressants in Patients with Mood Disorders: A Review of the Literature
Authors: Ali Sherese , Milev Roumen 
Published: July 2017

Objective: To review the literature for reported cases of mania related to discontinuing antidepressant treatment, as well as for possible explanations of this phenomenon, and to present a case report. Method: We undertook a literature review through the PubMed index, using the key words mania, antidepressant withdrawal, and antidepressants in bipolar disorder. We reviewed 11 articles featuring 23 cases. Where available, we noted and tabulated certain parameters for both bipolar disorder (BD) and unipolar depression. We use a case example to illustrate the phenomenon of mania induced by antidepressant withdrawal. Results: For patients with unipolar depression, we found 17 reported cases of mania induced by antidepressant withdrawal. Antidepressants implicated included tricyclic antidepressants (TCAs) (12/17), monoamine oxidase inhibitors (MAOIs) (2/17), trazodone (1/17), mirtazapine (1/17), and paroxetine (1/17). For patients with BD, we found 19 reported cases of mania induced by antidepressant withdrawal, including our own case example. Of these, selective serotonin reuptake inhibitors (SSRIs) (10/19), TCAs (4/19), MAOIs (2/19), and serotonin norepinephrine reuptake inhibiors (SNRIs) (2/19) were implicated. Conclusion: Our case report supports the observation of antidepressant withdrawal–induced mania in patients with BD. It is distinguishable from antidepressant-induced mania, physiological drug withdrawal, and mania as a natural course of the illness. Many theories have been put forward to explain this occurrence. Noradrenergic hyperactivity and “withdrawal-induced cholinergic overdrive and the cholinergic-monoaminergic system” are the 2 most investigated and supported models. The former is limited by poor clinical correlation and the latter by its applicability only to anticholinergic drugs.
Acute Neuroendocrine Response to Sexual Stimulation in Sexual Offenders
Authors: Haake Philip , Schedlowski Manfred , Exton Michael S , Giepen Christoph , Hartmann Uwe , Osterheider Michael , Flesch Martin , Janssen Onno E , Leygraf Norbert , Krüger Tillmann HC 
Published: July 2017

Background: Several pharmacotherapeutic approaches have confirmed the influence of neuroendocrine parameters on sexual desire, function, and fantasies in men; however, the relevance of acute neuroendocrine changes in mediating heightened sexual drive remains unknown. We recently demonstrated that plasma prolactin substantially increases following orgasm in healthy men, suggesting a feedback mechanism for peripheral prolactin in the control of acute sexual arousal. Because prolactin appears to play a regulatory role in acute sexual drive, we initiated this study to see whether sexual offenders with a high sexual drive have a different neuroendocrine response to sexual arousal. This study compares the prolactin response to orgasm of sexual offenders with high sexual drive and that of healthy subjects with average sexual drive. Methods: From a subject pool of 150 inpatients held because of sexual crimes, we recruited 10 volunteers, based on their high sexual drive according to an intensive, semistructured clinical interview. We defined sexual drive by a short refractory period and strong sexualization, or a high frequency of sexual stimulation. We analyzed the acute psychoneuroendocrine response to sexual arousal and orgasm continuously before, during, and after masturbation-induced orgasm in patients and control subjects. Results: Sexual offenders demonstrated higher sexual desire ( P < 0.001) and function ( P < 0.001) and a more positively perceived refractory period ( P < 0.05). Both groups displayed a prolonged, significant increase in prolactin plasma levels after orgasm ( P < 0.001). Sexual offenders did not differ from control subjects in neuroendocrine response to sexual arousal and orgasm. Conclusions: These data demonstrate that sexual offenders with a high sexual drive do not differ from control subjects in the postorgasmic neuroendocrine response, particularly in prolactin release. This study confirms that factors other than peripheral hormones influence deviant sexual behaviour.
Influence of Season and Latitude in a Community Sample of Subjects with Bipolar Disorder
Authors: Schaffer Ayal , Levitt Anthony J , Boyle Michael 
Published: July 2017

Objective: To report on the prevalence of seasonal bipolar disorder (BD) and the impact of latitude in a community sample in the province of Ontario. Method: This study used the telephone-administered Depression and Seasonality Interview. Exact latitude was determined for each participant. Results: Overall, 14 of 62 (22.6%) subjects with BD had the seasonal subtype of BD. Latitude did not appear to influence the proportion of subjects with the seasonal subtype. Conclusions: We identified a seasonal pattern of illness in a proportion of subjects with BD.
Assessing Suicidal Youth with Antisocial, Borderline, or Narcissistic Personality Disorder
Authors: Links Paul S , Gould Brent , Ratnayake Ruwan 
Published: July 2017

Objective: This paper has 3 objectives. First, we review the epidemiologic evidence for the association between suicidal behaviour and suicide in individuals diagnosed with antisocial, borderline, or narcissistic personality disorder. Second, we examine whether any potentially modifiable risk factors are associated with these diagnoses, based on existing empirical evidence. Last, we discuss clinical approaches to assessing youth with antisocial, borderline, or narcissistic personality disorder presenting at risk for suicide. Method: We reviewed the English-language literature for the last 12 years (from January 1, 1991, to December 31, 2002), using as search terms the names of the 3 disorders, as well as the key words suicide, suicidal behaviour, youth, and adolescents. Results: Patients with antisocial or borderline personality disorder are likely to be at increased risk for suicidal behaviour when they demonstrate such comorbid disorders as major depressive episodes or substance abuse disorders, when they experience recent negative life events, or when they have a history of childhood sexual abuse. Conclusions: For patients with antisocial personality disorder, the risk of violence has to be judged in addition to the risk of suicide or self-harm. For patients with borderline personality disorder, interventions are determined by differentiating acute-on-chronic from chronic risk of suicidal behaviour. Finally, patients with narcissistic personality disorder can be at high risk for suicide during periods when they are not suffering from clinical depression. These episodes can seem to be unpredictable.
Sexsomnia—A New Parasomnia?
Authors: Shapiro Colin M , Trajanovic Nikola N , Fedoroff J Paul 
Published: July 2017

Objective: To describe a distinct parasomnia involving sexual behaviour, which we have named sexsomnia. Method: We have used a case series as a basis for the description of sexsomina. Results: Eleven patients with distinct behaviours of the sexual nature during sleep are described. The features in common with other nonrapid eye movement arousal parasomnias, such as sleepwalking are documented. Some patients had simply been referred to a tertiary sleep clinic for investigation of unrelated sleep problems. A small number had been involved in medicolegal issues. Sexsomnia has some distinct features that separate it from sleepwalking. The automatic arousal is more prominent, motor activities are relatively restricted and specific, and some form of dream mentation is often present. Conclusions: A significant number of patients with this unusual parasomnic behaviour were identified only after specific questions were asked, suggesting that the behaviour is more common than previously thought.
Suicide Attempts in Turkey: Results of the WHO—EURO Multicentre Study on Suicidal Behaviour
Authors: Devrimci-Ozguven Halise , Sayıl Isık 
Published: July 2017

Objective: To investigate the rate and method of attempted suicides in a catchment area in Turkey as part of the WHO–EURO Multicentre Study on Suicidal Behaviour. Method: All hospitals in the catchment area were screened to identify suicide attempts for 4 years between January 1, 1998, and December 31, 2001. Results: In the 4-year period, 737 individuals attempted suicide (514 women and 223 men). The mean annual rate per 100 000 was 46.89 for men and 112.89 for women. The parasuicide rate increased by 93.59% between 1998 and 2001. The most frequent method used by both men and women was self-poisoning. Conclusion: Compared with the results from other European research centres, attempted suicide rates in Turkey were relatively low. However, the increase in rates was striking. This upward trend may be related to the intense economic difficulties, increasing unemployment, and rapid social change experienced in Turkey in recent years. The risk groups appeared to be younger and female. Information on author affiliations appears at the end of the article.
Adverse Effects Associated with Physical Restraint
Authors: Mohr Wanda K , Petti Theodore A , Mohr Brian D 
Published: July 2017

Objective: Restraint use is not monitored in the US, and only institutions that choose to do so collect statistics. In 1999, investigative journalists reported lethal consequences proximal to restraint use, making it a life-and-death matter that demands attention from professionals. This paper reviews the literature concerning actual and potential causes of deaths proximal to the use of physical restraint. Method: Searching the electronic databases Medline, Cinahl, and PsycINFO, we reviewed the areas of forensics and pathology, nursing, cardiology, immunology, psychology, neurosciences, psychiatry, emergency medicine, and sports medicine Conclusions: Research is needed to provide clinicians with data on the risk factors and adverse effects associated with restraint use, as well as data on procedures that will lead to reduced use. Research is needed to determine what individual risk factors and combinations thereof contribute to injury and death.
Insight and Neuropsychological Function in Patients with Schizophrenia and Bipolar Disorder with Psychotic Features
Authors: Arduini Luca , Kalyvoka Artemis , Stratta Paolo , Rinaldi Osvaldo , Daneluzzo Enrico , Rossi Alessandro 
Published: July 2017

Objectives: This study investigates the pattern of association between patient unawareness of illness and neuropsychological tests of frontal lobe function in subjects with schizophrenia and bipolar disorder (BD) with psychotic features. Method: We administered the Wisconsin Card Sort Test (WCST) and a shortened version of the Scale to Assess Unawareness of Mental Disorder (SUMD) to a sample of 64 patients with psychosis (42 with schizophrenia and 22 with BD). Results: None of the correlations between WCST scores and insight scores were statistically significant, either in the total group or in each group analyzed separately. Further, no differences were seen in insight scores between sexes and between the diagnostic groups. Conclusions: The 3 insight dimensions (that is, awareness of mental disorder, awareness of social consequences of mental disorder, and awareness of the benefits of medication) do not appear to be associated with frontal impairment, as measured by the WCST.
Diabetes Mellitus and Impaired Glucose Tolerance in Patients with Schizophrenia
Authors: Subramaniam Mythily , Chong Siow-Ann , Pek Elaine 
Published: July 2017

Objectives: This study aimed to establish the prevalence of diabetes mellitus (DM) and impaired glucose tolerance in patients with schizophrenia and to elucidate some of the factors associated with hyperglycemia. Methods: We studied a sample of 194 patients with schizophrenia. We determined fasting blood glucose and insulin levels at the start of the testing period; patients were given an oral glucose tolerance test after an overnight fast. Results: The overall prevalence of diabetes and impaired glucose tolerance in these patients was 16.0% and 30.9%, respectively. These rates were higher than those reported in the general population. Patients with disordered glucose homeostasis were significantly older ( P = 0.005, Kruskal–Wallis test). There was no significant effect of sex or ethnicity on diabetes. Conclusions: Our findings suggest that patients with schizophrenia are more vulnerable to developing DM. We caution clinicians to be mindful of the increased risk and to be vigilant for such a development.
Schizophrenia: The Quest for a Minimum Sense of Identity to Ward off Delusional Disorder
Authors: Noël-Jorand Marie-Christine , Reinert Max , Giudicelli Sébastien , Dassa Daniel 
Published: July 2017

Objective: This study was designed to analyze the language of patients with schizophrenia exhibiting negative symptoms during a 3-month period. Method: The computer-assisted ALCESTE method was used to simultaneously analyze the subjects' oral behaviour and speech patterns at various levels. Results: The tested subjects had very specific speech patterns. Most significantly, analysis of the underlying syntactic processes showed that the patients exhibited a sense of identity, however minimum, based on their own pathologies and on the surrounding world. In our previous study, no such characteristics were observed in the discourse of schizophrenia patients with delusions (exhibiting positive symptoms). This suggests that the minimum sense of identity that develops in patients with schizophrenia allows them to avoid positive symptoms. Conclusion: In studies of language production by subjects suffering from schizophrenia, it is necessary to distinguish between patients with positive symptoms and those with negative symptoms. The speech patterns of these 2 groups have to be analyzed separately, which has not been done previously, since the groups differ in too many respects.
Defining Best Practices for Specialty Geriatric Mental Health Outreach Services: Lessons for Implementing Mental Health Reform
Authors: Sullivan Mary Pat , Kessler Linda , Le Clair J Kenneth , Stolee Paul , Berta Whitney 
Published: July 2017

Objective: This paper reviews fundamental areas that inform best practices for outreach services as they relate to shared care, education, and program and systems development and illustrates a framework for defining best practices. Method: We examined literature that addresses the needs and characteristics of older persons with mental illness, studies that investigate geriatric mental health outreach services, and relevant theoretical developments. In addition, we synthesized some of the health services field research that we conducted. Results: This analysis provided a foundation for understanding the processes required to identify and implement best practices in specialty geriatric mental health outreach. Constructive insights for a comprehensive approach to the development, implementation, and evaluation of these services emerged. Conclusions: The needs of an aging population, the articulation of principal functions for specialty services within mental health reform, and the realities of individual communities converged to establish direction for service provision. The use of best practices across a range of health and social services, combined with an effective process that facilitates the exchange of knowledge between sectors, establishes an important mechanism by which shared care, education, and program and systems development can be achieved.