bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Department Assessment of Self-Harm Risk Using Psychometric Questionnaires
Authors: Randall Jason R , Rowe Brian H , Colman Ian 
Published: January 2017

Objective: To examine several potential predictive screening tools for emergency department assessment of risk of self-harm. Methods: Adult patients presenting with self-harm or suicidal ideation were enrolled at 2 emergency departments at large teaching hospitals in Edmonton, Alberta. Patients completed a brief interview assessing demographics and psychiatric history and several questionnaires (the Beck Hopelessness Scale, the Barrett Impulsiveness Scale [BIS], and the Brief Symptom Inventory [BSI]) and drug and alcohol abuse screens (Drug Abuse Screening Test [DAST-10] and the Cut down, Annoyed, Guilt, Eye-opener [commonly referred to as CAGE] Questionnaire). At 3 months, patients were followed up via telephone and electronic health records to ascertain self-harm outcome. Questionnaires and their subscales were assessed using logistic regression. Receiver operating characteristic (ROC) analysis was performed on the results. Results: Among the 157 patients enrolled, 49% were women and 36% (of the total) were aged 18 to 29 years. Several of the subscales of the BSI and BIS as well as the DAST-10 were significant predictors of self-harm ( P < 0.05). ROC analysis showed that none of the scales in isolation were very strong predictors. Hierarchical regression analysis that combined the significant scales with clinical risk factors that were significantly related to self-harm (that is, age, education level, history of self-harm, and whether they presented with self-harm or only suicidal ideation) indicated that the BIS and DAST-10 questionnaires each added significantly to the predictive ability of a model with these risk factors. Conclusions: While many of the questionnaires and their related constructs are related to future self-harm, none of them are particularly strong and their diagnostic usefulness is limited.
Wait Time Impact of Co-Located Primary Care Mental Health Services: The Effect of Adding Collaborative Care in Northern Ontario
Authors: Haggarty John M , Jarva Janelle A , Cernovsky Zack , Karioja Kim , Martin Lynn 
Published: January 2017

Objectives: In the shared care model, psychiatrists and physicians work in the same office areas, write their notes in the same casebooks, and can more rapidly exchange information about referrals and health conditions of their patients. We evaluated the impact of the introduction of a shared mental health care service, co-located with a primary care site, on wait times for mental health services in a northern Ontario city. Method: Chart reviews were conducted to examine a total of 3589 referrals for 5 mental health outpatient services (1 shared care and 4 existing services) from January 2001 to the end of June 2004. The shared mental health care service site was started in July 2001. Wait time was measured 6 months prior to and up to 3 years after the introduction of the shared care service. Results: The shared care site offered services more than 40 days sooner and also helped to reduce wait time on the nonshared care sites. After shared care began, the pre-existing, nonshared care services had wait times of about 13 days shorter during the 3 subsequent years. Conclusions: The shared care service maintained the lowest overall wait times, compared with the existing nonshared care services. The existing services experienced a decrease in the number of days waiting when the baseline wait time was compared with that of the following year.
Waist Circumference is a Sensitive Screening Tool for Assessment of Metabolic Syndrome Risk in Children Treated with Second-Generation Antipsychotics
Authors: Panagiotopoulos Constadina , Ronsley Rebecca , Kuzeljevic Boris , Davidson Jana 
Published: January 2017

Objective: To compare the prevalence of metabolic syndrome (MetS) and its components in second-generation antipsychotic (SGA)-treated and SGA-naive children; and to explore the utility of clinical markers, such as waist circumference (WC) and body mass index (BMI), as screening tools for MetS. Methods: Subjects were prospectively recruited from the Psychiatry Emergency Unit at British Columbia Children's Hospital. As part of a quality-assurance project, a metabolic monitoring protocol was implemented, including collection of anthropomorphic and laboratory data. Results: From January 2008 to February 2010, there were 117 SGA-treated and 217 SGA-naive children recruited. The overall prevalence of MetS was 19.0% (16/84; median treatment duration = 14 months) in SGA-treated and 0.8% (1/127) in SGA-naive children (OR 29.7; 95% CI 3.85 to 228.40, P < 0.001), with an increased prevalence of all components except high-density lipoprotein cholesterol (HDL-C), respectively: elevated WC (40.7% and 10.1%; P < 0.001); hypertriglyceridemia (33.7% and 18.8%; P = 0.01); impaired fasting glucose (12.5% and 0.7%; P = 0.005); and elevated blood pressure (41.2% and 16.5%; P < 0.001). SGA treatment was the strongest predictor of MetS (OR 19.2; 95% CI 2.30 to 160.44, P = 0.006) followed by male sex (OR 5.7; 95% CI 1.08 to 30.62, P = 0.04). Presence of abdominal obesity was more sensitive (92.9%) than BMI (68.8%), while fasting glucose of 5.6 mmol/L or more and HDL-C of 1.03mmol/L or less were most specific (94.1%) in correctly identifying MetS. Conclusions: SGA treatment confers a significantly increased risk for MetS over the long term. WC measurement is a simple and sensitive screening tool for determining MetS risk in SGA-treated children. These data highlight the dangers of SGA treatment and the importance of standardized metabolic monitoring using sex- and age-adjusted tables in this population.
Parental Sexual Abuse and Suicidal Behaviour among Women with Major Depressive Disorder
Authors: Cankaya Banu , Talbot Nancy L , Ward Erin A , Duberstein Paul R 
Published: January 2017

Objective: Women with major depressive disorder (MDD) and childhood sexual abuse histories have an increased risk for suicidal behaviours, but it is unclear whether specific abuse characteristics contribute to risk. We aimed to examine the contributions of abuse characteristics to lifetime history of suicide attempts and multiple suicide attempts, independent of posttraumatic stress disorder and borderline personality disorder. Method: Women with MDD and sexual abuse histories ( n = 106) were assessed regarding sexual abuse characteristics, psychiatric diagnoses, and suicide attempts. Results: In multivariate logistic regressions, the odds of having multiple suicide attempts increased 12.27-fold when childhood sexual abuse was perpetrated by a parent figure or a parent, compared with a nonparent. Conclusions: Parental perpetration of sexual abuse increases the likelihood of multiple suicide attempts among women outpatients. The relationship of the perpetrator to the abused woman is important in suicide risk evaluation and treatment planning. Clinical Trial Registration Number: NCT00843700
The Adequacy of Pharmaceutical Treatment of Schizophrenia in Quebec Varies with Age, but is Not Influenced by Sex or Neighbourhood Deprivation
Authors: Brouwers Frederieke M , Courteau Josiane , Grégoire Jean-Pierre , Moisan Jocelyne , Lauzier Sophie , Lesage Alain , Fleury Marie-Josée , Vanasse Alain 
Published: January 2017

Objective: Though high discontinuation rates for antipsychotics (APs) by patients with schizophrenia are frequently reported, the percentage of patients receiving pharmaceutical treatment for schizophrenia in routine practice in accordance with international clinical guidelines is unknown. Further, it is unknown if these rates are influenced by levels of neighbourhood deprivation or by a patient's age or sex. Our study aims to investigate if inequalities in AP treatment could be observed between patients living in neighbourhoods with the highest levels of material and social deprivation and those with the lowest deprivation levels, between patients from different age groups, or between men and women. Methods: We conducted a secondary analysis of medical-administrative data of a cohort of adult patients in the province of Quebec with a medical contact for schizophrenia in a 2-year period (2004–2005). We assessed the proportion of patients that filled at least 1 prescription for an AP and received adequate pharmaceutical treatment, defined as being in possession of APs at least 80% of the time as outpatients during a 2-year follow-up period. Results: Among the 30 544 study patients, 88.5% filled at least 1 prescription for an AP, and 67.5% of the treated patients received adequate treatment. Though no clinically significant differences were observed by deprivation or sex, younger age was associated with lower proportions of patients receiving adequate treatment (46% of treated patients aged between 18 and 29 years, compared with 72% aged between 30 and 64 years, and 77% aged 65 years and over). Conclusions: In Quebec's routine practice, over 70% of treated patients aged 30 and over received adequate pharmacological treatment, regardless of sex or neighbourhood socioeconomic status. In contrast, in patients aged between 18 and 29 years this percentage was 47%. This is a discouraging finding, especially because optimal treatment in the early phase of disease is reported to result in the best long-term outcomes.
Within-Hospital Readmission: An Indicator of Readmission after Discharge from Psychiatric Hospitalization
Authors: Vigod Simone N , Taylor Valerie H , Fung Kinwah , Kurdyak Paul A 
Published: January 2017

Objective: Readmission after psychiatric hospitalization is widely used as a quality of care indicator by government funding agencies, policy-makers, and hospitals deciding on clinical priorities. Readmission rates are calculated accurately to allow these varied groups to correctly translate the knowledge into appropriate, tangible outcomes. We aimed to assess how well hospital readmission rates, calculated using only readmissions to the discharging institution, can approximate actual readmission rates. Method: We used administrative data sources to identify patients with a mental health discharge in the province of Ontario (2008–2011). We identified mental health readmissions within 30 and 90 days of discharge occurring to the hospital from which the patient was discharged (within-hospital readmissions), and compared readmission rates using only within-hospital admissions with actual readmission rates. Results: The percentage of readmissions occurring to the discharging institution ranged from 39% to 89% (median 73%) and from 37% to 86% (median 70%) for 30- and 90-day readmissions, respectively. Using only within-hospital readmissions to rank hospitals by their readmission rates, only 56% of hospitals for 30-day readmissions and 50% for 90-day readmissions were ranked in the same quartile as when actual readmission rates were used. Conclusions: These findings highlight the importance of measuring psychiatric readmissions at the system level, particularly for hospitals with lower discharge volumes. As well, the high likelihood that multiple hospitals are involved in the hospital-based care of people who require readmission requires consideration at clinical and policy levels.
Repetitive Transcranial Magnetic Stimulation over the Dorsolateral Prefrontal Cortex for Treating Posttraumatic Stress Disorder: An Exploratory Meta-Analysis of Randomized, Double-Blind and Sham-Controlled Trials
Authors: Berlim Marcelo T , Van den Eynde Frederique 
Published: January 2017

Objective: Repetitive transcranial magnetic stimulation (rTMS) applied to the dorsolateral prefrontal cortex (DLPFC) has yielded promising results as a treatment for posttraumatic stress disorder (PTSD). However, to date, no quantitative review of its clinical utility has been published. Method: We searched for randomized and sham-controlled trials from 1995 to March 2013 using MEDLINE, Embase, PsycINFO, CENTRAL, and SCOPUS. We then performed an exploratory random effects meta-analysis. Results: Studies on rTMS applied to the right DLPFC included 64 adults with PTSD. The pooled Hedges g effect size for pre and post changes in clinician-rated and self-reported PTSD symptoms were, respectively, 1.65 ( P < 0.001) and 1.91 ( P < 0.001), indicating significant and large-sized differences in outcome favouring active rTMS. Also, there were significant pre and post decreases with active rTMS in overall anxiety (Hedges g = 1.24; P = 0.02) and depressive (Hedges g = 0.85; P < 0.001) symptoms. Dropout rates at study end did not differ between active and sham rTMS groups. Regarding rTMS applied to the left DLPFC, there is only one study published to date (using a high frequency protocol), and its results showed that active rTMS seems to be superior overall to sham rTMS. Conclusions: Our exploratory meta-analysis shows that active rTMS applied to the DLPFC seems to be effective and acceptable for treating PTSD. However, the small number of subjects included in the analyses limits the generalizability of these findings. Future studies should include larger samples and deliver optimized stimulation parameters.
Descriptive Epidemiology of Major Depressive Disorder in Canada in 2012
Authors: Patten Scott B , Williams Jeanne V A , Lavorato Dina H , Wang Jian Li , McDonald Keltie , Bulloch Andrew G M 
Published: January 2017

Objective: The epidemiology of major depressive disorder (MDD) was first described in the Canadian national population in 2002. Updated information is now available from a 2012 survey: the Canadian Community Health Study—Mental Health (CCHS-MH). Method: The CCHS-MH employed an adaptation of the World Health Organization World Mental Health Composite International Diagnostic Interview and had a sample of n = 25 113. Demographic variables, treatment, comorbidities, suicidal ideation, and perceived stigma were assessed. The analysis estimated adjusted and unadjusted frequencies and prevalence ratios. All estimates incorporated analysis methods to account for complex survey design effects. Results: The past-year prevalence of MDD was 3.9% (95% CI 3.5% to 4.2%). Prevalence was higher in women and in younger age groups. Among respondents with past-year MDD, 63.1% had sought treatment and 33.1% were taking an antidepressant (AD); 4.8% had past-year alcohol abuse and 4.5% had alcohol dependence. Among respondents with past-year MDD, the prevalence of cannabis abuse was 2.5% and that of dependence was 2.9%. For drugs other than cannabis, the prevalence of abuse was 2.3% and dependence was 2.9%. Generalized anxiety disorder was present in 24.9%. Suicide attempts were reported by 6.6% of respondents with past-year MDD. Among respondents accessing treatment, 37.5% perceived that others held negative opinions about them or treated them unfairly because of their disorder. Conclusions: MDD is a common, burdensome, and stigmatized condition in Canada. Seeking help from professionals was reported at a higher frequency than in prior Canadian studies, but there has been no increase in AD use among Canadians with MDD.
The Heterogeneity of Memory Dysfunction in Schizophrenia
Authors: Stip Emmanuel , Lussier Isabelle 
Published: January 2017

Objective: To characterize the memory dysfunction of schizophrenic patients. Method: The components of the human memory system are described, and then a review of the various memory deficits identified among patients suffering from schizophrenia is presented. Finally, an overview of the latest developments in the comprehension of schizophrenia and a discussion on certain proposals advanced by various researchers in the field intended to shed light on the disorder is provided. Results: Schizophrenia appears to be an amalgamation of many different disorders. No single model for identifying the disorder has been able to encompass every aspect of schizophrenia. Conclusion: Future studies will need to consider new ways of selecting and grouping schizophrenic patients.
A Critical Review of Marital Therapy Outcome Research
Authors: Wesley Stephen , Waring Edward M 
Published: January 2017

Objective: This review critically examines conceptual and methodological issues of outcome research designed to evaluate the efficacy of marital therapy (MT). Behavioural marital therapy (BMT), cognitively orientated marital therapy (COMT), emotionally focused marital therapy (EFMT), and insight-oriented marital therapy (IOMT) have provided evidence for efficacy. Method: The initial literature search involved the use of the MEDLINE and Psychlit CD-ROM data bases. A secondary literature search based on citations in articles discovered in the initial search was also conducted. Three broad categories involving the delineation of the client sample, study design considerations, and determination of treatment effects were addressed to investigate the quality of evidence concerning the efficacy of MT. Results: None of the 4 approaches has proven superiority in efficacy, and the research does not provide evidence for the superiority of any one approach in distinct types of marital discord. There is some evidence to indicate that future outcome research should avoid the use of “waiting list control groups,” since their use appears to be neither ethical nor humane in marital discord research. Conclusions: The authors suggest that the concept of treatment efficiency may be more clinically relevant to outcome research. A gold standard for “efficiency” would suggest that a marital therapy approach should produce subjective and objective improvement in 50% of eligible couples, and this improvement should be maintained in half of these couples at the one-year follow-up assessment. This standard would be comparable to the data on the 4 effective approaches described in this review.
An Examination of the Relationship of Homelessness to Mental Disorder, Criminal Behaviour, and Health Care in a Pretrial Jail Population
Authors: Zapf Patricia A , Roesch Ronald , Hart Stephen D 
Published: January 2017

Objective: To examine the prevalence of homelessness and its relationship to mental disorder, criminal behaviour, and health care. Method: Interview and file data were collected for 790 male admissions to a large, pretrial jail facility over a 12-month period. Results: A significant relationship was found between homelessness and severe mental disorder as well as between homelessness and prior psychiatric history. There were no significant differences found between the homeless and the nonhomeless on the types of crimes for which they were incarcerated or on contact with health care services within the past year. Conclusion: The findings indicate the need for a link between the jail and community services for homeless individuals.
Psychiatric Manifestations of Multiple Sclerosis: A Review
Authors: Rodgers Jennifer , Bland Roger 
Published: January 2017

Objective: To report the occurrence, type, causes, and management of psychiatric manifestations in multiple sclerosis (MS). Method: Review of recent, relevant literature. Results: Psychiatric illness, especially depression, occurs much more frequently than expected inpatients with MS, is frequently unrecognized or ignored, and is treatable using standard methods, although patients with MS may be unusually sensitive to side effects of tricyclic antidepressants. Conclusions: Research is needed to better define the causes of psychiatric syndromes inpatients with MS. Those treating MS should increase their awareness of and sensitivity to the likelihood of psychiatric disorder in these patients.
Neonatal Insult to the Hippocampal Region and Schizophrenia: A Review and a Putative Animal Model
Authors: Beauregard Mario , Bachevalier Jocelyne 
Published: January 2017

Objective: To review the mounting evidence implicating early hippocampal dysfunction in the pathogenesis and the pathophysiology of schizophrenia. An account is made of recent neurodevelopmental hypotheses indicating how an early dysfunction of the hippocampal region disrupts maturational events in brain systems connected to that structure, thus inducing dysfunctional connectional development. Finally, an animal model is presented. Method: Socioemotional behaviour of monkeys (Macaca mulatta) with selective neonatal hippocampal lesions was assessed by analyzing their interactions with their age-matched controls at 2 months, 6 months, and 5 to 8 years of age and by comparing the social interactions at each age with those of normal controls paired together. Results: At 2 months of age, monkeys with neonatal hippocampal lesions presented minor disturbances in initiation of social interactions. These subtle changes of behaviour were less evident at 6 months, although by that age, the operated monkeys displayed more withdrawals in response to an increase in aggressive responses from their unoperated peers. In adulthood, the amount of time spent by the hippocampectomized monkeys in social contacts with their normal peers decreased markedly. In addition, operated monkeys exhibited more locomotor stereotypies than normal controls. Conclusion: These experimental findings indicate that the time-course and nature of the behavioural disturbances resulting from early trauma to the hippocampal region have some similarities with the clinical symptoms of schizophrenic patients and the typical time-course of the disease.
Psychotropic Medication and Insomnia Complaints in Two Epidemiological Studies
Authors: Ohayon Maurice M , Caulet Malijaï 
Published: January 2017

Objective: This study compared prescribed psychotropic medication patterns for reported sleep disorders in French and Quebec samples. Method: The first study was undertaken in France (N = 5622) and the second in the metropolitan area of Montreal (N = 1722). Lay interviewers used a specialized knowledge-based system for the purpose of evaluating sleep disorders by telephone. Results: Results showed similar prevalence of insomnia complaints in both samples (20.1% and 17.8%, respectively). A higher level of psychotropic consumption was found in France (11.7% [95% confidence interval (CI), 10.9 to 12.5]) compared with Quebec, however, where consumption was less than half the French rate (5.5% [95% CI, 4.4 to 6.6]). Both studies identified females and the elderly as the primary consumers of these drugs. For approximately two-thirds of both samples, sleep-promoting medications were prescribed for a year or longer, revealing a chronicity of the consumption. Approximately 4 out of 5 prescriptions for sleeping medications were ordered by general practitioners in both samples. Conclusion: These findings clearly show a higher prevalence of psychotropic drug use in the French compared with the Quebec population. The patterns of consumption and prescription, however, are quite similar in both studies.
Alternatives, Agendas and Outcomes: Budget Cutting in Health Care Organizations
Authors: Bigelow Barbara 
Published: January 2017

The structural characteristics of health care organizations have received considerable attention since the early 1960s when Perrow (1961; 1965) and Gordon (1961; 1962) wrote about the relationships among the top management triangle. Despite dramatic changes in the industry since that time, the basic structure has changed little. Power is still more likely to be shared among administrators, medical staff and board members than concentrated in a managerial hierarchy (Morlock & Nathanson, 1983). Objectives held by each of these three groups still tend to be diverse and conflicting rather than congruent. This combination of diverse goals and shared power suggests that decision making in these organizations may be more akin to the process observed in political and community settings than to the hierarchically determined process attributed to most types of organizations. That is, administrators in health care organizations may be constrained in their choice of actions by the preferences of other groups (Young & Saltman, 1985), and by the dominance of values that may act to the benefit of medical interests.