bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of the Alcohol Use Disorders Identification Test and the Drug Abuse Screening Test in First Episode Psychosis
Authors: Cassidy Clifford M , Schmitz Norbert , Malla Ashok 
Published: January 2017

Objective: To determine the validity and reliability of the Alcohol Use Disorders Identification Test (AUDIT) and Drug Abuse Screening Test (DAST) for detecting alcohol and drug use disorders, respectively, in a population with first-episode psychosis (FEP). Method: Subjects with FEP completed the AUDIT and DAST and were divided into groups according to the presence or absence of a Structured Clinical Interview for DSM-IV (SCID) diagnosis of either current alcohol or drug misuse. The data were analyzed to see whether AUDIT and DAST scores were predictive of SCID diagnosis. Results: Patients with alcohol-related SCID diagnoses and those with drug-related SCID diagnoses scored significantly higher on the AUDIT and DAST, respectively, than the group without the respective SCID diagnosis ( P < 0.001 in both cases). The AUDIT functioned best with a problem drinking cut-off score of 10 (sensitivity, 85%; specificity, 91%). The DAST functioned best with a problem drug use cut-off score of 3 (sensitivity, 85%; specificity, 73%). The area under the receiver operating characteristic curve was 0.86 for the AUDIT and 0.83 for the DAST. Conclusion: The DAST and AUDIT may reliably identify FEP patients with substance abuse.
Collaborative Mental Health Care for the Homeless: The Role of Psychiatry in Positive Housing and Mental Health Outcomes
Authors: Stergiopoulos Vicky , Dewa Carolyn S , Rouleau Katherine , Yoder Shawn , Chau Nancy 
Published: January 2017

Objective: Factors associated with positive outcomes for homeless men referred to a shelter-based collaborative mental health care team were examined. Method: A chart review of 73 clients referred over 12 months was completed. Two outcome measures were examined, clinical status and housing status, 6 months after their referral to the program. Result: Among the referred clients, the prevalence of severe and persistent mental illness and substance use disorders was 76.5% and 48.5%, respectively. At 6 months, 24 clients (35.3%) had improved clinically, and 33 (48.5%) were housed. Logistic regression identified 2 factors associated with clinical improvement: the number of visits with a psychiatrist and treatment adherence. The same 2 factors were associated with higher odds of housing, and presence of substance use disorder was associated with lower odds of housing at 6-month follow-up. Conclusion: Care by a mental health specialist is positively associated with improved outcomes. Strategies to improve treatment adherence, access to mental health specialists, and innovative approaches to treatment of substance use disorders should be considered for this population. Having a psychiatrist as a member of a shelter-based collaborative care team is one possible way of addressing the complex physical and mental health needs of homeless individuals.
Excess Cancer Mortality in Psychiatric Patients
Authors: Kisely Stephen , Sadek Joseph , MacKenzie Adrian , Lawrence David , Campbell Leslie Anne 
Published: January 2017

Objectives: There are conflicting data on cancer incidence and mortality in psychiatric patients, although most studies suggest that while cancer mortality is higher, incidence is no different from that in the general population. Different methodologies and outcomes may account for some of the conflicting results. We investigated the association between mental illness and cancer incidence, first admission rates, and mortality in Nova Scotia using a standard methodology. Method: A population-based record-linkage study of 247 344 patients in contact with primary care or specialist mental health services during 1995 to 2001 was used. Records were linked with cancer registrations and death records. Results: Cancer mortality was 72% higher in males (95%CI, 63% to 82%) and 59% higher in females (95%CI, 49% to 69%) among patients in contact with mental health services. This was reflected in similarly elevated first admission rates. However, there was weaker and less consistent evidence for increased incidence. For several cancer sites, incidence rate ratios were lower than might be expected given the mortality and first admission rate ratios, and no higher than that of the general population. These were melanoma, prostate, bladder, and colorectal cancers in males. Conclusion: People with mental illness in Nova Scotia have increased mortality from cancer, which cannot always be explained by increased incidence. Possible explanations for further study include delays in detection or initial presentation leading to more advanced staging at diagnosis, and difficulties in communication or access to health care.
The Impact of a Smoking Cessation Policy on Visits to a Psychiatric Emergency Department
Authors: Kurdyak Paul , Cairney John , Sarnocinska-Hart Anna , Callahan Russell C , Strike Carol 
Published: January 2017

Objective: Smoking cessation policies are increasingly imposed in mental health facilities because of the high prevalence of tobacco smoking and its related adverse health consequences. The objective of this study was to measure the impact of 2 smoking cessation policies—one imposed in a specific psychiatric hospital and the other across the entire province of Ontario—on weekly visit rates to a psychiatric emergency department. Methods: Administrative data records from consecutive patient visits to a psychiatric emergency department were grouped by week from March 1, 2002, to December 31, 2005. The patients were grouped into 3 broad diagnostic categories: substance-related disorders, psychotic disorders, and other disorders. The impact of 2 smoking cessation policies—one imposed on September 21, 2005 at the Centre for Addiction and Mental Health (CAMH) and one imposed on May 31, 2006 across the province of Ontario—on psychiatric emergency department visit rates was measured using time series analysis. Results: The CAMH-specific smoking cessation policy had no impact on psychiatric emergency department visit rates in any diagnostic category. The province-wide smoking cessation policy resulted in a 15.5% reduction in patient visits for patients with a primary diagnosis of psychotic disorder. Conclusions: The benefits of a smoking cessation policy need to be balanced by the impact of the policy on the likelihood of patients to seek treatment.
The Incidence and Characteristics of Clozapine-Induced Fever in a Local Psychiatric Unit in Hong Kong
Authors: Chung Joseph Pui-Yin , Chong Catherine Shiu-Yin , Chung Ka-Fai , Dunn Eva Lai-Wah , Tang Orlando Wai-Nang , Chan Wah-Fat 
Published: January 2017

Objective: To determine the incidence, characteristics, and predictors of clozapine-induced fever in a sample of patients in a local psychiatric unit. Method: A retrospective review of case notes of 227 inpatients newly started on clozapine from March 2003 to December 2006 was conducted. Demographic characteristics, presence of fever, investigations carried out, fever characteristics, and complications of fever were recorded and analyzed. Patients with clozapine-induced fever were compared with their fever-free counterparts on demographic and clinical factors. Multivariate logistic regression was performed to identify predictors of clozapine-induced fever. Results: Thirty-one out of 227 patients (13.7%) developed clozapine-induced fever. The means for day of onset of clozapine-induced fever after clozapine initiation and duration of fever were 13.7 and 4.7 days, respectively. The mean highest body temperature was 38.8 °C. Fever resolved within 48 hours after clozapine discontinuation in 79% of the patients with clozapine-induced fever. One out of 7 patients (14.3%) had fever on re-challenge. Clozapine-induced fever was associated with rate of titration more than 50 mg/wk (OR 18.9; 95% CI 5.3 to 66.7; P < 0.01), concomitant use of valproate (OR 3.6; 95% CI 1.5 to 8.9; P = 0.01), and presence of physical illnesses (OR 3.2; 95% CI 1.2 to 8.3; P = 0.02). Conclusion: Clozapine-induced fever is common. Temporary withdrawal of clozapine may result in resolution of fever, and clozapine re-challenge may be considered after fever subsides. Slower rate of clozapine titration may be helpful in patients with underlying physical illness and concomitant valproate treatment.
Suicidal Ideation: The Role of Economic and Aboriginal Cultural Status after Multivariate Adjustment
Authors: Lemstra Mark , Neudorf Cory , Mackenbach Johan , Kershaw Tanis , Nannapaneni Ushasri , Scott Christina 
Published: January 2017

Objective: To determine if Aboriginal (in this paper, First Nations and Métis people) cultural status is independently associated with lifetime suicidal ideation in the Saskatoon Health Region after controlling for other covariates, particularly income status. Methods: Data collected by Statistics Canada in all 3 cycles of the Canadian Community Health Survey (CCHS) were merged with identical questions asked in February 2007 by the Saskatoon Health Region. The health outcome was lifetime suicidal ideation. The risk indicators included demographics, socioeconomic status, cultural status, behaviours, life stress, health care use, and other health problems. Results: Participants ( n = 5948) completed the survey with a response rate of 81.1%. The prevalence of lifetime suicidal ideation was 11.9%. After stratification, it was found that high-income Aboriginal people have similar low levels of suicidal ideation, compared with high-income Caucasian people. The risk–hazard model demonstrated a larger independent effect of income status in explaining the association between Aboriginal cultural status and lifetime suicidal ideation, compared with the independent effect of age. After full multivariate adjustment, Aboriginal cultural status had a substantially reduced association with lifetime suicidal ideation. The odds of lifetime suicidal ideation for Aboriginal people reduced from 3.28 to 1.99 after multivariate adjustment for household income alone. Conclusion: The results of this study suggest reductions in lifetime suicidal ideation can be observed in Aboriginal people in Canada by adjusting levels of household income.
The Restless Brain: Attention-Deficit Hyperactivity Disorder, Resting—State Functional Connectivity, and Intrasubject Variability
Authors: Castellanos F Xavier , Kelly Clare , Milham Michael P 
Published: January 2017

Objectives: To highlight recent advances in the conceptualization of attention-deficit hyperactivity disorder (ADHD) emerging from neuroimaging and endophenotypic approaches. Methods: We selectively reviewed recent published literature on the phenomena of resting-state functional connectivity, intrasubject variability, and diffusion tensor imaging pertaining to ADHD. Results: Recent advances based on the novel approach of resting-state functional connectivity appear to be highly promising and likely to link to studies of intrasubject variability. Conclusions: Endophenotypic fractionation may offer a means of addressing the complex heterogeneity of ADHD on the path to testable models of pathophysiology. Such models focusing on intrasubject variability, intrinsic brain activity, and reward-related processing are progressing rapidly.
Comorbidity in Adults with Attention-Deficit Hyperactivity Disorder
Authors: Cumyn Lucy , French Lisa , Hechtman Lily 
Published: January 2017

Objective: To examine the prevalence of comorbid Axis I (current and lifetime) and II disorders in adult men and women with attention-deficit hyperactivity disorder (ADHD). Method: Adult patients ( n = 447; 266 men, 181 women) received comprehensive assessments for ADHD and Axis I and II disorders. Adults were aged between 17 and 74 years. Among the patients diagnosed with ADHD ( n = 335), there were those with ADHD inattentive subtype (ADHD-I) ( n = 199), hyperactive–impulsive subtype (ADHD-H) ( n = 24), or combined ADHD subtype (ADHD-C) ( n = 112). Chi-square and logistic regression analyses were performed to examine associations between adults with and without ADHD on Axis I and II disorders. Results: Adults with ADHD, compared with those without ADHD, had higher rates of Axis I (46.9% and 27.31%) and Axis II (50.7% and 38.2%) disorders. Adults with ADHD-C were more likely to have mood disorder, anxiety, conduct disorder, and substance use disorder as well as obsessive–compulsive personality disorder, passive–aggressive personality disorder, depressive personality disorder, narcissistic personality disorder, and borderline personality disorder (BPD). Men with ADHD were more likely to have antisocial personality disorder and had higher rates of current drug abuse than women with ADHD. Women with ADHD had higher rates of past and current panic disorder, and past anorexia and bulimia. Women with ADHD were more likely to have BPD than men with ADHD. Conclusions: Adults with ADHD have very high rates of comorbid Axis I and II disorders, with differences found between men and women on certain comorbid disorders.
Traditional Postpartum Practices and Rituals: Clinical Implications
Authors: Grigoriadis Sophie , Robinson Gail Erlick , Fung Kenneth , Ross Lori E , Chee Cornelia (Yin Ing) , Dennis Cindy-Lee , Romans Sarah 
Published: January 2017

Objectives: In many cultures, postpartum rituals are observed because they are believed to have beneficial mental health effects. Our systematic review examines the research literature investigating the effects of postpartum rituals on postpartum depression (PPD) to determine if the rituals protect against PPD. Methods: MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Library were searched (from 1966 to October 31, 2008). Reference lists of relevant articles and links to related articles were also examined. Both qualitative and quantitative studies that focused on traditional practices and rituals in the postpartum period (that is, within the first year following childbirth) and their relation to PPD or mood were included. Results: Seventy-two studies were considered, with 12 meeting the inclusion criteria. The data were summarized according to the type of ritual including: organized support, diet, and other or multiple postpartum practices, and evidence for or against a protective effect on PPD. Although limited, not all studies suggested that the rituals prevent PPD. Overall, there is some evidence that postpartum rituals dictating appropriate and wanted social support may be of some protective value, depending on numerous contextual factors. Conclusions: This area needs more culturally sensitive and systematic research. Current studies suggest that the key protective element may be the presence of welcome support rather than the specific ritual.
Antipsychotics and Schizophrenia: From Efficacy and Effectiveness to Clinical Decision-Making
Authors: Foussias George , Remington Gary 
Published: January 2017

Objective: To comprehensively review the 2 recent and large antipsychotic effectiveness trials for treatment of schizophrenia: the United Kingdom's Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS), and the National Institute of Mental Health-initiated Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial. Method: We present a review of the rationale, methodology, and findings to date from the CUtLASS and CATIE schizophrenia trials, including all primary and secondary outcomes. Results: The primary findings from both trials, CUtLASS and CATIE, suggest that first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) are equally effective in the treatment of schizophrenia. The exception is in treatment-resistant populations where clozapine exhibits superiority, compared with other SGAs. In the CATIE trial, there is a suggestion that olanzapine is superior in effectiveness, compared with other nonclozapine SGAs, although this seems to be mediated by past history of olanzapine use, and carries with it increased weight gain and metabolic adverse events. From a cost-effectiveness perspective, there is no evidence that SGAs are superior to FGAs, with findings suggesting the possibility that FGAs may be superior. Conclusion: Past efficacy trials have strongly supported the position that SGAs are superior to FGAs in the treatment of schizophrenia and in side effect profile. Two large independent effectiveness trials, CUtLASS and CATIE, have offered a strong challenge to these claims. Both suggest that SGAs, except clozapine in the treatment-resistant population, offer little, if any, clinical benefits, and, moreover, harbour their own significant side effects.
Age of Onset of Cannabis Use is Associated with Age of Onset of High-Risk Symptoms for Psychosis
Authors: Dragt Sara , Nieman Dorien H , Becker Hiske E , van de Fliert Reinaud , Dingemans Peter M , de Haan Lieuwe , van Amelsvoort Thérèse A , Linszen Don H 
Published: January 2017

Objective: Increasing interest in the prodromal stage of schizophrenia over the past decade led us to perform our study to monitor people at high risk for developing a psychosis. We hypothesized that cannabis use or a cannabis use disorder at a younger age relates to high-risk symptoms at a younger age. Method: People referred to the Academic Medical Centre in Amsterdam, the Netherlands, with an ultra-high risk (UHR) for psychosis were interviewed with the Composite International Diagnostic Interview to assess their cannabis consumption. The Interview for the Retrospective Assessment of the Onset of Schizophrenia was used to collect data about age of onset of high-risk or prodromal symptoms. Nine high-risk symptoms were selected and clustered because of their known relation with cannabis use. Results: Among the 68 included participants, 35 had used cannabis (51.5%), of whom 15 had used recently. Twenty-two participants had been cannabis abusers or cannabis-dependent (32.4%) in the past. Younger age at onset of cannabis use was related to younger age of onset of the cluster of symptoms (rho = 0.48, P = 0.003) and also to 6 symptoms individually (rho = 0.47 to 0.90, P < 0.001 to 0.04). Younger age at onset of a cannabis use disorder was related to younger age of onset of the cluster of symptoms (rho = 0.67, P = 0.001) and also to 6 symptoms individually (rho = 0.50 to 0.93, P = 0.007 to 0.03). Conclusion: Cannabis use or a cannabis use disorder at a younger age in a group with an UHR for transition to psychosis is related to onset of high-risk symptoms for psychosis at a younger age.
Clinical Response to Methylphenidate in Children Diagnosed with Attention-Deficit Hyperactivity Disorder and Comorbid Psychiatric Disorders
Authors: Ter-Stepanian Mariam , Grizenko Natalie , Zappitelli Michael , Joober Ridha 
Published: January 2017

Objective: To determine to what extent the clinical response to methylphenidate (MPH) is affected by psychiatric comorbidities in children diagnosed with attention-deficit hyperactivity disorder (ADHD). Methods: Children ( n = 267) aged 6 to 12 years diagnosed with ADHD participated in a double-blind, placebo-controlled, 2-week medication trial of MPH. Children were assessed using parent and teacher ratings and laboratory measures. Clinical response to MPH was determined by integrating all obtained measures. Results: Meeting criteria for conduct disorder (CD) was 27.7% of children, 40.8% for oppositional defiant (ODD), 47.2% for anxiety, and 7.9% for depressive disorders. The presence of CD or ODD was associated with good response to MPH. In contrast, children diagnosed with only comorbid anxiety were more likely to receive poor response rating independent of age, sex, or socioeconomic status. Low family income was found to be predictive of good response to MPH. Conclusions: The response to MPH in children with ADHD may be dependent on the type of comorbid disorder present. Clinical Trial Registration Number: NCT00483106
Persistence and Remission of Psychiatric Disorders in the Quebec Older Adult Population
Authors: Préville Michel , Boyer Richard , Vasiliadis Helen-Maria , Grenier Sébastien , Streiner David , Cairney John , Brassard Joëlle ,   Scientific Committee of the ESA Study
Published: January 2017

Objective: To document the remission and persistence of psychiatric disorders in Quebec's older adult population. Method: Data came from the Enquěte sur la santé des aînés (ESA) study conducted in 2005–2008 using a representative sample ( n = 2784) of community-dwelling older adults. Results: The ESA study results indicate that 12% of respondents met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for depression, mania, anxiety disorders, or benzodiazepine drug dependency at the baseline interview. The results also indicate that the 12-month rate of patients with a persistent psychiatric condition was 19.4%. Sixty-seven percent of the patients in remission experienced a total recovery of their symptoms during the following year. The probability of presenting a persistent psychiatric condition or a partial remission after 1 year of follow-up, compared with those in total remission, did not vary according to sociodemographic characteristics. The results also showed that social support and the number of chronic health problems did not influence mental health at follow-up. However, results indicated that the use of health services (OR 7.4; 95% CI 3.72 to 14.55) and the change in the number of chronic health problems reported between baseline and the second interview (OR 1.2; 95% CI 1.06 to 1.34) increased the probability of patients with prevalent disorders at Time 1 having persistent disorders at Time 2. Conclusion: Results suggest that a deterioration of physical health status was associated with the persistence of DSM-IV disorders in the elderly. These results also suggest that the use of mental health services is associated with severity of the mental illness.
Associations of Risk of Depression with Sexual Risk Taking among Adolescents in Nova Scotia High Schools
Authors: Wilson Kevin , Asbridge Mark , Kisely Steve , Langille Don 
Published: January 2017

Objective: Several interrelated factors, including depression, influence adolescents' chances of risky sexual behaviour. We examined the relation between depression and sexual risk-taking behaviours in adolescents after accounting for the effects of other variables. Method: We surveyed male ( n = 1120) and female ( n = 1177) adolescents at 4 high schools in central Nova Scotia, measuring factors known to be associated with sexual risk taking. Risk of depression was assessed using the Center for Epidemiologic Studies Depression Scale. Outcomes were self-reported sexual behaviours. We used logistic regression to assess associations of multiple factors with sexual risk taking. Results: In univariate analyses, risk of depression was associated with 3 risk-taking behaviours for females (being sexually active, having unplanned sex when using substances, and not using effective contraception at last intercourse) and 2 for males (having unplanned sex when using substances and having more than 1 partner in the previous year). In full multivariate models, risk of depression in females remained significantly associated with unplanned sex and nonuse of effective contraception at last intercourse, but was no longer associated with being sexually active. For males, both associations remained significant. Conclusions: Risk of depression is consistently and independently associated with adolescent sexual risk behaviours after adjusting for other variables. Health care providers working with teenagers should screen for risky sexual behaviours and sexually transmitted infections if depression is apparent in their patients.