bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-Term Efficacy of Interventions by a Youth Crisis Team
Authors: Greenfield Brian , Hechtman Lily , Tremblay Claudine 
Published: April 2017

Objective To determine the impact of an outpatient psychiatric Emergency Room Follow-up Team (ERFUT) on the hospitalization rate of youth in crisis (mostly suicidal adolescents). Method The rate of psychiatric admissions of youth to a general pediatric hospital during a year prior to the ERFUT creation was compared to that same rate after the team's creation. The proportion of patients returning to the Emergency Room (ER) 2 or more times was also compared for those same years. Deaths were identified at 3-year follow-up for the experimental group. Results A 16% reduction in the hospitalization rate followed the team's creation, without an increase in the proportion of patients returning to the ER. Also, none of the experimental group subjects had died at 3-year follow-up. Conclusion There is a subpopulation of previously hospitalized suicidal adolescents who can be effectively cared for as outpatients when treated rapidly and intensively.
Tricyclic Medication in Children and the QT Interval: Case Report and Discussion
Authors: Harvey R. Alderton 
Published: April 2017

Objective To identify the necessity for close monitoring of the QT interval in children and adolescents treated with tricyclics. Method Guidelines for permissible ECG changes are reviewed and a case report of a 12-year-old girl with idiopathic long QT syndrome, no history of cardiac disorder, a questionable family history, and normal physical examination and baseline ECG is presented. Results Marked increase in QT corrected for heart rate (QTc) occurred on low-dose tricyclic. Possible factors in deaths on desipramine are reviewed. Conclusion It is recommended that children and adolescents on tricyclics receive an ECG at baseline and after each dose increase. Recommendations are made regarding ECG parameters and indications for cardiac consultation.
Training Residents for Rural Child Psychiatry: Defining the Objectives
Authors: Leverette John , Massabki Albert 
Published: April 2017

Objective To discuss the contribution of consultative skills to the practice of child psychiatry and to develop curriculum which enhances the ability of residents to participate in community-based care. Method The development of a training site for residents and fourth year medical students in a weekly half-day travelling child psychiatry clinic to a rural children's aid society is described. A method of designing educational objectives for community-based training is reviewed and expanded to provide a template for constructing a comprehensive curriculum. Results The educational objectives specific to the rural training site chosen are provided and their contribution as a subset of the curriculum is defined. Conclusion The authors suggest that a more fulsome discussion of curriculum design and content in the Canadian literature will aid in the development of emerging practice patterns in child psychiatry.
The Function of the Multidisciplinary Team in Child Psychiatry — Clinical and Educational Aspects
Authors: Constantin E Benierakis 
Published: April 2017

ObjectiveTo present experiences with teams in a university hospital and various community settings that promote the learning of collaboration among different professionals.MethodResearch in developmental psychopathology has increasingly linked childhood vulnerabilities and risk factors to adolescent and adult disorders. In this context the multidisciplinary teams can be seen as the expression of the expanding knowledge and expertise of the medical and allied health professionals, which can be directed toward promotion of health as well as prevention and cure of illness.ResultsCollaboration reflects the application of biopsychosocial principles to consultation and research both in the community and in hospital, and the general trend in medicine to move from solo to team practice.ConclusionPsychiatrists have the obligation to promote, develop and maintain the psychosocial and personal dimension in the teaching and practice of medicine.
Shared Psychotic Disorder: A Critical Review of the Literature
Authors: José M Silveira , Mary V Seeman 
Published: April 2017

Objective To search the literature to reassess the concept of shared psychotic disorder (SPD) using modern nosology and current biopsychosocial formulation. Method Analyzing published case reports from 1942 through to 1993 that meet DSM-IV criteria for SPD according to patient age, sex, nature and duration of the relationship with the “primary”, length of exposure to primary's psychosis, family psychiatric history, comorbidity, social isolation of the dyad, presence of hallucinations, delusional type, and the diagnosis of the primary. Results Findings revealed: 1. males and females were affected with equal frequency; 2. there was equal prevalence in younger and older patients; 3. the majority of shared psychoses (90.2%) were equally distributed among married couples, siblings, and parent-child dyads; 4. comorbid dementia, depression, and mental retardation were common; 5. hallucinations were common; 6. the majority of dyads (67.3%) were socially isolated. Conclusions SPD probably occurs in premorbidly disposed individuals in the context of social isolation which is shared with a psychotic person.
Treatment of Seasonal Affective Disorder: A Review
Authors: Tam Edwin M , Lam Raymond W , Levitt Anthony J 
Published: April 2017

Objective To review the status of current treatment of seasonal affective disorder (SAD). Method Treatment studies of SAD published between January 1989 and March 1995 were identified using a computerized MEDLINE literature search. Additional citations were obtained from the reference sections of these articles. Studies included in this review were selected using operational methodologic criteria. Results Many studies support the efficacy of bright light therapy using a fluorescent light box. The best studied protocol is >2500 lux white light for 2 hours per day, but newer protocols using 10,000 lux for 30 minutes have comparable response rates. Studies of light visors and other head-mounted devices also report similar response rates, but have not yet shown superiority over putative control conditions. There are fewer medication studies in SAD, but controlled studies suggest that fluoxetine, d-fenfluramine and propranolol are effective. Other treatments such as dawn simulation require further study. No studies of psychological treatments for SAD were found. Many studies had methodologic limitations, including brief treatment periods, small sample sizes, and lack of replication, that limit the generalizability of findings. Conclusion There are several well-studied, effective treatments for SAD, including light therapy and medications. However, further research must be done to demonstrate sustained treatment response over time, to clarify the intensity-response relationship of light therapy, to clarify the role of light therapy and medications, and to assess combination treatments.
Comparative Analysis of Native Admissions and Registrations to Northwestern Ontario Treatment Facilities: Hospital and Community Sectors
Authors: Dalrymple Andrew J , O'doherty James J , Nietschei Karin M 
Published: April 2017

Objective To study Native and non-Native admissions to acute psychiatric care in the northwestern region of Ontario in 1992. Method To replicate a 1986 to 1987 study comparing Native to non-Native admissions to acute psychiatric care in the northwestern region of Ontario in 1992 and examine Native registrations to community mental health agencies in the first 6 months of 1993. Results The comparative analysis of hospital admissions revealed that: Natives are still being admitted at 33% more than the rate expected on the basis of population; depression appears to be underdiagnosed for Natives; they continue to be admitted mainly for reasons other than major psychiatric conditions; substance abuse and forensic history are commonly involved; they stay in hospital for twice as long as their non-Native control; they more often come from rural settings; and they are less likely to be followed by the outpatient service and more likely to be followed by the criminal justice system. The examination of registrations to community mental health agencies revealed that: the same overrepresentation of Natives; mood- and thought-presenting problems of Natives in this sector were identical to non-Natives; and their length of stay was similar. The psychiatric hospital appears to be providing acute care treatment, not for the serious psychiatric illnesses for which it is mandated, but for atypical admissions that result from economic, social and cultural dislocation. There may be under diagnosis of atypical depression in the Native hospitalized population. When asked what they are being treated for the diagnostic profile of Natives and non-Natives is identical on mood and thought dimensions. Conclusion No appreciable change has occurred over the 5 years in the way hospital psychiatric services are used by Natives. Cultural stereotypes may be influencing the diagnosis of Natives in inappropriate ways. Enhancing Native control of treatment programs and community development may provide a partial solution. Properly mandated and accountable community agencies (both generic- and culture-specific) will help reduce unnecessary hospitalization.
Is a Diagnosis-Based Classification System Appropriate for Funding Psychiatric Care in Alberta?
Authors: Wellock Chantelle M 
Published: April 2017

Objective This study evaluated the appropriateness of the Refined Group Number (RGN) classification system for funding psychiatric discharges in Alberta. Method Multiple regression was used to calculate the amount of variation explained (R2) in length of stay by RGNs for psychiatric discharges. The distribution of short-stay cases (less than 5 days) was also reviewed. Results The R2 value was higher than those from American studies (0.284 versus less than 0.10) for psychiatric discharges. The length of stay distribution by RGN indicated that the mean was not representative of typical cases. Short-stay cases made up the majority of cases from rural hospitals and had a negative impact on the average length of stay. Conclusions The RGN methodology performed better than diagnosis-based classification systems in the United States. However, there were significant weaknesses in the classification system which suggest that a funding system using the RGN grouper would result in inequitable funding for psychiatric discharges.
The Psychopathology of Incarcerated Self-Mutilators
Authors: Haines Janet , Williams Christopher L , Brain Kerryn L 
Published: April 2017

ObjectiveTo investigate the symptomatology of severe psychopathology reported by male incarcerated self-mutilators.MethodComparisons were made with a nonmutilating incarcerated group and a nonincarcerated, nonmutilator group.ResultsA distinctive pattern of symptomatology emerged. Self-mutilators evidenced a wide range of elevated scores on general measures of psychological/psychiatric symptoms, particularly depression and hostility. Aspects of hostility that distinguished self-mutilators from other groups included the urge to act out hostile feelings, critical feelings towards others, paranoid feelings of hostility and guilt. Self-mutilators demonstrated substantial problems with substance abuse, particularly alcohol.ConclusionA pattern of passive-aggressive, schizoid and avoidant personality styles distinguished self-mutilators from other groups.
Depression Associated with Multiple Sclerosis: An Etiological Conundrum
Authors: Feinstein Anthony 
Published: April 2017

Objective Although depression frequently occurs in multiple sclerosis (MS), an association with cerebral pathology is unclear. This sets MS apart from other common neurological disorders. The reasons for this are explored. Method The literature on depression and magnetic resonance imaging (MRI) is reviewed and methodological issues are critically evaluated. Results Failure to demonstrate cerebral correlates of depression is in part a function of poor study design. However, the diffuse nature of cerebral demyelination creates difficulties in image analysis peculiar to MS. Conclusions More research using valid psychiatric assessment procedures, high field strength MRI and automated lesion detection is needed to resolve the issue. It is premature to reject psychosocial causes at this stage.
Self-Esteem and Cancer: Theory and Research
Authors: Katz Mark R , Rodin Gary , Devins Gerald M 
Published: April 2017

Objective To examine the relationship between self-esteem and the psychosocial response to cancer. Methods The authors review methodological issues associated with measuring self-esteem inpatients with cancer and examine existing empirical studies in light of these issues. Results Self-esteem in cancer has been variously viewed as an outcome variable, a mediator of other psychosocial outcomes, and as a personal resource that facilitates coping. Unidimensional measures of global self-esteem have been most often employed in research studies, despite increasing recognition that self-esteeem is multidimensional. Evaluation of global self-esteem has generally revealed no differences between cancer patients and controls. Aspects of multidimensional self-esteem, particularly body self-esteem, appears to be disturbed in many patients with cancer. Conclusions The clinical and theoretical literature have emphasized the importance of self-esteem to the psychosocial response to cancer. Empirical study of self-esteem in cancer has been limited by conceptual and methodological issues. Strategies for future research are discussed.
The Clozapine Experience from a Family Perspective
Authors: Dickson Ruth A , Williams Richard , Dalby J Thomas 
Published: April 2017

Objective To examine how the lives of family members of clozapine-treated patients with schizophrenia have been affected by this treatment. Methods Through the use of a questionnaire and an interview of family members, this qualitative study focused on the families' perceptions of change in their family member and the impact on the family unit. Results Fourteen patients and their family members participated. The family interview was conducted an average of 1.78 years after clozapine inititation (range 0.58 years to 3.73 years). Global ratings of behavioural change were positively and significantly correlated between all raters: patients, family members, and clinicians. Family members were positive about clozapine's effect on their relatives and the impact on the family. Conclusion A positive response to clozapine decreases the burden on the family. This is in part the result of a decreased need for rehospitalization.
The Psychobiology of First-Episode Schizophrenia
Authors: Waring Em 
Published: April 2017

Objective: To examine research and clinical interest in the first episode of schizophrenia. Pathobiological features have been shown to be a consequence of the disorder rather than the effects of chronicity, drug treatment or institutionalization. There is increasing evidence that ventricular enlargement is a robust finding and hypofrontality on PET and SPECT is associated more with symptomatology than with neuroleptic treatment. Results: Neuroleptic threshold studies suggest that lower daily dosages and onset of medication may be the most important response prediction parameters. Conclusion: The role of novel antipsychotics in the treatment of first-onset schizophrenia merits investigation for lower rates of extrapyramidal syndromes and tardive dyskinesia. To reduce relapse rates, psychiatrists need to introduce practice standards employing those biopsychosocial features in the management of first-episode schizophrenia.
Negative Symptoms and Affective Disturbance in Schizophrenia and Related Disorders
Authors: Malla Ak 
Published: April 2017

Objective: To review the data and discuss clinical recommendations for treating negative symptoms of schizophrenia. Negative symptoms (e.g., poverty of thought, affective blunting) have been regarded as part of schizophrenia since Kraepelin's early descriptions, although they remain a subject of controversy. For example, it is unclear if negative symptoms are distinct from other psychiatric symptoms such as depression, or are in actuality depression within schizophrenia. Recent evidence suggests that negative symptoms are independent of depression. Method: Factor analytic studies have suggested that a negative factor (loss of affect, volition, poverty of thinking) may be distinguished from other components and is separable from a depression factor. Experimental use of vignettes have also been useful in the assessment of negative symptoms. A second controversial area is whether or not the presence or absence of affect is the fundamental issue separating schizophrenia from other psychoses. Results: A continuum of psychosis has been hypothesized, with unipolar psychotic depression at one pole and schizophrenia with defect state at the other. Within this proposed continuum, negative symptoms are associated only with schizophrenia without affect and with defect state schizophrenia. As such, variation in affect could be a primary determinant of the type of psychosis. Conclusion: It appears that negative symptoms are a distinct aspect of schizophrenia and may aid in our understanding of psychotic disorders.
An Integrative Index for Predicting Extubation Outcomes After Successful Completion of a Spontaneous Breathing Trial in an Adult Medical Intensive Care Unit
Authors: Wu Tsung-Ju , Shiao Judith Shu-Chu , Yu Hsin-Liang , Lai Ruay-Sheng 
Published: April 2017

Background: Among respiratory predictors, rapid shallow breathing index (RSBI) has been a commonly used respiratory parameter to predict extubation outcomes. However, the outcome of prediction remains inconsistent. Regarding nonrespiratory predictors, serum albumin, hemoglobin, bicarbonate, and patients’ alertness have been reported to be associated with successful weaning or extubation. We aimed to develop an integrative index combining commonly used predictors in the adult medical intensive care units (MICUs) and to compare the predictability of the index with RSBI. Methods: This prospective observational study with retrospective data collection of planned extubations was conducted in a 14-bed adult MICU. We enrolled patients who received mechanical ventilation via an endotracheal tube in the adult MICU for >24 hours and passed a 2-hour spontaneous breathing trial and underwent extubation. Extubation failure was defined as reinstitution of invasive mechanical ventilation within 48 hours of extubation. Respiratory parameters and Glasgow Coma Scale (GCS) scores of patients were recorded prospectively. Nonrespiratory parameters were recorded retrospectively. Logistic regression was used to determine significant predictors of extubation outcomes. Results: Fifty-nine patients comprising 70 extubations were enrolled. Extubation failure was significantly and positively associated with lower serum albumin (albumin < 2.6 g/dL, odds ratio [OR] = 5.1; 95% confidence interval [CI], 1.04-24.66), lower hemoglobin (hemoglobin < 10.0 g/dL, OR = 10.8; 95% CI, 2.00-58.04), and lower GCS scores (GCS score ≤ 8, OR = 6.1; 95% CI = 1.15-32.34). By using an integrative index combining the 3 parameters together, the sensitivity and specificity to predict extubation outcomes were 78.6% and 75.9%, respectively. The area under the receiver operating characteristic curve of the index was significantly higher than RSBI (0.84 vs 0.61, P = .026). Conclusion: The integrative index combining serum albumin, hemoglobin, and GCS scores could predict extubation outcomes better than RSBI in an adult MICU.
Systematic review of the literature on reproducibility of the interpretation of renal biopsy in lupus nephritis
Authors: Restrepo-Escobar M , Granda-Carvajal P A , Jaimes F 
Published: April 2017

Objective Before using a test, it should be determined whether the results are reliable. The reliability of the interpretation of renal biopsy in patients with lupus nephritis has not been clearly elucidated. Our objective was to estimate inter and intra-observer reliability of the histological classification, as well as activity and chronicity indices in renal biopsy of patients with lupus nephritis. Methods We conducted a systematic search of the literature, which included articles in any language, using PubMed, Embase, Cochrane and Lilacs databases. Search terms included were: reproducibility, reliability, agreement, systemic lupus erythematosus and lupus nephritis. Comparative studies with any design were included, regardless of the year or the language of publication. Two investigators, independently, screened the literature published in accordance with pre-established inclusion and exclusion criteria. Results We found 13 relevant studies. Inter-observer reproducibility of most measurements was moderate or low, despite the fact that, in most cases, the readings were made by expert nephropathologists. There was great diversity among designs, participants, including samples and outcomes evaluated in different studies. Although there are too many reports on the clinical use, studies evaluating the reliability of classifications on renal biopsy in lupus nephritis are rare. The quality of the methodological design and reporting was fair. Conclusion The interpretation of renal biopsy in lupus nephritis is poorly reproducible, causing serious doubts about its validity and its clinical application. As it can lead to serious diagnosis, treatment and prognosis errors, it is necessary to intensify research in this field.
Subarachnoid and intraperitoneal hemorrhage secondary to segmental arterial mediolysis: A case report and review of the literature
Authors: Welch Brian T , Brinjikji Waleed , Stockland Andrew H , Lanzino Giuseppe 
Published: April 2017

Background Segmental arterial mediolysis (SAM) is an uncommon or underdiagnosed arteriopathy that presents with life-threatening hemorrhage. SAM can affect the intracranial, spinal, and visceral arteries, with reported cases of concomitant intracranial and visceral hemorrhage. Case description We present the case of a 61-year-old male with concurrent subarachnoid and intraperitoneal hemorrhage caused by simultaneously bleeding posterior spinal artery and splenic artery pseudoaneurysms. The posterior spinal artery pseudoaneurysms were treated with selective injection of polyvinyl alcohol particles into the posterior spinal artery, while the splenic artery pseudoaneurysm was treated with Gelfoam embolization. The constellation of imaging, clinical, and laboratory features led to a presumptive diagnosis of SAM, which remains the only reported cause of concurrent neurovascular and visceral artery aneurysm rupture. Conclusion SAM is a key diagnostic consideration in cases of concomitant intracranial, spinal, and visceral artery aneurysm rupture.