bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Course and Personality in Reactive, Compared with Nonreactive, Delusional Disorder
Authors: Pillmann Frank , Wustmann Tobias , Marneros Andreas 
Published: January 2017

Objective: Reactive delusional disorder (DD) (with a precipitating factor) has been postulated to differ clinically from nonreactive DD and to show a better prognosis. Our study tests this hypothesis in a sample of patients with persistent DD (International Classification of Diseases,10thRevision) or DD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) followed during a period of more than 10 years. Method: As part of a long-term study on DD, 19 patients with DD and a stressful life event preceding the onset of the disorder were compared with 24 DD patients without such a life event. Diagnoses, social and biographical data, life events, and outcome were assessed by a semistructured interview and validated rating scales. Personality features were assessed by the NEO Five-Factor Inventory and by the Inventory of Clinical Personality Accentuations. Results: Patients with reactive DD tended to be somewhat younger but showed otherwise little differences to patients with nonreactive DD. In particular, there were no differences in the course of the disorder. However, patients with reactive DD were significantly more often in a stable relationship and showed higher values on neuroticism and more pronounced dependent and borderline personality accentuations in dimensional personality measures. Conclusions: Reactive DD was not found to have a better prognosis than nonreactive DD. However, the results suggest an increased vulnerability for interpersonal conflicts in these patients.
A Population-Based Study of the Use of Selective Serotonin Reuptake Inhibitors before and after Introduction of Generic Equivalents
Authors: Bolton James M , Dahl Matthew , Sareen Jitender , Enns Murray W , Leslie William D , Collins David M , Alessi-Severini Silvia 
Published: January 2017

Objective: Generic drugs are less expensive than their branded equivalents, but receive limited promotion. This study sought to examine how user rates of individual selective serotonin reuptake inhibitors (SSRIs) changed after the introduction of their generic equivalents. Method: Administrative health and census data were used to examine the rates of use of all 6 SSRIs from 1996 to 2009 in the province of Manitoba (population of 1.2 million). The primary outcome measure was a comparison of the rates of use in the pre- and post-generic periods, using generalized estimating equations. Secondary analyses were stratified by specialty of physician prescriber. Results: Escalating rates of use of branded SSRIs in the pre-generic period significantly decreased after generic versions became available (all Ps < 0.001). Incident use of sertraline and paroxetine continued to decrease throughout the post-generic period (1.5% and 1.9% quarterly decreasing rates, respectively). During the years when generic sertraline, fluoxetine, and fluvoxamine were available, their use declined while branded paroxetine and citalopram use continued to increase. Use of branded citalopram, sertraline, and paroxetine prescribed by general practitioners (GPs) increased at rates significantly higher than when prescribed by psychiatrists (all Ps < 0.001). Conclusion: The introduction of cheaper generic alternatives of SSRIs paradoxically resulted in their use diminishing rather than increasing. With the exception of escitalopram, branded SSRIs tended to be preferentially used, compared with available less expensive generic SSRIs. These patterns were more pronounced for prescriptions by GPs.
The Canadian Survey of Standards of Electroconvulsive Therapy Practice: A Call for Accreditation
Authors: Chan Peter , Graf Peter , Enns Murray , Delva Nicholas , Gilron Ian , Lawson J Stuart , Gosselin Caroline , Patry Simon , Milev Roumen , Jewell Mark , Martin Barry 
Published: January 2017

Objective: To report the results of the policies and procedures subsection of a nationwide electroconvulsive therapy (ECT) survey: Canadian Electroconvulsive Therapy Survey/Enquête canadienne sur les electrochocs. Method: We contacted 1273 registered health care institutions in Canada and invited the 175 centres identified as providing ECT to complete a comprehensive postal questionnaire. Nonresponding sites were repeatedly reminded and then eventually contacted by telephone. Results: Sixty-one per cent (107/175) of the institutions returned survey questionnaires. Most (84%) of the responding sites have a written general policy for the delivery of ECT. Only 27% of respondents indicated having some written policy for managing concurrent medications during ECT, and practice was quite variable regarding individual psychotropics. Informed consent was usually obtained by the attending physician (88%), and most sites indicated conveying information before ECT by using interdisciplinary and multimodal means. Almost all of the sites (93%) discharged outpatients with accompaniment home by a responsible adult. Conclusions: It is reassuring to note that general ECT policies and procedures do exist in most Canadian ECT centres. Wider variations in practice were observed in several areas, such as the elements of consent provided to patients and families, the use of concurrent medications, and the degree of supervision on discharge home after outpatient ECT. However, adherence to these policies was not captured by the results of the survey. Based on experiences in other countries, establishing a Canadian ECT accreditation service could further improve standards of practice.
Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay
Authors: Aflalo Marc , Soucy Nathalie , Xue Xiaoqing , Colacone Antoinette , Jourdenais Emmanuelle , Boivin Jean-François 
Published: January 2017

Objective: To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds. Methods: This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional's evaluation. Descriptive and univariate analyses were performed. Results: A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients' needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%). Conclusions: Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients' needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients.
Personality Dimensions and Depression: Review and Commentary
Authors: Enns Murray W , Cox Brian J 
Published: January 2017

Objectives The relationship between dimensionally assessed personality and the onset, features, and course of depressive illness will be critically examined and considered in relation to 4 hypothesized models: predisposition or vulnerability; pathoplasty; complication or scar; and spectrum or continuity. Method Studies that have used clinically depressed adult patients to explore the relationship between personality dimensions and depression will be reviewed. Results Higher-order personality factors that have shown a significant and consistent association with major depressive illness include neuroticism, extraversion (negative relationship), and the factors of Cloninger's Tridimensional Personality Model. Neuroticism appears to be the most powerful predictor of depression. Lower-order factors showing a significant and consistent relationship with depressive illness include dependency, self-criticism, obsessionality, and perfectionism. The links between depression and dependency and self-criticism have the strongest empirical support. Conclusions Several personality dimensions are significantly associated with depressive illness, but the evidence that unequivocally demonstrates a true personality predisposition for depression is modest. Measures of personality may prove to be clinically useful for treatment selection.
Évaluation du potentiel de ressources communautaires en santé mentale
Authors: Wallot H 
Published: January 2017

Objectifs: Dans le cadre d'une réflexion sur l'organisation régionale des services de santé mentale, décrire et évaluer un modèle parallèle de services de santé mentale non professionnels de type centre de jour. Méthodologie: Sujets étudiés: 129 d'un échantillon stratifié de 3 organismes communautaires d'une sous-région surtout urbaine du Québec. La collecte des données s'est faite en plusieurs étapes auprès de 3 types de répondants: l'usager, l'équipe clinique et l'organisme communautaire. Outils: le GAS, le MRSS et un questionnaire visant à établir un profil sociodémographique, un profil de santé (diagnostic, médicaments, hospitalisations, suivi externe), et l'EDBES qui évalue la présence ou l'absence du besoin de 25 services de santé mentale et l'utilisation de ceux-ci au cours du dernier mois. Résultats: Les usagers sont majoritairement des personnes souffrant de troubles graves et persistants. Les organismes communautaires répondent à 40% des besoins. Conclusion: Les 3 organismes jouent un rôle prépondérant au sein des services. On pourrait toutefois améliorer leur apport en accroissant d'une part les subventions allouées, afin de les doter d'un personnel stable et de prolonger les heures d'accueil, et d'autre part, augmenter la coordination, ainsi que la coopération avec les équipes cliniques traitantes.
Cognitive-Behaviour Therapy and Medication in the Treatment of Obsessive-Compulsive Disorder: A Controlled Study
Authors: O'Connor K , Todorov C , Robillard S , Borgeat F , Brault M 
Published: January 2017

Objective: To evaluate the effect of combining cognitive-behaviour therapy (CBT) and medication in the treatment of obsessive-compulsive disorder (OCD). Method: Twenty-nine subjects diagnosed with OCD according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria were recruited through the Anxiety Clinic of Louis-H Lafontaine Hospital. They were evaluated at baseline and after treatment on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) by a psychiatrist who was blind to treatment modality. Subjects rated their degree of resistance to their rituals and the strength of their obsessional beliefs. Subjects then received 1 of 4 treatments: medication and CBT simultaneously (n = 9), CBT only (n = 6), medication while on a wait-list for CBT (n = 6), or no treatment while on a wait-list for CBT (n = 5). Results: Multivariate analysis revealed that Y-BOCS scores and clinical ratings significantly improved posttreatment in all groups except the nontreatment wait-list control group. Subjects in the 2 active treatment groups receiving CBT showed reduced strength in their obsessional beliefs. The subsequent administration of CBT to those groups on the wait-list also decreased the strength of their primary obsessional beliefs and beliefs about the consequences of not performing the rituals. Conclusions: Our results suggest that either CBT or medication alone is more effective than no treatment. The combination of CBT and medication seems to potentiate treatment efficacy, and we found it more clinically beneficial to introduce CBT after a period of medication rather than to start both therapies simultaneously.
Economic Impacts of Assertive Community Treatment: A Review of the Literature
Authors: Latimer Eric A 
Published: January 2017

Background: Assertive community treatment (ACT) is an extensively studied and widely imitated community support treatment model for severely mentally ill individuals. Several previous reviews have documented its favourable effects on clients and their families. This is the first review to focus on economic outcomes. Methods: Nineteen randomized studies and 15 nonrandomized studies describing ACT programs were identified based on 2 criteria: 1) provision of services primarily in the community and 2) shared caseloads. Percentage reduction in hospital days was calculated for the 34 study sites where reported data allowed it. Multiple-regression methods were used to relate reduction in hospital days to program fidelity and other contextual factors. The impacts of ACT on emergency-room use, use of outpatient services, housing, costs, and other economic outcomes were also examined. Results: Higher-fidelity programs appear to reduce hospital days by about 23 percentage points more than lower-fidelity programs (95% CI = −41.2, −5.2). The estimated regression coefficients imply that a high-fidelity program reduces hospitalizations by about 58% over 1 year if the alternative involves some type of case management and by 78% if it does not. A CT appears to increase the proportion of clients who live in independent housing situations, but the effect on use of supervised housing, and therefore on housing costs, is ambiguous. The effects on use of most other resources are inconsistent across studies. Overall, ACT appears to result in somewhat lower costs, whatever the perspective of analysis adopted. Conclusions: The most reliable cost offset to A CT treatment costs appears to be reduced hospital use. Using Quebec costs, an A CT program must enroll people with prior hospital use of about 50 days yearly, on average, to break even. As care systems evolve to reduce their reliance on hospitalization as a care modality with or without ACT, this threshold will become increasingly difficult to achieve. The primary justification for implementing ACT services will then become their clinical benefits.
The Valuation of Productivity Costs Due to Premature Mortality: A Comparison of the Human-Capital and Friction-Cost Methods for Schizophrenia
Authors: Goeree Ron , O'Brien Bernie J , Blackhouse Gordon , Agro Karen , Goering Paula 
Published: January 2017

Objective: To compare productivity-cost estimates/or schizophrenia-related premature mortality in Canada in 1996 using the human-capital (HC) approach and friction-cost (FC) method. Methods: The number of deaths directly attributed to schizophrenia was combined with the estimated number of deaths attributable to schizophrenia from suicide. These premature deaths were valued using 2 methods: J) the traditional HC approach, based on “potential” lost output to normal age of retirement, and 2) the FC method, based on finding a replacement worker. Results: In 1996, there were 342 male and female preretirement deaths attributed to schizophrenia, directly or indirectly by suicide, in Canada. Most deaths were in males (78%) and by suicide (97%). The productivity cost of these deaths was estimated to be $105 million using the HC approach but only $1.53 million using the FC method. Conclusions: Productivity-cost estimates from the HC approach are substantially higher than those obtained from the FC method (69 times higher). In circumstances of unemployment, the HC approach is an overestimate of future productivity losses for premature mortality.
Recruitment into Psychiatry: Increasing the Pool of Applicants
Authors: Weintraub Walter , Plaut S Michael , Weintraub Eric 
Published: January 2017

Objective: To demonstrate that it is possible to identify the cohort of students in their first year of medical school from which future psychiatrists will be recruited. Method: During a 3-year period, all first-year medical students at the University of Maryland completed a form indicating their specialty preference. Of those students, 403 pursued the regular psychiatry curriculum, and 34 participated in an enriched behavioural science and psychiatry program. Specialty was chosen after graduation. Results: The higher the first-year student ranked psychiatry as a preferred specialty, the more likely the student was to choose psychiatry as a career after graduation. This was true both for students in the regular psychiatry program and for those in the enriched program. Students in the enriched program were significantly more likely to choose psychiatry as a career than were “regular” psychiatry students who gave psychiatry the same ranking in their first year. Freshman students who ranked psychiatry 4th or lower were not likely to choose psychiatry, no matter how much encouragement they received from their psychiatry departments. Conclusions: 1)Specialty preferences in the freshman year are predictive of future career choices. 2) An enriched medical school program in psychiatry can increase the number of graduates choosing careers in psychiatry. To help resource-poor medical schools increase the number of American medical graduates choosing psychiatry, the authors propose 2 inexpensive enriched programs.
Patient Attitude towards Waiting in an Outpatient Clinic and its Applications
Authors: Huang Xiao-Ming 
Published: January 2017

Patient waiting time in outpatient clinics is often the major reason for patients' complaints about their experiences of visiting outpatient clinics. Therefore, patient satisfaction with waiting time plays a crucial role in the process of health quality assurance or quality management. This paper reports the results of a survey on patient attitude towards waiting in an outpatient surgery clinic Generally patients appear reasonably satisfied if they wait no more than 37 minutes when arriving on time, and no more than 63 minutes when late for appointments. Patients coming up to 15 minutes early are prepared to take full responsibility for the extra waiting caused, but the patients coming even earlier intend to be seen earlier and are only prepared to wait 15 minutes longer than otherwise. The potential applications of patient attitude towards waiting in the quality assurance process, ie setting up waiting time limits and designing patient dispatching rules, are also discussed.
Microbiological Flora in Men with Non-Gonococcal Urethritis with Particular Reference to Anaerobic Bacteria
Authors: Woolley P D , Kinghorn G R , Talbot M D , Duerden B I 
Published: January 2017

In a microbiological study of the urethral flora in men with non-gonococcal urethritis (NGU), Chlamydia trachomatis (isolated from 30% of men) was the only organism isolated significantly more often from men with NGU than controls ( P<0.01). Bacteroids species, especially of the melaninogenicus-oralis group, were the predominant anaerobic bacterial isolate from both men with NGU (isolated from 24%) and controls (isolated from 30%). There was no evidence that aerobic bacteria, anaerobic bacteria or herpes simplex virus made a significant contribution as primary pathogens in non-chlamydial NGU. Gram-positive cocci were the only anaerobic organism isolated more often from chlamydia-positive men (29%) than chlamydia-negative men (16%) with NGU ( P<0.01). The significance of this remains unclear.
Low Incidence of Anti-Interferon-Alpha Antibodies in Patients Treated with Interferon-Alpha-2A for AIDS-Associated Kaposi's Sarcoma
Authors: de Wit Ronald , Bakker Piet J M , Danner Sven A , Goudsmit Jaap , Veenhof Kees H N 
Published: January 2017

Anti-interferon (IFN)-alpha antibodies were determined in the serum of 28 patients treated with high-dose human recombinant IFN-alpha-2a for AIDS-associated Kaposi's sarcoma. After a median treatment duration of 3 months, 3 patients developed anti-IFN-alpha antibodies, of whom 2 showed a long lasting tumour response despite the development of these antibodies. None of 3 patients with tumour progression after an initial treatment response had developed IFN-alpha neutralizing antibodies. In conclusion, a low incidence of anti-IFN-alpha antibodies during treatment with high dose IFN-alpha was found, but the appearance had no detrimental effect on the duration of tumour responses in a small number of patients.
AIDS in the Netherlands: The Effects of Several Years of Campaigning
Authors: de Vroome E M M , Paalman M E M , Sandfort Th G M , Sleutjes M , de Vries K J M , Tielman R A P 
Published: January 2017

One of the primary aims of acquired immunodeficiency syndrome (AIDS) prevention campaigns in the Netherlands has been to inform the public of the facts about AIDS, thereby stimulating informed, but voluntary action to prevent transmission of the human immunodeficiency virus (HIV). By conducting successive population surveys from April 1987 until October 1989, the effects of this approach were assessed. Twice a year, approximately 1000 respondents, a random sample from the general population, were interviewed about AIDS and safe sex. Additionally, condom sales figures and STD incidences were evaluated. It appears that knowledge about the prevention of HIV transmission with condoms has reached 98% of the sample. During the study, there was an increase in the number of people who expressed an intention to use condoms or who already used them. Behaviour, however, appeared to fall short of intention. The observations were confirmed by condom sales figures and STD incidences. We conclude that the AIDS policy in the Netherlands has had beneficial effects, reflected by several indices.
How Much Paediatric HIV Infection Could Be Prevented by Antenatal HIV Testing?
Authors: Dunn David T , Nicoll Angus , Holland Fiona J , Davison Clare F 
Published: January 2017

Objective To estimate the reduction in the number of children infected with HIV that might be achieved by extending the provision of voluntary antenatal HIV testing. This effect would be mediated by increased numbers of women infected with HIV who receive an intervention to reduce the risk of vertical transmission (for example, zidovudine or caesarean section delivery), who use an alternative to breast feeding, or whose pregnancy is terminated. Setting London, United Kingdom. Methods Relevant data were derived from neonatal seroprevalence studies, obstetric and paediatric reporting schemes, and review of external information. Sensitivity analyses were performed for certain parameters. Results Of 106 000 births annually in London, an estimated 169 are to women infected with HIV whose infection is not currently recognised before pregnancy. An estimated 28–33 children born to these women will be infected. Precise prediction of the number of paediatric HIV infections that could be prevented is difficult because of uncertainty in certain factors, particularly the uptake of antenatal testing and the efficacy and acceptability of interventions to reduce prenatal or perinatal transmission. If a testing programme detected 70% of infected women, none of whom opted for a termination but all of whom exclusively bottle fed and received an intervention which halved the risk of transmission, about 12–16 (42–46%) paediatric HIV infections would be prevented annually. Conclusions — The estimated cost of preventing each paediatric infection is high, but this should be seen in the context of the lifetime health and social care costs for a child infected with HIV. The feasibility of selective testing should be considered when formulating policies on antenatal HIV testing. Programmes that are introduced should be audited to obtain better estimates of costs and benefits.