bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment-Resistant Depression: A Survey of Practice Habits of Canadian Psychiatrists
Authors: Chaimowitz G.A. , Links P.S. , Padgett R.W. , Carr A.C. 
Published: April 2017

Treatment-resistant depression is a fascinating yet poorly defined condition. The various management strategies in use are a source of controversy. The objective of this survey was to determine how Canadian psychiatrists treat patients with “intractable depression.” This information may be used to plan future research into the management of treatment-resistant depression. It may also provide information about the practices of Canadian psychiatrists and help direct residency training. Confidential questionnaires were mailed to all psychiatrists residing in Canada registered with the Canadian Psychiatric Association. Respondents indicated that 12.4% of their depressed patients were “resistant to treatment.” Respondents were asked to rank a list of treatment choices in the order they would use them to treat patients with treatment-resistant depression. Ninety-five point eight percent of respondents used tricyclics as the first treatment of choice. Almost equal portions of respondents chose a second tricyclic, a monoamine oxidase inhibitor (MAOI) or a combination of lithium and tricyclics as their treatment of second choice.
Offenses and Defenses against Patients: A Psychoanalyst's View of the Borderline between Empathic Failure and Malpractice
Authors: Sloane John A. 
Published: April 2017

The behaviour of physicians is increasingly coming under scrutiny and attack, both from patients and from institutions that represent the public interest. This social process is partly a necessary and healthy quest for healing and partly a retaliatory response to inevitable failures on the part of physicians to live up to the standards expected of them. The process can assume such ruthless and pervasive forms that physicians are becoming exposed to impossible demands and even abuse at the hands of those they are trying to help. As a result, many physicians become defensive, withdrawing from patient care or reasserting their own needs in regressive ways that further offend or injure their patients. This increases public anxiety and outrage resulting in regressive and even violent “solutions” creating a vicious cycle in which mutual trust and respect is eroded and true health eludes our grasp. Physicians who practise psychotherapy are particularly aware of such regressive emotional pressures and therefore their experience can be taken as a bellwether of social change. Stirred by recent encounters with colleagues who have undergone public inquisition, humiliation and punishment, and drawing on personal clinical experience with patients whose regressive self-expression could at times be considered “borderline”, the author attempts to understand the nature of the emotional forces being experienced by members of the profession at large. As in therapy, so in social change; the outcome depends on how well we understand, contain and channel the powerful feelings that underlie whatever actions are taken. Failure to do so makes the situation worse, while recognition of empathic failure at all levels can provide an opportunity for healing and for reintegration rather than polarization of opposing forces at the border between what is acceptable and what is not.
Psychiatrists' Attitudes to Multiple Personality Disorder: A Questionnaire Study
Authors: François M. Mai 
Published: April 2017

Objective To assess the attitudes of a random sample of Canadian psychiatrists to Multiple Personality Disorder (MPD) and assess the relative prevalence of the condition in three comparable cities in Ontario. Method A questionnaire was sent to all psychiatrists who were members of the Canadian Psychiatric Association and who were resident in Ottawa, Kingston and London. Questions were asked on the respondent's personal clinical experience of MPD and his/her attitude to this condition. Some personal and demographic questions were also included. Results 180 out of 294 questionnaires (61.2%) were returned. The existence of MPD was doubted by 27.8% of psychiatrists who responded to the questionnaire, with a significantly higher proportion in London than in Kingston or in Ottawa. A substantial majority in all three cities agreed that media publicity and the psychiatrist's own belief system affected the prevalence of MPD. Conclusion These results confirm that there is a split in the profession regarding belief in the existence of MPD as a diagnosis.
A Clinical Study of Clozapine Treatment and Predictors of Response in a Canadian Sample
Authors: William G. Honer , William Macewan G. , Kopala Lili , Altman Siemion , Chisholm-Hay Sherri , Singh Kulbir , Geoffrey N. Smith , Ehmann Thomas , Ganesan Soma , Lang M. 
Published: April 2017

Objective To study the clinical response to clozapine in patients with refractory schizophrenia. Method Open trial of clozapine in 61 consecutively-treated patients. Results Following clozapine, the level of function of patients was improved relative to admission (p = 0.0001) and to the highest level in the previous year (p = 0.0001). Severity of illness was decreased (p = 0.0001). Overall, 31% of the patients were classified as responders to clozapine and the responders were all identified by 32 weeks of treatment. Poor functioning in the previous year was associated with less favourable response. At a mean interval of 26 months following discharge, 72% of the patients were continuing clozapine treatment. Conclusions This open trial of patients who were treated consecutively indicates a comparable degree of response to clozapine as observed in controlled clinical trials, and that level of functioning in the previous year was the best predictor of response.
Direct Cost of Depression: Analysis of Treatment Costs of Paroxetine versus Imipramine in Canada
Authors: Lapierre Yvon , Bentkover Judith , Schainbaum Sandra , Manners Steven 
Published: April 2017

Objective To assess the potential economic impact of new and more expensive antidepressants on the overall cost of treatment using cost-effectiveness analysis. Method For this analysis, a computerized decision tree of clinical practice was developed to model the 12-month treatment of moderate to severe depression in Canada. To complete the model, data were obtained from physician panels, the Ontario Ministry of Health, and clinical comparative trials of paroxetine, a selective serotonin reuptake inhibitor, and Imipramine, a tricyclic antidepressant. Results The overall cost of treatment when paroxetine 30 mg per day was used first-line was found to be lower than when generic imipramine was used as the initial therapy ($1697 versus $1793). The higher drug cost of paroxetine ($1.69 per day) versus imipramine ($0.05 per day) was offset by a higher rate of treatment failures with the tricyclic necessitating an alternate therapy, additional physician visits and/or hospitalization. Sensitivity analysis of key variables determined that drug price and relapse rates after discontinuation were relatively insensitive predictors of the overall cost of care. More important was the continuation rate while on different therapies. Conclusion Paroxetine demonstrated a cost-benefit relative to Imipramine when the continuation rate was ≥ 47%. Clinical trials of paroxetine have reported continuation rates of 41% to 65%, suggesting that paroxetine is a cost-effective alternative to Imipramine in the 1-year management of patients with moderate to severe depression.
Pharmacologie Expérimentale et Clinique des Psychostimulants
Authors: Bourin Michel , Le Melledo Jean-Michel , Malinge Myriam 
Published: April 2017

ObjectifExpliquer à l'aide d'études animales le mode d'action des psychostimulants.MéthodeUne revue de la littérature psychiatrique sur l'usage des psychostimulants chez l'enfant et l'adulte.RésultatsEn étudiant la littérature psychiatrique, il s'avère que 50 ans après l'introduction de l'amphétamine en clinique, les psychostimulants sont des médicaments utilisés, notamment le méthylphénidate, dans le traitement de l'hyperactivité de l'enfant avec ou sans déficit de l'attention. En revanche, chez l'adulte les psychostimulants cherchent encore leur voie, malgré des études dans le traitement de la dépression et d'autres maladies mentales. Seule la narcolepsie semble être justifiable de tels produits.ConclusionLa preuve est largement faite de l'utilité des psychostimulants chez l'enfant. Chez l'adulte, ils pourraient être utiles à condition de mieux étudier les symptômes cibles.
Views on Classification and Diagnosis of Eating Disorders
Authors: Garfinkel Paul E , Kennedy Sidney H , Kaplan Allan S 
Published: April 2017

Objective To highlight developments in the taxonomy of eating disorders since Russell's original description of bulimia nervosa (BN) in 1979 and through 3 versions of the Diagnostic and Statistical Manual. Method Criteria for anorexia nervosa (AN), BN and binge eating disorder (BED) are systematically described. Results While criteria for AN remain largely unchanged between DSM-III-R and DSM-IV, the subclassification of binge/purge and restricter subgroups endorses previous research findings. For BN, the definition of “binge” has occupied considerable attention both in quantitative and qualitative terms. The arbitrary choice of 2 episodes per week as a minimum frequency is also discussed in light of recent data from the Ontario Health Supplement. A third eating disorder, BED, is now included in the appendix of DSM-IV under Eating Disorders — Not Otherwise Specified category. The potential overlap between this disorder and nonpurging BN is discussed. Finally, the relationship between eating disorders and other psychiatric disorders including depression, schizophrenia, obsessional, and conversion disorders is considered as well as the continuum from preoccupation with weight to eating disorder. Conclusion While significant advances have been made in understanding and classifying eating disorders during the past 15 years, further empirical work is necessary to clarify areas of uncertainty.
The Five-Factor Model of Personality in Borderline and Nonborderline Personality Disorders
Authors: Zweig-Frank Hallie , Paris Joel 
Published: April 2017

Objective The purpose of this study was to examine to what extent the phenomena associated with a diagnosis of borderline personality disorder (BPD) can be described by the five-factor model of personality. Method The sample consisted of female patients with BPD (n=29) and a control group with a mixture of nonborderline personality disorders (n=30). All subjects were given the NEO-PI-R. Results Borderline patients differed from community norms on all five factors, and were particularly high on Neuroticism, and particularly low on Agreeableness. The scores on the five factors did not differ significantly between the 2 clinical groups. Two facets of the conscientiousness scale (competence and deliberation) were significantly lower in the BPD group. Conclusions Dimensional profiles only partially account for the clinical symptomatology seen in formally diagnosed cases of BPD.
Treatment of Acute Bipolar Depression: A Review of the Literature
Authors: Srisurapanont Manit , Yatham Lakshmi N , Zis Athanasios P 
Published: April 2017

Objective Our goal was to ascertain the efficacy of various antidepressant treatments for acute bipolar depression. Method English articles that reported on the efficacy of antidepressant treatments in bipolar depression were located by computerized Medline and manual search. These studies were systematically reviewed and response rates for each treatment were computed. Results The available data suggest that mood stabilizers, MAOIs, cyclic antidepressants, and ECT are all effective in treating bipolar depression. All antidepressant treatments with the exception of mood stabilizers have been reported to induce a manic/hypomanic switch. Conclusions It is recommended that mood stabilizers may be the first step of treatment, followed by the addition of an antidepressant, especially a cyclic antidepressant. The specific symptoms profile of individual patients, such as anergic or psychotic features, may indicate more specific treatment options. ECT is an important measure for those who are pharmacotherapy-resistant or psychotic.
Tardive Dyskinesia: A Review
Authors: Latimer Paul R 
Published: April 2017

Objective: To review recent research findings on tardive dyskinesia (TD) with relevance to clinical practice. Method: TD is a syndrome of involuntary movements that can occur in association with chronic neuroleptic use. It is of unknown pathophysiology. It can be irreversible, is cosmetically disfiguring, and can be functionally disabling. Results: There is as yet no treatment of demonstrated efficacy for TD. It is an iatrogenic disorder whose incidence is increased by age and total cumulative dose of typical neuroleptics. It has been the source of successful litigation in some jurisdictions but, until very recently, there has been no effective antipsychotic agent without this effect. Conclusion: This litigation in some jurisdictions has been a major impetus to the development of novel antipsychotic agents. It is less well known that a similar, possibly identical, movement disorder occurs spontaneously particularly in the elderly and inpatients with schizophrenia, and that TD is often reversible.
Manganese Provision in Parenteral Nutrition: An Update
Authors: Livingstone Callum 
Published: April 2017

AbstractManganese (Mn) is an essential micronutrient required for the activity of metalloenzymes. It is an essential component of parenteral nutrition (PN), but requirements are low. Mn status is difficult to assess, with the commonest method being measurement of its concentration in whole blood. This method has limitations, including artifactually high concentrations resulting from contamination of specimen tubes. Mn toxicity is a well‐recognized complication of PN, the risk of which increases if there is cholestasis or if the patient has received high doses. It usually presents with parkinsonian‐like symptoms but may be detected presymptomatically as hypermanganesemia or as increased signal intensity of the basal ganglia upon T1‐weighted magnetic resonance imaging. Caution is necessary when providing Mn for patients on long‐term PN (>1 month). It is advisable to withhold supplementation if hypermanganesemia or cholestasis develops. Deficiency of Mn is rare in patients treated with PN. PN regimens are contaminated with Mn in amounts likely to meet requirements. Consequently, it is debated whether PN should be routinely supplemented with Mn. The currently recommended dose of Mn in adults treated with PN is 55 μg/d, but the doses provided by most currently available multi–trace element products exceed this. In response to calls for new products to be developed, 2 new multi–trace element products are currently available in Europe that provide Mn doses of 55 μg/d. Once these products are in general use, it is likely that the incidence of Mn toxicity will decrease.
Neuroscience Intermediate-Level Care Units Staffed by Intensivists: Clinical Outcomes and Cost Analysis
Authors: Kyeremanteng Kwadwo , Hendin Ariel , Bhardwaj Kalpana , Thavorn Kednapa , Neilipovitz Dave , Kubelik Dalibour , D’Egidio Gianni , Stotts Grant , Rosenberg Erin 
Published: April 2017

Introduction: With an aging population and increasing numbers of intensive care unit admissions, novel ways of providing quality care at reduced cost are required. Closed neurointensive care units improve outcomes for patients with critical neurological conditions, including decreased mortality and length of stay (LOS). Small studies have demonstrated the safety of intermediate-level units for selected patient populations. However, few studies analyze both cost and safety outcomes of these units. This retrospective study assessed clinical and cost-related outcomes in an intermediate-level neurosciences acute care unit (NACU) before and after the addition of an intensivist to the unit’s care team. Methods: Starting in October 2011, an intensivist-led model was adopted in a 16-bed NACU unit, including daytime coverage by a dedicated intensivist. Data were obtained from all patients admitted 1 year prior to and 2 years after this intervention. Primary outcomes were LOS and hospital costs. Safety outcomes included mortality and readmissions. Descriptive and analytic statistics were calculated. Individual and total patient costs were calculated based on per-day NACU and ward cost estimates and significance measured using bootstrapping. Results: A total of 2931 patients were included over the study period. Patients were on average 59.5 years and 53% male. The most common reasons for admission were central nervous system (CNS) tumor (27.6%), ischemic stroke (27%), and subarachnoid hemorrhage (11%). Following the introduction of an intensivist, there was a significant reduction in NACU and hospital LOS, by 1 day and 3 days, respectively. There were no differences in readmissions or mortality. Adding an intensivist produced an individual cost savings of US$963 in NACU and US$2687 per patient total hospital stay. Conclusion: An intensivist-led model of intermediate-level neurointensive care staffed by intensivists is safe, decreases LOS, and produces cost savings in a system increasingly strained to provide quality neurocritical care.
A single‐blinded, randomized, parallel group superiority trial investigating the effects of footwear and custom foot orthoses versus footwear alone in individuals with patellofemoral joint osteoarthritis: a phase II pilot trial protocol
Authors: Wyndow Narelle , Crossley Kay M. , Vicenzino Bill , Tucker Kylie , Collins Natalie J. 
Published: April 2017

AbstractBackgroundPatellofemoral joint osteoarthritis is a common condition, yet information regarding conservative management is lacking. Foot orthoses are an effective intervention for improving pain and function in younger individuals with patellofemoral pain and may be effective in those with patellofemoral osteoarthritis. This pilot study will seek to establish the feasibility of a phase III randomised controlled trial to investigate whether foot orthoses worn in prescribed motion controlled footwear are superior to prescribed motion control footwear alone in the management of patellofemoral osteoarthritis.Methods/designThis phase II pilot clinical trial is designed as a randomized, single‐blind, parallel group, two arm, superiority trial. The trial will recruit 44 participants from Queensland and Tasmania, Australia. Volunteers aged 40 years and over must have clinical symptoms and radiographic evidence of patellofemoral osteoarthritis to be eligible for inclusion. Those eligible will be randomized to receive either foot orthoses and prescribed motion control shoes, or prescribed motion control shoes alone, to be worn for a period of 4 months. The feasibility of a phase III clinical trial will be evaluated by assessing factors such as recruitment rate, number of eligible participants, participant compliance with the study protocol, adverse events, and drop‐out rate. A secondary aim of the study will be to determine completion rates and calculate effect sizes for patient reported outcome measures such as knee‐related symptoms, function, quality of life, kinesiophobia, self‐efficacy, general and mental health, and physical activity at 2 and 4 months. Primary outcomes will be reported descriptively while effect sizes and 95% confidence intervals will be calculated for the secondary outcome measures. Data will be analysed using an intention‐to‐treat principle.DiscussionThe results of this pilot trial will help determine the feasibility of a phase III clinical trial investigating whether foot orthoses plus motion control footwear are superior to motion control footwear alone in individuals with patellofemoral osteoarthritis. A Phase III clinical trial will help guide footwear and foot orthoses recommendations in the clinical management of this disorder.Trial registrationRetrospectively registered with the Australian New Zealand Clinical Trials Registry: ACTRN12615000002583. Date registered: 07/01/15.
The effectiveness and cost-effectiveness of a mindfulness training programme in schools compared with normal school provision (MYRIAD): study protocol for a randomised controlled trial
Authors:   the MYRIAD team, Kuyken Willem , Nuthall Elizabeth , Byford Sarah , Crane Catherine , Dalgleish Tim , Ford Tamsin , Greenberg Mark T. , Ukoumunne Obioha C. , Viner Russell M. , Williams J. Mark G. 
Published: April 2017

Abstract
Background
Mindfulness-based approaches for adults are effective at enhancing mental health, but few controlled trials have evaluated their effectiveness or cost-effectiveness for young people. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of a mindfulness training (MT) programme to enhance mental health, wellbeing and social-emotional behavioural functioning in adolescence.

Methods/design
To address this aim, the design will be a superiority, cluster randomised controlled, parallel-group trial in which schools offering social and emotional provision in line with good practice (Formby et al., Personal, Social, Health and Economic (PSHE) Education: A mapping study of the prevalent models of delivery and their effectiveness, 2010; OFSTED, Not Yet Good Enough: Personal, Social, Health and Economic Education in schools, 2013) will be randomised to either continue this provision (control) or include MT in this provision (intervention). The study will recruit and randomise 76 schools (clusters) and 5700 school students aged 12 to 14 years, followed up for 2 years.

Discussion
The study will contribute to establishing if MT is an effective and cost-effective approach to promoting mental health in adolescence.

Trials registration
International Standard Randomised Controlled Trials, identifier: ISRCTN86619085. Registered on 3 June 2016.