bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Delusional Parent: Family and Multisystemic Issues
Authors: Ulzen Thaddeus PM , Carpentier Russell 
Published: January 2017

Objectives: To examine the dilemmas for children, family, and mental health professionals posed by the presence of a delusional parent in a family, including someone with induced psychotic disorder (IPD); to identify frequently unrecognized problems; and to propose practical suggestions for professionals. Method: The pertinent literature on the effects of delusional parents on children, families, and professionals is reviewed. By way of 3 case vignettes, the dilemmas are identified and discussed. Results: Delusional disorders are underdiagnosed, resulting in poor anticipation of their implications. Unanticipated family factors, such as “pursuit of isolation” and the related heightened risk of violence, contribute to the failure of professional interventions, which has been described as “therapeutic systems paralysis.” Conclusions: These cases are complex, often requiring multisystemic involvement to reduce the risks of flight, violence, psychosis, posttraumatic stress disorder, and other psychiatric sequelae to children and other family members. The critical features of the innovative collaboration (“therapeutic consensus”) required between professionals for successful therapeutic interventions with these families are described.
Children of Parents with Bipolar Disorder: A Metaanalysis of Risk for Mental Disorders
Authors: Lapalme Micheline , Hodgins Sheilagh , LaRoche Catherine 
Published: January 2017

Objective: To compare the prevalence rates of mental disorders among children of parents with bipolar disorder and of parents with no mental disorders. Method: Seventeen studies, meeting specific selection criteria, were included in the metaanalyses. Risks for mental disorders among children were estimated by aggregating raw data from the selected studies. Results: Results indicate that in comparison with children of parents with no mental disorders, children of parents with bipolar disorder are 2.7 times more likely to develop any mental disorder and 4.0 times more likely to develop an affective disorder. The metaanalyses indicate that during childhood and adolescence, the risks for any mental disorder and for affective disorders in children are consistently but moderately related to having a parent who suffers from bipolar disorder. Conclusions: Risk factors that could account for the psychopathology observed in children of bipolar parents are explored.
Child Psychiatric Consultation Service to Community Agencies: A Collaborative Approach Involving Three Community Agencies
Authors: Froese Arthur , Dwyer-Sepic Patrice , Parker Kevin 
Published: January 2017

Objective: To report the early experience of a multiagency child psychiatric consultation service. Method: The program is described, and the demographic characteristics of clients referred to the consultation program over the first 25 months of operation are presented. Referrals were examined for demographics and the questions consultees wanted to have answered. Results: In 59 of 100 consultations, physical and/or sexual abuse was proved or highly suspected. In 82 of the 100 cases, consultees had questions pertaining to management issues. Questions related to diagnostic issues numbered 62, and there were 45 questions about safety issues. Conclusion: Effective psychiatric consultations services to rural areas can be established. Once established, the questions of consultees can provide an effective training ground for future community-oriented child psychiatrists.
Providing Psychiatric Backup to Family Physicians by Telephone
Authors: Kates Nick , Crustolo Anne-Marie , Nikolaou Lambrina , Craven Marilyn A , Farrar Sheryl 
Published: January 2017

Objective: To examine whether links between psychiatric services and family physicians can be strengthened and additional support provided for family physicians if a psychiatrist is available by phone to respond to clinical calls from family physicians. Method: A psychiatrist, who visited 18 family physicians in 5 practices on a regular basis to provide clinical consultations, was available to provide telephone backup concerning mental health problems the family physicians encountered. All calls received by the psychiatrist were documented and analysed at the end of a 12-month period. Results: Over the course of one year, 128 calls were received from the 5 practices. Fifty were considered urgent, while 78 involved more routine management or medication issues. Telephone advice enabled the family physicians to handle these cases more effectively, often reducing utilization of other mental health services and providing support that was not otherwise available. The average time spent per call was 8 minutes, which meant the psychiatrist was only spending 20 minutes per week on the phone responding to family physicians' requests. Conclusion: Providing telephone backup to family physicians is a time-efficient and effective method of supporting family physicians and reducing utilization of mental health services. It is applicable to psychiatrists working in any clinical setting.
Depression in Primary Care—More like Asthma Than Appendicitis: The Michigan Depression Project
Authors: Klinkman Michael S , Schwenk Thomas L , Coyne James C 
Published: January 2017

Objective: To explore the relationships between detection, treatment, and outcome of depression in the primary care setting, based upon results from the Michigan Depression Project (MDP). Methods: A weighted sample of 425 adult family practice patients completed a comprehensive battery of questionnaires exploring stress, social support, overall health, health care utilization, treatment attitudes, self-rated levels of stress and depression, along with the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HAM-D), and the Structured Clinical Interview for DSM-III (SCID), which served as the criterion standard for diagnosis. A comparison sample of 123 depressed psychiatric outpatients received the same assessment battery. Family practice patients received repeated assessment of depressive symptoms, stress, social support, and health care utilization over a period of up to 60 months of longitudinal follow-up. Results: The central MDP findings confirm that significant differences in past history, severity, and impairment exist between depressed psychiatric and family practice patients, that detection rates are significantly higher for severely depressed primary care patients, and that clinicians use clinical cues such as past history, distress, and severity of symptoms to “detect” depression in patients at intermediate and mild levels of severity. As well, there is a lack of association between detection and improved outcome in primary care patients. Conclusion: These results call into question the assumption that “depression is depression” irrespective of the setting and physician, and they are consistent with a model of depressive disorder as a subacute or chronic condition characterized by clinical parameters of severity, staging, and comorbidity, similar to asthma. This new model can guide further investigation into the epidemiology and management of mood disorders in the primary care setting.
The Meaning of Body Image for Women with Eating Disorders
Authors: Jarry Josée L 
Published: January 2017

Objective: To propose a theoretical model accounting for the meaning and function of body image disturbances for individuals with eating disorders. This model departs from available conceptualizations of body image focused on attractiveness and emphasizes the role of body image preoccupations in the regulation of self-esteem and affect. Method: This model was developed on the basis of the author's clinical observations and the available empirical research. Results: Three main functions of body image are described. The first one, “affiliation,” consists of using one's appearance in the establishment of interpersonal relationships, both at the level of friendship and romance. The second function, “avoidance,” consists of using one's body image to avoid abuse, be it psychological, physical, or sexual. The third function, “expression,” consists of using one's body image to communicate to the self and others one's capacity for accomplishment or one's inner feelings of dejection. Conclusion: This model is designed to be a therapeutic tool within body image therapy. Body image therapy can be most effective when focused on the unique meaning of body image for each individual patient.
A Group Therapy Approach to Facilitate Integration of Risk Information for Women at Risk for Breast Cancer
Authors: Esplen Mary Jane , Toner Brenda , Hunter Jonathan , Glendon Gordon , Butler Kate , Field Barbara 
Published: January 2017

Objective: To describe and illustrate elements of a group counselling approach designed to enhance the communication of risk information on breast cancer (BC) to women with a family history of this disease. Breast cancer is a leading cause of female cancer death. The most important risk factor for BC is a positive family history in at least 1 first-degree relative, and approximately one-third of women with BC have a family history of the disease. Recent evidence suggests that there is a significant psychological impact associated with having a family history of BC, and this may influence the psychological adjustment and response to being counselled for personal risk. New counselling approaches are required. Method: This paper describes a group therapy approach that incorporates principles of supportive-expressive therapy designed to address the emotional impact of being at risk for BC and to promote accuracy of perceived risk. The key elements of the intervention are described along with clinical illustrations from groups that are part of an ongoing study to develop and standardize the group therapy. Conclusion: Qualitative data from the groups suggest that this model of therapy is both feasible and effective.
Affect and Marital Adjustment in Women's Rating of Dyspareunic Pain
Authors: Meana Marta , Binik Irv , Khalife Samir , Cohen Deborah 
Published: January 2017

Objective: To investigate the extent to which depressive symptomatology, anxiety, and marital adjustment mediate pain ratings in women suffering from dyspareunia. Method: Seventy-six women with dyspareunia were administered the depression and anxiety scales of Derogatis's Brief Symptom Inventory and the McGill Pain Questionnaire. They also underwent a manual-visual gynecological examination, an ultrasound, and a colposcopy in an attempt to identify potential evidence and type of organicity. Results: Depressive symptomatology, anxiety, and marital adjustment together accounted for a significant amount of the variance in pain ratings, although only anxiety and marital adjustment were independent predictors of pain ratings in the entire group of women with dyspareunia. When multiple regression analyses were then applied to different diagnostic subgroups of dyspareunia, the independent predictors of pain rating varied depending on the findings from the gynecological examinations. Conclusion: Affect and marital adjustment appear to be significant predictors of dyspareunic pain rating, although the independent contribution of psychosocial variables may vary depending on the presence and type of organic findings.
Therapy with Lesbian Couples: The Issues and the Interventions
Authors: Igartua Karine J 
Published: January 2017

Objective: To highlight difficulties that are unique to lesbian couples by reviewing the data that contrast lesbian and heterosexual couples and exploring the theories that explain the observed differences in couple dynamics. Method: A review of the literature contrasting demographics and relationship characteristics in lesbians and heterosexual couples was conducted, and a review of lesbian psychotherapy literature was performed. Results: The differences in couple dynamics may be attributed to female relational styles and the stresses of being in a relationship that is not socially sanctioned (homophobia). Conclusions: Therapists should not use heterosexual standards when evaluating lesbian relationships because this may lead to misconstruance of a couple's emotional intensity as pathological. They should, however, recognize the problems that stem from pathological levels of fusion. When evaluating a couple, clinicians must assess the level of internalized homophobia so as to understand when the couple's difficulties originate from unresolved conflicts over sexual orientation.
Supervision of Termination in Psychotherapy
Authors: Robb Marjorie , Cameron Paul M 
Published: January 2017

Objective: To propose a model for teaching and supervising the termination process in psychoanalytic psychotherapy. Method: Group supervision of the 12-week termination phase of psychotherapy with a patient who had been in psychotherapy with a senior resident for 2 years. Results: This supervisory method provided a positive termination experience for the patient and valuable group-teaching experience for residents at various levels in their training. Conclusion: A group supervisory teaching process is a particularly effective way of teaching the termination process and is more efficient in terms of time, energy, and dissemination of knowledge than a traditional one-on-one supervision model.
The Use of Psychotropic Medication in Preschoolers: Some Recent Developments
Authors: Minde K 
Published: January 2017

Objective: To provide an overview of the use of psychotropic drugs in preschoolers. Method: Literature review. Results: Although controversy persists, the evidence suggests that preschool children are being given an increasing number of psychotropic drugs, especially by general practitioners and pediatricians. Conclusion: There is an urgent need to formally evaluate the efficacy of psychotropic medication for young children.
The Use of Psychotropic Medication in Preschoolers: Indications, Safety, and Efficacy
Authors: Greenhill Laurence L 
Published: January 2017

Objective: To review the indications, safety, and efficacy of psychotropic medications used in preschoolers. Methods: Proprietary prescription-use databases indicate that practitioners are prescribing psychotropic medications for preschool patients at an increasing rate. A Medline search was conducted using drug exposure for children below the age of 6 years to identify efficacy and safety reports of these agents in the preschool age-group. Results: The search yielded 22 reports that mention exposure to medications, including maternal exposure, accidental overdose, and adverse events in preschool children. Safety issues highlight the age-specific vulnerabilities of this age-group, including hepatotoxicity from valproic acid, among others. In addition, the prominence of adverse-event responses in this age group may be related to polypharmacy not seen in school-age children or adolescents. Less than a dozen controlled efficacy studies of psychotropic agents were identified for children in the preschool age-group. These are limited by the small numbers of subjects in the reports. Only 2 disorders described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), attention-deficit hyperactivity disorder (ADHD) and autistic disorder, are mentioned. The Food and Drug Administration (FDA) approved psychotropic medications for preschoolers but limited their use to medical purposes, not psychiatric, with the exception of use for ADHD. Conclusions: Because data about psychotropic drug safety and efficacy in adults have not been extended to children, new psychopharmacological research is required before clinicians can use these agents to treat psychiatric disorders in the preschool age-group.
Autism and other Pervasive Developmental Disorders: Exploring the Dimensional View
Authors: Myhr Gail 
Published: January 2017

Objective: To examine empirical data on children with autistic disorder (AD), Asperger's disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) for continuities or distinguishing features between disorders and to see to what extent the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic criteria reflect observed data. Method: Studies were identified in 4 ways. 1) A Medline search from 1976 to the present of articles with the key words autism, pervasive developmental disorder, autistic spectrum disorder, and Asperger; of these articles, those with mesh headings or textwords “cluster,” which identified cluster analyses deriving pervasive developmental disorder (PDD) subtypes, were retained. 2) The Journal of Autistic and Developmental Disorders from 1990 to the present was hand-searched to identify other empirically derived studies on diagnosis, prevalence, classification, and validity of PDD subtypes. 3) Key review articles were searched for their references. 4) The references of all identified articles were searched. Results: Eight cluster studies were retained for their relevance to diagnostic issues, as were 7 empirically derived studies delineating clinical characteristics of children with AD, Asperger's syndrome, or PDD-NOS. Data suggest that children with PDD may fit into 1 of 2 overlapping groups, including a lower-functioning group with greater developmental compromise, social aloofness, and a greater number of autistic symptoms and a higher-functioning group with higher IQ, fewer autistic symptoms, and more prosocial behaviour. The PDD subtypes resemble each other and can be seen as existing on a continuum, differing only by degree of impairment. Conclusion: Children exhibiting the triad of autistic impairments can be seen as suffering from disorders on a PDD continuum. While the DSM-IV does identify a lower-functioning autistic group (AD), the higher-functioning group is less well served. Asperger's disorder as defined in the DSM-IV is not clearly distinguishable from AD and PDD-NOS, and the PDD-NOS subcategory is not operationalized. Further research is required to elaborate criteria for the higher-functioning PDD group, and measures related to etiology, outcome, and treatment response may help determine which diagnostic criteria can meaningfully separate one disorder from another.
What Does Early Antisocial Behaviour Predict? A Follow-up of 4- and 5-Year-Olds from the Ontario Child Health Study
Authors: Lipman Ellen L , Bennett Kathryn J , Racine Yvonne A , Mazumdar Rupak , Offord David R 
Published: January 2017

Objective: To examine the predictive accuracy of antisocial behaviours among 4- and 5-year-old children for problem behaviours 4 years later (ages 8 and 9 years). Method: Data from the Ontario Child Health Study (1983) and Follow-Up (1987) are used. Predictive accuracy is conceptualized using positive predictive value (PPV) and sensitivity. The predictive accuracy of early antisocial behaviours for the 1987 outcomes is examined overall, by gender, by variable thresholds of predictor and outcome by gender, and by using contextual variables alone or in combination with antisocial behaviour recorded in 1983. Results: The predictive accuracy of 1983 antisocial behaviour for 1987 outcome is generally modest and differs by gender (better for boys for externalizing disorder [PPV = 41%, sensitivity = 57%]; better for girls for internalizing disorder [PPV = 13%, sensitivity = 80%]; better for boys for conduct problems [PPV = 54%, sensitivity = 21%]). Using either gender-specific thresholds or gender-neutral thresholds does not alter predictive accuracy in a consistent way, nor does the use of a single contextual variable. Use of a cumulative risk index increases PPV but decreases sensitivity. Conclusions: The predictive accuracy of antisocial behaviour in 4-and 5-year-old children over 4 years in a nonclinical community population is limited. The clinical, research, and policy implications of this work are discussed.
The Integration of Child Psychiatry into a Psychiatry Clerkship OSCE
Authors: Hanson Mark , Hodges Brian , McNaughton Nancy , Regehr Glenn 
Published: January 2017

Objective: To integrate child psychiatry into a psychiatry clerkship Objective Structured Clinical Examination (OSCE). Method: Child psychiatry OSCE stations were designed to evaluate clerks' skills in the identification of 4 common conditions. Child psychiatrists wrote case scenarios and checklists and supported standardized patient (SP) training for these stations. A bank of 4 child psychiatry OSCE stations is now available for use in the psychiatry OSCE. Child psychiatry faculty have been trained as examiners for ongoing administration of this OSCE. Results: This bank of child psychiatry OSCE stations has examined 402 clerks. Mean student scores for content were 68% to 86% and for process were 69% to 76%. Station reliability and examiner feedback were acceptable. Conclusions: Child psychiatry has been successfully integrated into a psychiatry clerkship OSCE. Although the commitment in terms of monetary and faculty costs has been considerable, the accompanying educational benefits of such integration warranted this expense.
Culture and Munchausen-by-Proxy Syndrome: The Case of an 11-Year-Old Boy Presenting with Hyperactivity
Authors: Amirali Evangelia L , Bezonsky Rhona , McDonough Rita 
Published: January 2017

Objectives: To discuss some of the challenges presented to the clinician who deals with a possible Munchausen-by-proxy (MBP) syndrome. Method: The case of an 11-year-old boy presenting with hyperactivity is discussed. Information from the initial assessment and the 9-month follow-up period is presented. We highlight some cultural considerations as they apply to this immigrant family. A commentary by Dr H Schrier follows the presentation. Results: The positive outcome is discussed in relation to the validation of the diagnosis as well as to cultural issues. Conclusion: Cultural issues and dynamic factors may be important when we consider the diagnosis of MBP syndrome in an immigrant family with different expectations from our health care system.