bluuebunny/crossref_metadata_2025_split huggingface dataset:
Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)
Authors: Fischer Benedikt , Cruz Michelle Firestone , Rehm Jürgen 
Published: January 2017

Objectives: To summarize key characteristics and consequences of illicit opioid use from the literature and to present corresponding data from a multisite sample of illicit opioid users in 5 Canadian cities (OPICAN study). Method: We undertook an overview of recent literature from North America, Australia, and Europe. We obtained data from the multicity OPICAN cohort study, which consisted of an interviewer-administered questionnaire, a standardized mental health instrument (the Composite International Diagnostic Interview Short Form for depression), and saliva-antibody tests for infectious disease (that is, HIV and hepatitis C virus). The baseline sample ( n = 679) was collected in 2002. Results: Illicit opioid use in Canada and elsewhere is becoming increasingly heterogeneous in terms of opioid drugs used, with heroin playing an increasingly minor role; further, it predominantly occurs in a context of polydrug use (for example, cocaine–crack or benzodiazepines). Large proportions of illicit opioid users have physical and (or) mental health comorbidities, including infectious disease and (or) depression, and therefore require integrated interventions. Finally, morbidity risks among illicit opioid users are often predicted by social marginalization factors, for example, housing status or involvement in crime. Conclusions: Given the epidemiologic profile and high disease burden associated with contemporary forms of illicit opioid use, more effective treatment approaches are urgently needed in Canada and elsewhere. Specifically, treatment must adjust to the extensive polysubstance use realities, yet it must also more effectively address the complex physical and (or) mental health comorbidities presented by this high-risk population.
Phenotypes, Endophenotypes, and Genotypes in Bulimia Spectrum Eating Disorders
Authors: Steiger Howard , Bruce Kenneth R 
Published: January 2017

Objectives: To review the main phenomenological variants observed among bulimia spectrum syndromes and the factors believed to act etiologically for them and also to generate an etiologic model that accommodates known heterogeneities within the population suffering bulimic syndromes. Method: Defining bulimic syndromes broadly, we address threshold and subthreshold forms of bulimia nervosa (BN) and also the provisional or newly proposed diagnoses of binge eating disorder (BED) and purging disorder (PD). We review evidence bearing on the validity of these diagnostic entities and on the place of sociocultural, family-developmental, neurobiological, and genetic factors in a multidimensional etiologic model for these classifications. Results: Available data validate certain bulimic phenotypes and subphenotypes that are characterized by such traits as impulsivity or affective instability. Findings associate subphenotypic, or trait-based, variations with putative endophenotypes, such as reduced serotonin transporter activity, and with candidate genotypes affecting the serotonin system; the data also indicate intriguing correspondences between gene–environment interactions and subphenotypic variations along such dimensions as novelty seeking. Conclusions: Bulimic syndromes sometimes reflect a primary disruption of controls over mood, impulses, and appetite in individuals showing marked psychopathology; at other times, they reflect a more circumscribed erosion of appetitive controls in relatively intact individuals, following prolonged dieting. We argue that dimensional perspectives involving careful attention to comorbid personality traits and symptoms are needed to accommodate existing heterogeneities within the population suffering from bulimia and to characterize the etiologic roles of familial-developmental, neurobiological, and genetic variables (and of interactions among these variables) in bulimic syndromes.
The Social Causes of Psychosis in North American Psychiatry: A Review of a Disappearing Literature
Authors: Jarvis G Eric 
Published: January 2017

Objective: To review the North American literature with respect to the role of social factors in the etiology of psychosis, including schizophrenia. Method: Relevant publications were identified through a search of MEDLINE from 1966 to 2006. Identified studies and articles had to originate in Canada or the United States to be included in the review. Articles written prior to 1966 were identified by cross-referencing bibliographies and reference lists. Articles were considered relevant if they discussed ethnoracial or other social factors as being causal or contributing to the development of psychosis or schizophrenia. Results: The relation between the etiology of psychosis and such social factors as poverty, migration, and racial discrimination has been neglected in the North American psychiatric literature for the last 40 years. In Canada and the United States, there is a dearth of research on these issues: the study of social causes of psychosis has been replaced by a focus on the clinical encounter, in which clinician bias is presumed to be responsible for widespread misdiagnosis of psychosis in minority (mainly African-American) populations. The reasons for neglecting social causes of psychosis in the North American psychiatric literature are obscure but may have to do with the rise of genetic–biological paradigms in recent decades. Conclusions: The neglect of social causes of psychosis in the North American psychiatric literature has been coincident with an increase in scholarly concern among European clinicians and researchers. Careful reading of the European literature may reveal helpful avenues for future investigation in the North American context. In addition, drawing on social science literature and methods may help to clarify mechanisms underlying poverty, migration, and racial discrimination that contribute to psychosis in vulnerable individuals and groups.
Use of Health Care Services for Psychological Distress by Immigrants in an Urban Multicultural Milieu
Authors: Kirmayer Laurence J , Weinfeld Morton , Burgos Giovani , du Fort Guillaume Galbaud , Lasry Jean-Claude , Young Allan 
Published: January 2017

Objective: Research in the United States tends to attribute low rates of use of mental health services by immigrants to economic barriers. The purpose of our study was to examine this issue in the context of Canada's universal health care system. Methods: A survey of the catchment area of a comprehensive clinic in Montreal interviewed random samples of 924 Canadian-born individuals and 776 immigrants born in the Caribbean ( n = 264), Vietnam ( n = 234), or the Philippines ( n = 278) to assess their health care use for somatic symptoms, psychological distress, and recent life events. Results: Overall rates of use of medical services in the past year were similar in immigrant (78.5%) and nonimmigrant (76.5%) groups. Rates of use of health care services for psychological distress were significantly lower among immigrants (5.5% compared with 14.7%, P < 0.001). This difference was attributable both to a lower rate of use of specialty mental health services by immigrants (2.5% compared with 11.7%, P < 0.001) and to differential use of medical services for psychological distress (3.5% compared with 5.8%, P = 0.02). When level of psychological distress was controlled, Vietnamese and Filipino immigrants were one-third as likely as Canadian-born residents to make use of mental health services. The lower rate of use by immigrants could not be explained by differences in sociodemographics, somatic or psychological symptoms, length of stay in Canada, or use of alternative sources of help. Conclusion: Immigrant status is associated with lower rates of use of mental health services, even with universal health insurance. This lower rate of use likely reflects cultural and linguistic barriers to care.
Problematic Physicians: A Comparison of Personality Profiles by Offence Type
Authors: Roback Howard B , Strassberg Donald , Iannelli Richard J , Finlayson AJ Reid , Blanco Mark , Neufeld Ron 
Published: January 2017

Objective: This exploratory study compares objective personality test findings among physicians exhibiting different forms of misconduct. The importance of delineating distinctive personality characteristics by type of offence is that such characterizations can direct therapy and prognosis for remediation. Method: Eighty-eight physicians referred to the Vanderbilt Comprehensive Assessment Program for Professionals (V-CAP) completed the Minnesota Multiphasic Personality Inventory-2, the Personality Assessment Inventory, or both, as part of their evaluation. On the basis of referral information, physicians were partitioned into 3 groups of offenders: “sexual boundary violators,” “behaviourally disruptive,” and “other misconduct.” Results: On both personality measures, the sexual boundary violators generated the greatest percentage of profiles indicative of character pathology. Conclusions: Although all 3 groups exhibited unacceptable behaviours, the pervasive personality features of the sexual boundary violators are associated with greater therapeutic challenge, and these individuals likely pose the greater risk of reoffending.
The Montreal Cognitive Assessment: Validity and Utility in a Memory Clinic Setting
Authors: Smith Tasha , Gildeh Nadia , Holmes Clive 
Published: January 2017

Objective: To prospectively validate the Montreal Cognitive Assessment (MoCA) in a UK memory clinic. Method: We administered the MoCA and Mini-Mental State Examination (MMSE) to 32 subjects fulfilling diagnostic criteria for dementia, to 23 subjects fulfilling diagnostic criteria for mild cognitive impairment (MCI), and to 12 memory clinic comparison subjects, at baseline and then at 6-month follow-up. Clinical diagnoses for dementia and MCI were made according to ICD-10 and Petersen criteria. The sensitivity and specificity of both measures were assessed for detection of MCI and dementia. Results: With a cut-off score of 26, the MMSE had a sensitivity of 17% to detect subjects with MCI, whereas the MoCA detected 83%. The MMSE had a sensitivity of 25% to detect subjects with dementia, whereas the MoCA detected 94%. Specificity for the MMSE was 100%, and specificity for the MoCA was 50%. Of subjects with MCI, 35% developed dementia within 6 months, and all scored less than 26 points on the MoCA at baseline. Conclusions: The MoCA is a useful brief screening tool for the detection of mild dementia or MCI in subjects scoring over 25 points on the MMSE. In patients already diagnosed with MCI, the MoCA helps identify those at risk of developing dementia at 6-month follow-up.
Community Treatment Orders in Toronto: The Emerging Data
Authors: Hunt Alison M , da Silva Angela , Lurie Steve , Goldbloom David S 
Published: January 2017

Objective: Over a 4-year period in Toronto, this study aimed to compare individuals on a community treatment order (CTO) with individuals not on a CTO in terms of sociodemographic and clinical variables, hospital use, and continued engagement with health services on exit from the case management program. Hospital stay reductions from preadmission into the program to various postadmission periods were compared across the 2 groups. Methods: Descriptive statistics and tests of statistical significance (chi-square and t test) were run on regularly collected administrative data for both groups. Results: Categorical data analysis indicated the 2 groups were statistically similar on a range of sociodemographic and clinical variables. Although both groups displayed reductions in hospital use, the CTO group displayed a significantly higher reduction in cumulative days in hospital per hospital admission within both the first and second 6-month period postadmission. This same group also had significantly greater reduction in hospital admissions during the second 6-month period postadmission. The CTO group also had a significantly higher portion of individuals exiting the program within these first two 6-month periods; as well, they were less likely to exit with support such as case management or assertive community treatment and more likely to continue with ongoing medical supervision than the comparison group. Conclusion: Although we were unable to rule out regression to the mean for hospitalization reductions, the Toronto experience has shown that CTOs are helpful in assisting individuals who historically refused services to remain engaged with treatment and support services. The study also calls for broadening operational measures of outcomes for CTO studies.
Epidemiology of Youth Gambling Problems in Canada: A National Prevalence Study
Authors: Huang Jiun-Hau , Boyer Richard 
Published: January 2017

Objectives: To describe the epidemiology of gambling problems among youth aged 15 to 24 years in Canada and to examine whether these gambling prevalence patterns differ by sex and (or) by geographic region. Method: We used data from The Canadian Community Health Survey: Mental Health and Well-Being. Gambling problems were determined according to the Canadian Problem Gambling Index. All prevalence estimates used appropriate sampling weights and bootstrap variance estimation procedures developed by Statistics Canada. Multivariate logistic regression modelling was also employed to supplement the above prevalence comparisons by age, sex, and region. Results: Among Canadian youth aged 15 to 24 years ( n = 5666), 61.35% gambled in the past 12 months and the national prevalence of moderate-risk or problem gambling was 2.22% (3.30% in male respondents and 1.10% in female respondents). Male respondents had significantly higher prevalence of gambling problems than female respondents. Regional prevalence estimates of youth moderate-risk or problem gambling were 1.37% in British Columbia, 2.17% in the Prairie provinces, 2.75% in Ontario, 2.12% in Quebec, and 1.71% in the Atlantic provinces. Conclusions: Youth, particularly young men, are at greater risk for gambling problems than adults. More prevention and research efforts are also needed to address the observed sex differences and interregional variability in the prevalence of gambling problems among youth. The national prevalence estimates from this study provide important baseline data against which future cohorts of Canadians can be monitored and measured.
Anxiety in a Socially High-Risk Sample of Pregnant Women in Canada
Authors: Bowen Angela , Bowen Rudy , Maslany George , Muhajarine Nazeem 
Published: January 2017

Objective: To determine if an anxiety dimension in the Edinburgh Postnatal Depression Scale (EPDS) could be identified in a sample of pregnant women with high social risk factors. Method: Four hundred women attending prenatal outreach programs, most of whom were single, low-income, and Aboriginal, participated in a study of feelings in pregnancy. The primary outcome measure was the EPDS. Data were also collected on sociodemographic, obstetrical–biological, psychological, and behavioural variables. Results: Factor analysis of the EPDS revealed 3 factors: anxiety, depression, and self-harm. The anxiety factor accounted for the greatest variance in the overall EPDS score. Comparisons of different groups of women revealed significantly more anxiety in the women aged under 19 years, compared with those over 25 years ( P < 0.01). Linear regression analysis showed anxiety was associated with age, stressors (that is, pregnancy, health of the baby, birth of the baby, money, and other), history of depression, and fluctuating moods. Conclusions: Anxiety symptoms were predominant in the emotional distress identified by the EPDS in this sample of socially high-risk pregnant women. Younger women appear to experience the highest levels of anxiety. Anxiety in pregnancy in socially high-risk women should not be normalized. Objectif: Déterminer si la dimension de l'anxiété à l'échelle de dépression postnatale d'Édimbourg (EPDS) pouvait être identifiée dans un échantillon de femmes enceintes ayant des facteurs de risque sociaux très élevés. Méthode: Quatre cents femmes assistant à des programmes prénataux de service d'approche, dont la plupart étaient célibataires, à faible revenu, et autochtones ont participé à une étude de sentiments durant la grossesse. La principale mesure des résultats était l'EPDS. Les données ont été recueillies sur des variables sociodémographiques, obstétrico–biologiques, psychologiques, et comportementales. Résultats: L'analyse factorielle de l'EPDS a révélé 3 facteurs: l'anxiété, la dépression, et l'automutilation. Le facteur anxiété représentait la plus grande variance dans le score global à l'EPDS. Les comparaisons de différents groupes de femmes ont révélé significativement plus d'anxiété chez les femmes de moins de 19 ans, comparativement à celles de plus de 25 ans ( P < 0,01). L'analyse de régression linéaire indiquait que l'anxiété était associée à l'âge, aux stresseurs (c'est-à-dire, la grossesse, la santé du bébé, la naissance du bébé, l'argent, et d'autres), aux antécédents de dépression, et aux humeurs changeantes. Conclusions: Les symptômes d'anxiété étaient prédominants dans la détresse émotionnelle identifiée par l'EPDS dans cet échantillon de femmes enceintes socialement à risque élevé. L'anxiété durant la grossesse chez les femmes socialement à risque élevé ne devrait pas être normalisée.
What Stress Does to Your Brain: A Review of Neuroimaging Studies
Authors: Dedovic Katarina , D'Aguiar Catherine , Pruessner Jens C 
Published: January 2017

Objective: Recent neuroimaging studies aimed at investigating effects of psychological stress on the neural activity have used a range of experimental paradigms to elicit an acute stress response. The goal of this review is to, first, summarize results from these studies from a perspective of task design and, second, assess the appropriateness of the different stress tasks used. Method: We completed a PubMed search on recent articles that have examined the effects of psychological stress on neural processes in a neuroimaging environment. Selected articles were arranged according to the stress task used in the following categories: script-driven stress stimuli, Stroop colour-word interference task, speech in front of an audience, serial subtraction, and Montreal Imaging Stress Task (MIST). Results: Only studies using serial subtraction or the MIST were able to induce a significant cortisol stress response in their participants. Most consistent findings include decreased activity in orbitofrontal regions in response to stress. Additional findings of note are increases in activity in the frontal lobes, particularly the anterior cingulate cortex, as well as deactivation of the limbic system, particularly the hippocampus. Conclusion: Research to date is beginning to outline the involvement of prefrontal and limbic regions in perception and modulation of psychological stress. However, additional research is needed in designing a neuroimaging stress task that will yield a significant cortisol stress response consistently, across populations and laboratories.
Imaging Stress Effects on Memory: A Review of Neuroimaging Studies
Authors: van Stegeren Anda H 
Published: January 2017

Objective: To review and give an overview of neuroimaging studies that look at the role of stress (hormones) on memory. Method: An overview will be given of imaging studies that looked at the role of stress (hormones) on memory. Stress is here defined as the acute provocation of the sympathetic adrenal medullar system and the hypothalamic–pituitary–adrenal axis in experimental designs. Stress hormone levels can be raised endogenously in response to stimulus material (for example, pictures and films) or social evaluative threat situations (stress tasks). Other studies use the exogenous application of drugs to enhance or decrease stress hormone levels. Finally, we review studies on chronic stress and memory. Results: Stress or emotional arousal, leading to increased noradrenaline or cortisol levels, led to better memory performance when it is applied during perception or encoding. Brain regions involved in this process were medial temporal lobe regions such as amygdala and hippocampus, and several parts of the prefrontal cortex (PFC). High stress levels accompanied by high cortisol levels during retrieval led to impaired memory performance. Sex effects on memory as well as lateralization effects on brain activation were found. Conclusion: High stress levels during encoding and consolidation of emotional material involve increased amygdala and hippocampus activation. The role of the anterior cingulate cortex and other parts of the PFC during perception and encoding of arousing material appears to be a modulating one. However, additional research is needed to shed more light on the nature of the brain changes during stress, especially during retrieval.
Cigarette Smoking, Nicotine Dependence, and Motivation for Smoking Cessation in Psychiatric Inpatients
Authors: Solty Heidi , Crockford David , White William D , Currie Shawn 
Published: January 2017

Objective: Cigarette smoking is the leading preventable cause of death and disease in Canada, and is disproportionately more frequent among psychiatric patients. Smoking cessation interventions can be successfully implemented with psychiatric patients, yet no Canadian studies have evaluated smoking prevalence, nicotine dependence, and motivation for smoking cessation in psychiatric inpatients. Our study did so to help plan appropriate interventions for these patients. Method: All inpatients aged 18 years or older admitted to acute-care psychiatry units at the Foothills Medical Centre in Calgary, Alberta, during a 6-month period completed a survey involving questions from the Canadian Tobacco Use Monitoring Survey, the Fagerstrom Test for Nicotine Dependence (FTND), the Readiness to Quit Ladder, and the Decisional Balance for Cigarette Smoking. Responses were analyzed for correlation with discharge diagnoses, age, and sex. Results: Among the total inpatients ( n = 342), 211 (62%) completed the survey. Among those, 55% were current cigarette smokers and 17.5% were former smokers. Nicotine dependence (FTND ≥ 6) was reported in 45.2% of smokers. Smoking prevalence and nicotine dependence severity was greatest in the substance use disorders (SUD) and psychotic disorders groups. Current smokers endorsed more negative than positive attributes of smoking. Regarding smoking cessation, 51% of patients were precontemplative, 12.7% contemplative, and 36.2% preparatory or action-oriented, despite few receiving advice to quit. Conclusions: Cigarette smoking and nicotine dependence are highly prevalent in psychiatric inpatients. However, self-reported motivation for smoking cessation is noteworthy, emphasizing that cessation advice and appropriate follow-up care should be provided to psychiatric inpatients who smoke.