bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario
Authors: Anderson Kelly K , Flora Nina , Ferrari Manuela , Tuck Andrew , Archie Suzanne , Kidd Sean , Tang Taryn , Kirmayer Laurence J , McKenzie Kwame 
Published: January 2017

Objective: To compare the pathways to care and duration of untreated psychosis (DUP) for people of Black-African, Black-Caribbean, or White-European origin with first-episode psychosis (FEP). Methods: We recruited a sample of 171 patients with FEP of Black-African, Black-Caribbean, and White-European origin from hospital- and community-based early intervention services (EIS) in the cities of Toronto and Hamilton. We compared the 3 groups on DUP and key indicators of the pathway to care. Results: We observed differences in pathways to care across the 3 groups. Black-Caribbean participants had an increased odds of referral from an inpatient unit to EIS (OR 3.33; 95% CI 1.46 to 7.60) and a decreased odds of general practitioner involvement on the pathway to care (OR 0.17; 95% CI 0.07 to 0.46), as well as fewer total contacts (exp[β] 0.77; 95% CI 0.60 to 0.99) when compared with White-European participants. Black-African participants had an increased odds of contact with the emergency department at first contact (OR 3.78; 95% CI 1.31 to 10.92). The differences in the DUP between groups were not statistically significant. Conclusions: Our findings suggest that there are significant differences in the pathways to EIS for psychosis for people of African and Caribbean origin in our Canadian context. It is essential to gain a comprehensive understanding of the pathways that different population groups take to mental health services, and the reasons behind observed differences, to inform the development of equitable services, targeting patients in the critical early stages of psychotic disorder.
A Youth Suicide Prevention Plan for Canada: A Systematic Review of Reviews
Authors: Bennett Kathryn , Rhodes Anne E , Duda Stephanie , Cheung Amy H , Manassis Katharina , Links Paul , Mushquash Christopher , Braunberger Peter , Newton Amanda S , Kutcher Stanley , Bridge Jeffrey A , Santos Robert G , Manion Ian G , McLennan John D , Bagnell Alexa , Lipman Ellen , Rice Maureen , Szatmari Peter 
Published: January 2017

Objective: We conducted an expedited knowledge synthesis (EKS) to facilitate evidence-informed decision making concerning youth suicide prevention, specifically school-based strategies and nonschool-based interventions designed to prevent repeat attempts. Methods: Systematic review of review methods were applied. Inclusion criteria were as follows: systematic review or meta-analysis; prevention in youth 0 to 24 years; peer-reviewed English literature. Review quality was determined with AMSTAR (a measurement tool to assess systematic reviews). Nominal group methods quantified consensus on recommendations derived from the findings. Results: No included review addressing school-based prevention ( n = 7) reported decreased suicide death rates based on randomized controlled trials (RCTs) or controlled cohort studies (CCSs), but reduced suicide attempts, suicidal ideation, and proxy measures of suicide risk were reported (based on RCTs and CCSs). Included reviews addressing prevention of repeat suicide attempts ( n = 14) found the following: emergency department transition programs may reduce suicide deaths, hospitalizations, and treatment nonadherence (based on RCTs and CCSs); training primary care providers in depression treatment may reduce repeated attempts (based on one RCT); antidepressants may increase short-term suicide risk in some patients (based on RCTs and meta-analyses); this increase is offset by overall population-based reductions in suicide associated with antidepressant treatment of youth depression (based on observational studies); and prevention with psychosocial interventions requires further evaluation. No review addressed sex or gender differences systematically, Aboriginal youth as a special population, harm, or cost-effectiveness. Consensus on 6 recommendations ranged from 73% to 100%. Conclusions: Our EKS facilitates decision maker access to what is known about effective youth suicide prevention interventions. A national research-to-practice network that links researchers and decision makers is recommended to implement and evaluate promising interventions; to eliminate the use of ineffective or harmful interventions; and to clarify prevention intervention effects on death by suicide, suicide attempts, and suicidal ideation. Such a network could position Canada as a leader in youth suicide prevention.
Suicide among Inuit: Results from a Large, Epidemiologically Representative Follow-Back Study in Nunavut
Authors: Chachamovich Eduardo , Kirmayer Laurence J , Haggarty John M , Cargo Margaret , McCormick Rod , Turecki Gustavo 
Published: January 2017

Objective: The Inuit population in Canada's North has suffered from high rates of death by suicide. We report on the first large-scale, controlled, epidemiologically representative study of deaths by suicide in an Indigenous population, which investigates risk factors for suicide among all Inuit across Nunavut who died by suicide during a 4-year period. Methods: We identified all suicides by Inuit ( n = 120) that occurred between January 1, 2003, and December 31, 2006, in Nunavut. For each subject, we selected a community-matched control subject. We used proxy-based procedures and conducted structured interviews with informants to obtain life histories, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I and II diagnoses, and measures of impulsive and (or) aggressive traits. Results: Compared with control subjects, subjects who died by suicide were more likely to have experienced childhood abuse (OR 2.38; 95% CI 1.39 to 4.08), have family histories of major depressive disorder ( P = 0.002) and suicide completion ( P = 0.02), and have been affected by major depressive disorder (OR 13.00; 95% CI 6.20 to 27.25), alcohol dependence (OR 2.90; 95% CI 1.59 to 5.24), or cannabis dependence (OR 3.96; 95% CI 2.29 to 6.8) in the last 6 months. In addition, subjects who died by suicide were more likely to have been affected with cluster B personality disorders (OR 10.18; 95% CI 3.34 to 30.80) and had higher scores of impulsive and aggressive traits ( P < 0.001). Conclusions: At the individual level, clinical risk factors for suicide among Inuit are similar to those observed in studies with the general population, and indicate a need for improved access to mental health services. The high rate of mental health problems among control subjects suggests the need for population-level mental health promotion.
Correlates of Nonsuicidal Self-Injury and Suicide Attempts among Tertiary Care, Emergency Department Patients
Authors: Chartrand Hayley , Bhaskaran Joanna , Sareen Jitender , Katz Laurence Y , Bolton James M 
Published: January 2017

Objective: In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the distinction between nonsuicidal self-injury (NSSI) and suicidal behaviour disorder is highlighted in the section Conditions for Further Study. Diagnostic criteria classify NSSI and suicidal behaviour disorder as distinct disorders, with the latter including suicide attempt (SA). This study examined the prevalence and correlates of NSSI in emergency department (ED) settings and compared them to SA. Methods: Data came from adult referrals to psychiatric services in 2 EDs between January 2009 and June 2011 ( n = 5336). NSSI was compared with SA, as well as no suicidal behaviour, across a broad range of demographic and diagnostic correlates. Results: NSSI was more highly associated with female sex, childhood abuse, anxiety disorders, major depressive disorder (MDD), aggression and impulsivity, age under 45, and substance use disorders (SUDs), compared with presentations without suicidal behaviour. Comparing NSSI and SA, no differences were observed on sex, age, history of child abuse, or presence of anxiety or SUDs. Recent life stressors (OR 1.44; 95% CI 1.05 to 1.99), active suicidal ideation (OR 8.84; 95% CI 5.26 to 14.85), MDD (OR 3.05; 95% CI 2.23 to 4.17), previous psychiatric care or SA (OR 1.89; 95% CI 1.36 to 2.64), and single marital status (OR 1.63; 95% CI 1.20 to 2.22) contributed to a higher SA rate. Among people with NSSI, 83.7% presented only once to an ED. Among people who presented multiple times, only 18.2% re-presented with NSSI. Conclusions: NSSI is associated with early life adversity and psychiatric comorbidity. Most people present only once to ED services, and self-harm presentations seemed to change over time. Future studies should continue to clarify whether NSSI and SA have distinct risk profiles.
Geriatric Psychiatry Subspecialization in Canada: Past, Present, and Future
Authors: Clair JK Le , Sadavoy J 
Published: January 2017

Objective: To describe the development, future challenges, and directions of geriatric psychiatry in Canada. Method: This review and description of geriatric psychiatry was developed in the context of the criteria established by the Royal College of Physicians and Surgeons of Canada for subspecialization applications. Information from key informants, both nationally and internationally, was combined with a review of relevant literature in the field. Results and Conclusions: Canada has provided important contributions to the field of geriatric psychiatry in Canada and abroad. The increased needs of older persons with severe mental illness and their families, combined with a significant body of knowledge and therapeutic options, provide an important foundation for further development. Subspecialization in geriatric psychiatry as part of the overall development of psychiatry in Canada is proposed as critical to meeting the challenges of our aging population.
The Pharmacologic Treatment of Alzheimer's Disease: A Guide for the General Psychiatrist
Authors: Flint Alastair J , Van Reekum Robert 
Published: January 2017

Objective: To review the drug treatment of Alzheimer's disease (AD) and to provide guidelines for the physician on how to integrate these treatments into the overall management of this disorder. Method: A qualitative review of randomized, double-blind, placebo-controlled trials of medications used to treat cognitive deficits, disease progression, agitation, psychosis, or depression in AD. A computerized search of Medline was used to identify relevant literature published during the period 1968–1998. Key words used in the search were 'randomized controlled trials, ' with 'dementia' and with 'Alzheimer's disease'. Results: Agents that are currently available in Canada to treat the cognitive deficits of AD include donepezil, ginkgo biloba, selegiline, and ergoloid mesylates. Donepezil and ginkgo biloba are associated with a statistically significant but clinically modest improvement in cognitive function in a substantial minority of patients with mild to moderate AD. Selegiline may have a mild beneficial effect on cognitive function in some patients with AD, but the data are inconclusive. Ergoloid mesylates have questionable efficacy in AD and can only be recommended as a last line of treatment. The results of a single trial suggest that vitamin E or selegiline (both have antioxidant properties) may slow the progression of AD. Antipsychotic medications can result in clinically significant improvement in agitation and psychosis. Carbamazepine also appears to be an effective treatment for agitation in AD, and there is preliminary evidence that the selective serotonin reuptake inhibitor Citalopram reduces irritability in this disorder. There is no evidence that other nonneuroleptic medications are more efficacious than placebo in treating agitation in AD. Limited data indicate that depression in dementia responds to antidepressant medication. Conclusion: These data indicate that selected medications can be used to treat cognitive deficits, disease progression, agitation, psychosis, and depression in AD. However, there is considerable heterogeneity in patients' responses to these medications. Pharmacotherapy needs to be considered as a component of a package of care that also includes psychosocial and environmental interventions and support of the caregiver.
Pharmacologic Treatments Effective in Both Generalized Anxiety Disorder and Major Depressive Disorder: Clinical and Theoretical Implications
Authors: Casacalenda Nicola , Boulenger Jean-Philipe 
Published: January 2017

Objective: To review the efficacy of anxiolytics (alprazolam and azapirones) in major depressive disorder (MDD) and that of antidepressants in generalized anxiety disorder (GAD), thereby exploring the possible theoretical and clinical implications of this efficacy. Method: A Medline literature search was performed for the period January 1980 to September 1997 of randomized, double-blind comparison studies between anxiolytics and antidepressants in the acute treatment of adult patients with either MDD or GAD. Results: Alprazolam, at doses double those generally recommended for anxiety disorders, appears to be as effective as tricyclic antidepressants (TCAs) in the acute treatment of mild to moderate MDD. Alprazolam was also found to have a more rapid onset of action than do TCAs, particularly for the improvement of anxiety, somatization, and insomnia. Two azapirones (buspirone andgepirone) also have demonstrated a modest acute antidepressant effect in preliminary studies, albeit only in a depressed outpatient sample with considerable anxiety at baseline. Finally, various antidepressant drugs (imipramine, trazodone, paroxetine) were shown to have, at the least, comparable efficacy to benzodiazepines (BZDs) in the acute treatment of GAD. Conclusions: The nonspecificity of treatment response suggests that GAD and MDD are 1) different expressions of a similar disorder with a common neurobiological substrate, 2) discrete diagnostic entities that respond to independent pharmacological effects of the same drugs, or 3) a combination of the two (heterogeneity hypothesis). The most relevant clinical finding is the efficacy of antidepressants in the acute treatment of GAD.
Psychotherapy and Disclosure: Recent Court Decisions
Authors: Furlong Allannah , Lefebvre Michèle S 
Published: January 2017

Objective: To encourage mental health professionals concerned about the practice of psychotherapy to add their voices to the legal debate on disclosure. Method: Analysis of recent court decisions, in particular 2 Supreme Court of Canada judgements, R. v. O'Connor and R. v. Carosella, and 1 United States Supreme Court judgement, Jaffee v. Redmond. Results: The lack of a common definition of psychotherapy may, in part, have made it awkward for mental health professionals to mount a concerted defence of psychotherapy dossiers. Conclusions: Unless mental health professionals develop a more robust justification and delimitation for privilege, in Canadian courts possible relevance of clinical material is likely to override concern for the patient's privacy interest. Future research might evaluate the impact of loss of privilege upon different types of psychotherapy.
Developments in Interpersonal Psychotherapy
Authors: Markowitz John C 
Published: January 2017

Background: Interpersonal psychotherapy (IPT), a time-limited psychotherapy, was developed in the 1970s as a treatment for outpatient adults with major depression. It since has grown in its range of research applications and in its clinical accessibility. Method: Review of recent research and educational developments on IPT. Results: IPT has demonstrated efficacy in randomized controlled trials for major depression in various patient populations and in patients with bulimia. It showed no advantages in treating 2 substance abuse samples. Numerous further studies are underway. Growing numbers of clinicians are learning IPT. Conclusions: At a time when both research developments and economic pressures are increasing interest in time-limited psychotherapies, IPT is expanding in both the research and clinical domains.
Refus catégorique de traitement des patients psychiatriques: Bilan, enquête et perspective
Authors: Trudeau Marie-Hélène , Bruneau Marie-Andrée , Stip Emmanuel , Grünberg Fréderic , Boivin Marie 
Published: January 2017

Historique: Le refus du patient d'être traité est une situation à laquelle le psychiatre est confronté couramment dans sa pratique. Au Québec, en 1990, une nouvelle loi est venue changer radicalement la situation, en introduisant au code civil une disposition imposant le recours à l'intervention judiciaire pour traiter contre son gré une personne jugée inapte à consentir. Dans le présent article, nous proposons un bilan accompagné d'une enquête menée auprès des patients et des psychiatres traitants qui ont eu recours à cette disposition du code civil. Méthode: Ainsi, 39 sujets refusant catégoriquement un traitement ont été amenés en cours. A un sous-groupe de ces patients, nous avons proposé un entretien basé sur le DAI (questionnaire sur l'attitude à l'égard des médicaments) sur le CGI (impression clinique globale), et sur 2 questionnaires conçus spécifiquement pour répondre à des questions sur l'expérience au tribunal des patients et des psychiatres traitants. Résultats: Les résultats de cette enquête montrent que les patients ont un souvenir plutôt désagréable de leur expérience en cour. Cependant, l'alliance thérapeutique est demeurée inchangée même après la procédure. Les médecins sont unanimes à dire que les patients n 'auraient pas pu présenter un état clinique suffisamment amélioré pour quitter l'hôpital s'ils n 'avaient pas reçu de traitement médicamenteux, par suite de ce jugement. L'analyse de la dissociation entre la perception des patients et celle des médecins est comparée à celle des résultats issus d'études antérieures conduites aux États-Unis. Conclusion: Tout en étant une recherche modeste, cette étude porte sur une situation délicate, difficile et de plus en plus fréquente. Elle propose d'étudier plus à fond d'autres voies que le recours au tribunal.
Living Arrangement Requirements for Individuals with Developmental Disability and Behavioural Problems
Authors: Fotheringham John B 
Published: January 2017

Objective: To review the need for a wide range of living arrangements and community support services for individuals with developmental disability (DD) and behavioural problems and for their caregivers. Methods: An analysis of a 1-year caseload of a consulting psychiatrist to 2 community support agencies for individuals with DD. Results and Conclusions: Of the individuals seen with DD and behavioural problems, one-half needed a different living arrangement, immediately in many cases. Living arrangements and support services are extensively deficient. Correcting these deficiencies requires the concerted involvement of local, provincial, and federal governments as well as of community groups and agencies.
Retention Rates in Placebo- and Nonplacebo-Controlled Clinical Trials of Schizophrenia
Authors: Labelle Alain , Boulay Luc Jean , Lapierre Yvon Denis 
Published: January 2017

Objective: To determine if the inclusion of a placebo control in clinical trials of schizophrenia affects retention rates in the first 35 days of inclusion relative to trials that did not have a placebo control. Method: This was a retrospective study of 8 double-blind clinical trials, 5 of which had a placebo control while 3 did not. Using survival analysis, retention rates between the placebo-controlled trials (PCTs) and the nonplacebo-controlled trials (NPCTs) were compared. Screening and percentage improvement on Brief Psychiatric Rating Scale and Positive and Negative Syndrome Scale scores were compared. Results: Significantly more patients were retained in the 35-day period for NPCTs. Also, the PCT group had significantly more psychopathology at screening than did the NPCT group. Conclusions: Differences in retention rates between PCTs and NPCTs cannot be uniquely attributed to placebo itself.
Engaging Parents to Promote Children’s Nutrition and Health
Authors: Dev Dipti A. , Byrd-Williams Courtney , Ramsay Samantha , McBride Brent , Srivastava Deepa , Murriel Ashleigh , Arcan Chrisa , Adachi-Mejia Anna M. 
Published: January 2017

Purpose: Using the Academy of Nutrition and Dietetics benchmarks as a framework, this study examined childcare providers’ (Head Start [HS], Child and Adult Care Food Program [CACFP] funded, and non-CACFP) perspectives regarding communicating with parents about nutrition to promote children’s health. Design: Qualitative. Setting: State-licensed center-based childcare programs. Participants: Full-time childcare providers (n = 18) caring for children 2 to 5 years old from varying childcare contexts (HS, CACFP funded, and non-CACFP), race, education, and years of experience. Methods: In-person interviews using semi-structured interview protocol until saturation were achieved. Thematic analysis was conducted. Results: Two overarching themes were barriers and strategies to communicate with parents about children’s nutrition. Barriers to communication included—(a) parents are too busy to talk with providers, (b) parents offer unhealthy foods, (c) parents prioritize talking about child food issues over nutrition, (d) providers are unsure of how to communicate about nutrition without offending parents, and (e) providers are concerned if parents are receptive to nutrition education materials. Strategies for communication included—(a) recognize the benefits of communicating with parents about nutrition to support child health, (b) build a partnership with parents through education, (c) leverage policy (federal and state) to communicate positively and avoid conflict, (d) implement center-level practices to reinforce policy, and (e) foster a respectful relationship between providers and parents. Conclusion: Policy and environmental changes were recommended for fostering a respectful relationship and building a bridge between providers and parents to improve communication about children’s nutrition and health.
Meeting Sleep Guidelines Is Associated With Better Health-Related Quality of Life and Reduced Premature All-Cause Mortality Risk
Authors: Loprinzi Paul D. , Joyner Chelsea 
Published: January 2017

Purpose: To examine whether meeting sleep guidelines (7-9 hours/night) is associated with better health-related quality of life (HRQOL) and reduced all-cause mortality risk. Design: Prospective cohort study. Setting: 2005 to 2010 National Health and Nutrition Examination Survey. Participants: A total of 13 423 adults. Measures: Sleep duration and HRQOL were assessed from self-report; covariates assessed via survey, examination, and laboratory data; and mortality assessed through 2011 via matching from the National Death Index. Analysis: Cox proportional hazard regression and ordinal logistic regression. Results: After adjusting for age, gender, race–ethnicity, body mass index, education, smoking, white blood cell level, iron level, red blood cell distribution width, mean platelet volume, blood pressure, diabetes, coronary artery disease, physical activity, and depression, those meeting sleep guidelines had an 19% reduced risk of premature all-cause mortality (hazard ratio = 0.81; 95% confidence interval [CI]: 0.67-0.99; P = .04). After adjustments, those meeting sleep guidelines had better HRQOL (β = −0.30; 95% CI: −0.38 to −0.21; P < .001). Results for the ordinal regression and Cox proportional analyses were similar in unadjusted and minimally adjusted models. Conclusion: Obtaining optimal levels of sleep is associated with better HRQOL and reduced premature mortality risk, independent of demographic, behavioral, and biological conditions. These findings underscore the importance of achieving optimal levels of sleep.