bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined Treatment of Major Depression in Patients with Borderline Personality Disorder: A Comparison with Pharmacotherapy
Authors: Bellino Silvio , Zizza Monica , Rinaldi Camilla , Bogetto Filippo 
Published: January 2017

Objective: Combined treatment with psychotherapy and antidepressants is more effective than monotherapies. Recent data show that combined therapy has better results in patients with depression and Axis II codiagnosis. The aim of this study was to compare combined treatment using interpersonal psychotherapy (IPT) with pharmacotherapy alone in patients with depression and borderline personality disorder (BPD). Methods: There were 39 consecutive outpatients diagnosed with BPD who presented with a major depressive episode enrolled in this study. They were randomly assigned to 1 of 2 treatment groups: fluoxetine 20 mg to 40 mg daily or fluoxetine 20 mg to 40 mg daily plus IPT 1 session weekly. Owing to noncompliance, 7 patients dropped out. We assessed the 32 patients who completed the 24 weeks of treatment at baseline, Week 12, and Week 24, using a semistructured interview for clinical characteristics, the Clinical Global Impression Scale (CGI), the Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS), and 2 self-report questionnaires, that is, the Satisfaction Profile (SAT-P) for quality of life and the 64-item Inventory for Interpersonal Problems (IIP-64). We performed statistical analysis, using univariate general linear models with 2 factors: duration and type of treatment. Results: Changes in remission rates, CGI, and HARS score did not differ between treatments. According to changes in the HDRS scores; changes in psychological functioning and social functioning scores on the SAT-P; and changes in vindictive or self-centred, cold or distant, intrusive or needy, and socially inhibited scores on the IIP-64, combined therapy was superior to fluoxetine alone. Conclusions: Combined therapy with IPT is more effective than antidepressant therapy alone, both in treating symptoms of major depression and in improving dimensions of quality of life and interpersonal functioning.
Survey of Atypical Antipsychotic Prescribing by Canadian Child Psychiatrists and Developmental Pediatricians for Patients Aged under 18 Years
Authors: Doey Tamison , Handelman Kenneth , Seabrook Jamie A , Steele Margaret 
Published: January 2017

Objective: To describe self-reported patterns of prescribing atypical antipsychotics (ATAs) and monitoring practices of child psychiatrists and developmental pediatricians in Canada. Method: We surveyed members of the Canadian Academy of Child and Adolescent Psychiatry and members of the Developmental Paediatrics Section of the Canadian Paediatric Society regarding the types and frequencies of ATAs they prescribed, the ages and diagnoses of patients for whom they prescribed these medications, and the types and frequencies of monitoring used. Results: Ninety-four percent of the child psychiatrists (95%CI, 90% to 97%) and 89% of the developmental pediatricians (95%CI, 75% to 96%) prescribed ATAs, most commonly risperidone (69%). Diagnoses included psychotic, mood, anxiety, externalizing, and pervasive developmental disorders. Prescribing for symptoms such as aggression, low frustration tolerance, and affect dysregulation was also common. Twelve percent of all prescriptions were for children under age 9 years. Most clinicians monitored patients, but there were wide variations in the type and frequency of tests performed. Conclusions: Despite the lack of formal indications, ATAs were prescribed by this group of clinicians for many off-label indications in youth under age 18 years, including very young children. Neither evidence-based guidelines nor a consensus on monitoring exist for this age group.
Gender Differences in Risk Factors for Suicide: Findings from a Swedish National Cohort Study
Authors: von Borczyskowski Annika , Lindblad Frank , Vinnerljung Bo , Hjern Anders 
Published: January 2017

Objective: To investigate whether childhood sociodemographic factors and parental psychopathology affect suicide risk differently in men and women. Method: Cox regressions were used to calculate interaction effects of gender for childhood and parental risk factors for 8815 suicides (27% women) in a national cohort of 2.47 million people born between 1946 and 1968. Results: Low parental socioeconomic status increased suicide risk only for men, hazard ratio (HR) = 1.22 ( P = 0.003 for gender interaction), while living in a metropolitan area increased the risk only for women, HR = 1.42 ( P < 0.001 for gender interaction). Parental psychotic or affective disorder increased suicide risk more strongly for women (HR = 2.08), than for men (HR = 1.52) ( P = 0.004 for gender interaction). Conclusion: Growing up in an urban environment and parental psychotic or affective disorder are significant gender-related risk factors for suicide, both conveying higher risks in women. The mechanisms linking childhood urbanicity to increased risk of suicide in adult women stand out as an important research area for the future.
Do the Health of the Nation Outcome Scales Measure Outcome?
Authors: Kisely Stephen , Campbell Leslie Anne , Cartwright Jennifer , Cox Martha , Campbell John 
Published: January 2017

Objective: Among mental health outcome measures that have been developed for routine use, most of the information concerns the Health of the Nation Outcome Scales (HoNOS). This instrument is widely used in Europe, Australia, and New Zealand, but not in Canada. We tested its sensitivity and predictive validity under conditions that would resemble, as closely as possible, routine use. Method: Treating clinicians were asked to assess patients of all ages referred to outpatient mental health facilities of 2 district health authorities in Nova Scotia using either the HoNOS for adults or the HoNOS for Children and Adolescents (HoNOSCA). Data were entered using the existing routine administrative data system. Results: We obtained at least 1 rating on 4620 patients, giving a completion rate of 82%. On follow-up, ratings for the global score and most of the individual items were sensitive to change ( n = 808). After adjusting for confounders, a baseline HoNOS score was significantly associated with subsequent in and outpatient service use including admissions, bed days, and psychiatric contacts ( n = 1359). Conclusions: HoNOS has satisfactory sensitivity and predictive validity for routine use. We could introduce the adult version and HoNOSCA simultaneously and collect data using routine databases. Given the widespread routine use of HoNOS internationally, using the same outcome measure in Canada would enable comparisons of illness severity and outcomes between jurisdictions.
Rates of Mental Illness and Suicidality in Immigrant, Refugee, Ethnocultural, and Racialized Groups in Canada: A Review of the Literature
Authors: Hansson Emily K , Tuck Andrew , Lurie Steve , McKenzie Kwame 
Published: January 2017

Objective: Studies from around the world point to differences in the rates of mental illnesses between immigrant, refugee, ethnocultural, and racialized (IRER) groups and host populations. Risk of illness depends on social contexts; therefore, to offer the best information for people aiming to develop and offer equitable services, local information on rates of mental illness in different population groups is required. Methods: We performed a literature review of peer-reviewed journals and the grey literature between 1990 and 2009 using standard techniques and identified primary research reporting the rates of mental illness and suicidality in IRER groups in Canada. Results: Among the 229 papers we reviewed, 17 were included. Most papers reported rates for depression. There was no clear pattern, with different IRER groups and different age groups reporting either elevated or lower rates, compared with white Canadians. Refugee youth in Quebec have higher rates of numerous mental health problems and illnesses. When immigrant groups were considered as a whole, suicide rates were low but different national origin groups reported different trajectories in rates across the generations. Conclusion: The literature on rates of mental illness and suicidality in IRER groups in Canada is diverse and not comprehensive. In addition, most research has been conducted in 3 provinces and, in particular, 3 major cities. The rates of mental illness seem to vary by national origin groups, age, and status in Canada. There is very little research on nonimmigrant, culturally diverse populations in Canada. This lack of information may undermine efforts to develop equitable mental health services for all Canadians.
Substantial Changes in Prescription Recommendations for Bipolar Disorder in Canada: 2002–2010
Authors: Bulloch Andrew GM , Bresee Lauren C , Beck Cynthia A , Patten Scott B 
Published: January 2017

Objectives: We examined trends in prescription recommendations for treatment of bipolar disorder (BD) in Canada during 2002–2010. Methods: Data collected by IMS Brogan in a database known as the Canadian Disease and Therapeutic Index were used for this analysis. These data are collected from a representative physician panel who record each drug recommendation and reason for recommendation in their practices for 2 consecutive days each calendar quarter of the year. Prescription patterns of medications for BD, including lithium, anticonvulsants, antipsychotic agents, anxiolytics, and antidepressants, were evaluated both for general practitioners and for specialists. Results: The number of prescription recommendations for BD increased by 72.1% from 2002 to 2009, and then dropped by 24.8% from 2009 to 2010. This increase from 2002 to 2009, and subsequent decrease from 2009 to 2010, was observed for all classes of medications. The overall increase from 2002 to 2010 was statistically significant for the atypical antipsychotics ( P = 0.04). The largest change for an individual drug during this period was a 438% increase in recommendations for quetiapine ( P = 0.01). Conclusions: The number of prescription recommendations for BD increased substantially from 2002 to 2009 and sharply dropped in the following year. These results suggest that the infuence of the concept of the bipolar spectrum and its promotion may have resulted in a substantial increase in treatment that has recently begun to wane.
Treatments for the Challenging Behaviours of Adults with Intellectual Disabilities
Authors: Matson Johnny L , Neal Daniene , Kozlowski Alison M 
Published: January 2017

Objective: To provide an overview and critical assessment of common problems and best evidence practice in treatments for the challenging behaviours (CBs) of adults with intellectual disabilities (IDs). Method: Commonly observed problems that present obstacles to successful treatment plans are discussed, followed by an analysis of available research on the efficacy of behavioural and pharmacological therapies. Results: Behavioural and pharmacological interventions are most commonly used when addressing CBs in people with IDs. However, within each of these techniques, there are methods that have support in the literature for efficacy and those that do not. As clinicians, it is important to follow research so that we are engaging in best practices when developing treatment plans for CBs. Conclusions: One of the most consuming issues for psychiatrists and other mental health professionals who work with people who evince developmental disabilities, such as IDs, are CBs. These problems are very dangerous and are a major impediment to independent, less restrictive living. However, there is a major gap between what researchers show is effective and much of what occurs in real-world settings.
Emergency Department Visits and Use of Outpatient Physician Services by Adults with Developmental Disability and Psychiatric Disorder
Authors: Lunsky Yona , Lin Elizabeth , Balogh Rob , Klein-Geltink Julie , Wilton Andrew S , Kurdyak Paul 
Published: January 2017

Objective: To compare the emergency department (ED), primary, and psychiatric care visit rates associated with the presence and absence of a developmental disability (DD) and a mental illness. Method: This is a population-based study comparing Ontario adults, with and without DDs and mental illnesses, in terms of rates of primary, psychiatric, and ED care, from April 2007 to March 2009. Results: In Ontario, 45% of adults with a DD received a psychiatric diagnosis during a 2-year period, and 26% of those with a psychiatric diagnosis were classified as having a serious mental illness (SMI), compared with 8% of those with a psychiatric diagnosis but no DD. People with DDs had an increased likelihood of psychiatric and ED visits. Patients with SMIs and DDs had the highest rates of such visits. Conclusions: People with more severe impairments had the greatest likelihood of ED visits, despite access to outpatient services, suggesting that outpatient care (primary and psychiatric), as currently delivered, may not be adequate to meet their complex needs.
Treatment of Bipolar Depression: A Survey of Canadian Psychiatrists
Authors: Sharma Verinder , Mazmanian Dwight S , Persad Emmanuel , Kueneman Karen M 
Published: January 2017

Objective This study was conducted to examine how Canadian psychiatrists manage bipolar depression. Method A questionnaire specific to the treatment of bipolar depression was mailed to 1639 active members of the Canadian Psychiatric Association. Results Seven hundred and sixty-six completed questionnaires were returned (46.7%). Most psychiatrists indicated that a combination of psychotherapy and somatic therapy was their preferred approach. For bipolar disorder, depressed, lithium carbonate and selective serotonin reuptake inhibitors (SSRIs) were the preferred treatment strategies. For substitution, tricyclic antidepressants (TCAs) were the favoured choice. Lithium carbonate was the preferred choice for augmentation and addition. Conclusion These findings indicate that a combination of psychotherapy and somatic therapy is the preferred treatment approach for bipolar depression. Lithium carbonate and SSRIs are the favoured somatic therapies.
Individual Differences in Posttraumatic Distress: Problems with the DSM-IV Model
Authors: Bowman Marilyn Laura 
Published: January 2017

Objective: To evaluate the evidence concerning the role of threatening life events in accounting for clinically significant posttraumatic stress responses. Method: Research was examined to review the epidemiology, evidence of dose-response relations, and individual difference factors in accounting for variations in conditions, including posttraumatic stress disorder, after exposure to threatening events. Results: The evidence is significantly discrepant from the clinical Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) model. Greater distress arises from individual differences than from event characteristics. Important individual differences that interact with threat exposures include trait negative affectivity (neuroticism); beliefs about emotions, the self, the world, and the sources and consequences of danger; and preevent acts, disorders, and intelligence. Reasons for the discrepancies between the evidence and the current model of posttraumatic distress are proposed. Conclusion: In accounting for responses to threatening life events, the relatively minor contribution of event qualities compared with individual differences has significant treatment implications. Treatment approaches assuming that toxic event exposure creates a posttraumatic disorder fail to consider individual differences that could improve treatment efficacy.
Cognitive Therapy for Bipolar Depression: A Pilot Study
Authors: Zaretsky Ari E , Segal Zindel V , Gemar Michael 
Published: January 2017

Objective: While the efficacy of cognitive-behaviour therapy (CBT) for the treatment of acute unipolar major depression is well-documented, there is almost no data evaluating its utility in the treatment of bipolar depression. This pilot study compares the efficacy of CBT combined with mood-stabilizer pharmacotherapy for bipolar depression and CBT alone for unipolar depression. Method: A matched-case control design was used to evaluate outcomes following 20 sessions of CBT in 11 depressed bipolar patients and 11 matched recurrent unipolar depressed control subjects. Results: Bipolar depressed patients achieved similar levels of reduction in depressive symptoms following CBT, as did the unipolar depressed group. However, on measures of more pervasive dysfunctional attitudes, bipolar patients did not improve to the same degree. Conclusions: Preliminary findings suggest that CBT warrants further investigation as an effective psychosocial intervention for depression in bipolar patients already receiving ongoing mood-stabilizing pharmacotherapy.
Vital Energy the Antebellum Health Movement
Authors: Diane Hamilton 
Published: January 2017

Abstract: While the notion of the relationship between well-being and energy attracts nurses, the idea is not new to health care. During antebellum America a “medical counterculture” embraced an assortment of holistic beliefs which challenged orthodox medicine. This historical essay describes the holistic health movement of the 1800's and emphasizes the notion that health is both a product and a prisoner of any epoch's social, economic, and intellectual context. Although the past is not prologue, the essay suggests patterns and reactions of the health movement which will seem familiar to holisic health nurse practioners. The conceptual struggle of mind/body interaction and the questions regarding which entity has priority or supremacy have puzzled health practioners for centuries.
Is Psychological Wellbeing Impaired in Long Term Survivors of Breast Cancer?
Authors: Ellman R , Thomas B A , Ellman R 
Published: January 2017

Objective To measure anxiety and depression in long term survivors of breast cancer. Design Case-control study. Setting Follow up of the trial of early detection of breast cancer in the South West Surrey Health District. Subjects 331 patients with breast cancer aged 50–78, attending mammographic follow up, who had been invited to screening before diagnosis, and 584 controls who had attended the same clinic but did not have breast cancer. The sample included 290 pairs matched by screening attendance pattern and year of birth. Main Outcome Measure – Anxiety and depression scores on the Hospital Anxiety and Depression Scale. Results Significantly fewer symptoms of anxiety and depression were reported by patients with cancer than by controls and significantly fewer had high scores suggesting the presence of psychological morbidity meriting treatment. Among the patients with cancer anxiety was more common at the first annual follow up than at later visits. Symptom scores were not significantly related to the manner of detection or to the type of initial treatment. Potentially confounding social and personal factors did not account for the differences between patients with cancer and controls. Conclusion The prevalence of anxiety and depression is not increased in long term survivors of breast cancer who are apparently free from disease and is not substantially affected by the manner in which a cancer is detected or by the treatment given. In the light of these findings it is difficult to justify large “quality adjustments” to the estimates of recurrence-free years of life saved by screening. Those who counsel patients with breast cancer should be aware that although the initial distress can be severe, meriting psychological treatment, patients do recover their normal ability to enjoy life.
Growth Screening and Urban Deprivation
Authors: White E , Wilson A , Greene S A , Berry W , McCowan C , Cairns A , Ricketts I 
Published: January 2017

Objectives — To assess the effect of urban deprivation on childhood growth in a modern British society by analysing data from a regional growth survey, the Tayside growth study. Setting — The Tayside Region in Scotland, which has three districts with distinct socioeconomic status: Dundee (D, urban city), Angus (A, rural), and Perth (P, rural and county town). Subjects and methods — Height and weight of 23 046 children (>90% of the regional childhood population) were measured as part of a child health surveillance programme, by community health care workers at 3, 5, 7, 9, 11, and 14 years. Height standard deviation score (calculated against Tanner) and body mass index (BMI-weight (kg)/height (m)2) were calculated for each child by a central computer program; mean height standard deviation score and BMI standard deviation score were calculated for each measuring centre (school, health clinic). A deprivation score for each centre was calculated from the prevalence of single parent families; families with more than three children; unemployment rate; the number of social class V individuals; the percentage of council houses. Results — Mean height standard deviation score for Tayside was 0·11. An intra-regional difference was demonstrated: mean height standard deviation score (SD) D = 0·04 (1·0); A = 0·14 (1·1); P = 0·21 (1·1); P<0·002. There was a positive association between short stature and increasing social deprivation seen throughout Tayside (P<0·05), with a strong association in Dundee primary school children (r = 0·6; P<0·001). Analysis by district showed that the association was significant only above the age of 8 (P<0·004). There was no relation between BMI and social deprivation. Conclusions — In an industrialised developed society, urban deprivation appears to influence height mostly in late childhood, and this association should be taken into consideration in the clinical management of short stature. Height seems to be a better physical indicator of urban deprivation, and hence an index of childhood health, than BMI.
United Kingdom Community Growth Screening 1994: A Survey of Current Practice
Authors: Hulse J A , Schilg S ,   For the “Screening for Growth Towards 2000” Scientific Organising Committee
Published: January 2017

Objective — To determine current policies, resources, and attitudes to community growth screening in the United Kingdom. Methods — A postal survey of community paediatricians and paediatric endocrinologists. Results — 164 replies were received – most from senior clinical medical officers or community paediatricians – covering between 68 and 78% of the United Kingdom population. One hundred and thirty three (81%) trusts or districts had a written growth policy. Preschool and school age height screening took place in 75% and 81% of districts respectively, but most children were only measured once before school or at school. Policies for the age at which measurements were made and their frequency varied enormously. Seventy three per cent used standard equipment, the most popular being the Millimetre. A wide variety of charts were used, of which 23% were decimal age charts. A large number of referral criteria were used, including height, height velocity, and weight. Most children were referred to hospital outpatient clinics rather than specialist growth clinics. Conclusions — Over 90% of respondents felt that growth screening was either extremely valuable or useful depending on resources. The survey showed a widespread lack of standardisation of equipment, charts, and policies. Referral criteria and objectives need to be clarified by research and audit, and growth monitoring integrated into a systematic programme of child health surveillance.