bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Duty to Warn and Protect—Impact on Practice
Authors: Chaimowitz Gary A , Glancy Graham D , Blackburn Janice 
Published: January 2017

Objective: To discuss the concepts of the duty to protect and the associated threat to confidentiality and their impact on practice for Canadian psychiatrists. Method: We review these concepts and provide a synthesis of legal cases impacting psychiatric practice. Conclusion: The onus is on the psychiatrist to make him or herself aware of the current state of the legal obligation with respect to duty to protect. The evolving concept of duty to protect has and will continue to have significant impact on the practice of psychiatry.
“Diet Pills” and Major Depression in the Canadian Population
Authors: Patten Scott B 
Published: January 2017

Objective: To evaluate epidemiological associations between self-reported diet pill consumption and major depressive episodes (MDEs), using data from a large-scale, cross-sectional survey of the Canadian population. Methods: Data from the National Population Health Survey (NPHS) were used in this analysis. The NPHS interview included a brief version of the Composite International Diagnostic Interview (CIDI) depression section, known as the CIDI Short Form for Major Depression (CIDI-SFMD), as well as provision for self-reported medication use. Results: Approximately 0.5% of the population reported the use of diet pills. Diet pill use was more common among women than among men. At the time of data collection (1996–1997), the most commonly used medication was fenfluramine (since withdrawn from the market because of cardiovascular toxicity). The use of these medications was strongly associated with MDE: the annual prevalence among persons reporting use was 17.1% (95%CI, 8.6 to 25.6), approximately 4 times the underlying population rate. Conclusions: Because the NPHS was a general health survey, and because self-reported exposure to these medications was relatively uncommon, the data did not permit a detailed multivariate analysis. These findings, however, indicate that depressive psychopathology is strongly associated with the use of appetite-suppressant medications.
In vivo Magnetic Resonance Spectroscopy and its Application to Neuropsychiatric Disorders
Authors: Stanley Jeffrey A 
Published: January 2017

In vivo magnetic resonance spectroscopy (MRS) is the only noninvasive imaging technique that can directly assess the living biochemistry in localized brain regions. In the past decade, spectroscopy studies have shown biochemical alterations in various neuropsychiatric disorders. These first-generation studies have, in most cases, been exploratory but have provided insightful biochemical information that has furthered our understanding of different brain disorders. This review provides a brief description of spectroscopy, followed by a literature review of key spectroscopy findings in schizophrenia, affective disorders, and autism. In schizophrenia, phosphorus spectroscopy studies have shown altered metabolism of membrane phospholipids (MPL) during the early course of the illness, which is consistent with a neurodevelopmental abnormality around the critical period of adolescence when the illness typically begins. Children and adolescents who are at increased genetic risk for schizophrenia show similar MPL alterations, suggesting that schizophrenia subjects with a genetic predisposition may have a premorbid neurodevelopmental abnormality. Independent of medication status, bipolar subjects in the depressive state tended to have higher MPL precursor levels and a deficit of high-energy phosphate metabolites, which also is consistent with major depression, though these results varied. Further bipolar studies are needed to investigate alterations at the early stage. Lastly, associations between prefrontal metabolism of high-energy phosphate and MPL and neuropsychological performance and reduced N-acetylaspartate in the temporal and cerebellum regions have been reported in individuals with autism. These findings are consistent with developmental alterations in the temporal lobe and in the cerebellum of persons with autism. This paper discusses recent findings of new functions of N-acetylaspartate.
The Impact of Latitude on the Prevalence of Seasonal Depression
Authors: Levitt Anthony J , Boyle Michael H 
Published: January 2017

Background: This study sought to determine whether the prevalence of the seasonal subtype of major depression (SAD) in the community varied as a function of latitude. Methods: Random telephone numbers were generated across 8 degrees of latitude (41.5 °N to 49.5°N) for the province of Ontario. Eight strata of 1 degree each were sampled equally throughout a 12-month period. Using a validated and structured diagnostic interview, we interviewed by telephone respondents over 20 years of age who had lived in the region for 3 years or more. We evaluated patterns of symptom change across seasons to establish a diagnosis of SAD according to DSM-IV criteria. Results: Of the 2078 households that were assessed for eligibility, 1605 (77%) completed the interview. The crude prevalence of lifetime SAD was 2.6% (95% CI, 1.9 to 3.5). There was no impact of latitude on prevalence of either major depression or the seasonal subtype across the 8 strata, although the global measure of the severity of seasonal change in mood was significantly negatively correlated with latitude. Conclusions: SAD is a common subtype of major depression in Ontario, but there is no evidence to support an increase in prevalence with increasing latitude. Contexte: Cette étude visait à déterminer si la prévalence du caractère saisonnier de la dépression majeure (DMS) dans la communauté variait selon la latitude. Méthodes: Des numéros de téléphone aléatoires ont été fournis sur 8 degrés de latitude (de 41,5°N. à 49,5°N.) dans la province de l'Ontario. Huit bandes de 1 degré chacune ont été échantillonnées également sur une période de 12 mois. À l'aide d'une entrevue diagnostique validée et structurée, nous avons interviewé par téléphone des répondants âgés de plus de 20 ans qui habitaient la région depuis 3 ans ou plus. Nous avons évalué les changements des modèles de symptômes selon les saisons pour établir un diagnostic de DMS selon les critères du DSM-IV. Résultats: Sur les 2 078 ménages admissibles, 1 605 (77 %) ont terminé l'entrevue. La prévalence brute de la DMS à vie était de 2,6 % (95 % IC, 1,9 à 3,5). La latitude n'influait pas sur la prévalence de la dépression majeure ou du caractère saisonnier dans les 8 bandes, bien que la mesure globale de la sévérité du changement saisonnier de l'humeur ait indiqué une corrélation négative significative à la latitude. Conclusions: La dépression majeure saisonnière est un sous-type répandu de la dépression majeure en Ontario, mais aucune preuve ne soutient une augmentation de la prévalence parallèle à l'accroissement de la latitude.
Randomization in a Substance Abuse Treatment Study: Participants Who Consent vs Those Who Do Not
Authors: Seraganian Peter , Brown Thomas G , Tremblay Jacques 
Published: January 2017

Objective: A mixed research design study compared patients who consented to treatment randomization with patients who opted for usual care. Methods: Patients in substance abuse rehabilitation who consented to randomization (that is, consenting group [CG]) were compared with those unwilling to undergo randomization (that is, nonconsenting group [NG]) but who, nevertheless, underwent the experimental assessment sessions, which spanned from intake to 6-month follow-up. Results: Patients in the CG exhibited a longer history of drug abuse, less occupational stability at intake, and following intensive treatment, tended not to do as well in terms of recovery, compared with those in the NG. Conclusion: Inclusion of data from partial participants in research protocols may offer a viable strategy to better appraise data generalizability.
Patient Attitudes regarding Causes of Depression: Implications for Psychoeducation
Authors: Srinivasan Janaki , Cohen Nicole L , Parikh Sagar V 
Published: January 2017

Objective: Patient attitudes toward mental illness are an important determinant of treatment compliance and treatment outcome. A patient's age, sex, style of thinking, lifestyle, and beliefs all may influence perceptions. This study aimed to determine patient attitudes. Method: Patients with a depressive disorder ( n = 102) who were referred for psychiatric consultation and treatment to a community general hospital psychiatric outpatient clinic completed a 9-item self-report questionnaire to determine their perceptions of the biological, psychological, cognitive, and spiritual causes of their depressive disorder. Results: Women were more likely to endorse their depressive disorder as related to a biological abnormality. With respect to age, older individuals were less likely to identify cognitive factors and loss of spirituality as causal factors in their depression. Conclusions: A relation exists between demographic variables, including sex and age, and beliefs about causes of depression and related disorders. These findings have implications for refining patient psychoeducation.
Subtypes of Schizophrenia: A Cluster Analytic Approach
Authors: Helmes Edward , Landmark Jhan 
Published: January 2017

Objectives: To identify empirical subtypes of schizophrenia, based upon the symptoms recorded over the duration of the illness, and to validate the resulting clusters against other systems that are used for subtyping schizophrenia. Method: Data for 55 symptoms of schizophrenia over the history of the illness from 107 chronic schizophrenia patients were analyzed using hierarchical cluster analysis with Euclidean distance and Ward's method. Except for 1 patient, all met DSM-III criteria. There were 40 men and 67 women, average (SD) age of 38.2 (9.91) years, with amean (SD) hospitalization of 27.9 (27.35) months. Results: No clear and unambiguous solution for the number of clusters was evident. Examination of the clusters led to further analysis of 2- and 6-cluster solutions. These were contrasted with DSM-III, DSM-III-R, and DSM-IV criteria and with the subtypes taken from the literature. There was limited support for any of these types, with none replicating, including the paranoid–nonparanoid distinction. Conclusions: Empirical clusters derived from lifetime symptom data failed to agree with either the established DSM or other empirically derived subtypes. Subtypes may have little utility when the variability of symptoms over the longitudinal course of the illness is considered.
Intramuscular Olanzapine and Intramuscular Haloperidol in Acute Schizophrenia: Antipsychotic Efficacy and Extrapyramidal Safety during the First 24 Hours of Treatment
Authors: Wright Padraig , Lindborg Stacy R , Birkett Martin , Meehan Karena , Jones Barry , Alaka Karla , Ferchland-Howe Iris , Pickard Anne , Taylor Cindy C , Roth John , Battaglia John , Bitter István , Chouinard Guy , Morris Philip LP , Breier Alan 
Published: January 2017

Objective: To determine the antipsychotic efficacy and extrapyramidal safety of intramuscular (IM) olanzapine and IM haloperidol during the first 24 hours of treatment of acute schizophrenia. Method: Patients ( n = 311) with acute schizophrenia were randomly allocated (2:2:1) to receive IM olanzapine (10.0 mg, n = 131), IM haloperidol (7.5 mg, n = 126), or IM placebo ( n = 54). Results: After the first injection, IM olanzapine was comparable to IM haloperidol and superior to IM placebo for reducing mean change scores from baseline on the Brief Psychiatric Rating Scale (BRPS) Positive at 2 hours (–2.9 olanzapine, −2.7 haloperidol, and −1.5 placebo) and 24 hours (–2.8 olanzapine, −3.2 haloperidol, and −1.3 placebo); the BPRS Total at 2 hours (–14.2 olanzapine, −13.1 haloperidol, and −7.1 placebo) and 24 hours (–12.8 olanzapine, −12.9 haloperidol, and −6.2 placebo); and the Clinical Global Impressions (CGI) scale at 24 hours (–0.5 olanzapine, −0.5 haloperidol, and −0.1 placebo). Patients treated with IM olanzapine had significantly fewer incidences of treatment-emergent parkinsonism (4.3% olanzapine vs 13.3% haloperidol, P = 0.036), but not akathisia (1.1% olanzapine vs 6.5% haloperidol, P = 0.065), than did patients treated with IM haloperidol; they also required significantly less anticholinergic treatment (4.6% olanzapine vs 20.6% haloperidol, P < 0.001). Mean extrapyramidal symptoms (EPS) safety scores improved significantly from baseline during IM olanzapine treatment, compared with a general worsening during IM haloperidol treatment (Simpson–Angus Scale total score mean change: −0.61 olanzapine vs 0.70 haloperidol; P < 0.001; Barnes Akathisia Scale global score mean change:−0.27 olanzapine vs 0.01 haloperidol; P < 0.05). Conclusion: IM olanzapine was comparable to IM haloperidol for reducing the symptoms of acute schizophrenia during the first 24 hours of treatment, the efficacy of both being evident within 2 hours after the first injection. In general, more EPS were observed during treatment with IM haloperidol than with IM olanzapine.
Impact of Antidepressant Side Effects on Adolescent Quality of Life
Authors: Cheung Amy H , Levitt Anthony J , Szalai John P 
Published: January 2017

Objective: This study examines the relative impact of antidepressant side effects on adolescents with a history of major depression. Methods: We used Q-sort methodology to capture the opinions of adolescents with a history of depression ( n = 22), adults with a history of depression ( n = 20), healthy adolescents ( n = 20), and clinicians ( n = 18) on the impact of 40 common antidepressant side effects. We asked subjects to force rank the side effects, judging each side effect on its relative impact on their daily lives. We also examined the impact of these side effects on health status and medication compliance. Primary analyses compared adolescents with depression with the other groups on their mean rankings for each of the 40 side effects. Secondary analyses included paired comparisons for ratings on health status and compliance. Results: Although all groups ranked syncope and vomiting among the worst 5 side effects, significant differences were found between the groups on other side effects, such as anxiety, sleepiness, and hair loss. Based on the side effect with the most negative impact, adolescents with depression judged their own compliance (mean = 22%) to be higher than predicted by clinicians (mean = 11%). There were no significant differences between the groups on the mean rating of health status. Conclusions: Adolescents with depression, adults with depression, healthy adolescents, and clinicians agreed on the negative impact of 2 side effects: vomiting and syncope. Q-sort methodology provides valuable insight into the similarities and differences in opinion regarding the potential impact of side effects in patient groups.
Depressive Symptomatology in the Immediate Postnatal Period: Identifying Maternal Characteristics Related to True- and False-Positive Screening Scores
Authors: Dennis Cindy-Lee , Ross Lori E 
Published: January 2017

Objective: To determine whether true- and false-positive postnatal depression screening scores can be distinguished during the early postpartum period by examining characteristic differences between 2 groups: 1) women with depressive symptomatology at 1 week postpartum who continue to exhibit symptoms at 8 weeks postpartum, compared with those who do not; and 2) women with depressive symptomatology at 8 weeks postpartum who previously exhibited symptoms at 1 week postpartum, compared with those who did not. Method: As part of a longitudinal postpartum depression study, a population-based sample of 594 women completed mailed questionnaires at 1, 4, and 8 weeks postpartum. Results: Among women with depressive symptomatology at 1 week postpartum, diverse variables distinguished between those whose symptoms persisted or remitted at 8 weeks. These variables included recent immigrant status, psychiatric history, premenstrual symptoms, vulnerable personality, low self-esteem, child abuse history, and insufficient support. Variables that distinguished between women with depressive symptomatology at 8 weeks postpartum who previously exhibited symptoms at 1 week postpartum and those who did not included vulnerable personality, life stressors, perceived stress, insufficient support, and partner conflict. Conclusions: To address both the benefits and potential harms of early screening, positive screening scores on the Edinburgh Postnatal Depression Scale should also include an assessment of each individual woman's risk for postpartum depression and (or) chronic major depression.
Left-Handedness and Developmental Coordination Disorder
Authors: Cairney John , Schmidt Louis A , Veldhuizen Scott , Kurdyak Paul , Hay John , Faught Brent E 
Published: January 2017

Objective: To examine the prevalence of left-handedness in a sample of children screened for developmental coordination disorder (DCD). Method: Using the Bruininks-Oseretsky Test of Motor Proficiency—Short Form (BOTMP-SF), 2297 children were screened with 128 scoring at or below the fifth percentile and identified as probable cases of DCD. Using the Movement-ABC (M-ABC) and the Kaufman Brief Intelligence Test, 30 children (24 from the DCD group, and 6 who scored above the cut-off) were randomly selected for further assessment. Results: Among the students who had previously scored at or below the fifth percentile on the BOTMP-SF, 24 were evaluated. Among the 19 children who met diagnostic criteria for DCD (IQ > 70, M-ABC < 16th percentile), 37% ( n = 9) were left-handed. Among children who scored at or below the fifth percentile of the M-ABC, 46% were left-handed (6/13). Conclusion: The prevalence of left-handedness in children with DCD suggests a possible role for cerebral lateralization in motor coordination problems.
Course and Outcome after the First Manic Episode in Patients with Bipolar Disorder: Prospective 12-Month Data from the Systematic Treatment Optimization Program for Early Mania Project
Authors: Yatham Lakshmi N , Kauer-Sant'Anna Marcia , Bond David J , Lam Raymond W , Torres Ivan 
Published: January 2017

Objective: To describe clinical characteristics, course, and outcome during a 1-year period after the first manic episode in patients with bipolar disorder (BD). Methods: This paper describes the project design, demographics, clinical outcomes, and predictors at 6 months to 1 year of follow-up of the first 53 recruited subjects with first-episode mania from the Systematic Treatment Optimization Program for Early Mania. Results: Survival analysis for recurrence of mood episodes showed that 46.7% of patients survived without a mood episode during 1-year of follow-up, and the mean time-to-mood event was 7.9 months. Earlier age of onset was the only variable that significantly predicted recurrence of mood episodes. When examined separately, the survival rates were 76% for a manic episode and 58.7% for a depressive episode. Conclusion: These results suggest that recurrences are common after the first manic episode with more than one-half of the patients experiencing a mood event within 12 months. Aggressive treatment strategies aimed at preventing depressive episodes are needed in the management of early course BD.
Childhood Disruptive Behaviour Disorders: Review of Their Origin, Development, and Prevention
Authors: Petitclerc Amélie , Tremblay Richard E 
Published: January 2017

Objective: To review preventive studies of disruptive behaviour disorders (DBDs) in light of recent empirical knowledge on their development. Method: We draw on the results of longitudinal studies of children starting in infancy to examine the onset, development, and risk factors for DBD symptoms. We review randomized controlled trials of preventive interventions provided to families before the child is aged 3 years, with reported outcome measures of DBD symptoms at follow-up. Results: Children who present high levels of DBD symptoms start to do so in the first 2 years of life and have risk factors that can be identified in the mother during pregnancy or even earlier, and shortly after the child's birth. Most preventive experiments have started relatively late after birth and have targeted parenting, with weak effects on children's DBDs. Preventive experiments that have provided intensive intervention to at-risk mothers starting during pregnancy have shown important effects in reducing key risk factors and some of the most severe consequences of DBDs. However, even those experiments have not succeeded in preventing childhood DBDs in the home and school contexts. Conclusions: We suggest adopting a sequential, multitarget, intergenerational, experimental approach both to increase our knowledge about causal mechanisms and to increase our effectiveness in curbing DBDs and their serious lifelong consequences.
The Design and Implementation of a Management Information System for Australian Public Hospitals
Authors: Stoelwinder Johannes U. , Abernethy Margaret A. 
Published: January 2017

Existing management information systems (MIS) in hospitals are often inadequate. This has occurred because of a variety of antecedents, including past funding mechanisms, organisational structure and the accepted role of management. A variety of new pressures, including demands for increased accountability, greater resource control and changing relationships between physicians and hospitals are demanding improved MIS to enable the hospital to manage. This paper explores these influences on past and future hospital MIS. It describes the design of a MIS that enables patient care to be costed in clinically meaningful ways. Patient costs may be aggregated to cost specific diagnoses and procedures, Diagnosis Related Groups (DRG), a clinician's case load, a clinical unit or a division. The information can be used for clinical budgeting, flexible budgeting, utilisation review and quality assurance.
A Conceptual Framework for Evaluating Joint Venture Opportunities between Hospitals and Physicians
Authors: Jacobson Carol K. 
Published: January 2017

A Conceptual Framework for Evaluating Joint Venture Opportunities Between Hospitals and Physicians This paper reviews the changes in the competitive and regulatory environment and examines the impact of those changes on the relationships between hospitals and physicians. Transaction cost economics (TCE) provides a conceptual framework for examining the emergence of closer linkages between hospitals and physicians than the traditional independent hospital and medical staff organisations. TCE predicts that as investments in support of transactions become more specialised, closer linkages are more efficient. To illustrate, two case studies of successful hospital-physician joint ventures are presented. The first case study describes a joint venture between hospitals and physicians to purchase durable medical equipment. The second case describes the breakdown of an informal arrangement and the subsequent formation of a joint venture to organise a clinical programme. The discussion reports the rationale for choosing these structural arrangements and their key features, pointing out how TCE would account for the decision to establish a joint venture. The conclusion discusses the implications of this argument for the strategic decisions of health care managers.