bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lithium Revisited
Authors: McIntyre Roger S , Mancini Deborah A , Parikh Sagar , Kennedy Sidney H 
Published: January 2017

Objective: To review lithium's utility in the treatment of mood disorders. Method: We reviewed the safety, tolerability, teratogenicity, optimal dosing regimens, and mortality-lowering effects of lithium. Clinical relevance and scientific rigour determined which articles we selected for review. Results: Lithium is the paradigmatic treatment for bipolar disorder (BD). In treating BD, optimal maintenance plasma levels may be approximately 0.75 to 0.85 mEq/L. Although nephrogenic diabetes insipidus is not uncommon, irreversible renal failure due to lithium appears to be a rare, idiosyncratic event. Lithium-induced cardiovascular teratology appears to be less common than previously thought. Optimal lithium dosing may be once daily, this agent appears to bestow a robust suicide-lowering effect, and emerging data hint at neurotrophic and neuroprotective effects. Conclusion: Lithium remains an effective and integral agent in the treatment of BD. Its ability to lower suicide rates in persons with BD warrants clinical attention.
Clinical Trials in Psychiatry: Do Results Apply to Practice?
Authors: Seeman Mary V 
Published: January 2017

Objective: The purpose of this communication is to alert psychiatrists to the difficulties of translating results of group difference obtained from large, randomized clinical trials to the treatment of individual patients. Method: Reported discrepancies between a) clinical trial participants and general psychiatric patients, b) clinical trial investigators and general clinicians, and c) study trial and usual clinic conditions were assessed. Results: The results confirm that important differences exist in all 3 areas. Conclusions: Recommendations for researchers include more complete assessments of factors that account for individual difference, an appraisal of outcomes more important to patients than symptom scores, and the use of statistical methods that permit the evaluation of individual difference. Recommendations for clinicians include a careful differentiation of results obtained in different phases of clinical trials and a clear appreciation of the different purposes of those trials. Clinicians should also appreciate that short-term effectiveness is not the same as long-term outcome and that aggregate scores may not apply to individual patients.
Managing Bipolar Disorder during Pregnancy: Weighing the Risks and Benefits
Authors: Viguera Adele C , Cohen Lee S , Baldessarini Ross J , Nonacs Ruta 
Published: January 2017

Background: Challenges for the clinical management of bipolar disorder (BD) during pregnancy are multiple and complex and include competing risks to mother and offspring. Method: We reviewed recent research findings on the course of BD during pregnancy and postpartum, as well as reproductive safety data on the major mood stabilizers. Results: Pregnancy, and especially the postpartum period, are associated with a high risk for recurrence of BD. This risk appears to be limited by mood-stabilizing treatments and markedly increased by the abrupt discontinuation of such treatments. However, drugs used to treat or protect against recurrences of BD vary markedly in teratogenic potential: there are low risks with typical neuroleptics, moderate risks with lithium, higher risks with older anticonvulsants such as valproic acid and carbamazepine, and virtually unknown risks with other newer-generation anticonvulsants and atypical antipsychotics (ATPs). Conclusions: Clinical management of BD through pregnancy and postpartum calls for balanced assessments of maternal and fetal risks and benefits. Contexte: Les problèmes liés au traitement clinique du trouble bipolaire (TB) durant la grossesse sont profonds et peuvent entraîner des risques concurrents pour la mère et l'enfant. Méthode: Nous avons examiné les résultats récents de la recherche sur le cours du TB durant la grossesse et le post-partum, de même que les données d'innocuité reproductrice des principaux régulateurs de l'humeur. Résultats: La grossesse et surtout la période du post-partum comportent des risques élevés de récurrence du TB. Les risques semblent être limités par les traitements aux régulateurs de l'humeur et notablement accrus par la cessation abrupte de ces traitements. Toutefois, les médicaments utilisés pour traiter ou prévenir les récurrences du TB varient beaucoup en ce qui concerne les risques tératogènes: les risques sont faibles pour les neuroleptiques typiques, modérés pour le lithium, élevés pour les anciens anticonvulsivants comme l'acide valproïque et la carbamazépine, et presque inconnus pour les autres anticonvulsivants de la nouvelle génération et les antipsychotiques atypiques (APA). Conclusions: Le traitement clinique des femmes souffrant du TB durant la grossesse et le post-partum demande des évaluations équilibrées des risques et des avantages pour la mère et le foetus.
Gender-Role Conflict and Suicidal Behaviour in Adolescent Girls
Authors: Pinhas Leora , Weaver Harriet , Bryden Pier , Ghabbour Nagi , Toner Brenda 
Published: January 2017

Objective: This study examined whether gender-role conflict influenced the suicidal behaviour of adolescent girls. Method: We designed a checklist and used it to perform a chart review. Results: Gender-role conflict was associated with suicidal behaviour in 26.79% of the adolescent girls, and 2.68% of the adolescent boys, that we studied. Conclusions: Gender-role conflict plays an important role in the suicidal behaviour of girls. At present, there is no published research examining the impact of gender-role conflict on suicidal adolescents. Objectif: Cette étude examine si le conflit entre sexe et rôle influence le comportement suicidaire des adolescentes. Méthode: Nous avons mis au point une liste de vérification et l'avons utilisée pour effectuer une étude de dossiers. Résultats: Le conflit sexe-rôle était associé au comportement suicidaire chez 26,79 % des adolescentes et chez 2,68 % des adolescents que nous avons observés. Conclusions: Le conflit sexe-rôle joue un rôle important dans le comportement suicidaire des filles. À l'heure actuelle, aucune étude n'a été publiée sur l'effet du conflit sexe-rôle sur le suicide des adolescentes.
Completed Suicides in a Youth Centres Population
Authors: Renaud Johanne , Chagnon François , Turecki Gustavo , Marquette Claude 
Published: January 2017

Objective: From 1995 to 2000, 422 youths, aged 18 years and under, died as a result of suicide in Quebec. More than one-third had received services from youth centres (YCs) at some point. This study sought to characterize a sample of those youths to improve services for this at-risk population. Method: From a retrospective study of YCs and coroner's office files, we investigated the clinical features of youths who had received YC services and died by suicide. We compared them with YC patients matched for age, sex, and geographic area who had reported suicidal behaviour or who had no such symptoms. Results: Among those who committed suicide, we found a ratio of 3.8 boys for 1 girl, with a mean age of 16.8 years. Hanging, used by 73.6%, was the most frequent means; 53.6% had a previous suicide attempt. The group that committed suicide had more indicators of major depression, substance abuse, and disruptive behaviours, as well as more adverse events. Conclusions: Interventions should focus on screening for mental disorders and suicidal behaviours on the initial contact with YC services. This screening should be implemented through a medical multidisciplinary team that includes psychoeducational services.
Body Image, Binge Eating, and Bulimia Nervosa in Male Bodybuilders
Authors: Goldfield Gary S , Blouin Arthur G , Woodside D Blake 
Published: January 2017

Objective: Male bodybuilders (MBB) exhibit more severe body dissatisfaction, bulimic eating behaviour, and negative psychological characteristics, compared with male athletic and nonathletic control subjects, but few studies have directly compared MBB and men with eating disorders. This study compared men with bulimia nervosa (MBN), competitive male bodybuilders (CMBB), and recreational male bodybuilders (RMBB) on a broad range of eating attitudes and behaviours and psychological characteristics to more accurately determine similarities and differences among these groups. Method: Anonymous questionnaires, designed to assess eating attitudes, body image, weight and shape preoccupation, prevalence of binge eating, weight loss practices, lifetime rates of eating disorders, anabolic androgenic steroid (AAS) use, and general psychological factors, were completed by 22 MBN, 27 CMBB, and 25 RMBB. Results: High rates of weight and shape preoccupation, extreme body modification practices, binge eating, and bulimia nervosa (BN) were reported among MBB, especially among those who competed. CMBB reported higher rates of binge eating, BN, and AAS use compared with RMBB, but exhibited less eating-related and general psychopathology compared with MBN. Few psychological differences were found between CMBB and RMBB. Conclusions: MBB, especially competitors, and MBN appear to share many eating-related features but few general psychological ones. Longitudinal research is needed to determine whether men with a history of disordered eating or BN disproportionately gravitate to competitive bodybuilding and (or) whether competitive bodybuilding fosters disordered eating, BN, and AAS use.
Metformin for Prevention of Weight Gain and Insulin Resistance with Olanzapine: A Double-Blind Placebo-Controlled Trial
Authors: Baptista Trino , Martínez Jessan , Lacruz Anny , Rangel Nairy , Beaulieu Serge , Serrano Ana , Arapé Yinet , Martinez Maritza , de Mendoza Soaira , Teneud Luis , Hernández Luis 
Published: January 2017

Objective: To assess whether metformin prevents body weight gain (BWG) and metabolic dysfunction in patients with schizophrenia who are treated with olanzapine. Method: Forty patients taking olanzapine (10 mg daily) were randomly allocated to a metformin ( n = 20; 850 to 1700 mg daily) or placebo ( n = 20) group in a 14-week double-blind study. Waist circumference (WC), BWG, body mass index (BMI) fasting glucose, insulin, and lipids were evaluated at baseline and at Weeks 7 and 14 of treatment. Results: At Week 14, BWG (kg) was similar in the metformin group (5.5 kg) and the placebo group (6.3 kg), P = 0.4. There were no differences between the changes in BMI, WC, glucose, insulin, insulin resistance index (HOMA-IR), and plasma lipid levels observed in the treatment group and the placebo group; however, glucose levels decreased significantly after metformin administration ( P = 0.02). The HOMA-IR decreased significantly in both groups, but 3 subjects from the placebo group developed fasting glucose levels greater than 5 mmol/L. After taking metformin, triglyceride levels increased, but the cholesterol profile improved significantly. Conclusions: Metformin did not prevent olanzapine-induced BWG. While some lipid parameters worsened during placebo, the HOMA-IR improved in both the placebo and the metformin groups. Carbohydrate metabolism impairment was not systematically observed during short-term olanzapine administration.
Pharmacologic and Nonpharmacologic Strategies for Weight Gain and Metabolic Disturbance in Patients Treated with Antipsychotic Medications
Authors: Faulkner Guy , Cohn Tony A 
Published: January 2017

Objectives: To provide an overview of pharmacologic and nonpharmacologic strategies for antipsychotic-associated weight gain and metabolic disturbance, to identify important areas for future research, and to make practice recommendations based on current knowledge. Methods: We undertook a selective review of interventions for weight gain and metabolic disturbance in the general population and in individuals treated with antipsychotic medications, focusing on randomized controlled trials in schizophrenia. Results: Pharmacologic strategies include medication choice, medication dosage and formulation, choice of concomitant psychotropic medications, medication switching, medication addition to effect weight loss or prevent weight gain, and medications to increase insulin sensitivity. Medication choice and medication switching may have the most potent influence on weight and metabolic parameters. Modest short-term weight loss can occur with the addition of selective medications and (or) lifestyle interventions. However, more rigorous and longer-term studies are needed. Conclusions: Although difficult, the prevention of weight gain and the promotion of weight loss are possible for individuals treated with antipsychotic medications. Further research, including diabetes prevention studies, is required. We suggest a pathway for the management of weight gain and emerging metabolic disturbance.
Cornerstones of Career Satisfaction in Medicine
Authors: Lepnurm Rein , Danielson Danton , Dobson Roy , Keegan David 
Published: January 2017

Objectives: To establish a reliable and concise measure of career satisfaction that covers all 4 of its dimensions and to document higher dimensions of satisfaction among the major medical specialties and across varying patterns of clinical practice. Methods: In 2004, we conducted a stratified, cross-sectional survey of physicians in Canada. Of the eligible population, 2810 physicians (56.7%) responded. We checked response bias and found it was negligible. Responding physicians completed a 17-item measure of career satisfaction along with a detailed breakdown of clinical, academic, and administrative duties. We used confirmatory factor analysis to verify the existence of the hypothesized dimensions of higher-order satisfaction. We then used Scheffe's tests to document differences in the levels of all satisfaction dimensions, both among specializations and by clinical practice profile. Results: Factor analysis revealed 4 reliable dimensions of satisfaction: personal (α = 0.85), professional (α = 0.78), inherent (α = 0.70), and performance (α = 0.75). Inherent satisfaction with medicine as a career was the most important dimension for all specializations and for all patterns of practice. The addition of administrative duties without a reduction of clinical duties compromised personal, professional, and performance dimensions of career satisfaction. Academic duties contributed significantly to most physicians' overall, inherent, and performance satisfaction. Conclusion: Distinguishing higher-order dimensions of satisfaction from basic ones is a groundbreaking finding because addressing higher-order dimensions supports self-actualization and superior performance of duties.
Add-on Quetiapine for Bipolar Depression: A 12-Month Open-Label Trial
Authors: Milev Roumen , Abraham Gebrehiwot , Zaheer Juveria 
Published: January 2017

Objectives: Bipolar disorder (BD) is a disabling and often chronic condition. Patients with BD suffer from depression at least one-third of the time, but they do not always respond well to conventional mood stabilizers. Attempts to treat them with antidepressants can provoke a switch to mania or increased cycling. Our open-label trial aimed to assess the long-term response of patients with bipolar depression to the addition of quetiapine to their usual treatment. Our study also sought to assess the safety and tolerability of quetiapine in patients with BD. Method: To meet inclusion criteria for the study, patients had a DSM-IV diagnosis of type I or II BD, were aged 18 years and older, currently suffered from depression with a score of > 18 on the Hamilton Depression Rating Scale (HDRS), and had no change in antidepressant use for at least 3 weeks prior to the study. We added quetiapine to patients' medication and attempted to increase the dosage to at least 400 mg daily. Outcome was measured at baseline and once monthly for 12 months on the HDRS, the Young Mania Rating Scale, the Clinical Global Impression Scale (CGI), and the Abnormal Involuntary Movement Scale. Results: There were 19 patients enrolled in the study (6 men and 13 women), 2 of whom dropped out because they could not tolerate the drug. Seventeen completed at least 2 assessments, and 7 patients completed the full 12-month trial. Data for the 17 patients (that is, last observation carried forward) at 12 months shows HDRS scores reduced from 27.2 to 12.1 and CGI scores reduced from 4.7 to 2.6. Conclusions: Quetiapine seems to be helpful to and relatively well tolerated by patients with bipolar depression when it is added to their usual treatment. There is, however, a need for controlled trials.
French Adaptation and Validation of the Helping Alliance Questionnaires for Child, Parents, and Therapist
Authors: Kermarrec Solenn , Kabuth Bernard , Bursztejn Claude , Guillemin Francis 
Published: January 2017

Objectives: To adapt the Helping Alliance Questionnaires for Child and Parents (HAQ-CP) into French and to assess their validity and reproducibility for use with the child, parent, and therapist. Method: First, the 3 US versions of the questionnaires were translated into French by 3 French-English bilingual translators (who were native speakers), and the translations were then discussed by an expert committee to ensure that the concept explored within the French context was efficiently targeted. Second, the psychometric properties of the French version were investigated in a cross-sectional, multicentre study. The questionnaires were completed by 148 children and adolescents, aged 9 years or older and with various conditions, who were followed in 3 university hospital outpatient clinics and 2 ambulatory psychiatry units, and also by their parents and therapists. Results: The instruments were quick and easy to administer, and acceptability was good. All 3 versions proved unidimensional in factorial analysis (80% of variance was explained) with high internal construct validity (Cronbach's α = 0.8). Reproducibility was satisfactory (intraclass correlation coefficients were as follows: child, 0.84; parent, 0.84; and therapist, 0.87). Concordance of the 3 alliance assessments was moderate. Conclusion: This work provides child psychiatrists with a valid measure of the therapeutic alliance. Its predictive value, while recognized in adults, remains to be demonstrated in children.
Adverse Cardiovascular Events in Antidepressant Trials Involving High-Risk Patients: A Systematic Review of Randomized Trials
Authors: Swenson J Robert , Doucette Steve , Fergusson Dean 
Published: January 2017

Objective: To examine whether selective serotonin reuptake inhibitor (SSRI) antidepressants were associated with an increased or decreased risk of cardiovascular adverse events (AEs). Methods: We conducted a systematic review of randomized controlled trials published between 1967 and May 2005 that treated patients with cardiac disease, diabetes mellitus, stroke, geriatric age, nicotine dependence, alcoholism, HIV infection, and obesity. We defined serious AEs as death due to a cardiovascular cause, heart failure, stroke, transient ischemic attack, and myocardial infarction. Nonserious AEs were defined as palpitations, chest pain, angina, arrhythmia, hypertension, hypotension–syncope, and unspecified cardiovascular or neurologic events. Adverse event rates were calculated in 4 groups: SSRIs, tricyclic antidepressants (TCAs), other active therapies, and placebo. Results: Stroke and cardiac patients were the highest-risk groups for cardiovascular AEs. We were unable to detect differences in odds between SSRI and placebo for both serious (odds ratio [OR] 0.69; 95% confidence interval [CI], 0.39 to 1.21) and nonserious (OR 1.18; 95%CI, 0.90 to 1.57) cardiovascular AEs. There was a significant decrease in the odds of nonserious cardiovascular AEs (OR 0.46; 95%CI, 0.24 to 0.86, P = 0.02) for patients receiving SSRIs, compared with TCAs. Over one-half of the selected trials did not report the presence or absence of cardiovascular events. Conclusions: This systematic review of antidepressant trials in high-risk patients did not determine whether SSRIs are associated with a greater or lesser risk of cardiovascular AEs. Reasons for this conclusion include the rarity of serious AEs, the lack of large trials in these patients, and a lack of adequate reporting of AEs in published trials. Further trials assessing the risk of cardiovascular AEs and better trial reporting are needed.
Long-Term Treatment of Depression with Antidepressants: A Systematic Narrative Review
Authors: Furukawa Toshi A , Cipriani Andrea , Barbui Corrado , Geddes John R 
Published: January 2017

Objective: To examine the available scientific evidence for answers to clinically relevant questions on the effectiveness and tolerability of antidepressant drugs (ADs) for the long-term treatment of depression. Method: The Cochrane Library was searched up to July 2006. When no complete Cochrane review was available, we looked in PubMed for relevant systematic reviews or individual randomized controlled trials. Results: There was no good evidence that increasing the dosage of the initial AD is an effective strategy for patients with no, or partial, response to acute-phase treatment. There was no good evidence that switching between chemical classes of antidepressant was more effective than switching within a class. There was limited support from randomized trials for several augmentation strategies. There was good evidence for the effectiveness of long-term therapy to prevent relapse in patients who remitted after acute-phase treatment. The application of principles of evidence-based medicine suggested that thoughtful, individualized application of evidence is more appropriate than general statements. Conclusions: Available evidence provides some support for the effectiveness of several augmentation strategies in the management of patients with no, or partial, response to acute-phase treatment and for the individualized application of groupwise robust evidence for maintenance treatment with ADs to prevent relapses. However, side effects of these long-term treatments with ADs are poorly studied and reported.
A Multisite Canadian Study of Outcome of First-Episode Psychosis Treated in Publicly Funded Early Intervention Services
Authors: Malla Ashok , Schmitz Norbert , Norman Ross , Archie Suzanne , Windell Deborah , Roy Paul , Zipursky Robert B 
Published: January 2017

Objective: The aim of this study was to determine 1-year symptomatic outcome and its predictors in patients with first-episode psychosis (FEP) treated at 3 different publicly funded sites. Method: We evaluated FEP patients ( n = 172) treated in specialized programs in 2 medium-sized centres and 1 large urban centre with an identical protocol for demographic variables, diagnosis, and duration of untreated psychosis (DUP) at entry, and positive, negative, and general psychopathology symptoms at entry, 6 months, and 1 year. We used a mixed model analysis of variance, with time and centre and interaction between time and centre as fixed effects and sex and DUP as covariates, to analyze data. Results: A significant effect of time and time x centre interaction on positive, negative, and general symptom outcome was shown after controlling for ethnicity, education, and diagnosis. Patients showed significantly better outcome on all dimensions of symptoms in the 2 medium-sized centres, compared with the 1 large urban centre. Sex had a significant effect on negative and general symptoms, while DUP had no effect on any outcome measure. Conclusions: Similarly enriched early intervention services may produce different outcomes, even within a relatively homogeneous mental health system.