Showing papers in "The Canadian Journal of Psychiatry in 2007"
TL;DR: One year after the outbreak of severe acute respiratory syndrome (SARS), SARS survivors still had elevated stress levels and worrying levels of psychological distress and mental health services could play an important role in rehabilitation.
Abstract: Objective:Our study examined the stress level and psychological distress of severe acute respiratory syndrome (SARS) survivors 1 year after the outbreak.Method:During the SARS outbreak in 2003, we ...
866 citations
TL;DR: Health care workers who were at high risk of contracting SARS appear not only to have chronic stress but also higher levels of depression and anxiety, which could benefit front-line staff as part of preparation for future outbreaks.
Abstract: Objective:To assess the immediate and sustained psychological health of health care workers who were at high risk of exposure during the severe acute respiratory syndrome (SARS) outbreak.Methods:At...
565 citations
TL;DR: The MoCA is a useful brief screening tool for the detection of mild dementia or MCI in subjects scoring over 25 points on the MMSE in patients already diagnosed with MCI, in patients at risk of developing dementia at 6-month follow-up.
Abstract: Objective:To prospectively validate the Montreal Cognitive Assessment (MoCA) in a UK memory clinic.Method:We administered the MoCA and Mini-Mental State Examination (MMSE) to 32 subjects fulfilling...
549 citations
TL;DR: A technique called receiver operating characteristic (ROC) curves allows us to determine the ability of a test to discriminate between groups, to choose the optimal cut point, and to compare the performance of 2 or more tests.
Abstract: It is often necessary to dichotomize a continuous scale to separate respondents into normal and abnormal groups. However, because the distributions of the scores in these 2 groups most often overlap, any cut point that is chosen will result in 2 types of errors: false negatives (that is, abnormal cases judged to be normal) and false positives (that is, normal cases placed in the abnormal group). Changing the cut point will alter the numbers of erroneous judgments but will not eliminate the problem. A technique called receiver operating characteristic (ROC) curves allows us to determine the ability of a test to discriminate between groups, to choose the optimal cut point, and to compare the performance of 2 or more tests. We discuss how to calculate and compare ROC curves and the factors that must be considered in choosing an optimal cut point.
437 citations
TL;DR: There is an important and clear need for studies that empirically test current definitions, assessment strategies, and staging methods of TRD, and they currently require extensive empirical support.
Abstract: Objective:Up to 15% of depression patients eventually present with treatment-resistant or refractory depression (TRD), a condition that causes significant social and economic burdens. Our paper aim...
333 citations
TL;DR: MBSR does not have a reliable effect on depression and anxiety, and the relation between practising mindfulness and changes in depression and Anxiety was equivocal.
Abstract: Objective:To review the impact of mindfulness-based stress reduction (MBSR) on symptoms of anxiety and depression in a range of clinical populations.Method:Our review included any study that was published in a peer-reviewed journal, used a control group, and reported outcomes related to changes in depression and anxiety. We extracted the following key variables from each of the 15 studies identified: anxiety or depression outcomes after the MBSR program, measurement of compliance with MBSR instructions, type of control group included, type of clinical population studied, and length of follow-up. We also summarized modifications to the MBSR program.Results:Measures of depression and anxiety were included as outcome variables for a broad range of medical and emotional disorders. Evidence for a beneficial effect of MBSR on depression and anxiety was equivocal. When active control groups were used, MBSR did not show an effect on depression and anxiety. Adherence to the MBSR program was infrequently assessed. ...
309 citations
TL;DR: Although performance of the 2 instruments is similar, the K6 is more attractive for use as a screening instrument because of the lower response burden and both appear to be excellent screening instruments, especially for current depression.
Abstract: Objective:Structured diagnostic interviews are very time-consuming and therefore increase both the expense and the respondent burden in epidemiologic surveys. A 2-staged interview that screens pote...
225 citations
TL;DR: Immigrant status is associated with lower rates of use of mental health services, even with universal health insurance, and this lower rate of use likely reflects cultural and linguistic barriers to care.
Abstract: Objective:Research in the United States tends to attribute low rates of use of mental health services by immigrants to economic barriers. The purpose of our study was to examine this issue in the c...
195 citations
TL;DR: The accumulating evidence suggesting a role for social factors in the development of schizophrenia arises primarily from studies of migrants conducted in Europe, which provide compelling support for the notion that social factors contribute to theDevelopment of schizophrenia.
Abstract: Objective: To investigate recent evidence suggesting that social factors are causally related to the development of schizophrenia. Method: I conducted a sytematic review of MEDLINE to identify possibly relevant studies. The search was limited to peer-reviewed studies and review articles appearing in English-language journals since 1996. Studies were included if they used standardized diagnostic criteria for schizophrenia or standardized assessment instruments for psychotic symptoms. Results: Studies of migrants to western Europe provide compelling support for the notion that social factors contribute to the development of schizophrenia. Findings such as excessively high risk for schizophrenia in second-generation immigrants are difficult to explain solely in terms of biological or genetic factors. A growing number of studies implicate childhood exposure to social adversity as a risk factor for schizophrenia, although few studies have used prospective designs. The increased incidence of schizophrenia risk associated with urban birth and (or) urban upbringing suggests possible social causation, but these findings are more ambiguous. Thus far, no studies have explored actual mechanisms by which exposure to social factors might generate psychotic symptoms, although animal experiments suggest that social defeat or social exclusion may cause dopamine dysregulation or sensitization. Conclusions: The accumulating evidence suggesting a role for social factors in the development of schizophrenia arises primarily from studies of migrants conducted in Europe. The mechanisms by which social factors exert their influence remain unknown. Future investigations of social causation should clarify the temporal relation between exposure to social defeat and (or) social adversity and the development of psychotic symptoms.
176 citations
TL;DR: Findings in this paper may explain some behavioural abnormalities associated with schizophrenia, notably, inadequate functional outcomes in everyday life and have implications for cognitive remediation and better social and work functioning of patients with schizophrenia.
Abstract: Objective:To achieve a better understanding of the functional mechanisms underlying episodic memory dysfunction in schizophrenia, which is a prerequisite for unravelling schizophrenia's neural corr...
134 citations
TL;DR: Antidepressant treatment for depression in AD is efficacious, with rates of discontinuation that are comparable to placebo, Nonetheless, clinicians must be vigilant regarding the potential side effects of antidepressants in this population.
Abstract: Objective:Depression in patients with Alzheimer's disease (AD) is common (15% to 63%) and is associated with significant morbidity and increased mortality. Our objective was to quantitatively summa...
TL;DR: Issues related to acceptability explain most of the unmet need for mental health services, and program planners should consider the development of targeted approaches to service delivery and outreach for low-income, working individuals who have not completed high school.
Abstract: Objective:Socially disadvantaged individuals are at high risk for having their mental health service needs unmet. We explored the relations among education level, income level, and self-reported ba...
TL;DR: Examination of service use rates in young Canadians with depression and suicidality and the influence of sex on the types of service provider chosen found female adolescents and young adults were more likely to receive services from nonspecialty mental health providers.
Abstract: Objectives:Despite being recognized as a serious public health concern, suicidality among adolescents and young adults is frequently missed, and completed suicide remains the second leading cause o...
TL;DR: An association between higher worship frequency and lower odds of depression is confirmed and it expands that finding to other psychiatric disorders.
Abstract: Objective: Research into risk and protective factors for psychiatric disorders may help reduce the burden of these conditions. Spirituality and religion are 2 such factors, but research remains limited. Using a representative national sample of respondents, this study examines the relation between worship frequency and the importance of spiritual values and DSM-IV psychiatric and substance use disorders. Method: In 2002, the Canadian Community Health Survey obtained data from about 37 000 individuals aged 15 years or older. While controlling for demographic characteristics, we determined odds ratios for lifetime, 1-year, and past psychiatric disorders, with worship frequency and spiritual values as predictors. Results: Higher worship frequency was associated with lower odds of psychiatric disorders. In contrast, those who considered higher spiritual values important (in a search for meaning, in giving strength, and in understanding life’s difficulties) had higher odds of most psychiatric disorders. Conclusion: This study confirms an association between higher worship frequency and lower odds of depression and it expands that finding to other psychiatric disorders. The association between spiritual values and mood, anxiety, and addictive disorders is complex and may reflect the use of spirituality to reframe life difficulties, including mental disorders.
TL;DR: Early identification and treatment of perinatal depression will minimize morbidity and mortality for the woman, the child, and the family.
Abstract: Objective:To promote prompt identification and treatment of perinatal depression and enhance preventive care for women at risk.Methods:Using MEDLINE and PubMed searches, we reviewed the recent rese...
TL;DR: Youth, particularly young men, are at greater risk for gambling problems than adults and more prevention and research efforts are also needed to address the observed sex differences and interregional variability in the prevalence of gambling problems among youth.
Abstract: Objectives:To describe the epidemiology of gambling problems among youth aged 15 to 24 years in Canada and to examine whether these gambling prevalence patterns differ by sex and (or) by geographic...
TL;DR: The answer to the question of who bears the costs of poor mental health is “everyone,” because the benefits associated with improved worker mental health are often distributed among several stakeholders, the incentives for any single stakeholder to pay for additional services for workers may be diluted.
Abstract: Objective:To discuss the burden of poor mental health in workers, who currently bears it, and how the associated rising costs are being addressed, from an international perspective.Method:We identi...
TL;DR: Women with perinatal depression and anxiety disorders require timely and efficient management with a goal of providing symptom relief for the suffering mother while simultaneously ensuring the baby's safety.
Abstract: Objectives:To review the nonpharmacologic and pharmacologic treatment modalities for perinatal mood and anxiety disorders and to discuss the importance of weighing the risks and the benefits of exp...
TL;DR: Mental health promotion and education efforts are needed to improve the general public's mental health literacy and to clarify misunderstanding about depression.
Abstract: Objective:To assess the public's knowledge about depression, attitudes toward treatments for depression, perceived causal factors for depression, and reported prognoses of depression, overall and b
TL;DR: It is argued that dimensional perspectives involving careful attention to comorbid personality traits and symptoms are needed to accommodate existing heterogeneities within the population suffering from bulimia and to characterize the etiologic roles of familial-developmental, neurobiological, and genetic variables (and of interactions among these variables) in bulimic syndromes.
Abstract: Objectives:To review the main phenomenological variants observed among bulimia spectrum syndromes and the factors believed to act etiologically for them and also to generate an etiologic model that...
Journal Article•
TL;DR: Suicidal behaviour comprises a spectrum with differing frequencies and risk factors, and while some risk factors are fixed, others, such as psychiatric illness and stressors, may be amenable to intervention.
Abstract: OBJECTIVE: This is Part 1 of a 2-part review of suicidal behaviour in children and adolescents. Part 1 explores the phenomenology and epidemiology of suicide in children and adolescents. METHOD: Systematic review of the literature since 1966. Behaviours included within this spectrum are discussed and differentiated. The literature regarding the impact of demographic, social, and psychological risk factors is summarized. RESULTS AND CONCLUSIONS: Suicide rates in youth are declining, but the reasons are speculative. Suicidal behaviour comprises a spectrum with differing frequencies and risk factors. While some risk factors are fixed, such as age and family history, others, such as psychiatric illness and stressors, may be amenable to intervention. Language: en
TL;DR: This review aims to look beyond the overt and startling “not eating” phenotype of anorexia nervosa and consider eating disorder endophenotypes and ideas about how to translate endophenotype into treatment are introduced.
Abstract: Treatment for anorexia nervosa has changed little from that described by Gull over a century ago. To focus merely on symptomatic relief from "not eating," as occurs with some forms of hospital care, is primitive. The evidence base to guide treatment is thin. Nevertheless, there is hope that better understanding of the causes and maintaining factors may translate into more sophisticated treatments. This review aims to look beyond the overt and startling "not eating" phenotype of anorexia nervosa and consider eating disorder endophenotypes. The first part of the review sets the eating behaviour, clinical, and psychopathological features into the context of what is now understood about the central control of appetite. The evidence base for a framework of potential eating disorder endophenotypes follows. Finally, ideas about how to translate endophenotypes into treatment are introduced.
TL;DR: The findings suggest that anxiety comorbidity in BD patients is related to lower quality of life, particularly on the psychological domain.
Abstract: Objective:To assess the impact of anxiety comorbidity on the quality of life of patients with bipolar disorder (BD).Methods:We undertook a cross-Sectional survey of 162 BD outpatients interviewed w...
TL;DR: Although children with mental disorders were less likely to have a permanency plan of adoption than were children without mental disorders, regression analysis found that only 2 variables—age on becoming a permanent ward and age at the time of the study—were predictive of children's adoption plans.
Abstract: OBJECTIVE: To identify the prevalence rate of mental disorders among Ontario children who are permanent wards and also the key practice and descriptive variables associated with their diagnostic status. METHOD: I reviewed case files from a stratified random sample of 429 Ontario children who were permanent wards with no access to biological parents on December 31, 2003. Data abstracted from files included information on descriptive variables (such as age, sex, and type of permanent ward), all disorders (that is, mental and other current medical diagnoses and disabilities), family history, maltreatment experiences, service history (such as age at admission to care and current residential placement type), and permanency plans. RESULTS: The prevalence of mental disorders was 31.7%. A significantly higher proportion of children with mental disorders experienced maltreatment. Children with mental disorders were almost 3 times more likely than those without mental disorders to be placed by Children's Aid Societies in privately operated resources, such as group homes, and almost 10 times less likely to be living in a probationary adoption home. Although children with mental disorders were less likely to have a permanency plan of adoption than were children without mental disorders, regression analysis found that only 2 variables--age on becoming a permanent ward and age at the time of the study--were predictive of children's adoption plans. CONCLUSIONS: The findings support the need for improved monitoring of the aggregate mental health needs of children who are permanent wards. Numerous implications for service delivery and future research are discussed. Language: en
TL;DR: EF impairments, particularly in inhibition, appear to underlie the behavioural manifestation of ADHD, however, parents and teachers do not always agree when reporting EF impairments at home and in school, and information from both types of informants is essential for understanding and treating children with this disorder.
Abstract: Objective: The primary purpose of this study was to compare parent and teacher reports of executive function (EF), as measured by the Behavior Rating Inventory of Executive Function (BRIEF), on a sample of children who had been diagnosed with attention-deficit hyperactivity disorder (ADHD). If differences were found, the secondary purpose was to explore these differences by determining which of the 8 BRIEF scales, each representing a different EF, would best predict symptoms of ADHD by the 2 proxy reporters. Method: We performed a secondary data analysis on the assessment information pertaining to 240 children, aged 5 to 15 years, accessing services at an urban Toronto psychiatric program specializing in ADHD. We compared parent and teacher ratings and applied logistical binary regressions to predict the probability of a child's meeting the criteria for clinically significant inattention and hyperactivity-impulsivity on the ADHD Rating Scale-IV. Results: As expected, teachers reported more variety and severity of EF impairments than did parents. In addition, teachers used inhibition, organization of materials, and planning and organizing as predictors of ADHD symptoms, whereas parents relied predominantly on inhibition, working memory, and planning and organizing as the risk factors. Conclusion: Consistent with the current theory, EF impairments, particularly in inhibition, appear to underlie the behavioural manifestation of ADHD. However, parents and teachers do not always agree when reporting EF impairments at home and in school. Thus information from both types of informants is essential for understanding and treating children with this disorder. (Can J Psychiatry 2007;52:527-534) Clinical Implications * Given that many children with ADHD struggle with various difficulties, clinicians should routinely use the BRIEF to obtain a more comprehensive understanding of each child. * Teachers should be regularly included in this assessment process because they are more familiar with age-appropriate expectations in the school setting and may play an important role in the early identification of EF problems not recognized by parents. Limitations * The generalizability of results from this clinical sample may be limited to nonclinical populations. * The staff psychiatrists providing diagnoses were not blind to the results of the BRIEF when conducting the assessment, which affects the internal validity. * Instrument bias may be present, given that items differ across the parent and teacher reports; however, both versions of the BRIEF measure identical constructs. Key Words: executive function, attention-deficit hyperactivity disorder, parent and teacher behaviour rating scales, children and adolescents Abbreviations used in this article ADHD attention-deficit hyperactivity disorder BRI Behavioral Regulation Index BRIEF Behavior Rating Inventory of Executive Function EF executive function GEC Global Executive Composite MI Metacognition Index OR odds ratio SD standard deviation Attention-deficit hyperactivity disorder is defined as a neurodevelopmental disorder characterized by persistent patterns of inattention and (or) hyperactivity-impulsivity accompanied by social impairment.1 The current diagnostic classification of ADHD relies predominantly on the presence of symptoms associated with these 3 behavioural constructs. This discrete classification system, however, fails to account for many of the cognitive and affective deficits experienced by individuals with this disorder. Children diagnosed with ADHD are reported to exhibit impairments with emotional control, behaviour regulation, planning and organizing, and working memory.2 These impairments are associated with reduced capacity in the executive system that consists of EFs. EFs are defined as a series of interrelated mental operations that govern cognitive, emotional, and behavioural functioning. …
TL;DR: It may be difficult for clinicians to recognize subtle types of clozapine-induced seizures, such as myoclonic, atonic, or partial seizures, so special attention should be paid when commencing or discontinuing concurrent medication that may affect the plasma level of clazapine.
Abstract: Objectives:To inform clinicians about the types of seizures that can be induced by clozapine and to provide recommendations for treatment.Methods:We identified articles on clozapine-induced seizures from a MEDLINE search of the English-language literature from 1978 to July 2006. The frequency of each type of seizure and the dosages of clozapine associated with seizures were compiled. In addition to this review, we report a new case illustrating the challenge of diagnosing subtle seizure activity.Results:The tonic-clonic variety is the most frequently described clozapine-induced seizure. Myoclonic and atonic seizures together constitute about one-quarter of the reported seizures. The mean dosage of clozapine associated with seizures is not high (less than 600 mg daily).Conclusions:It may be difficult for clinicians to recognize subtle types of clozapine-induced seizures, such as myoclonic, atonic, or partial seizures. Clinicians should not place excessive reliance on the plasma level of clozapine or electr...
TL;DR: Appraisal of major stressors in Iraq was significantly related to PTSD symptoms and was, for the most part, independent of neuroticism, but the strength of the association between minor stressors and PTSD symptoms dropped by 31% after statistical control for neuroticism.
Abstract: Objective:To investigate the extent to which preexisting neuroticism confounds the relation between appraisals of the severity of major and minor stressors and posttraumatic stress disorder (PTSD) symptoms.Method:A sample of 383 Dutch army soldiers completed a neuroticism scale before their 4-month tour of duty in Iraq. About 5 months after deployment, most of them rated the severity of stressors on deployment. PTSD symptoms were also assessed.Results:Appraisal of major stressors in Iraq was significantly related to PTSD symptoms and was, for the most part, independent of neuroticism. However, the strength of the association between minor stressors and PTSD symptoms dropped by 31% after statistical control for neuroticism.Conclusion:Neuroticism may partly compromise the relation between perceived minor stressors and PTSD symptoms.
TL;DR: Advances in PET and SPECT imaging have provided new insights into the biology of major psychiatric disorders and their treatment, and it can expect that these imaging techniques will become more central to the management of psychiatric disorders.
Abstract: Objectives:To review recent findings from positron emission tomography (PET) and single photon emission computed tomography (SPECT) studies that investigate the pathophysiology and treatment of sch...
TL;DR: Primary care practices need to examine how they can incorporate different concepts and models for managing depression and there is conclusive evidence for the benefits of changing systems of care delivery to support the more effective management of depression in primary care.
Abstract: Objective:To review randomized controlled trials (RCTs) evaluating chronic disease management models for depression in primary care and to look at the implications for clinical practice in Canada.M...
TL;DR: There was randomized evidence that ADs are efficacious in primary care settings and that there may be small, but clinically important, differences in efficacy between ADs, but there remains considerable residual uncertainty.
Abstract: OBJECTIVES: To examine the available scientific literature for answers to clinically relevant questions regarding the effectiveness and tolerability of antidepressant drugs (ADs) for the acute phase treatment of depression and to assess the degree to which the literature supports the findings. METHODS: We used several sources to identify primary reviews: MEDLINE (1955 to April 2006), EMBASE (1980 to April 2006), PsycINFO (1980 to April 2006), and the Cochrane Library 2006 Issue 1. Additional searches were also carried out on the following databases of the National Health Service Centre for Reviews and Dissemination: Abstracts of Reviews of Effects, Health Technology Assessment, and Turning Research into Practice. We also searched the National Institute of Health and Clinical Excellence guidance website. We carried out a metareview of selected high-quality systematic reviews of short-term pharmacologic interventions with ADs for major depression. To assess efficacy, we followed the hierarchy of evidence proposed by the Centre for Evidence Based Medicine (Oxford), including only reviews of randomized controlled trials. To assess tolerability, we also considered observational data when randomized evidence was not available. RESULTS: There was randomized evidence that ADs are efficacious in primary care settings and that there may be small, but clinically important, differences in efficacy between ADs. There was no good evidence that an AD combined with an antipsychotic is superior to AD monotherapy in cases of psychotic depression or that intravenous administration leads to more rapid response. There was evidence that monoamine oxidase inhibitors are superior to tricyclic antidepressants, but not to selective serotonin reuptake inhibitors (SSRIs), in treating atypical depression. There is some evidence of harm related to the use of SSRIs in pregnancy but not to their use when breastfeeding. There is evidence that SSRIs may increase suicidal thoughts, but not actual suicide, in early-phase therapy. CONCLUSIONS: We found a substantial body of evidence regarding the benefits and harms of ADs in the treatment of depressive disorder. Nonetheless, there remains considerable residual uncertainty. The evidence is inadequate for generally applicable recommendations; in most cases, the balance between risks and benefits will need to be considered for individual patients. Clinicians should also be guided by the recommendations and warnings issued by drug regulatory authorities. Language: en