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Journal Cover Canadian Journal of Psychiatry
  [SJR: 1.244]   [H-I: 79]   [16 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0706-7437 - ISSN (Online) 1497-0015
   Published by Sage Publications Homepage  [835 journals]
  • A Review of 20 Years of Research on Overdiagnosis and Underdiagnosis in
           the Rhode Island Methods to Improve Diagnostic Assessment and Services
           (MIDAS) Project
    • Authors: Zimmerman; M.
      Pages: 71 - 79
      Abstract: The Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project represents an integration of research methodology into a community-based outpatient practice affiliated with an academic medical centre. The MIDAS project is the largest clinical epidemiological study using semi-structured interviews to assess a wide range of psychiatric disorders in a general clinical outpatient practice. In an early report from the MIDAS project, we found that across diagnostic categories clinicians using unstandardized, unstructured clinical interviews underrecognized diagnostic comorbidity, compared with the results of semi-structured interviews. Moreover, we found that the patients often wanted treatment for symptoms of disorders that were diagnosed as comorbid, rather than principal, conditions. This highlighted the importance, from the patient’s perspective, of conducting thorough diagnostic interviews to diagnose disorders that are not related to the patient’s chief complaint because patients often desire treatment for these additional diagnoses. While several of the initial papers from the MIDAS project identified problems with the detection of comorbid disorders in clinical practice, regarding the diagnosis of bipolar disorder we observed the emergence of an opposite phenomenon—clinician overdiagnosis. The results from the MIDAS project, along with other studies of diagnosis in routine clinical practice, have brought to the forefront the problem with diagnosis in routine clinical practice. An important question is what do these findings suggest about the community standard of care in making psychiatric diagnoses, and whether and how the standard of care should be changed? The implications are discussed.
      PubDate: 2016-01-26T09:00:19-08:00
      DOI: 10.1177/0706743715625935
      Issue No: Vol. 61, No. 2 (2016)
  • Major Depression in Canada: What Has Changed over the Past 10 Years?
    • Authors: Patten, S. B; Williams, J. V. A, Lavorato, D. H, Wang, J. L, McDonald, K, Bulloch, A. G. M.
      Pages: 80 - 85
      Abstract: Objective: Major depressive episodes (MDE) make an important contribution to disease burden in Canada. The epidemiology of MDE in the national population has been examined in 2 mental health surveys, one conducted in 2002 and the other in 2012. Our objective was to compare selected variables from the 2 surveys to determine whether changes have occurred in the prevalence, treatment, and impact of MDE. Method: The World Health Organization World Mental Health Composite International Diagnostic Interview was used in both surveys and the MDE module (which was not modified) was scored using the same algorithm. Some variables assessing impact and management of MDE were also identical in the 2 surveys. The analysis was based on frequency estimates and associated 95% confidence intervals. Results: The annual prevalence of MDE was 4.7% (95% CI 4.3% to 5.1%) in 2012, nearly identical to 4.8% (95% CI 4.5% to 5.1%) in 2002. Receipt of potentially adequate treatment (defined as taking an antidepressant or 6 or more visits to a health professional for mental health reasons) increased from 41.3% in 2002 to 52.2% in 2012, mostly due to an increase in respondents reporting 6 or more visits. Use of second generation antipsychotics also increased. There was no evidence of diminishing prevalence or impact (as assessed by symptoms of distress). Conclusions: There appears to have been an increase in receipt of treatment for people with MDE and a changing pattern of management. However, it was not possible to confirm that the impact of MDE is diminishing as a result.
      PubDate: 2016-01-26T09:00:19-08:00
      DOI: 10.1177/0706743715625940
      Issue No: Vol. 61, No. 2 (2016)
  • Career Interests of Canadian Psychiatry Residents: What Makes Residents
           Choose a Research Career?
    • Authors: Laliberte, V; Rapoport, M. J, Andrew, M, Davidson, M, Rej, S.
      Pages: 86 - 92
      Abstract: Objectives: Training future clinician-researchers remains a challenge faced by Canadian psychiatry departments. Our objectives were to determine the prevalence of residents interested in pursuing research and other career options as part of their practice, and to identify the factors associated with interest in research. Method: Data from a national online survey of 207 Canadian psychiatry residents from a total of 853 (24.3% response rate) were examined. The main outcome was interest in research as part of residents’ future psychiatrist practice. Bivariate and multivariate analyses were performed to identify demographic and vocational variables associated with research interest. Results: Interest in research decreases by 76% between the first and fifth year of psychiatry residency (OR 0.76 per year, 95% CI 0.60 to 0.97). Training in a department with a residency research track did not correlate with increased research interest (2 = 0.007, df = 1, P = 0.93). Conclusions: Exposing and engaging psychiatry residents in research as early as possible in residency training appears key to promoting future research interest. Psychiatry residency programs and research tracks could consider emphasizing research training initiatives and protected research time early in residency.
      PubDate: 2016-01-26T09:00:19-08:00
      DOI: 10.1177/0706743715625952
      Issue No: Vol. 61, No. 2 (2016)
  • Investigating Possible Reciprocal Relations Between Depressive and Problem
           Gambling Symptoms in Emerging Adults
    • Authors: Chinneck, A; Mackinnon, S. P, Stewart, S. H.
      Pages: 93 - 101
      Abstract: Objective: Previous cross-sectional research has shown that depression and problem gambling co-occur. Longitudinal research, however, allows for a better determination of directionality, as behavioural changes in gambling involvement can be more reliably studied over time. Our study assesses symptoms of depression and problem gambling across 4 waves and addresses whether their relation is directional (with one reliably preceding the other), bidirectional, or pathoplastic. Method: As part of the Manitoba Longitudinal Study of Young Adults, prospective data were collected on Canadian young adults’ (Wave 1: n = 679, 51.8% female, aged 18 to 20 years) depressive symptoms, involvement in gambling, and risky gambling behaviour. Recruitment and the first cycle of data collection (Wave 1) took place in fall 2007. Three additional waves of data collection then occurred in 12- to 18-month intervals: fall 2008, spring 2010, and spring 2011. The Problem Gambling Severity Index and the Composite International Diagnostic Interview—Short Form were administered through telephone interview at each wave. Results: Bivariate growth curves showed that depressive and problem gambling symptoms were positively correlated at Wave 1, Wave 2, and Wave 4. Neither disorder was found to be a risk factor for the other, and depression and problem gambling were not pathoplastically related (that is, increases in one did not result in increases in the other over time, and vice versa). Conclusions: While depression and problem gambling are related, their co-occurrence may be better explained not by depressive- or gambling-related risk, but by the presence of a common underlying factor (such as substance abuse).
      PubDate: 2016-01-26T09:00:19-08:00
      DOI: 10.1177/0706743715625934
      Issue No: Vol. 61, No. 2 (2016)
  • A Longitudinal Study of the Temporal Relation Between Problem Gambling and
           Mental and Substance Use Disorders Among Young Adults
    • Authors: Afifi, T. O; Nicholson, R, Martins, S. S, Sareen, J.
      Pages: 102 - 111
      Abstract: Objective: Relatively little is known about the temporal relation between at-risk gambling or problem gambling (PG) and mental and substance use disorders (SUDs) in young adulthood. Our study aimed to examine whether past-year, at-risk, or PG is associated with incident mental disorders and SUDs (that is, depression, generalized anxiety disorder, obsessive–compulsive disorder [OCD], or alcohol dependence) and illegal drug use, and whether past-year mental disorders and SUDs and illegal drug use is associated with incident at-risk or PG. Method: Data for this longitudinal study were drawn from the Manitoba Longitudinal Study of Young Adults (MLSYA). Respondents aged 18 to 20 years in 2007 were followed prospectively for 5 years. Results: In cross-sectional analyses, at-risk or PG was associated with increased odds of depression, OCD, alcohol dependence, and illegal drug use. In longitudinal analysis at-risk or PG at cycle 1 was associated with incident major depressive disorder, alcohol dependence, and illegal drug use in the follow-up period. Only illegal drug use at cycle 1 was associated with incident at-risk or PG during follow-up. Conclusions: At-risk or PG was associated with more new onset mental disorders and SUDs (depression, alcohol dependence, and illegal drug use), compared with the reverse (illegal drug use was the only association with new onset at-risk or PG). Preventing at-risk or PG from developing early in adulthood may correspond with decreases in new onset mental disorders and SUDs later in adulthood.
      PubDate: 2016-01-26T09:00:19-08:00
      DOI: 10.1177/0706743715625950
      Issue No: Vol. 61, No. 2 (2016)
  • Forty-Five Years of Civil Litigation Against Canadian Psychiatrists: An
           Empirical Pilot Study
    • Authors: Mela, M; Luther, G, Gutheil, T. G.
      Pages: 112 - 118
      Abstract: Objectives: To extract the themes pertaining to prudent psychiatric practice from written court judgments in Canada. Methods: We searched the medical and legal literature for cases involving civil litigation against Canadian psychiatrist and reviewed all available written judgments. We completed a thematic analysis of the civil actions against psychiatrists as conveyed by those written court judgments. We classified the cases according to the disposal status and the essential lessons from the decisions on standard of care and practice by Canadian psychiatrists. Results: Forty such cases were identified as involving psychiatrists over a 45-year period. A subgroup included those dealing with limitation periods and disclosure applications. Thirty of the 40 cases (75%) were decided in favour of the defendant psychiatrists, including 2 dismissed for running over the limitation period. The cases that actually went to trial suggest that documentation and obtaining second opinions are protective against claims of negligence. Inpatient cases resulting in successful litigation against psychiatrists involved fatal outcomes, but not all fatal outcomes led to successful litigation. Conclusions: The key lessons from these cases are the importance and relevance of regular best clinical practices, such as documentation, obtaining second opinions, following guidelines, and balancing competencies in the expert and manager or advocate roles. Incorporating these practices should allay concerns about litigation against psychiatrists.
      PubDate: 2016-01-26T09:00:19-08:00
      DOI: 10.1177/0706743715625943
      Issue No: Vol. 61, No. 2 (2016)
  • Mental Health Service Use Among Children and Youth in Ontario:
           Population-Based Trends Over Time
    • Authors: Gandhi, S; Chiu, M, Lam, K, Cairney, J. C, Guttmann, A, Kurdyak, P.
      Pages: 119 - 124
      Abstract: Objective: Little is known about mental health service use among Canadian children and youth. Our objective was to examine temporal trends in mental health service use across different sectors of the health care system among children and youth living in Ontario. Methods: We conducted a population-based, repeated annual cross-sectional study of mental health service use, including mental health- and addictions-related emergency department (ED) visits, psychiatric hospitalizations, and mental health-related outpatient physician visits using linked health administrative databases. Subjects included Ontario residents between 10 and 24 years of age. We tested temporal trends between 2006 and 2011 using linear regression models. Results: Between 2006 and 2011, the relative increase in rates of mental health-related ED visits and hospitalizations were 32.5% and 53.7%, respectively. The absolute increase in anxiety disorders, the most common reason for ED visits, was 2.2 per 1000 population (P < 0.001) while mood and affective disorders, the most common reason for hospitalizations, showed an increase of 0.6 per 1000 population (P < 0.01). The overall relative increase in rates of outpatient visits was 15.8%, with the largest absolute increase found among family physician visits (28.7 per 1000 population, P = 0.01). Conclusions: Mental health care use for children and youth is increasing over time in all sectors, but appears to be increasing at a greater rate in the acute care sector. Further research is required to understand whether the observed differences reflect difficulty with access to outpatient care.
      PubDate: 2016-01-26T09:00:19-08:00
      DOI: 10.1177/0706743715621254
      Issue No: Vol. 61, No. 2 (2016)
  • Acadian Mental Health: A Review of Published Literature
    • Authors: Mahmoud, H. M; Sers, M. E, Tuite, J. E.
      Pages: 125 - 126
      PubDate: 2016-01-26T09:00:19-08:00
      DOI: 10.1177/0706743715619437
      Issue No: Vol. 61, No. 2 (2016)
  • Book Review: Attention-Deficit Hyperactivity Disorder: A Handbook for
           Diagnosis & Treatment
    • Authors: Bilkey; T.
      Pages: 127 - 127
      PubDate: 2016-01-26T09:00:19-08:00
      DOI: 10.1177/0706743715626405
      Issue No: Vol. 61, No. 2 (2016)
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