Pub Date : 2017-04-01DOI: 10.1177/0706743716673322
K. Anderson, P. Kurdyak
Objective: Physician follow-up after a first diagnosis of psychotic disorder is crucial for improving treatment engagement. We examined the factors associated with physician follow-up within 30 days of a first diagnosis of schizophrenia. Method: We conducted a retrospective cohort study using linked health administrative data to identify incident cases of schizophrenia between 1999 and 2008 among people aged 14 to 35 years in Ontario. We estimated the proportion of patients who had physician follow-up within 30 days of the index diagnosis. We used multilevel logistic regression models to examine the factors associated with any physician follow-up and follow-up by a psychiatrist. Results: We identified 20,096 people with a first diagnosis of schizophrenia. Approximately 40% of people did not receive any physician follow-up within 30 days, and nearly 60% did not receive follow-up by a psychiatrist. Males had lower odds of receiving any physician follow-up, and the odds of psychiatrist follow-up decreased with increasing age and were lower for those living in rural areas. Both prior contact with a general practitioner for a mental health reason and prior contact with a psychiatrist were strongly associated with higher odds of receiving both types of follow-up. Conclusions: Many people do not have any physician contact within 30 days of the first diagnosis of schizophrenia, and patients without prior engagement with mental health services are at highest risk. We need information on the reasons behind this lack of physician follow-up to inform strategies aimed at improving engagement with services during the early stages of psychosis.
{"title":"Factors Associated with Timely Physician Follow-up after a First Diagnosis of Psychotic Disorder","authors":"K. Anderson, P. Kurdyak","doi":"10.1177/0706743716673322","DOIUrl":"https://doi.org/10.1177/0706743716673322","url":null,"abstract":"Objective: Physician follow-up after a first diagnosis of psychotic disorder is crucial for improving treatment engagement. We examined the factors associated with physician follow-up within 30 days of a first diagnosis of schizophrenia. Method: We conducted a retrospective cohort study using linked health administrative data to identify incident cases of schizophrenia between 1999 and 2008 among people aged 14 to 35 years in Ontario. We estimated the proportion of patients who had physician follow-up within 30 days of the index diagnosis. We used multilevel logistic regression models to examine the factors associated with any physician follow-up and follow-up by a psychiatrist. Results: We identified 20,096 people with a first diagnosis of schizophrenia. Approximately 40% of people did not receive any physician follow-up within 30 days, and nearly 60% did not receive follow-up by a psychiatrist. Males had lower odds of receiving any physician follow-up, and the odds of psychiatrist follow-up decreased with increasing age and were lower for those living in rural areas. Both prior contact with a general practitioner for a mental health reason and prior contact with a psychiatrist were strongly associated with higher odds of receiving both types of follow-up. Conclusions: Many people do not have any physician contact within 30 days of the first diagnosis of schizophrenia, and patients without prior engagement with mental health services are at highest risk. We need information on the reasons behind this lack of physician follow-up to inform strategies aimed at improving engagement with services during the early stages of psychosis.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131515265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1177/0706743716675856
R. Whitley, Jiawei Wang
Objectives: The overarching aim of this article is to assess media portrayals of mental illness in Canada. We hypothesise that portrayals have improved over time, related to the various antistigma activities of organisations such as the Mental Health Commission of Canada (MHCC). Specific objectives are to assess 1) overall tone and content of newspaper articles, 2) change over time, and 3) variables associated with positive or negative content. Methods: We collected newspaper articles from print and online editions of over 20 best-selling Canadian newspapers from 2005 to 2015 (N = 24,570) that mentioned key search terms such as mental illness or schizophrenia. These were read by research assistants, who assessed tone and content for each article using preassigned codes and categories. Data were subjected to chi-squared and trend analysis. Results: Over the study period, 21% of the articles had a positive tone and 28% had stigmatising content. Trend analysis suggested significantly improved coverage over 11 years (P < 0.001). For example, articles with a positive tone had almost doubled from 2005 (18.9%) to 2015 (34.8%), and articles with stigmatising content had reduced by a third (22.3% vs 32.7%). Analysis also suggested that articles on the front page, as well as articles in broadsheet newspapers, had significantly more positive coverage. Conclusions: The study indicates that news media coverage related to mental illness has improved over the past decade. This may be related to the concerted efforts of the MHCC, which has executed a targeted strategy aimed at reducing stigma and improving media coverage since 2007.
{"title":"Good News? A Longitudinal Analysis of Newspaper Portrayals of Mental Illness in Canada 2005 to 2015","authors":"R. Whitley, Jiawei Wang","doi":"10.1177/0706743716675856","DOIUrl":"https://doi.org/10.1177/0706743716675856","url":null,"abstract":"Objectives: The overarching aim of this article is to assess media portrayals of mental illness in Canada. We hypothesise that portrayals have improved over time, related to the various antistigma activities of organisations such as the Mental Health Commission of Canada (MHCC). Specific objectives are to assess 1) overall tone and content of newspaper articles, 2) change over time, and 3) variables associated with positive or negative content. Methods: We collected newspaper articles from print and online editions of over 20 best-selling Canadian newspapers from 2005 to 2015 (N = 24,570) that mentioned key search terms such as mental illness or schizophrenia. These were read by research assistants, who assessed tone and content for each article using preassigned codes and categories. Data were subjected to chi-squared and trend analysis. Results: Over the study period, 21% of the articles had a positive tone and 28% had stigmatising content. Trend analysis suggested significantly improved coverage over 11 years (P < 0.001). For example, articles with a positive tone had almost doubled from 2005 (18.9%) to 2015 (34.8%), and articles with stigmatising content had reduced by a third (22.3% vs 32.7%). Analysis also suggested that articles on the front page, as well as articles in broadsheet newspapers, had significantly more positive coverage. Conclusions: The study indicates that news media coverage related to mental illness has improved over the past decade. This may be related to the concerted efforts of the MHCC, which has executed a targeted strategy aimed at reducing stigma and improving media coverage since 2007.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"117 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133915525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-29DOI: 10.1177/0706743717700845
M. Berber, E. Persad
This timely book by psychiatrist Dr. Kevin Hill increases awareness and understanding of the problems associated with the legalisation and medicalization of marijuana, an issue of great interest to Canadians. While the book is written for the lay audience, it contains information relevant to the practice of all physicians, especially psychiatrists. Students would also benefit from reading this book. Nine percent of adults and 17% of adolescents will become addicted to marijuana with destruction of social, occupational, and educational goals. These are large numbers considering that more than 47% of Americans age 12 or older use marijuana during their lifetime. Hill describes the short-term effects of marijuana, including the slowed reaction time affecting driving. The longterm effects include impaired executive brain function, structural brain changes, and a lowering of IQ with early, regular marijuana use. Although marijuana may temporarily reduce anxiety, Hill describes how anxiety levels rebound to even higher levels when the marijuana wears off, thus creating a cycle of increasing marijuana use. The delta-9-tetrahydrocannabinol (THC) component of marijuana (the ingredient producing the ‘high’ users want) has increased from 1%-2% to 13% (even as high as 27%), and these increased levels often trigger anxiety attacks. Hill highlights the very unpleasant features of marijuana withdrawal, explaining how irritability, anger, anxiety, and insomnia make quitting so difficult. According to Hill, legalisation of marijuana in the United States could save $7.7 billion per year by ceasing the enforcement of prohibition with an additional $6.2 billion per year raised through tax revenues. The black market would continue by selling to children and teenagers, avoiding taxation and providing marijuana with higher THC content. With a joint containing a half gram of marijuana and 1 ounce equivalent to 28 grams or 56 joints, Hill describes how excessive amounts are prescribed (and later sold to others). In our mental health clinic at the Markham Stouffville Hospital, adolescents report how they obtain marijuana from ‘friends’ who have obtained medical marijuana through their doctor. Hill describes 2 active ingredients (or cannabinoids) contained in marijuana: THC (‘psychoactive’) and cannabidiol (CBD; ‘calming’), explaining how increasing THC levels typically lower CBD levels. Two cannabinoids are available in the United States that are approved by the Food and Drug Administration for nausea and vomiting associated with cancer chemotherapy and appetite stimulation in wasting illnesses (e.g., human immunodeficiency virus): dronabinol (Marinol) and nabilone (Cesamet). By prescribing cannabinoids as tablets, it is possible to control dose, enable time release, avoid harmful toxins, and avoid respiratory diseases. Dronabinol is not available in Canada. Hill details the weak evidence supporting the use of cannabinoids for chronic pain and neuropathic pain, noting tha
精神病学家凯文·希尔博士的这本及时的书提高了人们对大麻合法化和医学化相关问题的认识和理解，这是加拿大人非常感兴趣的问题。虽然这本书是为外行观众写的，但它包含了与所有医生，尤其是精神科医生的实践相关的信息。学生们也会从这本书中受益。9%的成年人和17%的青少年会对大麻上瘾，破坏社会、职业和教育目标。考虑到超过47%的12岁或以上的美国人在他们的一生中使用大麻，这些数字很大。希尔描述了大麻的短期影响，包括影响驾驶的反应时间减慢。长期影响包括大脑执行功能受损，大脑结构变化，早期经常使用大麻会降低智商。虽然大麻可以暂时减轻焦虑，但希尔描述了当大麻逐渐消失时，焦虑水平会反弹到更高的水平，从而形成一个增加大麻使用的循环。大麻中的δ -9-四氢大麻酚(THC)成分(产生“快感”的成分)从1%-2%增加到13%(甚至高达27%)，而这些增加的水平经常引发焦虑发作。希尔强调了大麻戒断的令人不快的特点，解释了烦躁、愤怒、焦虑和失眠是如何使戒断变得如此困难的。根据希尔的说法，在美国，大麻合法化可以通过停止执行禁令每年节省77亿美元，每年通过税收增加62亿美元。黑市将继续向儿童和青少年出售大麻，以逃避税收，并提供含有更高THC含量的大麻。希尔用一根含有半克大麻和1盎司相当于28克或56根大麻的关节描述了过量的处方(后来卖给其他人)。在Markham Stouffville医院的精神健康诊所里，青少年报告了他们是如何从“朋友”那里获得大麻的，这些“朋友”通过他们的医生获得了医用大麻。希尔描述了大麻中含有的两种活性成分(或大麻素):THC(“精神活性”)和大麻二酚(CBD);“镇静”)，解释了THC水平的增加通常会降低CBD水平。在美国，有两种大麻素被美国食品和药物管理局批准用于治疗与癌症化疗相关的恶心和呕吐，以及在消耗性疾病(如人类免疫缺陷病毒)中刺激食欲:dronabinol (Marinol)和nabilone (Cesamet)。将大麻素作为片剂开处方，可以控制剂量，使时间释放，避免有害毒素，避免呼吸道疾病。屈大麻酚在加拿大是买不到的。Hill详细说明了支持使用大麻素治疗慢性疼痛和神经性疼痛的微弱证据，并指出50%的试验是阴性的。"数据不支持人们打算将医用大麻用于治疗的大多数疾病实体"(第111页)。希尔建议我们“停止美化大麻的使用，而是把它描绘成一种潜在的有害和上瘾的药物”(第181页)。这本书最后有一节是关于大麻成瘾的治疗，包括对那些遭受这种有毒物质有害影响的亲属和亲人的建议。我们相信，这本书将有利于所有的卫生保健提供者，并更好地准备他们正在进行的公开辩论在加拿大的大麻。The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatry 2017, Vol. 62(5) 355 a .作者2017转载并获得许可:sagepub.com/journalsPermissions.nav TheCJP。ca / LaRCP。加拿大精神病学协会
{"title":"Book Review: Marijuana: The Unbiased Truth about the World’s Most Popular Weed","authors":"M. Berber, E. Persad","doi":"10.1177/0706743717700845","DOIUrl":"https://doi.org/10.1177/0706743717700845","url":null,"abstract":"This timely book by psychiatrist Dr. Kevin Hill increases awareness and understanding of the problems associated with the legalisation and medicalization of marijuana, an issue of great interest to Canadians. While the book is written for the lay audience, it contains information relevant to the practice of all physicians, especially psychiatrists. Students would also benefit from reading this book. Nine percent of adults and 17% of adolescents will become addicted to marijuana with destruction of social, occupational, and educational goals. These are large numbers considering that more than 47% of Americans age 12 or older use marijuana during their lifetime. Hill describes the short-term effects of marijuana, including the slowed reaction time affecting driving. The longterm effects include impaired executive brain function, structural brain changes, and a lowering of IQ with early, regular marijuana use. Although marijuana may temporarily reduce anxiety, Hill describes how anxiety levels rebound to even higher levels when the marijuana wears off, thus creating a cycle of increasing marijuana use. The delta-9-tetrahydrocannabinol (THC) component of marijuana (the ingredient producing the ‘high’ users want) has increased from 1%-2% to 13% (even as high as 27%), and these increased levels often trigger anxiety attacks. Hill highlights the very unpleasant features of marijuana withdrawal, explaining how irritability, anger, anxiety, and insomnia make quitting so difficult. According to Hill, legalisation of marijuana in the United States could save $7.7 billion per year by ceasing the enforcement of prohibition with an additional $6.2 billion per year raised through tax revenues. The black market would continue by selling to children and teenagers, avoiding taxation and providing marijuana with higher THC content. With a joint containing a half gram of marijuana and 1 ounce equivalent to 28 grams or 56 joints, Hill describes how excessive amounts are prescribed (and later sold to others). In our mental health clinic at the Markham Stouffville Hospital, adolescents report how they obtain marijuana from ‘friends’ who have obtained medical marijuana through their doctor. Hill describes 2 active ingredients (or cannabinoids) contained in marijuana: THC (‘psychoactive’) and cannabidiol (CBD; ‘calming’), explaining how increasing THC levels typically lower CBD levels. Two cannabinoids are available in the United States that are approved by the Food and Drug Administration for nausea and vomiting associated with cancer chemotherapy and appetite stimulation in wasting illnesses (e.g., human immunodeficiency virus): dronabinol (Marinol) and nabilone (Cesamet). By prescribing cannabinoids as tablets, it is possible to control dose, enable time release, avoid harmful toxins, and avoid respiratory diseases. Dronabinol is not available in Canada. Hill details the weak evidence supporting the use of cannabinoids for chronic pain and neuropathic pain, noting tha","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125970382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-27DOI: 10.1177/0706743717697631
Anna Richard Bourgeois
{"title":"Book Review: La Famille et les Troubles émotionnels des Jeunes","authors":"Anna Richard Bourgeois","doi":"10.1177/0706743717697631","DOIUrl":"https://doi.org/10.1177/0706743717697631","url":null,"abstract":"","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125477788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-01DOI: 10.1177/0706743716673321
J. Kirkham, Chelsea Sherman, Clive Velkers, C. Maxwell, S. Gill, P. Rochon, D. Seitz
Antipsychotics are necessary for many older adults to treat major mental illnesses or reduce distressing psychiatric symptoms. Current controversy exists over the role of antipsychotics in the management of neuropsychiatric symptoms (NPS) in persons with dementia. Although some NPS may be appropriately and safely treated with antipsychotics, a fine balance must be achieved between the benefits of these medications, which are often modest, and adverse events, which may have significant consequences. Approximately one-third of all persons with dementia are currently prescribed antipsychotic medications, and there is significant variation in the use of antipsychotics across care settings and providers. Reducing the inappropriate or unnecessary use of antipsychotics among persons with dementia has been the focus of increasing attention owing to better awareness of the potential problems associated with these medications. Several approaches can be used to curb the use of antipsychotics among persons with dementia, including policy or regulatory changes, public reporting, and educational outreach. Recently, there has been encouraging evidence of a downward trend in the use of antipsychotics in many long-term care settings, although prescribing rates are still higher than what is likely optimal. Although reducing the inappropriate use of antipsychotics is a complex task, psychiatrists can play an important role via the provision of clinical care and research evidence, contributing to improved care of persons with dementia in Canada and elsewhere.
{"title":"Antipsychotic Use in Dementia","authors":"J. Kirkham, Chelsea Sherman, Clive Velkers, C. Maxwell, S. Gill, P. Rochon, D. Seitz","doi":"10.1177/0706743716673321","DOIUrl":"https://doi.org/10.1177/0706743716673321","url":null,"abstract":"Antipsychotics are necessary for many older adults to treat major mental illnesses or reduce distressing psychiatric symptoms. Current controversy exists over the role of antipsychotics in the management of neuropsychiatric symptoms (NPS) in persons with dementia. Although some NPS may be appropriately and safely treated with antipsychotics, a fine balance must be achieved between the benefits of these medications, which are often modest, and adverse events, which may have significant consequences. Approximately one-third of all persons with dementia are currently prescribed antipsychotic medications, and there is significant variation in the use of antipsychotics across care settings and providers. Reducing the inappropriate or unnecessary use of antipsychotics among persons with dementia has been the focus of increasing attention owing to better awareness of the potential problems associated with these medications. Several approaches can be used to curb the use of antipsychotics among persons with dementia, including policy or regulatory changes, public reporting, and educational outreach. Recently, there has been encouraging evidence of a downward trend in the use of antipsychotics in many long-term care settings, although prescribing rates are still higher than what is likely optimal. Although reducing the inappropriate use of antipsychotics is a complex task, psychiatrists can play an important role via the provision of clinical care and research evidence, contributing to improved care of persons with dementia in Canada and elsewhere.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130076432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-01DOI: 10.1177/0706743716689057
D. Dozois, K. Cohen
{"title":"Making Evidence-Based Psychological Care Accessible to Canadians","authors":"D. Dozois, K. Cohen","doi":"10.1177/0706743716689057","DOIUrl":"https://doi.org/10.1177/0706743716689057","url":null,"abstract":"","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130878573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-01DOI: 10.1177/0706743716689059
D. Gratzer, D. Goldbloom
{"title":"Psychotherapy Providers and the International Experience","authors":"D. Gratzer, D. Goldbloom","doi":"10.1177/0706743716689059","DOIUrl":"https://doi.org/10.1177/0706743716689059","url":null,"abstract":"","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127111517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-01DOI: 10.1177/0706743716689049
G. Hadjipavlou, D. Kealy, J. Ogrodniczuk
Dear Editor: We applaud Drs. Gratzer and Goldbloom for advocating greater access to psychotherapy for Canadians. Indeed, considering the research supporting the efficacy of psychotherapy—some of which is cited in their article—we fully agree that funding improved access to effective psychotherapy should be a Canadian public health priority. We have concerns, however, about the authors’ depiction of evidencebased psychotherapy. By focusing their advocacy on the distribution of so-called evidence-based psychotherapies, the authors overlook crucial developments in the psychotherapy research literature—an omission with significant implications for mental health policy and practice. Despite briefly acknowledging that other “forms” of psychotherapy are effective, Gratzer and Goldbloom squarely emphasize cognitive behavioural therapy (CBT) as being “rigorously evidence based” (p. 618), implicitly suggesting that CBT is superior to other approaches. While it is true that CBT researchers have amassed the largest number of clinical trials, many of these studies suffer from a reliance on comparisons with wait-list controls and insufficient statistical power; for instance, when researcher allegiance effects are controlled for, nondirective supportive therapy is shown to be as effective as CBT for depression. Fortunately, researchers have increased their attention to “common factors” that cut across all psychotherapy approaches. The evidence for common factors suggests that enhanced access to psychotherapy should focus not on matching patients to manualized protocols for specific disorders but on expanding the availability of “evidence based therapists.” By this term, we mean clinicians who understand and optimize common factors such as the therapeutic alliance—far and away the most robust predictor of outcome—and who are skilled at adapting psychotherapy to the context and needs of individual patients. A paradigm shift is required to follow the evidence as it leads us away from the tired notion of specific “forms” of therapy (or manualized treatment packages) for specific disorders (e.g., CBT for major depression). We believe that taking this step will contribute—along with the increased funding Gratzer and Goldbloom rightly call for—to improved access to more effective psychotherapy. First, training clinicians to develop and flexibly adapt core therapy principles will likely be less expensive than rolling out specific technical protocols. Second, “evidence-based therapists” would prioritize responsiveness to the patient over adherence to the techniques of a particular model, thus mitigating the problem of premature termination and reducing the risks of side effects or iatrogenic harm from pychotherapy. Common factors like the therapeutic alliance cannot be taken for granted: both clinicians and patients differ in their capacities to develop and maintain effective therapy relationships. These differences are most pronounced in the treatment of patients with
{"title":"Prioritizing the Development of Evidence-Based Therapists over the Deployment of Evidence-Based Therapies","authors":"G. Hadjipavlou, D. Kealy, J. Ogrodniczuk","doi":"10.1177/0706743716689049","DOIUrl":"https://doi.org/10.1177/0706743716689049","url":null,"abstract":"Dear Editor: We applaud Drs. Gratzer and Goldbloom for advocating greater access to psychotherapy for Canadians. Indeed, considering the research supporting the efficacy of psychotherapy—some of which is cited in their article—we fully agree that funding improved access to effective psychotherapy should be a Canadian public health priority. We have concerns, however, about the authors’ depiction of evidencebased psychotherapy. By focusing their advocacy on the distribution of so-called evidence-based psychotherapies, the authors overlook crucial developments in the psychotherapy research literature—an omission with significant implications for mental health policy and practice. Despite briefly acknowledging that other “forms” of psychotherapy are effective, Gratzer and Goldbloom squarely emphasize cognitive behavioural therapy (CBT) as being “rigorously evidence based” (p. 618), implicitly suggesting that CBT is superior to other approaches. While it is true that CBT researchers have amassed the largest number of clinical trials, many of these studies suffer from a reliance on comparisons with wait-list controls and insufficient statistical power; for instance, when researcher allegiance effects are controlled for, nondirective supportive therapy is shown to be as effective as CBT for depression. Fortunately, researchers have increased their attention to “common factors” that cut across all psychotherapy approaches. The evidence for common factors suggests that enhanced access to psychotherapy should focus not on matching patients to manualized protocols for specific disorders but on expanding the availability of “evidence based therapists.” By this term, we mean clinicians who understand and optimize common factors such as the therapeutic alliance—far and away the most robust predictor of outcome—and who are skilled at adapting psychotherapy to the context and needs of individual patients. A paradigm shift is required to follow the evidence as it leads us away from the tired notion of specific “forms” of therapy (or manualized treatment packages) for specific disorders (e.g., CBT for major depression). We believe that taking this step will contribute—along with the increased funding Gratzer and Goldbloom rightly call for—to improved access to more effective psychotherapy. First, training clinicians to develop and flexibly adapt core therapy principles will likely be less expensive than rolling out specific technical protocols. Second, “evidence-based therapists” would prioritize responsiveness to the patient over adherence to the techniques of a particular model, thus mitigating the problem of premature termination and reducing the risks of side effects or iatrogenic harm from pychotherapy. Common factors like the therapeutic alliance cannot be taken for granted: both clinicians and patients differ in their capacities to develop and maintain effective therapy relationships. These differences are most pronounced in the treatment of patients with ","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114415173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-01DOI: 10.1177/0706743716670129
L. Bergeron, N. Smolla, C. Berthiaume, Johanne Renaud, J. Breton, Marie St.-Georges, P. Morin, Elissa Zavaglia, R. Labelle
Objectives: The Dominic Interactive for Adolescents–Revised (DIA-R) is a multimedia self-report screen for 9 mental disorders, borderline personality traits, and suicidality defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This study aimed to examine the reliability and the validity of this instrument. Methods: French- and English-speaking adolescents aged 12 to 15 years (N = 447) were recruited from schools and clinical settings in Montreal and were evaluated twice. The internal consistency was estimated by Cronbach alpha coefficients and the test-retest reliability by intraclass correlation coefficients. Cutoff points on the DIA-R scales were determined by using clinically relevant measures for defining external validation criteria: the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, the Beck Hopelessness Scale, and the Abbreviated-Diagnostic Interview for Borderlines. Receiver operating characteristic (ROC) analyses provided accuracy estimates (area under the ROC curve, sensitivity, specificity, likelihood ratio) to evaluate the ability of the DIA-R scales to predict external criteria. Results: For most of the DIA-R scales, reliability coefficients were excellent or moderate. High or moderate accuracy estimates from ROC analyses demonstrated the ability of the DIA-R thresholds to predict psychopathological conditions. These thresholds were generally capable to discriminate between clinical and school subsamples. However, the validity of the obsessions/compulsions scale was too low. Conclusions: Findings clearly support the reliability and the validity of the DIA-R. This instrument may be useful to assess a wide range of adolescents’ mental health problems in the continuum of services. This conclusion applies to all scales, except the obsessions/compulsions one.
{"title":"Reliability, Validity, and Clinical Utility of the Dominic Interactive for Adolescents–Revised","authors":"L. Bergeron, N. Smolla, C. Berthiaume, Johanne Renaud, J. Breton, Marie St.-Georges, P. Morin, Elissa Zavaglia, R. Labelle","doi":"10.1177/0706743716670129","DOIUrl":"https://doi.org/10.1177/0706743716670129","url":null,"abstract":"Objectives: The Dominic Interactive for Adolescents–Revised (DIA-R) is a multimedia self-report screen for 9 mental disorders, borderline personality traits, and suicidality defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This study aimed to examine the reliability and the validity of this instrument. Methods: French- and English-speaking adolescents aged 12 to 15 years (N = 447) were recruited from schools and clinical settings in Montreal and were evaluated twice. The internal consistency was estimated by Cronbach alpha coefficients and the test-retest reliability by intraclass correlation coefficients. Cutoff points on the DIA-R scales were determined by using clinically relevant measures for defining external validation criteria: the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, the Beck Hopelessness Scale, and the Abbreviated-Diagnostic Interview for Borderlines. Receiver operating characteristic (ROC) analyses provided accuracy estimates (area under the ROC curve, sensitivity, specificity, likelihood ratio) to evaluate the ability of the DIA-R scales to predict external criteria. Results: For most of the DIA-R scales, reliability coefficients were excellent or moderate. High or moderate accuracy estimates from ROC analyses demonstrated the ability of the DIA-R thresholds to predict psychopathological conditions. These thresholds were generally capable to discriminate between clinical and school subsamples. However, the validity of the obsessions/compulsions scale was too low. Conclusions: Findings clearly support the reliability and the validity of the DIA-R. This instrument may be useful to assess a wide range of adolescents’ mental health problems in the continuum of services. This conclusion applies to all scales, except the obsessions/compulsions one.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128842660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-01DOI: 10.1177/0706743716673320
P. Brunault, R. Courtois, A. Gearhardt, P. Gaillard, Kevin Journiac, Sarah Cathelain, C. Réveillère, N. Ballon
Objective: The Yale Food Addiction Scale (YFAS) is the only questionnaire that assesses food addiction (FA) based on substance dependence criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, Text Revision. Following recent updating of addiction criteria, a new DSM-5 version (YFAS 2.0) has been developed. Our study tested the psychometric properties of the French YFAS 2.0 in a nonclinical population. Method: We assessed 330 nonclinical participants for FA (French YFAS 2.0), eating behaviour, and eating disorder (Binge Eating Scale, Emotional Overeating Questionnaire, Three-Factor Eating Questionnaire-R18, Questionnaire on Eating and Weight Patterns-Revised, Eating Disorder Diagnostic Scale). We tested the scale’s factor structure (confirmatory factor analysis based on 11 diagnostic criteria), internal consistency, and construct and incremental validity. Results: Prevalence of FA was 8.2%. Our results supported a 1-factor structure similar to the US version. In both its diagnostic and symptom count versions, the YFAS 2.0 had good internal consistency (Kuder-Richardson alpha was 0.83) and was associated with body mass index (BMI), binge eating, uncontrolled and emotional eating, binge eating disorder, and cognitive restraint. FA predicted BMI above and beyond binge eating frequency. Females had a higher prevalence of FA than males but not more FA symptoms. Conclusions: We validated a psychometrically sound French version of the YFAS 2.0 in a nonclinical population, in both its symptom count and diagnostic versions. Future studies should investigate psychometric properties of this questionnaire in clinical populations potentially at risk for FA (that is, patients with obesity, diabetes, hypertension, or other metabolic syndrome risk factors).
{"title":"Validation of the French Version of the DSM-5 Yale Food Addiction Scale in a Nonclinical Sample","authors":"P. Brunault, R. Courtois, A. Gearhardt, P. Gaillard, Kevin Journiac, Sarah Cathelain, C. Réveillère, N. Ballon","doi":"10.1177/0706743716673320","DOIUrl":"https://doi.org/10.1177/0706743716673320","url":null,"abstract":"Objective: The Yale Food Addiction Scale (YFAS) is the only questionnaire that assesses food addiction (FA) based on substance dependence criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, Text Revision. Following recent updating of addiction criteria, a new DSM-5 version (YFAS 2.0) has been developed. Our study tested the psychometric properties of the French YFAS 2.0 in a nonclinical population. Method: We assessed 330 nonclinical participants for FA (French YFAS 2.0), eating behaviour, and eating disorder (Binge Eating Scale, Emotional Overeating Questionnaire, Three-Factor Eating Questionnaire-R18, Questionnaire on Eating and Weight Patterns-Revised, Eating Disorder Diagnostic Scale). We tested the scale’s factor structure (confirmatory factor analysis based on 11 diagnostic criteria), internal consistency, and construct and incremental validity. Results: Prevalence of FA was 8.2%. Our results supported a 1-factor structure similar to the US version. In both its diagnostic and symptom count versions, the YFAS 2.0 had good internal consistency (Kuder-Richardson alpha was 0.83) and was associated with body mass index (BMI), binge eating, uncontrolled and emotional eating, binge eating disorder, and cognitive restraint. FA predicted BMI above and beyond binge eating frequency. Females had a higher prevalence of FA than males but not more FA symptoms. Conclusions: We validated a psychometrically sound French version of the YFAS 2.0 in a nonclinical population, in both its symptom count and diagnostic versions. Future studies should investigate psychometric properties of this questionnaire in clinical populations potentially at risk for FA (that is, patients with obesity, diabetes, hypertension, or other metabolic syndrome risk factors).","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132097804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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