The Canadian Journal of Psychiatry最新文献

{"title":"Health Service Utilisation, Detection Rates by Family Practitioners, and Management of Patients with Common Mental Disorders in French Family Practice","authors":"J. Norton, A. O. Engberink, C. Gandubert, K. Ritchie, A. Mann, M. David, D. Capdevielle","doi":"10.1177/0706743716686918","DOIUrl":"https://doi.org/10.1177/0706743716686918","url":null,"abstract":"Objective: Provide up-to-date detection rates for common mental disorders (CMD) and examine patient service-use since the Preferred Doctor scheme was introduced to France in 2005, with patients encouraged to register with and consult a family practitioner (FP) of their choice. Methods: Study of 1133 consecutive patients consulting 38 FPs in the Montpellier region, replicating a study performed before the scheme. Patients in the waiting room completed the self-report Patient Health Questionnaire (PHQ) and Client Service-Receipt Inventory with questions on registration with a Preferred Doctor and doctor-shopping. CMD was defined as reaching PHQ criteria for depression, somatoform, panic or anxiety disorder. For each patient, FPs completed a questionnaire capturing psychiatric caseness. Results: 81.2% of patients were seeing their Preferred Doctor on the survey-day. Of those with a CMD, 52.6% were detected by the FP. This increased with CMD severity and comorbidity. Detected cases were more likely to be consulting their Preferred Doctor (84.7% versus 79.4% for non-detected cases, p = 0.05) rather than another FP. They declared more visits to psychiatrists (17.2% versus 6.7%, p = 0.002). There was no association with consultation frequency or doctor-shopping, which both declined between the two studies. Conclusion: The CMD detection rate is relatively high, with no increase compared to our previous study, despite a decline in doctor-shopping. An explanation is the same high proportion of patients visiting their usual FP on the survey-day at both periods, suggesting a limited impact of the scheme on care continuity. FP action taken highlights the importance of improving detection for providing care to patients with CMDs.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"198 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126524248","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}

{"title":"ADHD Treatment in Primary Care: Demographic Factors, Medication Trends, and Treatment Predictors","authors":"Tanya S Hauck, C. Lau, Laura Wing, P. Kurdyak, K. Tu","doi":"10.1177/0706743716689055","DOIUrl":"https://doi.org/10.1177/0706743716689055","url":null,"abstract":"Background: The aim of this study is to determine the prevalence and characteristics of youth with attention-deficit hyperactivity disorder (ADHD) in Ontario, Canada, and to determine the predictors of psychotropic medication prescriptions in youth with ADHD. Method: This is a cross-sectional retrospective chart abstraction of more than 250 000 medical records from youth aged 1 to 24 years in a large geographical region in Ontario, Canada, linked to population-based health administrative data. A total of 10 000 charts were randomly selected and manually reviewed using predetermined criteria for ADHD and comorbidities. Prevalence, comorbidities, demographic indicators, and health service utilization characteristics were calculated. Predictors of treatment characteristics were determined using logistic regression modelling. Results: The prevalence of ADHD was 5.4% (7.9% males, 2.7% females). Youth with ADHD had significant psychiatric comorbidities. The majority (70.0%) of ADHD patients received prescriptions for stimulant or nonstimulant ADHD medication. Antipsychotic prescriptions were provided to 11.9% of ADHD patients versus 0.9% of patients without ADHD. Antidepressant prescriptions were provided to 19.8% versus 5.4% of patients with and without ADHD, respectively. Predictors of antidepressant prescriptions were increasing age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.07 to 1.21), psychiatric consultation (OR, 2.04; 95% CI, 1.16 to 3.58), and diagnoses of both anxiety and depression (OR, 18.4; 95% CI, 8.03 to 42.1), whereas the only predictor of antipsychotic prescriptions was psychiatric consultation (OR, 3.85; 95% CI, 2.11 to 7.02). Conclusions: Youth with ADHD have more psychiatric comorbidities than youth without ADHD. The majority of youth with ADHD received stimulant medications, and a significant number received additional psychotropic medications, with psychiatric consultation predicting medication use.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122116918","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}

{"title":"Impact of Skill-Based Approaches in Reducing Stigma in Primary Care Physicians: Results from a Double-Blind, Parallel-Cluster, Randomized Controlled Trial","authors":"Tara Beaulieu, S. Patten, S. Knaak, R. Weinerman, Helen L. Campbell, Bianca Lauria-Horner","doi":"10.1177/0706743716686919","DOIUrl":"https://doi.org/10.1177/0706743716686919","url":null,"abstract":"Objective: Most interventions to reduce stigma in health professionals emphasize education and social contact–based strategies. We sought to evaluate a novel skill-based approach: the British Columbia Adult Mental Health Practice Support Program. We sought to determine the program’s impact on primary care providers’ stigma and their perceived confidence and comfort in providing care for mentally ill patients. We hypothesized that enhanced skills and increased comfort and confidence on the part of practitioners would lead to diminished social distance and stigmatization. Subsequently, we explored the program’s impact on clinical outcomes and health care costs. These outcomes are reported separately, with reference to this article. Methods: In a double-blind, cluster randomized controlled trial, 111 primary care physicians were assigned to intervention or control groups. A validated stigma assessment tool, the Opening Minds Scale for Health Care Providers (OMS-HC), was administered to both groups before and after training. Confidence and comfort were assessed using scales constructed from ad hoc items. Results: In the primary analysis, no significant differences in stigma were found. However, a subscale assessing social distance showed significant improvement in the intervention group after adjustment for a variable (practice size) that was unequally distributed in the randomization. Significant increases in confidence and comfort in managing mental illness were observed among intervention group physicians. A positive correlation was found between increased levels of confidence/comfort and improvements in overall stigma, especially in men. Conclusions: This study provides some preliminary evidence of a positive impact on health care professionals’ stigma through a skill-building approach to management of mild to moderate depression and anxiety in primary care. The intervention can be used as a primary vehicle for enhancing comfort and skills in health care providers and, ultimately, reducing an important dimension of stigma: preference for social distance.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123817536","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}

{"title":"New Government, New Opportunity, and an Old Problem with Access to Mental Health Care","authors":"D. Gratzer, D. Goldbloom","doi":"10.1177/0706743716669084","DOIUrl":"https://doi.org/10.1177/0706743716669084","url":null,"abstract":"For those concerned about access to mental health services, the present moment in politics holds promise. A federal Liberal government has been elected promising to address mental health access issues, a commitment recently reaffirmed by the Minister of Health. In Ottawa, bettering mental health care is nonpartisan: in the last election, every major political party promised action on improving services (unprecedented in federal campaigns); in the last Parliament, all parties supported a national suicide strategy. Good news is frankly welcome news. The interest is there and the need is great: 1 in 5 Canadians experiences a mental health problem in any given year, and they face a patchwork of care; many Ontarians have their first contact with the mental health system through the emergency room (roughly 1 in 3 with an anxiety disorder), according to a newly released Health Quality Ontario–Institute for Clinical Evaluative Sciences (HQO-ICES) report. Access is problematic—especially if the bar is raised to the standard of access to evidence-based care. Consider recent articles published in this journal:","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116444064","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}

{"title":"Updating the Evidence and Recommendations for Short-Term Psychodynamic Psychotherapy in the Treatment of Major Depressive Disorder in Adults","authors":"Joel Town, A. Abbass, E. Driessen, P. Luyten, P. Weerasekera","doi":"10.1177/0706743716676751","DOIUrl":"https://doi.org/10.1177/0706743716676751","url":null,"abstract":"","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127011980","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}

{"title":"Further Evidence for Short-Term Psychodynamic Therapy in Major Depressive Disorder","authors":"F. Leichsenring, Christiane Steinert","doi":"10.1177/0706743716676752","DOIUrl":"https://doi.org/10.1177/0706743716676752","url":null,"abstract":"Dear Editor: The Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines recommend short-term psychodynamic therapy (STPP) as a second-line treatment for the acute treatment of depression ‘‘due to an absence of replication of specific models.’’ We would like to point out that the committee has not taken into account that for de Jonghe et al.’s model of STPP, 2 randomised controlled trials (RCTs) provide evidence for efficacy in the (acute) treatment of depression. In the first RCT, STPP was as efficacious as the combination of pharmacotherapy and STPP with no differences between treatment conditions in the intention to treat sample in any outcome measure at any time of measurement. With samples of 106 and 85 patients per group, sample size can be regarded as adequate. This study is a proof of the efficacy for STPP, since STPP fared as well as an efficacious treatment—the combined treatment was at least as efficacious as pharmacotherapy alone, for which efficacy has been established, as the success rates yielded by the combined treatment in the 2004 study are descriptively higher than those of pharmacotherapy alone in an earlier study by de Jonghe et al. For further comparisons, see also the recovery rates for pharmacotherapy listed by Craighead et al. Adding STPP to pharmacotherapy did not reduce efficacy but rather increased it. In the second RCT of the de Jonghe model, STPP was as efficacious as CBT. This led Thase to the following conclusion: ‘‘On the basis of these findings, there is no reason to believe that psychodynamic psychotherapy is a less effective treatment of major depressive disorder than CBT.’’ With 2 RCTs demonstrating efficacy, STPP following de Jonghe et al.’s model fulfils the criteria used by CANMAT (Table 1, p. 3) for level 1 evidence. This model can also be regarded as ‘efficacious’ according to the criteria for empirically supported psychotherapies. Furthermore, in another large RCT just published, STPP using Luborsky’s model proved to be as efficacious as CBT in the treatment of depression. According to the criteria used by CANMAT (Table 1, p. 3), a treatment may be considered first line if level 2 evidence (1 or more RCTs with adequate sample size) is available and clinical support exists. As this is the case for Luborsky’s model of STPP, it can be considered another first-line treatment for acute depression. In light of the above-mentioned findings, we ask the CANMAT committee to correct their grading of STPP and recommend the STPP models by de Jonghe et al. and Luborsky et al. as first-line treatments for acute depression. To rule out the possibility of biases in favor of any kind of therapy, a committee developing treatment guidelines ideally consists of proponents of all kinds of treatments involved (a form of adversarial collaboration). This is the case, for example, in Germany with regard to the treatment guidelines for depression and the evaluation of psychotherapy. We wonder whether this was the case","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"197 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130377693","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}

{"title":"The Case for a Federal Mental Health Transition Fund","authors":"A. Lesage, R. Bland, Ian Musgrave, E. Jonsson, Mike Kirby, H. Vasiliadis","doi":"10.1177/0706743716673324","DOIUrl":"https://doi.org/10.1177/0706743716673324","url":null,"abstract":"The Liberal government committed to making mental health services more accessible. Housing funding was increased in the last budget, but now commitment to comprehensive home care for the severely mentally ill and access to primary care treatments for common mental disorders are needed. Canada has poor financing of mental health services and lags behind other countries’ managed health care systems. Unlike Great Britain and Australia, Canada has failed to implement equitable access to psychotherapy for common mental disorders in primary care. Nor has it, as in the Netherlands, transitioned services to the community with home care for the severely mentally ill. Increasing funding is insufficient—there needs to be a targeted transition fund for mental health as well as clear federal targets that support system changes from the transition fund investments. The program’s effectiveness should be evidence based, implementable across the country, and accountable on quality and availability. Two targets are accessible psychotherapy for primary care treatment of common mental disorders and intensive home care for the severely mentally ill. Great Britain and Australia funded increased access to psychotherapy in primary care. In Australia, for example, psychotherapy prescribed by a general practitioner for anxiety-depressive disorder, administered by a registered psychologist, is reimbursed by the same agency reimbursing fees for services physicians. At least 1.6 million Australians were treated in that manner between 2007 and 2009. The United Kingdom, acting on scientific evidence, demonstrated that it is more expensive not to treat those who need psychotherapy than to carry the cost of repeated visits, hospitalisations, and additional services and showed that increased health service costs could be recovered within 3 to 5 years. Both medication and psychotherapy have been established as effective treatments of anxiety and depressive disorders. A Statistics Canada survey demonstrated that while needs for psychotropic medication are largely met, only half of the psychotherapy needs are met. Anxiety-depressive disorders are the main cause of incapacity in the workplace and start before age 18, and failure to treat early diminishes economic competitiveness. Equitable access to psychotherapy in Australia and the United Kingdom provides them with a competitive advantage, whereas Canada has lost such an advantage. The Institute of Health Economics (IHE), supported by the Alberta government, held a consensus conference in November 2014 on transitions to the community of services for the severely mentally ill, with wide-ranging contributions from countries at the forefront of community care and evidence-based approaches. It recommended 1 assertive community treatment team (ACT) and 1 intensive case management (ICM) team per 100,000 inhabitants, the same standards set in the recent Quebec Mental Health Action Plan 2015-2020. Typically, an ACT team, with a multidiscip","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128631082","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}

{"title":"Major Depression Prevalence Increases with Latitude in Canada","authors":"S. Patten, J. Williams, D. Lavorato, Jian Li Wang, A. Bulloch","doi":"10.1177/0706743716673323","DOIUrl":"https://doi.org/10.1177/0706743716673323","url":null,"abstract":"Objective: To determine whether there is an association between latitude and annual major depressive episode (MDE) prevalence in Canada. Methods: Data from 2 national survey programs (the National Population Health Survey and the Canadian Community Health Survey) were used, providing 10 data sets collected between 1996 and 2013, together including 922,260 respondents, of whom 495,739 were assessed for MDE using 1 of 2 versions of the Composite International Diagnostic Interview, a short-form version (8 studies), and a Canadian adaptation of the World Mental Health version (2 studies). Approximate latitude was determined by linkage to postal code data. Data were analyzed using logistic regression and pooled across surveys using individual-level meta-analytic methods. Results: In models including latitude as a continuous variable, a statistically significant association was observed, with prevalence increasing with increasing latitude. This association persisted after adjustment for a set of known risk factors. The latitude gradient was modest in magnitude, a 1% to 2% increase in the prevalence odds of MDE per degree of latitude was observed. Due to sparse data, this gradient cannot be confidently generalized beyond major population centres, which tend to occur at less than 55° latitude in Canada. Conclusion: A latitude gradient has not previously been reported. If replicated, the gradient may have implications for the planning of services and generation of aetiological hypotheses. However, this cross-sectional analysis cannot confirm aetiology and could not evaluate the potential contributions of variables such as light exposure, weather patterns, or social determinants.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130463818","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}

{"title":"Rating Short-Term Psychodynamic Therapy for the Canadian Network for Mood and Anxiety Treatments Depression Guidelines","authors":"S. Parikh, L. Quilty, P. Ravitz, M. Rosenbluth, B. Pavlova, S. Grigoriadis, V. Velyvis, R. Uher, S. Kennedy, R. Lam, G. MacQueen, R. Milev, A. Ravindran","doi":"10.1177/0706743716676754","DOIUrl":"https://doi.org/10.1177/0706743716676754","url":null,"abstract":"","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129190916","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}

{"title":"Suicide among Aboriginals","authors":"R. Tempier","doi":"10.1177/0706743716655787","DOIUrl":"https://doi.org/10.1177/0706743716655787","url":null,"abstract":"There is no question that suicide among Aboriginal peoples is a big and dramatic health issue in Canada as well as in other countries. This series of 3 articles will try to shed some light on a complex and pressing public health problem that we, as health professionals, must address. The Truth and Reconciliation Commission of Canada recently released a report focusing on all aspects of the status of First Nations peoples, including health status. This report identified suicide (rates) as an indicator of the progress in closing the gap between Aboriginal and non-Aboriginal communities. Suicide rates are quite high, and it is well known that suicide rates among Aboriginal populations are at least double that found in the general population. Kirmayer noted that among Aboriginals, there is an increase in suicide rates, and this author also stressed the fact that suicides often occur in clusters, a marked distinctive characteristic of Aboriginal suicides. Culture and language play an important but unclear role in the rise of suicide and mental health problems, in general. It seems that there is definitely a link between language, a major expression of culture, and suicide rates. For example, Chandler and Lalond found lower suicide rates among British Columbia Aboriginal communities where the native language was still spoken. Hallet et al. stipulated that many Aboriginal languages are in danger of disappearing and consequently contributing to the disappearance of cultural identities. These identities, which Aboriginal languages mediate, are definitely in threat. Hallet et al. added that failure to achieve any viable sense of self or cultural continuity is strongly linked with self-destructive and suicidal behaviors. Suicide is in fact the ‘coal miner’s canary’ of cultural distress, as Hallet et al. wrote. We still know very little about the intersection of culture, suicide, depression, and history, according to Waldram. One has to develop an integrated explanation of why some communities have much lower suicide rates than others and why some individuals suffer so much more distress than others. These 3 articles try to give some interpretations on a complex phenomenon such as suicide among Aboriginal people; they also propose some solutions about how to address and respond to this complex problem. The first article addresses similarities and differences in suicide prevention between the Māori in New Zealand and indigenous peoples of Canada. Hatcher stresses the fact that the problem of indigenous suicide is linked to coping with losses secondary to colonization in both former colonies such as New Zealand and Canada. Of major importance is the assessment of the identity in all clinical encounters as a cultural evaluation should be part of a psychiatric interview with any patient, as Hatcher proposes. Both countries share an ancient colonial model where ‘thwarted belongingness’ refers to a combination of loneliness and an absence of relationships marked b","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131614227","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}