Canadian Journal Of Psychiatry Research Articles

Developing and validating lower risk online gambling thresholds with actual bettor data from a major Internet gambling operator.

To help individuals avoid potential negative consequences associated with their gambling, researchers have developed lower risk limits for time and financial involvement among populations of land-based gamblers. The present study extended these efforts to online gambler populations with prospective longitudinal data. We used receiver operating characteristic curve analysis and logistic regression models predicting a positive Brief Biosocial Gambling Screen (BBGS; Gebauer et al., Canadian Journal of Psychiatry, 55, 2010, 82-90) to develop lower risk limits for six measures of gambling involvement among subscribers to an online gambling operator. We also tested the utility of these six newly developed online limits and three existing land-based limits for the BBGS outcome and proxies for gambling problems including: (a) voluntary self-limiting, (b) voluntary self-exclusion, (c) closing one's account, and (d) being assigned a flag for potential problem gambling by customer service. We identified five optimal limits for lower risk online gambling with adequate sensitivity and specificity for predicting BBGS-positive status, and four of those that also received additional empirical support. These four empirically supported gambling limits were: (a) wagering 167.97 Euros or less each month; (b) spending 6.71% or less of one's annual income on online gambling wagers; (c) losing 26.11 Euros or less on online gambling per month; and (d) demonstrating variability (i.e., standard deviation) in daily amount wagered of 35.14 Euros or less during one's duration active. Our findings have implications for lower risk gambling limits research and suggest that unique limits might apply to online and land-based gambler populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Teaching Strategy in Early Childhood Education: Child-Friendly Classroom Management to Anticipate Bullying Behaviours

Bullying behaviour can have a negative impact on a child's physical and psychological health. Bullying in the classroom is a challenge for early-childhood educators. Preschool is the first place outside the home where children face social challenges when interacting with their classmates. Child-Friendly Class is the first step and part of the Children Friendly School (CSF) as a UNICEF program and an important Indonesian government policy to prevent the emergence of child bullying behaviour. This study aims to identify needs in the process of developing a Child-Friendly Classroom Management model to anticipate bullying behaviour. This research and development method uses an adaptation of the Rowntree model which includes three stages of the process and data collection techniques using interviews, questionnaires, and observation. The results of this study indicate that the preparation of an effective classroom management guidebook to create child-friendly classes needs to be followed up immediately. Several findings related to teachers' perceptions of classroom management, and child-friendly classes prove that child-friendly classes have not been implemented properly in PAUD institutions, with bullying behaviour still appearing in early childhood in PAUD institutions. PAUD teachers understand that it is important to implement classroom management but so far there has been no manual on how to manage effective classrooms as well as training related to the implementation of effective classroom management. The creation of child-friendly classes is believed to be able to help teachers suppress the emergence of bullying behaviour in early childhood.
 Keywords: Child-Friendly Classroom Management, Bullying Prevention, Early Childhood Education

Reliability and Feasibility of the First-Episode Psychosis Services Fidelity Scale-Revised for Remote Assessment.

The authors sought to evaluate the interrater reliability and feasibility of the First-Episode Psychosis Services Fidelity Scale-Revised (FEPS-FS-R) for remote assessment of first-episode psychosis programs according to the coordinated specialty care model. The authors used the FEPS-FS-R to assess the fidelity of 36 first-episode psychosis program sites in the United States with information from three sources: administrative data, health record review, and phone interviews with staff. Four raters independently conducted fidelity assessments of five program sites by listening to each of the staff interviews and independently rating the two other data sources from each site. To calculate interrater reliability, the authors used intraclass correlation coefficients (ICCs) for each of the five sites and across the total scores for each site. Total interrater reliability was in the good to excellent range, with a mean ICC of 0.91 (95% confidence interval = 0.72-0.99, p<0.001). Two first-episode psychosis program sites (6%) achieved excellent fidelity, 25 (69%) good fidelity, and nine (25%) fair fidelity. Of the 32 distinct items on the FEPS-FS-R, 23 (72%) were used with good or excellent fidelity. Most sites achieved high fidelity on most items, but five items received ratings indicating low-fidelity use at most sites. The fidelity assessment proved feasible, and sites required on average 10.5 hours for preparing and conducting the fidelity review. The FEPS-FS-R has high interrater reliability and can differentiate high-, moderate-, and low-fidelity sites. Most sites had good overall fidelity, but the FEPS-FS-R identified some services that were challenging to implement at many sites.

Subtyping Schizophrenia by Treatment Response: Antipsychotic Development and the Central Role of Positive Symptoms.

(Reprinted with permission from The Canadian Journal of Psychiatry 2015; 60(11):515-522).

Tobacco Consumption Concerns With the Use of CYP1A2 Metabolized Antidepressants

Tobacco Consumption Concerns With the Use of CYP1A2 Metabolized Antidepressants

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults.

These Practice Guidelines for the Psychiatric Evaluation of Adults mark a transition in the American Psychiatric Association’s Practice Guidelines. Since the publication of the 2011 Institute of Medicine report Clinical Practice Guidelines We Can Trust, there has been an increasing focus on using clearly defined, transparent processes for rating the quality of evidence and the strength of the overall body of evidence in systematic reviews of the scientific literature. These guidelines were developed using a process intended to be consistent with the recommendations of the Institute of Medicine (2011), the Principles for theDevelopment of Specialty Society Clinical Guidelines of the Council of Medical Specialty Societies (2012), and the requirements of the Agency for Healthcare Research andQuality (AHRQ) for inclusion of a guideline in the National Guideline Clearinghouse. Parameters used for the guidelines’ systematic review are included with the full text of the guidelines; the development process is fully described in a document available on the APA website: http:// www.psychiatry.org/File%20Library/Practice/APA-GuidelineDevelopment-Process–updated-2011-.pdf. To supplement the expertise of members of the guideline work group, we used a “snowball” survey methodology to identify experts on psychiatric evaluation and solicit their input on aspects of the psychiatric evaluation that they saw as likely to improve specific patient outcomes (Yager 2014). Results of this expert survey are included with the full text of the practice guideline.

Mindfulness Meditation and Aromatherapy to Reduce Stress and Anxiety

Coping with symptoms of stress and anxiety is a challenging experience and continues to tax the resources and limits of modern conventional health care. In the past 25–30 years, western medical science has turned increasing attention to the psychological and physical correlates of meditation, with mindfulness becoming quite popular in recent years. An extensive literature review was performed; the majority of articles were rated at level ll evidence based on a scale of l–Vll (l being the best evidence). Findings of the literature review support the evidence-based practice project of using mindfulness meditation as an intervention to reduce both stress and anxiety levels ( Lee et al., 2007 Lee S.H. Ahn S.C. Lee Y.J. Choi T.K. Yook K.H. Suh S.Y. Effectiveness of a meditation-based management program as an adjunct to pharmacotherapy in patients with anxiety disorder. Journal of Psychosomatic Research. 2007; 62: 189-195 Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar , Leite et al., 2010 Leite J.R. De Moraes Ornellas F.L. Amemiya T.M. De Almeida A.A. Dias A.A. Afonso R. et al. Effect of progressive self-focus meditation on attention, anxiety, and depression scores. Perceptual and Motor Skills. 2010; 110: 840-848 Crossref PubMed Scopus (19) Google Scholar , Malini et al., 2011 Malini Srivastava Uddip Talukdar Vivek Lahan Meditation for the management of adjustment disorder, anxiety and depression. Complementary Therapies in Clinical Practice. 2011; 17: 241-250 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar , Piet and Esben, 2011 Piet Jacob Esben Hougaard The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysis. Clinical Psychology Review. 2011; 31: 1032-1040 Crossref PubMed Scopus (526) Google Scholar , Ramel et al., 2004 Ramel et al. The effect of mindfulness meditation on cognitive processes and affect in patients with past depression. Cognitive Therapy and Research. 2004; 28: 433-455 Crossref Scopus (362) Google Scholar , Schreiner and Malcolm James, 2008 Schreiner Istvan Malcolm James P. The benefits of mindfulness meditation: Changes in emotional states of depression, anxiety and stress. Journal of Psychosomatic Research. 2008; 25: 158-168 Google Scholar , Toneatto and Nguyen, 2007 Toneatto T. Nguyen L. Does mindfulness improve anxiety and mood symptoms? A review of the controlled research. Canadian Journal of Psychiatry. 2007; : 260-266 PubMed Google Scholar ). There was no prior research using a mindfulness intervention combined with aromatherapy to reduce stress and anxiety for hospitalized psychiatric patients.

The Canadian Journal of Psychiatry in 2014 and beyond

The Canadian Journal of Psychiatry (The CJP) has a mandate to report scientific findings and to present them in a way that illuminates theory and practice of psychiatry in Canada and internationally. The CJP must pursue its mandate within the rapidly shifting sands of contemporary scientific publishing. The past decade has seen an unprecedented proliferation of new journals and publication models, most notably the emergence and growth of online and open-access publishing. The results of these changes have been mixed. While open access has improved the widespread dissemination of scientific knowledge and has produced some top-tier online journals, it has also resulted in thousands of low-quality journals that have shaken the confidence of many people about the integrity of the peer-reviewed literature. Another development has been the emergence of large-scale, online publishing platforms, such as PLOS ONE. These more closely resemble multi-purpose archives than any traditional medical journal. At The CJP, our goal is to implement the best aspects of these new models, while preserving the strengths of traditional publishing models. We are proud of our 60-year tradition and the solid mission of the journal, but we must move with the times. Articles in The CJP become open access after 6 months, fulfilling the requirements of research funded by the Canadian Institutes of Health Research and the US National Institutes of Health. These articles are now indexed on PubMed Central, providing global and universal access to anyone, anywhere in the world, with the click of a mouse. We now provide authors with an open access option, at a discounted rate for Canadian Psychiatric Association members and affiliates, allowing immediate worldwide accessibility for their work. While the readership of The CJP makes it the best way to reach the national audience, it can now provide the same international accessibility as an international journal. In recent years, The CJP has introduced various publication formats for reviews, addressing various needs. The In Review series allows a focused and detailed treatment of contemporary topics. Perspective articles provide scholarly treatment of controversial issues, allowing authors to take a position on those issues. Systematic Review papers provide comprehensive summaries of important topics. Such reviews are increasingly important, given the rapid growth of the literature. In 2013, the Web of Science indexed 2 178 456 papers, about twice the number indexed 20 years earlier in 1993. Over 27 thousand articles were indexed under the research area of Psychiatry in 2013 alone. Topical syntheses of this literature are needed. Both Systematic Reviews and In Reviews provide an informed distillation of evidence from diverse sources, often systematically summarizing evidence from hundreds or even thousands of papers. The CJP continues to welcome research reports, both as full-length Original Research papers and as Brief Communications, as well as Letters to the Editor and Book Reviews. The Editorial Board’s aspiration is to become the preferred destination for the highest-quality, clinically relevant Canadian psychiatric research. We also hope to attract international contributions of increasing calibre. To this end, I express my gratitude to the Editorial Board of The CJP for the many hours they devoted to their work in 2014 and to the many scientists listed on the next page who have devoted their time and expertise to the processes of peer review for The CJP. Their efforts are the single most important protection of the quality of our published content. Their constructively critical comments also greatly improve the quality of manuscripts that are accepted for publication. While quality peer review does take time, the average article published in The CJP in 2014 was submitted less than 9 months before it was published, with authors receiving peer-review comments within 1.5 months. I also acknowledge Dr Joel Paris for the 10 years (2004 to 2014) of leadership that he provided to The CJP as its Editor-in-Chief, and for his mentorship and guidance during my transition into this role.

Diffusion of Prazosin Treatment for PTSD

Diffusion of Prazosin Treatment for PTSD

Reviews and Perspectives

The Canadian Journal of Psychiatry (The CJP) has a mandate to report scientific findings and to present them in a way that illuminates theory and practice of psychiatry in Canada and internationally. The medical literature is expanding rapidly. Nearly a million papers were indexed by MEDLINE in 2012—a doubling during the past 10 years. Review articles are essential for keeping up to date with this ever-expanding evidence base. To this end, The CJP has published, for some years now, a mixture of narrative and systematic reviews of the literature (including the In Review section that leads off each issue, along with a Guest Editorial) as well as original research. At this point, the Editorial Board would like to expand the journal’s mandate for reviewing research with important clinical implications. Therefore, the Editorial Board is introducing 2 relatively new sections to The CJP. The first, Systematic Reviews, will replace the older category of Review Papers. Our new Systematic Reviews will be focused investigations that seek to identify, appraise, select, and synthesize all high-quality research evidence relevant to a specific research question. The second, Perspectives, is one The CJP has used only occasionally. Our new Perspective papers will introduce a critical perspective on scientific issues that are controversial. While the Editorial Board has, by and large, avoided publishing opinion pieces, we, as a board, believe there is a role for papers that not only are strongly evidence-based but also take sides in a controversy. We believe these changes will make the journal livelier, and we invite submissions that meet these criteria. The CJP will continue to combine the invited In Review series on large topics with Original Research papers, with unsolicited manuscripts averaging 9.5 months from submission to publication in 2013, with peer-review comments being shared with authors less than 1.7 months after submission. These manuscript types are included in the updated Instructions for Authors, which is available online at http://www.TheCJP.ca and http://mc.manuscriptcentral.com/cjp. New for 2014 is a Manuscript Checklist, which will allow authors to ensure they meet The CJP’s requirements and, in turn, to avoid potentially delaying publication of their manuscripts. As well, the new Manuscript Template includes useful tips on preparing manuscripts, which the Editorial Board hopes will make manuscript preparation faster and easier, particularly for junior researchers. We would like to take this opportunity to thank the Editorial Board, as well as our peer reviewers and book reviewers, all of whom work hard for The CJP without compensation. We would also like to thank Roger Bland, who has been Deputy Editor under 3 different editors-in-chief. Finally, we are grateful to our staff, most particularly our indispensable Director, Scientific Publications, Virginia St-Denis. Virginia is aided by Christine Jensen, Sylvia Pollard, Candace Taylor, Smita Hamzeh, and Elizabeth Payne. The Canadian Psychiatric Association’s new Chief Executive Officer, Glenn Brimacombe, has been immensely supportive.

“Assisted Outpatient Treatment”: An Example of Newspeak?

Back to table of contents Previous article Next article LettersFull Access“Assisted Outpatient Treatment”: An Example of Newspeak?Erik Roskes, M.D.Erik RoskesSearch for more papers by this author, M.D.Published Online:1 Nov 2013https://doi.org/10.1176/appi.ps.641106AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: For years, proponents of involuntary outpatient commitment have put forth the euphemistic term “assisted outpatient treatment” in an apparent effort to render the coercive aspect of the procedure less obvious to the casual observer. Most recently in these pages, Torrey (1) used a book review as a forum to continue promoting this intervention.According to Webster’s online dictionary (www.merriam-webster.com), the verb “assist” used as a transitive verb means “to give usually supplementary support or aid to”; used as an intransitive verb, it means “to give support or aid.” The explicit implication of these meanings is that the “assistance” provided is in the furtherance of a goal sought by the receiver of the assistance.The earliest use of the term “assisted outpatient treatment” in this journal appears to have been in September 2001 (2). In that article, the authors noted that the term was devised by proponents of Kendra’s Law in New York, a response to a tragedy in which an individual with serious mental illness killed a woman by pushing her into the path of an oncoming subway train. Here is what the authors of that article wrote: “In many states a take-no-prisoners battle is under way between advocates of outpatient commitment—who call this approach assisted outpatient treatment—and its opponents—who use the term ‘leash laws.’ ” It is clear to me—and appears to have been clear to the authors of that article—that use of the term “assist” in this regard was a deliberate attempt to make the intervention seem less coercive and therefore more palatable.Somehow, the “assisted outpatient treatment” proponents have been winning the language battle such that the term has replaced the more accurate “involuntary outpatient commitment.” This defines Newspeak, the language in Orwell's masterpiece 1984, in which some terms “meant almost the exact opposite of what they appeared to mean.”If we are honest with ourselves, with our patients, and perhaps most importantly with our policy makers, we ought to recognize and oppose this linguistic sleight of hand. Calling a coercive, court-mandated treatment order “assisted,” as if it were a cane or a walker used to assist a person with impaired balance who wants to be able to safely navigate his living room or her sidewalk, is inaccurate and misleading. We are better than this. Whether there is a role for involuntary interventions should be debated honestly and openly and without trying to hide the nature of the interventions that we are proposing. Let’s just call it what it is.Dr. Roskes is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore.Acknowledgments and disclosuresThe opinions expressed are those of the author and do not necessarily reflect those of the Maryland Mental Hygiene Administration or Springfield Hospital Center.The author reports no competing interests.References1 Torrey EF: Against Autonomy: Justifying Coercive Paternalism [book review]. Psychiatric Services (E-pub, August 1, 2013)Medline, Google Scholar2 Monahan J, Bonnie RJ, Appelbaum PS, et al.: Mandated community treatment: beyond outpatient commitment. Psychiatric Services 52:1198–1205, 2001Link, Google Scholar FiguresReferencesCited byDetailsCited byInvoluntary Outpatient Commitment and the Elusive Pursuit of Violence Prevention25 October 2016 | The Canadian Journal of Psychiatry, Vol. 62, No. 2 Volume 64Issue 11 November 2013Pages 1179-1179 Metrics Acknowledgments and disclosuresThe opinions expressed are those of the author and do not necessarily reflect those of the Maryland Mental Hygiene Administration or Springfield Hospital Center.The author reports no competing interests.PDF download History Published online 1 November 2013 Published in print 1 November 2013

Resilience, Agency and Resistance in the Storytelling Practice of Aunty Hilda Wilson (1911-2007), Ngarrindjeri Aboriginal Elder

Resilience, Agency and Resistance in the Storytelling Practice of Aunty Hilda Wilson (1911-2007), Ngarrindjeri Aboriginal Elder

Case Management for Frequent Emergency Department Users

Case Management for Frequent Emergency Department Users

Why Are Canadians Complacent about Long-Acting Injectable Antipsychotic Therapies? Come on, Canada, You Can Do Better!

© 2013 by Canadian Psychiatric Association, Canadian Journal of Psychiatry / Revue Canadienene de Psychiatrie

Reversal of Aripiprazole-Induced Tardive Akathisia by Addition of Pregabalin

Reversal of Aripiprazole-Induced Tardive Akathisia by Addition of Pregabalin

Taking Disruptive Mood Dysregulation Disorder Out for a Test Drive

Taking Disruptive Mood Dysregulation Disorder Out for a Test Drive

Bigger and Better: Expanding in Reviews and the Electronic Era

The Canadian Psychiatric Association (CPA) has announced that a new Editor-in-Chief will be appointed for fall 2014, when my mandate ends. I am grateful to the CPA for this exciting job. In recent years, The Canadian Journal of Psychiatry (The CJP) has focused on original research and systematic review papers in all areas of psychiatry. The In Review series, which I helped to develop in 1997, is the most frequently referenced. The topics are chosen by the Editorial Board, and Guest Editors invite experts to review the literature. Readers of this section will note how much psychiatry has progressed, but also how much it still has to learn - research methods are only beginning to illuminate clinical issues, and many treatment methods have not yet been shown to be effective. In 2013, the January issue will focus on Psychosis in 3 In Reviews (specifically, risk of psychosis, prodromal symptoms, and social causes) and the February issue will have 2 In Reviews on Gene-Environment Interactions (relating to major depressive disorder and posttraumatic stess disorder) and Neuroplasticity (that is, schizophrenia as a neuroplasticity disorder). Future issues will deal with Disaster Mental Health Response, Melancholia, Behavioural Additions, Cognitive Remediation, Depression Psychotherapy, and more.The Editorial Office received nearly 200 manuscripts in 2012. While the quality of the submissions has risen, only about one-third make it to print, and a rapid publication policy has kept our time-to-publish rate down to less than 10 months in 2012 - only 2011 was faster at less than 9 months. The CJP's impact factor is stable at 2.4, above the median and ranked 62 of the 129 psychiatry journals listed in the Journal Citation Report.The new Editor-in Chief will need to guide The CJP into an electronic era when all articles will eventually be online only. As a first step, the cyberCJP was launched in 2012, providing CPA members with electronic access to the full issue, cover to cover. In 201 3, subscribers will also be given access. The print version will continue to be published, but readers have the option of receiving the cyberCJP alone.The CJP could not function without the devoted work of Virginia St-Denis (Director, Scientific Publications), and I am fortunate to have worked with Virginia for most of my mandate. A special thanks goes to the dedicated staff: Sylvia L Pollard (Senior Copy Editor), Candace Taylor (Copy Editor), Smita Hamzeh (Advertising and Production Manager), and Elizabeth Payne (Desktop Publisher). As I do every year, I would like to thank all of our peer reviewers, as well as our hard-working Editorial Board. Special thanks go to Deputy Editor Dr Roger Bland and Associate Editors Dr Paul Grof (Book Review Section), Dr Alain Lesage (French Submissions), Dr Glenda MacQueen, Dr Scott B Patten, and Dr David L Streiner (Statistical Consultant). …

Treatments and Prescriptions in Advanced Dementia Patients Residing in Long-Term Care Institutions and at Home

Dementia is an incurable condition resulting in a progressive but patchy decay characterized by dementia related events such as recurrence of infections and eating problems, as well as by acute conditions typical of frailty and/ or the worsening of chronic comorbidities. Its duration is reported to range from three to over nine years. Although not everyone will reach the advanced stage, many patients experience a highly severe and persistent disability. Health professionals may not always acknowledge advanced dementia as a terminal disease, and this may result in patients being exposed to aggressive treatments. The prescription regimen should be reconsidered not only to avoid overtreatment and side effects of drugs, but also to improve comfort and symptom control. In far advanced stages, some medications previously prescribed for comorbidities could likely be discontinued to reduce burden, adverse effects, and costs. A model for defining the concept of prescriptions’ appropriateness in advanced dementia was proposed by Holmes and colleagues taking into account factors such as patients’ life expectancy and goals of care. Many patients with advanced dementia are cared for until death in nursing homes (NHs), and studies have shown that drug regimens may be far from optimal. However, others die at home, cared for by home care service (HC). Information on the treatments and prescriptions for patients with advanced-stage dementia cared for at home are scarce. We expected differences, because drug regimes may be critically reconsidered and revised upon admission to institutional long-term care by physicians on staff of NHs. The aim of this paper is to assess and compare treatments and prescriptions of patients with advanced dementia cared for in NHs and in HC and assess their appropriateness from a palliative care perspective.

ECP05-02 - Early intervention in psychiatry: a waste of valuable resources?

In this presentation I will make the following points. 1. Attempts by the early intervention movement to prevent the onset of psychotic illnesses using either psychological or pharmacological methods have been unsuccessful. This was entirely predictable 2. Efforts to identify vulnerable people before they develop a psychotic illness do more harm than good. This is because the positive predictive value of any test is dependant on the prevalence of the condition to which it is applied. 3. In the United Kingdom, early intervention for psychosis clinicians have been narrow minded and extremely selfish. Their recruitment raids have made it even more difficult for ordinary psychiatric teams to provide decent care to people with serious mental disorders 4. Early intervention teams have been described as jewels in the crown of psychiatric services in England. Their spectacular “success” and enviable public relations skills have tempted some clinical academic colleagues to apply their methods to other psychiatric disorders. Some of this work could be worthwhile but it must be informed by clinical experience and an understanding of epidemiological principles. References McGorry P, Pelosi AJ (2009). Is early intervention in the major psychiatric disorders justified? British Medical Journal, 338, 802–803 Malla A, Pelosi AJ (2010). Is treating patients with first-episode psychosis cost effective? Canadian Journal of Psychiatry, 55, 3–8

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study