2024-03-28T18:49:46Z
http://ir.lib.uwo.ca/do/oai/
oai:ir.lib.uwo.ca:biologypub-1000
2009-05-06T22:16:20Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
publication:biologypub
publication:biology
19102774
DNA Methylation and mRNA Expression of SYN III, a Candidate Gene for Schizophrenia
Murphy, Brenda C.
O'Reilly, Richard L.
Singh, Shiva M.
Article
2008-12-22T08:00:00Z
Synapsin III gene
Schizophrenia susceptibility
SYN III methylation
mRNA expression
Genetics and Genomics
Medical Genetics
Medical Sciences
Psychiatry
Background: The synapsin III (SYN III) gene on chromosome 22q is a candidate gene for
schizophrenia susceptibility due to its chromosome location, neurological function, expression
patterns and functional polymorphisms.
Methods: This research has established the mRNA expression of SYN III in 22 adult human brain
regions as well as the methylation specificity in the closest CpG island of this gene. The methylation
specificity studied in 31 brain regions (from a single individual) was also assessed in 51 human blood
samples (representing 20 people affected with schizophrenia and 31 normal controls) including a
pair of monozygotic twin discordant for schizophrenia and 2 non-human primates.
Results: The results show that the cytosine methylation in this genomic region is 1) restricted to
cytosines in CpG dinucleotides 2) similar in brain regions and blood and 3) appears conserved in
primate evolution. Two cytosines (cytosine 8 and 20) localized as the CpG dinucleotide are partially
methylated in all brain regions studied. The methylation of these sites in schizophrenia and control
blood samples was variable. While cytosine 8 was partially methylated in all samples, the
distribution of partial to complete methylation at the cytosine 20 was 22:9 in controls as compared
to 18:2 in schizophrenia (p = 0.82). Also, there is no difference in methylation between the affected
and unaffected member of a monozygotic twin pair.
Conclusion: The variation in SYN III methylation studied is 1) not related to schizophrenia in the
population sample or a monozygotic twin pair discordant for schizophrenia and 2) not related to
the mRNA level of SYN IIIa in different human brain regions.
Published in: BMC Medical Genetics 2008, 9:115 (doi:10.1186/1471-2350-9-115). The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2350/9/115
https://ir.lib.uwo.ca/biologypub/1
oai:ir.lib.uwo.ca:nursingpub-1000
2009-05-15T23:17:00Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
publication:nursing
publication:nursingpub
Supported Housing Programs for Persons with Serious Mental Illness in Rural Northern Communities: A Mixed Method Evaluation
Montgomery, Phyllis
Forchuk, Cheryl
Duncan, Craig
Rose, Don
Bailey, Patricia H.
Veluri, Ramamohan
Article
2008-07-24T07:00:00Z
Supported housing program
Rural community
Supported housing intervention
Nursing
Psychiatry
Background: During the past two decades, consumers, providers and policy makers have recognized the
role of supported housing intervention for persons diagnosed with serious mental illness (SMI) to be able
to live independently in the community. Much of supported housing research to date, however, has been
conducted in large urban centers rather than northern and rural communities. Northern conditional and
contextual issues such as rural poverty, lack of accessible mental health services, small or non-existing
housing markets, lack of a continuum of support or housing services, and in some communities, a poor
quality of housing challenge the viability of effective supported housing services. The current research
proposal aims to describe and evaluate the processes and outcomes of supported housing programs for
persons living with SMI in northern and rural communities from the perspective of clients, their families,
and community providers.
Methods: This research will use a mixed method design guided by participatory action research. The
study will be conducted over two years, in four stages. Stage I will involve setting up the research in each
of the four northern sites. In Stage II a descriptive cross-sectional survey will be used to obtain information
about the three client outcomes: housing history, quality of life and housing preference. In Stage III two
participatory action strategies, focus groups and photo-voice, will be used to explore perceptions of
supported housing services. In the last stage findings from the study will be re-presented to the
participants, as well as other key community individuals in order to translate them into policy.
Conclusion: Supported housing intervention is a core feature of mental health care, and it requires
evaluation. The lack of research in northern and rural SMI populations heightens the relevance of research
findings for health service planning. The inclusion of multiple stakeholder groups, using a variety of data
collection approaches, contributes to a comprehensive, systems-level examination of supported housing
in smaller communities. It is anticipated that the study's findings will not only have utility across Ontario,
but also Canada.
Published in: BMC Health Services Research 2008, 8:156 (doi:10.1186/1472-6963-8-156). The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-6963/8/156
https://ir.lib.uwo.ca/nursingpub/1
oai:ir.lib.uwo.ca:psychologypub-1001
2009-05-23T01:17:12Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
publication:psychologypub
publication:psychology
Classifying Mother-Toddler Attachment Relationships in the Interesting-but-scary Paradigm: Scoring System for Interactive Behaviour
Forbes, Lindsey
Bento, Sandi
DeOliveira, Carey Anne
Report
2003-01-01T08:00:00Z
Mother-toddler attachment relationships
Developmental Psychology
https://ir.lib.uwo.ca/psychologypub/2
oai:ir.lib.uwo.ca:psychiatrypub-1000
2009-06-25T23:49:16Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
New Scale May Help Docs Manage Suicide Risk in Clinical Practice
Srivastava, Amresh
Nelson, Charles
Article
2008-12-01T08:00:00Z
suicide risk assessment
schizophrenia
assessment protocol
Canadian Psychiatry Aujourd’hui
Canadian Psychiatry Aujourd’hui
4
6
Psychiatry and Psychology
https://ir.lib.uwo.ca/psychiatrypub/1
oai:ir.lib.uwo.ca:nursingpub-1032
2011-11-14T02:25:54Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
publication:nursing
publication:nursingpub
18979865
Some Psychiatric Survivors Can’t Survive the System
Forchuk, Cheryl
Article
2008-10-01T07:00:00Z
Canadian Nurse
Canadian Nurse
104
8
44
44
Nursing
Psychiatry
https://ir.lib.uwo.ca/nursingpub/212
oai:ir.lib.uwo.ca:nursingpub-1034
2009-08-20T00:47:04Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
publication:nursing
publication:nursingpub
18647186
Interlocking Oppressions: The Effect of a Comorbid Physical Disability on Perceived Stigma and Discrimination among Mental Health Consumers in Canada
Bahm, Allison
Forchuk, Cheryl
Article
2009-01-01T08:00:00Z
comorbidity
discrimination
mental health
physical disability
quality of life
stigma
Health and Social Care in the Community
Health and Social Care in the Community
17
1
63
70
Nursing
Psychiatry
People living with mental health problems often face stigma and discrimination; however, there is a lack of research that examines how comorbid conditions affect this perceived stigma. This study sought to determine whether people who have a comorbid physical and psychiatric disability experience more stigma than those with only a psychiatric disability. It also looked at how perceived stigma and discrimination affect physical and mental health. A secondary analysis on data from interviews with 336 former and current clients of the mental health system in a mid-size Canadian city in 2005 was performed. Of these, 203 (60.4%) reported they had a psychiatric disability, 112 (33.0%) reported that they had a physical disability, with 74 reporting both a psychiatric and a physical disability. People with a self-reported psychiatric disability and a self-reported comorbid physical disability faced more overall perceived discrimination/stigma (P = 0.04), than those with a psychiatric disability alone. Perceived discrimination/stigma was positively correlated with psychiatric problem severity (P = 0.02), and negatively correlated with self-rated general health (P < 0.001), physical condition (P < 0.001), emotional well-being (P < 0.001) and life satisfaction (P < 0.001). These results bring to light the aggravating effect of a physical disability on the perceived stigma for those living with a mental illness, and also strengthen the knowledge that stigma and discrimination have a negative impact on health. Healthcare providers should recognise this negative impact and screen for these comorbid conditions. Policy-makers should take measures such as improving access to housing and employment services to help reduce stigma and discrimination against this particularly vulnerable group.
Published in: Health & Social Care in the Community, Volume 17 Issue 1, Pages 63 - 70. doi: 10.1111/j.1365-2524.2008.00799.x
https://ir.lib.uwo.ca/nursingpub/30
oai:ir.lib.uwo.ca:nursingpub-1097
2009-10-29T06:16:29Z
publication:kingspsychologypub
publication:psychiatrypub
publication:pmid
publication:kings_psychology
publication:affiliates
publication:faculties
publication:psychiatry
publication:nursing
publication:nursingpub
publication:psychology
publication:kings
19544125
Uprooted and Displaced: A Critical Narrative Study of Homeless, Aboriginal, and Newcomer Girls in Canada
Berman, Helene
Mulcahy, Gloria Alvernaz
Forchuk, Cheryl
Edmunds, Kathryn Ann
Haldenby, Amy
Lopez, Raquel
Article
2009-07-01T07:00:00Z
homelessness
diversity
Canada
Issues in Mental Health Nursing
Issues in Mental Health Nursing
30
7
418
430
Nursing
Uprooting and displacement are a common part of everyday life for millions of girls and young women throughout the world. While much of the discourse has centered on movement from one country to another, uprooting and displacement are also a reality for many within Canada. Notably, a growing population of homeless girls and Aboriginal girls also have experienced uprooting and dislocation from home, community, and in some cases, family. For many of these girls, multiple forms of individual and systemic violence are central features of their lives. The primary purpose of this critical narrative study is to examine how uprooting and displacement have shaped mental health among three groups: (1) newcomers to Canada (immigrant and refugee girls); (2) homeless girls; and (3) Aboriginal girls. In-depth narrative interviews were conducted with 19 girls in Southwestern Ontario. Narrative themes revealed that although there is much diversity within and between these groups, uprooting and displacement create social boundaries and profound experiences of disconnections in relationships. Barriers to re/establishing connections generate dangerous spaces within interlocking systems of oppression. However, in negotiating new spaces, there is the potential for the forming and re-forming of alliances where sources of support hold the promise of hope. It is within these spaces of hope and pathways of engagement where connections offer a renewed sense of belonging and well-being. The findings highlight the relevance of the construct of uprootedness in girls' lives, provide beginning directions for the design of gender-specific and culturally meaningful interventions, and comprise a substantial contribution to the growing body of research related to girls and young women.
Published in: Issues in Mental Health Nursing, Volume 30, Issue 7, July 2009 , pages 418 - 430. doi: 10.1080/01612840802624475
https://ir.lib.uwo.ca/nursingpub/92
oai:ir.lib.uwo.ca:nursingpub-1098
2009-10-29T06:32:52Z
publication:socialworkpub
publication:psychiatrypub
publication:pmid
publication:affiliates
publication:faculties
publication:psychiatry
publication:nursing
publication:nursingpub
publication:kings
19591023
Exploring Differences Between Community-Based Women and Men with a History of Mental Illness
Forchuk, Cheryl
Jensen, Elsabeth
Csiernik, Rick
Ward-Griffin, Catherine
Ray, Susan
Montgomery, Phyllis
Wan, Linda
Article
2009-08-01T07:00:00Z
Adult
Age of Onset
Attitude to Health
Chi-Square Distribution
Female
Homeless Persons
Housing
Humans
Longitudinal Studies
Male
Marital Status
Men
Mental Disorders
Middle Aged
Needs Assessment
Nursing Methodology Research
Ontario
Questionnaires
Sex Distribution
Sex Factors
Social Support
Women
Issues in Mental Health Nursing
Issues in Mental Health Nursing
30
8
495
502
Nursing
Relatively little is understood concerning the role of gender in persons with a history of mental illness residing in the community. This paper aims to explore gender's effect using data from the Community Research University Alliance project entitled, Mental Health and Housing. The primary five-year longitudinal study examined housing situations for psychiatric consumer/survivors in a mid-size, central Canadian region in an effort to improve the number and quality of appropriate housing situations. Data from 887 subjects in the original research underwent secondary analysis with particular relevance to differences between gender and indicators of health status including psychiatric history, levels of functioning, personal strengths and resources, and illness severity. Results of the secondary analysis found male and female differences that corroborated previous research. More women are housed than men, more women with mental illness were coupled than men, men have fewer social supports, and men have more substance abuse issues than women. These findings suggest health services within the community must consider these sex differences if they wish to properly assist Canadian individuals diagnosed with mental illnesses.
Published in: Issues in Mental Health Nursing, Volume 30, Issue 8 August 2009 , pages 495 - 502. doi: 10.1080/01612840802624467
https://ir.lib.uwo.ca/nursingpub/93
oai:ir.lib.uwo.ca:psychiatrypub-1001
2009-08-29T00:33:32Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
Prescribing Practices of Clozapine in India: Results of a Opinion Survey of Psychiatrists
Shrivastava, Amresh
Shah, Nilesh
Letter to the Editor
2009-07-01T07:00:00Z
Prescribing practices
clozapine
India
Indian Journal of Psychiatry
Indian Journal of Psychiatry
51
3
236
237
Psychiatry and Psychology
https://ir.lib.uwo.ca/psychiatrypub/2
oai:ir.lib.uwo.ca:nursingpub-1108
2009-11-04T08:30:26Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
publication:nursing
publication:nursingpub
17397689
Transitional Discharge Based on Therapeutic Relationships: State of the Art
Forchuk, Cheryl
Reynolds, William
Sharkey, Siobhan
Martin, Mary-Lou
Jensen, Elsabeth
Article
2007-04-01T07:00:00Z
Adaptation
Psychological
Clinical Nursing Research
Community Mental Health Services
Cross-Cultural Comparison
Humans
Mental Disorders
Models
Nursing
Nurse-Patient Relations
Ontario
Patient Discharge
Peer Group
Pilot Projects
Randomized Controlled Trials as Topic
Scotland
Social Support
Archives of Psychiatric Nursing
Archives of Psychiatric Nursing
21
2
80
86
Nursing
Psychiatric and Mental Health
The Transitional Discharge Model (TDM) has been used to facilitate effective discharge from psychiatric hospital to community. A summary of the research to date on TDM is given. The model is based on the provision of therapeutic relationships to provide a safety net throughout the discharge and community reintegration processes. These relationships include both staff and peer involvement; hospital inpatient staff continue to remain involved with the client until a therapeutic relationship is established with a community care provider, and peer support is offered from a former consumer of mental health services who is currently living in the community. Studies found that the TDM facilitates increased discharge rates, lower readmission rates, and cost savings--making it a collaborative, cost-effective method of providing quality patient care and positive health care outcomes. The TDM Plan of Research is presented and reflects the collaboration between stakeholders and the integration of consumer advocacy, clinical practice, education, policy, and research in various countries.
Published in: Archives of Psychiatric Nursing,
Volume 21, Issue 2, April 2007, Pages 80-86. doi: 10.1016/j.apnu.2006.11.002
https://ir.lib.uwo.ca/nursingpub/99
oai:ir.lib.uwo.ca:nursingpub-1109
2009-11-01T08:15:04Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
publication:nursing
publication:nursingpub
Peer Support Relationships: An Unexplored Interpersonal Process in Mental Health
Coatsworth-Puspoky, R.
Forchuk, C.
Ward-Griffin, C.
Article
2006-10-01T07:00:00Z
consumer-survivors
ethnonursing methodology
peer support relationships
Peplau
mental health
Journal of Psychiatric and Mental Health Nursing
Journal of Psychiatric and Mental Health Nursing
13
5
490
497
Nursing
Consumer-survivors (C/Ss) identify peer support as a resource that facilitates their recovery. However, little is known about the factors that influence or how the peer support relationship (PSR) develops/deteriorates. The purpose of the study was to explore and describe the PSR within the subculture of mental health. Using an ethnonursing method, the study focused on informants from two C/S organizations who received peer support (n = 14). Findings revealed that the PSRs may develop or deteriorate through three, overlapping phases. Contextual factors that influenced the development/deterioration of the PSR are discussed. Understanding the processes and factors that contribute to the development/deterioration of PSRs will enable clinicians and C/Ss to assess and promote the development of healthy, supportive PSRs in mental health.
Published in: Journal of Psychiatric and Mental Health Nursing, Volume 13 Issue 5, Pages 490 - 497. doi: 10.1111/j.1365-2850.2006.00970.x
https://ir.lib.uwo.ca/nursingpub/97
oai:ir.lib.uwo.ca:nursingpub-1110
2009-11-04T08:28:32Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
publication:nursing
publication:nursingpub
Integrating an Evidenced-Based Research Intervention in the Discharge of Mental Health Clients
Martin, Mary-Lou
Jensen, Elsabeth
Coatsworth-Puspoky, Robin
Forchuk, Cheryl
Lysiak-Globe, Tanya
Beal, Georgiana
Article
2007-04-01T07:00:00Z
Adaptation
Psychological
Anthropology
Cultural
Attitude of Health Personnel
Clinical Nursing Research
Community Health Nursing
Community Mental Health Services
Evidence-Based Medicine
Focus Groups
Hospitals
Psychiatric
Humans
Inservice Training
Mental Disorders
Nurse's Role
Nurse-Patient Relations
Ontario
Patient Acceptance of Health Care
Patient Discharge
Peer Group
Social Support
Archives of Psychiatric Nursing
Archives of Psychiatric Nursing
21
2
101
111
Nursing
Psychiatric and Mental Health
The purpose of this Canadian qualitative study was to explore the experiences of clinical staff who implemented a research intervention: the Transitional Discharge Model (TDM). The TDM provided mental health clients who were hospitalized with peer support and an inpatient staff member to bridge the therapeutic transitioning from hospital staff to the community care provider. Staff from three tertiary care mental health facilities in Canada identified their learning needs in regard to providing the intervention. An educational program was developed and delivered to the clinical staff to support and facilitate the implementation of the new TDM. The extent of the utilization of knowledge and implementation of the TDM varied across the three tertiary care mental health facilities. Focus groups (N=49) with clinical staff were conducted to explore various factors related to the training process as well as the challenges and benefits of implementing the TDM. Data were analyzed using Leininger's Phases of Ethnonursing Qualitative Data Analysis [Leininger, M. (2002). The theory of culture care and the ethnonursing research method. In M. Leininger & M. McFarland (eds.), Transcultural nursing: Concepts, theories, research, and practice (3rd ed.). New York: McGraw-Hill]. Findings revealed that clinical staff experienced challenges in roles and responsibilities, relationships with others, values and beliefs of clients, staff and community, resources, and the processes of care. From the findings, strategies were identified to support the integration of knowledge about the TDM into practice and to increase clinical staff's skills in implementing research interventions. These included support from others, as well as support of practice, policy, and education.
Published in: Archives of Psychiatric Nursing,
Volume 21, Issue 2, April 2007, Pages 101-111. doi: 10.1016/j.apnu.2006.11.004
https://ir.lib.uwo.ca/nursingpub/100
oai:ir.lib.uwo.ca:psychiatrypub-1003
2009-08-29T00:45:56Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
Should Antipsychotics Be Used in Prodromal Phase of Psychosis?
Srivastava, Amresh
Article
2007-07-26T07:00:00Z
Antipsychotics
Psychosis
Psychiatry and Psychology
A message posted to the Feature Forums of the World Federation of Societies of Biological Psychiatry on July 26, 2007.
https://ir.lib.uwo.ca/psychiatrypub/3
oai:ir.lib.uwo.ca:psychiatrypub-1002
2009-08-29T00:38:52Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
Perspectives in Social Outcome of Schizophrenia
Srivastava, Amresh
Response or Comment
2009-07-16T07:00:00Z
Social Outcome
Schizophrenia
Psychiatry and Psychology
Comments to "ICOSR 2009—Social Outcome and Schizophrenia: Back to the Future" in the Schizophrenia Research Forum.
https://ir.lib.uwo.ca/psychiatrypub/4
oai:ir.lib.uwo.ca:psychiatrypub-1004
2009-09-05T01:12:49Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
Response, Remission & Recovery: Need to Review Outcome Measures for Schizophrenia
Shrivastava, Amresh
Shah, Nilesh
Article
2008-01-01T08:00:00Z
schizophrenia
outcome measures
Indian Journal of Social Psychiatry
Indian Journal of Social Psychiatry
24
1/2
5
12
Psychiatry and Psychology
Schizophrenia is a complex neurobehavioral disorder known to be associated with poor outcome. It causes significant disability in patients and burden of care amongst relatives. Outcome in developing countries has been reported to be far better than western world, which has come into scientific scanner recently. Wide gap exists between expectations of outcome amongst patients, relatives, caregivers and professionals, which is possibly because of limitations in measurements tools. Significant number of patients remain marginalized without improvement in social & occupational functioning preventing their integration into mainstream of society despite 'clinically reported good outcome' and significant advancement in treatments. The contemporary outcome measure does not capture real-life situations. The concept of response, remission and recovery is being revisited scientifically. There is a strong need to develop culture specific, comprehensive and reliable outcome measures for schizophrenia, which reflects clinical and social outcome in multidimensional measures.
Dr. Amresh Shrivastava has received the publisher's permission to make this article freely available online.
https://ir.lib.uwo.ca/psychiatrypub/5
oai:ir.lib.uwo.ca:biologypub-1006
2009-10-10T02:57:25Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
publication:biologypub
publication:biology
16512914
Breakpoint Associated with a Novel 2.3 Mb Deletion in the VCFS Region of 22q11 and the Role of Alu (SINE) in Recurring Microdeletions
Uddin, Raihan K.
Zhang, Yang
Siu, Victoria Mok
Fan, Yao-Shan
O'Reilly, Richard L.
Rao, Jay
Singh, Shiva M.
Article
2006-03-02T08:00:00Z
Adolescent
Alu Elements
Chromosome Breakage
Chromosome Deletion
Chromosomes
Human
Pair 22
DiGeorge Syndrome
Humans
Male
Models
Genetic
Recombination
Genetic
BMC Medical Genetics
7
18
Biology
Medical Genetics
Background: Chromosome 22q11.2 region is highly susceptible to rearrangement, specifically deletions that give rise to a variety of genomic disorders including velocardiofacial or DiGeorge syndrome. Individuals with this 22q11 microdeletion syndrome are at a greatly increased risk to develop schizophrenia.
Methods: Genotype analysis was carried out on the DNA from a patient with the 22q11 microdeletion using genetic markers and custom primer sets to define the deletion. Bioinformatic analysis was performed for molecular characterization of the deletion breakpoint sequences in this patient.
Results: This 22q11 deletion patient was established to have a novel 2.3 Mb deletion with a proximal breakpoint located between genetic markers RH48663 and RH48348 and a distal breakpoint between markers D22S1138 and SHGC-145314. Molecular characterization of the sequences at the breakpoints revealed a 270 bp shared sequence of the breakpoint regions (SSBR) common to both ends that share >90% sequence similarity to each other and also to short interspersed nuclear elements/Alu elements.
Conclusion: This Alu sequence like SSBR is commonly in the proximity of all known deletion breakpoints of 22q11 region and also in the low copy repeat regions (LCRs). This sequence may represent a preferred sequence in the breakpoint regions or LCRs for intra-chromosomal homologous recombination mechanisms resulting in common 22q11 deletion.
Published in: BMC Medical Genetics, 2006, 7:18. doi: 10.1186/1471-2350-7-18
https://ir.lib.uwo.ca/biologypub/7
oai:ir.lib.uwo.ca:psychiatrypub-1005
2010-04-07T00:34:52Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
publication:epidem
publication:epidempub
19825168
The Abilities of Improved Schizophrenia Patients to Work and Live Independently in the Community: A 10-year Long-term Outcome Study from Mumbai, India
Srivastava, Amresh Kumar
Stitt, Larry
Thakar, Meghana
Shah, Nilesh
Chinnasamy, Gurusamy
Article
2009-10-13T07:00:00Z
schizophrenia
Mumbai
recovery
independence
Annals of General Psychiatry
Annals of General Psychiatry
8
24
http://dx.doi.org/10.1186/1744-859X-8-24
Psychiatry and Psychology
Background: The outcome of schizophrenia has several determinants. Socioecological factors, particularly living conditions, migration, community and culture, not only affect the level of risk but also the outcome. Mega cities around the world show a unique socioecological condition that has several challenges for mental health. The present study reports on the long-term status of patients with schizophrenia in such a mega city: Mumbai, India. Aim This study aims to reveal the long-term outcome of patients suffering from schizophrenia with special reference to clinical symptoms and social functioning.
Methods: The cohort for this study was drawn from a 10-year follow-up of first episode schizophrenia. Patients having completed 10 years of consistent treatment after first hospitalisation were assessed on psychopathological and recovery criteria. Clinical as well as social parameters of recovery were evaluated. Descriptive statistics with 95% confidence intervals are provided.
Results: Of 200 patients recruited at the beginning of this study, 122 patients (61%) were present in the city of Mumbai at the end of 10-year follow-up study period. Among 122 available patients, 101 patients (50.5%) were included in the assessment at the end of 10-year follow-up study period, 6 patients (3.0%) were excluded from the study due to changed diagnosis, and 15 patients (7.5%) were excluded due to admission into long-term care facilities. This indicates that 107 out of 122 available patients (87.7%) were living in the community with their families. Out of 101 (50.5%) patients assessed at the end of 10 years, 61 patients (30.5%) showed improved recovery on the Clinical Global Impression Scale, 40 patients (20%) revealed no improvement in the recovery, 43 patients (72.9%) were able to live independently, and 24 patients (40%) were able to find employment.
Conclusions: With 10 years of treatment, the recovery rate among schizophrenia patients in Mumbai was 30.5%. Among the patients, 87.7% of patients lived in the community, 72.9% of patients lived independently, and 40% of patients obtained employment. However, 60% of patients were unable to return to work, which highlights the need for continued monitoring and support to prevent the deterioration of health in these patients. It is likely that socioecological factors have played a role in this outcome.
https://ir.lib.uwo.ca/psychiatrypub/6
oai:ir.lib.uwo.ca:psychiatrypub-1007
2010-03-05T00:55:59Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
20174512
Prodromal Research: Public Health Initiatives for Prevention of Schizophrenia
Shrivastava, Amresh
Editorial
2010-01-01T08:00:00Z
Prodromal research
Public health
schizophrenia
Indian Journal of Psychiatry
Indian Journal of Psychiatry
52
1
13
16
http://dx.doi.org/10.4103/0019-5545.58889
Psychiatry and Psychology
https://ir.lib.uwo.ca/psychiatrypub/7
oai:ir.lib.uwo.ca:psychiatrypub-1006
2010-03-05T00:55:33Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
20057314
Redefining Outcome Measures in Schizophrenia: Integrating Social and Clinical Parameters
Shrivastava, Amresh
Johnston, Megan
Shah, Nilesh
Bureau, Yves
Article
2010-03-01T08:00:00Z
clinical
outcome
schizophrenia
social
Current Opinion in Psychiatry
Current Opinion in Psychiatry
23
2
120
126
http://dx.doi.org/10.1097/YCO.0b013e328336662e
Psychiatry and Psychology
PURPOSE OF REVIEW: Schizophrenia is a complex neurobehavioral disorder for which there are many promising new treatments. There is, however, a discrepancy in outcome measure reports when they are obtained from patients, relatives, caregivers, or professionals, making it difficult to determine the level of recovery. This lack of agreement may result from limitations of the measurement tools themselves, which are not comprehensive and may be measuring different aspects of outcome. Alternatively, it could be that the conceptual understanding of outcome and recovery require development.
RECENT FINDINGS: For various reasons, patients assessed as 'recovered' remain excluded from mainstream society. We are of the opinion that present outcome measures do not capture real-life situations. We propose that the concept of recovery be carefully defined and the gold standard of outcome should incorporate social and clinical parameters. We attempt to redefine recovery. Patients who have shown clinical improvement do not necessarily do well in everyday situations even though there is obvious clinical improvement. Therefore, it has been repeatedly argued that a consensus of recovery should be determined and that routine clinical practice should then adapt to the agreed criteria.
SUMMARY: We argue that the outcome measures should be multidimensional and consist of at least two parameters: clinical remission and social outcome.
https://ir.lib.uwo.ca/psychiatrypub/8
oai:ir.lib.uwo.ca:psychiatrypub-1008
2010-03-05T00:56:33Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
21327170
Weight-Gain in Psychiatric Treatment: Risks, Implications, and Strategies for Prevention and Management
Shrivastava, Amresh
Johnston, Megan E.
Book Chapter
2010-01-01T08:00:00Z
Weight gain
psychiatric patients
antipsychotics
antidepressants
treatment-induced weight-gain
psychopharmacology
53
68
http://dx.doi.org/10.4103/0973-1229.58819
Pharmacy and Pharmaceutical Sciences
Psychiatry and Psychology
Weight-gain in psychiatric populations is a common clinical challenge. Many patients suffering from mental disorders, when exposed to psychotropic medications, gain significant weight with or without other side-effects. In addition to reducing the patients' willingness to comply with treatment, this weight-gain may create added psychological or physiological problems that need to be addressed. Thus, it is critical that clinicians take precautions to monitor and control weight-gain and take into account and treat all problems facing an individual. In this review, we examine some of the key issues surrounding weight-gain in individuals suffering from mental disorders for contemporary practitioners in community clinics. We describe some factors known to make certain patients more susceptible to treatment-induced weight-gain and mechanisms implicated in this process. We also highlight a few psychological and pharmacological interventions that have proven effective in weight management. Importantly, we provide critical steps for management and prevention of weight-gain and related issues in the clinical practice of psychopharmacology.
Published as a book chapter in: <em>Psychopharmacology Today: Some Issues</em>. Ajai R. Singh and Shakuntala A. Singh. (Eds.).
https://ir.lib.uwo.ca/psychiatrypub/9
oai:ir.lib.uwo.ca:nursingpub-1166
2010-04-02T00:21:21Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
publication:nursing
publication:epidem
publication:nursingpub
publication:epidempub
Deriving a Mental Health Outcome Measure Using the Pooled Index: An Application to Psychiatric Consumer–survivors in Different Housing Types
Speechley, Mark
Forchuk, Cheryl
Hoch, Jeffrey
Jensen, Elsabeth
Wagg, Jennifer
Article
2009-06-01T07:00:00Z
outcome mesaure
pooled index
psychiatric survivors
mental health
housing
Health Services and Outcomes Research Methodology
Health Services and Outcomes Research Methodology
9
2
133
143
http://dx.doi.org/10.1007/s10742-009-0044-4
Nursing
Objective: We demonstrate the combination of several source measures into a comprehensive pooled index (PI) that measures functioning at a single point in time as well as improvement or worsening in functioning over time, and illustrate how this measure can be used to compare functioning in psychiatric clients living in three different housing types.
Methods: One hundred and forty-eight clients (55% women, mean age 45 yr.) were administered comprehensive interviews at two times one year apart. Four variables measured at both times were combined into a PI: three subscale scores from the Colorado Client Assessment Record, and the Quality of Life score from the Lehman interview. The PI was calculated for the initial interview, and between the two interviews to measure change in functioning over time (ΔPI).
Results: The greatest improvements in ΔPI scores occurred in those living independently, very slight worsening was seen among those in subsidized housing, and considerable worsening occurred among those in shelters. Regression results showed that living in a shelter, being older, PI at Year 1, being non-compliant with medications, duration of symptoms, and having more than 1 undesirable move in the past 2 years were independently associated with worsening in overall functioning over one year.
Conclusion: A pooled index change score, calculated from existing scale scores, provides a single dependent variable that quantifies the improvement or worsening of the overall functioning of psychiatric clients living in different housing types over time. A pooled index is one method of reducing multiple outcomes for analysis.
https://ir.lib.uwo.ca/nursingpub/147
oai:ir.lib.uwo.ca:psychiatrypub-1009
2010-05-06T01:20:45Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
20302634
A Canadian Naturalistic Study of a Community-based Cohort Treated for Bipolar Disorder
Sagman, Doron
Lee, Bobbie
Chandresena, Ranjith
Jones, Barry
Brunner, Elizabeth
Article
2010-03-19T07:00:00Z
Bipolar disorder
Naturalistic study
Community-based cohort
BMC Psychiatry
BMC Psychiatry
10
24
http://dx.doi.org/10.1186/1471-244X-10-24
Psychiatry and Psychology
BACKGROUND: Bipolar illness is associated with significant psychosocial morbidity and health resource utilization. Second generation antipsychotics, used alone or in combination with mood stabilizers are effective in treating acute mania in community settings. This study was designed to compare the change in clinical parameters and resource utilization at one month in a group of patients who required treatment intervention for exacerbation of mania. The clinical response at one year was also evaluated.
METHODS: 496 patients were enrolled at 75 psychiatric practices across Canada. The Olanzapine cohort (n = 287) included patients who had olanzapine added to their medication regimen or the dose of olanzapine increased. The Other cohort (n = 209) had a medication other than olanzapine added or the dose adjusted. Changes from baseline in the Young Mania Rating Scale (YMRS), Montgomery Asberg Depression Rating Scale, Beck Anxiety Inventory and SF-12 Health Survey were compared at one month using ANCOVA. Categorical variables at one month for health resource utilization, employment status, abuse/dependency, and the number of suicide attempts were compared using Fisher's Exact test. Patients were followed for one year and a subgroup was evaluated.
RESULTS: At one month, patients in the Olanzapine cohort recorded a mean reduction in the YMRS of 11.5, significantly greater than the mean reduction in the Other cohort of 9.7 (ANCOVA P = 0.002). The Olanzapine cohort was significantly improved compared to the Other cohort on the scales for depression and anxiety and did not experience the deterioration in physical functioning seen in the Other cohort. No significant differences were detected in health-related quality-of-life measures, employment status, drug abuse/dependency, number of suicide attempts, mental functioning, emergency room visits or inpatient psychiatric hospitalizations. In a subgroup treated for 12 months with a single second generation antipsychotic, improvements in illness severity measures were maintained with no evidence of significant differences among the antipsychotics.
CONCLUSIONS: Patients with bipolar disorder requiring treatment intervention for exacerbation of mania in the community setting responded to olanzapine at one month. In a subset analysis, second generation antipsychotic treatment continued to be beneficial in reducing bipolar symptoms at one year.
https://ir.lib.uwo.ca/psychiatrypub/10
oai:ir.lib.uwo.ca:nursingpub-1175
2010-07-23T02:59:38Z
publication:socialworkpub
publication:psychiatrypub
publication:pmid
publication:affiliates
publication:faculties
publication:psychiatry
publication:nursing
publication:nursingpub
publication:kings
20608241
Gaining Ground, Losing Ground: The Paradoxes of Rural Homelessness
Forchuk, Cheryl
Montgomery, Phyllis
Berman, Helene
Ward-Griffin, Catherine
Csiernik, Rick
Gorlick, Carolyn
Jensen, Elsabeth
Riesterer, Patrick
Article
2010-06-01T07:00:00Z
Mental health
Rural
Homelessness
Poverty
Canadian Journal of Nursing Research
Canadian Journal of Nursing Research
42
2
138
152
Nursing
Social Work
The study examined rural housing and homelessness issues and looked at similarities and differences between rural and urban areas. It involved a secondary analysis of focus group data collected in a 2001-06 Community University Research Alliance study of mental health and housing. The findings highlight concerns regarding the lack of services, which can precipitate a move from a rural to an urban community. Inadequate transportation services often posed a challenge to rural residents attempting to access services. Many participants preferred rural living but felt they had to choose between residing where they wanted to and having access to essential services. In some cases entire families were uprooted in pursuit of services. Once in an urban environment, rural participants had ongoing difficulty obtaining employment, housing, and services, which in turn led to disappointment in their new environment. The primary reason given for entering the shelter system was lack of alternatives and supports. Increased services need to be allocated to rural communities so that a health promotion and illness-prevention model of care can replace the current emphasis on crisis management.
Cet article examine les questions relatives au logement et à l'itinérance en milieu rural en établissant une comparaison avec le contexte urbain. Elle se fonde sur une analyse secondaire de données recueillies lors d'une étude sur la santé mentale et le logement menée de 2001 à 2006 dans le cadre des Alliances de recherche universités-communautés. Les résultats mettent en lumière certaines préoccupations concernant le manque de services, un facteur susceptible de précipiter un déménagement de la campagne à la ville. Les services de transport inadéquats posent souvent des difficultés aux habitants des régions rurales qui tentent d'accéder aux services. Bon nombre de répondants ont rapporté préférer vivre à la campagne, mais qu'il leur avait fallu choisir entre le lieu de résidence et l'accès aux services essentiels. Dans certains cas, des familles entières ont été déracinées dans leur quête de services adéquats. Une fois arrivés en milieu urbain, les participants ont éprouvé des difficultés à accéder à un emploi, à un logement et aux services, une source de déception à l'égard de leur nouvel environnement. La raison première invoquée par les personnes qui ont recours aux refuges est le manque de ressources et de solutions de rechange. Il faudra augmenter les services offerts en région rurale de façon à remplacer le modèle actuel de gestion de crise par un modèle de soins axé sur la promotion de la santé et la prévention des maladies.
https://ir.lib.uwo.ca/nursingpub/155
oai:ir.lib.uwo.ca:psychiatrypub-1011
2010-08-06T18:04:36Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
20838495
Cognitive Neurosciences: A New Paradigm in Management and Outcome of Schizophrenia
Shrivastava, Amresh K.
Johnston, Megan E.
Editorial
2010-04-01T07:00:00Z
Cognitive neurosciences
Schizophrenia
Indian Journal of Psychiatry
Indian Journal of Psychiatry
52
2
100
105
http://dx.doi.org/10.4103/0019-5545.64575
Psychiatry and Psychology
Psychology
https://ir.lib.uwo.ca/psychiatrypub/12
oai:ir.lib.uwo.ca:psychiatrypub-1012
2010-08-06T18:05:06Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
Should “Risk Syndrome for Psychosis” Be Included as a Diagnosis in DSM-V?
Shrivastava, Amresh
Letter to the Editor
2010-06-01T07:00:00Z
DSM-V
Risk syndrome
Psychosis
World Psychiatry
World Psychiatry
9
2
123
123
Psychiatry and Psychology
https://ir.lib.uwo.ca/psychiatrypub/13
oai:ir.lib.uwo.ca:psychiatrypub-1010
2010-08-06T18:03:36Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
publication:epidem
publication:epidempub
20838506
Effects of Duration of Untreated Psychosis on Long-term Outcome of People Hospitalized with First Episode Schizophrenia
Shrivastava, Amresh
Shah, Nilesh
Johnston, Megan
Stitt, Larry
Thakar, Meghana
Chinnasamy, Gurusamy
Article
2010-04-01T07:00:00Z
Psychosis
Hospitalization
Schizophrenia
Duration of untreated psychosis
First-episode schizophrenia
Long-term outcome
Indian Journal of Psychiatry
Indian Journal of Psychiatry
52
2
164
167
http://dx.doi.org/10.4103/0019-5545.64583
Epidemiology
Psychiatry and Psychology
Psychology
Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome but continues to remain under scientific scrutiny. The present study examines the effect of differential periods of DUP on long-term outcome of first episode schizophrenia at Mumbai, India. This research was a prospective, 10-year follow-up naturalistic study. Hospitalized patients of first episode schizophrenia were selected and followed up. Results showed that the mean DUP was higher for a group which showed clinical recovery on Clinical Global Impression Scale [14.0 months (SD=8.0) in recovered and 10.8 months (SD=5.7) in non-recovered group (P=0.091)]. DUP was not found to be significantly associated with any of the end point parameters of good clinical or social outcome. Thus, this study found that DUP alone does not determine outcome status confirming the role of psychopathological heterogeneity.
https://ir.lib.uwo.ca/psychiatrypub/11
oai:ir.lib.uwo.ca:psychiatrypub-1013
2010-08-14T23:16:52Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
20591137
German Screen for Child Anxiety Related Emotional Disorders (SCARED): Reliability, Validity, and Cross-Informant Agreement in a Clinical Sample
Weitkamp, Katharina
Romer, Georg
Rosenthal, Sandra
Wiegand-Grefe, Silke
Daniels, Judith
Article
2010-06-30T07:00:00Z
Screen for Child Anxiety Related Emotional Disorders
SCARED
Reliability
Validity
Child and Adolescent Psychiatry and Mental Health
Child and Adolescent Psychiatry and Mental Health
4
19
http://dx.doi.org/10.1186/1753-2000-4-19
Pediatrics
Psychiatry and Psychology
BACKGROUND: The psychometric properties and cross-informant agreement of a German translation of the Screen for Child Anxiety Related Emotional Disorders (SCARED) were assessed in a clinical sample.
METHODS: 102 children and adolescents in outpatient psychotherapy and their parents filled out the SCARED and Youth Self Report/Child Behaviour Checklist (YSR/CBCL).
RESULTS: The German SCARED showed good internal consistency for both parent and self-report version, and proved to be convergently and discriminantly valid when compared with YSR/CBCL scales. Cross-informant agreement was moderate with children reporting both a larger number as well as higher severity of anxiety symptoms than their parents.
CONCLUSION: In conclusion, the German SCARED is a valid and reliable anxiety scale and may be used in a clinical setting.
https://ir.lib.uwo.ca/psychiatrypub/14
oai:ir.lib.uwo.ca:psychologypub-1074
2010-11-15T05:35:21Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
publication:psychologypub
publication:psychology
21134842
Improving Risk Assessment with Suicidal Patients: A Preliminary Evaluation of the Clinical Utility of <em>The Scale for Impact of Suicidality - Management, Assessment and Planning of Care (SIS-MAP)</em>
Nelson, Charles
Johnston, Megan
Srivastava, Amresh
Article
2010-01-01T08:00:00Z
Suicide
Suicide risk
Assessment
Prevention
SIS-MAP
Journal of Clinical Psychology Practice
Journal of Clinical Psychology Practice
1
19
26
Psychiatry
Psychology
Although a number of suicide risk assessment tools are available to clinicians, the high levels of suicide still evident in society suggest a clear need for new strategies in order to facilitate the prevention of suicidal behaviors. The present study examined the utilization of a new structured clinical interview called the Scale for Impact of Suicidality Management, Assessment and Planning of Care (SIS-MAP). SIS-MAP ratings were obtained from a group of incoming psychiatric patients over a 6-month period at Regional Mental Health Care, St. Thomas, Ontario. A canonical discriminant function analysis resulted in a total 74.0% of original grouped cases correctly classified based on admission status (admitted or not; Wilks Lambda = .749, p< 0.001). The specificity of the scale was 78.1% while the sensitivity of the scale was 66.7%. Additionally, mean total scores on the scale were used to establish clinical cut- offs to facilitate future level of care decisions. Preliminary analysis suggests the SIS-MAP is a valid and reliable tool in determining the level of psychiatric care needed for adults with suicidal ideation.
https://ir.lib.uwo.ca/psychologypub/75
oai:ir.lib.uwo.ca:psychiatrypub-1014
2010-11-15T23:04:15Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
publication:epidem
publication:epidempub
20957123
Persistent Suicide Risk in Clinically Improved Schizophrenia Patients: Challenge of the Suicidal Dimension
Shrivastava, Amresh
Johnston, Megan E.
Shah, Nilesh
Innamorati, Marco
Stitt, Larry
Thakar, Meghana
Lester, David
Pompili, Maurizio
Article
2010-01-01T08:00:00Z
Suicide
Risk
Schizophrenia
Neuropsychiatric Disease and Treatment
Neuropsychiatric Disease and Treatment
6
633
638
http://dx.doi.org/10.2147/NDT.S12044
Psychiatry and Psychology
BACKGROUND: Suicide is a major problem in schizophrenia, estimated to affect 9%-13% of patients. About 25% of schizophrenic patients make at least one suicide attempt in their lifetime. Current outcome measures do not address this problem, even though it affects quality of life and patient safety. The aim of this study was to assess suicidality in long-term clinically improved schizophrenia patients who were treated in a nongovernmental psychiatric treatment centre in Mumbai, India.
METHOD: Participants were 61 patients out of 200 consecutive hospitalized first-episode patients with schizophrenia diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders who were much improved on the Clinical Global Impression Scale-Improvement (CGI-I) scale at the endpoint of a 10-year follow-up. Clinical assessment tools included the Positive and Negative Syndrome Scale for Schizophrenia, CGI-I, Global Assessment of Functioning, and suicidality.
RESULTS: Many of the patients, although clinically improved, experienced emerging suicidality during the 10-year follow-up period. All of the patients reported significant suicidality (ie, suicide attempts, suicidal crises, or suicidal ideation) at the end of the study, whereas only 83% had reported previous significant suicidality at baseline. No sociodemographic and clinical variables at baseline were predictive of suicidal status at the end of the 10-year follow-up.
CONCLUSION: Schizophrenia is a complex neurobehavioral disorder that appears to be closely associated with suicidal behavior. Adequate assessment and management of suicidality needs to be a continual process, even in patients who respond well to treatment.
https://ir.lib.uwo.ca/psychiatrypub/15
oai:ir.lib.uwo.ca:psychiatrypub-1016
2010-11-15T23:01:15Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
21836717
Psychiatrists and Neuroscientists of Indian Origin in Canada: Glimpses
Shrivastava, Amresh
Natarajan, D.
Article
2010-01-01T08:00:00Z
Indian
Psychiatrists
Canada
Indian Journal of Psychiatry
Indian Journal of Psychiatry
52
7
64
67
http://dx.doi.org/10.4103/0019-5545.69213
Psychiatry and Psychology
Psychiatrists of Indian origin are popular in Canada, being firmly rooted in the Canadian mental health system, and they have been making considerable contributions internationally. The Indian Psychiatric Society has long been collaborating with and inviting contributions from overseas Indian psychiatrists, particularly those in academics, and this collaboration has fructified well. There are several different challenges these psychiatrists have had to face in their own specialty work, with having to adjust to a new culture, new ways of living, and new ways of work. Our colleagues of Indian origin have demonstrated excellence in almost all fields of mental health and neurosciences. There are many popular teachers, outstanding researchers, and psychiatrists in community practice and community development. The Early Psychosis Program, Mood and Anxiety Program, Perinatal Psychiatry, Women's Mental Health, and Postpartum Mental Health are some of their key areas of research. Our basic scientists are involved in experimental design, neurochemistry, imaging, and genetics, where they have made their mark with acclaim. This article highlights some of the achievements of a few members and is by no means completely representative of the entire work that psychiatrists of Indian origin are doing in Canada, providing readers with a glimpse of our labors away from home.
https://ir.lib.uwo.ca/psychiatrypub/17
oai:ir.lib.uwo.ca:psychiatrypub-1015
2010-11-15T22:58:18Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
Initiatives in Biological Research in Indian Psychiatry
Shrivastava, Amresh
Article
2010-01-01T08:00:00Z
Indian
Research
Biological psychiatry
Indian Journal of Psychiatry
Indian Journal of Psychiatry
52
7
110
119
http://dx.doi.org/10.4103/0019-5545.69222
Psychiatry and Psychology
Biological psychiatry is an exploratory science for mental health. These biological changes provide some explicit insight into the complex area of 'brain-mind and behavior'. One major achievement of research in biological field is the finding to explain how biological factors cause changes in behavior. In India, we have a clear history of initiatives in research from a biological perspective, which goes back to 1958. In the last 61 years, this field has seen significant evolution, precision and effective utilization of contemporary technological advances. It is a matter of great pride to see that in spite of difficult times in terms of challenges of practice and services, administration, resource, funding and manpower the zest for research was very forthcoming. There was neither dedicated time nor any funding for conducting research. It came from the intellectual insight of our fore fathers in the field of mental health to gradually grow to the state of strategic education in research, training in research, international research collaborations and setting up of internationally accredited centers. During difficult economic conditions in the past, the hypothesis tested and conclusions derived have not been so important. It is more important how it was done, how it was made possible and how robust traditions were established. Almost an entire spectrum of biological research has been touched upon by Indian researchers. Some of these are electroconvulsive therapy, biological markers, neurocognition, neuroimaging, neuroendocrine, neurochemistry, electrophysiology and genetics. A lot has been published given the limited space in the Indian Journal of Psychiatry and other medical journals published in India. A large body of biological research conducted on Indian patients has also been published in International literature (which I prefer to call non-Indian journals). Newer research questions in biological psychiatry, keeping with trend of international standards are currently being investigated by the younger generation with great enthusiasm. What we have achieved so far is the foundation work in last 60 years. Our main challenge in development of biological psychiatry research in India remains resources in terms of manpower, funding and dedicated time for research psychiatrists. Developing basic sciences laboratories, discrete research questions, high quality methodology, and logistical support are some of the essentials. In the present time the culture of research has changed. It is specific and evidence-based. We have time-tested examples of International collaborative research. We need to get more resources, develop education, collaboration and effective leadership. In times to come, India will provide international leadership in basic and clinical biological psychiatry. There is hope.
https://ir.lib.uwo.ca/psychiatrypub/18
oai:ir.lib.uwo.ca:psychiatrypub-1017
2010-11-15T22:51:41Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
Early Intervention in Psychotic Disorders: Challenges and Relevance in the Indian Context
Keshavan, Matcheri S.
Shrivastava, Amresh
Gangadhar, Bangalore N.
Article
2010-01-01T08:00:00Z
Early intervention
India
Neurobiology
Psychosis
Schizophrenia
Indian Journal of Psychiatry
Indian Journal of Psychiatry
52
7
153
158
http://dx.doi.org/10.4103/0019-5545.69228
Psychiatry and Psychology
Over the last two decades, there has been an increasing interest in the concept of early intervention (EI) in psychotic disorders, notably schizophrenia. Several lines of research underlie this emerging paradigm shift: (a) an increasingly well-established association between the duration of prolonged untreated illness and poor outcome; (b) evidence of progressive neurobiological changes in the early course of schizophrenia both in the pre-psychotic and psychotic phases, as evidenced by brain imaging studies in schizophrenia; and (c) emerging data, albeit preliminary, suggesting the efficacy and effectiveness of EI programs in improving the outcome in these patients. Mental health service systems across the globe, including Asian countries, have been incorporating specialized early intervention programs. However, literature on EI in the Indian setting is relatively sparse. In this article, we will review the rationale and approaches to EI and the application of these approaches to the Indian context, in light of the available literature. We also examine the constraints in the implementation of EI. Controlled data are needed to evaluate EI and the roadblocks to them, in order to implement EI in the resource-strapped mental health service settings in India.
https://ir.lib.uwo.ca/psychiatrypub/16
oai:ir.lib.uwo.ca:psychiatrypub-1018
2011-01-04T08:20:51Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
publication:epidem
publication:epidempub
Predictors of Long-term Outcome of First-episode Schizophrenia: A Ten-year Follow-up Study
Shrivastava, Amresh
Shah, Nilesh
Johnston, Megan
Stitt, Larry
Thakar, Meghana
Article
2010-10-01T07:00:00Z
Follow-up studies
Outcome assessment
Psychosocial factors
Schizophrenia
Treatment outcome
Indian Journal of Psychiatry
Indian Journal of Psychiatry
52
4
320
326
http://dx.doi.org/10.4103/0019-5545.74306
Psychiatry and Psychology
Objective: Schizophrenia is a severe mental disorder for which final outcomes continue to be unfavorable. The main
objectives of this research were to examine and determine the baseline predictors of outcome status of first-episode
schizophrenia in a long-term follow-up of ten years and of recovery ten years later.
Materials and Methods: The study was carried out in a non-governmental, psychiatric hospital and participants
consisted of patients available for assessment ten years following their initial diagnosis. Outcome was assessed on
clinical and social parameters. Clinical measures of outcome included psychopathology, hospitalization, and suicidality.
Social parameters included quality of life functioning, employability, interpersonal functioning, and the ability to live
independently.
Results: In our sample, mean positive symptoms’ score were reduced by more than 65% between baseline and endpoint.
The percentage of reduction in scores of negative symptoms is much less than reduction in positive symptoms. It was
observed that only 23-25% patients showed social recovery on two or three different parameters. Additionally, fewer
negative symptoms, lower depression scores, and low levels of aggression at baseline predicted good outcome. A higher
level of positive symptoms at baseline also predicted recovery. The two social variables that predicted later outcomes
were initially high levels of work performance and the ability to live independently at baseline.
Conclusions: Clinical information is not sufficient to make an accurate prediction of outcome status; rather, outcome
depends upon multiple factors (including social parameters). A major implication of this research is the argument for
moving toward a comprehensive assessment of outcome and to plan management accordingly. Bringing social outcome
measures to the forefront and into the communities will allow for a more patient-centric approach. It also opens newer
vistas for addressing the complex interaction of clinical and social parameters.
https://ir.lib.uwo.ca/psychiatrypub/19
oai:ir.lib.uwo.ca:psychiatrypub-1019
2011-01-12T09:06:27Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
Lessons Learned from Research in Prodromal Phase of Schizophrenia
Shrivastava, Amresh
Johnston, Megan
Article
2010-01-01T08:00:00Z
Prodrome
At-risk
Risk syndrome
Psychosis
Schizophrenia
Early intervention
Indian Journal of Social Psychiatry
Indian Journal of Social Psychiatry
26
1-2
16
23
Psychiatry and Psychology
In the last ten years, a significant amount of research data has accumulated to identify and predict the vulnerability of
individuals to develop psychosis. At a time when DSM-V academia is becoming active with field trials, researchers in
prodromal psychosis research are arguing for inclusion of 'risk syndrome for psychosis,' which has generated an
interesting debate. Studies indicate that approximately 80-85% of cases experience subsyndromal symptoms for a
period lasting from several months to several years prior to the onset of the illness, including impaired perception,
thought processes, subjective cognitive functions and mood. Also, much of the functional decline associated with
schizophrenia occurs during this prodromal phase. The major research achievements in this field have indicated that it
is possible to identify candidates who might develop psychosis. It is also known that a delay in treatment compromises
the outcome; once the 'critical period' for intervention is missed the treatment outcome shall remain poor. Function can
be restored and quality of life can be enhanced with a range of therapeutic interventions during the early phase. This
paper examines clinical and public health implications of prodromal research.
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https://ir.lib.uwo.ca/psychiatrypub/20
oai:ir.lib.uwo.ca:psychiatrypub-1020
2011-01-21T07:54:15Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
21431011
“Attenuated Psychotic Symptoms Syndrome” as a Risk Syndrome of Psychosis, Diagnosis in DSM-V: The Debate
Shrivastava, Amresh
McGorry, P. D.
Tsuang, Ming
Woods, Scott W.
Cornblatt, Barbara A.
Corcoran, Cheryl
Carpenter, William
Article
2011-01-01T08:00:00Z
Attenuated psychotic symptoms syndrome
Risk
Psychosis
DSM-V
Indian Journal of Psychiatry
Indian Journal of Psychiatry
53
1
57
65
http://dx.doi.org/10.4103/0019-5545.75560
Psychiatry and Psychology
Schizophrenia is a common disorder, affecting approximately 1 out of every 100 people, with a typical onset during adolescence and early adulthood. The personal and societal costs of schizophrenia are extremely high. Prevention of schizophrenia, would offer substantial benefits to patients, their family members, and the community at large. The prodromal phase of schizophrenia has been recognized since the 19th century. At-risk individuals for psychosis and schizophrenia are the subjects who can provide information for intervention prior to development of frank psychosis. This approach is currently being investigated. The question remains, however, whether it can be a diagnostic category by itself. The proposal for including the risk syndrome is one of the recommendations by the working group on schizophrenia and psychotic disorders for the forthcoming DSM-V. There are differing views in academia regarding this proposal. Prior to becoming fully psychotic, a consistent literature demonstrates that patients generally had suffered from accelerating attenuated symptoms and distress. It is important that the prodromal phase be accurately recognized in order to accomplish the goal of prevention. We can then purposefully engage in early intervention aiming toward prevention. A recent strong resurgent interest in this area stems largely from two developments: First, the identification of the neurobiological deficit processes associated with the severity and chronicity of schizophrenia, and second, the development of reliable criteria for diagnosis. Although the general at-risk construct appears to offer great potential to advance both the treatment and research dealing with psychotic illnesses, it seems premature to many researchers to include the syndrome as an established entity in the text of the new DSM-V. It would be far more appropriate to include this proposed syndrome in the appendix and evaluate the many contemporary issues in future studies. The main issues involved in this discussion are the clinical validity of the syndrome, concern about stigma and unnecessary treatment, and need for responding to patients' distress in addition to the ethical dilemma. In this review we examine the issue of inclusion of the risk syndrome as a diagnosis.
https://ir.lib.uwo.ca/psychiatrypub/21
oai:ir.lib.uwo.ca:psychiatrypub-1021
2011-08-26T23:39:44Z
publication:psychiatrypub
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:psychiatry
publication:rwkex
publication:institutes
publication:osircpub
21586149
Aripiprazole Augmentation in the Treatment of Military-related PTSD with Major Depression: A Retrospective Chart Review
Richardson, J. Don
Fikretoglu, Deniz
Liu, Aihua
McIntosh, Diane
Article
2011-05-17T07:00:00Z
Aripiprazole Augmentation
Treatment
Military
PTSD
Depression
Post-traumatic stress disorder
BMC Psychiatry
BMC Psychiatry
11
86
http://dx.doi.org/10.1186/1471-244X-11-86
Psychiatry and Psychology
<p>BACKGROUND: In this chart review, we attempted to evaluate the benefits of adding aripiprazole in veterans with military-related PTSD and comorbid depression, who had been minimally or partially responsive to their existing medications.</p>
<p>METHODS: A retrospective chart review of patients who received an open-label, flexible-dose, 12- week course of adjunctive aripiprazole was conducted in 27 military veterans meeting DSM-IV criteria for PTSD and comorbid major depression. Concomitant psychiatric medications continued unchanged, except for other antipsychotics which were discontinued prior to initiating aripiprazole. The primary outcome variable was a change from baseline in the PTSD checklist-military version (PCL-M) and the Beck Depression Inventory (BDI-II).</p>
<p>RESULTS: PTSD severity (Total PCL scores) decreased from 56.11 at baseline to 46.85 at 12-weeks (p < 0.0001 from Wilcoxon signed rank test) and the depression severity decreased from 30.44 at baseline to 20.67 at 12-weeks (p < 0.0001 from Wilcoxon signed rank test). Thirty seven percent (10/27) were considered responders, as defined by a decrease in total PCL scores of at least 20 percent and 19% (5/27) were considered as responders as defined by a decrease in total BDI score of at least 50%.</p>
<p>CONCLUSIONS: The addition of aripiprazole contributed to a reduction in both PTSD and depression symptomatology in a population that has traditionally demonstrated poor pharmacological response. Further investigations, including double-blind, placebo-controlled studies, are essential to confirm and further demonstrate the benefit of aripiprazole augmentation in the treatment of military related PTSD.</p>
https://ir.lib.uwo.ca/psychiatrypub/22
oai:ir.lib.uwo.ca:biologypub-1018
2011-09-06T01:34:56Z
publication:psychiatrypub
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:psychiatry
publication:biologypub
publication:rwkex
publication:biology
21399695
Ontogenetic De Novo Copy Number Variations (CNVs) as a Source of Genetic Individuality: Studies on Two Families with MZD Twins for Schizophrenia
Maiti, Sujit
Kumar, Kiran Halagur Bhoge Gowda
Castellani, Christina A.
O'Reilly, Richard
Singh, Shiva M.
Article
2011-03-02T08:00:00Z
Chromosomes
Human
DNA Copy Number Variations
Demography
Family
Humans
Individuality
Inheritance Patterns
Middle Aged
Mosaicism
Pedigree
Repetitive Sequences
Nucleic Acid
Schizophrenia
Monozygotic Twins
PLoS ONE
6
3
17125
17125
http://dx.doi.org/10.1371/journal.pone.0017125
Biology
Medical Genetics
Psychiatry and Psychology
<p>Genetic individuality is the foundation of personalized medicine, yet its determinants are currently poorly understood. One issue is the difference between monozygotic twins that are assumed identical and have been extensively used in genetic studies for decades. Here, we report genome-wide alterations in two nuclear families each with a pair of monozygotic twins discordant for schizophrenia evaluated by the Affymetrix 6.0 human SNP array. The data analysis includes characterization of copy number variations (CNVs) and single nucleotide polymorphism (SNPs). The results have identified genomic differences between twin pairs and a set of new provisional schizophrenia genes. Samples were found to have between 35 and 65 CNVs per individual. The majority of CNVs (~80%) represented gains. In addition, ~10% of the CNVs were de novo (not present in parents), of these, 30% arose during parental meiosis and 70% arose during developmental mitosis. We also observed SNPs in the twins that were absent from both parents. These constituted 0.12% of all SNPs seen in the twins. In 65% of cases these SNPs arose during meiosis compared to 35% during mitosis. The developmental mitotic origin of most CNVs that may lead to MZ twin discordance may also cause tissue differences within individuals during a single pregnancy and generate a high frequency of mosaics in the population. The results argue for enduring genome-wide changes during cellular transmission, often ignored in most genetic analyses.</p>
https://ir.lib.uwo.ca/biologypub/19
oai:ir.lib.uwo.ca:psychiatrypub-1022
2011-10-31T03:46:19Z
publication:psychiatrypub
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:psychiatry
publication:rwkex
21962174
Sales of Antidepressants, Suicides and Hospital Admissions for Depression in Veneto Region, Italy, from 2000 to 2005: An Ecological Study
Guaiana, Giuseppe
Andretta, Margherita
Griez, Eric
Biancosino, Bruno
Grassi, Luigi
Article
2011-09-30T07:00:00Z
Antidepressant
Suicide
Hospital admission
Depression
Veneto Region
Italy
Annals of General Hospital Psychiatry
Annals of General Hospital Psychiatry
10
24
http://dx.doi.org/10.1186/1744-859X-10-24
Psychiatry and Psychology
<p>BACKGROUND: Increased prescription of antidepressants has been consistently associated with a decrease in suicide rates in several countries. The aim of this study is to explore antidepressant consumption, suicide rates and admission for depression in the Veneto Region, Italy, in order to see whether the same pattern could be detected.</p>
<p>METHODS: Data from the Italian Ministry of Health (admissions for depression), the Pharmacy Service of a Local Health Unit (antidepressant prescribing) and from the Epidemiological System of the Veneto region (suicide rates) were collected from 2000 to 2005 for the Veneto region.</p>
<p>RESULTS: Suicide rates did not show any marked increase but were stable in males and females. Antidepressant prescribing increased exponentially over the period examined, whilst admissions for depression markedly decreased. The trend for an exponential increase in antidepressant prescribing in the Veneto region is shared with other countries and locales.</p>
<p>CONCLUSIONS: It is possible that the increase in antidepressant prescribing might be associated with earlier treatment of depression, thus decreasing the likelihood of aggravation of depression.</p>
https://ir.lib.uwo.ca/psychiatrypub/23
oai:ir.lib.uwo.ca:nursingpub-1233
2012-03-16T03:41:24Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
publication:nursing
publication:nursingpub
22435309
The Health of Women Temporary Agricultural Workers in Canada: A Critical Review of the Literature
Edmunds, Kathryn Ann
Berman, Helene
Basok, Tanya
Ford-Gilboe, Marilyn
Forchuk, Cheryl
Article
2011-12-01T08:00:00Z
Determinants of health
Gender
Health disparities
Underserved populations
Vulnerable populations
Women's health
Canadian Journal of Nursing Research
Canadian Journal of Nursing Research
43
4
68
91
Nursing
<p>Among high-income countries such as Canada, there is growing dependency on "low skilled" temporary foreign workers in a variety of sectors. The purpose of this review is to critically synthesize and analyze the theoretical and empirical literature on gendered and temporary migration in the context of globalization and the health of temporary agricultural workers, particularly women in Canadian programs. While the social sciences literature contains well-developed conceptualizations of gendered migration, the research has focused on women in feminized occupations such as domestic work. Multidisciplinary searches produced only 11 research and review publications on the gendered constraints or health of temporary agricultural workers in Canada. Further investigation is needed to explore and integrate the strengths, resiliencies, and health-care needs of women migrant agricultural workers in Canada, as well as the barriers they face, within the intersecting and gendered forces of inequities at all levels: local, national, and global.</p>
<p>Les pays à revenu élevé comme le Canada dépendent de plus en plus d'une main-d'œuvre étrangère temporaire « peu spécialisée » dans divers secteurs. Cette recension vise à synthétiser et analyser de façon critique la littérature théorique et empirique portant sur la migration sexospécifique et temporaire en contexte de mondialisation et sur la santé des travailleurs agricoles temporaires, notamment les femmes recrutées dans le cadre de programmes canadiens. Bien que la littérature en sciences sociales présentent des conceptualisations sexospécifiques très élaborées sur la migration, les chercheuses se sont particulièrement penchées sur les femmes qui occupent des emplois traditionnellement féminins, comme le travail ménager. Des recherches multidisciplinaires n'ont révélé que 11 publications de recherche et de recension critique traitant des contraintes liées au genre ou de la santé des travailleurs agricoles temporaires au Canada. D'autres recherches devront être réalisées pour explorer et intégrer la question des forces, de la résilience et des besoins des travailleuses agricoles migrantes en matière de santé, qui œuvrent au Canada. Elles devront aussi se pencher sur les obstacles auxquels elles font face, dans une perspective tenant compte du croisement des forces sexospécifiques de l'iniquité à tous les paliers, soit local, national et mondial.</p>
https://ir.lib.uwo.ca/nursingpub/214
oai:ir.lib.uwo.ca:psychiatrypub-1023
2012-03-16T23:09:51Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
publication:healthstudies
publication:healthstudiespub
16112447
Evaluating Clinical Rating Scales for Evidence-Based Dermatology: Some Basic Concepts
Gupta, Madhulika A.
Johnson, Andrew M.
Chren, Mary-Margaret
Article
2005-10-01T07:00:00Z
Dermatology
Evidence-Based Medicine
Predictive Value of Tests
Psychometrics
Quality of Life
Skin Diseases
Dermatologic Clinics
Dermatologic Clinics
23
4
703
706
http://dx.doi.org/10.1016/j.det.2005.05.004
Dermatology
Medicine and Health Sciences
Psychiatry and Psychology
<p>Evidence-based dermatology has necessitated the development of rating scales that measure multidimensional and abstract constructs, such as quality of life. This article discusses some basic psychometric concepts, such as reliability, validity, standardization, and measurement precision, which need to be considered when choosing a clinical rating instrument. Also discussed is the impact of these parameters on increasing the statistical power of a clinical trial.</p>
https://ir.lib.uwo.ca/psychiatrypub/24
oai:ir.lib.uwo.ca:psychiatrypub-1024
2015-07-25T21:53:56Z
publication:psychiatrypub
publication:faculties
publication:rwkex_presentationslidedecks
publication:psychiatry
publication:rwkex
Severe Mental Illnesses: Training and Education
Srivastava, Amresh
Presentation
2015-07-20T07:00:00Z
Education. Severe mental illness
psychosis
Medicine and Health Sciences
Psychiatry and Psychology
<p>Amresh Srivastava</p>
<p>MD,MRCPsych,FRCPC</p>
<p>Associate Professore of Psychiatry</p>
<p>Western University</p>
<p>London.ON</p>
<p>Severe Mental Illnesses: Training and Education</p>
<p>-</p>
<p>About 4% patients in the community suffer from severe mental illness and about 16% from ‘any mental disorder’</p>
<p>Maximum financial and human resource allocations for mental health is consumed in managing severe mental disorders, leaving very little for treatment of early phase of illness and for developing preventive program.</p>
<p>All of us, psychiatrists, family physicians, other mental health professionals like, nurse, psychologists, socal workers, occupational therapists, counsellors, and members of advocacy groups and mental health organisations, face the challenge for managing patients who are repeatedly hospitalised, attempt suicide and suffer from complex physical health problem.</p>
<p>We need to find innovative, effective and evidence-based methods for management of such complex problems within the available resources.</p>
<p>Education is key to success.</p>
<p>, knowledge translation, understanding the subject from ABC to advances will be of immense value in achieving the objectives of prevention of mental disorders.</p>
<p>We propose to share most fundamental educational contents regarding severe mental illnesses.</p>
<p>We shall try to provide a short presentation for understanding a number of clinical problems. We hope to circulate such presentations at least twice in a month.Our objective is to provide minimum basic information in shortest possible time ( not more tha 5 to 10 minnits ). This is an ongoing series which shall address about 40 clinical questions.</p>
<p>The first one, attached here is an introduction about severe mental illness.</p>
<p>Severe Mental Illnesses: Training and Education</p>
https://ir.lib.uwo.ca/psychiatrypub/25
oai:ir.lib.uwo.ca:psychiatrypub-1027
2017-02-08T20:54:01Z
publication:psychiatrypub
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:psychiatry
publication:rwkex
27703774
A training programme involving automatic self-transcending meditation in late-life depression: preliminary analysis of an ongoing randomised controlled trial.
Vasudev, Akshya
Arena, Amanda
Burhan, Amer M
Ionson, Emily
Hirjee, Hussein
Maldeniya, Pramudith
Wetmore, Stephen
Newman, Ronnie I
Article
2016-03-01T08:00:00Z
Meditation
BJPsych Open
2
2
195
198
10.1192/bjpo.bp.115.002394
Psychiatry and Psychology
<p>: Late-life depression affects 2-6% of seniors aged 60 years and above. Patients are increasingly embracing non-pharmacological therapies, many of which have not been scientifically evaluated. This study aimed to evaluate a category of meditation, automatic self-transcending meditation (ASTM), in alleviating symptoms of depression when augmenting treatment as usual (NCT02149810). The preliminary results of an ongoing single-blind randomised controlled trial comparing a training programme involving ASTM with a wait-list control indicate that a 12-week ASTM programme may lead to significantly greater reductions in depression and anxiety severity. As such, ASTM may be an effective adjunctive therapy in the treatment of late-life depression.</p>
<p>DECLARATION OF INTEREST: R.I.N. is Director of Research and Health Promotion for the Art of Living Foundation, Canada and supervised the staff providing ASTM training.</p>
<p>COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.</p>
https://ir.lib.uwo.ca/psychiatrypub/26
oai:ir.lib.uwo.ca:psychiatrypub-1028
2017-02-08T20:56:01Z
publication:psychiatrypub
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:psychiatry
publication:rwkex
27513855
Risk of Ventricular Arrhythmia with Citalopram and Escitalopram: A Population-Based Study.
Qirjazi, Elena
McArthur, Eric
Nash, Danielle M
Dixon, Stephanie N
Weir, Matthew A
Vasudev, Akshya
Jandoc, Racquel
Gula, Lorne J
Oliver, Matthew J
Wald, Ron
Garg, Amit X
Article
2016-01-01T08:00:00Z
arrhythmia
escitalopram
PLoS One
11
8
0160768
0160768
Psychiatry and Psychology
<p>BACKGROUND: The risk of ventricular arrhythmia with citalopram and escitalopram is controversial. In this study we investigated the association between these two drugs and the risk of ventricular arrhythmia.</p>
<p>METHODS: We conducted a population-based retrospective cohort study of older adults (mean age 76 years) from 2002 to 2012 in Ontario, Canada, newly prescribed citalopram (n = 137 701) or escitalopram (n = 38 436), compared to those prescribed referent antidepressants sertraline or paroxetine (n = 96 620). After inverse probability of treatment weighting using a propensity score, the baseline characteristics of the comparison groups were similar. The primary outcome was a hospital encounter with ventricular arrhythmia within 90 days of a new prescription, assessed using hospital diagnostic codes. The secondary outcome was all-cause mortality within 90 days.</p>
<p>RESULTS: Citalopram was associated with a higher risk of a hospital encounter with ventricular arrhythmia compared with referent antidepressants (0.06% vs. 0.04%, relative risk [RR] 1.53, 95% confidence intervals [CI]1.03 to 2.29), and a higher risk of mortality (3.49% vs. 3.12%, RR 1.12, 95% CI 1.06 to 1.18). Escitalopram was not associated with a higher risk of ventricular arrhythmia compared with the referent antidepressants (0.03% vs. 0.04%, RR 0.84, 95% CI 0.42 to 1.68), but was associated with a higher risk of mortality (2.86% vs. 2.63%, RR 1.09, 95% CI 1.01 to 1.18).</p>
<p>CONCLUSION: Among older adults, initiation of citalopram compared to two referent antidepressants was associated with a small but statistically significant increase in the 90-day risk of a hospital encounter for ventricular arrhythmia.</p>
https://ir.lib.uwo.ca/psychiatrypub/27
oai:ir.lib.uwo.ca:psychiatrypub-1029
2017-03-21T14:15:41Z
publication:psychiatrypub
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:psychiatry
publication:rwkex
26572722
Music therapy in patients with dementia and behavioral disturbance on an inpatient psychiatry unit: results from a pilot randomized controlled study.
Thornley, Joanna
Hirjee, Hussein
Vasudev, Akshya
Article
2016-05-01T07:00:00Z
Aged
Aged
80 and over
Behavioral Symptoms
Dementia
Female
Humans
Inpatients
Male
Middle Aged
Music Therapy
Pilot Projects
Psychomotor Agitation
Treatment Outcome
International psychogeriatrics / IPA
28
5
869
871
10.1017/S1041610215001866
Psychiatry and Psychology
<p>The prevalence of dementia continues to grow worldwide due to an aging population and is projected to affect 65.7 million people by 2030 (World Health Organization, 2012). Behavioral and psychological symptoms of dementia (BPSD), including agitation, anxiety, aggression, depression, and psychosis, can occur in as much as 80% of the affected population, frequently necessitating psychiatric admission. Traditionally BPSD have been treated using pharmacological approaches. However, such medications could have serious adverse effects and additionally have limited efficacy in reducing such symptoms (Ballard et al., 2009).</p>
https://ir.lib.uwo.ca/psychiatrypub/29
oai:ir.lib.uwo.ca:psychiatrypub-1031
2017-02-08T21:05:45Z
publication:psychiatrypub
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:psychiatry
publication:rwkex
25317371
Mania induced by clarithromycin in a geriatric patient taking low-dose prednisone.
Liu, Eddie Y
Vasudev, Akshya
Article
2014-01-01T08:00:00Z
Prim Care Companion CNS Disord
16
3
Psychiatry and Psychology
https://ir.lib.uwo.ca/psychiatrypub/28
oai:ir.lib.uwo.ca:psychiatrypub-1032
2017-02-08T21:13:38Z
publication:psychiatrypub
publication:rwkex_researcharticles
publication:faculties
publication:psychiatry
publication:rwkex
Improving trainee psychiatrist’s handover: standard setting and audit
gupta, arun
Bevan, Ruth
Vasudev, Akshya
Article
2014-07-01T07:00:00Z
handover
trainee
psychiatry
Clinical Governance: An International Journal, 19(2), pp. 83–93. doi: 10.1108/cgij-07-2013-0026.
19
2
83
93
http://dx.doi.org/10.1108/CGIJ-07-2013-0026
Psychiatry and Psychology
https://ir.lib.uwo.ca/psychiatrypub/31
oai:ir.lib.uwo.ca:psychiatrypub-1030
2017-03-21T14:18:04Z
publication:psychiatrypub
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:psychiatry
publication:rwkex
26525997
Trends in Psychotropic Dispensing Among Older Adults with Dementia Living in Long-Term Care Facilities: 2004-2013.
Vasudev, Akshya
Shariff, Salimah Z
Liu, Kuan
Burhan, Amer M
Herrmann, Nathan
Leonard, Sean
Mamdani, Muhammad
Article
2015-12-01T08:00:00Z
Aged
80 and over
Cross-Sectional Studies
Dementia
Female
Homes for the Aged
Humans
Long-Term Care
Male
Nursing Homes
Ontario
Psychotropic Drugs
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
23
12
1259
1269
http://dx.doi.org/10.1016/j.jagp.2015.07.001
Psychiatry and Psychology
<p>OBJECTIVE: Guidelines worldwide have cautioned against the use of antipsychotics as first-line agents to treat neuropsychiatric symptoms of dementia. We aimed to investigate the changes over time in the dispensing of antipsychotics and other psychotropics among older adults with dementia living in long-term care facilities.</p>
<p>METHODS: We used drug claims data from Ontario, Canada, to calculate quarterly rates of prescription dispensing of six psychotropic drug classes among all elderly (≥65 years of age) long-term care residents with dementia from January 1, 2004, to March 31, 2013. Psychotropic drugs were classified into the following categories: atypical and conventional antipsychotics, non-sedative and sedative antidepressants, anti-epileptics, and benzodiazepines. We used time-series analysis to assess trends over time.</p>
<p>RESULTS: The study sample increased by 21% over the 10-year study period, from 49,251 patients to 59,785 patients. The majority of patients (within the range of 75%-79%) were dispensed at least one psychotropic medication. At the beginning of the study period atypical antipsychotics (38%) were the most frequently dispensed psychotropic, followed by benzodiazepines (28%), non-sedative antidepressants (27%), sedative antidepressants (17%), anti-epileptics (7%), and conventional antipsychotics (3%). Dispensing of anti-epileptics (2% increase) and conventional antipsychotics (1% decrease) displayed modest changes over time, but we observed more pronounced changes in dispensing of benzodiazepines (11% decrease) and atypical antipsychotics (4% decrease). Concurrently, we observed a substantial growth in the dispensing of both sedative (15% increase) and non-sedative (9% increase) antidepressants. The proportion of patients dispensed two or more psychotropic drug classes increased from 42% in 2004 to 50% in 2013.</p>
<p>CONCLUSIONS: Utilization patterns of psychotropic drugs in institutionalized patients with dementia have changed over the past decade. Although their use declined slightly over the study period, atypical antipsychotics continue to be used at a high rate. A decline in the use of benzodiazepines along with an increased use of sedative and non-sedative antidepressants suggests that the latter class of drugs is being substituted for the former in the management of neuropsychiatric symptoms. Psychotropic polypharmacy continues to be highly prevalent in these patient samples.</p>
https://ir.lib.uwo.ca/psychiatrypub/30
oai:ir.lib.uwo.ca:psychiatrypub-1033
2018-09-11T14:28:53Z
publication:psychiatrypub
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:psychiatry
publication:rwkex
30187288
A Review of the Pharmacological and Clinical Profile of Newer Atypical Antipsychotics as Treatments for Bipolar Disorder: Considerations for Use in Older Patients.
Vasudev, Akshya
Chaudhari, Sumit
Sethi, Rickinder
Fu, Rachel
Sandieson, Rachel M
Forester, Brent P
Article
2018-09-06T07:00:00Z
2019-09-06T07:00:00Z
bipolar disorder
OABD
geriatrics
Drugs & Aging
1
9
https://doi.org/10.1007/s40266-018-0579-6
Psychiatry and Psychology
<p>Bipolar disorder prevalence rates vary in the older adult population (defined as age ≥ 65 years), ranging from 1% in community dwellers to as high as 8-10% in hospital inpatients. Although older agents, including lithium and valproic acid, offer significant antimanic efficacy, as supported by a recent randomized controlled trial (RCT), there is growing interest in using atypical antipsychotics to treat bipolar disorder in older adults. Newer atypical antipsychotics are of interest based on their tolerability and efficacy in the general adult bipolar population. The aim of this review was to systematically examine efficacy and tolerability of newer atypical antipsychotics for older adult bipolar disorder (OABD). We conducted a systematic search utilizing the MEDLINE, EMBASE, PsycINFO and Cochrane Library electronic databases, with the aim of identifying all RCTs comparing newer atypical antipsychotics approved by the US FDA since 2002 (including brexpiprazole, cariprazine, lurasidone, iloperidone, asenapine, paliperidone, and aripiprazole) with placebo or another comparator, in the treatment of any phase of bipolar disorder (including mania, depression or mixed episodes while used as an acute or maintenance treatment) in older adults (> 65 years). We found no RCT data on any of the examined agents. Hence, we changed our search criteria to include studies with a lower age cut-off (≥ 55 years), as well as the inclusion of post hoc studies. Two post hoc studies on lurasidone suggest its reasonable safety and efficacy profile in the acute and maintenance treatment of OABD; however, there are no pharmacoeconomic data on the use of lurasidone in the treatment of OABD. Research data from open-label studies on oral asenapine and aripiprazole as add-on therapy suggest that these two agents are adequately tolerated and improved symptoms of depression and mania in OABD; hence, there is an urgent need to conduct RCTs on these two agents. Lastly, we found no studies for the treatment of OABD with brexpiprazole, cariprazine, iloperidone, or paliperidone.</p>
<p>This is the Author Accepted version of an article originally published in Drugs & Aging.</p>
https://ir.lib.uwo.ca/psychiatrypub/32
oai:ir.lib.uwo.ca:psychiatrypub-1034
2020-08-10T16:50:06Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
The influence of depression-PTSD comorbidity on health-related quality of life in treatment-seeking veterans
forchuk, Callista
Nazarov, Anthony
Hunt, Renee
Davis, Brent
St. Cyr, Kate
Richardson, J Donald
Article
2020-06-04T07:00:00Z
Mental health
posttraumatic stress disorder
major depressive disorder
military psychiatry
comorbidity
quality of life
European Journal of Psychotraumatology
European Journal of Psychotraumatology
1
11
https://doi.org/10.1080/20008198.2020.1748460
Psychiatry and Psychology
<p>Objective: Posttraumatic stress disorder (PTSD) and depression substantially impair healthrelated quality of life (HRQOL) for many Canadian Armed Forces (CAF) veterans. Although PTSD and depression are highly comorbid, little is known about whether the disorders may interact in their association with HRQOL. We sought to investigate whether depressive symptoms modify the relation between PTSD and HRQOL in treatment-seeking veterans. Method: We accessed the clinical data of 545 CAF veterans aged 18 to 65 years who were seeking treatment at a specialized clinic in London, Ontario. We used hierarchical linear regression to assess the additive and multiplicative relations between depression and PTSD symptoms on HRQOL, controlling for age and alcohol/substance abuse. Simple slopes were examined to probe significant interactions. Results: Probable PTSD and major depression were present in 77.4% and 85.3% of the sample, respectively, and 73.0% of the sample presented with probable PTSD-depression comorbidity. Depression symptoms significantly modified the relation between PTSD symptoms and overall mental HRQOL (β = 0.12, p</p>
http://creativecommons.org/licenses/by-nc/4.0/
https://ir.lib.uwo.ca/psychiatrypub/33