August 25, 2016

The Canadian Journal of Psychiatry
October 2015, Volume 60, Number 10

Original Research

Short-Term Natural Course of Depressive Symptoms and Family-Related Stress in Adolescents After Separation From Father

Gabriella Gobbi, MD, PhD; Nancy C P Low, MD; Erika Dugas, MSc; Marie-Pierre Sylvestre, PhD; Gisèle Contreras, MSc; Jennifer O’Loughlin, PhD

Correspondence: Dr Jennifer O’Loughlin, 850 Saint-Denis, Montreal, QC H2X 0A9; Researcher, Centre de recherche, Centre hospitalier de l’université de Montréal, Montreal, Quebec; Professor, Department of Social and Preventive Medicine, University of Montréal, Montreal, Quebec.

Objective: To determine if separation from a father is associated with short-term changes in mental health or substance use in adolescents.
Methods: Every 3 months, during a 5-year period, we followed 1160 Grade 7 students participating in the Nicotine Dependence in Teens Study who were living with both parents. Participants who reported not living with their father for 6 or more consecutive months during follow-up were categorized as separated from father. Pooled regressions within the framework of generalized estimating equations were used to model the associations between separation from father and indicators of mental health (depressive symptoms, and worry and [or] stress about family relationships or the family situation) and substance use (alcohol use and cigarette smoking) 4 to 6 and 7 to 9 months postseparation, controlling for age, sex, and baseline level of the outcome variable.
Results: Compared with adolescents living with both parents, adolescent offspring separated from their fathers were more likely to report depressive symptoms (β = 0.17,
95% CI 0.01 to 0.33) 4 to 6 months postseparation, as well as worry and (or) stress about their parents separating or divorcing (OR 2.39, 95% CI 1.29 to 4.43), a new family
(OR 4.25, 95% CI 2.33 to 7.76), and the family financial situation (OR 2.35, 95% CI 1.53 to 3.60). Separation from father was also marginally significantly related to worry and (or) stress about their relationship with their father (OR 1.53; 95% CI 0.98 to 2.39). At 7 to 9 months postseparation, separation from father continued to be associated with worry and (or) stress about their parents separating or divorcing, a new family, and the family financial situation. Separation from father was no longer associated with worry and (or) stress about their relationship with their father, but it was associated with worry and (or) stress about their relationship with their mother. Separation from father was not related to use of alcohol or cigarettes.
Conclusion: Adolescent offspring experienced family-related stress and transient depression symptoms in the 4- to 9-month period following separation from their fathers.

Key Words: father absent, adolescent, mental health, depression, stress, longitudinal, cohort

Received July 2014, revised, and accepted January 2015.

Can J Psychiatry 2015;60(10):417–426

Original Research

Bullying Victimization (Being Bullied) Among Adolescents Referred for Urgent Psychiatric Consultation: Prevalence and Association With Suicidality

Nazanin Alavi, MD; Nasreen Roberts, MBBS, MRCPsych (UK), FRCPC, MSc (Epid);
Chloe Sutton, BSc; Nicholas Axas, MSW, RSW; Leanne Repetti, RN

Correspondence: Dr Nazanin Alavi, Hotel Dieu Hospital, 166 Brock Street, Kingston, ON K7L 5G2; Psychiatry Resident, Department of Psychiatry, Queen’s University, Kingston, Ontario.

Objective: To examine the prevalence of bullying victimization among adolescents referred for urgent psychiatric consultation, to study the association between bullying victimization and suicidality, and to examine the relation between different types of bullying and suicidality.
Method: A retrospective chart review was conducted for all adolescents referred to a hospital-based urgent consultation clinic. Our study sample consisted of adolescents with a history of bullying victimization. The Research Ethics Board of Queen’s University provided approval. Data analysis was conducted using SPSS (IBM SPSS Inc, Armonk, NY). Chi-square tests were used for sex, suicidal ideation, history of physical and sexual abuse, and time and type of bullying, and an independent sample t test was used for age.
Results: The prevalence of bullying victimization was 48.5% (182 of 375). There was a significant association between being bullied and suicidal ideation (P = 0.01), and between sex and suicidal ideation (P ≤ 0.001). Victims of cyberbullying reported more suicidal ideation than those who experienced physical or verbal bullying (P = 0.04).
Conclusions: Bullying victimization, especially cyberbullying, is associated with increased risk of suicidal ideation among adolescents referred for psychiatric risk assessment. The detailed history of the type and duration of bullying experienced by the victims should be considered when conducting a psychiatric risk assessment.

Key Words: bullying victimization, suicidal ideation, adolescence, urgent and emergency psychiatric consultation

Received August 2014, revised, and accepted April 2015.

Can J Psychiatry 2015;60(10)427–431

Original Research

Lifetime Prevalence of Attention-Deficit Hyperactivity Disorder in Young Adults: Examining Variations in the Socioeconomic Gradient

Lauren Yallop, PhD; Marni Brownell, PhD; Dan Chateau, PhD; John Walker, PhD;
Michelle Warren, PhD; Dan Bailis, PhD; Michael LeBow, PhD

Correspondence: Dr Lauren Yallop, 6th Floor, Sheldon M Chumir, 1213–4th Street SW, Calgary, AB T2R 0X7; Clinical Psychologist, Alberta Health Services, Calgary, Alberta.

Objective: It has only recently been accepted that attention-deficit hyperactivity disorder (ADHD) persists into adulthood. Accordingly, less is known about adult diagnostic and treatment prevalence. We aimed to determine the lifetime prevalence of ADHD diagnosis and psychostimulant prescriptions for young adults in the province of Manitoba and to explore how diagnosis differs according to sociodemographic characteristics and age at diagnosis; and to investigate whether a socioeconomic gradient exists within young adults with a lifetime ADHD diagnosis, as well as the variables that moderate the gradient.
Methods: Using the Manitoba Population Health Research Data Repository, our cross-sectional analysis used 24 fiscal years of data (1984/85 to 2008/09) and included all adults aged 18 to 29 during 2007/08 to 2008/09 in Manitoba (n = 207 544) who had a lifetime diagnosis of ADHD (n = 14 762). Regression analyses tested for differences in rates by sex, region, age, age at diagnosis, and socioeconomic status.
Results: Lifetime prevalence for ADHD diagnosis (7.11%) and psychostimulant prescriptions (3.09%) differed according to sex, region, and age. In contrast to previous Manitoban research on childhood ADHD, the socioeconomic gradient for ADHD diagnosis was not found in young adulthood. When region was accounted for, a small negative gradient in the urban population and a positive gradient in the rural population were evident. People from the highest income quintile were significantly less likely to be diagnosed before age 18, compared with other income quintiles.
Conclusions: Given the high lifetime prevalence of ADHD in Manitoban young adults and significant socioeconomic correlates for diagnosis, further investigation into the trajectory of this relatively unexplored population is recommended.

Key Words: attention-deficit hyperactivity disorder, lifetime prevalence, young adult, socioeconomic status, socioeconomic gradient, childhood-limited, urban–rural, psychostimulant

Received July 2014, revised, and accepted December 2014.

Can J Psychiatry 2015;60(10):432–440

Original Research

Increased Risk of Obesity and Metabolic Dysregulation Following 12 Months of Second-Generation Antipsychotic Treatment in Children: A Prospective Cohort Study

Rebecca Ronsley, MD; Duc Nguyen, MD, PhD; Jana Davidson, MD, FRCPC;
Constadina Panagiotopoulos, MD, FRCPC

Correspondence: Dr Constadina Panagiotopoulos, Endocrinology and Diabetes Unit, British Columbia Children’s Hospital, Department of Pediatrics, University of British Columbia, 4480 Oak Street, ACB K4–213, Vancouver, BC V6H 3V4; Pediatric Endocrinologist, British Columbia Children’s Hospital, Vancouver, British Columbia; Clinical Professor, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.

Objective: To determine the risk of developing obesity and related metabolic complications in children following long-term treatment with risperidone or quetiapine.
Methods:This was a 1-year naturalistic longitudinal study conducted between February 2009 and March 2012. A total of 130 children aged 2 to 18 years without prior exposure to second-generation antipsychotics (SGAs) were enrolled at initiation of treatment with either risperidone or quetiapine. Metabolic parameters were measured at baseline and months 6 and 12. Data of 37 participants (20 treated with risperidone and 17 treated with quetiapine) who completed 12-month monitoring were used in the analysis.
Results: After 1 year of SGA treatment, mean weight increased significantly by
10.8 kg (95% CI 7.9 kg to 13.7 kg) for risperidone and 9.7 kg (95% CI 6.5 kg to 12.8 kg) for quetiapine. Body mass index z score also increased significantly in both groups (P < 0.001). There was a high incidence of children becoming overweight or obese (6/15 [40.0%] for risperidone-treated and 7/14 [50.0%] for quetiapine-treated). The mean levels of fasting glucose (for risperidone-treated) and ratio of total cholesterol to high-density lipoprotein cholesterol (for quetiapine-treated) increased significantly by 0.23 mmol/L
(95% CI 0.03 mmol/L to 0.42 mmol/L) and 0.48 mmol/L (95% CI 0.15 mmol/L to 0.80 mmol/L), respectively.
Conclusion: Children treated with risperidone or quetiapine are at a significant risk for developing obesity, elevated waist circumference, and dyslipidemia during 12 months of treatment. These data emphasize the importance of regular monitoring for early identification and treatment of metabolic side effects.

Key Words: risperidone, quetiapine, antipsychotic, dyslipidemia, obesity, diabetes, insulin, glucose

Received October 2014, revised, and accepted April 2015.

Can J Psychiatry 2015;60(10):441–450

Original Research

Explicit and Implicit Attitudes of Canadian Psychiatrists Toward People With Mental Illness

Layla Dabby, MD; Constantin Tranulis, MD; Laurence J Kirmayer, MD

Correspondence: Dr Layla Dabby, Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Côte-Ste-Catherine Road, Montreal, QC H3T 1E4;Psychiatrist, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec; Assistant Professor, Department of Psychiatry, McGill University,
Montreal, Quebec.

Objective: People with mental illness suffer stigma and discrimination across various contexts, including the health care setting, and clinicians’ attitudes play an important role in perpetuating stigma. Effective stigma-reduction interventions for physicians require a better understanding of explicit (that is, conscious and controllable) and implicit (that is, subconscious and automatic) forms of bias, and of predictors and moderators of stigma.
Methods: Members of a Canadian university psychiatry department and of the Canadian Psychiatric Association (CPA) were invited to participate in a web-based study consisting of 2 measures of explicit attitudes, the Social Distance Scale (SDS) and the Opening Minds Scale for Health Care Providers (OMS-HC), and 1 measure of implicit attitudes, the Implicit Association Test (IAT).
Results: Thirty-five psychiatry residents and 68 psychiatrists completed the study (response rates of 12.1% for the university sample and 3.3% for the CPA sample). Participants desired greater social distance from the vignette patient with schizophrenia. Mean IAT scores, although negative, did not reach the threshold for a meaningful effect size. Patient contact positively predicted IAT scores, while age, sex, and level of training (resident, compared with psychiatrist) did not. Neither patient contact nor implicit attitudes predicted SDS or OMS-HC scores.
Conclusion: Psychiatrists did not differ from psychiatry residents on any measures of explicit or implicit attitudes toward mental illness. Explicit attitudes toward people with mental illness were relatively negative; implicit attitudes were neither negative nor positive; and implicit and explicit attitudes were not correlated. Greater patient contact predicted more positive implicit attitudes, but did not predict explicit attitudes.

Key Words: mental illness, psychiatric diagnoses, labelling, stigma, discrimination, health care, physicians, medical education, Implicit Association Test

Received June 2014, revised, and accepted December 2014.

Can J Psychiatry 2015;60(10):451–459


Lost in Translation: The Gut Microbiota in Psychiatric Illness

Rebecca Anglin, MD, PhD, FRCPC; Michael Surette, PhD; Paul Moayyedi, MB ChB, PhD; Premysl Bercik, MD, FRCPC

Correspondence: Dr Rebecca Anglin, 3V30 Health Sciences Centre, McMaster University Medical Centre, 1280 Main Street West, Hamilton, ON L8S 4K1; Assistant Professor, Department of Psychiatry and Behavioural Neurosciences and Department of Medicine (Gastroenterology), McMaster University, Hamilton, Ontario.

Despite decades of research, and many promising hypotheses, the underlying etiology and pathophysiology of psychiatric illness remains unknown. There is evidence for the involvement of the HPA axis, monoamine neurotransmitters, inflammation, early life events, and the environment, among other factors,1 but, to date, there has not been a unifying theory to connect these different lines of research. Concurrently, there has been burgeoning interest in the role the gut microbiota may play in health and disease. In fact, the gut microbiota influences many of the factors that may be involved in psychiatric illness and is shaped by early life events and environmental factors, including diet, migration, and urbanicity.2 There is now a wealth of animal studies demonstrating that the gut microbiota plays a critical role in modulating the brain and behaviour; however, to date, there has been a paucity of studies looking at the gut microbiota in psychiatric illness. Given the potential for development of preventative and therapeutic interventions targeting the microbiota, it is essential that clinical studies of the gut microbiota in psychiatric illness be performed.

Key Words: gut microbiota, gut–brain axis, psychiatric illness, depression, anxiety

Received July 2014, revised, and accepted March 2015.

Can J Psychiatry 2015;60(10):460–463


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