strDatabasePath = "/publications/archives/stats"
December 1996, Volume 41, Number 10
Antidepressant Treatment of Depression: A
Russell Joffe, MD, Stephen Sokolov, MD, David Streiner, PhD
To carry out a metaanalysis of antidepressant studies to calculate the effect sizes for
antidepressant effect in depressive disorder.
A metaanalysis of all antidepressant studies that included an active comparison drug as
well as placebo was used to calculate the effect size. Articles were selected from a
MEDLINE search for the period January 1966 to June 1995. Forty-nine studies were
included in the metaanalysis.
The effect sizes for antidepressant treatment are moderately larger than for placebo. A
larger effect size was observed in studies where objective diagnostic criteria for depression
We conclude that the superior efficacy of antidepressants over placebo can be
depression, metaanalysis, antidepressant
(Can J Psychiatry 1996;41:613-616)
Improving the Management of Patients with
Schizophrenia in Primary Care: Assessing Learning
Needs as a First Step
John Toews, MD, FRCPC, Jocelyn Lockyer, MHA, Donald Addington, MBBS, MRCPsych,
FRCPC, Gerald McDougall, MD, FRCPC, Richard Ward, MD, CCFP, Elizabeth Simpson,
To assess family physician learning needs related to the care of patients with schizophrenia.
Questionnaires were mailed to all family physicians and general practitioners practising in
southern Alberta. Physicians were asked to indicate the number of patients with
schizophrenia cared for, their interest in improving the care they provided, their preferred
learning methods, and the content they wished to learn.
A total of 539 surveys were returned for a return rate of 43.8%. Over half of the physicians
(53.5%) indicated that they saw 1 to 2 patients with schizophrenia each month. Almost half
(48.5%) indicated they were somewhat or very interested in increasing the care provided.
Primary learning needs included increasing their knowledge of psychopharmacologic
agents and monitoring and adjusting medications. Lectures and half-day workshops were
the preferred learning methods.
Our study was helpful in identifying the types of education that physicians wanted as well
as the duration of the programming prior to the development of teaching interventions.
schizophrenia, needs assessment, continuing medical education, practising physician
(Can J Psychiatry 1996;41:617-622)
Teaching Child and Adolescent Psychiatry to Family
Medicine Trainees: A Pilot Experience
Sandra Fisman, MB, BCh, FRCPC, John Sangster, MD, MCISc, CCFP, FCFP, Margaret M
Steele, HBSc, MD, FRCPC, Moira A Stewart, PhD, Naomi Rae-Grant, MB, BS, FRCPsych,
To develop learning objectives for teaching child psychiatry to family medicine trainees
and to evaluate the best method of teaching these objectives.
For this descriptive study, knowledge, attitude, and skill objectives were presented to
trainees at the start of a 6-month rotation, and an evaluation mechanism was developed
based on the learning objectives. The method of instruction in each of the training locations
was described independently by the child psychiatry consultant and attending family
physician. The trainees' evaluations were presented according to training locations.
Family medicine trainees perceived the teaching-consultation method, with live interviews,
to be the most helpful and the didactic lecture format to be least helpful.
The importance of teaching family medicine residents to recognize mental health problems
in children and adolescents, preferably by using live interviews, and the implications for
postresidency practice are emphasized.
primary care, child psychiatric disorder, learning objectives, teaching-consultation
(Can J Psychiatry 1996;41:623-628)
Acute Day Hospitalization as an Alternative to
Vincent Russell, MB, FRCPC, François Mai, MD, FRCPC, Keith Busby, PhD, David
Attwood, MD, Marie Davis, BSc, MBA, Monica Brown, BA
This paper describes the administrative process by which the Ottawa General Hospital
(OGH) closed 6 beds and used the staff and space resources thus released to set up an acute
day hospital (ADH) for the treatment of 8 acutely ill psychiatric patients. Outcome data are
presented on the first 160 patients admitted to the ADH.
Demographic and clinical information including diagnostic (DSM-III-R; Global
Assessment of Functioning [GAF]) and questionnaire data (Symptom Checklist-90 Revised
[SCL-90R]; Beck Depression Inventory [BDI]; State-Trait Anxiety Inventory [STAI];
patient satisfaction) were obtained from 160 ADH patients at admission and discharge.
Forty-two of these patients provided follow-up data 3 to 6 months postdischarge. The
outcome of ADH patients was compared with that of a retrospectively obtained random
sample (n = 100) of inpatients on selected diagnostic and demographic variables.
On clinician-rated and self-report clinical scales, ADH patients showed significant clinical
improvement reflected in higher GAF scores and less psychological distress, depression,
and anxiety at discharge relative to admission. There were no significant group differences
in outcome indices except for shorter length of stay in the ADH group compared with
inpatients. The ADH group rated the program highly in help received and quality of
service. Short-term follow-up showed that gains made during treatment were maintained 3
to 6 months later.
These results show that a time-limited day hospital program is clinically effective for
acutely ill psychiatric patients and leads to a more efficient use of inpatient resources. We
believe that partial hospitalization for the treatment of acute psychiatric disorders may
have wide application in psychiatric hospital practice.
partial hospitalization, day hospital, health care administration, utilization
(Can J Psychiatry 1996;41:629-637)
Psychogeriatric Consultation Services: Effect and
Louise Teitelbaum, MD, FRCPC, Dorothy Cotton, PhD, M Lynne Ginsburg, MB, ChB,
FRCPC, Yousery H Nashed, MD, FRCPC
To determine the nature of referrals to a psychogeriatric consultation/outreach service, the
types of interventions provided, and the effects and effectiveness of the service.
The study used a prospective approach in which 67 consecutive patients referred for
psychogeriatric assessment were followed up 6 to 8 weeks after the initial assessment and
then again 6 months after initial contact. Patients were rated at the time of referral and at
follow-up on presence of psychiatric diagnosis, need for institutional care, and placement
Of the 67 patients initially seen, 51 (76%) experienced memory problems and 46 (69%) had
depressed mood. Consistent with this finding, 36 (54%) were diagnosed by consultants as
having a dementia, and 15 (22%) received a diagnosis of depression. The most frequent
recommendations included medication changes in 34 cases (50%) and further assessments
in 37 cases (55%). Although information at 6-week follow-up was available for only 58% (n
= 38) of the sample, 18 (46%) patients were generally improved. Interestingly, only 12
(31%) of referring physicians indicated that they had followed the advice of the
consultants. Cognitive impairment and depressive symptoms were major concerns among
referring physicians. The most common recommendation made involved
pharmacotherapy. While compliance of family doctors to recommendations made was
poor, patients improved over time. Patients requiring inpatient assessment were very old,
living alone, experiencing behavioural problems, and not depressed.
Psychogeriatric consultations appear most useful in cases where patients are more severely
affected and/or are suffering from a greater range of symptoms.
psychogeriatric, consultation, outreach services, effect and effectiveness
(Can J Psychiatry 1996;41:638-644)
Familial Dementia of Frontal Lobe Type
Albert HC Wong, MD, Hubert HM van Tol, PhD, Oscar Schoots, PhD, Gerald Shugar, MD
To describe an unusual case of familial frontal lobe dementia (FLD) with probable
spongiform encephalopathy (SE).
The patient's clinical presentation, neuropsychological test results, family history, and
results on magnetic resonance imaging (MRI) and positron emission tomography (PET)
scans, among other routine investigations, are described. His leucocyte deoxyriboneucleic
acid (DNA) was isolated, and his Prp (prion protein) gene was amplified with the
polymerase chain reaction and sequenced using the Sanger method.
Clinically, the patient had a presenile frontal lobe dementia. Four of the 8 members of the
generation preceding the patient had presenile dementia. Autopsies performed on 2 of these
cases revealed SE, and a pathological diagnosis of Creutzfeldt-Jakob disease (CJD) was
made. One other member of that generation died of a limbic encephalitis, although the
neuropathological findings were atypical. Sequencing of the patient's Prp gene did not
reveal the abnormalities expected in a familial case of CJD. The results of other
investigations were compatible with FLD but were not specific to a particular diagnosis.
This case is a novel type of SE. The patient presented clinically with FLD, but based on the
family history and neuropathology, a diagnosis of prion dementia seems likely. There were
no mutations found in the Prp gene, so it is possible that there are SEs caused by genes or
other pathological processes unrelated to the Prp gene.
dementia, frontal lobe, prion, Creutzfeldt-Jakob disease, spongiform encephalopathy
(Can J Psychiatry 1996;41:645-647)
Self-Induced Water Intoxication Treated with
Richard C Millson, MD, Craig E Emes, MD, William G Glackman, PhD
To determine whether or not risperidone is efficacious in treating self-induced water
intoxication in patients with chronic schizophrenia.
We carried out a prospective 11-month open-label study using risperidone to treat 8 men
with chronic schizophrenia and self-induced water intoxication.
The 8 men were not able to reduce their fluid consumption compared with their baseline
intake. Risperidone, however, significantly decreased the Brief Psychiatric Rating Scale
(BPRS) scores of this very chronic group.
Although risperidone decreased schizophrenic symptoms, it did not have significant
efficacy in treating self-induced water intoxication. This study may have implications for
the treatment of addictive behaviour.
water intoxication, polydipsia, risperidone, clozapine, schizophrenia, addiction
(Can J Psychiatry 1996;41:648-650)
Depressive Symptoms Attributable to Medication
Exposure in a Medical Inpatient Population
Scott B Patten, MD, PhD, Jeanne VA Williams, BA, Edgar J Love, MD, PhD
Exposure to certain drugs--angiotensin-converting enzyme inhibitors, betablockers,
calcium channel blockers, corticosteroids, H2 blockers, and sedative hypnotics--may be
associated with an increased risk of depression. These drugs are commonly used in
inpatient medical therapeutics. Since population attributable risk (PAR) is generally
related both to strength of association and to the frequency of exposure to a risk factor, the
PAR of depressive symptoms associated with these drug exposures is potentially high. The
objective of this study was to estimate the depressive symptoms population attributable
risk percent (PAR%) in a medical inpatient population.
A prospective cohort design was used in this study. Nondepressed, nondrug-exposed
subjects (N = 178) were selected from a series of 369 newly admitted medical inpatients at
the Calgary General Hospital. Eighty-six of these 178 subjects were prescribed one of the
drugs in question, forming an exposed cohort. The remaining subjects formed a
nonexposed cohort. Depressive symptoms and associated psychosocial variables were
measured in both subgroups during the hospital stay.
Seventeen of the 86 exposed subjects and 5 of the 92 nonexposed subjects developed
incident depressive symptoms during their stay in hospital. The PAR% associated with
drug exposure (56.0%) exceeded that associated with poverty (17.9%) or unemployment
Drug exposures may have a sizeable impact on the incidence of depressive symptoms in
medical inpatient populations.
depressive symptoms, substance-induced depression, population attributable risk percent,
adverse drug reactions
(Can J Psychiatry 1996;41:651-654)