The Canadian Journal of Psychiatry

This article reviews sex differences in psychiatric comorbidity among individuals with substance use disorders and, in particular, the clinical significance of these differences for treatment outcome among women.

We undertook a computerized search of major health care databases. To enhance the search, we drew prior relevant articles from the reference list.

Women with alcohol and other drug use disorders present higher rates of psychiatric comorbidity, particularly mood and anxiety disorders, than do men. Moreover, the comorbid diagnosis, particularly of depression, is more often primary in women, while in men the comorbidity is more often secondary to the substance abuse diagnosis. In addition, there is evidence that psychiatric comorbidity is associated with distinct, sex-specific outcomes for substance use treatment.

Sex differences in the clinical presentation of substance-dependent individuals with psychiatric comorbidity present specific treatment challenges and opportunities.

To review the current knowledge on the problem of psychoactive substance abuse by persons with schizophrenia, with particular attention to issues of direct relevance to clinical practice.

The author examined the literature from the last 2 decades and data from studies in which he was involved.

Schizophrenia sufferers show an elevated liability for substance abuse. Such comorbidity may derive from self-medication attempts, a common neuropathology for addiction and schizophrenia, the psychotogenic properties of certain drugs, or the influence of environmental factors. Among schizophrenia patients receiving treatment, substance misuse is associated with more severe symptoms and poorer therapeutic response. The presence of a chronic psychosis impedes treatment of the substance problem in traditional, nonpsychiatric addiction programs. Better outcomes are observed in integrated therapy services, where patients receive appropriate care for both conditions.

Dual-pathology patients need comprehensive care with appropriate pharmacotherapy and psychosocial interventions. This treatment can be best provided within the context of a continuing care psychiatric service.

Treatment approaches for pathological gambling have been modelled after preexisting substance addiction models. This paper reviews cognitive-behavioural models in a search for original insights that are specific to gambling treatment.

A computerized search of major health care databases (Medline and PsycINFO) was performed.

New cognitive-behavioural approaches to the treatment of pathological gambling provide 3 original additions to the traditional multimodal treatment of addictions: cognitive restructuring, in vivo exposure, and imaginal desensitization. Other cognitive-behavioural techniques, such as relapse prevention, problem solving, and social skill training, are shared by gambling treatment and addictions treatment.

When treating pathological gamblers, clinicians must consider introducing techniques to address cognitive distortions related to gambling. Also, cue exposure—whether in vivo or imaginal—may help deal with urges prompted by such cues. The blending of these new techniques into a multimodal addiction treatment potentially balances the rational and external orientation of the cognitive-behavioural approach with interpersonal and introspective components of the traditional addiction treatment.

This paper focuses on the relation between memory and posttraumatic stress disorder (PTSD). More specifically, it addresses the debate regarding the role of memory of the traumatic event in the development of PTSD. Traumatic brain injury (TBI) is used as a naturally occuring model for traumatic exposure that is often associated with memory impairment.

We present a critical review of the literature on studies assessing the relation between TBI and PTSD, with a focus on memory of the traumatic event as a critical factor. We also discuss results from recent studies conducted by our group.

The literature review offers an inconclusive picture wherein a significant proportion of the studies indicate that PTSD and TBI are mutually exclusive, especially in individuals who exhibit lack of memory for the traumatic event. This finding supports the possibility that lack of memory may protect against the development of PTSD. However, some studies show that PTSD does occur in patients with head injury, suggesting that PTSD may develop in TBI survivors—even in those who cannot remember the traumatic event. Generally speaking, though, the overall balance of the findings (including our own findings) seems to support the possibility that, in subjects with TBI, impaired memory of the traumatic event is associated with reduced prevalence of PTSD.

The suggestion that amnesia regarding the traumatic event may protect against the development of PTSD has both theoretical and practical importance. This review focused on the case of trauamtic brain injury as a model for impaired memory for the traumatic event. However, it still remains to be proven that the conclusions based on these findings are generalizable beyond the case of TBI. While some patients with posttraumatic amnesia do develop PTSD despite lack of memory for the traumatic event, the majority of those who lack memory for the event seem to be protected from developing the disorder. Nevertheless, based on this assumption, we suggest that pharmacologic disruption of newly acquired—or even old—traumatic memories, which has been shown to be possible in animals, might therapeutically benefit trauma survivors.

To describe the development of the Thought Disorder Questionnaire (TDQ), including data on reliability and validity, and to explain the questionnaire's feasibility and diagnostic accuracy.

The TDQ has 6 scales, each with 10 items (on a scale from 0 [for never] to 4 [for always]). The 6 scales measure content of thought, control of thought, orientation, perception, fantasy, and symptoms.

The TDQ is a reliable 60-item, self-report questionnaire that measures the quantity and quality of disordered thinking in patients with mental disorders. It has established reliability and validity.

The TDQ's clinical and research utility remains to be determined.

Recent studies of patients with juvenile bipolar disorder report low rates of recovery and high rates of chronicity. However, we lack data on the short-term outcome. This study examines the pattern of recovery from the index episode in an aggressively treated juvenile sample.

We assessed 25 subjects (< 16 years) with a diagnosis of mania, using the Diagnostic Interview for Children and Adolescents-Revised) (DICA-R), Young Mania Rating Scale (YMRS), and Children's Global Assessment Scale (CGAS) at intake and at 3 and 6 months. We studied the time taken to recover from the index episode, the level of functioning, and the factors predicting them.

After 6 months, 24 (96%) subjects had recovered from the index manic episode. The median time to recovery was 27 days. Total episode length was significantly longer among those with previous affective episodes.

The findings suggest that juvenile-onset mania has high rates of recovery and low rates of chronicity. These differences from the existing literature need further exploration.

This report presents a French translation and validation of the Impact of Event Scale-Revised (IES-R) in a population of women exposed to a natural disaster during or preceding pregnancy.

A total of 223 francophone women who were either pregnant at the time of the 1998 ice storm or who became pregnant shortly thereafter completed the IES-R and other questionnaires 6 months after the disaster.

The French IES-R has good internal consistency, with alpha coefficients ranging from 0.81 to 0.93 for its 3 subscales and total score. The test–retest reliability of the scale, although examined with another sample, proved to be satisfactory, with correlation coefficients ranging from 0.71 to 0.76 for its 3 subscales and total score. Its convergent validity with perceived life threat and general psychiatric symptoms was judged to be marginally acceptable. Finally, a principal components analysis was conducted and a 3-factor solution, which explained 56% of the variance, was retained: a hyperarousal factor (7 items), an avoidance factor (6 items), and an intrusion factor (6 items).

The French version of the IES-R has satisfactory internal validity and test–retest reliability. Further, the factor structure of the translation was similar to the proposed theoretical structure of the IES-R.