The Canadian Journal of Psychiatry

To evaluate a media intervention designed to improve one newspaper's portrayal of mental illnesses, specifically, schizophrenia. The project was part of an international antistigma program, Open the Doors, organized by the World Psychiatric Association.

The media intervention attempted to influence news content directly by providing reporters with more accurate background information and helping them develop more positive story lines. The evaluation compared story content and length over a 24-month period: 8 months prior to the antistigma intervention and 16 months postintervention.

Positive stories outnumbered negative stories by a factor of 2 in both pre- and postperiods. Positive mental health stories increased by 33% in the postintervention period and their word count increased by an average of 25%. Stories about schizophrenia also increased by 33%, but their word count declined by 10%. At the same time, negative stories about mental illness increased by 25% and their word count by 100%. The greatest increase was in negative news about schizophrenia. Stigmatizing stories about schizophrenia increased by 46%, and their length increased from 300 to 1000 words per story per month.

The immediate effects of the media intervention were positive, resulting in more and longer positive news stories about mental illness and more positive news stories about schizophrenia. However, when considered from a broader perspective, locally focused efforts yielded meager results in light of the larger increases in negative news, particularly in negative news concerning people with schizophrenia—the target group for the program.

To examine the extent to which the public's desire for social distance from people with schizophrenia is influenced by beliefs about the disorder and stereotypes about those suffering from it.

In spring 2001, we carried out a representative survey of individuals of German nationality aged 18 years and over (n = 5025). Each subject was given a fully structured interview that began with the presentation of a vignette.

Both labelling and beliefs about the disorder's causes and prognosis, as well as the perception that those suffering from it are unpredictable and dangerous, had an impact on the public's desire for social distance. However, the latter proved to be more important. As expected, respondents who identified the disorder depicted in the vignette as mental illness, those who blamed the individual for its development, and those who anticipated a poor prognosis expressed a stronger desire for social distance. Endorsing biological factors as a cause was also associated with increased social distance.

Our findings have important implications for interventions aimed at reducing stigma and discrimination related to schizophrenia. Targeting the stereotype of unpredictability and dangerousness appears to be particularly important.

Since publication of the DSM-IV, there remains a group of patients with depression and anxiety symptoms who are not well classified. We therefore wanted to determine more accurately the type of patients best described by the term “anxious depression.” We also wanted to review the literature to assess the most appropriate treatment(s) for these patients.

We surveyed the medical literature published after 1994 for all articles containing the relevant terms and assessed all possible articles in detail to determine those relevant to the diagnosis and those that involved relevant clinical studies.

The term anxious depression can encompass 3 groups of patients: those with comorbid major depressive disorder (MDD) and an anxiety disorder, those with MDD but with subthreshold anxiety symptoms, and those with subthreshold depressive and subthreshold anxiety symptoms (also called mixed anxiety and depressive disorder).

Based upon our literature review, we believe that the term anxious depression should only be used for the second group; that is, those patients with an MDD and subthreshold anxiety symptoms. From our literature review to determine the most appropriate treatment for this group of patients, it appears likely that drugs inhibiting the reuptake of both noradrenaline and serotonin may have greater clinical utility than single-action drugs such as the selective serotonin reuptake inhibitors (SSRIs). However, it is also clear that much more research needs to be undertaken in this important patient group so that we can better understand its prevalence, clinical features, and treatment.

To investigate the relation between psychiatric distress and road rage, paying particular attention to the potential link between psychiatric illness and frequent involvement in serious forms of road rage.

This study reports data on road rage involvement, demographic characteristics, and mental health for a representative sample of 2610 adults in Ontario. The mental health indicator was the 12-item General Health Questionnaire.

A cluster analysis revealed 5 distinct groups of people affected by road rage. The most serious offenders (referred to hereafter as the hard core road rage group), representing 5.5% of those affected, exhibited frequent involvement in the most severe forms of road rage and were the most likely (27.5%) to report psychiatric distress.

Road rage, particularly experiences of victimization, is related to psychiatric distress. Evidence of psychiatric distress was highest among hard core road rage perpetrators, individuals noted for frequent involvement in serious aggressive and violent conduct. Further research is needed on violence and road rage and its link to mental health.

Antipsychotic-induced weight gain occurs in a substantial percentage of treated persons. There remains a paucity of naturalistic data that describe relative weight-gain liability with the available novel atypical antipsychotics (NAPs). This investigation describes comparative NAP-induced weight gain in a prospective naturalistic cohort of persons with schizophrenia and related psychotic disorders.

The Canadian National Outcomes Measurement Study in Schizophrenia (CNOMSS) is an ongoing prospective, longitudinal, naturalistic study involving 32 academic and community sites across Canada. Persons with DSM-IV–defined schizophrenia, schizophreniform or schizoaffective disorder, and psychosis not otherwise specified were consecutively enrolled. The overarching objectives of this initiative were to collect and compare global effectiveness, tolerability, safety, and humanistic outcomes in persons receiving commercially available NAPs in Canada. This analysis reports only weight change with the respective NAPs. Other outcomes were reported in separate companion papers.

A spectrum of weight-gain liability was noted with quetiapine (QUE) (mean 7.55 kg, SD 9.20; P = 0.28), olanzapine (OLZ) (mean 3.72 kg, SD 0.56; P = 0.15), and risperidone (RIS) (mean 1.62 kg, SD 7.72; P = 0.43). Categorically defined weight gain (that is, over 7% of baseline weight) was observed in 55.6% of QUE patients, 24.1% of OLZ patients, and 23.7% of RIS patients. Adjusting for demographic and disease-specific confounding factors, QUE patients had greater odds of gaining over 7% of their baseline weight, compared with RIS patients (odds ratio [OR] 3.62; 95%CI, 1.02 to 12.83; P = 0.05). No statistical difference was detected between OLZ patients and RIS patients for over 7% of baseline weight (OR 1.54; 95%CI, 0.63 to 3.75; P = 0.12) or over 10% weight gain (OR 1.44; 95%CI, 0.50 to 4.13; P = 0.58).

Clinicians are reminded to monitor anthropometric and metabolic parameters in all NAP-treated persons. Clinically significant differences in weight gain liability exist among the available NAPs.

To evaluate the feasibility of screening and recruiting patients with major depression and congestive heart failure (CHF) in a tertiary care cardiology hospital and to obtain preliminary efficacy, tolerability, and safety data for nefazodone treatment of a major depressive episode in CHF patients.

We conducted a 12-week, open-label trial of nefazodone given in dosages up to 600 mg daily. We assessed patients at baseline, 1, 2, 4, 8, and 12 weeks. Measures used were the 17-item Hamilton Depression Rating Scale (HDRS), the Clinical Global Impression Scale, the Beck Depression Inventory, Spielberger's State-Trait Anxiety Inventory, and the Minnesota Living with Heart Failure Questionnaire. We also obtained pre- and poststudy ECGs, 24-hour Holter monitor recordings, and plasma levels of norepinephrine.

After screening 443 CHF patients, 28 patients with major depression met study eligibility criteria. The 23 patients who completed 4 or more weeks of medication showed significant improvement on all depression scales and in quality of life. Of 19 subjects who completed the full 12-week trial, 74% experienced a decline of 50% or more on HDRS scores. The completers also showed a significant reduction in heart rate, an increase in QT intervals (but not in the QTc), and a marginally significant decrease in plasma norepinephrine. There were no changes in heart rate variability.

It is feasible to screen and recruit CHF patients with major depression for an antidepressant trial. Nefazodone seems sufficiently safe, tolerable, and efficacious to justify a larger, placebo-controlled trial.

To identify empirical subtypes of schizophrenia, based upon the symptoms recorded over the duration of the illness, and to validate the resulting clusters against other systems that are used for subtyping schizophrenia.

Data for 55 symptoms of schizophrenia over the history of the illness from 107 chronic schizophrenia patients were analyzed using hierarchical cluster analysis with Euclidean distance and Ward's method. Except for 1 patient, all met DSM-III criteria. There were 40 men and 67 women, average (SD) age of 38.2 (9.91) years, with amean (SD) hospitalization of 27.9 (27.35) months.

No clear and unambiguous solution for the number of clusters was evident. Examination of the clusters led to further analysis of 2- and 6-cluster solutions. These were contrasted with DSM-III, DSM-III-R, and DSM-IV criteria and with the subtypes taken from the literature. There was limited support for any of these types, with none replicating, including the paranoid–nonparanoid distinction.

Empirical clusters derived from lifetime symptom data failed to agree with either the established DSM or other empirically derived subtypes. Subtypes may have little utility when the variability of symptoms over the longitudinal course of the illness is considered.