The Canadian Journal of Psychiatry

Assessment in palliative care requires a multidimensional review of physical symptoms and psychosocial concerns in a format appropriate for patients with advanced illness. In this study, we describe the initial development and validation of a structured interview for assessing common symptoms and concerns faced by terminally ill individuals.

We constructed a 13-item Structured Interview for Symptoms and Concerns (SISC) based on a review of end-of-life issues and administered it to 69 patients receiving palliative care for advanced cancer. Along with the interview, each participant completed visual analog scales (VAS) addressing the same constructs. Test–retest and interrater reliability were determined, as was the concordance between interview ratings and VAS scores.

Overall, the interview items had excellent interrater reliability (intraclass correlations were > 0.90) and at least moderate temporal stability (test–retest correlations ranged from 0.50 to 0.90). Concurrent validity was evident in the good concordance between interview items and VAS measures (correlations were > 0.70). The SISC was also sensitive to individual differences between subgroups of participants who did or did not meet diagnostic criteria for anxiety or depressive disorders.

This study demonstrates that structured interviews provide a reliable and valid approach to assessment in palliative care and may be an appropriate alternative for some research applications.

To present the results of a systematic review of literature published between January 1, 1980, and December 31, 2000, that reports epidemiologic estimates of substance-related disorders.

We conducted a literature search of substance-related epidemiologic studies, using medline and HealthSTAR databases and applying a set of predetermined inclusion and exclusion criteria to identify relevant studies. We extracted and analyzed prevalence and incidence data for heterogeneity.

A total of 19 prevalence studies of substance-related disorders met inclusion criteria for this review. Heterogeneity analyses revealed significant variability across 1-year and lifetime prevalence of both alcohol and other substance use disorders. The corresponding 1-year and lifetime pooled rates were 6.6 per 100 and 13.2 per 100, respectively, for alcohol use disorders and 2.4 per 100 and 2.4 per 100, respectively, for other substance use disorders. We observed variability among countries and also among regions within the same country. In contrast to other drug problems, alcohol use disorders were substantially more common, were more likely to occur among male subjects, and were more likely to be associated with abuse symptoms. For other drugs, dependence was consistently more prevalent than abuse.

Studies using rigorous and comparable methodologies report significant variability in rates of alcohol and other substance use disorders. These data suggest that different policies and regional practices are associated with variability in rates of disorders. Policy-makers and health planners require regular, regionally sensitive estimates of prevalence rates to respond effectively to unique patterns of need in their constituencies.

To examine stress and psychological impact in severe acute respiratory syndrome (SARS) patients during the 2003 outbreak. SARS is a novel, highly infectious pneumonia, and its psychological impact is still unclear.

At the peak of the outbreak, SARS patients (n = 79) and healthy control subjects (n = 145) completed the Perceived Stress Scale (PSS) and documented a range of psychological responses. Groups were balanced for age, sex, education, and living circumstances.

Stress was significantly higher in SARS patients than in healthy control subjects. Stress correlated significantly with negative psychological effects. Of SARS patients, 39% (n = 30) were infected health care workers; these individuals reported significantly more fatigue and worries about health than did other patients. Of patients, 25% (n = 20) requested psychological follow-up.

General stress and negative psychological effects are increased in SARS patients, particularly among infected health care workers. This may increase the risk of mood and stress-related disorders. Functional impairment is apparent in the postrecovery phase.

To quantify stress and the psychological impact of severe acute respiratory syndrome (SARS) on high-risk health care workers (HCWs).

We evaluated 271 HCWs from SARS units and 342 healthy control subjects, using the Perceived Stress Scale (PSS) to assess stress levels and a structured list of putative psychological effects of SARS to assess its psychological effects. Healthy control subjects were balanced for age, sex, education, parenthood, living circumstances, and lack of health care experience.

Stress levels were raised in both groups (PSS = 18) but were not relatively increased in the HCWs. HCWs reported significantly more positive (94%, n = 256) and more negative psychological effects (89%, n = 241) from SARS than did control subjects. HCWs declared confidence in infection-control measures.

In HCWs, adaptive responses to stress and the positive effects of infection control training may be protective in future outbreaks. Elevated stress in the population may be an important indicator of future psychiatric morbidity.

This study was designed to analyze the language of patients with schizophrenia exhibiting negative symptoms during a 3-month period.

The computer-assisted ALCESTE method was used to simultaneously analyze the subjects' oral behaviour and speech patterns at various levels.

The tested subjects had very specific speech patterns. Most significantly, analysis of the underlying syntactic processes showed that the patients exhibited a sense of identity, however minimum, based on their own pathologies and on the surrounding world. In our previous study, no such characteristics were observed in the discourse of schizophrenia patients with delusions (exhibiting positive symptoms). This suggests that the minimum sense of identity that develops in patients with schizophrenia allows them to avoid positive symptoms.

In studies of language production by subjects suffering from schizophrenia, it is necessary to distinguish between patients with positive symptoms and those with negative symptoms. The speech patterns of these 2 groups have to be analyzed separately, which has not been done previously, since the groups differ in too many respects.

This study examines the links among diabetes, tardive dyskinesia (TD), and other extrapyramidal symptoms (EPS) in schizophrenia outpatients treated with typical and atypical antipsychotics.

Using a retrospective chart review, we compared 30 schizophrenia patients with diabetes mellitus (DM) with 30 schizophrenia patients, matched for age and sex, with no DM. We compared prevalence and severity of parkinsonism, akathisia, TD, dystonia, and antipsychotic type (that is, typical vs atypical).

We found no statistically significant differences between the DM group and the non-DM group prevalence and severity of EPS, including TD.

We did not find DM and TD association to be significant in the era of atypical antipsychotics, possibly because of their antidyskinetic effect.

To examine the psychosocial effects on health care workers of being quarantined because of exposure to severe acute respiratory syndrome (SARS).

We used semistructured qualitative interviews.

We identified 3 major themes concerning psychosocial effects: loss, duty, and conflict.

Quarantined workers experienced stigma, fear, and frustration. We highlight the need for clear and easily accessible information on dealing with infectious diseases. Practical advice on coping and stress management techniques for health care workers are needed in preparation for potential future outbreaks of infectious diseases.

Information on author affiliations appears at the end of the article.

Although a relatively large body of research has now accumulated concerning the relation between negative life events, social support, and major depressive disorder (MDD), little is known about the relation between seasonal affective disorder and these psychosocial variables. This study aimed to compare baseline levels of negative life events (NLEs) and perceived social support (SS) in patients with seasonal and nonseasonal depression.

Canadian patients with winter seasonal affective disorder (SAD) (n = 26) and nonseasonal recurrent MDD (n = 66) completed measures of recent NLEs (the List of Threatening Experiences) and perceived SS (the Social Support Survey) prior to treatment.

No significant between-group differences were observed in mean number of NLEs experienced or in quality of SS. Perceived SS was impaired in both groups, compared with patients with chronic medical conditions.

The results of this study complement those of previous research reporting increased incidence of NLEs and decreased SS in primary care patients with high seasonality in the UK. Future research is required to determine the causal relation between these psychosocial risk factors and SAD and to assess whether they have an effect on, or are affected by, treatment interventions for SAD.