The Canadian Journal of Psychiatry

To explore hippocampal structural abnormalities in fire victims with recent-onset posttraumatic stress disorder (PTSD).

We compared 12 patients with recent-onset PTSD diagnosed according to DSM-IV criteria 6 to 8 months after a major fire with 12 individuals without PTSD who were victims of the same fire accident. Voxel-based morphometry (VBM) and magnetic resonance spectroscopy (MRS) were combined to examine hippocampal structural abnormalities in patients with recent-onset PTSD.

Results of VBM showed that the grey matter density of the left hippocampus was lower in the group with PTSD than it was in the group without PTSD. Results of MRS showed that the ratio of N-acetyl asparate and creatine in the left hippocampus was significantly lower in patients with PTSD than in control subjects.

Patients with recent-onset PTSD had hippocampal structural abnormalities.

To review psychiatrists' documentation of informed consent and present data on Canadian psychiatrists' attitudes and practices regarding documentation of the informed consent process.

We surveyed a stratified random sample of psychiatrists practising in Ontario, using a mailed self-report questionnaire.

The response rate was 72%. Among respondents, 63% routinely documented the consent process, with younger respondents reporting more documentation than older ones. Although most respondents (77%) favoured recording the consent process, only 11% felt signed consent forms were necessary.

There are differences in the self-reported documentation behaviour of younger and older psychiatrists. Psychiatrists should document the consent process in the clinical record.

To identify predictors of resumed benzodiazepine use after participation in a benzodiazepine discontinuation trial.

We performed multiple Cox regression analyses to predict the long-term outcome of a 3-condition, randomized, controlled benzodiazepine discontinuation trial in general practice.

Of 180 patients, we completed follow-up for 170 (94%). Of these, 50 (29%) achieved long-term success, defined as no use of benzodiazepines during follow-up. Independent predictors of success were as follows: offering a taper-off program with group therapy (hazard ratio [HR] 2.4; 95% confidence interval [CI], 1.5 to 3.9) or without group therapy (HR 2.9; 95%CI, 1.8 to 4.8); a lower daily benzodiazepine dosage at the start of tapering off (HR 1.5; 95%CI, 1.2 to 1.9); a substantial dosage reduction by patients themselves just before the start of tapering off (HR 2.1; 95%CI, 1.4 to 3.3); less severe benzodiazepine dependence, as measured by the Benzodiazepine Dependence Self-Report Questionnaire Lack of Compliance subscale (HR 2.4; 95%CI, 1.1 to 5.2); and no use of alcohol (HR 1.7; 95%CI, 1.2 to 2.5). Patients who used over 10 mg of diazepam equivalent, who had a score of 3 or more on the Lack of Compliance subscale, or who drank more than 2 units of alcohol daily failed to achieve long-term abstinence.

Benzodiazepine dependence severity affects long-term taper outcome independent of treatment modality, benzodiazepine dosage, psychopathology, and personality characteristics. An identifiable subgroup needs referral to specialized care.

Combined treatment with psychotherapy and antidepressants is more effective than monotherapies. Recent data show that combined therapy has better results in patients with depression and Axis II codiagnosis. The aim of this study was to compare combined treatment using interpersonal psychotherapy (IPT) with pharmacotherapy alone in patients with depression and borderline personality disorder (BPD).

There were 39 consecutive outpatients diagnosed with BPD who presented with a major depressive episode enrolled in this study. They were randomly assigned to 1 of 2 treatment groups: fluoxetine 20 mg to 40 mg daily or fluoxetine 20 mg to 40 mg daily plus IPT 1 session weekly. Owing to noncompliance, 7 patients dropped out. We assessed the 32 patients who completed the 24 weeks of treatment at baseline, Week 12, and Week 24, using a semistructured interview for clinical characteristics, the Clinical Global Impression Scale (CGI), the Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS), and 2 self-report questionnaires, that is, the Satisfaction Profile (SAT-P) for quality of life and the 64-item Inventory for Interpersonal Problems (IIP-64). We performed statistical analysis, using univariate general linear models with 2 factors: duration and type of treatment.

Changes in remission rates, CGI, and HARS score did not differ between treatments. According to changes in the HDRS scores; changes in psychological functioning and social functioning scores on the SAT-P; and changes in vindictive or self-centred, cold or distant, intrusive or needy, and socially inhibited scores on the IIP-64, combined therapy was superior to fluoxetine alone.

Combined therapy with IPT is more effective than antidepressant therapy alone, both in treating symptoms of major depression and in improving dimensions of quality of life and interpersonal functioning.

To study the differences in levels of alexithymia, depression, and anxiety between a sample of adolescents diagnosed with ICD-10 persistent somatoform pain disorder (defined by the DSM-IV as a pain disorder associated with psychological factors) and healthy adolescent control subjects.

Using the Toronto Alexithymia Scale and the Hospital Anxiety and Depression Scale, we investigated the point prevalence of alexithymia, anxiety, and depression among adolescents aged 12 to 17 years, with somatoform disorder, who were hospitalized in Kaunas Medical University Hospital, Lithuania (n =120), and a healthy control group (n = 60) of adolescents aged 12 to 17 years, who were randomly selected from 6 schools in Kaunas, Lithuania.

The rate of alexithymia in adolescents with somatoform disorder was 59%, which was significantly higher than that in healthy control subjects (1%, P < 0.001). Similarly, the rate of anxiety was significantly higher in the patient group (62%), compared with control subjects (15%, P < 0.001). The rate of depression was low in both groups and did not differ significantly between groups.

Adolescents with somatoform disorder have higher levels of alexithymia and anxiety than healthy adolescent control subjects, but adolescents with somatoform disorder and adolescent control subjects do not have significantly different levels of depression.