The Canadian Journal of Psychiatry

To detect the incidence of diabetes in patients with schizophrenia in Taiwan.

The National Health Research Institute provided a database of 1 million random subjects for study, from which we drew a random sample of 617 068 subjects aged 18 years and older in the year 2000. Subjects who had at least one service claim during this year, with a primary diagnosis of schizophrenia, diabetes, or with a prescription for treatment of diabetes, were identified. We compared initial diagnosis of diabetes between patients with schizophrenia and the general population in 2000. We also followed a cohort of subjects with schizophrenia from 2000 to 2005.

The incidence of diabetes was higher in patients with schizophrenia than in the general population (1.46% and 1.12%, respectively; OR 1.47; 95% CI 1.09 to 1.97) in 2000. Compared with the general population, patients with schizophrenia showed a higher incidence of diabetes in the group aged 18 to 29 years; among females; among those with insurance of more than US$1281; among those living in the northern region; and among those residing in urban areas. The average annual incidence of diabetes in patients with schizophrenia was 1.84% from 2000 to 2005. Higher incidence of diabetes in patients with schizophrenia was associated with increased age, females, hypertension, and hyperlipidemia.

Patients with schizophrenia had a higher incidence of diabetes for the youngest adult age group and for females than for the general population. Increased age, females, hypertension, and hyperlipidemia were risk factors of diabetes in patients with schizophrenia.

We examined the prevalence and correlates of prescription drug misuse (PDM) in a population-based sample of adults from Alberta.

Data were collected from 3511 adults in Alberta aged 18 years and older in 2002 using a computer-aided telephone survey; the survey response rate was 57.4%.

The prevalence of 12-month PDM in Alberta was 8.2% in 2002. Opiates were the most frequently misused drug class, followed by sedatives, stimulants, and tranquilizers. Current disability was particularly associated with PDM. Odds of PDM were also elevated among adult students and adults with a high school diploma relative to adults with a post-secondary degree. Past-year problem gambling, illicit drug use, and alcohol use and dependence were each associated with PDM, while past-year binge drinking and daily smoking were not.

Findings suggest PDM was an important public health concern in Alberta in 2002. Estimates suggest prescription use and misuse have increased substantially in Canada since that time. There is an urgent need for an ongoing assessment of this evolving problem so that effective prevention and therapeutic strategies can be developed.

To compare the rates of all Axis I and II mental disorders and suicide attempts in sexual orientation minorities with rates in heterosexuals using a nationally representative sample.

Data used were from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 (n = 34 653, response rate = 70.2%). Cross-tabulations and multivariate logistic regression analyses were performed to determine differences in rates of mental disorders and suicide attempts by sexual orientation. All analyses were stratified by sex.

Compared with their heterosexual counterparts, lesbians and bisexual women demonstrated a 3-fold increased likelihood of substance use disorders, and gay and bisexual men showed twice the rate of anxiety disorders and schizophrenia and (or) psychotic illness, even after accounting for mental disorder comorbidity. Suicide attempts were independently associated with bisexuality, with odds 3 times higher than in heterosexuals.

Findings from our study emphasize the fact that sexual orientation minorities are vulnerable to poor mental health outcomes, including suicide attempts. Clinicians need to be aware of these specific negative mental health consequences when assessing sexual orientation minorities.

A growing body of research consistently shows that detained minors bear substantial mental health needs. However, the relation between mental disorder and criminal recidivism has largely remained unexplored. Our study examines whether psychiatric disorders increase the likelihood of recidivism after controlling for time at risk, criminal history, and the presence of other disorders.

Participants (n = 232) were detained male adolescents from all 3 youth detention centres in Flanders, Belgium, who were interviewed with the Diagnostic Interview Schedule for Children, Version IV. Two to 4 years later, information on serious recidivism was retrieved from the official judicial registration system. Serious recidivism was defined as having at least one arrest charge for violent, severe property crime, or substance-related offences.

Serious recidivism was high, with 81% (n = 191) of the participants being rearrested. Psychiatric disorders predicted neither serious recidivism in general nor violent and severe property recidivism. However, other drug use disorder (OR 2.41; 95% CI 1.22 to 4.75) and general comorbidity (OR 2.64; 95% CI 1.40 to 4.99) were significantly predictive of substance-related recidivism.

Common psychiatric disorders in detained male adolescents do not significantly increase the likelihood of subsequent arrests, with the exception that substance use disorders appear to increase the risk of later substance-related recidivism. Effective treatment of these disorders may prevent detained juveniles to experience the detrimental outcomes associated with substance-related crimes as adults (for example, mental illness).

Les résultats des méta-analyses concluent à l'efficacité de la thérapie cognitivo-comportementale des psychoses (TCCp) sur les symptômes persistants. Cependant, la validité externe reste à explorer. L'application de la TCCp aux psychoses débutantes (c'est-à-dire, les 5 premières années suivant le diagnostic) paraît particulièrement pertinente, compte tenu de l'effet possible sur l'évolution au long cours. Cependant, les quelques études ayant expérimenté la TCCp auprès de cette population ont eu des résultats décevants. Toutes ont introduit la thérapie en phase psychotique aiguë et la plupart ont effectué un nombre limité de séances. Ainsi, la présente étude ouverte d'implantation vise à évaluer l'efficience d'un programme de TCCp australien de 25 séances, introduit en phase stable, auprès de patients de Québec souffrant de psychoses débutantes.

Le programme Active Cognitive Psychotherapy for Early Psychosis a été offert à 20 patients âgés de 14 ans et plus, à raison d'une séance hebdomadaire pendant 6 mois.

Le taux d'acceptation était de 75 %, le taux moyen d'observance des séances de 84 %, et les participants étaient satisfaits du programme. Les analyses d'avant et d'après la TCCp rapportent des améliorations statistiquement significatives de la symptomatologie psychotique, lesquelles sont maintenues au suivi de 6 mois. L'autocritique est également améliorée de façon statistiquement significative après la TCCp.

La TCCp semble applicable à nos milieux cliniques, notamment chez les adolescents. De plus, la posologie employée semble favoriser l'observance des rencontres.

Identifier des prédicteurs distaux et proximaux de l'initiation de la consommation d'ecstasy à l'adolescence.

L'échantillon comprenait 2162 adolescents issus d'écoles secondaires de milieux défavorisés du Québec, suivis annuellement pendant 5 ans. L'analyse causale a été utilisée pour prédire l'initiation de la consommation d'ecstasy en secondaire 5 (16–17 ans) à partir de prédicteurs en secondaire 1 et 2 (12–14 ans) et en secondaire 4 (15–16 ans).

Les adolescents qui initiaient la consommation d'ecstasy en secondaire 5 présentaient un risque accru sur de multiples facteurs, comparativement aux non-consommateurs. L'initiation était principalement prédite par des facteurs de risque proximaux liés à la consommation individuelle ainsi qu'à la consommation et à la déviance des pairs. Néanmoins, plusieurs facteurs proximaux se développaient en continuité avec leur facteur distal correspondant (lien indirect). La consommation de marijuana était le prédicteur le plus puissant de l'initiation de la consommation d'ecstasy, le risque relatif étant, toutes choses égales par ailleurs, 2,04 fois plus élevé chez les adolescents ayant consommé de la marijuana l'année précédente (secondaire 4).

L'initiation de la consommation d'ecstasy en secondaire 5 semble globalement liée à un profl extériorisé plutôt qu'intériorisé. Cette consommation était fortement associée à la consommation d'autres substances et partage probablement plusieurs facteurs de risque avec la consommation de ces autres substances, en particulier la consommation de marijuana.