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Medical assistance in dying (MAiD) was introduced into Canadian federal legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is currently excluded from eligibility; such exclusion is scheduled to expire on March 17, 2024. Irremediability, capacity, quality of life, autonomy, family involvement, and healthcare system constraints have been debated intensively. Recent studies have not explored the views of family members of persons with mental illness on MAiD MI-SUMC. This study aimed to fill this knowledge gap. Twenty-five Ontario residents who had a loved one with mental illness participated. A persona-scenario exercise was designed to explore participants' views on MAiD MI-SUMC in hypothetical situations. Reflexive thematic analysis was used to analyze the data. A lived experience-advisory panel was engaged throughout the study. Seven themes were developed: Witnessing suffering; A road with barriers and limitations; Societal barriers; The unknowns of mental illness; Individual choices: the life or death that a person wants; MAiD MI-SUMC as an acceptable choice when suffering cannot be relieved with available treatments and supports; and The emotional outcome. Participants constructed their views based on their experience of supporting a loved one with mental illness. MAiD MI-SUMC was perceived as a multifaceted issue, whose acceptability and potential introduction required a concurrent exploration and discussion of the challenges arising due to limitations of the healthcare system, the opportunities and limits to family involvement, and the value of patient autonomy., Competing Interests: Declaration of Conflicts InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Hamer Bastidas-Bilbao, Vicky Stergiopoulos, Vivien Cappe, Mary Rose van Kesteren, Alexander I. F. Simpson, Michael Dawthorne, and Lisa D. Hawke declare that there is no conflict of interest. Donna Eileen Stewart declares that she has served in the Expert Panel on MAiD and Mental Illness, the Canadian Psychiatric Association Working Group on MAiD, and as a reviewer of the Canadian Association of MAiD Assessors and Providers (CAMAP) curriculum on MAiD. Mona Gupta declares that she has received funding related to this subject from CIHR; she was Chair of Health Canada’s Task Group on MAiD Practice Standards, the Chair of the Federal Expert Panel on MAiD and Mental Illness, and the Chair of the AMPQ ad hoc committee on MAiD. Tarek K. Rajji has received research support from Brain Canada, Brain and Behavior Research Foundation, BrightFocus Foundation, Canada Foundation for Innovation, Canada Research Chair, Canadian Institutes of Health Research, Centre for Aging and Brain Health Innovation, National Institutes of Health, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research and Innovation, and the Weston Brain Institute; he has also received for an investigator-initiated study in-kind equipment support from Newronika, and in-kind research online accounts from Scientific Brain Training Pro, and participated in 2021 and 2022 in an advisory activity for Biogen Canada Inc; he is also an inventor on the United States Provisional Patent No. 17/396,030 that describes cell-based assays and kits for assessing serum cholinergic receptor activity; he served on the MAiD Practice Standards Task Group as CAMH representative. David Castle has received grant monies for research from NHMRC (Australia), Barbara Dicker Research Fund, Milken Institute, Canadian Institutes of Health Research, and Psyche Foundation; consulting fees from Seqirus; honoraria for talks from Seqirus, Servier, and Mindcafe Forum; and honoraria as advisory board member from Seqirus and Lundbeck; he is a founder of the Optimal Health Program (OHP) and holds 50% of the IP for OHP; is part owner and board member of Clarity Healthcare; and is unpaid board chair of the Psyche Institute; he does not knowingly have stocks or shares in any pharmaceutical company.

Background: Canadian First Nations (FN) people have experienced and continue to experience significant adversities, yet many demonstrate aspects of resilience., Aim: The aim of this qualitative study was to specifically understand Cree adults' meanings and mechanisms of resilience following maltreatment., Methods: Ten Cree adults were interviewed individually. Modified grounded theory was used to interpret the transcribed interviews., Results: Participants discussed resilience as a journey of 'survival' and 'overcoming' and pathways to healing that were multifactorial and included traditional teachings., Conclusion: Mental health providers should consider and incorporate these mechanisms into treatment for Cree people, when appropriate, to aid recovery., (© The Author(s) 2015.)

Elevated levels of irritability have been reported across a range of psychiatric and medical conditions. However, research on the causes, consequences, and treatments of irritability has been hindered by limitations in existing measurement tools. This study aimed to develop a brief, reliable, and valid self-report measure of irritability that is suitable for use among both men and women and that displays minimal overlap with related constructs. First, 63 candidate items were generated, including items from two recent irritability scales. Second, 1,116 participants (877 university students and 229 chronic pain outpatients) completed a survey containing the irritability item pool and standardized measures of related constructs. Item response theory was used to develop a five-item scale (the Brief Irritability Test) with a strong internal structure. All five items displayed minimal conceptual overlap with related constructs (e.g., depression, anger), and test scores displayed negligible gender bias. The Brief Irritability Test shows promise in helping to advance the burgeoning field of irritability research., (© The Author(s) 2014.)

Background: Not much is known about factors that contribute to resilience among women facing intimate partner violence (IPV), particularly from countries where patriarchy predominates. This qualitative study aimed to gather the perspectives of Indian women self-identified as resilient in the face of IPV and tried to understand the strategies and resources that helped them to maintain or regain resilience., Materials: Data were collected from 16 consenting women who reported IPV and whose husbands were being treated for alcohol problems at a psychiatric centre in Bangalore, India. A semi-structured guided interview format that aimed at understanding factors that enabled them to feel resilient despite IPV in their challenging circumstances was used to gather narratives from the participants., Discussion: Six themes were identified using QSR NVivo software. They were as follows: the support of women, men and family; personal attributes; dignity and work; being strong for the children; and faith in God. Among these women, supportive social networks, personal attributes and aspirations were major clusters contributing to resilience., Conclusion: Attention to these factors may provide an important, strengths-based perspective for interventions to enhance women's resilience when facing IPV., (© The Author(s) 2013.)

Confounding of depressive and cardiac symptoms may hold implications for assessment. This study investigated psychometric properties and sex differences in two depression scales among cardiac patients. Cardiac inpatients from 11 hospitals were recruited and completed a mailed survey including the Beck Depression Inventory-II and Gotland Scale of Male Depression 1 year later. The scales were significantly correlated and both were associated with social desirability. Females scored higher than males on the fatigue factor only (p < .001). Psychometric properties of the Beck Depression Inventory-II were more favorable in this population. Practitioners must not overlook reports of fatigue in female cardiac patients., (© The Author(s) 2013.)

Objective: The purpose of this study was to investigate the factor structure and psychometric properties of the Cardiac Rehabilitation Barriers Scale (CRBS)., Design, Setting, and Participants: In total, 2636 cardiac inpatients from 11 hospitals completed a survey. One year later, participants completed a follow-up survey, which included the CRBS. A subsample of patients also completed a third survey which included the CRBS, the Cardiac Rehabilitation Enrolment Obstacles scale, and the Beliefs About Cardiac Rehabilitation scale three weeks later. The CRBS asked participants to rate 21 cardiac rehabilitation barriers on a five-point Likert scale regardless of cardiac rehabilitation referral or enrolment., Results: Maximum likelihood factor analysis with oblique rotation resulted in a four-factor solution: perceived need/healthcare factors (eigenvalue = 6.13, Cronbach's α = .89), logistical factors (eigenvalue = 5.83, Cronbach's α = .88), work/time conflicts (eigenvalue = 3.78, Cronbach's α = .71), and comorbidities/functional status (eigenvalue = 4.85, Cronbach's α = .83). Mean total perceived barriers were significantly greater among non-enrollees than cardiac rehabilitation enrollees (P < .001). Convergent validity with the Beliefs About Cardiac Rehabilitation and Cardiac Rehabilitation Enrolment Obstacles scales was also demonstrated. Test-retest reliability of the CRBS was acceptable (intraclass correlation coefficient = .64)., Conclusion: The CRBS consists of four subscales and has sound psychometric properties. The extent to which identified barriers can be addressed to facilitate greater cardiac rehabilitation utilization warrants future study.

Understanding why and how perpetrators of intimate partner violence (IPV) change their behavior is an important goal for both policy development and clinical practice. In this study, the authors investigated the concept of "turning points" for perpetrators of IPV by conducting a systematic review of qualitative studies that investigated the factors, situations, and attitudes that facilitated perpetrators' decisions to change their abusive behavior. Two literature databases were searched and six studies were found that met the inclusion criteria for the systematic review. Most included participants from batterer intervention programs (BIPs). The data indicate that community, group, and individual processes all contribute to perpetrators' turning points and behavioral change. These include identifying key incidents that precede change, taking responsibility for past behavior, learning new skills, and developing relationships within and outside of the BIP. By using a qualitative systematic review, the authors were able to generate a more complete understanding of the catalysts for and process of change in these individuals. Further research, combining quantitative and qualitative approaches, will be helpful in the modification of existing BIPs and the development of new interventions to reduce IPV.

This study investigated the impact of patient and caregiver gender on caregiver depressive symptoms. Caregivers' use of relationship-focused coping and dimensions of caregiver burden were examined as potential mediators of gender differences in depressive symptoms. Ninety-three organ transplant candidates and their caregivers completed written questionnaires (N = 186). Females providing care to male patients reported significantly higher depressive symptoms than the other caregivers in our sample. Multiple mediation analyses revealed that less support from family members and a greater negative health impact of caregiving helped explain these gender differences. Women caring for men were also perceived as more overprotective, but this did not explain gender differences in depression. Results highlight the benefits of a contextual, dyadic approach to studying caregiver distress.

This study evaluated the sociodemographic, clinical and behavioral correlates of post-traumatic growth (PTG) in coronary artery disease (CAD) patients, and the degree of PTG compared to other patient groups. Using a prospective design, 1497 CAD outpatients completed a survey assessing potential PTG correlates. A total of 1268 responded to a nine-month follow-up survey assessing PTG. Significant PTG correlates were being younger, non-white, having lower income, functional status, and depressive symptoms, greater social support, and positive illness perceptions. The degree of PTG was equivalent to that of cardiac patients in other countries, but was lower than that of breast cancer and multiple sclerosis patients.

This descriptive study seeks to understand what first and second generation Portuguese women believe about wife abuse and what actions they believe are appropriate for an abused wife. Eighty first generation and 54 second generation women participated. The researcher read the questionnaire items aloud in one-on-one meetings. Overall, participants defined wife abuse broadly, did not approve of wife abuse, were most likely to believe that women should seek external help, and did not hold strong patriarchal beliefs. However, a number of generational differences were found. Second generation women were more likely to label an abusive behavior as abuse, and first generation women were more likely to approve of abuse, endorse indirect or traditional options to deal with wife abuse, and hold stronger patriarchal beliefs. The study's implications for research and practice within Portuguese communities are discussed.

Patients admitted to an Intensive Care Unit (ICU) frequently have underlying cardiac dysfunction. Early interventions are sometimes difficult to initiate because of diagnostic uncertainty as to whether cardiac failure is present As B-type natriuretic peptide (BNP) has been shown to be increased in cardiac dysfunction, we sought to demonstrate whether BNP can be used as a screening tool for cardiac dysfunction in patients admitted to ICU. All patients admitted to a combined medical and surgical ICU over a four-week period were included in the study. BNP was measured on the point of admission using a hand-held meter. Clinicians were blinded from the measurement when diagnoses were made as to whether or not the patients had clinically significant cardiac dysfunction. Patients with cardiac dysfunction had a significantly higher level of BNP when compared to the non-cardiac dysfunction group: 516 +/- 385 pg/ml (n = 26) v 67 +/- 89 pg/ml (n = 58) (P < 0.0001) A BNP cut-off value at 144 pg/ml exhibited a 92% sensitivity, 86% specificity and 96% negative predictive value. The sensitivity improved to 96% when the analysis was confined to patients > or = 55 years. At this cut-off value, BNP is a strong predictor of cardiac dysfunction. BNP measurement offers a rapid and affordable way to screen for cardiac dysfunction in patients admitted to ICU. An increased BNP level warrants further cardiac investigations so as to implement early interventions for cardiac decompensation in ICU patients.

Objective: The study's objective was to determine the quality and severity of grief after spontaneous abortion and to statistically determine the effect of significant demographics and social variables such as age, number of previous losses and the effect of perceived family support on the grief experienced., Methods: Two hundred and ninety-four women who had experienced a miscarriage within the last year were the participants. One hundred and seventy-five had miscarried three months prior to participation in the study; one hundred and nineteen had miscarried one year previously. Ninety-five percent of women approached consented to participate. Standardized psychometric tests and Likert Scales measured elements of grief such as depression, self-esteem, perceived guilt and stress at two time periods in the first year after loss., Results: Women in both time periods after miscarriage had mean depression scores in the "clinical risk for depression" or "in need of treatment" range, i.e., pharmacotherapy or psychotherapy. A majority of women showed negative emotions like self blame and stress. Younger women with multiple miscarriages showed more depression in the early time period after miscarriage than older women (p < .05). However, at one year younger women had the least depression. Marital and family conflict correlated positively with depressive symptomatology (p < .05)., Conclusions: Women assessed in the first year after spontaneous abortion show grief characterized by perceived stress and high levels of depressive symptoms including self-blame. Marital or family problems increase emotional risk to a woman after miscarriage.

Objective: To determine if women with high psychologic distress attending a menopause clinic report more previous psychiatric disorders (especially depression), or psychologic distress associated with oral contraceptive use and reproductive cycle events than women with low psychologic distress attending the clinic., Method: Consecutive women attending a university hospital menopause clinic were administered the Brief Symptom Inventory (BSI). Women with high psychologic distress (who met case severity on the BSI general severity index) were compared to a similar number of the lowest scoring clinic women on their reports of previous psychiatric diagnoses and treatment, and depression or distress related to oral contraceptive use, the premenstrual period, or associated with pregnancy., Results: The forty-four women with high psychologic distress were significantly more likely than the forty-two menopause clinic patients with low psychologic distress to report a past psychiatric diagnosis (usually depression) (p = 0.001), requiring anti-depressant treatment (p = 0.002), oral contraceptive dysphoria (p = 0.004), dysphoric premenstrual syndrome (p = 0.000), postnatal blues (p = 0.02) and postpartum depression (p = 0.004)., Conclusions: Although the halo effect of current distress or retrospective reporting may have biased these results, the similarity of ratings in the two groups on physical symptoms in menopause and psychologic symptoms during pregnancy makes this less likely. These findings corroborate other recent studies showing that women who suffer from affective disorders following one reproductive event are more vulnerable to recurrences associated with others. Clinicians should inquire about possible relationships between previous depression or psychologic distress and reproductive cycle events as it may help predict women who are vulnerable to affective disorders and psychological distress at these critical times.

Objective: This study prospectively evaluates the effectiveness and patient acceptability of professionally-led support groups in alleviating psychologic distress in infertility patients., Method: Sixty-four consecutive patients in a university hospital infertility program were administered a battery of psychologic tests before and after attendance at an 8 weekly session support group. The comparison group consisted of 35 consecutive infertility referrals to the same unit who were not initially offered the support group and were similarly tested over an 8 week period., Results: Support group patients had significantly greater (p less than or equal to 0.01) entry than exit scores on several measures of psychologic distress and depression (the Beck Depression Inventory, the Hamilton Rating Scale for Depression, and the Global Severity Index, Anxiety, Depression, Hostility and Obsessive Compulsive Subscales of the Brief Symptom Inventory). The Avoidance Coping Style on the Moos Coping Responses Inventory was correlated with a higher Global Severity Index (p less than or equal to 0.01). Comparison group patients had similar psychometric scores to the support group patients at entry but showed no change over 8 weeks. Attenders expressed a high rate of satisfaction with the support group., Conclusions: Professionally-led support groups are a highly acceptable and effective intervention in self-referred patients in alleviating psychological distress related to infertility.

Objective: This study measures psychologic distress in women attending a menopause clinic to determine if significant differences exist between peri-menopausal and menopausal women., Method: Consecutive women attending a university hospital menopause clinic were administered the Brief Symptom Inventory (BSI) and a study questionnaire to determine menopausal symptoms, menstrual cycle status, and use of hormone replacement therapy (HRT). The BSI results were compared between menopausal and perimenopausal women, and to a normative sample of middle-aged women who were nonpatients., Results: Two hundred and fifty-nine menopause clinic women completed the questionnaire: 113 perimenopausal and 146 menopausal women. There was significantly greater psychologic distress on the BSI among perimenopausal as compared to menopausal women on the global severity index, and each of the anxiety, hostility, somatization, depression, paranoid, and psychoticism subscales. Perimenopausal women met BSI caseness severity criteria significantly more often than did menopausal women on the global severity index, and on the subscales for depression, anxiety, and psychoticism. On the BSI, menopausal women showed results similar to those of a normative sample of nonpatient middle-aged women., Conclusions: Perimenopausal women attending menopause clinics have significantly higher levels of psychologic distress meeting case severity criteria on the BSI. Further research is warranted to define the subgroups of perimenopausal women who are at increased risk, in the hopes of developing effective interventions.

This case illustrates a pharmacokinetic interaction between the tricyclic antidepressant, nortriptyline, and the antituberculosis drug, rifampin. Higher than expected doses of nortriptyline were required to obtain a therapeutic drug level while the patient was receiving rifampin. Following the discontinuation of rifampin, the patient became drowsy and the serum nortriptyline levels rose precipitously into the toxic range. The authors suggest that patients receiving rifampin and nortriptyline, (or other psychotropic drugs) be monitored closely and that similar drug interactions be anticipated.

Pseudocyesis is a rare condition in which a woman believes herself to be pregnant when she is not. Its incidence has fallen in the last fifty years, probably due to a number of sociocultural and medical factors. Six cases are described which show common features of recent pregnancy loss or infertility, psychological and medical naivete, social isolation, recent loss and membership in a cultural or religious group that focuses on childbearing as the central role of women. Etiology includes psychological, sociocultural and endocrine factors which interact with each other demonstrating the reciprocal interplay between mind and body. Guidelines are provided for the assessment and management of this ancient and fascinating condition.

Idiopathic anejaculation is a relatively rare cause of sexual dysfunction that usually presents as an infertility problem. When such patients have nocturnal emissions the problem is usually considered psychogenic and referral is made to a psychiatrist. Various treatments for this condition have been described including psychotherapy, sexual, marital and behavioral therapy, vibratory stimulation of the penis and pharmacotherapy. A patient with idiopathic anejaculation referred by an infertility clinic is described in which all of the above treatments failed over a five-year period. A newly described procedure in humans, electroejaculation, was employed to obtain semen which was used to artificially inseminate the wife resulting in the first reported successful pregnancy by electroejaculation done for idiopathic anejaculation.