Search

Background: Although international medical graduates (IMGs) are essential in health care service delivery, a gap exists in the literature about how IMGs are selected into psychiatry residency programs in Canada. The purpose of this study was to identify the relative weight or importance that Canadian program directors (PDs) of psychiatry place on certain selection criteria when matching IMGs into residency programs.Methods: We electronically distributed a web-based questionnaire to 16 university residency program directors of psychiatry in Canada. Program Directors were asked to rate the importance of 43 selection criteria using 5-point Likert Scales. Criteria were grouped into six domains: academic criteria, extracurricular activities, supporting information, behavioural issues of concern, medical school country, and other education. Mean total values for each set of criteria were calculated and used to create rank orders within each domain.Results: Eight out of 16 program directors responded. Our analysis indicated that academics and behavioral issues of concern were the most important selection criteria.Conclusion: Our findings provide valuable insight about the perspectives of Program Directors toward IMGs who apply for psychiatry residency programs in Canada. Further studies are needed to better understand which criteria contribute to IMGs’ performances as psychiatric residents.

Background Behavioural and psychological symptoms of dementia (BPSD) are prevalent and have an impact on the care of persons with dementia. Previous studies regarding predisposing factors have included pharmacotherapy, but other factors may not have been sufficiently studied. We hypothesized that psychotropic medications, past history, comorbid psychiatric disorders and other factors may be relevant factors related to BPSD. Methods Data were collected from patients' medical charts at an extended care facility over a 2-year period from 1 May 2008 to 30 April 2010. Information obtained included the presence of BPSD, gender, age, marital status, past history, comorbid psychiatric disorder and medication use. Patients were divided into two groups: a group with BPSD (n = 29) and a group without BPSD (n = 10). A binomial logistic regression analysis was performed for the above factors. Results Comorbid major depression was linked to BPSD (odds ratio = 12.57, 95% confidence interval: 1.31–120.74) as well as to the use of antidepressants (odds ratio = 6.49, 95% confidence interval: 1.02–41.25). There was a trend towards statistical significance in the relationship between greater use of antidepressants for the patients with comorbid major depression and the presence of BPSD. Past history of depression (Fisher's exact test; P = 0.03) and cerebral vascular accident (degrees of freedom = 1, χ2 = 4.44, P = 0.04) were linked to the presence of BPSD and comorbid major depression. Conclusion Accurate evaluation and treatment of comorbid major depression may affect BPSD. In order to reduce the burden of BPSD on patients and caregivers, there should be a careful and thoughtful diagnosis of comorbid major depression in patients with dementia.

Epidemiological studies show chronic marijuana users have poorer outcomes for both physical health and psychosocial functioning. Evidence has shown that a potential mechanism of action for marijuana's effect is the endogenous cannabinoid system and the active compound Δ9-tetrahydrocannabinol (THC). There is mounting evidence that marijuana withdrawal has clinically identifiable symptoms which follow a time course typical of other substance withdrawal syndromes. Substitution strategies are a typical treatment strategy in addiction treatment. Nabilone [Cesamet®] is a synthetic cannabinoid that may mediate the effects of marijuana; however this has not been evaluated in humans. Therefore, we assessed the safety of Nabilone [Cesamet®] in subjects using marijuana. Subjects were randomized into treatment (n = 22) and control (n = 22) arms, and received a three-week, daily dose of Nabilone [Cesamet®] at 1 mg/day or placebo. Safety outcomes consisted of vital signs, hematology, ECG, urinalysis, and adverse events...

A review of the Western mental health scales that have been utilized in Nepal was conducted. Academic search engines (PubMed, MEDLINE, PsychLIT, Social Sciences Citation Index, and Anthropology Plus) were searched using relevant terms for the years 1990-2011. Search results indicated a limited number of mental health scales had been used and/or developed in Nepal with mixed emphasis on reliability and validity, as well as cultural considerations. These scales, methods and limitations are discussed within the cultural and social background of Nepal.

Introduction This study investigated the prevalence rate of current alcohol, substance use, post-traumatic stress disorder (PTSD) and depression in a cohort of Middle-Eastern government-assisted refugees (GAR) to British Columbia. Methods A group of GARs (32 men and 36 women) were interviewed and assessed using four clinical assessments (AUDIT, DUDIT, IES-R, PHQ-9) at an intake facility in Metro Vancouver. Results Men had a higher prevalence of alcohol use compared to women (15.6% versus 0%, P

Background: There is a paucity of research on the use of pro re nata (PRN) medications in psychiatry, and even more so, their use in patients diagnosed with concurrent disorder (CD). Aim: To provide an initial review and description of this population with respect to the administration of PRN medications. Method: A retrospective review of 135 charts was conducted on patients admitted to the University of British Columbia Concurrent Disorder Unit from 1 June 2008 to 31 December 2008. Results: A total of 133 (98.5%) of the 135 patients had at least one PRN order in their charts. The most frequently ordered medications for use as a PRN were Lorazepam (103 orders), Quetiapine (91 orders), and Loxapine (68 orders). The mean dosages delivered for all medications were in the low, sedative range. The most common reasons for prescribing across medications were for: sleep, agitation, anxiety, and withdrawal symptoms. With respect to the proportion of PRN orders to actual PRN medications administered, Quetiapine (83...

Study design We have conducted an outcome instrument validation study. Objective Our objective was to develop a computerized adaptive test (CAT) to measure 5 domains of health-related quality of life (HRQL) and assess its feasibility, reliability, validity, and efficiency. Summary of background data Kopec and colleagues have recently developed item response theory based item banks for 5 domains of HRQL relevant to back pain and suitable for CAT applications. The domains are Daily Activities (DAILY), Walking (WALK), Handling Objects (HAND), Pain or Discomfort (PAIN), and Feelings (FEEL). Methods An adaptive algorithm was implemented in a web-based questionnaire administration system. The questionnaire included CAT-5D-QOL (5 scales), Modified Oswestry Disability Index (MODI), Roland-Morris Disability Questionnaire (RMDQ), SF-36 Health Survey, and standard clinical and demographic information. Participants were outpatients treated for mechanical back pain at a referral center in Vancouver, Canada. Results A total of 215 patients completed the questionnaire and 84 completed a retest. On average, patients answered 5.2 items per CAT-5D-QOL scale. Reliability ranged from 0.83 (FEEL) to 0.92 (PAIN) and was 0.92 for the MODI, RMDQ, and Physical Component Summary (PCS-36). The ceiling effect was 0.5% for PAIN compared with 2% for MODI and 5% for RMQ. The CAT-5D-QOL scales correlated as anticipated with other measures of HRQL and discriminated well according to the level of satisfaction with current symptoms, duration of the last episode, sciatica, and disability compensation. The average relative discrimination index was 0.87 for PAIN, 0.67 for DAILY and 0.62 for WALK, compared with 0.89 for MODI, 0.80 for RMDQ, and 0.59 for PCS-36. Conclusion The CAT-5D-QOL is feasible, reliable, valid, and efficient in patients with back pain. This methodology can be recommended for use in back pain research and should improve outcome assessment, facilitate comparisons across studies, and reduce patient burden.

Behavioural and psychological symptoms of dementia (BPSD) are prevalent and have an impact on the care of persons with dementia. Previous studies regarding predisposing factors have included pharmacotherapy, but other factors may not have been sufficiently studied. We hypothesized that psychotropic medications, past history, comorbid psychiatric disorders and other factors may be relevant factors related to BPSD.Data were collected from patients' medical charts at an extended care facility over a 2-year period from 1 May 2008 to 30 April 2010. Information obtained included the presence of BPSD, gender, age, marital status, past history, comorbid psychiatric disorder and medication use. Patients were divided into two groups: a group with BPSD (n = 29) and a group without BPSD (n = 10). A binomial logistic regression analysis was performed for the above factors.Comorbid major depression was linked to BPSD (odds ratio = 12.57, 95% confidence interval: 1.31-120.74) as well as to the use of antidepressants (odds ratio = 6.49, 95% confidence interval: 1.02-41.25). There was a trend towards statistical significance in the relationship between greater use of antidepressants for the patients with comorbid major depression and the presence of BPSD. Past history of depression (Fisher's exact test; P = 0.03) and cerebral vascular accident (degrees of freedom = 1, χ(2) = 4.44, P = 0.04) were linked to the presence of BPSD and comorbid major depression.Accurate evaluation and treatment of comorbid major depression may affect BPSD. In order to reduce the burden of BPSD on patients and caregivers, there should be a careful and thoughtful diagnosis of comorbid major depression in patients with dementia.

A review of the Western mental health scales that have been utilized in Nepal was conducted. Academic search engines (PubMed, MEDLINE, PsychLIT, Social Sciences Citation Index, and Anthropology Plus) were searched using relevant terms for the years 1990-2011. Search results indicated a limited number of mental health scales had been used and/or developed in Nepal with mixed emphasis on reliability and validity, as well as cultural considerations. These scales, methods and limitations are discussed within the cultural and social background of Nepal.

This descriptive study presented an overview of culturally sensitive mental health services and potential barriers for immigrant Canadians. A semi-structured questionnaire was developed and administered to 173 patients who attended a large cross-cultural psychiatry outpatient clinic in Vancouver, British Columbia, Canada. Results indicated that only 21% of patients were able to state their diagnosis or were able to describe the symptoms of their diagnosis that met the DSM-IV criteria given by a psychiatrist. Examination of patient ethnicity showed that more South Asian (25%) or Southeast Asian (24%) patients had more diagnoses of anxiety disorder in comparison to other ethnic groups. Refugees characterized mental illness in terms of stress or stress-related factors (30%) in comparison to non-refugees (13%). There was a greater preference in women, when compared to men, to prefer the term ‘client’ versus ‘patient’. These results elucidate the importance of cultural and systemic barriers for immigrant Canadians. The need for appropriate service delivery is discussed.

Miyagi Chojun (1888-1953) was the founder of Goju-ryu; a karate-do style that purportedly had ties to a Chinese boxing school established on Okinawa in 1828 and was based on the teachings of his primary instructor Higaonna Kanryo (1850-1915). Yet, the continuity of modern Goju-ryu with respect to its katas (forms) and these historical sources has never been established. Therefore, we employed a statistical technique to examine the relationship between the classical katas of modern Goju-ryu. It was reasoned that there would be continuity across all katas of modern Goju-ryu if they indeed came from a similar source. The results were insightful and suggest the possible origins of Goju-ryu katas.

Background: Schizophrenia is a chronic debilitating disease that affects ~110,000 Canadians (0.55% lifetime prevalence). Risperidone long-acting injection (RLAI) is the first injectable, long-acting, atypical antipsychotic drug marketed in Canada. Objective: The aim of this study was to assess the clinical effectiveness and hospitalization rates of patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder treated with RLAI in a community mental health care setting. Methods: Data were collected between August 1, 2006 and September 30, 2006 via a retrospective chart review of outpatients diagnosed with schizophrenia, schizoaffective disorder, or schizophreniform disorder who received treatment from 1 of the 8 mental health teams within the Vancouver Community Mental Health Organization (VCMHO) in Vancouver, British Columbia, Canada. Collected data included: frequency and duration of institutional care, discharge and relapse rates, demographic variables, diagnosis history, RLAI medication history, and history of other medications. The overall severity of symptoms before and after RLAI treatment and the improvement in symptoms during treatment were evaluated using the Clinical Global Impression Scales for severity (CGI-S)(1 = not ill to 7 = extremely ill) and improvement (CGI-I)(1 = very much improved to 7 = very much worse). Results: Forty-four patients were identified as having received RLAI. The charts of 19 patients (10 men, 9 women; mean [SD] age at time of chart audit, 36.7 [11.7] years; mean [SD] age at primary diagnosis, 23.6 [7.4] years; race: white, 10 [52.6%]; Asian, 6 [31.6%]; American Indian, 1 [5.3%]; black, 1 [5.3%]; other, 1 [5.3%]) were included in the analysis. The majority of patients (78%) had been treated with another antipsychotic drug prior to treatment with RLAI: risperidone (77%), quetiapine (47%), zuclopenthixol (43%), olanzapine (43%), and loxapine (17%). Mean (SD) CGI-S Scale score declined significantly from 5.29 (1.3) before treatment initiation to 3.05 (1.0) posttreatment (P < 0.001). Mean (SD) CGI-I Scale score was 2.58 (0.71) (P < 0.001); 94% of patients had a CGI-I score ≤3. Mean (SD) duration of hospitalization decreased significantly from 15.7 (19.7) days before treatment to 2.4 (6.0) days after treatment (P < 0.05). Mean (SD) number of hospializations also decreased significantly from 2.0 (1.8) before treatment to 0.5 (1.3) after treatment (P < 0.01). Conclusions: The results of this pilot study suggest that use of the atypical-antipsychotic medication RLAI significantly decreased duration and rates of hospitalization, compared with baseline, in these VCMHO patients with schizophrenia spectrum illnesses.

Introduction: There is a dearth of evidence on indications for transfer of care from adult to geriatric mental health services for patients with adult-onset mental illness. In Vancouver, Canada, it is the responsibility of the Vancouver Coastal Health Authority Older Adult Mental Health Centralized Intake Service (OAMHCI) to triage referrals to older adult mental health teams (OAMHT). OAMHCI has seen increasing referrals from adult mental health teams (AMHT). This patient population is followed by adult psychiatrists for chronic mental illnesses such as Schizophrenia and Depression. Given changing demographics, anticipated growth in the geriatric population and limited resources, it is increasingly important to understand the reasons for these referrals and clarify indications for acceptance into geriatric psychiatry. This study is a retrospective chart review of referrals to OAMHCI of patients with chronic psychiatric diagnoses from AMHT. Its aim is to determine what factors predict acceptance to an OAMHT versus bounce-back to AMHT care. This information potentially serves to inform recommendations to adult psychiatrists regarding necessary screening prior to referral as well as characteristics of appropriate patients for geriatric psychiatry services. Older adult mental health resources are increasingly strained with the aging population. Optimizing the triage process is therefore a critical issue looming on the healthcare horizon with implications for empowering aging in those with chronic mental illness. Methods: A detailed, structured data form was used to abstract clinical and demographic information from the medical records of 81 patients (female1⁄451; male1⁄430) referred to OAMHCI in order to determine which factors contributed to acceptance into the program. Institutional ethics approval was in place. Results: Sixty patients (77%; mean age: 68.13 8.4 years) were accepted into an OAMHT while nineteen (23%; mean age: 67.16 9.9 years) were not. Chi-square analysis revealed that rejected patients were less likely to have a confirmed diagnosis of cognitive impairment or dementia (84% vs. 16%; X21⁄45.84, p

Understanding the role of religion and spirituality is significant for psychiatric practice. Implementation of formal education and training on religious and spiritual issues, however, is lacking. Few psychiatric residencies offer mandatory courses or evaluation of course utility. The authors present findings from a pilot study of a course on the interface between spirituality, religion, and psychiatry. Course objectives were to increase both residents’ understanding of clinically relevant spiritual/religious issues and their comfort in addressing these issues in their clinical work. A 6-hour mandatory course was implemented for third- and fourth-year psychiatry residents at the University of British Columbia. Teaching sessions consisted of didactic and case-based modules delivered by multidisciplinary faculty. The Course Impact Questionnaire, a 20-item Likert scale, was used to assess six areas: personal spiritual attitudes, professional practice attitudes, transpersonal psychiatry, competency, attitude change toward religion and spirituality, and change in practice patterns. A pre/post study design was used with the questionnaire being administered at week 0, week 6, and 6 months follow-up to two groups of residents (N=30). Qualitative feedback was elicited through written comments. The results from this pilot study showed that there was increased knowledge and skill base for residents who participated in the sessions. Paired t test analysis indicated a statistically significant difference between the pre- and postsession scale for competency. No other statistically significant differences were found for the other components. The findings suggest improvement in the competency scores for residents and overall usefulness of this course; however, limited conclusions can be made due to a small sample size and lack of adequate comparison groups. Establishing educational significance will require gathering larger usable control data as well as validation of the Course Impact Questionnaire tool to distinguish between different skill levels.