Introduction: Using an animal model, we examined weight gain in rats exposed to olanzapine, as well as whether increased weight was associated with food intake, visceral fat and/or locomotion. Methods: Sprague-Dawley rats were chronically treated with olanzapine while being offered diets including standard chow, a high fat (60% fat) diet, and a high fat/high carbohydrate (42% fat; 42.7% carbohydrate) diet. Body weight, food intake, visceral fat and locomotor activity were measured. Results: Our findings related to weight gain are in line with other reports indicating that while olanzapine-induced weight gain can be observed, it does not mirror what is observed in humans on two levels: (i) it is not of the same magnitude, and (ii) it is more gender specific i.e., females greater than males. Conclusions: These data confirm that chronic treatment with olanzapine has varying effects on weight gain, food intake, visceral fat and locomotor activity.

Siblings of children with cancer encounter stressors and challenges that can lead to severe distress and a host of psychological difficulties. Factors including age, gender, and disease characteristics of the child with cancer are reported to influence sibling adjustment. The majority of research, however, is dated, inconsistent, and marred by methodological problems. Guided by the disability-stress-coping model, the study examined the: (a) frequency of sibling and parent reported symptoms of anxiety and depression, internalizing and externalizing behavior problems, and somatic problems, (b) influence of sibling, family, and disease factors on sibling adjustment, (c) moderating effects of age on the relationship between sibling factors and sibling adjustment, and (d) mediating effect of primary cognitive appraisal on the relationship between self-esteem and sibling adjustment. One hundred and eight siblings (7-17 years; 51 males; 57 females) participated. Siblings completed the State-Trait Anxiety Inventory for Children and the Children’s Depression Inventory to provide measures of sibling reported symptoms of anxiety and depression. Parents completed the Child Behavior Checklist to provide measures of parent reported internalizing behavior problems, externalizing behavior problems, and somatic problems. The communication and intrapersonal thoughts and feelings subscales of the Sibling Perception Questionnaire, completed by siblings, were used to assess perceived social support and primary cognitive appraisal. Self-esteem was assessed with the global self-worth subscale of the Self Perception Profile for Children/Adolescents, completed by siblings. Hierarchical regression analyses were conducted to assess the direct and indirect effects of sibling, family, and disease factors on psychological outcomes. Siblings and parents reported higher incidents of clinically significant symptoms of anxiety, internalizing behavior problems, and somatic problems than expected in a normative population. Sibling age and gender, diagnosis of the child with cancer, social support, self-esteem, and primary cognitive appraisal were significantly associated with sibling and parent reported psychological adjustment measures. Age moderated the relationship between gender, social support, and primary cognitive appraisal and several adjustment outcomes. Lastly, primary cognitive appraisal partially mediated the relationship between self-esteem and sibling reported anxiety and depression symptoms. These findings highlight the need for sibling psychosocial interventions and provide direction for the development and implementation of such groups.

Background: Reduced bone mineral density (BMD) is an established complication of anorexia nervosa (AN). There is inconclusive evidence as to whether this reduction in bone mass is permanent or can be reversed with recovery from AN. The objectives of this study were to: i. determine the extent of reversal of skeletal deficits with recovery from AN, and the duration of recovery required for complete reversal, if this occurred; and, ii. evaluate the effect of key illness characteristics on BMD. Methods: Women (aged 17-40 years) who had previously received inpatient treatment for AN at one of two hospital-based programs were selected for this cross-sectional study; 514 healthy premenopausal women recruited from the community served as a control group. A detailed lifetime illness history was obtained by a Life History Calendar interview. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the spine, hip and total body. Low BMD was defined as a weight and age-matched standard deviation (Z-score) of ≤ -1.5 at one or more skeletal sites. Participants were considered recovered if they had maintained a body mass index ≥ 18.5 kg/m2 and resumed regular menstruation for ≥ 1 year. Results: Of 190 AN participants, 77 were considered recovered and 113 were ill. The prevalence of low BMD was 11.7% in the recovered group, 47.3% in the ill group and 6.8% in the control group. The odds of low BMD in the recovered participants was significantly lower than in the ill participants (odds ratio [OR] = 0.17, 95% CI 0.07, 0.36, p<0.0001) and was not significantly different from the controls (OR = 1.81, 95% CI 0.79, 3.78, p=0.15). Duration of illness was associated with low BMD (OR = 1.16, 95% CI 1.08, 1.25, p<0.0001) and was negatively associated with the odds of AN recovery. Normal mean BMD values at each skeletal site were observed in women recovered ≥ 3 years. Conclusion: The results emphasize the importance of early and sustained AN recovery for the prevention and treatment of low bone mass in this population and may offer motivation for AN patients to make positive behavioural changes leading to successful, long-term recovery.

BACKGROUND: Teratology Information Services (TIS) educate the public and health professionals via telephone regarding the safety of drugs and other exposures during pregnancy and lactation. Currently TIS consultations are free, but funding is eroding. A cost-benefit analysis may inform resource allocation. It was hypothesized that an individual TIS consultation regarding anti-depressant use during pregnancy provides a positive net benefit compared to a family doctor (FD) consultation. METHODS: A survey of international TIS was conducted to gauge TIS costs. A discrete choice experiment (DCE) was designed to assess preferences and willingness-to-pay (WTP, an estimate of benefit) for teratology counseling. DCE respondents (local community volunteers) chose between potential counseling services following an anti-depressant exposure during pregnancy. Services were described by five service attributes and one cost attribute, which were generated in focus groups. Preferences and WTP were estimated using logit regression. Incremental benefits and costs of counseling by TIS and FD were compared in a probabilistic sensitivity analysis to obtain the incremental net benefit from both a societal (productivity costs included) and health system perspective. The FD consultation was costed through OHIP billing codes. The TIS consultation was micro-costed. RESULTS: Eighteen TIS in North America and 16 international TIS completed the survey. Most TIS are small (median two employees, median budget US$69,000). The DCE had 175 respondents. The most important attribute of counseling was receiving very helpful information; information delivery methods were less important. WTP for the TIS scenario was CDN$124 (SD $12); WTP for the FD scenario was CDN$79 (SD $8). Service costs were similar for TIS and FD (approximately $32/consultation); FD had higher productivity costs. Incremental TIS benefits were likely to outweigh costs under both the societal and health system perspectives (probability 99% and 97% respectively). CONCLUSIONS: An economic evaluation of a program that delivers pregnancy health information via telephone required a novel approach. While there are some methodological challenges to valuing benefits through willingness-to-pay, it may be appropriate for valuing counseling. TIS should emphasize their ability to provide high quality information. The benefits of an individual TIS consultation on anti-depressant use during pregnancy are likely greater than the costs.

Background: Reduced bone mineral density (BMD) is an established complication of anorexia nervosa (AN). There is inconclusive evidence as to whether this reduction in bone mass is permanent or can be reversed with recovery from AN. The objectives of this study were to: i. determine the extent of reversal of skeletal deficits with recovery from AN, and the duration of recovery required for complete reversal, if this occurred; and, ii. evaluate the effect of key illness characteristics on BMD. Methods: Women (aged 17-40 years) who had previously received inpatient treatment for AN at one of two hospital-based programs were selected for this cross-sectional study; 514 healthy premenopausal women recruited from the community served as a control group. A detailed lifetime illness history was obtained by a Life History Calendar interview. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the spine, hip and total body. Low BMD was defined as a weight and age-matched standard deviation (Z-score) of ≤ -1.5 at one or more skeletal sites. Participants were considered recovered if they had maintained a body mass index ≥ 18.5 kg/m2 and resumed regular menstruation for ≥ 1 year. Results: Of 190 AN participants, 77 were considered recovered and 113 were ill. The prevalence of low BMD was 11.7% in the recovered group, 47.3% in the ill group and 6.8% in the control group. The odds of low BMD in the recovered participants was significantly lower than in the ill participants (odds ratio [OR] = 0.17, 95% CI 0.07, 0.36, p<0.0001) and was not significantly different from the controls (OR = 1.81, 95% CI 0.79, 3.78, p=0.15). Duration of illness was associated with low BMD (OR = 1.16, 95% CI 1.08, 1.25, p<0.0001) and was negatively associated with the odds of AN recovery. Normal mean BMD values at each skeletal site were observed in women recovered ≥ 3 years. Conclusion: The results emphasize the importance of early and sustained AN recovery for the prevention and treatment of low bone mass in this population and may offer motivation for AN patients to make positive behavioural changes leading to successful, long-term recovery.

BACKGROUND: Teratology Information Services (TIS) educate the public and health professionals via telephone regarding the safety of drugs and other exposures during pregnancy and lactation. Currently TIS consultations are free, but funding is eroding. A cost-benefit analysis may inform resource allocation. It was hypothesized that an individual TIS consultation regarding anti-depressant use during pregnancy provides a positive net benefit compared to a family doctor (FD) consultation. METHODS: A survey of international TIS was conducted to gauge TIS costs. A discrete choice experiment (DCE) was designed to assess preferences and willingness-to-pay (WTP, an estimate of benefit) for teratology counseling. DCE respondents (local community volunteers) chose between potential counseling services following an anti-depressant exposure during pregnancy. Services were described by five service attributes and one cost attribute, which were generated in focus groups. Preferences and WTP were estimated using logit regression. Incremental benefits and costs of counseling by TIS and FD were compared in a probabilistic sensitivity analysis to obtain the incremental net benefit from both a societal (productivity costs included) and health system perspective. The FD consultation was costed through OHIP billing codes. The TIS consultation was micro-costed. RESULTS: Eighteen TIS in North America and 16 international TIS completed the survey. Most TIS are small (median two employees, median budget US$69,000). The DCE had 175 respondents. The most important attribute of counseling was receiving very helpful information; information delivery methods were less important. WTP for the TIS scenario was CDN$124 (SD $12); WTP for the FD scenario was CDN$79 (SD $8). Service costs were similar for TIS and FD (approximately $32/consultation); FD had higher productivity costs. Incremental TIS benefits were likely to outweigh costs under both the societal and health system perspectives (probability 99% and 97% respectively). CONCLUSIONS: An economic evaluation of a program that delivers pregnancy health information via telephone required a novel approach. While there are some methodological challenges to valuing benefits through willingness-to-pay, it may be appropriate for valuing counseling. TIS should emphasize their ability to provide high quality information. The benefits of an individual TIS consultation on anti-depressant use during pregnancy are likely greater than the costs.

Mental stress resulting from a traumatic event in the workplace has a noteworthy impact on employees. Psychological debriefing is offered to TTC employees as a means of immediate trauma support, however, the usefulness of the intervention is unknown. This thesis explores the debriefing intervention using a mixed methods approach. TTC employees who have experienced a traumatic event were recruited. Post Traumatic Stress Disorder (PTSD) symptom development and time lost from work were compared between debriefed and not debriefed employees. In addition, purposively selected employees were qualitatively interviewed. The quantitative analysis showed no significant differences in PTSD symptomatology or lost time from work between the groups. Despite these results, however, employees who were debriefed had an overall positive perception of the intervention. Further exploration in this area of study would be beneficial to not only the TTC, but to all workplaces at high risk of exposure to traumatic events.

Background: Serum estradiol levels decline after menopause and the effect on mental health-related quality of life (MHR-QOL) is unclear. Objective: To determine if there is an association between endogenous serum estradiol levels and MHR-QOL in healthy postmenopausal women. Methods: This cross-sectional study used baseline Canadian data from the Mammary Prevention.3 trial. Serum estradiol was measured with liquid chromatography-tandem mass spectrometry. Outcomes for MHR-QOL were the Medical Outcomes 36-Item Short Form Health Survey (SF-36) Mental Health Inventory-5 (MHI-5), Mental Component Summary (MCS), and the Menopause-Specific Quality of Life Questionnaire (MENQOL)-psychosocial domain. Results: There were no statistically significant associations between estradiol levels and MHR-QOL in univariate analyses (n=455). Multivariable linear regression predicted statistically significant differences in MCS (R2=0.10, P=0.03) and MENQOL-psychosocial domain (R2=0.10, P=0.04), however estradiol was not a significant predictor. Conclusions: This study did not find a statistically significant association between endogenous serum estradiol levels and MHR-QOL in healthy postmenopausal women.

Mental stress resulting from a traumatic event in the workplace has a noteworthy impact on employees. Psychological debriefing is offered to TTC employees as a means of immediate trauma support, however, the usefulness of the intervention is unknown. This thesis explores the debriefing intervention using a mixed methods approach. TTC employees who have experienced a traumatic event were recruited. Post Traumatic Stress Disorder (PTSD) symptom development and time lost from work were compared between debriefed and not debriefed employees. In addition, purposively selected employees were qualitatively interviewed. The quantitative analysis showed no significant differences in PTSD symptomatology or lost time from work between the groups. Despite these results, however, employees who were debriefed had an overall positive perception of the intervention. Further exploration in this area of study would be beneficial to not only the TTC, but to all workplaces at high risk of exposure to traumatic events.

The discovery that it is possible to identify an individual before the onset of first episode psychosis and that treatment may prevent or delay onset have led to a proliferation of early intervention clinics designed to intervene before symptoms of psychosis have fully appeared. Early intervention has generated considerable debate, given the risks associated with intervening and that the majority of those identified will never develop full-blown psychosis. Despite potential stigmatizing effects, little is known about young people’s views regarding the favourable and/or adverse consequences of early intervention. This research examines the experiences and meaning of illness in young people identified as being at ultra high risk for psychosis and participating in a psychological intervention program. Specifically, the study uses photo elicitation to explore how participants construct and interpret their experiences, and the impact an at risk label has on their sense of self, identity, and social relationships. Five young people were invited to photograph their daily experiences at home, at school, and in the community. The participants and I then analyzed the photographs together in a photo elicitation interview. I further analyzed the visual and textual data from an interactionist perspective, exploring the concept of stigma and its relationship to young people’s experiences. Visual and narrative data revealed that young people reject their at risk status and redefine their experiences to fit with more acceptable and familiar notions of health. Participants are conscious of the stigma associated with psychosis and actively undertake strategies of resistance to avoid stigmatization and uphold a normal self conception and social impression. Photo elicitation provided insight and understanding into the experiences of young people at risk for psychosis that were not available through more traditional methods. The results from this study support the call for a reconsideration of the psychosis risk paradigm. There is a need to increase awareness about the power of diagnostic information and the labeling process. Non-specialized settings such as schools and community health centres may offer more appropriate environments for mental health monitoring and intervention.