Abnormal connectivity between the prefrontal cortex (PFC) and other brain regions has been demonstrated in subjects with schizophrenia. We tested if abnormal connectivity, particularly between PFC and the medial temporal lobes (MTL), underlies the reduced brain activity and level of accuracy observed in schizophrenia subjects during episodic memory tests. We used fMRI to examine activation in fifteen chronic, medicated schizophrenia subjects and eighteen control subjects in two different recognition memory tests. The item recognition memory test required subjects to make old/new judgments, and the associative recognition memory test required them to make intact/rearranged judgments. We examined brain connectivity separately, with a structural equation modeling, based on anatomical links found in the literature. During associative recognition memory, subjects with schizophrenia failed to demonstrate the significant connectivity bilaterally between different areas of PFC and posterior MTL/fusiform regions that was observed in control subjects. However, during recognition memory of individual items, subjects with schizophrenia demonstrated significant connectivity between the anterior part of the MTL and medial PFC similar to control subjects. These findings provide evidence of a lack of proper integration between PFC and fusiform/MTL areas underlying episodic memory deficits of visual objects in schizophrenia, particularly during associative recognition memory.

The present study was designed to investigate the neuropsychological functioning of two groups of children: one evaluated as having borderline psychopathology, and a second with psychiatric disorders such as conduct disorder and/or attention deficit hyperactivity disorder, but not BPD. The total sample included 83 subjects, 71 boys and 12 girls, ranging in age from seven-12 years. Borderline psychopathology was assessed using the Child Diagnostic Interview for Borderlines (C-DIB-R). Frontal-system functioning was assessed with the Continuous Performance Test, the Wisconsin Card Sorting Test, and the Rey Complex Figure Test. IQ was evaluated with the Wechsler Intelligence Scale for Children - Third Edition, and the Quick Neurological Screening Test was given to identify any soft sign neurological impairments. It was found that there were specific neuropsychological deficits associated with borderline pathology, including poor attentiveness, marked impulsivity, risk taking behaviour and poor conceptual learning.

In an epidemiological study of mental health in couples, individual and systemic approaches were compared in terms of their appropriateness for general versus clinical populations. / The primary results from the study of 845 couples in the general population suggest that there exists a significant spouse-similarity across the various mental health dimensions examined (psychological distress, general well-being, and role satisfaction). / The main results from the study of 17 couples in marital therapy suggest that significant sex differences exist in dyadic adjustment. Sex differences were also noted in the correlations between dyadic adjustment and depressive symptoms. / In conclusion, it appears that epidemiological research on the mental health of couples should have as its objective a simultaneous consideration of both the individual and the couple, as well as a simultaneous consideration of clinical and general populations, in order to create a double complementarity out of this apparent double dichotomy.

This thesis presents a qualitative study that used the making of self-portraits and their incorporation in collages to investigate issues of identity among recently arrived adolescent refugees. These collages were then analyzed to shed light on the influence of both the migration process and adolescence on the subjects' sense of their identity. / Fourteen asylum claimant teenagers---recently arrived in Canada from Latin America, the Middle East, and Africa---were asked to produce a collage that represents him- or herself. The collages consisted of a photographic self-portrait and images that the subjects culled from various newspapers and magazines made available to them. Nondirective interviews with the subjects, conducted in a subsequent session, provided biographical information that was used to support the analysis of the collages. / The study indicates that, transcending differences in geo-cultural origin, there are clear differences in the self-representation of male and female adolescents. This result underlines how much the construction of identity during adolescence is primarily that of gender identity. In addition, the study shows that despite the predominance of a "globalized youth culture," each teenager appropriates this culture according to his/her need to identify with and differentiate from the host society. The collages also indicated an engagement by the subjects in working out the comfort they draw or pain they feel in relation to the country and culture they have left behind. Finally, the collages also included a temporal dimension and the emphasis on the past, present, or future seems to correspond to the subjects' differing strategies for working through the experience of geo-cultural dislocation. / The study concludes that creative exercises such as self-portraiture and collage provide a rich source of psychological material and a non-threatening way of gaining access to the imaginary of recently arrived refugee teenagers. Consequently, the approach used here could also be used as a tool to provide support to adolescent asylum seekers. The results also indicate a need for a greater understanding of the relationship between self-image and mental health.

The present investigation explored the determinants and effects of switching antipsychotic medications in a "real-world" clinical setting. Methods . A hospital chart review of randomly selected patient files was undertaken. Comparisons were made between patients who were maintained on the same antipsychotic versus those who were switched or initiated on polypharmacy for socio-demographic and clinical characteristics, and psychiatric services utilized during the two year study period. Results. Eleven per cent (n=23) of the included patients (N=201) experienced a switch, and 11 % (n=22) had another antipsychotic added to their treatment. A history of recent psychiatric hospitalizations and secondary diagnoses of personality disorders were more common among switched and add-on patients than maintenance group patients. During the study period, significantly more switched and add-on patients used outpatient, emergency and inpatient psychiatric services than maintained patients. Conclusions. Patients whose antipsychotic treatment was changed had likely been experiencing clinically significant problems for which a change was implemented. The high rate of study service use indicates that these problems were conserved despite changes in antipsychotic medications.

Background. Diagnosing major depression in the medically ill is difficult because of the overlap of somatic symptoms between the two entities. No studies have examined this issue in advanced HIV disease. Methods. Male subjects with a CD4 count ≤200 were recruited from a specialised outpatient HIV treatment centre. They completed a 30 minute questionnaire and then participated in a diagnostic interview with an HIV psychiatrist. Results. Eight (19.0%) of 42 subjects were diagnosed with major depression. Both inclusive and exclusive approaches to the diagnosis increased the prevalence to 21.4%. Predictive items on the self-report depression scales were inserted in a logistic regression. Four items pertaining to self-worth, discouragement, crying and irritability were left in the model. All somatic items were excluded. Conclusion. This study is an important first step in devising a self-report instrument that would be useful in detecting clinical depression in patients with advanced HIV disease.

Mortality rates have consistently been shown to be greater in patients with delirium compared to those without. Published work over the last decade has revealed however, that several confounding factors play key roles in contributing to the excess mortality in the delirium population and that statistical adjustment for these factors in multivariate analyses minimizes, if not eliminates, the association between delirium and mortality. These factors include pre-existing dementia, advanced age, severe medical illness, diminished functional status, and intoxication or withdrawal from medications. However, studies on prognosis and prognostic indicators of delirium in the past have been limited to subjects admitted to the hospital where the sample may include both incident and prevalent cases of delirium. / Objective. To determine whether prevalent delirium is an independent predictor for mortality among elderly patients seen in the Emergency department. Potentially confounding factors were assessed to reveal their prognostic contributions in this population. Survival analysis was carried out using the Cox Proportional Hazards Modelling technique. / Methods. As part of a larger study, 268 patients seen in the Emergency department in two Montreal hospitals (107 delirium cases, 161 controls) were followed up in 6 month intervals for a total of 18 months. Dates of deaths for the deceased were obtained from the Ministere de la Sante et des Service Sociaux. / Results. The analysis revealed a non-significant association between delirium and mortality rate for the English speaking subjects, when adjusted for age, sex, pre-morbid cognitive decline (IQCODE), Basic ADL, Instrumental ADL, comorbidity, number of medication, education (years), eyesight, and hearing problems (p = 0.752, HR =1 .095, CI: 0.622--1.929). On the other hand, for the French speaking subjects, the same model revealed a highly significant association between delirium and death rate (p = 0.001, HR = 9.078, CI: 2.362--34.892). Possible explanations for the different results are discussed.

The family history and comorbidity of 97 sequential outpatients with DSM-III panic disorder (with or without agoraphobia) was examined. Patients were diagnosed by a psychiatrist and 71 were additionally diagnosed via structured clinical interview (SCID or A-DIS-R). All subjects resided in the province of Quebec. Subjects consisted of two groups: patients referred for treatment and patients recruited by a newspaper advertisement for a drug study on panic disorder. The age of onset in both groups was inversely related to having a family history of panic disorder, or anxiety disorders, or major affective disorders, or substance abuse disorders. To evaluate the presence of psychopathology in family members a semi-structured family history interview was used throughout. Multigenerational panic disorder was defined as having three or more affected relatives in at least two generations. This familial form of panic disorder was present in 15% of the pedigrees overall. There was a significant difference between the two groups in regard to family history of major affective disorder with the referral group having significantly more probands with a family history of major affective disorder. There was no difference between groups with respect to panic disorder, anxiety disorders, or substance abuse disorders. Age of onset of panic disorder was significantly lower in probands who were referred for treatment than those recruited for the drug study. / Subjects were then recombined with respect to a history of comorbid depression. The presence of a comorbid diagnosis of depression in the proband predicted a multigenerational family history of major affective disorder.

Research has indicated that the adjustment of psychiatric patients is adversely affected by family criticism. The present study elaborated on this theme by focusing on fifty schizophrenic patients who were formally interviewed, using a standard visual analog scale format, about their perception of family criticism. Two important conceptual distinctions were proposed. The first was the extent to which criticism was perceived as "constructive" or "destructive", and the second was the extent to which the criticism was perceived to be "person directed" or "behavior directed". Regression analyses were performed in order to determine the predictive utility of the various dimensions of criticism on patient outcomes. The results indicate first, that criticism is not always perceived as negative and secondly, patients who perceived high levels of negative criticism (destructive, person directed) had relatively poor outcomes. Those who perceived high levels of positive criticism (constructive, behavior directed) had more positive outcomes. The results therefore indicate that criticism is multidimensional. This awareness of different meanings of criticism may lead to early identification of adjustment difficulties and subsequent interventions to prevent them.

Background. Previous research has indicated that although obsessive compulsive disorder (OCD) is associated with immense suffering, and social and economic costs, individuals afflicted with the disorder have a very low rate of seeking help from mental health professionals. Methods. From standardized psychiatric interviews of 7214 Edmonton residents we identified 172 subjects with a lifetime diagnosis of OCD; 37% (63/172) had consulted a doctor about their symptoms. Results. Total number of symptoms (odds ratio, OR = 3.44) and severe obsessions of violence and other unpleasant thoughts (OR = 2.62) were significantly associated with treatment seeking in the multivariate analysis. Conclusion. This study was an important step in examining which specific symptoms and comorbid conditions are associated with treatment seeking. It was somewhat surprising that neither comorbid disorders nor any compulsive symptoms were related to treatment seeking behaviour. This study may be of benefit to future public education programs especially by teaching the public about compulsions.