Background. Various treatments for ADHD have been used, but no long-term maintenance of gains have been documented once treatment was discontinued. This has led to the development of multimodal treatment. Diverse interventions are potentially beneficial to ADHD patients. / Objective. To determine whether any differences exist between the multimodal treatment group, and the two control groups, 4--7 years after completion of the program. This study examines the subjects' social, academic and behavioral functioning. / Method. A parental telephone interview was used to conduct this follow-up. / Results. At follow-up, mean age was 15.02 years. There were no significant differences between the groups, on any measure. Many subjects showed language difficulties and deteriorated upon entry into high school. / Conclusions. No differences between treatment groups emerged over time. Multimodal treatment did not significantly improve outcome over stimulant treatment alone. Language difficulties and greater risk for failure upon entry into high school are apparent in this population. Overall, despite difficulties, parental reports indicate most of the subjects are functioning reasonably well: 33.3% of parents reported improvement, 41.6% reported stability of their child's behavior, and 25.1% reported deterioration. This may be due to the fact that 60% were still on medication.

Although clinical heterogeneity of schizophrenia has been well established, attempts to account for variance in clinical measures, with environmental risk factors, have been limited. Previous studies failed to examine numerous course and outcome measures within the context of multiple risk factors, within one sample. The goal of this study was to examine the role of three environmental risk factors (birth season, prenatal maternal stress and obstetric complications (OCs)) in explaining heterogeneity in clinical measures in a single sample. Our results suggest the three risk variables are independent of one another. Our findings also consistently implicated summer-fall birth season with poor premorbid adjustment, and with greater negative symptomatology. A causal model with birth season, social problems, onset of prodrome and negative symptoms found both summer-fall birth and earlier onset of prodrome to directly predict greater negative symptoms. Summer-fall birth season also predicted earlier onset of prodrome, via greater childhood social problems.

Evidence indicates that levels of insulin-like growth factor-I (IGF-I) are elevated in the serum of Alzheimer's disease patients. In the present study, using membrane binding assays, we have shown that [125I]IGF-I receptor binding sites are not significantly altered in the frontal cortex, hippocampus and cerebellum of the AD brain. However, in vitro receptor autoradiography revealed significant increases in the density of [125I]IGF-I receptor binding sites in layer IV of the frontal cortex, the stratum oriens of the hippocampus and the putamen nucleus of the striatum but not in other regions of the AD brain. IGF-I immunoreactivity was evident in the pyramidal neurons of the frontal cortex, pyramidal layer of CA1--CA4 subfields and the hilar neurons of the hippocampus, as well as the Purkinje cells of the cerebellum in control and AD brains. Additionally, in the AD brain, IGF-I immunoreacitivity was also observed to be localized with Abeta-containing diffuse and neuritic plaques as well as in astrocytes in the gray matter of the cortex and the hippocampus. These findings, taken together, indicate that although no striking alterations have been found in the number of IGF-I receptors or the peptide itself in the AD brain, the presence of immunoreactive IGF-I in the neuritic plaques suggests a putative role for the growth factor in AD pathology.

Objective. To determine whether having a condition of unknown medical cause contributes to perceived stigma in individuals with functional somatic syndromes (FSS). / Methods. Subjects in three FSS groups, irritable bowel syndrome (IBS), fibromyalgia (FM), and chronic fatigue syndrome (CFS), were matched to medical control groups. Self-report measures were used to collect sociodemographic information, and rates of depression, physical functioning, and perceived stigma. / Results. Having the FSS was associated with perceived stigma in CFS compared to the medical control group, and remained an independent predictor when controlling for depression and physical functioning on multivariate analysis. These effects were not seen in FM or IBS compared to medical control groups. / Conclusions. The ambiguity of having a medically unexplained syndrome may contribute to perceived stigma in CFS. The absence of this effect in FM and IBS may reflect a greater acceptance of FM and IBS as medical conditions.

<p> This study investigated the effects of the Trauma, Recovery, and Empowerment Model (TREM) on the female offender population in a community setting. The TREM intervention is a 33-topic model that focuses on trauma specific to women through psycho-education and cognitive-behavioral methods. This quasi-experimental study with an intervention and treatment-as-usual (TAU) group used the Brief Symptom Inventory-18, Modified Posttraumatic Symptom Scale, Addiction Severity Index, the Daily Living/Role Functioning and Relation to Self and Others Subscales (BASIS 32), and Trauma, Recovery and Empowerment Profile (TREP) to determine whether the group receiving the TREM intervention had reduced PTSD symptoms, general mental health symptoms, substance use, increased social role functioning and increased relation to self and others, as well as increased trauma-related coping skills. T-tests, correlations, and effect sizes were used to assess outcomes from baseline to post-intervention or 3-month follow up within the intervention group, and between the intervention and TAU group. Results of the t-tests ns between variables of interest failed to reach statistical significance, however significant correlations and non-significant medium to large effect sizes were found on the BASIS-32 Subscales and Modified Posttraumatic Symptom Scale, small to medium effects were found on the Global Severity Index (BSI-18), with small to no effect for the Trauma, Recovery and Empowerment Profile, and the Addiction Severity Index Drug and Alcohol Composite scores. Qualitative analysis also revealed support for the model by participants. These results somewhat support the current research in showing effectiveness for the TREM intervention with females, however more research and investigation into the TREM intervention is warranted.</p>

Schizophrenia (SCZ) is believed to be a neurodevelopmental disorder resulting from genetic and environmental factors. Obstetric complications, particularly fetal hypoxia, seem to be a risk factor for SCZ. The hippocampus is highly sensitive to ischemic episodes, and there is substantial evidence for hippocampal malfunction in SCZ. Thus, utilizing a rat model of global anoxia (15 min and 21 min) during Cesarean-section birth (C-section), hippocampal proliferation was examined in the dentate gyrus and CAI region at postnatal day 21 and day 60. Incorporation of 5-bromo-2-deoxyuridine (BrdU) was used as a marker of cell proliferation. Rats were sacrificed 2 hours after BrdU injection to quantify cell proliferation, or 4 weeks after BrdU injection to quantify survival of newly proliferating cells and to identify if these cells express a neuronal phenotype. Only rats that had undergone 15 minutes of hypoxia during C-section birth compared to C-sectioned controls, showed a significant increase in cell proliferation in the dentate gyrus on postnatal day 21. Thus perinatal hypoxia can have lasting effects on the hippocampus that depend on the duration of the hypoxic insult.

The three studies described in this Doctoral Thesis pertain to the neurotransmitter serotonin, the environmental factor light, and their role in the regulation of human mood as well as behavioural and perceptual aspects of daily social interaction. Participants were healthy at the time of the study but considered at risk for mood disorders in the future. In Study 1, the serotonin system was manipulated by administering tryptophan. This resulted in a decrease in quarrelsome behaviours, an increase in agreeable behaviours, and improved mood. Changes in perceptions of others were also seen. In Study 2, acute tryptophan depletion was used in conjunction with dim or bright light exposure during test days. A worsening of mood was seen under dim but not bright light conditions, which suggests that bright light was able to regulate mood by interacting with the brain serotonin system. In Study 3, this idea was explored further by investigating the links between light exposure levels and mood, as well as social behaviours and social perceptions, in everyday life. Higher levels of natural bright light exposure were associated with less quarrelsomeness, more agreeableness, and better mood. In conclusion, serotonin appears to mediate aspects of human social interaction that have been linked to a variety of mental and physical health issues. Bright light may regulate mood in part by altering the activity of the brain serotonin system. An increase in bright light exposure may have effects on mood and social interaction similar to a pharmacological manipulation of the brain serotonin system. The findings of the three studies presented here may have implications for the development of a nonpharmacological approach to the prevention of mental as well as physical disease. The various processes underlying factors that modulate social inclusion and acceptance deserve more attention in psychiatry and human neuroscience.

This study explored: (1) The test-retest reliability of DSM III lifetime diagnoses in 69 active alcoholic subjects interviewed twice, before entering treatment and 4 weeks later with the computerized format of the DISSI (derived from the NIMH-Diagnostic Interview Schedule). (2) The stability of psychiatric diagnoses yielded by both interviews as influenced by subjects' age, gender, current level of psychological distress and current toxic status. Poor agreement (Kappa values below 0.5) was found for panic disorder (k = 0.337) and phobic disorder (k = 0.477) while generalized anxiety disorder and depression/dysthymia presented only fair agreement (k = 0.658 and k = 0.696 respectively). Current levels of psychological distress assessed by the Hopkins Symptom Checklist-58 (HSCL-58) was found to predict the risk of inconsistent reports. Contrary to expectations abstinence did not significantly influence the report of symptoms; neither did the age or gender of the respondents. Levels of self-perceived psychological distress may influence the recall of past symptom experiences among alcoholics and thus affect the reliability of lifetime reports in this population.

Comorbidity between Axis I mental disorders and substance use disorders range from 5%--60% (Farrell, 1998; Fowler, 1998). It has been suggested that dually diagnosed patients are inadequately treated for both disorders and that they are problematic from a diagnostic, clinical management and economic perspective. Dual Diagnosis (DD) maybe associated with a number of issues including increased aggression, increased non-compliance with medication (Swartz, 1998), and exacerbated psychopathology (Tomasson, 1997). However, contradictory evidence has also been found (Leon, 1998), which suggests that patients with DD may be a higher functioning population of mentally ill patients. The objectives of the present study were to determine the prevalence and clinical characteristics of dual diagnosis patients in a chronic psychiatric population. A sample of 217 patients with schizophrenia spectrum disorders was randomly sampled from the psychiatric facilities of the Montreal General Hospital. Almost half of the sample presented with comorbid addictive disorders; the most common drugs abused were alcohol, cannabis and cocaine. Those patients who had a lifetime diagnosis of substance abuse or dependence were more likely to be male, had a more severe course of psychiatric illness, higher rates of psychiatric symptomology, were more likely to be tobacco smokers and had higher rates of non-compliance with psychiatric medications. Further analyses revealed lower levels of social support and more legal problems in patients with DD, all of which may negatively impact on the quality of care for dual diagnosis patients in the clinical setting.

Although much of the research on burnout has focused on the human service professions, there have been few studies investigating those working in the field of mental health, and even fewer looking specifically at community follow-up teams of the severely mentally ill. Two types of follow-up teams, hospital affiliated and community organisations, were compared in our study for levels of burnout and job satisfaction. As well, predictor variables such as stressors (daily hassles), work environment perceptions, caseload characteristics and employee characteristics were included to examine whether they explain the variance of burnout and job satisfaction. 25 staff members from four community follow-up teams completed questionnaires. Significant differences were found between teams on levels of burnout and job satisfaction. Work pressure was demonstrated as a significant predictor of burnout. There was a strong tendency for work experience to predict job satisfaction.