Suicide is a serious problem in our society with a high emotional, as well as financial, burden. Research has identified a number of risk factors for suicidal behaviour, including the presence of psychiatric diagnosis, and the comorbidity of psychiatric diagnosis. In particular, high lifetime aggression and impulsiveness have repeatedly been implicated as risk factors for suicidal behaviour, and have also been observed to cluster in families. This study investigates the phenotype of suicide completion through exploration of comorbid patterns of psychopathology and seasonality in order to gain a better understanding of possible subgroups of suicide completers, particularly with respect to impulsive-aggressive behaviours and their psychopathological correlates. This study also explores the familiality of suicidal behaviour, and its relationship to impulsive-aggressive behaviours and their psychopathological correlates. Our findings show that suicide cases can be clustered into three different groups according comorbidity: a low-comorbidity group, a substance-dependent group, and a group exhibiting childhood onset of psychopathology. We also find that seasonal variation in suicide varies according to psychopathology. Finally, we confirm that suicide has a familial component independent of psychopathology, and find evidence to suggest that this may be mediated by severity of suicidal ideation, and aggressive behaviour.

Ce discours vient du postulat que toute societe et culture contient son propre systeme de croyances et un modele de solutions aux problemes de la vie. Je dois aussi postuler qu'aucune tradition culturelle ne peut pretendre a etre plus ou moins valable par rapport a d'autres. Il faut plutot que des tentative soient faites pour examiner et decouvrir autant que possible les variables nous partageons cette planete. / Beaucoup de malades mentaux de la Trinite et Tobague croient que la cause de leur maladie est une malediction ou un mauvais esprit et, de ce fait, vont chez les practiciens d'"obeah" au lieu ou en plus des medecins occidentaux pour leur traitement. Cet etude est le resultat d'un travail de researche que j'ai meme sur l'Ile de Trinite du mois d'avril au mois juillet 1988, et du mois de janvier au mois de mai 1989. Elle contient des observations, des practiques et des donnes sur le systeme medical indigene dit "obeah". Je vais decrire l'"obeah", les guerisseurs qui la guerisson chez ces medicins traditionels de la Trinite. Dix practiciens d'"obeah" ont ete entrevues et leurs histoires personnelles, des maladies et modes de traitement ont ete enregistes. Trente-cinq patients a travers l'Ile ont ete aussi entrevues et leur etats symptomatologiques, modes de traitement et resultats ont ete documentes. (Abstract shortened by UMI.)

The aims of the study were to examine substance abuse and physical and mental health in an urban Aboriginal population. Data was collected through structured interviews (n = 202) with Aboriginals in the greater Montreal area. The majority were single, unemployed, and lived in the urban area for a long time (mean of 9.96 +/- .76 years). One third reported having a current substance abuse problem. Results indicated high levels of psychological distress augmented by substance abuse. Substance abusers were also more likely to have been the victims of abuse. / Ethnographic interviews with urban Aboriginals and community workers were also conducted (n = 30). One third were victims of abuse and 6 reported having a current substance abuse problem. Psychological and biological understructures were used in defining addiction and explaining substance use among Aboriginal peoples. Cultural traditions were viewed as integral components of substance abuse treatment and the need for outpatient treatment facilities and aftercare programs were indicated.

Objectives. To determine whether the emergency psychiatric treatment of patients with psychosis varies with immigrant status and ethnicity. Methods. Data on immigrant and ethnic status of psychotic patients admitted in 1999 were extracted from records of a general hospital in Montreal. Of the 217 subjects, 97 (44.7%) were immigrants, 125 were Euro-Canadian (57.6%),39 were Asian (18.0%), and 27 were Black (12.4%). All Asians and most Blacks (87%) were immigrants. Measures of emergency psychiatric treatment included use of seclusion, restraints, and medication in the emergency department. Multiple regression models examined the relationship of immigrant status and ethnicity to emergency psychiatric treatment controlling for age, gender, patient height and weight, and mode of emergency department admission (coercive versus non-coercive). Results. Immigrant status and Asian ethnicity were not associated with emergency treatment measures. Coercive mode of emergency department admission (i.e. by police or ambulance) predicted use of seclusion (p < .001) and restraints (p < .05), but being Black was independently and positively associated with received dose of emergency antipsychotic (p < .05). Being Black was also positively associated with police or ambulance contact prior to emergency department presentation (p < .01). Conclusion. While some aspects of the emergency treatment of psychosis seem to occur as a consequence of the mode of admission, the administration of antipsychotic medication may be motivated by patient ethnicity. These results point to the need for training of emergency department staff to reduce potential bias in treatment.

The investigation of neuroendocrine abnormalities have been an active area of research in biological psychiatry. Nevertheless, there has been little prospective research on the Dexamethasone Suppression Test (DST) and 24 hour cortisol profile in Bipolar patients. These tests are measures of cortisol and the Hypothalamic-Pituitary-Adrenal axis which are indirect indications of abnormal limbic: system activity. The present study examined 24-hour cortisol levels and DST responses in 18 bipolar patients (6 depressed, 5 hypomanic and 7 euthymic) and 5 age and sex matched controls. In addition, two patients were examined in depressed, hypomanic, and euthymic states and served as their own control. The population studied consisted of outpatients between 25 to 62 years of age who were diagnosed with Bipolar Disorder following DSM-IV criteria. In the group study, bipolar patients in all phases exhibited substantially higher cortisol levels than age and sex matched controls. Higher cortisol levels in the hypomanic state have been observed when bipolar patients served as their own control. In addition, the DST did not appear to be highly sensitive or specific in bipolar patients and was not associated with 24 hour cortisol levels or severity of symptoms. The results demonstrate that HPA disturbances occur in all phases of bipolar disorder, not only during depressed states. These findings bring us closer to understanding the neuroendocrine pathophysiology occurring in bipolar disorder.

Functional disability assessments are recognized as being important for the diagnosis of Dementia of the Alzheimer's type (DAT) as well as for monitoring the impact of intervention and determining the need for home assistance or institutionalization. Existing instruments designed for the assessment of functional disability with this population are generally unsatisfactory with regards to their content or psychometric properties. The objective of this research project was to develop a more appropriate French and English assessment of functional disability for use with proxy-respondents of community-dwelling individuals who have DAT. The Disability Assessment for Dementia (DAD) was developed in several stages using three panels composed of health care professionals and caregivers of individuals with DAT. Forward-backward translation procedures were performed at each stage to ensure that the French and English versions of the scale were comparable. Content validity was verified by a fourth panel of experts. The DAD was then administered to 59 community-dwelling DAT subjects and their caregivers to determine internal consistency and the need to eliminate items. The instrument developed, which consisted of 46 items, was reduced to 40 items, 17 related to basic self-care and 23 to instrumental activities of daily living, as a result of this process. The content validity of the final version was established by a majority of members from the panel of experts. It also demonstrated a high degree of internal consistency (Cronbach's alpha = 0.96) and excellent interrater (N = 31) and test-retest (N = 45) reliability (Intraclass correlation coefficients of 0.95 and 0.96 respectively). In addition, it was found not to have gender bias. Estimates of its validity were determined in another study. The DAD represents a valid and reliable instrument which is short and easy to administer. This instrument should have a positive impact on geriatric rehabilitation, and on clinical and

The implication of central noradrenergic and serotonergic systems in the control of mood has been known for forty years. Indeed, the different classes of molecules prescribed in the treatment of major depression directly interfere with the transmission mediated by these amines, either at the level of the synthesis, the release, the stimulation of receptors, the reuptake or the degradation. According to the leading theory in the field, the increase in serotonergic transmission is the final convergence point of currently prescribed antidepressant drugs. / Pharmacological and electrophysiological studies have shown the essential role of the somatodendritic 5-HT1A autoreceptor in the control of dorsal raphe 5-HT neuronal firing frequency and release; these characteristics make this receptor an extremely interesting target for adjuvant drugs that potentiate or even accelerate the effect of actual antidepressants molecules. In fact, augmentation of synaptic levels of 5-HT, thought to be necessary for the beneficial action of antidepressants in mood, does not immediately occur subsequent to acute administration of those molecules but depends on the desensitization of 5-HT1A somatodendritic autoreceptors located in the dorsal raphe, a phenomenom temporally correlated with the onset of action of all antidepressant classes.

A delicate balance exists between the protective effects of adrenal glucocorticoids (GCs) secreted in response to stress and the negative consequences that the excessive production of these hormones may have for numerous systems. GCs are involved in the regulation of the stress response, have effects on feeding and body weight gain and are associated with the acceleration of central nervous system aging. Their production, secretion, and containment are subject to both environmental modulation and individual variation. Neonatal manipulations known to affect the development of the adult hypothalamic-pituitary-adrenal (HPA) response to stress had profound effects on both basal and stress-induced dietary choice, body weight and insulin dynamics. We followed this study with an examination of how the physiological and emotional response to stress can affect diet choices and affective status. Stress had an impact on diet choice and had a strong effect on emotional status but did not affect subjects uniformly. We then explored the reciprocal relationship, i.e. how diet itself can affect the response to stress and found that basal and stress-induced activation of the HPA axis in both young and aged rats is augmented following the feeding of high-fat diets and fat-feeding cause aberrations in glucose-insulin axis. Since aging can be associated with profound changes in HPA axis function, we assessed how dietary habits may contribute to the emergence of the cortisol (F) profile in a population of healthy elderly humans. We found a strong positive relationship between individual F production, feelings of depression and the high fat content in their diets. While dietary habits may have a negative impact on the emergence of an individuals' cortisol profile and on the aging process, we wanted to explore whether a beneficial intervention at mid-life would allow animals to age "successfully" by reducing glucocorticoid production. Environmental enrichment lowered corticosterone lev

Alzheimer's disease (AD) has been shown to involve impairments in both cognitive function and affective behavior. Animal models of AD, to date, have largely ignored the affective components of the disorder. Therefore, we investigated whether nucleus basalis magnocellularis (NBM)-lesioned rats, an animal model which mimics some of the cognitive deficits associated with AD, would display behavioral alterations on tests evaluating anxiety. We also tested the ability of neural transplants to normalize lesion-related changes in anxious behavior, as it has been demonstrated that grafting embryonic cholinergic or adult chromaffin cells can ameliorate NBM lesion-induced deficits in cognitive abilities and reverse lesion-related neurochemical alterations. Thus, rats were bilaterally NBM-lesioned and, 10 to 12 days post-lesion, either behaviorally tested or grafted with chromaffin or kidney cell suspensions and tested 4 weeks post-grafting. Findings suggest that the NBM lesion-induced cognitive deficits in rodents appear homologous to the impairments in cognition associated with AD. (Abstract shortened by UMI.)

Parent and teacher ratings of hyperactivity are compared with an objective measure of activity level (actigraphy) for 19 ADHD children and 18 control subjects. All subjects wore the actigraph during a full day diagnostic assessment. Mean actigraph scores were calculated for the structured (including time during the Continuous Performance Test (CPT)) and unstructured element of the assessment. The structured, unstructured and CPT settings were significantly differentiated for the sample as whole by actigraphic measures. However no significant difference in activity level was found when we compared the subgroups (Controls, medicated ADHD, non-medicated ADHD). Parent ratings were not correlated with actigraphic measures in any setting. Teacher ratings on the Hyperactivity Index were significantly correlated with activity during the structured and unstructured setting for the whole sample and the ADHD subjects. These data indicate that teacher ratings of hyperactivity are more reliable than parent ratings on identical items when one is interested in gross motor activity. Issues concerning the situational relevance of rating scales and applications of actigraphic technology are discussed.