Psychotropic medications commonly used with children have been associated with side effects significant enough to warrant warnings from the Food and Drug Administration. The risks of these side effects are potentially increased in children who are long-term survivors of childhood cancer because of damage to the heart and central nervous system (CNS) due to chemotherapy and radiation therapy. There are few empirical studies addressing whether children treated for cancer have greater exposure to psychotropic medications than the general population, the reasons for use of psychotropic medications in cancer survivors, or whether risks associated with cancer treatment are considered when psychotropic medications are used. The specific aims of this study were: (1) to examine the prevalence of psychotropic medication use among children treated for cancer, (2) to obtain descriptive data regarding variables associated with medication usage, and (3) to develop a model to predict which children are likely to be prescribed psychotropic medication. A cross-sectional sample of 69 children, ages two to 17 years, who were undergoing treatment or had successfully completed treatment for leukemia/lymphoma, central nervous system (CNS) tumors, or other non-CNS related cancers were recruited. Caregivers completed measures of psychosocial functioning, medication use, and developmental history. Medical history was also obtained. Results indicated that 15% of subjects were taking psychotropic medication, specifically stimulants and antidepressants. The Classification and Regression Trees (CART) algorithm was used to develop a predictive model. Results indicated gender, age, and presence of school difficulty explained a total of 46% of the variance in psychotropic medication use in the pediatric cancer population; children treated for cancer who were male, age 10 or older and had reported school difficulty were more likely to be prescribed psychotropic medication. No cancer variables were found to influence psychotropic medication use. Several limitations likely influenced results including limited sample size, inclusion of multiple diseases in the non-CNS involved solid tumor diagnosis group, and recruitment limited to three sites. Results indicate a need for continuous examination of psychotropic medication use and possible side effects in the childhood cancer population.

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disability diagnosed in an increasing number of children. ASD has few effective treatment options. This study describes ASD prevalence and use of psychotropic medications among children and youth in Manitoba. Methodology: Administrative data from the Repository at the Manitoba Centre for Health Policy (MCHP) were used to create a cohort of children born in Manitoba. Diagnoses of ASD were based on medical claim records, hospital abstracts, or special education funding data. Results: Between 2010 and 2014, 3079 Manitoba children aged 0-14 had an ASD diagnosis (1.2% prevalence). Child demographic, health and education, and family environmental characteristics were compared between children with ASD and children in the general population; children with ASD with and without psychotropic medications; and among all children with psychotropic medications. Children with ASD were more likely to have a psychotropic medication than children in the general population. Children with ASD were more likely to receive a psychotropic medication if they were older than age 4, were diagnosed with ASD later than age 4, received special education funding, had participated in behavioural programming, had a co-occurring psychiatric condition, had a sibling diagnosed with ASD or had ever been in the care of child welfare. This study demonstrated that children with ASD received a greater number and intensity of psychotropic medications than children in the general population with similar demographic and psychiatric conditions. Conclusions: In Manitoba, the prevalence of ASD is increasing and differences exist between children with ASD and children in the general population. Future research and treatment planning for children with mental disorders and developmental disabilities should consider the appropriateness of the patterns of medication use and equity of treatment interventions found in this study. / October 2016

This study examined psychotropic medication claims in a sample of Protestant clergy. It estimated the proportion of clergy in the sample who had a claim for psychotropic medication (i.e., anti-depressants and anxiolytics) in 2005 and examined associations between sociodemographic characteristics, occupational distress and having a claim. Protestant clergy (n = 749) from nine denominations completed a mail survey and provided access to their pharmaceutical records. Logistic regression models assessed the effect of sociodemographic characteristics and occupational distress on having a claim. The descriptive analysis revealed that 16 % (95 % Confidence interval [CI] 13.3 %-18.5 %) of the clergy in the sample had a claim for psychotropic medication in 2005 and that, among clergy who experienced frequent occupational distress, 28 % (95 % CI 17.5 %-37.5 %) had a claim. The regression analysis found that older clergy, female clergy, and those who experienced frequent occupational distress were more likely to have a claim. Due to recent demographic changes in the clergy population, including the increasing mean age of new clergy and the growing number of female clergy, the proportion of clergy having claims for psychotropic medication may increase in the coming years. To the best of our knowledge, this is the first study to examine the use of psychotropic medication among clergy.

This study examined psychotropic medication claims in a sample of Protestant clergy. It estimated the proportion of clergy in the sample who had a claim for psychotropic medication (i.e., anti-depressants and anxiolytics) in 2005 and examined associations between sociodemographic characteristics, occupational distress and having a claim. Protestant clergy (n = 749) from nine denominations completed a mail survey and provided access to their pharmaceutical records. Logistic regression models assessed the effect of sociodemographic characteristics and occupational distress on having a claim. The descriptive analysis revealed that 16 % (95 % Confidence interval [CI] 13.3 %-18.5 %) of the clergy in the sample had a claim for psychotropic medication in 2005 and that, among clergy who experienced frequent occupational distress, 28 % (95 % CI 17.5 %-37.5 %) had a claim. The regression analysis found that older clergy, female clergy, and those who experienced frequent occupational distress were more likely to have a claim. Due to recent demographic changes in the clergy population, including the increasing mean age of new clergy and the growing number of female clergy, the proportion of clergy having claims for psychotropic medication may increase in the coming years. To the best of our knowledge, this is the first study to examine the use of psychotropic medication among clergy.

In light of the increasing number of mentally ill inmates in the criminal justice system, felony mental health courts aim to de-criminalize these individuals and link them to appropriate types of treatment within the community. Few studies have investigated the successful linkage of community-based treatment among felony mental health court participants. More specifically, there is an absence of research on the efficacy of pharmacotherapy on recidivism status among felony mental health court defendants. This retrospective study used archival data to determine if receiving pharmacotherapy will increase duration of time between arrests and keep felony mental health court participants out of the criminal justice system longer. The study also aimed to investigate if psychotropic medication use helped to reduce the risk of violent arrests among those participating in the felony mental health program. Lastly, it evaluated whether drugs from specific classes had more of an effect on recidivism status than others. Cox regression analyses, with propensity score adjustments, were used to determine if psychotropic medication keeps felony mental health court participants out of the criminal justice system longer. Cox regression analysis was also used to determine if specific drugs from different classes had more of an effect on time to re-arrest than others. Lastly, a binary logistic regression, with propensity score adjustments, was used to determine if psychotropic medication helped to reduce the risk of future violent offenses after entry into the FMHC program. All analyses included covariates to control for any potentially confounding factors to the outcome. The study yielded non-significant results when testing whether or not the use of psychotropic medication had an impact on the time to re-arrest, and on risks of future violent offenses.

Polypharmacy, or the concurrent use of multiple medications, is associated with detrimental outcomes for patients and has gathered increasing attention within the scientific clinical literature. Pediatric populations warrant special consideration for the practice of polypharmacy, as medication effects are more pronounced in youth and adverse effects may have a lasting impact on development. This dissertation study examined psychotropic prescribing practices in a sample of adolescents who have engaged in sexually abusive behaviors, a subset of justice-involved youth who are at risk for polypharmacy. General prescribing trends were examined, and a principle components analysis involving variables associated with risk of polypharmacy was conducted. Results indicated that polypharmacy was common, with many youth being prescribed medications at a young age. Use of risky medications such as antipsychotics was also prevalent, even for individuals without psychosis. Analyses suggested that behavioral issues, trauma and residential instability, and complex psychological concerns were significantly associated with polypharmacy outcomes. Clinical implications of findings are discussed.

Background: People with intellectual disability are more likely than the general population to be prescribed psychotropic agents. The most common indications include treatment of a psychiatric disorder and management of behaviours that challenge. Aim: The study aimed to assess the prescribing patterns of psychotropic medication to outpatients with intellectual disability at a psychiatric hospital. Setting: Alexandra hospital outpatient clinic, Cape Town. Methods: This was a retrospective folder and prescription chart review. Folders of all new patients (103) seen between January 2018 and August 2019 were examined at two points, the initial appointment and again at six months. The information was examined against the World Psychiatric Association (WPA) and the National Institute for Health and Care Excellence (NICE) guidelines for prescribing in people with intellectual disability. Results: psychotropic medication was prescribed to 88% of patients. Antipsychotics accounted for more than 56% of the medication prescribed and was used mainly to manage behaviours that challenge. Clinicians at Alexandra hospital followed prescribing guidelines to some extent; however, more still needs to be done to ensure best practice and care. Conclusion: This review revealed a few shortcomings in meeting prescribing guidelines by clinicians at Alexandra hospital. Measures to address these shortcomings could be the inclusion of medication review schedules and standardised forms for clerking and monitoring of side effects in patient files, the use of behavioural strategies as the primary management of behaviours that challenge, and the performance of regular clinical practice audits.

L'objectif principal de ce mémoire est d'évaluer le rôle modérateur de trois traits de personnalité, soit l'estime de soi, le sentiment de cohésion, ainsi que le centre de contrôle interne sur la relation entre les conditions de l'organisation du travail et la consommation d'alcool à risque, ainsi que la consommation de médicaments psychotropes des travailleurs canadiens. Les données sur lesquelles nous nous sommes basés proviennent de l'Enquête Nationale sur la Santé de la Population (ENSP) de Statistique Canada. Celle-ci a été conduite à des intervalles de deux ans, de l’année 1994 jusqu'à l’année 2003, et comprend ainsi cinq cycles longitudinaux. Les analyses multiniveaux que nous avons effectuées nous ont permises d’identifier cinq variables des conditions de l'organisation du travail qui s’associent de manière significative à la consommation d'alcool à risque, soit l’utilisation des compétences qui augmente de 7% le risque de faire partie du groupe de consommation d’alcool à risque par un travailleur, les demandes psychologiques qui augmentent ce risque de 69%, et les travailleurs confrontés à un horaire de travail irrégulier qui consomment 61% plus d’alcool à risque que les travailleurs qui ont un horaire de travail régulier. Inversement, l’insécurité d’emploi réduit de 12% le risque de faire partie du groupe de consommation d’alcool à risque, et les travailleurs bénéficiant d’un soutien social au travail courent 5% moins de risque de consommation d’alcool à risque. Pour ce qui est des médicaments psychotropes, nos analyses multiniveaux nous ont permises d’identifier deux variables des conditions de l’organisation du travail qui y sont associées de manière significative. Il s’agit de l’utilisation des compétences qui augmente de 8% le risque de faire partie du groupe de consommation de médicaments psychotropes, alors que le nombre d’heures travaillées diminue de 1% ce risque. En ce qui concerne les traits de personnalité, l’estime de soi augmente de 17% le risque de consommation d’alcool à risque, alors que le sentiment de cohésion diminue de 1% ce risque. L’estime de soi joue un rôle modérateur faible entre les conditions de l’organisation du travail et la consommation d’alcool à risque, puisque celle-ci diminue de 3% l’effet pathogène des demandes physiques imposées sur les travailleurs sur leur consommation d’alcool à risque. Pour ce qui est des médicaments psychotropes, nos résultats indiquent que l’estime de soi diminue de 4% le risque de consommation de médicaments psychotropes, le centre de contrôle interne diminue de 9% ce risque, et le sentiment de cohésion quant à lui, diminue ce risque de 3%. D’ailleurs, aucun trait de personnalité ne joue un rôle modérateur entre les conditions de l’organisation du travail et la consommation de médicaments psychotropes. / The main objective of this master's thesis is to determine the moderator effect of personality traits (self esteem, sens of cohesion, sens of control) on the relationship between work organization conditions, and risky alcohol consumption, as well as psychotropic medication consumption by canadian workers. In order to conduct our project, we relied on data that came from five cycles of the National Population Health Survey (NPHS). This survery was conducted at a two year interval, spanning from the year 1994 until 2003, and includes five longitudinal cycles. The multilevel analyis we performed, allowed us to identify five work organization conditions that increase the risk of risky alcohol consumption.Skill utilisation increases by 7% the risk of being part of a risky alcohol consumption group, while psychological demands increase risky alcohol consumption by 69%, and workers confronted to an irregular work schedule consume 61% more risky alcohol. However, job insecurity decerases by 12% the risk of being part of a risky alcohol consumption group, and workers that enjoy social support at work have a 5% lesser risk of being part of a risky alcohol consumption group. As for psychotropic medications consumption, our multilevel analysis allowed us to identify two work organization conditions that are associated in a significant manner to the psychotropic medication consumption. Skill utilisation at work increases by 8% the risk of being part of a pscyhotropic medication consumption group, while the number of hours worked decreases by 1% the risk of being part of a psychotropic medication consumption group. As for personnality traits, our results indicate that self esteem increases by 17% the risk of risky alcohol consumption, while sense of cohesion decreases by 1% this risk. In addition, self esteem plays a moderator role by diminuishing by 3% the pathologic impact of physical demands at work on risky alcohol consumption. Concerning psychotropic medications consumption, our results indicate that self esteem diminuishes by 4% the risk of psychotropic medications consumption, sense of control diminuishes by 9% the risk of psychotropic medications consumption, and sense of cohesion diminuishes by 3% this risk. In addition, none of the personnality traits plays a moderator role between work’s organization’s conditions and psychotropic medications consumption.

Adults with intellectual disability (ID) experience twice the rate of mental health disorders when compared to the general population. Despite increased prevalence of mental health disorders, caregivers supporting adults with ID rarely seek mental health counseling supports, but instead are referred to psychiatric services. There is limited understanding among researchers about the lack of counseling services for adults with ID. The purpose of this study was to explore the lived experiences of mental health counselors who have worked with adults with ID in a counseling relationship. Hermeneutic phenomenology was used to develop thick and rick experiential detail about counselor experiences providing services for adults with ID. The conceptual framework involved the social constructivist and hermeneutic phenomenological lenses. The 8 participants were recruited using a purposive snowball sampling method and provided data through semi-structured interviews. Data analysis involved coding for themes with the help of NVivo software. Findings indicated counselor perceptions of adults with ID as being stigmatized and marginalized within their communities, which aligned with literature. Adults with ID must be prepared for counseling and there must be appropriate adaptations to support meaningful participation and benefit from counseling interventions. Exposure to adults with ID was a factor in counselors being willing to engage with this population, and questions about counselor education and preparedness were a consistent theme. The social implications of exploring this gap will lead to a better understanding of counselor experiences and can inform the professional body about how to increase access to counseling services for adults with ID.

L'objectif principal de ce mémoire est d'évaluer le rôle modérateur de trois traits de personnalité, soit l'estime de soi, le sentiment de cohésion, ainsi que le centre de contrôle interne sur la relation entre les conditions de l'organisation du travail et la consommation d'alcool à risque, ainsi que la consommation de médicaments psychotropes des travailleurs canadiens. Les données sur lesquelles nous nous sommes basés proviennent de l'Enquête Nationale sur la Santé de la Population (ENSP) de Statistique Canada. Celle-ci a été conduite à des intervalles de deux ans, de l’année 1994 jusqu'à l’année 2003, et comprend ainsi cinq cycles longitudinaux. Les analyses multiniveaux que nous avons effectuées nous ont permises d’identifier cinq variables des conditions de l'organisation du travail qui s’associent de manière significative à la consommation d'alcool à risque, soit l’utilisation des compétences qui augmente de 7% le risque de faire partie du groupe de consommation d’alcool à risque par un travailleur, les demandes psychologiques qui augmentent ce risque de 69%, et les travailleurs confrontés à un horaire de travail irrégulier qui consomment 61% plus d’alcool à risque que les travailleurs qui ont un horaire de travail régulier. Inversement, l’insécurité d’emploi réduit de 12% le risque de faire partie du groupe de consommation d’alcool à risque, et les travailleurs bénéficiant d’un soutien social au travail courent 5% moins de risque de consommation d’alcool à risque. Pour ce qui est des médicaments psychotropes, nos analyses multiniveaux nous ont permises d’identifier deux variables des conditions de l’organisation du travail qui y sont associées de manière significative. Il s’agit de l’utilisation des compétences qui augmente de 8% le risque de faire partie du groupe de consommation de médicaments psychotropes, alors que le nombre d’heures travaillées diminue de 1% ce risque. En ce qui concerne les traits de personnalité, l’estime de soi augmente de 17% le risque de consommation d’alcool à risque, alors que le sentiment de cohésion diminue de 1% ce risque. L’estime de soi joue un rôle modérateur faible entre les conditions de l’organisation du travail et la consommation d’alcool à risque, puisque celle-ci diminue de 3% l’effet pathogène des demandes physiques imposées sur les travailleurs sur leur consommation d’alcool à risque. Pour ce qui est des médicaments psychotropes, nos résultats indiquent que l’estime de soi diminue de 4% le risque de consommation de médicaments psychotropes, le centre de contrôle interne diminue de 9% ce risque, et le sentiment de cohésion quant à lui, diminue ce risque de 3%. D’ailleurs, aucun trait de personnalité ne joue un rôle modérateur entre les conditions de l’organisation du travail et la consommation de médicaments psychotropes. / The main objective of this master's thesis is to determine the moderator effect of personality traits (self esteem, sens of cohesion, sens of control) on the relationship between work organization conditions, and risky alcohol consumption, as well as psychotropic medication consumption by canadian workers. In order to conduct our project, we relied on data that came from five cycles of the National Population Health Survey (NPHS). This survery was conducted at a two year interval, spanning from the year 1994 until 2003, and includes five longitudinal cycles. The multilevel analyis we performed, allowed us to identify five work organization conditions that increase the risk of risky alcohol consumption.Skill utilisation increases by 7% the risk of being part of a risky alcohol consumption group, while psychological demands increase risky alcohol consumption by 69%, and workers confronted to an irregular work schedule consume 61% more risky alcohol. However, job insecurity decerases by 12% the risk of being part of a risky alcohol consumption group, and workers that enjoy social support at work have a 5% lesser risk of being part of a risky alcohol consumption group. As for psychotropic medications consumption, our multilevel analysis allowed us to identify two work organization conditions that are associated in a significant manner to the psychotropic medication consumption. Skill utilisation at work increases by 8% the risk of being part of a pscyhotropic medication consumption group, while the number of hours worked decreases by 1% the risk of being part of a psychotropic medication consumption group. As for personnality traits, our results indicate that self esteem increases by 17% the risk of risky alcohol consumption, while sense of cohesion decreases by 1% this risk. In addition, self esteem plays a moderator role by diminuishing by 3% the pathologic impact of physical demands at work on risky alcohol consumption. Concerning psychotropic medications consumption, our results indicate that self esteem diminuishes by 4% the risk of psychotropic medications consumption, sense of control diminuishes by 9% the risk of psychotropic medications consumption, and sense of cohesion diminuishes by 3% this risk. In addition, none of the personnality traits plays a moderator role between work’s organization’s conditions and psychotropic medications consumption.