[Epidemiological perspectives of the psychiatric services' change to ambulatory care].
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Ambulatory Care↗
Biomedical subjects
A Lesage
Publications and source records attributed to A Lesage.
History of early loss among a group of suicide survivors.
Suicide-bereaved families have been described as more depression-prone and their bereavement process as more complicated and difficult. Few studies have aimed specifically to investigate the history of transgenerational childhood loss in suicide survivor families as an indicator of greater vulnerability. Childhood separation experiences are associated with difficulties in forming and maintaining attachments. Bonding difficulties are also associated with greater vulnerability to depression and may constitute a suicide risk factor. This exploratory study (n = 32) focused on two groups, each of 16 mothers who had lost a son to suicide and car accidents, respectively. History of loss and early separation experiences were investigated through a clinical interview of the bereaved mothers and through a psychological autopsy of the deceased sons. Results indicate significant transgenerational indices of loss, separation, and inadequate child-rearing. Pre-death life events and adversities in the family may be as important to bereavement outcome as post-death happenings. The cycle of these events, the role of fathers and the role of protective factors must be further studied using detailed life-course reconstructions.
Adolescent↗
Parental bereavement after suicide and accident: a comparative study.
In what way is the bereavement process following suicide different from other types of bereavement? The participants were 30 survivors of suicide and 30 survivors of car accidents who were interviewed twice at an average of six months, and the second measure was taken at an average of nine months after the death, with standardized questionnaires to measure depression and grief reaction. Measures of shame, social support, family adaptation, psychological distress, and prior losses were also obtained during the second interview. All survivors were parents who had lost a son aged between 18 and 35 years. The results indicate that suicide survivors were more depressed than accident survivors at the first measure but this difference disappeared at the second measure. Survivors of suicide experienced greater feelings of shame and had experienced more life events after the death than did accident survivors. There was also a greater history of loss in parents bereaved by suicide. Parental bereavement after suicide appears to differ in several ways from other types of bereavement and appears to happen more often in vulnerable families.
Accidents, Traffic↗
[Evaluation of long-term effectiveness of a social reintegration program].
This study evaluates the impact of a rehabilitation program developed by a specific unit (304) of Louis H. Lafontaine Hospital to prepare severely disabled long-term psychiatric inpatients for discharge. Patients who participated in the program were evaluated three years after their discharge and compared to control patients paired to them by age, sex and years of hospitalization and discharged from other units of the hospital. The results suggest that the rehabilitation program, if coupled with an adequately staffed residential environment giving patients continuous care, offers a better outcome, at least in the case of the severely disabled long-term psychiatric inpatients.
Adult↗
[After suicide: a unique mourning experience?].
Canada's national task force on suicide suggests that people who mourn a suicide make up a group that is itself at risk. Literature shows that mourners of a suicide have a suicide rate that is nine times higher than average. While some authors suggest that this type of mourning is more intense and of a longer duration that for other types of mourning, other authors doubt this hypothesis. But what happens in reality? Is suicide mourning truly different from other types of mourning? Is it really a unique mourning experience? These are some of the questions the authors of this article have attempted to answer. Following an in-depth review of studies on the matter, the authors conclude that the mourning of a suicide encompasses certain characteristics that manifest themselves especially in more vulnerable people.
Bereavement↗
[Mental disorders and suicide].
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Adolescent↗
The relationship of social network deficits with deficits in social functioning in long-term psychiatric disorders.
It has been suggested that deficits or impairments in social functioning may explain the depleted support networks of the mentally ill. With this in mind, 145 long-term users of day care psychiatric facilities, 57% of whom had a life-time diagnosis of schizophrenia, were examined to determine whether deficits in social and survival skills explained deficits in their social networks. Compared with patients with acute depression, long-term patients had smaller social networks. There was a very small but statistically significant association between observer ratings of deficits in social functioning (daily social and living skills) and self-reported family social networks size. Behavioural problems were also associated with smaller family networks. Among the long-term patients, duration of service contact and type of disorder (affective vs nonaffective psychosis) were not related to network size. These preliminary findings are discussed.
Female↗
Neural regulation of phenylethanolamine N-methyltransferase in vivo: transcriptional and translational changes.
The hypothesis that neural regulation of rat adrenal medullary phenylethanolamine N-methyltransferase (PNMT, EC 2.1.1.28) occurs through transcriptional control is examined by following temporal changes in PNMT mRNA expression using paradigms of acute and chronic reserpine treatment. Concommitant changes in PNMT activity and protein were also measured to determine if reserpine induced changes depend solely on gene activation. Further, changes in adrenal corticosterone were measured to examine whether mRNA and enzyme responses might be mediated via reserpine induced changes in ACTH, and hence, corticosterone. Steady-state levels of PNMT mRNA peaked at approximately 8-fold normal by 6 h after a single reserpine injection (10 mg/kg i.p.), and then declined to control values. With continued treatment, a second, slower rise occurred after three alternate day injections (approximately 3-fold basal levels). Enzyme activity and protein rose simultaneously but were attenuated in magnitude and time course by comparison to message. With both acute and chronic treatment, activity increased 2.0-fold, peaking at 12 h after a single dose of reserpine and again after four doses of the drug. Protein, as measured by immunotitration, was elevated 1.2-and 1.4-fold, respectively. Adrenal corticosterone rose approximately 8-fold at 6 h, declined slightly at 12 h, rose again, and remained elevated thereafter. Comparison of the time courses for the various indices demonstrated that the early parallel bursts in PNMT mRNA and corticosterone are consistent with an increase in transcriptional activity.(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenal Medulla↗
New findings on tardive dyskinesia in a community sample.
In a geographically defined area sample of 141 long-term psychiatric patients in day care in south London, the relationship between tardive dyskinesia (TD) and other aspects of illness, treatment, and social and psychological functioning were studied. The results are compared with previous findings. TD was significantly associated with parkinsonian symptoms and with the number of years in contact with the psychiatric services. There was a trend, in affective disorder only, towards an association with current neuroleptic dose. The patients with affective disorder also had higher rates of TD than patients with schizophrenia and paranoid psychosis. History of treatment with ECT correlated negatively with TD among those with schizophrenia, and positively among those with affective disorder. As in other studies, duration of neuroleptic treatment did not correlate with the presence or absence of TD. In contrast to some previous reports, age and cognitive status were not related to TD status. Possible reasons for this are discussed.
Aged↗
Adrenergic expression in the rat adrenal gland: multiple developmental regulatory mechanisms.
Phenylethanolamine N-methyltransferase (PNMT, EC 2.1.1.28) has been used as a marker to examine development of adrenergic expression in the rat adrenal gland and the putative role of glucocorticoids in this process. PNMT enzymatic activity increases 7-10-fold from birth to postnatal day 35. Immunotitration studies show that PNMT protein only increases 4-5-fold during this same time period. Moreover, the slopes from the immunotitration curves decrease with increasing age. Thus, a more active enzyme with lower affinity for the antiserum appears to be present in the older animals. Quantitative solution hybridization shows that PNMT mRNA increases 2.5-fold from birth through postnatal day 11. Thereafter, it declines, and eventually plateaus at values insignificantly different from birth by postnatal day 25. Northern analysis further shows that two forms of PNMT mRNA are expressed. Adrenal corticosterone remains low from birth through postnatal day 11, but then increases nearly 10-fold by adulthood. The lack of concordance between changes in PNMT activity, protein, and mRNA suggests that adrenergic expression is developmentally regulated at multiple levels; the above provides evidence for both transcriptional and post-transcriptional controls, since changes in PNMT mRNA may differ in both magnitude and direction from changes in PNMT activity and protein during the developmental window examined. These developmental regulatory mechanisms may be in part glucocortocoid-mediated, but corticosteroid control of PNMT gene expression does not appear to be the predominant mechanism of control.
Actins↗
Glucocorticoid regulation of phenylethanolamine N-methyltransferase in vivo.
In vivo, supraphysiological doses of glucocorticoids are required to restore adrenal medullary phenylethanolamine N-methyltransferase (PNMT, E.C. 2.1.1.28) activity after hypophysectomy. However, in vitro, phenylethanolamine N-methyltransferase gene expression appears normally glucocorticoid-responsive. To explore this paradox, rats were given dexamethasone or the type II-specific glucocorticoid RU28362 (1-1000 micrograms/day), and adrenal phenylethanolamine N-methyltransferase activity and mRNA levels were determined. At low doses (1-30 micrograms/day), neither steroid altered mRNA whereas at higher doses (100-1000 micrograms/day), mRNA rose 10- to 20-fold, with dexamethasone approximately 3 times as potent as RU28362. In contrast, enzyme activity fell with low doses of either steroid, consistent with suppression of ACTH and endogenous steroidogenesis. At higher doses of RU28362, enzyme activity remained low and unchanged despite increased mRNA expression, whereas higher doses of dexamethasone progressively restored the enzyme to normal. These findings suggest 1) that glucocorticoid regulation of phenylethanolamine N-methyltransferase activity occurs largely independent of gene expression; 2) that glucocorticoid effects on enzyme activity are primarily indirect, probably through cosubstrate regulation and/or enzyme stabilization; and 3) that these effects are not mediated via a classical (type II) glucocorticoid receptor mechanism, given the high doses of dexamethasone and corticosterone required and the inability of RU28362 to mimic the effects of these less selective steroids.
Animals↗
Burden of care of families not living with young schizophrenic relatives.
A program that provides comprehensive support services to young schizophrenic adults and their families in Montreal was evaluated after one year to assess the needs of families, especially single-parent families, after the young adult patient left home. Results of the evaluation, which employed a case-control design, showed that compared with families receiving the usual services, families in the program reported feeling less burdened by the patients' personal problems. They also received more services and had more contact with professionals. Patients living away from home spent more than 18 hours a week in face-to-face contact with their families. Single parents of mentally ill young adults spent much less time with their offspring and expressed more need for services and a greater burden of care than married parents.
Activities of Daily Living↗
Lower incidence and increased male:female ratio in schizophrenia.
Patients with an ICD-9 diagnosis of psychotic disorder were assessed for DSM-III-R schizophrenia. Rates of schizophrenia were found to be higher in males (39.8 per 100,000) than females (22.4 per 100,000). The DSM-III-R incidence supports recent studies which suggest a decrease in rates of schizophrenia across time, and also suggests that men suffer from both more schizophrenia and a more severe form of the disease.
Adult↗
Stark broadening in krypton and xenon.
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Journal Article↗
Needs for care among the relatives of long-term users of day care. A report from the Camberwell High Contact Survey.
We report the results of a survey of the burdens and needs for items of care of 45 supporters of long-term users of psychiatric day care facilities in Camberwell. The supporters reported high levels of disturbed behaviour and low levels of self-care skills in the attenders. They were also subject to high levels of social and economic burden, not all of which could be attributed to the attenders' problems. The needs assessment identified a large number of unmet needs, although the supporters themselves were largely resigned to their situation and expressed little dissatisfaction with the services they were offered. The advantage of conducting this kind of assessment of supporters' needs as a routine part of clinical practice was discussed.
Adaptation, Psychological↗
A test of the therapeutic mechanism in social skills training with avoidant personality disorder.
Twenty-eight patients meeting the criteria for DSM-III avoidant personality disorder were randomly assigned to two treatment groups consisting each of five sessions of social skills training plus homework and five sessions of group discussion plus homework administered in different order in accordance with a latin-square (crossover) design. Twenty-one subjects completed the study. No significant differences between the treatment groups or treatment modalities (i.e., social skills training and group discussion combined with homework each) were found. Significant improvements in time on most measures were found when data from both groups were amalgamated.
Adult↗
How many sheltered housing places.
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Halfway Houses↗
[Residential resources necessary to the pursuit of deinstitutionalization.].
A survey was conducted amongst physicians responsible for long term inpatients of Louis-H. Lafontaine mental hospital. Physicians were asked to identify patients with a potential for resettlement outside the hospital. A random sample of 300 patients (out of 831) were screened. 29% were identified as suitable for such a transfer. This is comparable to the 25 % ("community living") obtained from the 1984 survey using the Levels of Care Survey with this population. However, the present survey also indicate the 24-hour supervised residential settings would be needed for most of these patients.
English Abstract↗