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Alain Lesage

Publications and source records attributed to Alain Lesage.

32 records · Page 2Linked to original sources
PubMed2005

[Implementation of the multi-site Integrated Psychological Treatment (IPT) program for people with schizophrenia. Elaboration of renewed version].

Brenner's Integrated Psychological Treatment (IPT) program (Brenner et al., 1992 ; Pomini et al., 1998), a cognitive-behavioural approach, was implemented in nine of Quebec's clinical settings that treat people with schizophrenia. A study allowed an evaluation of the IPT program in each location, with emphasis on the level of satisfaction of both participants and professionals, the program's strong points, and areas where improvements were needed. The results have shown that the implementation of the program has been successful in all nine clinical settings. Professionals and participants appreciated the IPT program not only for its hierarchic structure that considers the rehabilitation needs of people affected by schizophrenia, but also for its customised application framework, which allows a regular follow-up of a similar group of patients over the course of a one year period. As a result of this study, the modifications proposed and additions have enabled the creation of a Quebec version of the IPT program, which better achieves its objectives, particularly those relating to the maintenance and generalisation of social learning in the context of a participant's real-life situation.

Delivery of Health Care, Integrated↗
PubMed2005

[Foster home caregivers' point of view on the transformation of mental health services in Québec].

This article presents the major findings from a study that examined foster home caregivers' views on the impact of the transformation of mental health services on caregivers and their work with persons with serious mental illness. In Québec foster homes, (or more commonly known as foster families), represent one of the oldest models of community based housing for persons with serious mental illness. In fact, the emergence of the first foster home dates back to the 1950ies. Over time, a large number of persons discharged from psychiatric hospitals during the process of deinstitutionalization were placed into these homes. Foster homes are private homes located in the community and operated by non professionals who can accommodate up to nine individuals. These residences provide a normal environment for its residents. Foster home caregivers must ensure a secure and safe environment as well as obtain certain services and encourage the social integration of the residents. Today foster homes are regulated by Bill 120 (Québec Government, 1995) and are designated as "family type resources" (RTF).

Adult↗
PubMed2004

The crucial role of sustained attention in community functioning in outpatients with schizophrenia.

The aim was to explore the pattern of associations between visual cognitive performance and community functioning in a sample of outpatients with schizophrenia participating in a rehabilitation program. Visuo-spatial tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered to assess cognitive performances in 88 subjects. The Multnomah Community Ability Scale (MCAS) was used to measure dimensions of community functioning. Our results showed that the sustained attention score was significantly associated with the global community functioning score and with two specific dimensions: "adjustment to living" and "behavioral problems". No association was found between other cognitive indices and MCAS scores. Since the sustained attention task mainly involves the executive component of working memory, these findings suggest that attentional control processes are limiting factors for community functioning in schizophrenia outpatients. Measures of such processes could serve as key indices of disability in clinical practice. Attention and working memory training may be helpful to improve community functioning in subjects with schizophrenia.

Adult↗
PubMed2004

Self-assessed cognitive dysfunction and objective performance in outpatients with schizophrenia participating in a rehabilitation program.

OBJECTIVE: To explore the pattern of associations between self-assessed and objective neuropsychological performance in a sample of outpatients with schizophrenia participating in a rehabilitation program. METHOD: The Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) [Compr. Psychiatry 44 (2003) 331] was used to assess cognitive complaints in 73 subjects with schizophrenia. Visuo-spatial tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) [Cogn. Neuropsychiatry 3 (1998) 45] were administered as objective measures. RESULTS: Cognitive complaints in several cognitive domains were mainly correlated with a true difficulty in memory. Higher SSTICS attention scores, i.e. increased complaints, were associated with poorer CANTAB explicit visual memory and planning performances. Higher SSTICS executive functioning scores were associated with poorer CANTAB explicit visual memory scores. CONCLUSION: These findings suggest that outpatients with schizophrenia express some cognitive difficulties. However, the cognitive nature of these subjective complaints does not strictly correspond with objective performances. These results also suggest that theoretical constructs of cognitive functions do not always have ecological validity. Thus, subjective cognitive complaints should be taken into account in assessment of patient well-being, but cannot be used as a substitute to objective cognitive measures. The simultaneous use of subjective and objective measures of cognitive dysfunction may provide a more complete picture of individual rehabilitation targets in patients with schizophrenia.

Adult↗
PubMed2004

Suicide and no axis I psychopathology.

BACKGROUND: It is unclear why approximately 10% of suicide completers seem to be psychiatrically normal. To better understand this issue, we studied suicide completers without an axis I diagnosis and compared them, on measures of psychopathology other than axis I, to normal controls and suicide cases with axis I psychopathology. METHODS: 168 suicide cases were examined by way of a psychological autopsy with the best possible informant. Sixteen cases did not meet criteria for an axis I diagnosis; each of these cases was then age and gender matched to 52 suicide completers with an axis I disorder and 110 normal controls. RESULTS: Fourteen of sixteen suicide cases without an axis I diagnosis had detectable abnormalities that were more similar to the axis I diagnosed suicide group than to a living group. Both suicide groups were similar in the total number of past suicide attempts, the total number of individuals with an axis II disorder, and similar scores on measures of impulsive-aggressive behaviors. CONCLUSIONS: These findings suggest that most of the individuals who committed suicide and appeared psychiatrically normal after a psychological autopsy may probably have an underlying psychiatric process that the psychological autopsy method, as commonly carried out, failed to detect.

Adolescent↗
PubMed2004

Alpha 2A adrenergic receptor gene and suicide.

Suicide is a complex trait resulting from the interaction of several predisposing factors, among which genes seem to play an important role. Alterations in the noradrenergic system have been observed in postmortem brain studies of suicide victims when compared to controls. The purpose of this study was to test the hypothesis that genetic variants of the alpha(2A) adrenergic receptor gene are implicated in suicide and/or have a modulatory effect on personality traits that are believed to mediate suicidal behavior. We studied a sample of suicides (N=110) and control subjects (N=130) for genetic variation at four loci, including three in the promoter region (g-1800t, c-1291 g and the g-261a) of the alpha(2A) adrenergic receptor gene, and a potentially functional locus, N251K, which leads to an amino acid change (asparagine to lysine). No significant differences were observed at the promoter loci in terms of allelic or genotypic distribution between suicides and controls. However, analysis of the functional polymorphism N251K revealed that the 251 K allele was only present among suicides, though only three suicide cases had this allele, two of which were homozygous. These results are preliminary. If confirmed, they suggest that variation at the alpha(2A) adrenergic receptor gene may play a role in a small proportion of suicide cases.

Adult↗
PubMed2004

Investigation of completed suicide and genes involved in cholesterol metabolism.

BACKGROUND: Several lines of evidence support the association between low or lowered levels of serum total cholesterol and suicide. Genetic epidemiological studies suggest that genes predispose to suicide. Given that genes control many aspects of cholesterol biosynthesis and metabolism, one approach through which to explore the putative association between low cholesterol and suicide is through genetic studies. METHODS: We examined the potential role of five genes encoding proteins involved in cholesterol biosynthesis and transport in a total sample of 305 male Caucasian subjects, consisting of 145 suicide completers and 160 controls. We investigated variation in the HMG CoA reductase (HMGCR), 7-dehydrocholesterol reductase (DHCR7), lipoprotein lipase (LPL), low-density lipoprotein receptor (LDLR), and apolipoprotein E (APOE) genes. RESULTS: We were unable to detect significant differences in allele or genotype frequencies between the suicide cases and controls for any of the genes studied. No relationship was found between genotype and impulsivity or aggression as measured using the BIS and BDHI, respectively. LIMITATIONS: The limitations of this study are consistent with the typical limitations inherent in most genetic association studies involving complex behavioral traits. CONCLUSION: Although these genes are unlikely to play a major role in susceptibility to suicide, further studies in a larger sample are necessary to reveal the smaller genetic effects, if present.

Adult↗
PubMed2004

Nature and prevalence of mental illness in the workplace.

This discussion paper explores the state of knowledge about the prevalence of mental illness and its effect on the working population. Major trends in the literature are also commented on, and significant gaps in knowledge are identified. Annually, 12% of Canadians from 15 to 64 years suffer from a mental disorder or substance dependence. Few studies have examined the prevalence of mental disorders among Canadian workers. Results from Ontario estimate that monthly, about 8% of the working population has a diagnosable mental disorder. Preliminary findings also indicate differences in the prevalence of mental disorders among workers with regard to occupation, age, sex, physical disorders, work environment and work-related stress. Studies indicate that mental and emotional health problems are associated with staggering social and economic costs, which create a heavy burden on the workplace. About one-third of society's depression-related productivity losses can be attributed to work disruptions. The impact of mental illness on the workplace has been examined in terms of its effect on presenteeism, absenteeism and disability days. The presence of any of these has been used to indicate decreased productivity, the largest burden arising from presenteeism. In total, Canada annually loses about $4.5 billion from this decreased productivity. Mental illness is also associated with short-term and long-term disability, which in turn is often related to insurance coverage. Mental illness related disability claims have doubled and mental illness accounts for 30% of disability claims, at a cost of $15 to $33 billion annually. The needs of the working population and employers must be addressed. We must be aware of patterns of mental disorder among occupational groups and industry sectors. In addition, we must understand how the disability benefit structure impacts the prevalence as well as patterns of disability related to mental illness. Effective policies and programs must be based on solid evidence.

Absenteeism↗
PubMed2003

Wolfram syndrome and suicide: Evidence for a role of WFS1 in suicidal and impulsive behavior.

There is evidence suggesting that subjects affected with the Wolfram syndrome (WFS) and normal carriers present an increased risk of psychiatric disorders, particularly depression and suicidal behavior. We investigated a possible role of the gene involved in WFS (WFS1) in the neurobiology of suicide and the potential modulatory effect on traits associated to suicidal behavior. Genetic variation at WFS1 (H611R, R456H, and I333V) was investigated in 111 suicide victims and 129 normal controls. Possible effects on psychopathology and behavioral traits were investigated in a subsample of suicide cases (N = 31) for whom phenotyping was carried out by means of structured psychiatric interviews and questionnaires adapted for psychological autopsies. We found a significantly higher frequency of the 611R/611R genotype in suicide completers as compared to controls (chi(2) = 19.21, df=2, P = 0.001). Suicide completers with this genotype had higher scores on measures of impulsivity (t = -3.15, df = 15.3, P = 0.006); novelty seeking (NS) (t = -3.35, df = 13.8, P = 0.005); and conversely, lower scores of persistence (t = 2.4, df = 16.6, P = 0.028). Scores of impulsivity and NS remained higher in subjects with the associated genotype after adjusting for age, gender, and psychopathology. These results suggest a role for WFS1 in the pathophysiology of impulsive suicide, and are consistent with previous clinical reports suggesting an increased risk of suicidal behavior in WFS homozygotes and heterozygotes. However, these findings are preliminary and should be confirmed in independent samples.

Adult↗
PubMed2003

The construct validity of the client questionnaire of the Wisconsin Quality of Life Index--a cross-validation study.

The Wisconsin Quality of Life Index (W-QLI, Becker, Diamond and Sainfort, 1993) consists of eight scales: satisfaction with life domains, occupational activities, symptoms, physical health, social relations/support, finances, psychological wellbeing, and activities of daily living. The W-QLI has been modified to fit the characteristics of the Canadian population, the universal Canadian health system, and community and social services in Canada and the modified form was named CaW-QLI (Diaz, Mercier, Hachey, Caron, and Boyer, 1999). This study will verify the empirical basis of these theoretical dimensions by applying a cross-validation procedure on two samples, most of whose subjects have a serious mental illness. Confirmatory factor analyses and exploratory factor analyses using the principal component extraction technique with varimax rotation were applied. With the exception of the occupational activities domain, the remaining scales were correctly identified by the factor analyses on each sample. The occupational activities scale should be developed by additional items for representing this scale, which is too brief, and two other items should be revised in order to improve the quality of the instrument.

Adult↗
PubMed2002

Chronic my A**.

Explore the source record for details and available documents.

Chronic Disease↗
PubMed2002

Strategies of collaboration between general practitioners and psychiatrists: a survey of practitioners' opinions and characteristics.

BACKGROUND: The description of collaboration models and the key underlying principles provide important information for designing services. However, to apply this broad corpus of information to clinical services and policymaking, we need to know which key principles (or strategies) of collaboration are the most accepted by local physicians. METHOD: In this context, we designed a survey that included 2 objectives: 1) to collect the opinions of practising general practitioners (GPs) and psychiatrists in Montreal with respect to strategies for improving collaboration between these 2 groups and 2) to identify demographic and practice characteristics of those physicians associated with the acceptance of such strategies. We designed a questionnaire to specifically elicit physicians' opinions about strategies involving communication, continuing medical education (CME) for GPs in psychiatry, and access to consulting psychiatrists, as well as to identify the profiles of the respondent physicians. We mailed the questionnaire to 203 GPs and 203 psychiatrists who were randomly selected. RESULTS: The response rate was 86% for GPs and 87% for psychiatrists. Physicians expressed favourable opinions about most strategies involving 1) the improvement of communication and 2) the organization of CME activities concerning GP practices in the field of psychiatry. On the other hand, they did not indicate acceptance of the strategies involving on-site collaboration between GPs and psychiatrists. Physician age, sex, place of practice, type of practice (such as seeing patients with or without appointments), and responsibility for administrative duties associated significantly with the degree of acceptance of the proposed strategies. CONCLUSION: Communication and CME strategies for GPs in psychiatry can be an option to improve collaboration between GPs and psychiatrists. However, strategies of access to consulting psychiatrists require significant alterations to established clinical routines and professional roles.

Attitude of Health Personnel↗
PubMed2002

Family physicians and psychiatrists. Qualitative study of physicians' views on collaboration.

OBJECTIVE: To understand how to improve collaboration between psychiatrists and family physicians in primary care settings. DESIGN: Qualitative study using 10 in-depth interviews and a focus group session. SETTING: Catchment area in eastern Montreal, Que. PARTICIPANTS: Five FPs and five psychiatrists. METHOD: Ten interviews and a focus group were conducted to identify ways of improving collaboration between FPs and psychiatrists. All session were audiotaped and transcribed verbatim. Analysts used Atlas.ti to compare findings vertically and horizontally. MAIN FINDINGS: Three strategies were identified: communication, continuing medical education (CME) for FPs, and access to consulting psychiatrists. The first two can be implemented by FPs and psychiatrists together, but psychiatrists thought the last one was not feasible due to lack of both time and remuneration for such activity. CONCLUSION: Better communication and CME for FPs in psychiatry can help improve collaboration between FPs and psychiatrists. Increased access to consulting psychiatrists requires substantial alteration in established clinical roles and routines.

Attitude of Health Personnel↗