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Iverson G.L.,British Columbia Mental Health and Addiction Services | Iverson G.L.,University of British Columbia | Hakulinen U.,Pirkanmaa Hospital District | Waljas M.,University of Tampere | And 7 more authors.
Brain Injury | Year: 2011

Objective: A practical methodological issue for diffusion tensor imaging (DTI) researchers is determining what to do about incidental findings, such as white matter hyperintensities (WMHI). The purpose of this study was to compare healthy control subjects with or without WMHIs on whole brain DTI. Method: Participants were 30 subjects (age=37.7, SD=11.3, Range=18-60; 70% female) who had no known developmental, general medical, neurological or psychiatric condition that could have had an adverse affect on brain morphology. Results: MRI (3 Tesla) revealed, at minimum, a WMHI in eight subjects (26.7%). Fractional anisotropy (FA) was calculated for 19 regions of interest (ROI). Frequency distributions of FA scores for the 19 ROIs were calculated. The 10th percentile for each ROI was selected as a cut-off score. Having four or more low FA scores occurred in 16.7%. More subjects with incidental findings met criterion for low FA scores (37.5%), compared to 9.1% of subjects with no findings. When subjects with minor WMHIs were retained and only those with multiple incidental findings were excluded, 8.3% of the retained subjects met criterion for low FA scores compared to 50.0% of the excluded subjects. Conclusions: The decision to include or exclude subjects who have incidental findings can influence the results of a study. © 2011 Informa UK Ltd All rights reserved.


Strub D.S.,Simon Fraser University | Douglas K.S.,Simon Fraser University | Douglas K.S.,Mid Sweden University | Nicholls T.L.,University of British Columbia | And 2 more authors.
International Journal of Forensic Mental Health | Year: 2014

The current study presents an empirical evaluation of the performance of the third version of the HCR-20. This prospective research project was conducted using a sample of 106 offenders and psychiatric patients who were transitioning out of institutions and into the community. Results provided strong support for the bivariate associations between the ratings of the presence and relevance of risk factors, as well as summary risk ratings, and violence at 4 to 6 weeks and 6 to 8 months. Although relevance ratings did not add incrementally to presence ratings, summary risk ratings added incrementally to both. Findings were not moderated by either sub-sample or gender. Version 3 of the HCR-20 was highly correlated with Version 2. Associations with violence were comparable between instruments. Findings were supportive of these basic elements of Version 3. © 2014 International Association of Forensic Mental Health Services.


Lange R.T.,Defense and Veterans Brain Injury Center | Lange R.T.,University of British Columbia | Iverson G.L.,University of British Columbia | Iverson G.L.,British Columbia Mental Health and Addiction Services | Brubacher J.R.,University of British Columbia
Journal of Head Trauma Rehabilitation | Year: 2012

OBJECTIVE: To examine the role of the protein S100B as a biomarker for traumatic brain injury (TBI) in the presence of acute alcohol intoxication. PARTICIPANTS: A total of 159 patients who presented to a large urban level 1 trauma center in Vancouver, British Columbia, Canada, were included. Patients were classified into 4 clinical groups-medical controls (MC), trauma controls (TC), uncomplicated mild TBI (MTBI), and definite TBI (DTBI)-and 2 day-of-injury alcohol intoxication groups (ie, sober and intoxicated). PROCEDURE: Blood samples were collected within 8 hours of injury. MAIN OUTCOME MEASURE: Protein S100B concentration (μg/L; Sangtec 100 Elisa, DiaSorin, Stillwater, Minnesota). RESULTS: Higher S100B levels were found in patients who sustained a TBI than in those in the MC and TC groups (DTBI & MTBI>TC & MC). There was a positive linear relation between S100B levels and brain injury severity (DTBI>MTBI). Alcohol consumption at the time of injury did not generally affect S100B levels. The S100B levels had medium diagnostic accuracy for the majority of patients, with the exception of the DTBI-sober group in which S100B levels had very high diagnostic accuracy. CONCLUSION: Patients with uncomplicated MTBIs and DTBIs had much higher levels of S100B than MC and TC participants. This biomarker had medium diagnostic accuracy for detecting DTBI in the presence of alcohol intoxication and very high accuracy in sober patients. © 2012 Lippincott Williams & Wilkins, Inc.


Brickell T.A.,British Columbia Mental Health and Addiction Services | Brickell T.A.,Defense and Veterans Brain Injury Center | McLean C.,British Columbia Mental Health and Addiction Services | McLean C.,Simon Fraser University | McLean C.,Alberta Health Services Addiction and Mental Health
Journal of Patient Safety | Year: 2011

Objectives: It is only recently that patient safety in mental health was considered a field in its own right, and there is a lack of awareness of the issues and a shortage of readily available information. This research builds on existing knowledge by soliciting the expertise of leaders in the area of patient safety and/or mental health via 2 qualitative methods. Methods: Qualitative interviews were held with 19 key informants. Small group discussions were held during a Canadian invitational roundtable event with 72 participants. A thematic qualitative analysis involving a 2-step process was performed: (1) coding each interview, and (2) identifying larger themes. Results: The findings revealed that more work is required to establish clear patient safety definitions, develop awareness, set priorities, and develop strategies for responding to patient safety incidents in mental health settings. Establishing a culture of patient safety and embedding it within all levels of an organization is vital, including adopting a systems level approach to examining patient safety incidents, encouraging open reporting and communication, considering the patient/caregiver perspective, and eliminating discrimination and stigma. Patient safety issues pertaining to community care settings are an urgent issue and require greater understanding. The need to promote national leadership, standardization of practice, ongoing training, information sharing, and additional research also was voiced. Conclusions: The results from this research highlight that greater action is required to improve patient safety in mental health settings. This research has identified several potentially important future directions for improving patient safety in mental health. Copyright © 2011 by Lippincott Williams & Wilkins.


Misri S.,Oak Street Health | Misri S.,University of British Columbia | Misri S.,British Columbia Mental Health and Addiction Services | Abizadeh J.,Oak Street Health | And 5 more authors.
Journal of Women's Health | Year: 2015

Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum. © 2015 Mary Ann Liebert, Inc.


Olson R.A.,BC Cancer Agency | Iverson G.L.,University of British Columbia | Iverson G.L.,British Columbia Mental Health and Addiction Services | Carolan H.,University of British Columbia | And 6 more authors.
Journal of Neuro-Oncology | Year: 2011

Cognitive screening tests are frequently used in brain tumor clinics. The Mini Mental State Examination (MMSE) is the most commonly used, and the Montreal Cognitive Assessment (MoCA) is an alternative. This study compares the diagnostic accuracy of both screening tests. Fifty-eight patients with brain tumors were prospectively accrued and administered the MMSE and MoCA, 67% of who completed a comprehensive neuropsychological evaluation as a gold standard comparison. Quality of life and community integration were measured with the Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Community Integration Questionnaire (CIQ), respectively. At the pre-defined cut-off scores, the MoCA had superior sensitivity (61.9% vs. 19.0%, P < 0.005) and the MMSE had superior specificity (94.4% vs. 55.6%, P < 0.017). The areas under the ROC curve for the MMSE (0.615, standard error = 0.091) and MoCA (0.606, standard error = 0.092) were poor, indicating that at no single cut-off score is either test both sensitive and specific. Neither the MMSE (ρ = 0.12; P < 0.444) nor MoCA (ρ = 0.24; P < 0.108) were significantly correlated with the FACT-Br. The MoCA was modestly correlated with the CIQ (ρ = 0.35; P < 0.017), but the MMSE was not (ρ = 0.14; P < 0.359). The MMSE has extremely poor sensitivity. Using this test in clinical practice, research, and clinical trials will result in failing to detect cognitive impairment in a substantial percentage of patients. The MoCA has superior sensitivity, and is better correlated with self reported measures of community integration, and therefore should be preferentially chosen in practice and clinical trials. © 2011 Springer Science+Business Media, LLC.


Hart S.L.,Ryerson University | Hart S.L.,Mount Sinai Hospital | Torbit L.A.,Ryerson University | Crangle C.J.,Ryerson University | And 7 more authors.
Psycho-Oncology | Year: 2012

Objectives Although the hereditary breast and ovarian cancer literature has demonstrated short-term gains in psychological adjustment following genetic counseling, there has been limited research examining long-term outcomes and moderators. Moreover, there has been minimal research into the psychological effects of this intervention in populations at high risk for pancreatic cancer. This study examines the long-term effects of pancreatic cancer screening and genetic counseling on cancer-related distress and cancer worry in a high-risk population at 1-year follow-up. Additionally, this study explores potential moderators of the effectiveness of this intervention. Methods One hundred twenty-nine participants with familial pancreatic cancer or with the BRCA2 gene mutation completed a baseline questionnaire prior to their first pancreatic cancer screening and genetic counseling session. Participants also completed questionnaires at 3- and 12-month follow-up. Results Cancer-related intrusive thoughts decreased significantly over time, whereas cancer-related worry decreased at 3 months and showed a small but significant increase at 1 year. Age and baseline distress exhibited moderator effects. Younger individuals showed a significant decrease in cancer-related intrusive thoughts, cancer-related avoidant thoughts, and cancer worry. Additionally, individuals with greater baseline distress showed a significant decrease in cancer-related intrusive thoughts over time. Conclusions Analysis of the long-term effects of pancreatic cancer screening and genetic testing reveal psychological gains that are maintained at 1-year follow-up. This intervention is particularly effective for younger participants and individuals with greater baseline distress. Copyright © 2011 John Wiley & Sons, Ltd.


Iverson G.L.,University of British Columbia | Iverson G.L.,British Columbia Mental Health and Addiction Services
Journal of Head Trauma Rehabilitation | Year: 2010

Background: A vast majority of traumatic brain injuries sustained by military personnel are mild in severity. In 2008, the United States Department of Defense officially mandated a screening program designed to identify deployment-related mild traumatic brain injuries and associated residual symptoms. Objective: This article reviews this screening program, illustrates the clinical and methodological challenges associated with screening, and makes recommendations for improving the process of screening for mild traumatic brain injuries and related symptoms. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Brooks B.L.,Alberta Childrens Hospital | Brooks B.L.,University of Calgary | Iverson G.L.,University of British Columbia | Iverson G.L.,British Columbia Mental Health and Addiction Services
Archives of Clinical Neuropsychology | Year: 2010

Clinicians can use the prevalence of low scores to help interpret test performance. However, this information is limited for most test batteries. In 2007, Crawford, Garthwaite, and Gault presented Monte Carlo simulation software for estimating the base rates of low scores for any battery of tests. The purpose of this study is to examine the accuracy of a Monte Carlo simulation program for estimating the base rates of low scores. Base rates of low scores were: (a) calculated from large normative samples (actual base rates) for the Neuropsychological Assessment Battery and the Wechsler Adult Intelligence Scale-III/Wechsler Memory Scale-Third Edition and compared to (b) Monte Carlo estimations (estimated base rates). Monte Carlo estimations of the base rates of low scores had good accuracy when compared with the actual base rates of low scores for the two batteries. However, estimated base rates lose considerable accuracy in those with low or high intelligence. Monte Carlo simulation software is a potential option for clinicians to compute the base rates of low scores for any battery with published intercorrelations. However, the Monte Carlo program underestimates the base rates for those with low intelligence and overestimates the base rates for those with high intelligence.


Iverson G.L.,British Columbia Mental Health and Addiction Services | Iverson G.L.,University of British Columbia | Brooks B.L.,Alberta Childrens Hospital | Brooks B.L.,University of Calgary | And 2 more authors.
Journal of Affective Disorders | Year: 2011

Background: We hypothesized that only a minority of patients with mood disorders have measurable cognitive impairment, and this minority drives the small-to-medium effect sizes detected in group studies. Removal of this minority from group statistical analyses will illustrate that the majority appear to have broadly normal cognitive functioning. Methods: Participants were adults between the ages of 20 and 54, including 659 healthy control subjects, 84 unmedicated outpatients diagnosed with depression, 59 outpatients diagnosed with depression who were on medications at the time of the evaluation, and 43 outpatients with bipolar disorder. All completed the CNS Vital Signs computerized cognitive screening battery. Results: The prevalence rates of low cognitive test scores were calculated for the healthy control subjects and the patients with mood disorders. Having two scores at or below the 5th percentile occurred in 31.2% of the patients and only 8.2% of the control subjects [χ2(1) = 66.67, p <.0001; Odds Ratio = 5.1, 95% CI = 3.4-7.7]. For the control subjects, this low false positive rate for cognitive impairment was maintained across age groups, sexes, and education levels. A larger proportion of patients with bipolar disorder (41.9%) than patients with depression (27.1-28.6%) met this criterion for cognitive impairment. Conclusions: This study suggests that cognitive impairment associated with mood disorders is limited to a minority of patients with the majority being broadly cognitively normal. Future research should determine if this identified subgroup has neuroanatomical, neurophysiological, or neuroendocrine abnormalities. Cognitive screening tools of this type might be useful in selecting participants for studies. © 2011 Elsevier B.V. All rights reserved.

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