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Verdun, Canada

Lloyd S.,Douglas Institute | Moreau N.,University of Ottawa
Medical Anthropology: Cross Cultural Studies in Health and Illness | Year: 2011

Throughout the process of being treated for mood and anxiety disorders, people dream of the "normal life" that awaits them. However, post-therapy, the distinctiveness of clinical normality (i.e., reduced symptomatology) and social normativity become more apparent. In this article we suggest that for people who have long felt socially excluded because of their psychiatric symptoms, being "normally shy" or "normally awkward" is not enough. Instead they aspire to an ideal life. This confusion between means and ends, between a nonsymptomatic self, a normative self, and an ideal self, leads these individuals to long-term self-doubt and confusion about how to reach their elusive goals. Yet, their never-ending pursuit of normative ideals applies to "normal" and "abnormal" people alike. An analysis of narratives of exclusion allows us to reflect the life-long search for social inclusion via a normal life. © 2011 Copyright Taylor and Francis Group, LLC. Source

Brunet A.,McGill University | Brunet A.,Douglas Institute | Monson E.,McGill University
Canadian Journal of Psychiatry | Year: 2014

This In Review features a primer by Dr Jitender Sareen1 on PTSD and some of its most well-established risk and resilience factors. As noted by Dr Sareen, there is increasing evidence that PTSD is associated with suicidal risk. The second paper in this In Review is a systematic review by Dr Nicola T Fear and colleagues (see Hines et al2) on the PTSD rates observed in various armies of the world following deployment to Iraq and Afghanistan. As this issue of The Canadian Journal of Psychiatry is being prepared, the last members of the CAF have recently returned from Afghanistan. Several suicides by returnees from Afghanistan have been made public and reports have been echoed by the media; as a result, suicidality among the CAF's active and retired members has once again become a source of concern for all Canadians. Source

Cherkasova M.V.,McGill University | Faridi N.,McGill University | Casey K.F.,McGill University | O'Driscoll G.A.,McGill University | And 8 more authors.
Neuropsychopharmacology | Year: 2014

Converging evidence from clinical, preclinical, neuroimaging, and genetic research implicates dopamine neurotransmission in the pathophysiology of attention deficit hyperactivity disorder (ADHD). The in vivo neuroreceptor imaging evidence also suggests alterations in the dopamine system in ADHD; however, the nature and behavioral significance of those have not yet been established. Here, we investigated striatal dopaminergic function in ADHD using [11C]raclopride PET with a d-amphetamine challenge. We also examined the relationship of striatal dopamine responses to ADHD symptoms and neurocognitive function. A total of 15 treatment-free, noncomorbid adult males with ADHD (age: 29.87±8.65) and 18 healthy male controls (age: 25.44±6.77) underwent two PET scans: one following a lactose placebo and the other following d-amphetamine (0.3 mg/kg, p.o.), administered double blind and in random order counterbalanced across groups. In a separate session without a drug, participants performed a battery of neurocognitive tests. Relative to the healthy controls, the ADHD patients, as a group, showed greater d-amphetamine-induced decreases in striatal [11C]raclopride binding and performed more poorly on measures of response inhibition. Across groups, a greater magnitude of d-amphetamine-induced change in [11C]raclopride binding potential was associated with poorer performance on measures of response inhibition and ADHD symptoms. Our findings suggest an augmented striatal dopaminergic response in treatment-naive ADHD. Though in contrast to results of a previous study, this finding appears consistent with a model proposing exaggerated phasic dopamine release in ADHD. A susceptibility to increased phasic dopamine responsivity may contribute to such characteristics of ADHD as poor inhibition and impulsivity. © 2014 American College of Neuropsychopharmacology. Source

Lee L.,McGill University | Li C.,McGill University | Landry T.,McGill University | Latimer E.,McGill University | And 4 more authors.
Annals of Surgery | Year: 2014

OBJECTIVE:: To perform a systematic review of economic evaluations of enhanced recovery pathways (ERP) for colorectal surgery. BACKGROUND:: Although there is extensive literature investigating the clinical effectiveness of ERP, little is known regarding its cost-effectiveness. METHODS:: A systematic literature search identified all relevant articles published between 1997 and 2012 that performed an economic evaluation of ERP for colorectal surgery. Studies were included only if their ERP included all 5 of the key components (patient information, preservation of GI function, minimization of organ dysfunction, active pain control, and promotion of patient autonomy). Quality assessment was performed using the Consensus on Health Economic Criteria instrument (scored 0-19; high quality ≥ 12). Incremental cost-effectiveness ratios were calculated if sufficient data were provided, using difference in length of stay and overall complication rates as effectiveness measures. RESULTS:: Of a total of 263 unique records identified (253 from databases and 10 from other sources), 10 studies met our inclusion criteria and were included for full qualitative synthesis. Overall quality was poor (mean quality 7.8). Eight reported lower costs for ERP. The majority (8 of 10) of studies were performed from an institutional perspective and therefore did not include costs related to changes in productivity and other indirect costs (eg, caregiver burden). Five studies provided enough information to calculate ICERs, of which ERP was dominant (less costly and more effective) in all cases for reduction in length of stay and was dominant or potentially cost-effective in 4 and questionable (no difference in costs nor effectiveness) in 1 for reduction in overall complications. CONCLUSIONS:: The quality of the current evidence is limited but tends to support the cost-effectiveness of ERP. There is need for well-designed trials to determine the cost-effectiveness of ERP from both the institutional and societal perspectives. © 2013 by Lippincott Williams & Wilkins. Source

Burhan A.M.,St. Josephs Health Care London | Bartha R.,University of Western Ontario | Bocti C.,Universite de Sherbrooke | Borrie M.,St. Josephs Health Care London | And 3 more authors.
Alzheimer's Research and Therapy | Year: 2013

The Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4) was held 3 to 4 May 2012 in Montreal, Quebec, Canada. A group of neuroimaging experts were assigned the task of reviewing and summarizing the literature on clinical and research applications of different neuroimaging modalities in cognitive disorders. This paper summarizes the literature and recommendations made to the conference regarding the role of several emerging neuroimaging modalities in cognitive disorders. Functional magnetic resonance imaging (MRI), magnetic resonance spectroscopy, and diffusion tensor imaging are discussed in detail within this paper. Other emergent neuroimaging modalities such as positron emission tomography with novel ligands, high-field MRI, arterial spin labeling MRI and noncerebral blood flow single-photon emission computerized tomography are only discussed briefly. Neuroimaging modalities that were recommended at the CCCDTD4 for both clinical and research applications such as amyloid and flurodeoxyglucose positron emission tomography, computerized tomography and structural MRI are discussed in a separate paper by the same authors. A literature search was conducted using the PubMed database including articles in English that involved human subjects and covered the period from the last CCCDTD publication (CCCDTD3; January 2006) until April 2012. Search terms included the name of the specific modality, dementia, Alzheimer's disease, and mild cognitive impairment. A separate search used the same parameters but was restricted to review articles to identify recent evidence-based reviews. Case studies and small case series were not included. Papers representing current evidence were selected, reviewed, and summarized, and the results were presented at the CCCDTD4 meeting with recommendations regarding the utility of various neuroimaging modalities in cognitive disorders. The evidence was graded according to the Oxford Centre for Evidence Based Medicine guidelines. Due to the limitations of current evidence, the neuroimaging modalities discussed in this paper were not recommended for clinical investigation of patients presenting with cognitive impairment. However, in the research setting, each modality provides a unique contribution to the understanding of basic mechanisms and neuropathological markers of cognitive disorders, to the identification of markers for early detection and for the risk of conversion to dementia in the at-risk populations, to the differentiation between different types of cognitive disorders, and to the identification of treatment targets and indicators of treatment response. In conclusion, for all of the neuroimaging modalities discussed in this paper, further studies are needed to establish diagnostic utility such as validity, reliability, and predictive and prognostic value. More multicenter studies are therefore needed with standardized image acquisition, experimental protocols, definition of the clinical population studied, larger numbers of participants, and longer duration of follow-up to allow generalizability of the results to the individual patient. © 2013 BioMed Central Ltd. Source

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