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University Institute of Mental Health

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Van Elburg A.,University Institute of Mental Health | Treasure J.,King's College London
Current Opinion in Psychiatry | Year: 2013

Purpose of review: To systematize new neurobiological findings on the cause and treatment of eating disorders. Recent findings: The conceptual framework of the cause of eating disorders has undergone great changes in the past decades. Recently, the National Institute of Mental Health proposed a new set of criteria for research purposes - the Research Domain Criteria (RDoC). We aim to structure this study as much as possible using these constructs across biological units of analysis, summarizing new findings. Brain imaging techniques have become sophisticated in identifying brain circuits related to illness behaviour and to fundamental traits such as reward and social processing. Genetic studies have moved from candidate gene studies onto genome-wide association studies; however, the field needs to cooperate to collect larger samples in order to benefit from this approach. Hormonal changes as the results of starvation or as underlying factors for behavioural changes still receive attention in both animal and human studies. Advances made in neuropsychology show problems in cognition (set shifting and central coherence) and in other RDoC domains. Some of these findings have been translated into treatment. Summary: New biological models are being developed which explain causal and maintaining factors. The RDoC construct may be used to systematize these findings. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Grant
Agency: European Commission | Branch: FP7 | Program: CP-IP | Phase: HEALTH-2009-2.2.1-2 | Award Amount: 15.03M | Year: 2010

The aim of EU-GEI is to identify the interactive genetic, clinical and environmental determinants involved in the development, severity and outcome of schizophrenia (EU-GEI, Schiz. Res. 2008; 102: 21-6). In order to identify these interactive determinants, EU-GEI will employ family-based, multidisciplinary research paradigms, which allow for the efficient assessment of gene-environment interactions. In order to go beyond old findings from historical convenience cohorts with crude measures of environmental factors and clinical outcomes, the focus in EU-GEI will be on recruitment of new, family-based clinical samples with state-of-the-art assessments of environmental, clinical and genetic determinants as well as their underlying neural and behavioural mechanisms. New statistical tools will be developed to combine the latest multilevel epidemiological with the latest genome-wide genetic approaches to analysis. Translation of results to clinical practice will be facilitated by additional experimental research and risk assessment bioinformatics approaches. This will result in the identification of modifiable biological and cognitive mechanisms underlying gene-environment interactions and the construction of Risk Assessment Charts and Momentary Assessment Technology tools which can be used for (i) early prediction of transition to psychotic disorder in help-seeking individuals with an at-risk mental state and (ii) early prediction of course and outcome after illness onset. In order to reach these goals, EU-GEI has assembled a multidisciplinary team of top schizophrenia researchers who have the range of skills required to deliver a program of research that meets all the calls requirements and who have access to / will collect a number of unique European samples. The partners in EU-GEI represent the nationally funded schizophrenia / mental health networks of the UK, Netherlands, France, Spain, Turkey and Germany as well as other partners.


Berlim M.T.,University Institute of Mental Health | Neufeld N.H.,University of Toronto | Van den Eynde F.,University Institute of Mental Health
Journal of Psychiatric Research | Year: 2013

Objective: Randomized and sham-controlled trials (RCTs) on repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) have yielded conflicting results that may be due to limited statistical power among individual studies. We pursued the present systematic review and meta-analysis to assess the efficacy of rTMS for OCD and to generate hypotheses for more robustly powered RCTs. Method: We searched the literature for RCTs on rTMS for OCD from 1995 through December 2012 using MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and SCOPUS. We then performed an exploratory random-effects meta-analysis with the main outcome measures as pre-post changes in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores, response to treatment and overall dropout rates at study end. Results: Data were obtained from 10 RCTs, totaling 282 subjects with OCD. The pooled Hedges' g for pre-post Y-BOCS scores was 0.59 (z=2.73, p=0.006), indicating a significant and medium-sized difference in outcome favoring active rTMS. Furthermore, response rates were 35% and 13% for patients receiving active and sham rTMS, respectively (OR=3.4, p=0.002). Sub-group analyses indicated that LF-rTMS and rTMS protocols targeting non-DLPFC regions (i.e., orbitofrontal cortex or supplementary motor area) seem to be the most promising for reducing OCD-related symptoms. No differences on baseline depression scores or dropout rates at study end were observed between active and sham rTMS groups, although OCD severity at baseline was higher in the active group. Conclusions: Our exploratory analyses show that active rTMS seems to be efficacious for treating OCD. Moreover, LF-rTMS and protocols targeting the orbitofrontal cortex or the supplementary motor area seem to be the most promising. Nevertheless, future RCTs on rTMS for OCD should include larger sample sizes and be more homogeneous in terms of demographic/clinical variables as well as stimulation parameters and brain targets. © 2013 Elsevier Ltd.


Lepage M.,University Institute of Mental Health | Bodnar M.,University Institute of Mental Health | Bowie C.R.,Queen's University
Canadian Journal of Psychiatry | Year: 2014

Schizophrenia is characterized by significant heterogeneity in outcome. The last decades have witnessed a significant interest in identifying factors that can moderate or influence clinical and functional outcomes in people with schizophrenia. One factor of particular interest is neurocognition, as performance on various measures of cognitive abilities, such as memory, attention, and executive functions, have been consistently related to functional outcome and, to a lesser extent, clinical outcome. This review aims to provide an up-todate description of recent studies examining the association between neurocognition and clinical and (or) functional outcomes. In the first section, studies examining neurocognitive performance in relation to clinical outcome are examined. When clinical outcome is defined dichotomously (for example, comparing remitted and nonremitted), verbal memory performance consistently exhibits a strong association with clinical status, with the poor outcome group showing the largest deficits. In the second section, studies exploring the relation between neurocognition and various dimensions of functional outcome are reviewed. These dimensions include independent living, social functioning, and vocational functioning, among others. Again, a strong link between neurocognitive deficits and impairments in several aspects of functioning clearly emerges from this review. Finally, several measurement issues are discussed that pertain to the need to standardize definitions of clinical and (or) functional outcomes, the importance of defining cognitive domains consistently across studies, and distinguishing between one's competence to perform tasks and what one actually does in everyday life. Addressing these measurement issues will be key to studies examining the development of effective interventions targeting neurocognitive functions and their impact on clinical and functional outcomes.


Shiri Z.,Montreal Neurological Institute | Manseau F.,University Institute of Mental Health | Levesque M.,Montreal Neurological Institute | Williams S.,University Institute of Mental Health | Avoli M.,Montreal Neurological Institute
Annals of Neurology | Year: 2015

Seizures in temporal lobe epilepsy can be classified as hypersynchronous and low-voltage fast according to their onset patterns. Experimental evidence suggests that low-voltage fast-onset seizures mainly result from the synchronous activity of γ-aminobutyric acid-releasing cells. In this study, we tested this hypothesis using the optogenetic control of parvalbumin-positive interneurons in the entorhinal cortex, in the in vitro 4-aminopyridine model. We found that both spontaneous and optogenetically induced seizures had similar low-voltage fast-onset patterns. In addition, both types of seizures presented with higher ripple than fast ripple rates. Our data demonstrate the involvement of interneuronal networks in the initiation of low-voltage fast-onset seizures. © 2014 American Neurological Association.


Economou M.,University Institute of Mental Health
Psychiatrikē = Psychiatriki | Year: 2012

Mental health telephone help-lines usually play a significant role in mental health services system. Their importance is substantiated during periods of financial crisis, where the mental health of the population is gravely inflicted. Media reports have documented a large increase in calls made to mental health telephone help-lines around the world as a corollary to the global economic crisis; however, a systematic investigation of this observation is still lacking. In this context, the present study endeavours to fill this gap in the literature, while it adds strength to the handful of studies which have empirically supported the impact of the financial crisis on mental health in Greece. Data were extracted from information gleaned during the calls made to the Depression Telephone Helpline of the Greek University Mental Health Research Institute. The information entailed the reason for calling, the socio-demographic and clinical profile of the person with mental health problems, his/her previous and current contacts with mental health professionals and the treatment he/she might be receiving. The results showed a steep increase in calls with direct or indirect reference to the economic crisis during the first half of 2010 and onwards. The callers who referred to the economic crisis manifested depressive symptomatology of clinical significance to a greater degree than callers who made no such reference. The latter exhibited increased levels of distress and agitation as well as drug/alcohol misuse. Concomitantly, a higher frequency of depressive symptomatology was discerned among the unemployed, whereas employed people were found to experience anxiety symptoms to a higher degree. The impact of the financial crisis on the mental health of the Greek population has been considerable, underscoring in this way the importance of mental health help-lines as emotional buffers and as guides for timely and appropriate service use in response to the emerging mental health problems.


Latimer E.,University Institute of Mental Health
British Journal of Psychiatry | Year: 2010

Evidence to date indicates that the individual placement and support model of supported employment helps people with mental illness to obtain competitive jobs. The study by Howard et al (this issue) is the first unsuccessful trial of this model. Vocational workers had far fewer contacts with clients and employers than normal.


Piat M.,University Institute of Mental Health
Psychiatric rehabilitation journal | Year: 2012

With the use of a qualitative approach, this study focuses on service providers' experiences and perspectives on recovery-oriented reform. Nine focus groups were conducted with a sample of 68 service providers recruited from three Canadian sites. Three major themes were identified: 1) positive attitudes towards recovery-oriented reform; 2) skepticism towards recovery-oriented reform; and 3) challenges associated with implementing recovery-oriented practice. These challenges pertained to conceptual uncertainty and consistency around the meanings of recovery; application of recovery-oriented practice with certain populations and in certain contexts; bureaucratization of recovery-oriented tools; limited leadership support; and, societal stigma and social exclusion of persons with mental illnesses. The findings point towards challenges that might arise as system planners move ahead in their efforts toward implementing recovery within the mental health system. In this regard, we offer several recommendations for the planning of organizational and educational practices that support the implementation of recovery-oriented practice.


Hovington C.L.,University Institute of Mental Health
Expert review of neurotherapeutics | Year: 2012

Negative symptoms have been a conundrum to researchers and clinicians alike since having first been identified by Bleuler and Kraepelin. The term 'negative symptoms' has been scrutinized with regards to what it encompasses. Negative symptomatology has been categorized into distinct subdomains, including primary symptoms, secondary symptoms, deficit syndrome and, more recently, persistent negative symptoms (PNS). Although there have been some theories put forward with regards to negative symptoms, there are still discordant findings regarding PNS. Thus, this article aimed to review the structural, functional and cognitive correlates of PNS in an attempt to better understand these specific negative symptoms in schizophrenia. According to the reviewed literature, deficit syndrome appears to have similar neurocognitive and structural deficits as PNS; however, some minor distinctions may suggest that PNS are a separate subtype of negative symptoms. White matter decrements in the frontal lobe and gray matter reductions in the temporal lobe may be related more specifically to PNS. Furthermore, unlike deficit syndrome, structural abnormalities in the frontal and temporal lobe also appear to be related to PNS in patients with first-episode schizophrenia. Cognitive domains, such as memory, are impaired and appear to be predominantly related to PNS. Hence, PNS do appear to have neuroimaging and neurocognitive correlates and warrant further research.


Ray J.V.,University Institute of Mental Health
Personality disorders | Year: 2013

A concern among researchers is that self-report measures may not be valid indicators of psychopathic traits due to the core features of psychopathy (e.g., lying, deception/manipulation). The current study addresses this issue by combining effects sizes from studies published on or before March 31, 2010 to examine the relation between scores of 3 widely used self-report psychopathy measures--the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996) and its revised version (PPI-R; Lilienfeld & Widows, 2005) and Levenson's Self-Report Psychopathy scale (LSRP; Levenson, Kiehl, & Fitzpatrick, 1995) and scores on measures assessing response style (i.e., faking good and faking bad). Effect sizes were obtained from 45 studies for total, Factor 1, and Factor 2 scores (faking good: k = 54, 55, and 55, respectively; faking bad: k = 51, 50, and 50, respectively). Based on a random effects model, a significant negative association was found between social desirability/faking good and both total (r(w) = -.11, p < .01) and F2 (r(w) = -.16, p < .01) scores, and moderation analyses suggested that effect sizes varied as a function of psychopathy scale and validity scale used. Significant positive associations were also found between faking bad and both total (r(w) = .27, p < .05) and F2 (r(w) = .32, p < .05) scores. Also, moderation analyses suggested that effect sizes varied as a function of study location, psychopathy scale, and validity scale. Despite several limitations (e.g., inclusion of only published studies, limited moderators, exclusion of other measures), the general findings temper concerns of positive response bias and underscore the validity of self-report psychopathy scales.

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