Objectives. To describe a case of fluvoxamine-induced severe hyponatremia, most likely due to abn... more Objectives. To describe a case of fluvoxamine-induced severe hyponatremia, most likely due to abnormal antidiuretic hormone excretion (SIADH), and to discuss the implication for maintenance treatments for these patients. Clinical Observations. Although this syndrome had its incidence most commonly among the elderly, we report a case of severe hyponatremia (serum sodium <114 mmol/L), in a relatively young male. Treatment. Symptoms responded well to IV hyperosmolar sodium and to the discontinuation of fluvoxamine. This patient was maintained for treatment on an alternative Selective Serotonin Reuptake Inhibitor (SSRI), Citalopram, without developing recurrence of symptoms. Outcome and Conclusion. Protocols to monitor the maintenance treatments in high-risk patients may be needed to prevent recurrence of serious complications.
Canadian Journal of Psychiatry Revue Canadienne De Psychiatrie, Oct 1, 1997
To explore the effect of chronic institutionalization on cognitive performance in chronic psychia... more To explore the effect of chronic institutionalization on cognitive performance in chronic psychiatric patients with emphasis on age disorientation, a phenomenon that was found in previous research to occur in up to 25% of chronic schizophrenic patients.
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 1997
To explore the effect of chronic institutionalization on cognitive performance in chronic psychia... more To explore the effect of chronic institutionalization on cognitive performance in chronic psychiatric patients with emphasis on age disorientation, a phenomenon that was found in previous research to occur in up to 25% of chronic schizophrenic patients. One hundred and ten chronic psychiatric patients, forming 4 main groups--schizophrenic patients, nonschizophrenic patients, institutionalized, and noninstitutionalized--were examined for age disorientation (inability to give one's chronological age correctly on request), and their Minimental State scores (MMSE) were compared across the 4 groups. Twelve out of 43 patients (26%) who were institutionalized according to our definition were age-disoriented and had significantly lower MMSE scores than the other 3 groups. The chronic, noninstitutionalized schizophrenic group and the other chronic psychiatric patients, whether they were institutionalized or not, were negative for this phenomenon. One of the 12 age-disoriented patients wa...
The purpose of this study was to compare the effectiveness of novel antipsychotics in the treatme... more The purpose of this study was to compare the effectiveness of novel antipsychotics in the treatment of psychotic depression. Method: Consecutive patients who were admitted (n = 51) with a confirmed diagnosis of major depression with psychotic features (delusions or hallucinations or both) participated in this open-label, naturalistic study. All patients were treated with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (citalopram or venlafaxine extended release [XR]), and atypical antipsychotic agents were added, as tolerated, during the first week of initiating the citalopram or venlafaxine. There were patients (n = 16) who received risperidone, who received quetiapine (n = 20), and who received olanzapine (n = 15), as an adjunctive treatment to either citalopram or venlafaxine for at least 8 weeks. Outcome measures included the Clinical Global Impression-Severity subscale (CGI-S), as the primary outcome measure, as well as the Hamilton Rating Scale for Depression-21 item (HAM-D21) and the Brief Psychiatric Rating Scale (BPRS). Tolerance to treatments and weight changes were monitored over the period of the trial. Results: All patients completed the trial with no drop outs. At 8 weeks, there was a statistically significant (P , 0.001) clinical improvement in all outcome measures for both the depressive and psychotic symptoms, for all three groups of atypical adjunctive treatments. Utilizing analysis of variance (ANOVA), there were no significant differences between the three adjunctive treatment groups in outcome measures. The three antipsychotic agents were equally tolerated. At 8 weeks there was slight increase in weight in the three treatment groups, which was statistically significant (P .01) in the olanzapine group. Conclusion: Quetiapine, risperidone, and olanzapine, given as adjunctive treatment with SSRIS or SNRIs can significantly and equally improve depressive and psychotic symptoms, in the short-term treatment of major depression with psychotic features. The author recommends that large controlled trials be conducted to examine the differences in long-term efficacy and tolerance between the atypical antipsychotic agents, in the treatment of major depression with or without psychotic features.
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2007
To examine efficacy and tolerability of topiramate as an adjunctive treatment for overweight refr... more To examine efficacy and tolerability of topiramate as an adjunctive treatment for overweight refractory bipolar patients. Patients (n=30) with Bipolar I or II, were provided with an open label treatment with topiramate as an add-on therapy. All patients deemed refractory to at least one mood stabilizer, were overweight, and were treated with topiramate as an adjuvant to existing medication for at least 12 weeks. The primary effectiveness measure was the Clinical Global Impression Scale (CGI). Other scales included the Young&amp;amp;#39;s Mania Rating Scale (YMRS), and the Hamilton Depression scale (HAMD21). Measures prior to adding topiramate were compared to those repeated at 4, 8 and 12 weeks. Tolerance, and weight changes were monitored. There was significant reduction in both depressive and manic symptoms with adjunctive treatment. The mean BMI at 12 weeks of topiramate treatment dropped by 2 points (p&amp;amp;lt;0.0001). Topiramate is an effective adjunctive treatment in bipolar refractory patients and the significant weight reduction effects may result in important medical risk reductions, and make topiramate attractive for some obese bipolar patients.
The study reported here aimed to develop and psychometrically assess an instrument to measure exa... more The study reported here aimed to develop and psychometrically assess an instrument to measure examination anxiety among undergraduate university students. Based on empirical evidence and recent literature review we developed a 12 item scale to measure the severity of examination anxiety. The instrument was administered to students, two weeks before they wrote their examinations. Experts (n=10) participated in a validation process of the instrument before it was administered to students (n= 40). Internal consistency reliability for the instrument was 0. 82 (Cronbach's alpha) and there was 92 % overall agreement between experts about the relevance of the instruments' items to measure students' examination anxiety, providing evidence for content validity. Factor analysis resulted in three cohesive and theoretically meaningful factors. There is evidence for content and convergent validity. The developed instrument is a reliable, valid and empirical measure to assess the severity of examination anxiety. The scale will take five minutes to complete.
Objective: To conduct a literature review of patient-and population-based research on depression ... more Objective: To conduct a literature review of patient-and population-based research on depression literacy and determine the implications of the findings for patient psycho-education. Method: The authors searched PubMed for articles published between January 1995 and January 2007; they chose English-language articles of studies based on samples drawn from the general population as well as clinical studies conducted in North America, Australia, and European countries. Results: A total of 48 published papers in referred journals (two review articles and 46 original research papers) met the inclusion criteria. Most studies examined the public's knowledge and attitudes towards treatment of depression. To examine the ability of participants to recognize clinical depressive symptoms and attitudes towards depression and its treatment, researchers commonly used vignettes involving survey methods based on community samples. Depression literacy is generally poor among the general public an...
Background: Non-adherence to treatment can result from forgetting, carelessness, stopping the dru... more Background: Non-adherence to treatment can result from forgetting, carelessness, stopping the drug when feeling worse, or stopping the drug when feeling better. Objective: To develop and psychometrically assess a brief instrument that can be easily used in clinical practice to measure adherence to antidepressants. Method: We developed the Antidepressants Adherence Scale (AAS); a self report rating scale including four items to assess the degree to which forgetting, carelessness, and stopping due to feeling worse or feeling better interfere with adherence in the last 4 weeks. Our proposed fouritem adherence instrument was developed based on previous research and theory. Participants: Experts in mood disorders (n = 12) participated in the formal validity assessment of the instrument, and the developed instrument was administered to patients who were prescribed antidepressants (n = 63). All patients also completed a multiple choice question instrument to measure knowledge of depression, and a Likert self report questionnaire to assess attitudes towards depression and its treatment. Results: There was 90% agreement among experts that the items were highly relevant providing strong evidence for content validity. Also, there was empirical evidence for validity. There were significant correlations (p b 0.05) between knowledge and attitude subscales and adherence items. The internal consistency reliability (Cronbach's alpha) was 0.66 for the instrument Conclusion and significance: Knowledge of and attitudes to depression and its treatment may have significant impact on the adherence to antidepressants. The AAS can be used in clinical settings (2-3 min to administer) to evaluate patients' adherence to antidepressants.
To develop and psychometrically assess an instrument to measure patients&amp;amp;amp;amp;amp;... more To develop and psychometrically assess an instrument to measure patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attitudes towards depression, to its treatments, and aspects of professional help in patients suffering from depression. A 27 item Likert type instrument was developed and written based on an evidence from a literature review and in consultation with experts in depression. Psychiatrists (n=12) participated in a validation process of the instrument before it was administered to outpatients (n=63) suffering from non-psychotic depression. Internal consistency reliability for the instrument was 0.79 (Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha) and there was 88% overall agreement between experts about the relevance of the instruments&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; items to test patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attitudes to depression and its treatments, providing evidence for content validity. Factor analysis resulted in five cohesive and theoretically meaningful factors: 1) Acceptance of treatment, 2) Perceived stigma and shame, 3) Negative attitude towards antidepressants, 4) Self stigma, and 5) Preference for psychotherapy. The developed instrument is a reliable, valid and empirical measure to assess attitudes towards depression and its treatments. Future research should be designed to replicate and extend the present findings with larger and more heterogeneous samples.
Background: To develop and psychometrically assess a multiple choice question (MCQ) instrument to... more Background: To develop and psychometrically assess a multiple choice question (MCQ) instrument to test knowledge of depression and its treatments in patients suffering from depression.
The purpose of this study was to examine and compare diagnostic success and its relationship with... more The purpose of this study was to examine and compare diagnostic success and its relationship with the diagnostic reasoning process between novices and experts in psychiatry. Methods: Nine volunteers, comprising five expert psychiatrists and four clinical clerks, completed a think-aloud protocol while attempting to make a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of a selected case with both Axis I and Axis III diagnoses. Results: Expert psychiatrists made significantly more successful diagnoses for both the primary psychiatric and medical diagnoses than clinical clerks. Expert psychiatrists also gave fewer differential options. Analyzing the think-aloud protocols, expert psychiatrists were much more organized, made fewer mistakes, and utilized significantly less time to access their knowledge than clinical clerks. Both novices and experts seemed to use the hypothetic-deductive and scheme-inductive approaches to diagnosis. However, experts utilized hypothetic-deductive approaches significantly more often than novices. Conclusion: The hypothetic-deductive diagnostic strategy was utilized more than the schemeinductive approach by both expert psychiatrists and clinical clerks. However, a specific relationship between diagnostic reasoning and diagnostic success could not be identified in this small pilot study. The author recommends a larger study that would include a detailed analysis of the think-aloud protocols.
ADHD Attention Deficit and Hyperactivity Disorders, 2011
To examine changes in partially responsive anxiety symptoms utilizing adjunctive treatment with a... more To examine changes in partially responsive anxiety symptoms utilizing adjunctive treatment with atomoxetine in the treatment of adult ADHD patients with comorbid partially responsive anxiety symptoms. Consenting adult patients (n=29) with confirmed diagnosis of generalized anxiety and comorbid attention deficit hyperactivity disorder (ADHD) participated in this open-label study. All patients had significant comorbid anxiety symptoms (HAM-A&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;7) and failed to respond to 8-week trials of selective serotonin reuptake inhibitors (SSRIs) or noradrenaline reuptake inhibitors (SNRIs). All patients were treated with atomoxetine as adjunctive to SSRIs or to SNRIs and were followed for at least 12 weeks. The primary outcome measure was the Clinical Global Impression severity subscale. Other scales included the Hamilton Anxiety Scale (HAM-A), the adult ADHD Self-Report Scale (ASRS-v1.1) symptom checklist, and Sheehan&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Disability Scale. Baseline measures prior to the treatment with atomoxetine were compared to those at 4, 8, and at 12 weeks of treatment. Monitoring for pulse, blood pressure, and weight changes was carried out at baseline and at end point. Twenty-seven patients (93%) completed this open-label study. There was significant resolution of symptoms of all outcome measures, including the symptoms of anxiety, as shown by changes from baseline in HAM-A, ASRS-v1.1, and CGI at 12 weeks (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). Also, there was significant reduction in the disability score at 12 weeks. Patients completed the study, tolerated the adjunctive treatment, and there were no significant cardiovascular or weight changes. Two patients withdrew from the study during the first 4 weeks of treatment due to side effects. Atomoxetine can be used as an adjunctive treatment in adult patients with ADHD and comorbid partially responsive anxiety symptoms.
Objective: To develop and psychometrically assess a short instrument that can be easily used in c... more Objective: To develop and psychometrically assess a short instrument that can be easily used in clinical practice to measure knowledge-seeking behavior in patients suffering from depression. Method: We developed the knowledge seeking instrument (KSI), a self-report scale of three items to assess the number of hours spent in knowledge seeking behavior such as reading written materials, surfing the internet, or watching audio-visual tools. Experts in mood disorders (n = 12) participated in the formal validity assessment of the instrument, and the developed instrument was administered to outpatients who were attending psychiatry clinic (n = 63). All patients also completed a multiple choice question instrument to measure knowledge of depression, a Likert self report questionnaire to assess attitudes towards depression and its treatment, and an adherence to antidepressants scale. Results: In addition to the empirical evidence for validity, there was 68% agreement among experts that the items were highly relevant in measuring behavior of knowledge seeking, providing evidence for content validity. There were significant correlations (pb 0.05) between knowledge of psychological and biological treatments of depression and knowledge seeking reading scores. The internal consistency reliability (Cronbach's alpha) was 0.67 for the instrument. Conclusion and significance: The KSI takes 2 min to complete. There is evidence for reliability, content, and criterion based concurrent validities. The KSI can be utilized to assess knowledge seeking behavior in patients with depression.
Objectives. To describe a case of fluvoxamine-induced severe hyponatremia, most likely due to abn... more Objectives. To describe a case of fluvoxamine-induced severe hyponatremia, most likely due to abnormal antidiuretic hormone excretion (SIADH), and to discuss the implication for maintenance treatments for these patients. Clinical Observations. Although this syndrome had its incidence most commonly among the elderly, we report a case of severe hyponatremia (serum sodium <114 mmol/L), in a relatively young male. Treatment. Symptoms responded well to IV hyperosmolar sodium and to the discontinuation of fluvoxamine. This patient was maintained for treatment on an alternative Selective Serotonin Reuptake Inhibitor (SSRI), Citalopram, without developing recurrence of symptoms. Outcome and Conclusion. Protocols to monitor the maintenance treatments in high-risk patients may be needed to prevent recurrence of serious complications.
Canadian Journal of Psychiatry Revue Canadienne De Psychiatrie, Oct 1, 1997
To explore the effect of chronic institutionalization on cognitive performance in chronic psychia... more To explore the effect of chronic institutionalization on cognitive performance in chronic psychiatric patients with emphasis on age disorientation, a phenomenon that was found in previous research to occur in up to 25% of chronic schizophrenic patients.
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 1997
To explore the effect of chronic institutionalization on cognitive performance in chronic psychia... more To explore the effect of chronic institutionalization on cognitive performance in chronic psychiatric patients with emphasis on age disorientation, a phenomenon that was found in previous research to occur in up to 25% of chronic schizophrenic patients. One hundred and ten chronic psychiatric patients, forming 4 main groups--schizophrenic patients, nonschizophrenic patients, institutionalized, and noninstitutionalized--were examined for age disorientation (inability to give one's chronological age correctly on request), and their Minimental State scores (MMSE) were compared across the 4 groups. Twelve out of 43 patients (26%) who were institutionalized according to our definition were age-disoriented and had significantly lower MMSE scores than the other 3 groups. The chronic, noninstitutionalized schizophrenic group and the other chronic psychiatric patients, whether they were institutionalized or not, were negative for this phenomenon. One of the 12 age-disoriented patients wa...
The purpose of this study was to compare the effectiveness of novel antipsychotics in the treatme... more The purpose of this study was to compare the effectiveness of novel antipsychotics in the treatment of psychotic depression. Method: Consecutive patients who were admitted (n = 51) with a confirmed diagnosis of major depression with psychotic features (delusions or hallucinations or both) participated in this open-label, naturalistic study. All patients were treated with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (citalopram or venlafaxine extended release [XR]), and atypical antipsychotic agents were added, as tolerated, during the first week of initiating the citalopram or venlafaxine. There were patients (n = 16) who received risperidone, who received quetiapine (n = 20), and who received olanzapine (n = 15), as an adjunctive treatment to either citalopram or venlafaxine for at least 8 weeks. Outcome measures included the Clinical Global Impression-Severity subscale (CGI-S), as the primary outcome measure, as well as the Hamilton Rating Scale for Depression-21 item (HAM-D21) and the Brief Psychiatric Rating Scale (BPRS). Tolerance to treatments and weight changes were monitored over the period of the trial. Results: All patients completed the trial with no drop outs. At 8 weeks, there was a statistically significant (P , 0.001) clinical improvement in all outcome measures for both the depressive and psychotic symptoms, for all three groups of atypical adjunctive treatments. Utilizing analysis of variance (ANOVA), there were no significant differences between the three adjunctive treatment groups in outcome measures. The three antipsychotic agents were equally tolerated. At 8 weeks there was slight increase in weight in the three treatment groups, which was statistically significant (P .01) in the olanzapine group. Conclusion: Quetiapine, risperidone, and olanzapine, given as adjunctive treatment with SSRIS or SNRIs can significantly and equally improve depressive and psychotic symptoms, in the short-term treatment of major depression with psychotic features. The author recommends that large controlled trials be conducted to examine the differences in long-term efficacy and tolerance between the atypical antipsychotic agents, in the treatment of major depression with or without psychotic features.
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2007
To examine efficacy and tolerability of topiramate as an adjunctive treatment for overweight refr... more To examine efficacy and tolerability of topiramate as an adjunctive treatment for overweight refractory bipolar patients. Patients (n=30) with Bipolar I or II, were provided with an open label treatment with topiramate as an add-on therapy. All patients deemed refractory to at least one mood stabilizer, were overweight, and were treated with topiramate as an adjuvant to existing medication for at least 12 weeks. The primary effectiveness measure was the Clinical Global Impression Scale (CGI). Other scales included the Young&amp;amp;#39;s Mania Rating Scale (YMRS), and the Hamilton Depression scale (HAMD21). Measures prior to adding topiramate were compared to those repeated at 4, 8 and 12 weeks. Tolerance, and weight changes were monitored. There was significant reduction in both depressive and manic symptoms with adjunctive treatment. The mean BMI at 12 weeks of topiramate treatment dropped by 2 points (p&amp;amp;lt;0.0001). Topiramate is an effective adjunctive treatment in bipolar refractory patients and the significant weight reduction effects may result in important medical risk reductions, and make topiramate attractive for some obese bipolar patients.
The study reported here aimed to develop and psychometrically assess an instrument to measure exa... more The study reported here aimed to develop and psychometrically assess an instrument to measure examination anxiety among undergraduate university students. Based on empirical evidence and recent literature review we developed a 12 item scale to measure the severity of examination anxiety. The instrument was administered to students, two weeks before they wrote their examinations. Experts (n=10) participated in a validation process of the instrument before it was administered to students (n= 40). Internal consistency reliability for the instrument was 0. 82 (Cronbach's alpha) and there was 92 % overall agreement between experts about the relevance of the instruments' items to measure students' examination anxiety, providing evidence for content validity. Factor analysis resulted in three cohesive and theoretically meaningful factors. There is evidence for content and convergent validity. The developed instrument is a reliable, valid and empirical measure to assess the severity of examination anxiety. The scale will take five minutes to complete.
Objective: To conduct a literature review of patient-and population-based research on depression ... more Objective: To conduct a literature review of patient-and population-based research on depression literacy and determine the implications of the findings for patient psycho-education. Method: The authors searched PubMed for articles published between January 1995 and January 2007; they chose English-language articles of studies based on samples drawn from the general population as well as clinical studies conducted in North America, Australia, and European countries. Results: A total of 48 published papers in referred journals (two review articles and 46 original research papers) met the inclusion criteria. Most studies examined the public's knowledge and attitudes towards treatment of depression. To examine the ability of participants to recognize clinical depressive symptoms and attitudes towards depression and its treatment, researchers commonly used vignettes involving survey methods based on community samples. Depression literacy is generally poor among the general public an...
Background: Non-adherence to treatment can result from forgetting, carelessness, stopping the dru... more Background: Non-adherence to treatment can result from forgetting, carelessness, stopping the drug when feeling worse, or stopping the drug when feeling better. Objective: To develop and psychometrically assess a brief instrument that can be easily used in clinical practice to measure adherence to antidepressants. Method: We developed the Antidepressants Adherence Scale (AAS); a self report rating scale including four items to assess the degree to which forgetting, carelessness, and stopping due to feeling worse or feeling better interfere with adherence in the last 4 weeks. Our proposed fouritem adherence instrument was developed based on previous research and theory. Participants: Experts in mood disorders (n = 12) participated in the formal validity assessment of the instrument, and the developed instrument was administered to patients who were prescribed antidepressants (n = 63). All patients also completed a multiple choice question instrument to measure knowledge of depression, and a Likert self report questionnaire to assess attitudes towards depression and its treatment. Results: There was 90% agreement among experts that the items were highly relevant providing strong evidence for content validity. Also, there was empirical evidence for validity. There were significant correlations (p b 0.05) between knowledge and attitude subscales and adherence items. The internal consistency reliability (Cronbach's alpha) was 0.66 for the instrument Conclusion and significance: Knowledge of and attitudes to depression and its treatment may have significant impact on the adherence to antidepressants. The AAS can be used in clinical settings (2-3 min to administer) to evaluate patients' adherence to antidepressants.
To develop and psychometrically assess an instrument to measure patients&amp;amp;amp;amp;amp;... more To develop and psychometrically assess an instrument to measure patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attitudes towards depression, to its treatments, and aspects of professional help in patients suffering from depression. A 27 item Likert type instrument was developed and written based on an evidence from a literature review and in consultation with experts in depression. Psychiatrists (n=12) participated in a validation process of the instrument before it was administered to outpatients (n=63) suffering from non-psychotic depression. Internal consistency reliability for the instrument was 0.79 (Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha) and there was 88% overall agreement between experts about the relevance of the instruments&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; items to test patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attitudes to depression and its treatments, providing evidence for content validity. Factor analysis resulted in five cohesive and theoretically meaningful factors: 1) Acceptance of treatment, 2) Perceived stigma and shame, 3) Negative attitude towards antidepressants, 4) Self stigma, and 5) Preference for psychotherapy. The developed instrument is a reliable, valid and empirical measure to assess attitudes towards depression and its treatments. Future research should be designed to replicate and extend the present findings with larger and more heterogeneous samples.
Background: To develop and psychometrically assess a multiple choice question (MCQ) instrument to... more Background: To develop and psychometrically assess a multiple choice question (MCQ) instrument to test knowledge of depression and its treatments in patients suffering from depression.
The purpose of this study was to examine and compare diagnostic success and its relationship with... more The purpose of this study was to examine and compare diagnostic success and its relationship with the diagnostic reasoning process between novices and experts in psychiatry. Methods: Nine volunteers, comprising five expert psychiatrists and four clinical clerks, completed a think-aloud protocol while attempting to make a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of a selected case with both Axis I and Axis III diagnoses. Results: Expert psychiatrists made significantly more successful diagnoses for both the primary psychiatric and medical diagnoses than clinical clerks. Expert psychiatrists also gave fewer differential options. Analyzing the think-aloud protocols, expert psychiatrists were much more organized, made fewer mistakes, and utilized significantly less time to access their knowledge than clinical clerks. Both novices and experts seemed to use the hypothetic-deductive and scheme-inductive approaches to diagnosis. However, experts utilized hypothetic-deductive approaches significantly more often than novices. Conclusion: The hypothetic-deductive diagnostic strategy was utilized more than the schemeinductive approach by both expert psychiatrists and clinical clerks. However, a specific relationship between diagnostic reasoning and diagnostic success could not be identified in this small pilot study. The author recommends a larger study that would include a detailed analysis of the think-aloud protocols.
ADHD Attention Deficit and Hyperactivity Disorders, 2011
To examine changes in partially responsive anxiety symptoms utilizing adjunctive treatment with a... more To examine changes in partially responsive anxiety symptoms utilizing adjunctive treatment with atomoxetine in the treatment of adult ADHD patients with comorbid partially responsive anxiety symptoms. Consenting adult patients (n=29) with confirmed diagnosis of generalized anxiety and comorbid attention deficit hyperactivity disorder (ADHD) participated in this open-label study. All patients had significant comorbid anxiety symptoms (HAM-A&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;7) and failed to respond to 8-week trials of selective serotonin reuptake inhibitors (SSRIs) or noradrenaline reuptake inhibitors (SNRIs). All patients were treated with atomoxetine as adjunctive to SSRIs or to SNRIs and were followed for at least 12 weeks. The primary outcome measure was the Clinical Global Impression severity subscale. Other scales included the Hamilton Anxiety Scale (HAM-A), the adult ADHD Self-Report Scale (ASRS-v1.1) symptom checklist, and Sheehan&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Disability Scale. Baseline measures prior to the treatment with atomoxetine were compared to those at 4, 8, and at 12 weeks of treatment. Monitoring for pulse, blood pressure, and weight changes was carried out at baseline and at end point. Twenty-seven patients (93%) completed this open-label study. There was significant resolution of symptoms of all outcome measures, including the symptoms of anxiety, as shown by changes from baseline in HAM-A, ASRS-v1.1, and CGI at 12 weeks (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). Also, there was significant reduction in the disability score at 12 weeks. Patients completed the study, tolerated the adjunctive treatment, and there were no significant cardiovascular or weight changes. Two patients withdrew from the study during the first 4 weeks of treatment due to side effects. Atomoxetine can be used as an adjunctive treatment in adult patients with ADHD and comorbid partially responsive anxiety symptoms.
Objective: To develop and psychometrically assess a short instrument that can be easily used in c... more Objective: To develop and psychometrically assess a short instrument that can be easily used in clinical practice to measure knowledge-seeking behavior in patients suffering from depression. Method: We developed the knowledge seeking instrument (KSI), a self-report scale of three items to assess the number of hours spent in knowledge seeking behavior such as reading written materials, surfing the internet, or watching audio-visual tools. Experts in mood disorders (n = 12) participated in the formal validity assessment of the instrument, and the developed instrument was administered to outpatients who were attending psychiatry clinic (n = 63). All patients also completed a multiple choice question instrument to measure knowledge of depression, a Likert self report questionnaire to assess attitudes towards depression and its treatment, and an adherence to antidepressants scale. Results: In addition to the empirical evidence for validity, there was 68% agreement among experts that the items were highly relevant in measuring behavior of knowledge seeking, providing evidence for content validity. There were significant correlations (pb 0.05) between knowledge of psychological and biological treatments of depression and knowledge seeking reading scores. The internal consistency reliability (Cronbach's alpha) was 0.67 for the instrument. Conclusion and significance: The KSI takes 2 min to complete. There is evidence for reliability, content, and criterion based concurrent validities. The KSI can be utilized to assess knowledge seeking behavior in patients with depression.
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