The aim of this project is to conduct a scoping review to (1) identify caregiver-infant mental he... more The aim of this project is to conduct a scoping review to (1) identify caregiver-infant mental health interventions and (2) identify the barriers and facilitators to implementing these types of interventions.
This issue’s interviewee is Richard Ballon Goldbloom, (O.C., B.Sc., M.D., C.M., F.R.C.P.C., D.Lit... more This issue’s interviewee is Richard Ballon Goldbloom, (O.C., B.Sc., M.D., C.M., F.R.C.P.C., D.Litt (Hon), LLD (Hon), a paediatrician who has always advocated for closer ties with psychiatry. In 1967, he was appointed Professor and Head of the Department of Pediatrics at Dalhousie University, and Physician-in-Chief and Director of Research at the Izaak Walton Killam Hospital for Children in Halifax, Nova Scotia. He held these posts from 1967 to 1985. He was appointed Officer of the Order of Canada in 1987 in recognition of contributions to regional health care for children. He has authored over 120 original papers in the medical literature and numerous textbook chapters. He edited (with Dr. Robert S. Lawrence) a book entitled “Preventing Disease, Beyond the Rhetoric”, published in 1990. His second book, “Pediatric Clinical Skills”, first published by Churchill-Livingstone, NY, in June 1992, has been extremely popular with medical undergraduates and postgraduates. A fourth edition wil...
Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Académie canadienne de psychiatrie de l'enfant et de l'adolescent, 2013
A fter four and a half wonderful and exciting years at the helm of the Indigo Journal it is time ... more A fter four and a half wonderful and exciting years at the helm of the Indigo Journal it is time to pass the baton to our new team of Editors – Drs. Abel Ickowicz and Russell Schachar. I am extremely confident that the new editors will help grow the Journal and launch it into the new stratosphere of high quality research and academic debate. They are supported by a dedicated team of professionals (Vicki Simmons, Elizabeth Waite and Smita Hamzeh) who must receive the lion's share of ac-colades for the Journal's growth and progress over the last number of years. have worked tirelessly to bring cutting edge information and topical issues to their sections. To all these individuals I owe an immense debt of gratitude for asking them to go the extra mile especially under the pressure of a looming journal deadline. I am indebted as well to all the reviewers who have helped uphold the standards of the Journal. I salute as well all the guest editors who have contributed so generously to what amounts to 50% of the Journal's output over the years. It really is a colossal effort and takes impeccable team work to pull off each issue of the Journal but the results speak for themselves. Also as Editor I have benefit-ted from the unwavering support of the CACAP Board of Directors and last but not least is you, my dear reader, the membership that forms the bedrock of the Indigo. We are living in exciting times as child psychiatrists. In any one day I could be refreshing my knowledge of attachment theory by reading Bowlby's still highly relevant trilogy on attachment and loss while in the evening I could be updating myself on models of chromatin re-modeling in the epigenome and how it is shaped by gene and early environment interactions. Everywhere all over the country Canadian child psychiatrists are doing cutting edge research in molecular biology or at the systemic level advocating for better models of care in Canada or internationally. It is not foreign anymore for child psychiatrists to be literate or bilingual at several levels of discourse. We are indeed called upon to integrate and translate more and more how each of these levels " cross-talk " or are " embedded " within each other, to coin Jack Shonkoff's phrase " from neurons to neighborhoods. " And while we have not been …
Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Académie canadienne de psychiatrie de l'enfant et de l'adolescent, 2008
49 As far back as 1959, Wooten warned about the dangers of “premature hardening of the categories... more 49 As far back as 1959, Wooten warned about the dangers of “premature hardening of the categories” referring to how, inevitably, refinements of classification become incorporated into social practice with disproportionate speed, surpassing the careful data collection and hypothesis testing still necessary to validate categories. Sound familiar? And these were the pre-internet days! As I researched the history of classification I came across a wonderful two volume collection on “Issues of Classification of Children: A Sourcebook on Categories, Labels and their Consequences” by Nicholas Hobbs dating back to 1976. It was a thoughtful discussion about classifying and its effects, penned by psychiatrists, educators, parents and yes, even children, the often passive recipients of our musings. It was after the appearance of the Diagnostic and Statistical Manuals I and II (DSM-I and II) and the “DSM approach” was one of many models competing for the attention of child and youth clinicians and researchers in search of a more satisfying and practical approach to classification. The Group for the Advancement of Psychiatry (GAP) child
Twelve predominantly psychotic patients who were at high risk for relapse and rehospitalization p... more Twelve predominantly psychotic patients who were at high risk for relapse and rehospitalization participated in a treatment regime that combined medicationand supportive andinsigbt-orientedgroup therapy. The group was studied over a 44-month period during which the same psychiatrist was present. None ofthe l2group members required rebospitalization during the study period, and the quality oflifeandleveloffunctioningsign:ficantly imp rovedformost ofthem. Factors that possibly contributed to the patients' responses are ad4ressed. The delivery of competent professional care to chronic psychotic outpatients has always posed a challenge to mental health professionals. Current increased demands for care from an expanding population, financial stringencies mandating a shift away from inpatient treatment, and decreases in staffing have inten
Despite increasing on-label and off-label use of antipsychotics, prescribing antipsychotics to ch... more Despite increasing on-label and off-label use of antipsychotics, prescribing antipsychotics to children remains controversial due to uncertainty of their relative benefits and safety. We systematically reviewed the effectiveness and safety of first- (FGA) and second-generation antipsychotics (SGA) for patients aged ≤24 years with psychiatric and behavioral conditions. We searched 10 databases from January 1987 to February 2011, gray literature, trial registries, and reference lists. Two reviewers independently selected studies, assessed methodologic quality, and graded the evidence. One reviewer extracted, and a second verified, data. We summarized findings qualitatively and conducted meta-analyses when appropriate. Sixty-four trials and 17 cohort studies were included. Most trials had a high risk of bias; cohort studies had moderate quality. All comparisons of FGAs versus SGAs, FGAs versus FGAs, and FGAs versus placebo had low or insufficient strength of evidence. There was moderate strength of evidence for the following comparisons. Olanzapine caused more dyslipidemia and weight gain, but fewer prolactin-related events, than risperidone. Olanzapine caused more weight gain than quetiapine. Compared with placebo, SGAs improved clinical global impressions (schizophrenia, bipolar and disruptive behavior disorders) and diminished positive and negative symptoms (schizophrenia), behavior symptoms (disruptive behavior disorders), and tics (Tourette syndrome). This is the first comprehensive review comparing the effectiveness and safety across the range of antipsychotics for children and young adults. The evidence on the comparative benefits and harms of antipsychotics is limited. Some SGAs have a better side effect profile than other SGAs. Additional studies using head-to-head comparisons are needed.
Age-related abnormalities in caudate volumes have been reported to differ across the periods of c... more Age-related abnormalities in caudate volumes have been reported to differ across the periods of childhood and puberty in children with ADHD. This study assessed caudate volumetric abnormalities across two narrow age clusters within the childhood period. Three-dimensional manual tracings of the head and body of the caudate nucleus and of the cerebrum were acquired from 26 medication-naïve boys with a diagnosis of ADHD (ages 5.9-10.8 years), and 24 age-matched normal controls. Boys with ADHD had smaller total caudate volumes relative to controls, F(1,48)=4.29, p=0.04. Adjustment of caudate volumes with respect to age demonstrated that this group difference was driven solely by participants in the 5.9-7.3 year range, F(1, 46)=5.64, p=0.022, with an effect size of d=0.69. No Group effect was found in older participants, F(1, 46)=0.82, p=0.37. These novel findings suggest a different pattern of caudate volume abnormalities across narrow age clusters prior to puberty in boys with ADHD. Anatomical differences in brain structures related to ADHD in prepubertal children should be evaluated with respect to the changing developmental trajectory of brain regions within this period of rapid brain growth.
Objective: This study aimed to investigate the cortical thickness in areas of the brain that are ... more Objective: This study aimed to investigate the cortical thickness in areas of the brain that are hypothesized to be involved in response inhibition and error-monitoring behaviors. The authors hypothesized that children with ADHD would have a thinner prefrontal cortex (PFC) and anterior cingulate cortex (ACC) than healthy children. Method: In all, 25 ADHD and 25 healthy control male children (5-12 years) underwent magnetic resonance imaging. Results: The authors found thinner right superior frontal gyrus in ADHD patients compared with controls ( t = 2.01, df = 45, p = .049). The older children with ADHD drove this effect when participants were further subdivided into a younger and older age group (older participants: p = .004; younger participants: p = ns). Conclusion: These findings have implications for the developmental trajectory of the frontal lobe in ADHD.
Methylphenidate (MPH, Ritalin) is a psychostimulant drug used in very young children with attenti... more Methylphenidate (MPH, Ritalin) is a psychostimulant drug used in very young children with attention deficit hyperactivity disorder (ADHD). To explore the central effects of MPH, we compared repeated MPH treatments on c-fos and fosB expression in the striatum of immature and adult rats. Prepubertal (PD25-38) or adult (PD53-66) male rats were treated once daily for: (a) 14 days with either saline or MPH (2 or 10 mg/kg) or (b) 13 days with saline followed by a single dose of MPH (2 or 10 mg/kg) on day 14. To determine long-term effects of MPH, another group of prepubertal rats was allowed a drug-free period of 4 weeks following the initial 14 days of treatment, and received a challenge dose of MPH at adulthood. All rats were sacrificed 2 h post-injection on the final day. Expression of c-fos and fosB was quantified by densitometric analysis of cFOS and FOSB-immunoreactivity (-ir). We demonstrated that FOSB-ir was increased by a single dose of MPH in the prepubertal and adult striatum, and this effect was further elevated by chronic MPH in prepubertal rats, in contrast to the inhibitory effect of MPH (2 and 10 mg/kg) on cFOS-ir. In adult rats, repeated MPH down-regulated cFOS-ir only at the higher dose (10 mg/ kg), while fosB expression remained at levels comparable to acute MPH. The reduction in cFOS-ir observed in prepubertal rats given repeated MPH (10 mg/kg) persisted in the adult striatum following MPH challenge at adulthood. Our results suggest that (1) repeated MPH treatment differentially regulates c-fos and fosB expression in the immature and adult brain; (2) MPH-induced changes in gene expression may be enduring, and (3) the immature brain is more sensitive to the stimulant effects of MPH than the adult. Thus, our findings have implications for the long-term use of MPH in ADHD.
The aim of this project is to conduct a scoping review to (1) identify caregiver-infant mental he... more The aim of this project is to conduct a scoping review to (1) identify caregiver-infant mental health interventions and (2) identify the barriers and facilitators to implementing these types of interventions.
This issue’s interviewee is Richard Ballon Goldbloom, (O.C., B.Sc., M.D., C.M., F.R.C.P.C., D.Lit... more This issue’s interviewee is Richard Ballon Goldbloom, (O.C., B.Sc., M.D., C.M., F.R.C.P.C., D.Litt (Hon), LLD (Hon), a paediatrician who has always advocated for closer ties with psychiatry. In 1967, he was appointed Professor and Head of the Department of Pediatrics at Dalhousie University, and Physician-in-Chief and Director of Research at the Izaak Walton Killam Hospital for Children in Halifax, Nova Scotia. He held these posts from 1967 to 1985. He was appointed Officer of the Order of Canada in 1987 in recognition of contributions to regional health care for children. He has authored over 120 original papers in the medical literature and numerous textbook chapters. He edited (with Dr. Robert S. Lawrence) a book entitled “Preventing Disease, Beyond the Rhetoric”, published in 1990. His second book, “Pediatric Clinical Skills”, first published by Churchill-Livingstone, NY, in June 1992, has been extremely popular with medical undergraduates and postgraduates. A fourth edition wil...
Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Académie canadienne de psychiatrie de l'enfant et de l'adolescent, 2013
A fter four and a half wonderful and exciting years at the helm of the Indigo Journal it is time ... more A fter four and a half wonderful and exciting years at the helm of the Indigo Journal it is time to pass the baton to our new team of Editors – Drs. Abel Ickowicz and Russell Schachar. I am extremely confident that the new editors will help grow the Journal and launch it into the new stratosphere of high quality research and academic debate. They are supported by a dedicated team of professionals (Vicki Simmons, Elizabeth Waite and Smita Hamzeh) who must receive the lion's share of ac-colades for the Journal's growth and progress over the last number of years. have worked tirelessly to bring cutting edge information and topical issues to their sections. To all these individuals I owe an immense debt of gratitude for asking them to go the extra mile especially under the pressure of a looming journal deadline. I am indebted as well to all the reviewers who have helped uphold the standards of the Journal. I salute as well all the guest editors who have contributed so generously to what amounts to 50% of the Journal's output over the years. It really is a colossal effort and takes impeccable team work to pull off each issue of the Journal but the results speak for themselves. Also as Editor I have benefit-ted from the unwavering support of the CACAP Board of Directors and last but not least is you, my dear reader, the membership that forms the bedrock of the Indigo. We are living in exciting times as child psychiatrists. In any one day I could be refreshing my knowledge of attachment theory by reading Bowlby's still highly relevant trilogy on attachment and loss while in the evening I could be updating myself on models of chromatin re-modeling in the epigenome and how it is shaped by gene and early environment interactions. Everywhere all over the country Canadian child psychiatrists are doing cutting edge research in molecular biology or at the systemic level advocating for better models of care in Canada or internationally. It is not foreign anymore for child psychiatrists to be literate or bilingual at several levels of discourse. We are indeed called upon to integrate and translate more and more how each of these levels " cross-talk " or are " embedded " within each other, to coin Jack Shonkoff's phrase " from neurons to neighborhoods. " And while we have not been …
Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Académie canadienne de psychiatrie de l'enfant et de l'adolescent, 2008
49 As far back as 1959, Wooten warned about the dangers of “premature hardening of the categories... more 49 As far back as 1959, Wooten warned about the dangers of “premature hardening of the categories” referring to how, inevitably, refinements of classification become incorporated into social practice with disproportionate speed, surpassing the careful data collection and hypothesis testing still necessary to validate categories. Sound familiar? And these were the pre-internet days! As I researched the history of classification I came across a wonderful two volume collection on “Issues of Classification of Children: A Sourcebook on Categories, Labels and their Consequences” by Nicholas Hobbs dating back to 1976. It was a thoughtful discussion about classifying and its effects, penned by psychiatrists, educators, parents and yes, even children, the often passive recipients of our musings. It was after the appearance of the Diagnostic and Statistical Manuals I and II (DSM-I and II) and the “DSM approach” was one of many models competing for the attention of child and youth clinicians and researchers in search of a more satisfying and practical approach to classification. The Group for the Advancement of Psychiatry (GAP) child
Twelve predominantly psychotic patients who were at high risk for relapse and rehospitalization p... more Twelve predominantly psychotic patients who were at high risk for relapse and rehospitalization participated in a treatment regime that combined medicationand supportive andinsigbt-orientedgroup therapy. The group was studied over a 44-month period during which the same psychiatrist was present. None ofthe l2group members required rebospitalization during the study period, and the quality oflifeandleveloffunctioningsign:ficantly imp rovedformost ofthem. Factors that possibly contributed to the patients' responses are ad4ressed. The delivery of competent professional care to chronic psychotic outpatients has always posed a challenge to mental health professionals. Current increased demands for care from an expanding population, financial stringencies mandating a shift away from inpatient treatment, and decreases in staffing have inten
Despite increasing on-label and off-label use of antipsychotics, prescribing antipsychotics to ch... more Despite increasing on-label and off-label use of antipsychotics, prescribing antipsychotics to children remains controversial due to uncertainty of their relative benefits and safety. We systematically reviewed the effectiveness and safety of first- (FGA) and second-generation antipsychotics (SGA) for patients aged ≤24 years with psychiatric and behavioral conditions. We searched 10 databases from January 1987 to February 2011, gray literature, trial registries, and reference lists. Two reviewers independently selected studies, assessed methodologic quality, and graded the evidence. One reviewer extracted, and a second verified, data. We summarized findings qualitatively and conducted meta-analyses when appropriate. Sixty-four trials and 17 cohort studies were included. Most trials had a high risk of bias; cohort studies had moderate quality. All comparisons of FGAs versus SGAs, FGAs versus FGAs, and FGAs versus placebo had low or insufficient strength of evidence. There was moderate strength of evidence for the following comparisons. Olanzapine caused more dyslipidemia and weight gain, but fewer prolactin-related events, than risperidone. Olanzapine caused more weight gain than quetiapine. Compared with placebo, SGAs improved clinical global impressions (schizophrenia, bipolar and disruptive behavior disorders) and diminished positive and negative symptoms (schizophrenia), behavior symptoms (disruptive behavior disorders), and tics (Tourette syndrome). This is the first comprehensive review comparing the effectiveness and safety across the range of antipsychotics for children and young adults. The evidence on the comparative benefits and harms of antipsychotics is limited. Some SGAs have a better side effect profile than other SGAs. Additional studies using head-to-head comparisons are needed.
Age-related abnormalities in caudate volumes have been reported to differ across the periods of c... more Age-related abnormalities in caudate volumes have been reported to differ across the periods of childhood and puberty in children with ADHD. This study assessed caudate volumetric abnormalities across two narrow age clusters within the childhood period. Three-dimensional manual tracings of the head and body of the caudate nucleus and of the cerebrum were acquired from 26 medication-naïve boys with a diagnosis of ADHD (ages 5.9-10.8 years), and 24 age-matched normal controls. Boys with ADHD had smaller total caudate volumes relative to controls, F(1,48)=4.29, p=0.04. Adjustment of caudate volumes with respect to age demonstrated that this group difference was driven solely by participants in the 5.9-7.3 year range, F(1, 46)=5.64, p=0.022, with an effect size of d=0.69. No Group effect was found in older participants, F(1, 46)=0.82, p=0.37. These novel findings suggest a different pattern of caudate volume abnormalities across narrow age clusters prior to puberty in boys with ADHD. Anatomical differences in brain structures related to ADHD in prepubertal children should be evaluated with respect to the changing developmental trajectory of brain regions within this period of rapid brain growth.
Objective: This study aimed to investigate the cortical thickness in areas of the brain that are ... more Objective: This study aimed to investigate the cortical thickness in areas of the brain that are hypothesized to be involved in response inhibition and error-monitoring behaviors. The authors hypothesized that children with ADHD would have a thinner prefrontal cortex (PFC) and anterior cingulate cortex (ACC) than healthy children. Method: In all, 25 ADHD and 25 healthy control male children (5-12 years) underwent magnetic resonance imaging. Results: The authors found thinner right superior frontal gyrus in ADHD patients compared with controls ( t = 2.01, df = 45, p = .049). The older children with ADHD drove this effect when participants were further subdivided into a younger and older age group (older participants: p = .004; younger participants: p = ns). Conclusion: These findings have implications for the developmental trajectory of the frontal lobe in ADHD.
Methylphenidate (MPH, Ritalin) is a psychostimulant drug used in very young children with attenti... more Methylphenidate (MPH, Ritalin) is a psychostimulant drug used in very young children with attention deficit hyperactivity disorder (ADHD). To explore the central effects of MPH, we compared repeated MPH treatments on c-fos and fosB expression in the striatum of immature and adult rats. Prepubertal (PD25-38) or adult (PD53-66) male rats were treated once daily for: (a) 14 days with either saline or MPH (2 or 10 mg/kg) or (b) 13 days with saline followed by a single dose of MPH (2 or 10 mg/kg) on day 14. To determine long-term effects of MPH, another group of prepubertal rats was allowed a drug-free period of 4 weeks following the initial 14 days of treatment, and received a challenge dose of MPH at adulthood. All rats were sacrificed 2 h post-injection on the final day. Expression of c-fos and fosB was quantified by densitometric analysis of cFOS and FOSB-immunoreactivity (-ir). We demonstrated that FOSB-ir was increased by a single dose of MPH in the prepubertal and adult striatum, and this effect was further elevated by chronic MPH in prepubertal rats, in contrast to the inhibitory effect of MPH (2 and 10 mg/kg) on cFOS-ir. In adult rats, repeated MPH down-regulated cFOS-ir only at the higher dose (10 mg/ kg), while fosB expression remained at levels comparable to acute MPH. The reduction in cFOS-ir observed in prepubertal rats given repeated MPH (10 mg/kg) persisted in the adult striatum following MPH challenge at adulthood. Our results suggest that (1) repeated MPH treatment differentially regulates c-fos and fosB expression in the immature and adult brain; (2) MPH-induced changes in gene expression may be enduring, and (3) the immature brain is more sensitive to the stimulant effects of MPH than the adult. Thus, our findings have implications for the long-term use of MPH in ADHD.
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