Louise Nadeau

Computerized ambulatory monitoring in psychiatry: a multi-site collaborative study of acceptability, compliance, and reactivity

Computerized ambulatory monitoring overcomes a number of methodological and conceptual challenges to studying mental disorders, however concerns persist regarding the feasibility of this approach with severe psychiatric samples and the potential of intensive monitoring to influence data quality. This multi‐site investigation evaluates these issues in four independent samples. Patients with schizophrenia (n = 56), substance dependence (n = 85), anxiety disorders (n = 45), and a non‐clinical sample (n = 280) were contacted to participate in investigations using computerized ambulatory monitoring. Micro‐computers were used to administer electronic interviews several times per day for a one‐week period. Ninety‐five percent of contacted individuals agreed to participate in the study, and minimum compliance was achieved by 96% of these participants. Seventy‐eight percent of all programmed assessments were completed overall, and only 1% of micro‐computers were not returned to investigators. There was no evidence that missing data or response time increased over the duration of the study, suggesting that fatigue effects were negligible. The majority of variables investigated did not change in frequency as a function of study duration, however some evidence was found that socially sensitive behaviors changed in a manner consistent with reactivity. Copyright

Les facteurs de résilience chez les victimes d’abus sexuel: état de la question

Resume Objectif: L’objectif de cette recension des ecrits est d’examiner les facteurs protecteurs pouvant contribuer au retablissement des victimes d’abus sexuel dans l’enfance. Methode: Sont presentes, une definition de la resilience, puis les facteurs protecteurs lies a l’individu et ceux lies a l’environnement, pour terminer avec une critique methodologique des etudes. Resultats: Les donnees des differentes etudes indiquent qu’environ 20–44% des victimes d’abus sexuel ne presentent pas d’effets deleteres. Or, rares sont les recherches qui se sont interessees aux facteurs protecteurs presents chez ces femmes resilientes. Les premiers travaux portant sur les facteurs protecteurs indiquent que la recherche de soutien, la revelation et le fait de donner un sens a l’abus sont tous des strategies cognitives adaptatives. De meme, mettre l’accent sur les aspects positifs et faire de l’attribution externe sont associes avec moins de detresse psychologique. Par ailleurs, le soutien social, tant celui recu en general qu’apres la revelation de l’abus, semble determinant dans le retablissement. A l’inverse, l’evitement, bien que largement utilise par les victimes, s’avere une strategie non adaptative pouvant meme agir comme catalyseur au niveau de la symptomatologie des victimes. Les nombreux problemes methodologiques des etudes, notamment ceux en lien avec la definition de la resilience, limitent la portee des donnees. Conclusions: Les rares etudes realisees aupres des victimes resilientes indiquent que le soutien recu ainsi que certaines strategies cognitives peuvent contribuer au retablissement. Cependant, la portee de leur contribution demeure inconnue.

Are Online Gamblers More At Risk Than Offline Gamblers

OBJECTIVES To characterize and compare sociodemographic profiles, game-play patterns, and level of addictive behaviors among adults who gamble online and those who do not, and to examine if, at the population level, online gambling is associated with more risky behaviors than offline gambling. METHODS Respondents were 8,456 offline gamblers and 111 online gamblers who participated in a population-based survey conducted in the province of Québec, in 2009. The study sample is representative of adult general population. RESULTS There is an unequal distribution of online gambling in the population. A disproportionate number of men, young people, and students say they participate in online gambling. Poker players are overrepresented among online gamblers and gambling behaviors tend to be more excessive on the Internet. Compared with offline gamblers, online gamblers report more co-occurring risky behaviors, namely alcohol and cannabis use. CONCLUSION Those who gamble online appear to be more at risk for gambling-related problems, but the present findings alone cannot be used as evidence for that conclusion. Future research designs could combine longitudinal data collection and multilevel analyses to provide more insight into the causal mechanisms associated with online gambling.

High-risk sexual behaviors in a context of substance abuse: a focus group approach.

Clinical studies show that heavy and dependant substance users engage with high frequency in high-risk sexual behaviors. To better understand the dynamics of unsafe sexual practices among alcoholics or non-intravenous drug users (IDUs), a series of focus group discussions was conducted with 26 single, sexually active men and women in treatment for substance abuse. Results show that unsafe sexual practices in this subgroup may be explained by three factors: (1) intoxication, (2) negative perceptions of condoms, and (3) cognitive distortions. Furthermore, mens negative perceptions of condoms and womens concerns about not opposing men by fear of being rejected seem to be synergetic to bringing about the negative outcome. Implications for clinical practices are discussed.

Prevalence of personality disorders among clients in treatment for addiction.

This study determined the prevalence of personality disorders among clients in treatment for addiction; this prevalence was compared with those found in similar studies and in clinical samples of individuals suffering from other Axis I disorders. Our sample comprised 255 subjects. The first edition of the Millon Clinical Multiaxial Inventory (MCMI) was used. Only 11.8% of the subjects did not score over 84 on any of the 11 Axis II scales. Over one-half had a score of 84 or higher on the passive-aggressive and dependent-personality scales. The mean number of scales in the 84+ category was 2.68. Comparisons show that this sample was more severe in most cases.

Feasibility and validity of computerized ambulatory monitoring in drug-dependent women

AIM To examine the feasibility and validity of computerized ambulatory monitoring in drug-dependent women. METHOD 61 women recruited from public substance abuse treatment centers in Montreal, Canada participated in the current study, 84% of whom reported past 30-day polysubstance use. Mood states, craving, and drug use were assessed by standard clinical instruments and by electronic interviews during 7-days of computerized ambulatory monitoring. Feasibility was assessed by examining compliance with intensive monitoring and equipment loss. Concurrent validity was assessed by examining the degree of correspondence of ambulatory data on craving, mood, and substance use with clinic-based assessments of similar constructs. RESULT Participants completed an average 80% of all electronic assessments and no data collection devices were lost or stolen. Relationships among mood, stress, consumption, and craving assessed in the electronic interviews conformed to well-established patterns, and evidence of concurrent validity were found between scores from standard clinical instruments and similar constructs in daily life. Center for Epidemiological Studies-Depression Scale (CESD) scores were positively related to sad mood reported during the electronic interviews (p=0.001) and negatively related to happy mood states (p<0.001), explaining approximately 20% of the variance in each mood state. ASI drug use severity scores were positively associated with craving (p<0.001) and substance use (p<0.001), and explained 46% and 30% of these outcomes, respectively. CONCLUSION Computerized ambulatory monitoring is a feasible and valid data collection strategy in drug-dependent individuals.

Decision-making capacities and affective reward anticipation in DWI recidivists compared to non-offenders: A preliminary study

OBJECTIVES Impaired decision making is seen in several problem behaviours including alcoholism and problem gambling. Decision-making style may contribute to driving while impaired with alcohol (DWI) in some offenders as well. The Somatic Marker Framework theorizes that decision making is the product of two interacting affective neural systems, an impulsive, rapid, amygdala-dependent process for emotionally signalling the immediate negative or positive consequences of an option, and a reflective, longer-lasting, ventral medial prefrontal cortex dependent system for emotionally signalling the future negative or positive prospects of an option. This study tested the hypothesis that offenders who showed disadvantageous decision-making would be at higher risk for recidivism than those who showed more advantageous decision-making. In addition, in line with the Somatic Marker Hypothesis, offenders who showed disadvantageous decision-making would exhibit a distinct pattern of somatic activation compared to offenders who showed more advantageous decision-making. METHODS A sample of 21 DWI offenders with from 2 to 7 past DWI convictions and a reference group consisting of 19 non-offender (N-O) drivers were recruited and administered the Iowa Gambling Task (IGT), as well as evaluated on sociodemographic, driving and alcohol use dimensions. In addition, anticipatory skin conductance response (aSCR) was measured in the 5s prior to each of a 100 card draws on the IGT. RESULTS Median split of the DWI offender sample based upon overall performance on the IGT yielded two subgroups (IGT-R Hi and IGT-R Lo). Hypothesis 1 was supported, as the IGT-R Lo group possessed significantly greater frequency of past DWI convictions and severity of past drinking. Descriptive analyses revealed that on the IGT, IGT-R Hi group performed similarly to the N-O reference group while the IGT-R Lo group performed significantly worse. Hypothesis 2 was not supported. CONCLUSIONS Decision making is a plausible explanatory neurocognitive pathway to severer forms of DWI. The role of emotional processing in DWI risk is uncertain. Subtyping DWI offenders using neurocognitive criteria seems a promising avenue for improving clinically meaningful methods of DWI risk assessment and intervention.

From the brain to bad behaviour and back again: neurocognitive and psychobiological mechanisms of driving while impaired by alcohol.

ISSUES Driving while impaired by alcohol (DWI) is responsible for substantial mortality and injury. Significant gaps in our understanding of DWI re-offending, or recidivism, reduce our ability to practically assess recidivism probability and to match interventions to individual risk profiles. These shortcomings reflect the baffling heterogeneity in the DWI population and the limited focus of much existing DWI recidivism research to psychosocial, psychological and substance use correlates. APPROACH This narrative review summarises the evidence for the contribution of neurocognitive and psychobiological mechanisms to DWI behaviour and recidivism. Given the nascent nature of this literature, insight into the putative contribution of these mechanisms to DWI is also drawn from other experimental literatures, particularly those on alcohol use disorders and cognitive and behavioural neuroscience. KEY FINDINGS Alcohol-related neurotoxicity and dysregulation of hypothalamic-pituitary-adrenal axis and serotonergic systems may underlie certain offender characteristics consistently correlated with heightened DWI risk, persistence and intervention resistance. Their markers are less vulnerable to sources of bias than subjective psychosocial indices and are more far-reaching than alcohol abuse in explaining DWI behaviour and recidivism. Implications. The investigation of neurocognitive and psychobiological mechanisms in DWI research is a promising avenue for discerning clinically meaningful subgroups within the DWI population. This can lead to research and development in alternative assessment and more targeted intervention technologies. CONCLUSION Multidimensional research in DWI and recidivism offers novel avenues for increasing road safety.

Positional Role Changes and Drinking Patterns: Results of a Longitudinal Study

This study of heavily drinking males in the general population assesses the effect of positional role changes on drinking behaviors. The data are derived from a longitudinal study over a three-year period (1992–1995) of a representative sample of 617 male heavy drinkers from the Quebec (Canada) adult population. Three types of positional roles have been examined: employment, marital, and parental status. This study examined two dimensions of the drinking pattern: the annual frequency of drinking and the annual frequency of five drinks or more on a single occasion. Standard multiple regression analyses were conducted independently for each dimension of the drinking patterns. Results indicated that baseline annual frequency and baseline annual frequency of five drinks or more per occasion were the main predictors of both drinking patterns under study. Furthermore, positional role changes contributed to explain the Δ1992–1995 annual frequency of drinking, but marginally. Men who reported a childs birth between 1992 and 1995 reduced their annual frequency of drinking, while men who reported being unemployed in 1992 and in 1995 increased their annual frequency of drinking. Further research should take into account the qualitative aspects of positional roles.

Area variations in the prevalence of substance use and gambling behaviours and problems in Quebec: a multilevel analysis.

Objectives: This study aimed to examine whether variations among regions in Quebec existed after we controlled for individual characteristics in the prevalence of 1) alcohol, cannabis, and gambling behaviours and 2) substance-related disorders and pathological gambling. Methods: Using data derived from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), we nested 5332 respondents from the province of Quebec within 374 regions equivalent to census subdivisions (CSDs). Outcome variables included 1) drinking status (past 12 months), alcohol consumption (last week), and 12-month diagnosis of alcohol dependence; 2) cannabis use (past 12 months and lifetime) and diagnosis of illicit drug dependence; and 3) gambling status, severity of gambling problems, and number of reported gambling activities (past 12 months). Multilevel regression models with individuals (Level 1) nested in regions (CSDs, Level 2) assessed the variations among regions in the prevalence of various outcomes and disorders when individual characteristics were controlled for. Results: Variance component models revealed that all alcohol-related variables, the prevalence of cannabis use (12 months), and problem gambling did not vary among areas. Gambling rates and the average number of reported gambling activities varied among areas, even when individual-level variables were accounted for in the models, whereas for lifetime cannabis use, variations among areas became nonsignificant. Conclusion: Intervention programs may need to address the environment as a relevant determinant of health-related behaviours and lifestyles.