Shree Bhalerao

Evaluation of an online cognitive behavioural therapy program by patients with traumatic brain injury and depression

Primary objective: The most frequently reported psychiatric symptom after traumatic brain injury (TBI) is depression. This study examined whether internet-delivered cognitive behaviour therapy (CBT) could be appropriate and effective for patients with mild or moderate TBI and depression. Methods and procedures: Patients were recruited for an at-home, 6-week internet-based CBT program (MoodGYM). Participants were assessed during this period by weekly telephone calls and at 12 months post-enrolment. Intervention completion rates, predictors of adherence, user feedback and changes in scores on validated depression scales were assessed. Main outcomes and results: Twenty-one patients were recruited: 64% and 43% completed the 6-week intervention and the 12-month follow-up, respectively. Adherence rates were not predicted by demographic or injury characteristics in this small sample. Patients identified reading, memory and comprehension requirements as limitations of the program. Scores on the depression scales were significantly decreased upon completion of the intervention and at the 12-month follow-up. Conclusions: The MoodGYM program may be effective for treating symptoms of depression in patients with TBI. While adherence rates were not predicted by age, education level or injury severity, demands upon memory and concentration which may already be compromised in these patients need to be considered.

47,XYY Karyotypes and Pervasive Developmental Disorders

Objective: The presence of a 47,XYY karyotype in boys with pervasive developmental disorders (PDDs) has rarely been described in the past. Herein, 2 boys with PDDs and a supernumerary Y chromosome are presented. Methods: The case histories of the 2 patients are described along with the results of associated testing. The literature on psychosocial development as well as brain morphology and physiology in males with 47,XYY karyotypes is reviewed. Results: Both boys had presentations typical of PDDs, one with autistic disorder and the other with PDD not otherwise specified. Conclusions: The finding that, in a clinic for children with developmental disorders, 2 of 40 male referrals had 47,XYY karyotypes suggests that the rate of this sex chromosome anomaly may be increased in PDDs. An extra Y chromosome may be related to abnormal brain development, which may, in turn, predispose vulnerable males to PDDs.

Web-Based Intervention Programs for Depression: A Scoping Review and Evaluation

Background Although depression is known to affect millions of people worldwide, individuals seeking aid from qualified health care professionals are faced with a number of barriers to treatment including a lack of treatment resources, limited number of qualified service providers, stigma associated with diagnosis and treatment, prolonged wait times, cost, and barriers to accessibility such as transportation and clinic locations. The delivery of depression interventions through the Internet may provide a practical solution to addressing some of these barriers. Objective The purpose of this scoping review was to answer the following questions: (1) What Web-delivered programs are currently available that offer an interactive treatment component for depression?, (2) What are the contents, accessibility, and usability of each identified program?, and (3) What tools, supports, and research evidence are available for each identified program? Methods Using the popular search engines Google, Yahoo, and Bing (Canadian platforms), two reviewers independently searched for interactive Web-based interventions targeting the treatment of depression. The Beacon website, an information portal for online health applications, was also consulted. For each identified program, accessibility, usability, tools, support, and research evidence were evaluated and programs were categorized as evidence-based versus non-evidence-based if they had been the subject of at least one randomized controlled trial. Programs were scored using a 28-point rating system, and evidence- versus non-evidence-based programs were compared and contrasted. Although this review included all programs meeting exclusion and inclusion criteria found using the described search method, only English language Web-delivered depression programs were awarded an evaluation score. Results The review identified 32 programs meeting inclusion criteria. There was a great deal of variability among the programs captured in this evaluation. Many of the programs were developed for general adolescent or adult audiences, with few (n=2) focusing on special populations (eg, military personnel, older adults). Cognitive behavioral therapy was the most common therapeutic approach used in the programs described. Program interactive components included mood assessments and supplementary homework sheets such as activity planning and goal setting. Only 12 of the programs had published evidence in support of their efficacy and treatment of depressive symptoms. Conclusions There are a number of interactive depression interventions available through the Internet. Recommendations for future programs, or the adaptation of existing programs include offering a greater selection of alternative languages, removing registration restrictions, free trial periods for programs requiring user fees, and amending programs to meet the needs of special populations (eg, those with cognitive and/or visual impairments). Furthermore, discussion of specific and relevant topics to the target audience while also enhancing overall user control would contribute to a more accessible intervention tool.

Treatment of Delirium Following Cardiac Surgery

Abstract  Postoperative delirium is a common medical complication following cardiac surgery. This paper will outline the treatment options for delirium with a focus on prophylactic use of risperidone before cardiac surgery. (J Card Surg 2012;27:589‐593)

Reconsidering Pimozide for New-Onset Delusions of Parasitosis

Dear Editor: The selective serotonin reuptake inhibitors (SSRIs) are used to treat a wide array of psychiatric conditions (1). Patients experience fewer side effects, compared with the older antidepressants (2). However, sexual dysfunction may occur in up to 75% of patients taking antidepressants (3). I report a case in which a patient taking sertraline experienced decreased to almost nonexistent erections, with a return to his baseline functioning following treatment with vardenafil. To my knowledge, this is the first reported case of vardenafil used to treat antidepressantinduced sexual dysfunction.

Gamma hydroxybutyrate withdrawal in an orthopedic trauma patient

Discussion Although all patients had clinical galactorrhea, 3 were unwilling to have prolactin levels measured. Apart from hypothyroidism (6), fluoxetine, sertraline, fluvoxamine, and paroxetine therapy have been reported to cause galactorrhea (7–10). However, given that this patient’s galactorrhea had a definite onset and offset with risperidone therapy, risperidone appears to be the main etiological agent for galactorrhea in this series.

Identification of hidden health utilization services and costs in adults awaiting tertiary care following mild traumatic brain injury in Toronto, Ontario, Canada

Aim: The cognitive, emotional, behavioral and physical impairments experienced by adults after mild traumatic brain injury (mTBI) can produce substantial disability, with 15–20% requiring referral to tertiary care (TC) for persistent symptoms. Methods: A convenience sample of 201 adult patients referred to TC as a result of mTBI was studied. Self-reported data were collected at first TC visit, on average 10 months postinjury. Patients reported the type and intensity of healthcare provider visit(s) undertaken while awaiting TC. Results: On average males reported 37 and females 30 healthcare provider visits, resulting in over

Conversion disorder in a patient with diffuse axonal injury.

500,000 Canadian dollars spent on potentially excess mTBI care over 1 year. Discussion: Based on conservative estimate of 15% of mTBI patients receiving TC, this finding identifies a possible excess in care of

Understanding the psychiatric effects of concussion on constructed identity in hockey players: Implications for health professionals

110 million for Ontario. Accurate diagnosis of mTBI and early coordination of follow-up care for those needing TC could increase cost–effectiveness.

Common Data Elements for Concussion in Tertiary Care: Phase One in Ontario

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