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1.  Psychotropic Medication Use in Canadian Long-Term Care Patients Referred for Psychogeriatric Consultation 
Background and Puspose
Prior studies have shown a high prevalence of psychotropic medication use among patients residing in long-term care homes (LTCHs). The purpose of this study was to examine psychotropic medication use by LTCH patients in a metropolitan Canadian city referred to outreach teams for psychiatric assessment.
A retrospective review of charts from specialized psychogeriatric outreach teams serving a large metropolitan city in Canada was undertaken. Data from 68 charts were reviewed. Data were analyzed using descriptive and correlational statistics.
Antipsychotic medications were the most frequent drugs prescribed to patients referred for psychogeriatric assessment (55.9%), followed by antidepressants (50.0%), cognitive enhancers (44.1%) and benzodiazepines (29.4%). More than a quarter of patients (26.5%) were on three psychotropic medications. Medications were adjusted in 35.3% of cases mostly resulting in dose increases. Only 5.9% of patients had their medication dose reduced.
This preliminary exploratory study suggests that patients referred to specialized outreach teams may be a difficult-to-treat population. Further studies are required to establish effective prescribing practices and service delivery models.
PMCID: PMC3516351  PMID: 23251317
antipsychotic agents; behavioral disturbances; aggression; dementia; depression
2.  Long-term Psychological and Occupational Effects of Providing Hospital Healthcare during SARS Outbreak 
Emerging Infectious Diseases  2006;12(12):1924-1932.
TOC Summary Line: Healthcare workers in hospitals affected by SARS experience increased psychological stress 1–2 years after the outbreak.
Healthcare workers (HCWs) found the 2003 outbreak of severe acute respiratory syndrome (SARS) to be stressful, but the long-term impact is not known. From 13 to 26 months after the SARS outbreak, 769 HCWs at 9 Toronto hospitals that treated SARS patients and 4 Hamilton hospitals that did not treat SARS patients completed a survey of several adverse outcomes. Toronto HCWs reported significantly higher levels of burnout (p = 0.019), psychological distress (p<0.001), and posttraumatic stress (p<0.001). Toronto workers were more likely to have reduced patient contact and work hours and to report behavioral consequences of stress. Variance in adverse outcomes was explained by a protective effect of the perceived adequacy of training and support and by a provocative effect of maladaptive coping style and other individual factors. The results reinforce the value of effective staff support and training in preparation for future outbreaks.
PMCID: PMC3291360  PMID: 17326946
Severe Acute Respiratory Syndrome; Stress, Psychological; Health Personnel; Stress, Traumatic; Burnout, Professional, research
3.  A population health framework for inner-city mental health 
Dealing with mental health problems in the inner city presents a major challenge to planners and service providers. Traditional mental health service-oriented interventions often prove ineffective due to the complexity of individual's needs. This article argues that a population health framework can be used to identify critical risk and protective factors and facilitate more effective, upstream, population-based interventions for mental health problems in the inner city. A community report card is seen as a useful measure of key indicators at any point in time and of changes over time at the community or neighborhood level. A number of issues with regard to report card development are identified and discussed, as is the process of creating a report card, including key domains and the organization of findings.
PMCID: PMC3456616  PMID: 12473695
4.  Inner city health 
PMCID: PMC80685  PMID: 11332318
5.  Views on ageing 
Canadian Medical Association Journal  1978;118(12):1493-1494.
PMCID: PMC1818097  PMID: 20312992
6.  Coping With Change In Retirement 
Canadian Family Physician  1978;24:133-136.
Retirement is a poorly understood life event which often signals the onset of old age. Adjustment may be difficult for many reasons, but there is little empirical support for the view that retirement results in premature physical and/or psychological deterioration. Flexible individuals who have derived satisfaction from many sources throughout life will do best in retirement. People who are rigid and for whom work provides an identity may be expected to experience difficulties. A knowledge of crisis theory and of stages in the process of retirement may be helpful in dealing with increasing numbers of older patients.
PMCID: PMC2379111  PMID: 21301493

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