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1.  Oxytocin in Pregnancy and the Postpartum: Relations to Labor and Its Management 
The purpose of this study was to examine variations in endogenous oxytocin levels in pregnancy and postpartum state. We also explored the associations between delivery variables and oxytocin levels. A final sample of 272 mothers in their first trimester of pregnancy was included for the study. Blood samples were drawn during the first trimester and third trimester of pregnancy and at 8 weeks postpartum. Socio-demographic data were collected at each time point and medical files were consulted for delivery details. In most women, levels of circulating oxytocin increased from the first to third trimester of pregnancy followed by a decrease in the postpartum period. Oxytocin levels varied considerably between individuals, ranging from 50 pg/mL to over 2000 pg/mL. Parity was the main predictor of oxytocin levels in the third trimester of pregnancy and of oxytocin level changes from the first to the third trimester of pregnancy. Oxytocin levels in the third trimester of pregnancy predicted a self-reported negative labor experience and increased the chances of having an epidural. Intrapartum exogenous oxytocin was positively associated with levels of oxytocin during the postpartum period. Our exploratory results suggest that circulating oxytocin levels during the third trimester of pregnancy may predict the type of labor a woman will experience. More importantly, the quantity of intrapartum exogenous oxytocin administered during labor predicted plasma oxytocin levels 2 months postpartum, suggesting a possible long-term effect of this routine intervention, the consequences of which are largely unknown.
PMCID: PMC3902863  PMID: 24479112
labor; oxytocin; pregnancy; epidural; syntocinon
2.  Helpseeking of Immigrant and Native Born Parents: A Qualitative Study from a Montreal Child Day Hospital 
This qualitative study of the perceptions of native-born Canadian and immigrant parents whose children attended a psychiatric day hospital for significant behavior impairment, focused on parental helpseeking pathways, explanatory models of mental health, and referral or access experiences.
A sample of ten immigrant and ten native born parents were recruited for semi-structured interviews analyzed thematically to discern similarities and differences between the two groups.
The immigrant group more frequently reported barriers and delays in accessing mental health services. They often reported lack of primary care physicians and language barriers. They were less likely to have a biomedical perspective or to use specialized resources for their children prior to admission. Both groups reported apprehension about medication trials, though the immigrant parents were less likely to agree to psychopharmacological treatment. None of the professionals treating parents for mental health problems initiated referral of their impaired children.
Based on the qualitative analysis of this sample, native born single parents and immigrant parents may feel especially vulnerable to lack of social support. Adjustments of primary care, schools and community resources, as well as promoting best practices of culturally competent child mental health care, may increase access and willingness to pursue treatment in both groups.
PMCID: PMC3825467  PMID: 24223046
helpseeking; immigrant health; access; day hospital; cultural competence; recherche d’aide; santé des immigrants; accès; hôpital de jour; compétence culturelle
3.  Role overload, pain and physical dysfunction in early rheumatoid or undifferentiated inflammatory arthritis in Canada 
Inflammatory arthritis impairs participation in societal roles. Role overload arises when the demands by a given role set exceed the resources; time and energy, to carry out the required tasks. The present study examines the association between role overload and disease outcomes in early inflammatory arthritis (EIA).
Patients (n = 104) of 7.61 months mean duration of inflammatory arthritis completed self-report questionnaires on sociodemographics, disease characteristics and role overload. Pain was assessed using the Short Form McGill Pain Questionnaire (MPQ) and physical functioning was measured with the Medical Outcomes Study Short Form 36 (SF-36) physical functioning score. Role overload was measured by the Role Overload Scale. Patients indicated the number of social roles they occupied from a total of the three typical roles; marital, parental and paid work.
Participants’ mean age was 56 years and 70.2% were female. Role overload was not correlated to the number of social roles, however, it was positively associated with pain (p = 0.004) and negatively associated with physical functioning (p = 0.001). On multivariate analysis, role overload was negatively associated with physical functioning after controlling for the relevant sociodemographic variables.
This study identifies a possible reciprocal relationship between role overload and physical functioning in patients with EIA.
PMCID: PMC3428668  PMID: 22554167
Arthritis; Role overload; Physical functioning; Pain
4.  Outcomes in Women Diagnosed With Borderline Personality Disorder in Adolescence 
This study examined the outcomes of patients diagnosed with borderline personality disorder (BPD) prior to age 18.
In a group of 47 adolescent girls assessed over a 10 year period, 31 had a past diagnosis of BPD while 16 had not met criteria. Subjects were assessed with the SCID-I, the Diagnostic Interview for Borderlines (DIB), the SCL-90-R, the Social Adjustment Scale (SAS-SR), the Affective Lability Scale (ALS), the Barratt Impulsivity Scale (BIS), the Continuous Performance Test (CPT), the Wisconsin Card Sorting Test (WCST), and the Attention Network Task (ANT).
4.3 years after initial presentation (mean age=19.6), only 11 index patients still met criteria for BPD and no new cases developed. Those who did not remit were significantly more likely to have a current episode of major depressive disorder, lifetime substance use disorder, and self-reported childhood sexual abuse. Those who still met BPD criteria also scored higher on the ALS and the total severity scale as well as several subscales of the SCL-90, but not on other measures.
These findings support the validity of an adolescent diagnosis of BPD and show that the majority of cases that develop in early adolescence can be expected to remit within 4 years.
PMCID: PMC3143691  PMID: 21804844
borderline personality disorder; adolescent; longitudinal course; trouble de personnalité borderline; adolescente; étude longitudinale
5.  The Relationship between Alliance, Attachment and Outcome in a Child Multi-Modal Treatment Population: Pilot Study 
This pilot study explored the relationship between parental therapeutic alliance, maternal attachment style and child and family functioning in a sample of families with a child aged five to twelve years receiving child psychiatry day hospital treatment for complex co-morbid disorders.
Self-report measures of therapeutic alliance, maternal attachment style, child behaviour and family functioning were administered to parents at the end of the assessment period (T1) and at discharge (T2). The original study cohort included 90 families, and 44 families completed all the study measures at T2. Correlational analysis was conducted on these 44 families measuring parental alliance, maternal attachment style with child and family functioning scores. Comparisons were made between participants that completed T1 and T2 of the study with participants that only completed T1.
For the 44 families who completed both T1 and T2 measures, the combination of secure maternal attachment style and positive therapeutic alliance at T1 was associated with positive child outcomes, that is, improved scores on both the internalizing and externalizing dimensions as measured by the CBCL between T1 and T2. Significant changes were identified in family functioning with improvement on cohesion and expressiveness, enhanced intellectual-cultural orientation and improved family organization as measured by the FES.
Capacity for secure attachment and positive alliance are associated with improved child and family systems outcomes in a high risk cohort of children with co-morbid disorders from a day and evening multimodal family treatment program.
PMCID: PMC3143695  PMID: 21804848
high risk children; family factors; attachment style; child multimodal treatment; enfants à risque élevé; facteurs familiaux; style d’attachement; traitement multimodal; enfant
6.  The Cues and Care Trial: A randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infants 
BMC Pediatrics  2008;8:38.
Very low birthweight infants are at risk for deficits in cognitive and language development, as well as attention and behaviour problems. Maternal sensitive behaviour (i.e. awareness of infant cues and appropriate responsiveness to those cues) in interaction with her very low birthweight infant is associated with better outcomes in these domains; however, maternal anxiety interferes with the mother's ability to interact sensitively with her very low birthweight infant. There is a need for brief, cost-effective and timely interventions that address both maternal psychological distress and interactive behaviour. The Cues and Care trial is a randomized controlled trial of an intervention designed to reduce maternal anxiety and promote sensitive interaction in mothers of very low birthweight infants.
Methods and design
Mothers of singleton infants born at weights below 1500 g are recruited in the neonatal intensive care units of 2 tertiary care hospitals, and are randomly assigned to the experimental (Cues) intervention or to an attention control (Care) condition. The Cues intervention teaches mothers to attend to their own physiological, cognitive, and emotional cues that signal anxiety and worry, and to use cognitive-behavioural strategies to reduce distress. Mothers are also taught to understand infant cues and to respond sensitively to those cues. Mothers in the Care group receive general information about infant care. Both groups have 6 contacts with a trained intervener; 5 of the 6 sessions take place during the infant's hospitalization, and the sixth contact occurs after discharge, in the participant mother's home. The primary outcome is maternal symptoms of anxiety, assessed via self-report questionnaire immediately post-intervention. Secondary outcomes include maternal sensitive behaviour, maternal symptoms of posttraumatic stress, and infant development at 6 months corrected age.
The Cues and Care trial will provide important information on the efficacy of a brief, skills-based intervention to reduce anxiety and increase sensitivity in mothers of very low birthweight infants. A brief intervention of this nature may be more readily implemented as part of standard neonatal intensive care than broad-based, multi-component interventions. By intervening early, we aim to optimize developmental outcomes in these high risk infants.
Trial Registration
Current Controlled Trials ISRCTN00918472
The Cues and Care Trial: A randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infants
PMCID: PMC2572053  PMID: 18822128
7.  Borderline Pathology of Childhood: Implications of Early Axis II Diagnoses 
A personality pathology framework may be useful in the diagnosis and treatment of children with chronic psychopathology and impairment in many domains of functioning. This paper presents the utility of such an approach through a description of research investigating borderline pathology of childhood (BPC).
Literature regarding the phenomenology, risk factors, and outcomes of BPC and similar disorders is reviewed.
Research conducted at the SMBD-Jewish General Hospital in Montreal has shown that children with BPC can be reliably identified via chart review, and that they exhibit a pattern of risk factors similar to that of adults with borderline personality disorder, such as psychological trauma and deficits in executive function. Preliminary results of a follow-up study in adolescence suggests that these children remain more functionally impaired than a comparison group. Our current research investigates neuropsychological deficits and their relationship to trauma in children with BPC. We are also exploring whether a similar pattern can be observed in their parents.
We conclude that BPC symptom patterns may diagnostically define a group of high risk children and may eventually guide our approach to early intervention.
PMCID: PMC2538735  PMID: 19030501
Borderline pathology of childhood; personality development; risk factors; Pathologie(s) borderline de l’enfance; développement de la personnalité; facteurs de risques

Results 1-7 (7)