Psychosocial Interventions in Reducing Cannabis Use in Early Phase Psychosis: A Canadian Survey of Treatments Offered.

OBJECTIVE: Cannabis use in people with early phase psychosis (EPP) can have a significant impact on long-term outcomes. The purpose of this investigation was to describe current cannabis use treatment practices in English-speaking early intervention services (EISs) in Canada and determine if their services are informed by available evidence. METHOD: Thirty-five Canadian English-speaking EISs for psychosis were approached to complete a survey through email, facsimile, or online in order to collect information regarding their current cannabis use treatment practices. RESULTS: Data were acquired from 27 of the 35 (78%) programs approached. Only 12% of EISs offered formal services that targeted cannabis use, whereas the majority (63%) of EISs offered informal services for all substance use, not specifically cannabis. In programs with informal services, individual patient psychoeducation (86%) was slightly more common than individual motivational interviewing (MI) (76%) followed by group patient psychoeducation (52%) and information handouts (52%). Thirty-seven percent of EISs offered formal services for substance use, and compared to programs with informal services, more MI, cognitive-behavioural therapy, and family services were offered, with individual treatment modalities more common than groups. No EISs used contingency management, even though it has some preliminary evidence in chronic populations. Evidence-based service implementation barriers included appropriate training and administrative support. CONCLUSIONS: While most English-speaking Canadian EIS programs offer individual MI and psychoeducation, which is in line with the available literature, there is room for improvement in cannabis treatment services based on current evidence for both people with EPP and their families.

Low Prevalence of Elevated ApoB Levels in Patients with Type 2 Diabetes Not Receiving Lipid-Lowering Therapy.

OBJECTIVE: Cardiovascular disease (CVD) is the leading cause of death in people with type 2 diabetes. Apolipoprotein B (apoB) is known to be a better marker of CVD risk than low-density lipoprotein cholesterol (LDL-C). This study investigated apoB levels in people with type 2 diabetes. METHODS: We obtained blood samples from 507 consenting people with type 2 diabetes who were not receiving lipid-lowering medication and who had no previous history of CVD. Subjects were divided into 3 groups: men (M), women <50 years old (W1) and women ≥50 years old (W2). Primary analysis examined lipid parameters, specifically apoB. Secondary analysis involved classifying patients according to the Canadian Diabetes Association's apoB, LDL-C and triglyceride (TG) targets. RESULTS: We found a total mean apoB level of 0.92 g/L. Among patients who failed to achieve the LDL-C target, 28% of M, 39% of W1 and 30% of W2 met the apoB target. The proportions of individuals categorized as being above the LDL-C and apoB targets were significantly different in all 3 groups (p<0.01). When LDL-C was below target and TG was <1.5 mmol/L, 100% of M and W1 and 93% of W2 met the apoB target. CONCLUSIONS: The discordance between the proportions of patients meeting LDL-C and apoB targets may lead to patients being erroneously classified. ApoB and LDL-C correlate very well when TG is <1.5 mmol/L, but not when ≥1.5 mmol/L. Approximately one-third of patients met both LDL-C and apoB goals. Thus, not all patients with type 2 diabetes should be considered to be at a high risk of CVD.

Responses to depression in children: reconceptualizing the relation among response styles.

We propose that researchers should utilize ratio scores when examining the response styles theory rather than examine each of the response styles separately. Higher ratio scores indicate a higher probability of engaging in ruminative, as opposed to distracting and problem solving, behaviors. In Phase One, we examined the factor structure and reliability of the Children's Response Styles Questionnaire (CRSQ) in a sample of 287 third through sixth grade schoolchildren. A two factor solution was obtained: (1) Rumination and (2) Distraction and Problem Solving. Both factors exhibited strong psychometric properties. In Phase Two, 140 children completed the CRSQ and the Children's Depression Inventory (CDI). Six weeks later, children completed the CDI. Confirmatory factor analysis indicated that the two-factor solution fit the data well. In line with hypotheses, CRSQ ratio scores were more strongly associated with CDI residual change scores than were either CRSQ rumination or distraction and problem solving scores.

Sulfonylurea therapy is associated with increased NT-proBNP levels in the treatment of type 2 diabetes.

BACKGROUND: We sought to determine N-terminal pro-Brain Natriuretic Peptide (NTproBNP) levels among a population of individuals with type 2 diabetes, and to correlate these levels with diabetes medications and patient demographics. METHODS: We analyzed data from 506 patients with type 2 diabetes. We compared NT-proBNP levels of these patients with those from the general population. We also sought to determine whether patients' NT-proBNP levels were correlated with diabetes medications, age, gender, creatinine, hemoglobin A1C levels, BMI, blood pressure, and lipid levels. RESULTS: Increasing doses of sulfonylureas were associated with increasing levels of NT-proBNP. However, patients on combined sulfonylurea and metformin therapy had lower NT-proBNP levels than those on sulfonylureas alone. Neither thiazolidinediones nor insulin were associated with NT-proBNP levels. The majority of patients with type 2 diabetes had similar NT-proBNP levels compared to a reference group from the general population. In no age category did NT-proBNP levels differ significantly between men and women. Levels of NT-proBNP were positively associated with age (p<0.0001), systolic blood pressure (p<0.01) and creatinine levels (p<0.0001), and negatively associated with diastolic blood pressure (p<0.001). Levels of NT-proBNP were not associated with A1C, BMI, triglycerides, and high density lipoprotein (p=NS). CONCLUSIONS: Levels of NT-proBNP are associated with increasing sulfonylurea dosage, age, blood pressure, and creatinine levels. There is unlikely to be clinically significant differences in NT-proBNP levels between patients with type 2 diabetes and a normal population.

Operationalizing the "vulnerability" and "stress" components of the hopelessness theory of depression: a multi-wave longitudinal study.

The current study tested of the diathesis-stress component of the hopelessness theory (HT) using (1) a "weakest link" approach towards operationalizing vulnerability (e.g., an individual is as vulnerable to depression as his/her most depressogenic inferential style-DIS) and (2) an idiographic approach towards operationalizing high levels of stress. The procedure involved an initial assessment during which participants completed measures assessing DISs and depressive symptoms. The procedure also involved a series of eight follow-up assessments, occurring every 6 weeks, during which depressive symptoms and hassles were assessed. Hypotheses were tested in two samples of adults (i.e., adults diagnosed with a current MDE and adults diagnosed with a past MDE at Time 1). In line with hypotheses, in both samples, depressogenic weakest links were associated with greater elevations in depressive symptoms following elevations in hassles. At the same time, equally strong support was obtained for the HT when stress was operationalized from a nomothetic perspective and when vulnerability was operationalized as a DIS about causes (but not consequences or self).

Motivation influences the underestimation of cumulative risk.

Past research has shown that people typically underestimate the cumulative risk of events. This effect has mainly been interpreted as resulting from the use of cognitive heuristics and judgment strategies, such as availability or anchoring and adjustment. The authors suggest that motivational processes can be an additional force in the generation of cumulative risk estimates. Using an experimental design, Study 1 shows that people underestimate the cumulative risk of infection with sexually transmitted diseases of appealing prospective sexual partners by using risk-irrelevant information for their judgment. Using a correlational design, Study 2 demonstrates that people underestimate the cumulative risk of being infected with a sexually transmitted disease and that commitment to the present partner is directly related to a low cumulative risk estimate as well as indirectly through its effect on the perceived risk of the present partner. Together, the two studies demonstrate that motivation influences the underestimation of cumulative risk.