These findings are consistent with a role for differential amygdala (and associated limbic) functioning in GSP. The pronounced response to contemptuous and angry facial expressions suggests that the amygdala in GSP may be particularly active in the processing of disorder-salient stimuli.

Objectives The personality of medical students may have an important impact on both their academic performance and emotional adjustment during medical school. There has been little systematic study of the impact of perfectionism on medical students. The present study sought to compare the perfectionism pro®le of medical students with that of a general arts student group and to examine the relationship among perfectionism, distress symptoms and academic expectations and satisfaction.Design Medical students (n 96) and arts students (n 289) completed a baseline assessment including two multidimensional perfectionism scales. The medical students also completed measures of distress symptoms, personality (neuroticism, conscientiousness) and questions about their perceptions of their academic performance. Of the medical students, 58 completed a second set of questionnaires 6 months later (time 2).Subjects First-, second-and third year medical students and ®rst-year arts students. ResultsIn comparison with arts students, the perfectionism pro®le of medical students showed higher personal standards, lower doubts about actions and lower maladaptive perfectionism scores. In the medical students adaptive perfectionism (achievement striving) was signi®cantly correlated with baseline academic performance expectations and conscientiousness and was predictive of dissatisfaction with academic performance at time 2. Maladaptive perfectionism (excessive evaluative concerns) was signi®cantly correlated with baseline distress symptoms and neuroticism and was predictive of symptoms of depression and hopelessness at time 2.Conclusions Perfectionism in medical students differs systematically from perfectionism in general arts students. Distinguishing adaptive and maladaptive aspects of perfectionism is important in understanding the cross-sectional and longitudinal implications of perfectionism for medical students.

Introduction. The mental health of Canadian Armed Forces (CAF) populations emerged as an important concern in the wake of difficult CAF deployments in the 1990s. This article is the first comprehensive summary of findings from subsequent surveys of mental health and well-being in CAF Veterans, undertaken to inform mental health service renewals by CAF Health Services and Veterans Affairs Canada (VAC). Methods. Epidemiological findings in journal publications and government reports were summarized from four cross-sectional national surveys: a survey of Veterans participating in VAC programs in 1999 and three surveys of health and well-being representative of whole populations of Veterans in 2003, 2010, and 2013. Results. Although most Veterans had good mental health, many had mental health problems that affected functioning, well-being, and service utilization. Recent Veterans had a higher prevalence of mental health problems than the general Canadian population, earlier-era Veterans, and possibly the serving population. There were associations between mental health conditions and difficult adjustment to civilian life, physical health, and multiple socio-demographic factors. Mental health problems were key drivers of disability. Comparisons with other studies were complicated by methodological, era, and cultural differences. Discussion. The survey findings support ongoing multifactorial approaches to optimizing mental health and well-being in CAF Veterans, including strong military-to-civilian transition support and access to effective mental and physical health services. Studies underway of transitioning members and families in the peri-release period of the military-to-civilian transition and longitudinal studies of mental health in Veterans will address important knowledge gaps.

Background: Despite their favourable toxicology profile, benzodiazepines and the related Z-drugs (zopiclone, zolpidem and zaleplon) have been associated with physiological tolerance, dependence and addiction. Evidence of harm (e.g., falls, motor vehicle collisions and cognitive disturbances) has been reported in older populations. The aim of this study was to determine the relation between users' characteristics and the use of benzodiazepines and Z-drugs in Manitoba over a 16-year period. Methods:This time-series analysis was based on prescription data from Apr. 1, 1996, to Mar. 31, 2012, obtained from the Drug Product Information Network database of Manitoba. We obtained sociodemographic information on benzodiazepine and Z-drug users from the Population Registry and determined changes in utilization rates over time using generalized estimating equations.Results: Overall, the prevalence of benzodiazepine use remained stable at about 61.0 per 1000 population between 1996/97 and 2011/12; however, the prevalence of Z-drug use increased steadily from 10.9 to 37.0 per 1000 over the same period. In older people (≥ 65 yr), the incidence of benzodiazepine use decreased from 55.5 to 30.3 users per 1000, whereas the incidence of Z-drug use increased from 7.3 to 20.3 users per 1000 over the study period. Among those 18-64 years of age, the incidence of benzodiazepine use decreased from 30.1 to 27.6 users per 1000, but the increase in incidence of Z-drug use was more than 2-fold. The youngest population (≤ 17 yr) showed the lowest rates of use of these drugs. The highest rates of use were observed among older women and the low-income population.Interpretation: Over the study period, benzodiazepines have been prescribed less frequently to older patients in Manitoba; however, zopiclone prescribing has continued to increase for all age groups. The reasons for this increase remain to be determined. AbstractCMAJ OPEN, 2(4) E209 Research CMAJ OPEN Methods Study populationAll Manitoba residents registered with the provincial health care system who were prescribed a benzodiazepine or a Z-drug between 1996/97 and 2011/12 were included. No age restrictions were applied, but patients were stratified by sex and age (0-17, 18-64 and ≥ 65 yr). Location of residence (urban v. rural) and socioeconomic status were also assessed. According to validated definitions, 23 incident (new) users were defined as people who had not received a prescription for any of the medications of interest in the year before receiving their first prescription, while prevalent users for each fiscal year were defined as people who had received at least 1 pres cription for a medication of interest that year.

The Royal Canadian Mounted Police (RCMP), like all public safety personnel (PSP), are frequently exposed to potentially psychologically traumatic events that contribute to posttraumatic stress injuries (PTSI). Addressing PTSI is impeded by the limited available research. In this protocol paper, we describe the RCMP Study, part of the concerted efforts by the RCMP to reduce PTSI by improving access to evidence-based assessments, treatments and training as well as participant recruitment and RCMP Study developments to date. The RCMP Study has been designed to (1) develop, deploy and assess the impact of a system for ongoing annual, monthly and daily evidence-based assessments; (2) evaluate associations between demographic variables and PTSI; (3) longitudinally assess individual differences associated with PTSI; (4) augment the RCMP Cadet Training Program with skills to proactively mitigate PTSI; and (5) assess the impact of the augmented training condition (ATC) versus the standard training condition (STC). Participants in the STC (n = 480) and ATC (n = 480) are assessed before and after training and annually for 5 years on their deployment date; they also complete brief monthly and daily surveys. The RCMP Study results are expected to benefit the mental health of all participants, RCMP and PSP by reducing PTSI among all who serve.

P ublic safety personnel in Canada include those working as police, firefighters, paramedics, correctional workers and call centre operators/dispatchers. 1 These people experience substantial mental health problems 2 strongly associated with suicidal behaviour. 3,4 Recent Canadian estimates suggest that 27.8% of public safety personnel report lifetime suicidal ideation, 13.3% report lifetime planning, and 4.6% report a lifetime suicide attempt(s), 5 rates that are higher than representative general population rates of 13.3%, 4.6% and 3.5%, respectively. 6 The Canadian Standing Committee of Public Safety and National Security identified suicide as important to address, along with risk factor research, to inform prevention strategies. 1 Public safety personnel are commonly exposed to potentially traumatic events, 7-9 which are also associated with suicidal behaviour. 10-14 However, elevated suicidal outcomes were seen among nondeployed US soldiers, 15 and precareer suicidality was elevated among US female firefighters. 16 Accordingly, other possible risk factors, such as a history of child abuse, warrant research. A total of 32% and 48% of Canadian general and military populations, respectively, reported experiencing physical abuse, sexual abuse and/or exposure to intimate partner violence before the age of

C hronic pain, physical conditions and mental disorders are prevalent among military personnel. Chronic pain estimates in former members of the Canadian Armed Forces (CAF) are estimated to be about 41%. 1 Although some research has shown higher chronic pain estimates in the Canadian veteran population compared with the general population, 2 other studies have shown comparable prevalence estimates among the two populations. 3 In addition, there are no recent estimates of the prevalence of chronic pain in the serving CAF. Canadian regular force veterans have higher rates of conditions characterized by pain, including arthritis, back pain and bowel disorders compared with the general population. 4 High estimates of mental health conditions are also seen. In 2002, the Canadian Community Health Survey Canadian Forces Supplement (CCHS-CF) showed significantly higher pastyear prevalence rates of depression and panic disorder among regular members of the CAF compared with the rates seen in the general population. 5 High prevalence rates in the CAF are corroborated by more recent research, with the prevalence of general anxiety disorder being twice as high as that of the general population in 2008. 4

Objective: To determine whether childhood maltreatment is associated with immune-mediated inflammatory disorders (IMIDs; multiple sclerosis [MS], inflammatory bowel disease [IBD], and rheumatoid arthritis [RA]). We further aimed to determine the relationship between maltreatment and psychiatric comorbidity in IMIDs and whether these relationships differed across IMID. Methods: Six hundred eighty-one participants (MS, 232; IBD, 216; RA, 130; healthy controls, 103) completed a structured psychiatric interview to identify psychiatric disorders, and the Childhood Trauma Questionnaire to evaluate five types of maltreatment: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. We evaluated associations between maltreatment, IMID, and psychiatric comorbidity using multivariable logistic regression models. Results: The prevalence of having ≥1 maltreatment was similar across IMID but higher than in controls (MS, 63.8%; IBD, 61.6%; RA, 62.3%; healthy controls, 45.6%). Emotional abuse was associated with having an IMID (adjusted odds ratio [aOR] = 2.37; 1.15-4.89). In the sex-specific analysis, this association was only present in women. History of childhood maltreatment was associated with a lifetime diagnosis of a psychiatric disorder in the IMID cohort (OR = 2.24; 1.58-3.16), but this association did not differ across diseases. In those with IMID, total types of maltreatments (aOR = 1.36; 1.17-1.59) and emotional abuse (aOR = 2.64; 1.66-4.21) were associated with psychiatric comorbidity. Conclusions: Childhood maltreatment is more common in IMID than in a healthy population and is associated with psychiatric comorbidity. Given the high burden of psychiatric disorders in the IMID population, clinicians should be aware of the contribution of maltreatment and the potential need for trauma-informed care strategies.