Les affiches électroniques seront accessibles en tout temps pendant le congrès. Les délégués pourront les visionner sur des moniteurs disposés dans l’espace du congrès ou sur leur téléphone intelligent personnel, leur ordinateur portable, leur tablette ou leur ordinateur de bureau.

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P01 – “I would see each week these trusted, compassionate faces, even on the Zoom.” How a Virtual Community of Practice Supported Health Care Professionals During the COVID-19 Pandemic
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Chantalle Clarkin*, RN, PhD; Sanjeev Sockalingam, MD, MPHE, FRCPC; Javed Alloo, MD, CCFP, MPL; Mark Bonta, MD, FRCPC; Jake Chaput, BSc; Heather Flett, MD, FRCPC; Andrea Furlan, MD, PhD; Mona Loutfy, MD, MPH; Thiyake Rajaratnam, MSc; Terri Rodak, MA, MISt; Eva Serhal, MB, PhD; Allison Crawford, MD, PhD, FRCPC

Rôles CanMEDS :

1. Promoteur de la santé
2. Leader
3. Communicateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify the effectiveness of a virtual tele-mentoring program to support the psychosocial needs of health care professionals across waves of the pandemic; 2) Reflect on the potential value of the ECHO model to create a virtual community of practice, deliver education, and promote resilience; and 3) Describe how cycles of rapid qualitative analysis were used in this project to create a responsive community of practice.

Health care professionals (HCPs) face considerable mental health impacts from the COVID-19 pandemic, including increased risks of psychological distress, emotional fatigue, and burnout. In March 2020, the Centre for Addiction and Mental Health launched Project Extension for Community Healthcare Outcomes-Coping with COVID (ECHO-CWC), a weekly initiative featuring adaptive curriculum and using videoconferencing to foster an interprofessional virtual community of practice (CoP). ECHO-CWC aims to promote resilience, enhance knowledge, encourage creative coping practices, and reduce isolation among HCPs across Canada.

This exploratory, qualitative study examined the effectiveness of ECHO-CWC as a model to support the educational and psychosocial needs of HCPs throughout the COVID-19 pandemic. Semistructured interviews were conducted with ECHO-CWC participants at two time points: August 2020 (n = 19) and August 2021 (n = 17). Interview transcripts (n = 36) were analyzed within and across time points with a stepped approach and cycles of rapid qualitative analyses (RQA).

Three overarching themes were distilled during analysis: the significant personal and professional impacts of COVID-19 across HCPs, the effectiveness of adaptive curriculum in addressing learning needs that surfaced over time, and the perceived benefits of membership in a virtual CoP. Benefits included reduced perceptions of isolation, increased psychosocial support, enhanced uptake of self-care and reflexive practices, and the application of learning beyond ECHO-CWC.

ECHO can be used to support the psychosocial needs of HCPs during COVID-19. Participants felt strongly that ECHO-CWC moved beyond emotional support to promote the synthesis and application of knowledge in personal and professional contexts and to stimulate the development of adaptive expertise.

Références :

1. Sockalingam S, Clarkin C, Serhal E, et al. Responding to health care professionals’ mental health needs during COVID-19 through the rapid implementation of project ECHO. J Contin Educ Health Prof 2020;40:211–4.
2. Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med 2011;364:2199–207.

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P02 – A Radical Acceptance Online Forum for Heavy Drinkers: A Mixed-Methods Linguistic Analysis
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Andrew Lustig*, MD

Rôles CanMEDS :

1. Communicateur
2. Expert médical
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Describe treatment paradigms in addictions, including abstinence, harm reduction, and radical acceptance; 2) Describe the role of online support groups in people with alcohol use disorder; and 3) Discuss the dialectical tension of abstinence and acceptance of dysfunctional substance use.

Alcohol use is a major source of morbidity and mortality globally. Numerous adverse health outcomes have been linked to alcohol use, including liver disease, road injuries, violence, cancer, cardiovascular disease, and suicide. Alcohol use is responsible for approximately three million deaths per year across the globe. Different paradigms have been employed in the treatment of alcohol use disorder, including abstinence-based and harm-reduction models. Radical acceptance, which has been successfully applied elsewhere in mental health, has not gained acceptance in the treatment of addictions. We used a set of techniques known as corpus linguistics to analyze a dataset of approximately 10,000 posts on an online forum for self-identified alcoholics. The forum we studied purports to embrace a radical acceptance approach to alcohol use disorder. The forum claims to be « for people who accept their lifestyle choice and don’t want to be interrupted . . . » We combined quantitative methods (keyword and collocation analysis) and qualitative methods (concordancing) to conduct a discourse analysis on the linguistic and rhetorical practices employed in the forum and based our analysis in a critical realist ontology. We found that, although the forum purports to embrace acceptance and eschew change, in fact, the discursive practices in the forum reveal a highly ambivalent relation with both acceptance and change. We found that acceptance and change are in dialectical tension that mirrors the structure agency dialectic described in critical realism. We suggest there may be merit in considering employing a radical acceptance paradigm in addictions treatment.

Références :

1. Savic M, Room R, Mugavin J, et al. Defining “drinking culture”: a critical review of its meaning and connotation in social research on alcohol problems. Drugs: Education, Prevention and Policy 2016;23:270–82.
2. MacLean S, Dwyer R, Pennay A, et al. The ‘social worlds’ concept: a useful tool for public health–oriented studies of drinking cultures. Addict Res Theory 2021;29:231–8.

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P03 – Adapted Dialectical-Behavioural Therapy Skills Group for Patients in Intensive Eating Disorder Treatment
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Carrol Zhou*, MD, FRCPC; Danielle MacDonald, PhD, CPsych; Kathryn Trottier, PhD, Cpsych; Karina Rego, MSc

Rôles CanMEDS :

1. Expert médical
2. Érudit
3. Communicateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the current evidence for dialectical-behavioural therapy (DBT) for people with eating disorders (EDs); 2) Identify elements of a DBT skills group that may benefit from modifying for people with EDs; and 3) Learn practical tips to implement into modified DBT skills group for people with EDs.

Emerging evidence indicates that dialectical-behavioural therapy (DBT) is useful in treating eating disorders (EDs), including in patients with significant psychiatric comorbidity. However, the standard DBT skills group is 24 weeks long, which is incompatible with the duration of typical intensive ED treatments. Specific DBT skills are also less relevant or suitable to people participating in ED treatment. The University Health Network Eating Disorders Program has developed an adapted and condensed DBT skills group to complement intensive ED treatment. The manual was adapted from Linehan (2015) over several iterations into an eight-week rotation. It focuses on a selection of DBT skills deemed most applicable to people participating in intensive ED treatment. Specific adaptations to some skills have been made to better meet the needs of this patient group while retaining core content and teaching points from the original DBT manual. Skills from all four DBT modules are included, and administration of the group is synchronized between our inpatient and outpatient services, enabling seamless participation in DBT groups for patients who transition from inpatient to intensive outpatient treatment. The poster will describe the specific modifications made for DBT for the ED population and clinical lessons learned from its implementation in an intensive clinical setting. They should be updated on the most recent epidemiological data on mental disorders and addiction-based disorders on administrative databanks;

Références :

1. Brown TA, Wisniewski L, Anderson LK. Dialectical behavioral therapy for eating disorders: state of the research and new directions. Eat Disord 2020;28(2):97–100.
2. Linehan MM. DBT Skills Training Manual, 2nd ed. New York (NY): Guilford; 2015.

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P04 – Aerobic Exercise versus Resistance Training: What Works Better for Depression?
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Shabbir Amanullah*, MD, FRCPC; Adnan Shabbir, Kinesiology; Hamza Sardar, Kinesiology

Rôles CanMEDS :

1. Collaborateur
2. Leader
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Learn the difference in effectiveness between aerobic exercise and resistance training when treating depression; 2) Learn about the optimal duration of exercise when trying to manage depressive symptoms; and 3) Learn how different levels of exercise intensity may impact depressive symptoms.

The COVID-19 pandemic has exerted enormous pressure on an already stretched mental health system, further limiting access to timely help. Not only has the extended isolation from family and friends increased rates of depression, but the economic recession has also taken a toll on many. Further, given social distancing requirements and the rapid need to adapt to newer technology for visits, consults, etc., many are in dire need of aid. Even in a remote setting, exercise has been shown to reduce depressive symptoms significantly (1) and can aid in handling the abundance of patients currently requiring help. Although there is evidence for the effectiveness of both aerobic exercise (cardiovascular conditioning) and resistance training (using opposing forces to increase muscle contraction), current research does not provide a general consensus on which of the two is better, (2) as previous research has reported mixed results. This review examines the optimal duration for an exercise program, how intensity affects results, and if there is a difference between aerobic exercise and resistance training in reducing depressive symptoms. We selected articles about aerobic exercise and resistance training based on the assessed age group and program length and intensity.

Références :

1. Puterman E, Hives B, Mazara N, et al. COVID-19 Pandemic and Exercise (COPE) trial: a multigroup pragmatic randomised controlled trial examining effects of app-based at-home exercise programs on depressive symptoms. Br J Sports Med 2021;104379104379 [online ahead of print].
2. Doyne EJ, Ossip-Klein DJ, Bowman ED, et al. Running versus weight lifting in the treatment of depression. J Consult Clin Psychol 1987;55:748–54.

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P05 – An Approach to Addressing Physician Burnout and Loneliness Through Novel Digital Platforms
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Landi Zhou*, MD HBSc; Noel Amaladoss, MD

Rôles CanMEDS :

1. Promoteur de la santé
2. Communicateur
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify at least three different barriers physicians face in accessing mental health supports; 2) Describe the unique advantages of digital platforms as a mental health resource; and 3) Be aware of digital platforms to treat mental health and consider their use as low-cost adjuncts to pre-existing treatments in clinical practice.

Physician burnout is a growing concern in Canada. Although the causes of burnout are multifactorial, physician loneliness is a contributing factor that has only since been exacerbated by the pandemic. The need to provide mental health-related resources for physicians is well known, and yet current institution-backed resources are limited in usage, due to physician hesitancy and, in addressing loneliness, due to personal time constraints. We have therefore conceptualized a novel approach to address physician burnout and loneliness: an online platform to connect physicians for peer-to-peer anonymous support. This will be achieved by real-time matching algorithms between physicians to engage in conversation, with the option of wider community-based discussions. The online modality serves to provide anonymity to address physician hesitancy and can be accessed from any time or location for convenience. Further resources for self-care and other community resources will similarly be available. We expect that, as users engage with our platform, levels of loneliness and burnout will decrease. Mental health applications have shown promising results in addressing mental health disorders, with unique advantages over more traditional treatment options. Widespread adoption of this platform could benefit physicians’ mental health nationally, leading to a cost-effective resource to decrease burnout and loneliness. Further extrapolation to other similar health care groups and legitimization of digital platforms to address mental health disorders would then follow.

Références :

1. Ofei-Dodoo S, Mullen R, Pasternak A, et al. Loneliness, burnout, and other types of emotional distress among family medicine physicians: results from a national survey. J Am Board Fam Med 2021;34:531–41.
2. Chandrashekar P. Do mental health mobile apps work: evidence and recommendations for designing high-efficacy mental health mobile apps. Mhealth 2018;4:6.

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P06 – Antipsychotic Utilization Trajectories in Schizophrenia: A State Sequence Analysis Approach
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Sebastien Brodeur*, MD, MSc; Josiane Courteau, PhD; Alain Vanasse, MD, PhD; Marie-Josée Fleury, PhD; Mireille Courteau, MSc; Alain Lesage, MD, MSc, FRCPC; Emmanuel Stip, MD, MSc; Marie-France Demers, BPharm, MSc; Olivier Corbeil, PharmD, MSc; Laurent Béchard, PharmD, MSc; Maxime Huot-Lavoie, MSc; Marc-André Roy, MD, MSc

Rôles CanMEDS :

1. Expert médical
2. Communicateur
3. Promoteur de la santé

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the basics of an innovative method (state sequence analysis); 2) Identify the antipsychotic use trajectories three years after initiating or reinitiating treatment of schizophrenia; and 3) Recognize the potential impact of the antipsychotic chosen to initiate treatment in schizophrenia as a key factor in long-term treatment continuation.

Objective: This study aims to describe the use patterns of antipsychotics (APs) in patients with schizophrenia (SCZ), three years after initiating or reinitiating a given AP.

Methods: Based on medico-administrative information on patients living in Quebec, this retrospective cohort study included 6,444 patients with a previous diagnosis of SCZ, initiating or reinitiating AP medication between January 1, 2012, and December 31, 2014, with continuous coverage by public drug insurance. For each day of follow up (1,092 days), patients were either exposed to one of the chosen categories of APs or none. This patient’s sequence of AP exposure over time has been referred to as the “antipsychotic utilization trajectory.” These trajectories were analyzed with a state sequence analysis (SSA), an innovative approach that provides useful visual information on the continuation and discontinuation patterns of use over time.

Results: Clozapine and long-acting injectable second-generation APs had the best continuation and discontinuation patterns over three years among all other groups, including less switching of APs, whereas oral first-generation APs had the poorest patterns. These findings were comparable among incident and non-incident cohorts. Oral second-generation APs, excluding clozapine, had a poorer continuation and discontinuation pattern than long-acting injectable APs.

Conclusion: SSA provides a clear representation of treatment adherence in comparison with dichotomous indicators of adherence or discontinuation. This innovative method has shed light on the impact of the AP chosen to initiate or reinitiate treatment in SCZ, which has been identified as a key factor for long-term treatment continuation and discontinuation.

Références :

1. Brodeur S, Courteau J, Vanasse A, et al. Association between previous and future antipsychotic adherence in patients initiating clozapine: real-world observational study. Br J Psychiatry 2022;Jan 27:1–8.
2. Vanasse A, Blais L, Courteau J, et al. Comparative effectiveness and safety of antipsychotic drugs in schizophrenia treatment: a real-world observational study. Acta Psychiatr Scand 2016;134:374–84.

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P07 – Association Between Cannabis and Violence in Community-Dwelling Patients with Severe Mental Disorders: A Cross-Sectional Study Using Machine Learning
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Alexandre Dumais* MD, PhD; Alexandre Hudon BEng, MD; Laura Dellazizzo, MSc; Kingsada Phraxayavong, FSA, FICA; Stéphane Potvin, PhD

Rôles CanMEDS :

1. Expert médical
2. Promoteur de la santé
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the role of cannabis in predicting violence in patients with severe mental disorders; 2) Identify predictors correlated to violence in patients with severe mental disorders; and 3) Understand the use of a data-driven approach in patients with severe mental disorders.

Objectives: The objective of this cross-sectional study was to identify cannabis-related features and other characteristics predictive of violence in patients with severe mental disorders (SMDs), using a data-driven approach.

Methods: A least absolute shrinkage and selection operator regularization regression model was used on the database consisting of 97 patients with SMDs, who completed questionnaires measuring substance use and violence.

Results: Cannabis use, particularly related to patients’ decision to consume or time spent using, was a key predictor associated to violence. Other patterns of substance use and personality traits were identified as strong predictors. Stable addictive patterns of cannabis use and interpersonal issues related to cannabis or stimulant abuse were inversely correlated to violence.

Conclusion: This study enabled the identification of several predictors correlated to violence in patients with SMDs. Findings may help to identify the profiles of patients who may be more likely to perpetrate violent behaviours.

Références :

1. Dellazizzo L, Potvin S, Giguère C, et al. The psychometric properties of the Life History of Aggression evaluated in patients from a psychiatric emergency setting. Psychiatry Res 2017;257:485–9.
2. Dellazizzo L, Potvin S, Beaudoin M, et al. Cannabis use and violence in patients with severe mental illnesses: a meta-analytical investigation. Psychiatr Res 2019;274:42–8.

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P08 – Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder: Shared or Unique Neurocognitive Impairments?
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Russell Schachar*, MD
Parrainè par le Académie Canadienne de psychiatrie de l’enfant et l’adolescent

Rôles CanMEDS :

1. Expert médical
2. Professionnel

À la conclusion de cette activité, les participants seront en mesure de : 1) Describe why it is important to consider similarities and differences in executive function between attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD); 2) Describe what is known about similarities and differences between ADHD and ASD; and 3) Describe the results of the largest comparison of executive function between ADHD and ASD.

Attention-deficit hyperactivity disorder (ADHD) and autism spectrum (ASD) disorder are impairing disorders with partially overlapping genetic and neural underpinnings. Few direct comparisons of neurocognition in ADHD and ASD have been conducted and these have used a wide range of measures. Few studies have controlled for comorbidity and all direct comparisons have been based on clinic samples, leaving the question of the generalizability of results unanswered. We compared neurocognitive performance in a rigorously assessed clinic sample of ASD (n = 261), ADHD (n = 423), and control subjects (n = 162) aged 6 to 17.9 years and in a community sample of ASD (n = 190), ADHD (n = 926), and control subjects (n = 14,842) of similar age. Using the stop-signal task (SST), we measured response inhibition (stop-signal reaction time [SSRT]), sustained attention/arousal (reaction time variability [RTV]), and reaction time (RT) and controlled for comorbid ADHD with ADHD and ASD quantitative trait scores and categorically defined ADHD. ADHD and ASD did not differ in SSRT or RTV and both groups were impaired, compared to control subjects. ADHD traits and (or) comorbidity accounted for most of the observed impairment in ASD. Control for ASD traits did not alter the effect of ADHD on neurocognition. ADHD, ASD, and control subjects did not differ in RT. The largest direct comparison of ADHD and ASD indicates that atypical response inhibition and reaction time variability are hallmarks of both disorders. In ASD, neurocognitive impairment is strongly associated with comorbid ADHD. Response inhibition and RT variability likely play a role in the mechanism of both ADHD and ASD.

Références :

1. Karalunas SL, Geurts HM, Konrad K, et al. Annual research review: reaction time variability in ADHD and autism spectrum disorders: measurement and mechanisms of a proposed trans-diagnostic phenotype. J Child Psychol Psychiatry 2014;55:685–710.
2. Antshel K, Zhang-James Y, Wagner K, et al. An update on the comorbidity of ADHD and ASD: a focus on clinical management. Expert Rev Neurother 2016;16:279–93.

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P09 – Benzodiazepine Use During Cariprazine Treatment in Acute Schizophrenia
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Christine Di Cresce*, PhD

Rôle CanMEDS :

1. Expert médical

À la conclusion de cette activité, les participants seront en mesure de : 1) Better understand the potential for longer illness duration as a result of requiring benzodiazepines (BZDs) for the treatment of acute schizophrenia; 2) Better understand the potential for poorer response in acute schizophrenia with required use of BZDs; and 3) Better understand the comparable effects of BZDs on patients who used cariprazine versus placebo patients.

Although antipsychotics are first-line treatment for schizophrenia, benzodiazepines (BZDs) are often used concomitantly in acutely exacerbated patients, due to their anxiolytic and sedative effects. Cariprazine (CAR), a D3-preferring dopamine D2/D3 partial agonist antipsychotic, has been examined in clinical studies for the treatment of acute schizophrenia, with and without BZDs. This analysis delineates the effects of BZD use during CAR treatment in acute schizophrenia.

Methods: Pooled data of CAR-treated (1.5–6 mg per day) and placebo-treated patients from four short-term randomized double-blind trials (NCT00404573, NCT01104766, NCT01104779, NCT00694707) were analyzed. Baseline characteristics (age, duration of illness) and efficacy outcome parameters (total and hostility factor score of the Positive and Negative Syndrome Scale [PANSS]) were compared in patients receiving BZDs (for 3 or more consecutive days) and not receiving BZDs (fewer than 3 consecutive days).

Results: Altogether, 36.7% and 40.7% of the CAR-treated and PBO-treated patients required BZDs. BZD-taking was associated with an older age in both the CAR-treated (p = 0.0002) and PBO-treated (p < 0.0001) patients and with longer illness duration in both treatment groups (p < 0.0001). PANSS total score at baseline was similar for BZD users and non-users (CAR: least-square [LS] mean = 96.36 and 96.27; PBO: LS mean = 95.55 and 96.66). Change from baseline in the PANSS total score was greater for patients who did not use BZD versus those who took CAR (LS mean = –23.8 vs. LS mean –17.2, p < 0.0001) but not with PBO (LS mean = –14.0 vs. LS mean –12.9, p = 0.5776).

Conclusion: These findings may suggest that requiring BZDs is a potential indicator of longer illness duration and poorer antipsychotic response in acute schizophrenia.

Références :

1. Fontanella CA, Campo J V, Phillips GS, et al. Benzodiazepine use and risk of mortality among patients with schizophrenia: a retrospective longitudinal study. J Clin Psychiatry 2016;77:661–7.
2. Kane JM, Zukin S, Wang Y, et al. Efficacy and safety of cariprazine in acute exacerbation of schizophrenia: results from an international, phase III clinical trial. J Clin Psychopharmacol 2015;35:367–73.

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P11 – Cannabis Use in Borderline Personality Disorder: A Double-Edged Sword
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Michele Korostil*, MD, PhD, FRCPC; James Mirabelli, BSc; James MacKillop, PhD; Margaret McKinnon, PhD, CPsych; David Streiner, PhD, CPsych; Katherine Holshausen, PhD CPsych

Rôles CanMEDS :

1. Érudit
2. Expert médical

À la conclusion de cette activité, les participants seront en mesure de : 1) Describe the moderating effect of cannabis on the relation between psychotic vulnerability and borderline personality disorder symptomatology; 2) Describe rationale for adjunct cannabis-related treatments in borderline personality disorder; and 3) Consider the possibility of adding a clinically relevant psychotic subtype of borderline personality disorder.

Cannabis use is elevated in those with borderline personality disorder (BPD). Current research suggests this group may use cannabis as a form of self-medication. However, cannabis is also related to elevated BPD symptoms. This suggests heterogeneity in cannabis’ effect in BPD. A subset of individuals with BPD are vulnerable to psychosis. This vulnerability is associated with elevated BPD severity, and cannabis use is related to exacerbated psychotic symptoms. The relation between psychosis vulnerability and BPD symptoms may therefore be influenced by cannabis use, which may explain the potential differential effect of cannabis in BPD populations.

Methods: Seventy-nine participants with BPD completed questionnaires assessing BPD symptoms (Borderline Symptom List-23), cannabis use (Cannabis Use Disorder Identification Test-Revised), and psychosis vulnerability (Prodromal Questionnaire, 16-item version). Regression and moderation analyses were performed. Cannabis use was assessed as a moderator between psychosis vulnerability and BPD symptoms, and psychosis vulnerability was assessed as a moderator between cannabis use and BPD symptoms.

Results: Psychosis vulnerability predicted more severe BPD symptoms. Further, as cannabis use increased, the relation between psychosis vulnerability and BPD symptoms was strengthened. Among those experiencing the lowest levels of psychosis vulnerability, cannabis use was negatively related to BPD symptomatology.

Conclusions: People with BPD who are vulnerable to psychosis may benefit from concurrent cannabis use disorder treatment, and those who are not vulnerable to psychosis may benefit from adjunct administration of medicinal cannabis. Given the limited number of efficacious treatments for this group, further investigation is merited.

Références :

1. Vest NA, Tragesser S. Coping motives mediate the relationship between borderline personality features and alcohol, cannabis, and prescription opioid use disorder symptomatology in a substance use disorder treatment sample. Personal Disord 2020;11:230–6.
2. Escelsior A, Belvederi MM, Pietro CG, et al. Cannabinoid use and self-injurious behaviours: a systematic review and meta-analysis. J Affect Disord 2021;278:85–98.

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P12 – Cariprazine’s Efficacy in Treating Affective Symptoms: Pooled Data from Schizophrenia and Bipolar Depression Trials
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Christine Di Cresce*, PhD

Rôle CanMEDS :

1. Expert médical

À la conclusion de cette activité, les participants seront en mesure de : 1) Better understand the significant reduction in anxiety symptoms (i.e., anxiety and tension) after treatment with cariprazine; 2) Better understand the significant reduction in depressive symptoms (e.g., depression, sadness, reduced sleep, etc.) after treatment with cariprazine; and 3) Better understand cariprazine’s greater effect on treating symptoms in people with both schizophrenia and bipolar I depression compared to placebo.

Affective symptoms are a common feature of schizophrenia and define bipolar disorder. (1) Alterations in dopamine neurotransmission and activity at D3-D2 receptors is associated with depressive symptoms, providing the rationale for targeting D3-D2 receptors with partial agonists. This analysis examines and compares the efficacy of cariprazine in treating affective symptoms in both schizophrenia and bipolar depression.

Methods: Data from three schizophrenia [NCT00694707, NCT01104766, NCT01104779] and three bipolar I depression studies [NCT013896447, NCT02670538, NCT0267055] were pooled for the analyses. To investigate efficacy across individual affective symptoms, the Marder anxiety/depression and negative symptom items of the Positive and Negative Syndrome Scale (PANSS) and single items of the Montgomery-Asberg Depression Rating Scale (MADRS) were analyzed. Improvement across affective symptoms was examined, primarily evaluating least square mean differences (LSMDs), compared to placebo, in mean change from baseline.

Results: The pooled intent-to-treat (ITT) population comprised people with schizophrenia (placebo = 442, cariprazine = 1,024) and bipolar disorder (placebo = 460, cariprazine = 923). Cariprazine resulted in a significantly greater reduction when compared to placebo in three of the four Marder anxiety/depression items; anxiety (p < 0.01), tension (p < 0.001), and depression (p < 0.05). Similarly, cariprazine was significantly better than placebo in 9 of the 10 MADRS individual items: apparent sadness (p < 0.001), reported sadness (p < 0.001), reduced sleep (p < 0.05), reduced appetite (p < 0.001), concentration difficulties (p < 0.001), lassitude (p < 0.001), inability to feel (p < 0.001), pessimistic thoughts (p < 0.01) and suicidal thoughts (p < 0.05).

Conclusion: The results indicate that cariprazine treatment is significantly effective at treating affective symptoms in people with both schizophrenia and bipolar I depression.

Références :

1. McIntyre RS, Berk M, Brietzke E, et al. Bipolar disorders. Lancet 2020;396:1841–56.
2. Barabássy Á, Sebe B, Acsai K, et al. Safety and tolerability of cariprazine in patients with schizophrenia: a pooled analysis of eight phase II/III studies. Neuropsychiatr Dis Treat 2021;17:957–70. https://doi.org/10.2147/NDT.S301225.

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P13 – Co-Creating a Logic Model for Program Evaluation of a General Residency Psychiatry Program with Resident, Faculty, Program, and Hospital Site Representatives
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Adrienne Tan*, MD, FRCPC; Certina Ho, PhD; Christina Truong, BSc, PharmD; Petal Abdool, MD, FRCPC; Inbal Gafni, MD, FRCPC; Deanna Chaukos, MD, FRCPC; Sanjeev Sockalingam, MD, MHPE, FRCPC

Rôles CanMEDS :

1. Leader
2. Professionnel
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Recognize key components of the logic model to set priorities and guide program evaluation of the General Psychiatry Residency Program (GPRP); 2) Relate lessons learned from stakeholders of the GPRP, regarding program evaluation and continuous quality improvement; and 3) Appraise our approach to program evaluation of the GPRP.

The recent implementation of competency-based medical education in Canadian residency programs has presented new opportunities and challenges to residents, faculty, residency programs, and hospital sites. The department of psychiatry planned a half-day online retreat for the General Psychiatry Residency Program (GPRP), with a focus on program evaluation. Our project was aimed to co-create a program evaluation framework (i.e., a logic model) for the GPRP with resident, faculty, program, and hospital site representatives. Four virtual breakout groups were arranged during the online retreat, representing the key stakeholders of the GPRP: residents, faculty, program, and hospital sites. Insights and suggestions from retreat participants regarding « input, » « activities, » « output, » and « outcome » components of the logic model, in addition to external factors and unintended outcomes, of the GPRP were discussed, followed by a large group debrief session. A logic model was developed to set priorities and guide evaluation of the GPRP. We refer to this framework to 1) monitor actions and activities for achieving desired residency program outcomes, 2) collect and analyze data to prove and improve our program on an ongoing basis, and 3) document and reflect on short-term (program-related) and long-term (system-wide) accomplishments or changes as a result of the residency program. We also considered external factors and unintended outcomes of the GPRP while ensuring feasibility and sustainability of the evaluation efforts. By engaging and gathering insights from retreat participants, the department of psychiatry can improve the delivery and achieve ongoing program evaluation and quality improvement of the GPRP.

Références :

1. Van Melle E. Using a logic model to assist in the planning, implementation, and evaluation of educational programs. Acad Med 2016;91:1464.
2. Van Melle E, Hall AK, Schumacher DJ, et al. Capturing outcomes of competency-based medical education: the call and the challenge. Med Teach 2021;43:794–800.

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P14 – Co-Design of a Virtual Reality Intervention to Improve Workplace Functioning in Depression: An End User, Qualitative Study of the bWell-D Cognitive Care Platform
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Elena Hernandez*, PhD

Rôle CanMEDS :

1. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify the usefulness of including cognitive remediation as part of a depression treatment; 2) Assess the feasibility of implementing a cognitive remediation intervention through virtual reality; and 3) Acknowledge the role of end-user feedback when designing virtual interventions.

Major depressive disorder (MDD) is the leading cause of global disability; however, existing treatments do not always promote full functional recovery. Cognitive dysfunction, a core feature of MDD, is an important target when improving workplace functioning. Immersive virtual reality (VR) has emerged as a promising modality to enhance real-world effectiveness of cognitive remediation. To this end, we have developed the first prototype VR cognitive remediation program for MDD (‘bWell-D’). This study gathered qualitative data from end users early in the design process of bWell-D, to enhance its efficacy and feasibility in clinical settings.

Method: Semi-structured end-user interviews were conducted remotely (patients [n = 15]; clinicians [n = 12]), assessing participants’ perceptions and goals for a VR cognitive remediation program. Video samples of bWell-D were also shared to obtain feedback regarding the program. Interviews were transcribed, coded, and analyzed through thematic analysis.

Results: Participants considered VR an entertaining and safe treatment modality. Recurrent themes among participants included wanting tasks to be 1) multisensory, 2) reflective of real-world settings, and 3) sufficiently challenging. A home-based treatment option was preferred. Some skepticism about effectiveness in the short- and long term was expressed (especially when the purpose and real-world applications of practised skills was not made explicit), as well as concerns about equipment accessibility.

Conclusions: Patients and clinicians considered bWell-D interesting, acceptable, and potentially feasible and provided suggestions to enhance the multisensorial and real-world applicability of this VR intervention. The inclusion of end-user feedback is encouraged when developing future VR programs for clinical purposes.

Références :

1. Chakrabarty T, Hadjipavlou G, Lam RW. Cognitive dysfunction in major depressive disorder: assessment, impact, and management. Focus (Am Psychiatr Publ) 2016;14:194–206.
2. Birckhead B, Khalil C, Liu X, et al. Recommendations for methodology of virtual reality clinical trials in health care by an international working group: iterative study. JMIR Ment Health 2019;6(1):e11973.

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P15 – Comparison of Buprenorphine/Naloxone and Methadone for Reducing Craving in People with Prescription-Type Opioid Use Disorder: Exploratory Results from a Randomized Controlled Trial
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Christina McAnulty*, MSc; Gabriel Bastient, PhD; Suzanne Brissette, MD, MSc; Julie Bruneau, MD; Bernard Le Foll, MD; Ronald Lim, MD, CCFP(AM); Omar Ledjiar, MSc; Stéphanie Marsan, MD; Maria Eugenia Socias, MD, MSc; Annie Talbot, MD; Didier Jutras-Aswad, MD, MS

Rôles CanMEDS :

1. Érudit
2. Collaborateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Explain the importance of craving as a treatment target in people with prescription-type opioid use disorder (POUD); 2) Describe the effects of buprenorphine/naloxone (BUP/NX) versus methadone on craving in people with POUD in realistic treatment conditions; and 3) Discuss potential mechanisms by which BUP/NX may contribute to lower craving, compared to methadone, in OPTIMA.

Craving is a crucial target of opioid agonist therapies (OATs) for prescription-type opioid use disorder (POUD). Buprenorphine/naloxone (BUP/NX) has an improved safety profile, relative to methadone, that allows for a more rapid induction and quicker access to take-home doses. We hypothesized that BUP/NX would be superior to methadone for craving reduction in POUD.

Methods: The OPTIMA trial was a 24-week, pragmatic, pan-Canadian, multicentric, open-label randomized controlled trial comparing the effectiveness of flexible early take-home BUP/NX to the typical methadone model of care in people with POUD. Craving was measured with the Brief Substance Craving Scale at baseline and weeks 2, 6, 10, 14, 18, and 22. We performed exploratory analyses to determine if BUP/NX flexible take-home dosing was superior to the standard methadone model of care for craving reduction.

Results: Craving was significantly reduced in both groups over 22 weeks (BUP/NX adjusted mean difference = –5.52, 95% confidence interval (CI) = –6.91 to –4.13; methadone adjusted mean difference = –3.95, 95%CI = –5.28 to –2.63; p < 0.001). Craving was significantly lower in the BUP/NX group (p < 0.001), specifically at Week 2 of treatment (adjusted mean difference = –1.58, 95%CI = –3.13 to –0.03; p = 0.041).

Conclusions: When prescribed within a flexible model of care with early take-home doses, BUP/NX was associated with lower opioid craving compared to methadone, especially early into treatment. These findings can help guide shared decision making around the choice of OAT in people with POUD.

Références :

1. Socias ME, Ahamad K, Le Foll B, et al. The OPTIMA study, buprenorphine/naloxone and methadone models of care for the treatment of prescription opioid use disorder: study design and rationale. Contemp Clin Trials 2018;69:21–7.
2. Canadian Research Initiative in Substance Misuse. CRISM national guideline for the clinical management of opioid use disorder. Ottawa (ON): Author; 2018.

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P16 – Crisis and Opportunity: The COVID Story of an Undergraduate Psychiatry Assessment Program
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Kien Dang*, MD, FRCPC; Certina Ho, PhD; David Rojas, PhD; Yuxin Tu, PhD; Carla Garcia, MD, FRCPC; Katina Tzanetos, MD, FRCPC; Glendon Tait, MD, FRCPC; Kulamakan Kulasegaram, PhD

Rôles CanMEDS :

1. Érudit
2. Leader

À la conclusion de cette activité, les participants seront en mesure de : 1) List various components to an undergraduate assessment program; 2) Describe the impact of COVID, changes to an assessment program, and the use of key feature questions on medical student performance; and 3) Reflect on the necessity and opportunity for changes in assessment during the COVID pandemic.

The COVID-19 pandemic created challenges to undergraduate (UG) psychiatric education. In response to the pandemic, it was necessary for us to modify the UG psychiatry assessment program. We leveraged this opportunity to revisit our assessment program, with an objective to improve the validity and quality of our assessment strategies while monitoring its impact on measurement and evaluation of student performance.

Methods: We made the following changes in response to COVID:

1. For clinical skills assessment, we removed the OSCE and placed more emphasis on workplace-based assessment (WBA) requirements. 

2. For written examinations, we created a new blueprint and increased overall validity for the assessment of clinical reasoning, through the use of key feature questions (KFQs). We developed an assessment sub-committee for quality assurance that is based on evidence-informed assessment practices.

Results: For clinical skills, no students failed WBAs, compared to 1% of students failing the OSCE pre-COVID. For written examinations, with the use of KFQs, 6% of students failed, compared to 3% pre-COVID. Mean scores decreased from 76% to 71%. There was no significant change in reliability. WBAs were less sensitive in detecting students below the threshold for clinical skills competency. KFQs identified more students struggling to apply knowledge.

Conclusions: The COVID pandemic created an opportunity for us to modify and improve our assessment program. Continuous quality improvement is needed to fine-tune our assessment strategies to better align with evidence- informed practices and support early identification of students who may need remediation.

Références :

1. Hauer K, Lockspeiser T, Chen H, et al. The COVID-19 pandemic as an imperative to advance medical student assessment: three areas for change. Acad Med 2021;96:182–5.
2. Hatala R, Norman GR. Adapting the key features examination for a clinical clerkship. Med Educ 2002;36:160–5.

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P17 – Defining and Measuring Indicators of Successful Transitions for Youth Aging Out of Child Welfare Systems: A Scoping Review and Narrative Synthesis
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Sabrina Agnihotri*, MD, PhD; Mitesh Patel, MD
Parrainè par le Section sur la psychiatrie des enfants et adolescents

Rôles CanMEDS :

1. Promoteur de la santé
2. Érudit
3. Collaborateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify indicators that have been used to measure the success of youth transitioning out of child welfare systems; 2) Summarize the methods or assessment tools that have been used to measure these indicators; and 3) Appreciate areas for further study to better support youth prior to their aging out of child welfare systems.

Youth aging out of child welfare systems face an abrupt transition to adulthood and expectation for self-sufficiency, with few supports. This scoping review and narrative synthesis seeks to identify indicators used to measure the success of aging out youth and their corresponding methods of assessment. A database search was conducted and 150 articles were included in the review. Results revealed eight broad indicators of successful transitions emerging from the literature, including the following: education, employment, basic needs, social support and relationships, conduct and victimization, health, general living skills, and resilience and psychological empowerment. As a larger category, health was broken down into five subdomains of physical, mental health symptoms, reproductive/sexual health, substance use, and access to care/service use. The wide range of indicators identified in the literature highlights the heterogeneity of needs to be addressed among youth aging out of care. Despite the importance of conducting tailored, needs-based assessments for youth prior to aging out, there is currently no validated tool that collates these indicators for comprehensive assessment. Continued research is needed before developing an empirically driven assessment tool that comprehensively measures the transitional needs of aging out youth. Having a universal mode of assessment can better support advocacy efforts, as well as improve our understanding of a youth’s future concerns, given the interdependency of indicator outcomes related to successful transitions. The use of strength-based indicators, such as general life skills and resilience and psychological empowerment, in the needs-based assessment of aging out youth remains a key area of future research.

Références :

1. Sakai C, Mackie TI, Shetgiri R, et al. Mental health beliefs and barriers to accessing mental health services in youth aging out of foster care. Acad Pediatr 2014;14:565–73.
2. Jones A, Sinha V, Trocmé N. Children and youth in out-of-home care in the Canadian provinces. CWRP information sheet #167E. Montreal (QC): Centre for Research on Children and Families, McGill University; 2015.

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P18 – Development and Implementation of a Canadian Psilocybin-Assisted Therapy Training Program
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Joshua Rosenblat*, MD, MSc; Roger McIntyre, MD, FRCPC

Rôles CanMEDS :

1. Érudit
2. Expert médical
3. Communicateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the framework for psilocybin-assisted therapy; 2) Appreciate unique challenges of training therapists to deliver psilocybin-assisted therapy; and 3) Evaluate the feasibility of psychedelic training programs in Canada.

Psilocybin-assisted psychotherapy (PAP) has shown great promise for antidepressant effects. Psilocybin is considered a catalyst to achieve benefits from psychotherapy that would otherwise not have been possible. Therefore, high-quality psychotherapy is essential to maximize the potential benefits of PAP. We developed a de novo psilocybin-assisted therapy training program to train 20 therapists in this modality.

Program Description: Twenty qualified therapists were selected for the training program. The program included didactic teaching, peer teaching, group discussion, and simulations, followed by a practicum component. The practicum component included administering PAP for participants with depression as part of any Health Canada approved clinical trial (https://clinicaltrials.gov/ct2/show/NCT05029466). We recruited an interdisciplinary group from diverse backgrounds of medicine, psychiatry, psychology, social work, and spiritual care. Therapists worked in dyads, pairing physician therapists with non-physician therapists, as at least one physician is required for all psilocybin doses administered. Therapists received group peer supervision. No component of this training program included personal use of psilocybin.

Results: At the time of submission, twenty therapists are actively participating in the final component of the training program, completing hands-on training providing PAP as part of a Health Canada approved trial. The program will be completed by December 2022. We will report feedback from therapists on the training experience, providing qualitative and quantitative appraisal of the program.

Conclusions and potential impact: Developing training programs is an essential part of developing psychedelic treatments. Having well-trained psychedelic therapists is an important limiting factor in our capacity to conduct psychedelic clinical trials.

Référence :

1. Psilocybin for Treatment-Resistant Depression. https://clinicaltrials.gov/ct2/show/NCT05029466.

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P19 – Dispositional Mindfulness as a Protective Factor for COVID-19–Related Anxiety and Emotional and Behavioural Problems in Youth
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Shavon Stafford*, BSc; Fariha Chowdhury, MSc; Kimberly Belfry, PhD; Jennifer Crawford, PhD; Soyeon Kim, PhD

Rôles CanMEDS :

1. Érudit
2. Promoteur de la santé

À la conclusion de cette activité, les participants seront en mesure de : 1) Be knowledgeable about the negative effects that COVID-19–related anxiety has on youth mental health; 2) Be knowledgeable about a protective factor for COVID-19–related anxiety and emotional and behavioural problems in youth; and 3) Be knowledgeable about how improving dispositional mindfulness may be helpful in reducing COVID-19–related anxiety and emotional/behavioural problems.

The CMHA indicated that the risk of Ontario youth developing a mental health issue increased to 50% since March 2020. COVID-19 has exacerbated an already fragile mental health crisis in Canada. Nevertheless, little is known about the relation between COVID-19–related anxiety (CRA) and mental health problems and the protective factors in reducing CRA in youth. A sample of Ontario youth aged 12 to 25 years (N = 117, mean age 16.8 years old, male = 21.6 %) were recruited at five time points during the pandemic (early spring 2021, late spring 2021, fall 2021, winter 2022, spring 2022). Participants completed the Mindful Attention Awareness Scale (MAAS), Coronavirus Anxiety Scale (CAS), and Strengths and Difficulties Questionnaire (SDQ). Preliminary analyses show that CRA is significantly and positively associated with SDQ subscales conduct problems (r = 0.19, p < 0.05) and emotional symptoms (r = 0.31, p < 0.01), suggesting heightened emotional and behavioral difficulties in youth may be linked to CRA. MAAS was significantly and negatively associated with SDQ subscales hyperactivity (r = –0.50, p < 0.01) and peer problems (r = –0.31, p < 0.01). Overall, our findings suggest that dispositional mindfulness may serve as a protective factor for emotional and behavioral problems. Unlike the hypothesis, MAAS was not associated with CRA beyond cohort three. Perhaps the increased CRA upon youth’s return to in-person schooling (20% dysfunctional CRA) may have influenced the association. Interventions that improve dispositional mindfulness may be helpful in reducing emotional and behavioral problems in youth.

Références :

1. Centre for Addiction and Mental Health. Mental health in Canada: COVID-19 and beyond. CAMH policy advice [website]. Toronto (ON): Author; 2020. Available from: https://www.camh.ca/-/media/files/pdfs—public-policy-submissions/covid-and-mh-policy-paper-pdf.pdf.
2. Courtney D, Watson P, Battaglia M, et al. COVID-19 impacts on child and youth anxiety and depression: challenges and opportunities. Can J Psychiatry 2020;65:688–91.

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P20 – Do Inpatient Psychiatric Units Benefit from an Embedded Clinical Pharmacist?
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Shabbir Amanullah*, MD, FRCPC; Victoria Wong, RPh, PharmD; Sachidanandam Udaya-Shankar, FRCPC; Sarah Hanna, PharmD student; Vanan Pahwa, Medical student

Rôles CanMEDS :

1. Leader
2. Communicateur
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Learn about the role of a pharmacist on an inpatient psychiatric unit; 2) Learn about the potential benefits of an integrated clinical pharmacist; and 3) Learn about the pathways to decision making for a pharmacist.

The rapid emergence of novel treatments, along with myriad other medications being used for treatment in other medical disorders, can become challenging for a busy clinician. An integrated clinical pharmacist can help in navigating this potential minefield of complex medication interaction. Despite the paucity of research in Canada, compared to other parts of the world, on the role of pharmacists on an inpatient psychiatric unit, there are studies that have demonstrated the significant role pharmacists can play and their positive contribution to patient outcomes. Pharmacists’ interventions, such as performing medication reviews, collaborating with psychiatrists on prescribing, participation in case discussions and education programs, and monitoring laboratory parameters, have been shown to improve the management of psychiatric disorders. Further, there are studies that demonstrate substantial cost savings.These findings have provided a promising glimpse into the importance of clinical embedded pharmacists in psychiatric teams; nevertheless, it is crucial to note that many of the studies concluded there is a need for further research. 3 Time constraints, lack of support from management, and excessive workload are only some of the barriers to expanding inpatient pharmacist services, identified by the previous investigations6. Given the importance of pharmacists in inpatient management and their various expanded scopes of practice in Canada, there is a need for exploration into how their expertise has been used in mental health and whether embedded clinical pharmacist services on inpatient psychiatric units should be advocated for.

Références :

1. Dakwa DS, Marshall VD, Chaffee BW. The impact of drug order complexity on prospective medication order review and verification time. J Am Med Inform Assoc 2020;27:284–93.
2. Canales PL, Dorson PG, Crismon ML. Outcomes assessment of clinical pharmacy services in a psychiatric inpatient setting. Am J Health Syst Pharm 2001;58:1309–16.

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P21 – Evaluation of a Blended Learning Electroconvulsive Therapy Curriculum for Psychiatry Residents to Treat Depression and Dementia in Older Adults
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Anita Acai*, PhD; Sawayra Owais, MSc; Sarah Payne, MD; Michael Brown, MD; Anthony Levinson, MD, MA, MSc; Karen Saperson, MBChB

Rôles CanMEDS :

1. Expert médical
2. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the importance of training psychiatry residents on the use of electroconvulsive therapy (ECT) for older adult patients with depression and/or dementia, particularly given a lack of existing curricula and an aging population; 2) Describe possible components of a blended learning curriculum on the use of ECT to treat depression and/or dementia in older adults; and 3) Understand the implementation of a blended learning curriculum in ECT for psychiatry learners.

Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression in late life, yet psychiatry residents do not receive standardized effective training on its use. Blended learning, which combines online and face-to-face learning, can allow for the most efficient use of scarce geriatric psychiatry faculty resources, while allowing residents to learn at their own pace. This study evaluated a blended curriculum for psychiatry residents on the use of ECT to treat depression and/or dementia in older adults. Second- and third-year psychiatry residents from McMaster University participated in didactic seminars, hands-on clinical management, and two online clinical cases during their geriatric psychiatry rotation. Resident perceptions of the online program were measured through a self-report questionnaire based on the Medical E-Learning Evaluation Survey, and immediate recall following module completion was measured with a nine-question multiple-choice test. Of the 24 residents who participated, 10 (42%) completed the self-report questionnaire and 21 (88%) completed the knowledge post-test. All participants (100%) agreed or strongly agreed that the modules were relevant to their clinical work, evidence-based, able to be completed in a reasonable amount of time, and a valuable learning experience. The average score on the knowledge test was 81%. General psychiatry residents are satisfied with the content and delivery of a blended learning ECT curriculum and there is evidence of immediate recall. Future work should examine satisfaction with the remainder of the curricula, in addition to impact on longer-term learning and patient care.

Références :

1. UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003;361:799–808.
2. Patry S, Graf P, Delva NJ, et al. Electroconvulsive therapy teaching in Canada: cause for concern. J ECT 2013;29:109–12.

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P22 – Exploration of Existing Integrated Mental Health and Addictions Care Services for Indigenous People in Canada
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Jasmine Wu*

Rôles CanMEDS :

1. Promoteur de la santé
2. Professionnel
3. Collaborateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand that incorporating culture when working with Indigenous people is the core of integrated care; 2) Understand the nuances and complexity when engaging in integrated care, due to historical and ongoing injustices against Indigenous people; and 3) Use the concept of IND-equity to overcome the challenges within integrated care.

Due to the impacts of colonialism, Indigenous people of Canada face disproportionate rates of mental health and substance use disorders, which are often insufficiently addressed by Eurocentric ‘mainstream’ mental health and addiction services. The need to better address Indigenous mental health has led to integrated care: programs that incorporate both Indigenous and Western practices into their care delivery. This research describes the common lessons, disjunctures, and solutions experienced by existing integrated care programs for Indigenous adults. Thus, it is a resource for future integrated care programs, contributing to the Truth and Reconciliation Commission of Canada’s calls to action.

This study, co-designed by an Indigenous practitioner, collects factual data using online surveys administered to integrated care program staff and explores the programs’ relational processes through interviewing key informants. The data have been analyzed in consultation with Indigenous collaborators to highlight Indigenous values and interpretations.

In highlighting the complexity of integrated care, study results show the lessons of real commitment to communities and community involvement and tensions and disjunctures of culture as healing, people-focused versus practitioner-focused programs, community-oriented versus individual-oriented programs, and colonial power dynamics in integrated care. The discussion explores why the tensions and disjunctures exist and suggests how to move forward with integrated care’s lessons and the concept of IND-equity. Ultimately, self-determination is paramount to integrated care and should be reflected in its use of Two-Eyed Seeing. Moving forward, we plan to explore the relationships Indigenous mental health programs have with their funders and funding arrangements in greater detail.

Références :

1. Downey B. Completing the Circle: Towards the achievement of IND-equity – a culturally relevant health equity model by/for Indigenous populations. Witness: The Canadian Journal of Critical Nursing Discourse 2020;2(1):97–110.
2. National Centre for Truth and Reconciliation. Honouring the truth, reconciling for the future: summary of the final report of the Truth and Reconciliation Commission of Canada. Ottawa (ON): Truth and Reconciliation Commission of Canada; 2015.

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P23 – Hypothyroidism and Risk of Schizophrenia in People with a High-Impact Genetic Variant
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Anne Bassett*, MD, FRCPC; Brigid Conroy, MSc; Tracy Heung, MA; Erik Boot, MD; Maria Corral, MD; Lily Van, MD; Sarah Malecki, MD; Susan George, MD

Rôles CanMEDS :

1. Expert médical
2. Professionnel
3. Collaborateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the importance of assessing thyroid function in patients with schizophrenia; 2) Appreciate a possible autoimmune mechanism of schizophrenia; and 3) List three advantages associated with making a molecular diagnosis of 22q11.2 deletion syndrome in people with schizophrenia.

To inform the possibility of a genetic connection, the authors investigated hypothyroidism and expression of schizophrenia in a genetic high-risk model: 22q11.2 deletion syndrome (22q11.2DS), where a priori risk of schizophrenia is 25% and hypothyroidism is common.

Methods: The authors analyzed data from a well-characterized cohort of 382 adults with a 22q11.2 deletion (median age 31.7 years, range 18.1 to 76.3 years), using a Cox proportional hazards model to evaluate the effect of primary hypothyroidism on risk of schizophrenia, while accounting for other variables, including age, in a retrospective nested case-control design. Kaplan-Meier curves provided comparisons of time to schizophrenia onset between those with and without hypothyroidism.

Results: Hypothyroidism was significantly associated with increased risk of schizophrenia (hazard ratio [HR] = 2.40, 95% confidence interval [CI] 1.62 to 3.57, p < 0.0001) while accounting for age, sex, and ethnicity. Kaplan-Meier curves showed significantly greater risk of schizophrenia expression in the subgroup, with a lifetime diagnosis of hypothyroidism (p < 0.0001) and a stronger effect for men (p < 0.0001) than women (p = 0.037). The onset of hypothyroidism (median age 25.1 years) was at or before onset of schizophrenia in 32.6% of those with both conditions.

Conclusions: Discovery of a significant association between schizophrenia and hypothyroidism in people sharing a 22q11.2 deletion extends findings from genetically uncharacterized populations and contributes to a growing literature indicating a possible risk relation between schizophrenia and autoimmune disease. The findings support 22q11.2DS as a genetic model to help identify genome-wide risk variants, additional to the deletion, that could inform shared disease mechanisms relevant to idiopathic schizophrenia.

Références :

1. Blagojevic C, Heung T, Theriault M, et al. Estimate of the contemporary live-birth prevalence of recurrent 22q11.2 deletions: a cross-sectional analysis from population-based newborn screening. CMAJ Open 2021;9:E802–E809.
2. Benros ME, Pedersen MG, Rasmussen H, et al. A nationwide study on the risk of autoimmune diseases in people with a personal or family history of schizophrenia and related psychosis. Am J Psychiatry 2014;171:218–26.

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P24 – Identifying Sexual Health Service Needs and Priorities Among Women and Non-Binary People with First-Episode Psychosis
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Lucy Barker*, MD; Simone Vigod, MD, MSc; Zakia Hussain, BSc; Julia France, BA(Hons); Ananka Rodriguez, BScN; Shakked Lubotzky-Gete, PhD; Suze Berkhout, MD, PhD; Robert Dmytryshyn, MD; Sheila Dunn, MD, MSc; Renu Gupta, MD; Fardous Hosseiny, MSc; Frank Sirotich, PhD; Sophie Soklaridis, PhD; Aristotle Voineskos, MD, PhD; Juveria Zaheer, MD, MSc

Rôles CanMEDS :

1. Promoteur de la santé
2. Collaborateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the sexual health experiences of women and non-binary people who are cared for within first-episode psychosis (FEP) programs; 2) Describe service user and clinician perspectives on sexual health for young women and non-binary people experiencing psychosis; and 3) Appreciate the importance of addressing sexual and reproductive health within FEP programs.

Sexual and reproductive health is understudied among women and gender-diverse people with first-episode psychosis (FEP); this is a potential missed opportunity to improve well-being and prevent adverse outcomes in a high-risk population. (1,2) This study explored sexual health service needs and priorities among women and non-binary people with FEP.

Methods: We conducted semi-structured individual qualitative interviews with 19 service user participants (aged 18 to 31 years) who identified as cis-women, transgender, or non-binary/gender-diverse and who were receiving clinical care in two FEP programs in Ontario. Service user participants were asked about experiences with sexual health and priorities for care. Additionally, we conducted interviews and focus groups with 36 clinicians who work with this population. Thematic analysis was used to analyze service users perspectives, while clinician data were used for triangulation.

Results: Service user participants were diverse in terms of gender identity (cis- and trans-women, non-binary people), sexual orientation, race and ethnicity, and religion. Clinician participants were interprofessionally diverse. Identified themes among service users were as follows: (1) Understanding interactions between psychotic illness and sexual health and function; (2) Accessing information and resources for sexual and reproductive health; (3) Intimacy and relationships; and (4) Intersectional influences on sexual health. Clinicians emphasized risk prevention within each theme, in contrast to service users’ more holistic approach.

Conclusions: Young women and non-binary people with psychosis have wide-ranging sexual health needs, which intersect with their experiences of psychosis in diverse ways and impact many facets of their lives; proactive sexual health services for this population are needed.

Références :

1. Barker LC, Vigod SN. Sexual health of women with schizophrenia: a review. Front Neuroendocrinol 2020;57:100840.
2. Brown A, Lubman DI, Paxton SJ. Reducing sexually-transmitted infection risk in young people with first-episode psychosis. Int J Ment Health Nurs 2011;20:12–20.

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P25 – Improving Quality and Outcome of Patient Care in Psychosis. The First-Episode Psychosis Services Fidelity Scale 1.0: A Standards-Based Measure
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Donald Addington*, MBBS

Rôles CanMEDS :

1. Érudit
2. Promoteur de la santé

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the role of fidelity measures in setting standards for mental health services; 2) Learn about the development and testing of the First Episode Psychosis Services Fidelity Scale; and 3) Know the multiple ways of applying the scale.

The First Episode Psychosis Fidelity Scale, first published in 2016 and revised and updated in 2021, is based on a list of essential components identified by systematic reviews and an international consensus process. It has 35 components, which rate access and quality of health care delivered by early-psychosis teams. Twenty-five components rate service components and 15 components rate team functioning. Each component is rated on a scale of 1 to 5; a rating of 4 is satisfactory. The fidelity rater completes ratings based on administrative data, health record review, and interviews. Fidelity raters from two multicentre studies provided feedback on the clarity and precision of component definitions and ratings. When administered by trained raters, the scale demonstrated good to excellent interrater reliability. The scale can be used for on-site reviews, remote reviews, as a self-report measure, and as a checklist. The selection of components can be adjusted to rate programs serving patients with bipolar disorder or an attenuated psychosis syndrome. The scale can be used to assess and improve the quality of individual programs and compare programs and program networks. Researchers can use the scale as an outcome measure for implementation studies and as a process measure for outcome studies. Recent studies have demonstrated a strong relation between good fidelity and outcomes. The scale has been widely used in national and international studies.

Références :

1. Addington D. First Episode Psychosis Services Fidelity Scale 1.0. Schizophrenia Bulletin Open 2021;2(1).
2. Addington D. First Episode Psychosis Services Fidelity Scale and Manual. Calgary (AB): University of Calgary Press; 2021.

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P26 – Informatics Approaches to Enhancing Delivery of Forensic Passes and Privileges at a Canadian Mental Health Hospital
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Treena Wilkie*, MD; Colin Chu, BA; Brian Lo, MHI; Damian Jankowicz, PhD; Sandy Simpson, MD; Tania Tajirian, MD
Parrainè par le Section sur la psychiatrie médico-légale

Rôles CanMEDS :

1. Collaborateur
2. Leader

À la conclusion de cette activité, les participants seront en mesure de : 1) Outline the opportunities of the electronic health record (EHR) system in supporting forensic passes and privileges; 2) Understand how a Canadian mental health hospital leveraged the EHR to enhance transparent and effective delivery of forensic passes; and 3) Demonstrate how digital tools and the EHR can help implement recovery-oriented, patient-centric forensic models of care.

Participating in community and rehabilitation programs using passes are critical components of recovery-oriented forensic care. However, unauthorized leaves of absence continue to pose a challenge and can be detrimental to the therapeutic relationship. Digital health tools, including the electronic health record (EHR) system, can be useful for making decisions related to use of passes, but there is limited evidence on how the EHR can support the unique needs of forensic care. In this presentation, we share our experience with the EHR to support the data-driven delivery of passes.

Methods: A needs assessment was conducted as part of implementing a new forensic model of care at a Canadian mental health hospital. From these findings, there was a desire for greater transparency of pass usage and processes that promote patient engagement and rehabilitation. To support these needs, the team explored informatics approaches within the EHR.

Results: A pass tracker and pass dashboard were developed to provide insight on pass use and inform decision making. The pass tracker allows clinicians to identify who is currently out on a pass, as well as the status at the unit and patient level. The pass dashboard allows aggregate visualization of pass usage alongside clinical indicators. Details of these tools will be shared in the presentation.

Discussion: This presentation outlines how digital tools can help enable effective delivery of passes in forensic psychiatry settings. Other mental health organizations can explore how these opportunities can be useful for care in their patient population.

Références :

1. Watson TM, Choo L. Understanding and reducing unauthorized leaves of absence from forensic mental health settings: a literature review. J Forens Psychiatry Psychol 2021;32:181–97.
2. Voss I. Containment is not the cure: least restrictive approaches to the management of absconding. J Psychiatr Ment Health Nurs 2019;26:287–8.

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P27 – Intellectual and Developmental Disability Competencies of Practising Psychiatrists in Canada: A Needs Assessment Study
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Anupam Thakur*, MBBS, MD, MSc; Irfan Jiwa, MD; Yona Lunsky, PhD; Alyssa Yip, BSc; Johanna Lake, PhD
Parrainè par le Section des déficiences intellectuelles et développementales

Rôles CanMEDS :

1. Expert médical
2. Professionnel
3. Collaborateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Describe practising psychiatrists’ current levels of knowledge, skills, and attitudes related to people with intellectual and developmental disabilities (IDDs); 2) Discuss the competencies needed to provide high-quality care to patients with IDDs; and 3) Describe learning frameworks and resources needed to develop competency-based CPD programs for practising psychiatrists.

Poorly addressed mental health needs in people with intellectual and developmental disabilities (IDDs) leads to delayed diagnoses, over-prescription of inappropriate medication, repeated emergency department visits, prolonged hospitalizations, and premature mortality. Despite the clinical imperative to address complexities, high service usage, and increased health costs, graduating residents in psychiatry continue to report feeling inadequately prepared to manage patients with IDDs. Studies have reported self-perceived lack of knowledge about IDDs in practising psychiatrists and lack of confidence in working with people with IDDs. This study explores current levels of knowledge, skills, and attitudes related to IDDs in clinical practice and the current training opportunities available for practising psychiatrists. Also, the skill development needs of practising psychiatrists have been explored. This research study involved the use of three data sources: 1) Survey, to understand psychiatrists’ levels of self-perceived knowledge, skills, and attitudes towards people with IDDs; 2) Focus groups and interviews with patients who have IDDs and family members of patients with IDDs, to understand the patient and family perspective of mental health needs in people with IDDs; and 3) Interviews with IDD psychiatrists (content experts) commenting on the need for IDD training for all practising psychiatrists. We have completed data collection and are currently analyzing and summarizing our findings. So far, themes that have emanated from patient and family interviews are the need for psychiatrists to have IDD-specific knowledge, communication, and counselling skills tailored to people with IDDs and attitudes and approaches that are accommodating and trauma-informed.

Références :

1. Werner S, Stawski M, Polakiewicz Y, et al. Psychiatrists’ knowledge, training, and attitudes regarding the care of individuals with intellectual disability. J Intellect Disabil Res 2013;57:774–82.
2. Schneeweiss S, Ahmed S, Burhan A, et al. Competency-based CPD: implications for physicians, CPD providers and health care institutions. Ottawa (ON): Royal College of Physicians and Surgeons of Canada; 2015. Available from: http://www.royalcollege.ca/rcsite/documents/cbd/cb-cpd-white-paper-implications-e.pdf.

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P28 – Lemborexant versus Zolpidem: An Assessment of Wake Bouts in Adults with Insomnia
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Thomas Roth*, PhD; Gary Zammit, PhD; Dinesh Kumar, PhD; Elizabeth Pappadopulos, PhD; Margaret Moline, PhD

Rôles CanMEDS :

1. Communicateur
2. Expert médical
3. Professionnel

À la conclusion de cette activité, les participants seront en mesure de : 1) Examine the duration and frequency of wake bouts underlying the wake after sleep onset (WASO) benefit reported with lemborexant; 2) Identify differences in wake bout characteristics between hypnotics with different mechanisms of action; and 3) Understand how wake bouts were assessed in the phase 3 Study 304 trial (NCT02783729).

Dual orexin receptor antagonists (DORAs) are thought to promote sleep by inhibiting orexin-mediated wakefulness. We evaluated the effect of lemborexant (LEM), a DORA, on wake bout (WB) frequency and duration.

Methods: Study E2006-G000-304 (NCT02783729) was a 1mo, randomized double-blind, placebo (PBO)- and active-controlled (zolpidem tartrate extended release 6.25mg [ZOL]) study of LEM 5 mg (LEM5) and LEM 10 mg (LEM10) in adults aged 55 years and over with insomnia (n = 1006). The number and total duration of short (SWB ≤ 2min) and long (LWB >2 min) WB were determined with polysomnographic data from Night (NT) 2 and NT31 of treatment. P values are based on differences in LSM changes from baseline in WB number and total duration.

Results: LEM-treated subjects had more SWB during NT2 (LEM5, 30.4; LEM10, 33.4; PBO, 26.9; ZOL, 26.3) and NT31 (LEM5, 32.8, LEM10, 34.7, PBO, 26.1; ZOL, 25.9); and spent more minutes in SWB during NT2 (LEM5, 22.0 [P < 0.05 vs. PBO, ZOL]; LEM10, 24.5 [P < 0.0001 vs. PBO, ZOL]; PBO, 20.1; ZOL,19.5) and NT31 (LEM5, 23.9; LEM10, 25.7 [both P < 0.0001 vs. PBO, ZOL]; PBO, 19.4; ZOL,19.3). ZOL was not significant versus PBO for SWB total time.

LEM-treated subjects had fewer LWB during NT2 (LEM5, 4.7; LEM10, 4.4; PBO, 5.9; ZOL, 5.2); LWB numbers were similar across groups during NT31 (5.1, 5.6, 5.5, 5.2). LEM-treated subjects spent fewer minutes in LWB during NT2 (LEM5, 40.3; LEM10, 30.8 [both P < 0.0001 vs. PBO, ZOL]; PBO, 73.0; ZOL, 53.2) and NT31 (LEM5, 42.5; LEM10, 41.6 [both P < 0.0001 vs. PBO, ZOL]; PBO, 73.0; ZOL, 60.4). ZOL was significant versus PBO at NT2 and NT31 (both P < 0.001).

Conclusion: LEM treatment decreased LWB number and duration, thereby decreasing wake time after sleep onset relative to PBO and ZOL.

Références :

1. Rosenberg R, Murphy P, Zammit G, et al. Comparison of lemborexant with placebo and zolpidem tartrate extended release for the treatment of older adults with insomnia disorder: a phase 3 randomized clinical trial. JAMA Netw Open 2019;2(12):e1918254.
2. Svetnik V, Snyder ES, Tao P, et al. Insight into reduction of wakefulness by suvorexant in patients with insomnia: analysis of wake bouts. Sleep 2018;41(1).

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P29 – Medical Crowdsourcing in Clinical Care
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Alexander Bahadur*, MD, BHSc; Jason Perdue, MD; Kathleen Sheehan, MD, DPhil, FRCPC

Rôles CanMEDS :

1. Collaborateur
2. Érudit
3. Communicateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Develop an awareness of the benefits of medical crowdsourcing; 2) Consider the use of medical crowdsourcing to assist with challenging or treatment-resistant clinical cases; and 3) Identify potential medicolegal issues associated with using medical crowdsourcing.

Clinicians often face challenges managing complex patient presentations when treatment options within evidence-based clinical guidelines are exhausted. Subspecialist consultations, whether formal or “curbside,” can be limited by geography or professional isolation. Further, reviewing evidence-based literature may not yield applicable results. This study explores the concept of medical crowdsourcing to overcome these limitations. It discusses the use of secure email listservs comprised of medical colleagues to obtain expert management recommendations. It describes a case of atypical treatment-resistant catatonia on an inpatient psychiatric unit at an academic hospital in Toronto, Canada. When faced with treatment non-response, a secure email listserv was used to seek further clinical recommendations. A total of 84 qualitative responses were received through the listserv, which were coded for analysis. Responses ranged from remarks validating the challenging nature of the case, to responses recommending additional resources to consider, and those recommending lesser-known clinical management options. These recommendations were carefully considered and implemented, leading to rapid and robust clinical improvement of the patient’s catatonic symptoms. The use of a secure email listserv yielded clinically relevant, timely, and effective management recommendations from medical experts in this complex case. Therefore, the increased use of medical crowdsourcing, via listservs or other secure modalities, may allow practitioners to elicit clinical recommendations from a breadth of experts for managing challenging cases, with the goal of improving patient outcomes.

Références :

1. Sims MH, Hodges Shaw M, Gilbertson S, et al. Legal and ethical issues surrounding the use of crowdsourcing among healthcare providers. Health Informatics J 2019;25:1618–30.
2. Perley CM. Physician use of the curbside consultation to address information needs: report on a collective case study. J Med Libr Assoc 2006;94:137–44.

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P30 – Medically Supervised Ketogenic Therapy in the Treatment of Adult Attention-Deficit Hyperactivity Disorder: A Pilot Feasibility Study
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Elisa Brietzke*, MD, PhD; Vitor Breda, MD, PhD; Arun Chinna Meyyappan, BScH; Roumen Milev, MD, PhD; Jennifer Fabe, BSc, MSc, RD; Fabiano Gomes, MD, PhD

Rôles CanMEDS :

1. Expert médical
2. Professionnel
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Consider that nutritional interventions might impact mental health; 2) Be aware of the nonpharmacological approaches to attention deficit hyperactivity disorder (ADHD); and 3) Understand how ketogenic diets are being studied for neuropsychiatric conditions.

Attention-deficit hyperactivity disorder (ADHD) in adults is a frequent condition characterized by symptoms of inattention and/or hyperactivity and impulsivity. The most effective psychopharmacological treatments are stimulants, which are often poorly tolerated by patients. (1) The main objective of this project is to assess the feasibility and potential benefits of a medically supervised ketogenic therapy (MSKT) in the treatment of ADHD in adults.

Methods: This is an open-label single arm clinical trial of a dietary intervention to improve ADHD symptoms. The efficacy and tolerability of the MSKT will be evaluated in a four-week induction phase, followed by a 12-week maintenance phase trial in 20 adults with DSM-5–defined ADHD. Symptoms and impairment will be assessed at baseline and endpoint through the Teacher and Parent Rating Scale (SNAP-IV) adapted for adults and the clinical global improvement (CGI) scales. MSKT will be implemented gradually, with calculated progressive reduction of carbohydrates and increase in fat content in the diet, under the supervision of a registered dietician. Monitoring of the diet will be performed with the support of the KetoSuite application software.

Results: The primary outcome of our study will be the acceptability of the ketogenic diet, which will be evaluated by recruitment success, attrition, and tolerability. Secondary outcomes will be ADHD symptoms, cognitive performance, and adverse effects.

Conclusion: MSKT has been extensively evaluated for children with treatment-resistant epilepsy, with benefits beyond seizure control, such as cognitive and behavioural improvements. (2) Our study will be the first to explore these potential effects in adults with ADHD.

Références :

1. Elliott J, Johnston A, Husereau D, et al. Pharmacologic treatment of attention deficit hyperactivity disorder in adults: a systematic review and network meta-analysis. PLoS One 2020;15:e0240584.
2. Pavón S, Lázaro E, Martínez O, et al. Ketogenic diet and cognition in neurological diseases: a systematic review. Nutr Rev 2021;79:802–13.

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P31 – Monitoring the Use of Medications for Attention-Deficit Disorder with or without Hyperactivity in Children and Young Adults in Quebec, 2000–2020
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Martin Gignac*, MD; Fatoumata-Binta Diallo, PhD; Victoria Massamba, PhD; Elham Rahme, PhD; Carlotta Lunghi, PhD; Helen-Maria Vasiliadis, PhD; Alvin Fansi, PhD; Louis Rochette, PhD; Samuel Cortese, MD; Eric Pelletier, MD; Alain Lesage, MD, MSc

Rôles CanMEDS :

1. Promoteur de la santé
2. Expert médical
3. Professionnel

À la conclusion de cette activité, les participants seront en mesure de : 1) Explore trends in attention-deficit hyperactivity disorder medication prescription; 2) Discuss regional differences among precription rates; and 3) Review factors (type of medications, socioeconomic status, medical speciality) that influence prescription rate.

Attention-deficit hyperactivity disorder (ADHD) is frequently diagnosed among children, adolescents, and youth. Pharmacologic treatment is an important component of the multimodal intervention strategy. Updated pharmacoepidemiologic data from Canada are needed. We examined prescription rates of medications for ADHD in Quebec from April 1, 2000, to March 31, 2020, drawn from the Integrated Chronic Disease Surveillance System of Quebec (SISMACQ).

Method: Data on ADHD medication delivered were obtained for Quebec residents aged up to 24 years, eligible for the Quebec public drug insurance plan (RPAM).

Results: A steady increase in the prevalence of ADHD prescriptions delivered was observed, from 1.9% (1.9%–2%) in 2000–2001 up to 7.7% (7.6%–7.8%) in 2019–2020. The overall prevalence of prescribing medication for ADHD varied considerably among regions, ranging from 3.2% to 14.4% for 2019–2020. Those living in high socioeconomic status areas had a lower prevalence of prescribed ADHD medications. More than one-half of all participants received the first prescription from a family physician. Psychostimulants remained the most prescribed classes of ADHD medications.

Conclusion: Prescription rates of ADHD medication rose during the study period. Nevertheless, the more recent rates remain within the range of the estimated worldwide prevalence of diagnosed ADHD (5%–8%). These results confirm a recent survey in Ontario that found one-half to two-thirds of children and adolescents with ADHD being treated. Different hypotheses arose as to why the portrait differs among regions in Quebec.

Références :

1. Vasiliadis HM, Diallo FB, Rochette L, et al. Temporal trends in the prevalence and incidence of diagnosed ADHD in children and young adults between 1999 and 2012 in Canada: a data linkage study. Can J Psychiatry 2017;62:818–26.
2. Georgiades K, Duncan L, Wang L, et al. Six-month prevalence of mental disorders and service contacts among children and youth in Ontario: evidence from the 2014 Ontario Child Health Study. Can J Psychiatry 2019;64:246–55.

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P32 – Moral Distress in Canadian Respiratory Therapists During the COVID-19 Pandemic: Comparing Experiences On and Off COVID-19 Units
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Andrea D’Alessandro*, MSc(c); Kim Ritchie, RN, PhD; Andrea Brown, PhD; Yuanxin Xue, MSc; Mina Pichtikova, BSc; Fatima Foster, RRT; Kelly Hassall, RRT; Max Altman, BASc; Isaac Beech, BSc; Ruth Lanius, MD, PhD; Randi McCabe, PhD, CPsych; Margaret McKinnon, PhD, CPysch

Rôles CanMEDS :

1. Promoteur de la santé
2. Érudit
3. Communicateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Define moral distress; 2) Summarize potential sources of moral distress for respiratory therapists during the COVID-19 pandemic; and 3) Understand differences in moral distress experienced by respiratory therapists on and off COVID-19 units.

The COVID-19 pandemic has introduced novel morally distressing experiences for respiratory therapists (RTs), including working with a lack of personal protective equipment (PPE), or being the sole person at the bedside of dying patients, due to visitation restrictions. (1,2) It remains unclear at present, however, how working on a designated COVID-19 unit may differentially impact RTs’ experiences with moral distress during the pandemic period. Accordingly, the purpose of this study was to compare moral distress between those working on and off designated COVID-19 units. RTs from across Canada participated in an online survey between March and June 2021. The survey included a basic demographic form (e.g., sex, gender, age, ethnicity, occupational setting, COVID-19 unit) and the Measure of Moral Distress – Healthcare Professional (MMD-HP). A total of 242 (N = 242) RTs participated. Over two-thirds (69.4%) of the sample reported working on a designated COVID-19 unit. Total MMD-HP scores significantly differed between those on and off COVID-19 units, such that RTs on COVID-19 units scored greater than their counterparts (p = 0.018). Probing this relation further revealed that RTs on COVID-19 units rated patient-level sources of moral distress significantly greater than those off COVID-19 units (p < 0.001). There were no significant differences in ratings of team- and system-level sources of moral distress between RTs on and off COVID-19 units. Working on a COVID-19 unit may place RTs at greater risk of moral distress and, consequently, the associated mental health impacts. Future research is needed to understand the unique experiences of RTs on COVID-19 units throughout the pandemic period.

Références :

1. Smallwood N, Pascoe A, Karimi L, et al. Moral distress and perceived community views are associated with mental health symptoms in frontline health workers during the COVID-19 pandemic. Int J Environ Res Public Health 2021;18:8723.
2. D’Alessandro AM, Ritchie K, McCabe RE, et al. Healthcare workers and COVID-19–related moral injury: an interpersonally- focused approach informed by PTSD. Front Psychiatry 2022;12:784523.

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P33 – Online Sexual Experiences and Negative Psychosocial Outcomes in Adolescents
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Ahila Vithiananthan*, MD

Rôles CanMEDS :

1. Promoteur de la santé
2. Communicateur
3. Collaborateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Reflect on various avenues in which teens learn about sexual behaviour; 2) Identify the youth that are vulnerable to engaging with sharing explicit content online; and 3) Identify negative psychosocial outcomes and legal implications that result when teens share explicit content with their peers and strangers online.

In this era of technological advancement, there has been a surge in the number of social networking sites and social media use. These new opportunities of communication, through various forms of personal devices, have provided youth with outlets to interact with other individuals while remaining largely unmonitored online. This poster will reflect on various avenues in which teens learn about sexual behaviour, both through mass media and pornography, and the resulting concerns when they solicit and share intimate images of themselves with their peers and strangers online. We have identified the youth more vulnerable to distributing intimate images of themselves through social media or for monetary benefit. The negative psychosocial outcomes of sharing explicit content online with peers and strangers were then investigated. The implications of being sexually solicited and trafficked online was also investigated. The Canadian Criminal Code and current Canadian legislature regarding the exchange of explicit content online and exploiting minors was explored. This presentation will review potential criminal charges and the negative psychosocial outcomes associated with online solicitation. It will reflect on mass media perspectives, legal implications of sharing explicit content online, as well as the perspectives from law enforcement and mental health professionals regarding the surge of online distribution of intimate images and the resulting negative psychosocial outcomes.

Références :

1. Doornwaard S, Bickham D, Rich M, et al. Adolescents’ use of sexually explicit Internet material and their sexual attitudes and behavior: parallel development and directional effects. Dev Psychol 2015;51:1476–88. https://doi.org/10.1037/dev0000040.
2. Maas MK, Bray BC, Noll JG. A latent class analysis of online sexual experiences and offline sexual behaviors among female adolescents. J Res Adolesc 2018;28:731–47.

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P34 – Opioid Antagonists and Alcohol Use Disorders in Transitional-Aged Youth: Results of a Systematic Review
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Alison Freeland*, MD, FRCPC; Julia Davies, BScN, MScN

Rôles CanMEDS :

1. Expert médical
2. Promoteur de la santé
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Appreciate current evidence for the use of opioid antagonists to treat alcohol use disorders in youth; 2) Understand challenges in systematically reviewing evidence for treatment interventions in transitional-aged youth; and 3) Be aware of limitations in current research in the area of pharmacological treatment of alcohol use disorders in transitional- aged youth.

Pharmacotherapy for adult alcohol use disorders has been shown to be effective, but few studies have explored efficacy in youth, where problematic drinking can increase risk for negative psychosocial outcomes, adult substance use disorders, and mental illness. The purpose of this systematic review was to evaluate the efficacy of opioid antagonists to treat alcohol use disorders and problematic drinking in transitional-aged youth. Eligible studies included randomized controlled trials between 1990 and 2021 that compared opioid antagonists with an active comparator, placebo, or no treatment in youth aged 10 to 25 years. Studies were assessed for risk of bias and quality of evidence. Only six studies met criteria for the review. Two similarly designed studies compared naltrexone to disulfiram. There was low-quality evidence that naltrexone performed less favourably than disulfiram in maintaining abstinence but more favourably in decreasing craving. The remaining studies compared naltrexone to placebo. There was variation in participant ages, types of alcohol misuse, dose of naltrexone, and drinking outcomes. Naltrexone performed significantly better than placebo in some, but not all, markers of decreased alcohol consumption and craving. No serious adverse events were reported. Risk of bias was unclear. Conclusions: Six randomized controlled trials demonstrated some benefit from naltrexone in maintaining abstinence, decreasing alcohol consumption, or relieving craving in this age group. Results were limited by small sample sizes, lack of comparable study characteristics, low-quality evidence and unclear risk of bias. More research is needed to evaluate the use of medications to treat alcohol misuse in this population.

Références :

1. National Institute for Health and Clinical Excellence. Alcohol use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence [Internet]. London (UK): National Institute for Health and Care Excellence; 2011 [updated 2014 Oct]. Available from: https://www.nice.org.uk/guidance/CG115/.
2. O’Malley SS, Corbin W, Leeman RF, et al. Reduction of alcohol drinking in young adults by naltrexone: a double-blind, placebo-controlled, randomized clinical trial of efficacy and safety. J Clin Psychiatry 2015;76(2):e207–e213.

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P35 – Orientation Day for New Faculty: What We Learned After Seven Years
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
John Teshima*, MD, FRCPC; Certina Ho, PhD; Eulaine Ma, BSc; Wei Wei, BSc; Shaheen Darani, MD, FRCPC; Sanjeev Sockalingam, MD, MHPE, FRCPC

Rôles CanMEDS :

1. Leader
2. Professionnel
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Recognize curricular components of the department of psychiatry Orientation Day for New Faculty (ODNF); 2) Relate lessons learned from a seven-year review of the ODNF, about its impact on career advancement and continuing professional development, respectively; and 3) Appraise our approach to program evaluation of the ODNF.

The department of psychiatry introduced the Orientation Day for New Faculty (ODNF), a full-day workshop, to new faculty members in 2013. Since then, the ODNF has been offered in the fall every year, to provide an orientation and overview of teaching and research activities at the department and expectations in undergraduate and postgraduate medical education in psychiatry. Our project is the first to conduct a seven-year trend and thematic analysis of the in-person ODNF full-day workshop evaluation that we received in 2013–2019 (pre-pandemic). Findings will be used to inform future offerings of ODNF at the department (post-pandemic). ODNF post-workshop evaluation surveys were administered to 208 participants immediately after their attendance, with an annual response rate of at least 60%. Two independent analysts conducted a thematic analysis of the participants’ free-form qualitative responses and identified common themes. Participants appreciated the opportunity to network with colleagues and be part of an academic community of practice. They reported a desire to change their current teaching practice to incorporate goal setting and providing feedback to learners. They would like to see more content addressing career advancement and a better balance in covering clinical aspects and approaches to research and grant writing. Expectations of career-oriented topics, such as continuing professional development, increased from 2013 to 2019, implying more attention on self-development among new faculty beyond the traditional focus on teaching and research. Going forward, it will be of interest to compare the (pandemic/post-pandemic) virtual ODNF evaluations with our findings to identify further quality improvement opportunities.

Références :

1. Fox EC 3rd, Waldron JA, Bohnert P, et al. Mentoring new faculty in a department of psychiatry. Acad Psychiatry 1998;22(2):98–106.
2. Teshima J, McKean AJS, Myint MT, et al. Developmental approaches to faculty development. Psychiatr Clin North Am 2019;42:375–87.

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P36 – Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training: Resilience Promotion and Individual and Collective Empowerment
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Kenneth Fung*, MD, FRCPC, MSc; Jenny Jing Wen Liu, PhD; Alan Li, MD; Mateusz Zurowski, MD; Mandana Vahabi, PhD; Josephine Wong, PhD
Parrainè par le Section sur la psychiatrie communautaire

Rôles CanMEDS :

1. Expert médical
2. Communicateur
3. Promoteur de la santé

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify the need for individual and collective mental health promotion for diverse populations during the pandemic; 2) Describe the acceptance and commitment to empowerment (ACE) model and its integration of acceptance and commitment therapy (ACT) and group empowerment psychoeducation (GEP) to promote resilience; and 3) Describe the process and outcomes of delivering a blended learning model of mental health promotion for diverse populations.

The COVID-19 pandemic has had a tremendous impact on the mental health and well-being of all Canadians. In response, we developed an online program to increase the resilience and well-being of two specific groups with a relatively higher risk of distress: frontline health care providers (HCPs) and the Chinese Canadian community (CH-CAD). The Pandemic Acceptance and Commitment to Empowerment Response (PACER) program is a unique blended learning model. PACER consists of self-directed learning coupled with facilitated weekly discussions. The program is also unique in combining the promotion of individual well-being, focusing on internal resilience, with community empowerment, using a social justice lens. Using the acceptance and commitment to empowerment (ACE) model, it integrates acceptance and commitment therapy (ACT), a mindfulness-based intervention, to enhance individual psychological flexibility and group-based empowerment training (GEP) to increase collective empowerment and social justice activism. Results support its effectiveness in improving resilience, psychological flexibility, mental health well-being, and empowerment in two vulnerable groups. As the pandemic continues to evolve, the PACER program and the ACE model will continue to be relevant in meeting the mental health needs of various high-risk groups, including during pandemic recovery.

Références :

1. Fung K, Liu JJ, Vahabi M, et al. Pandemic Acceptance and Commitment to Empowerment Response (PACER) training: protocol for the development and rapid-response deployment. JMIR Res Protoc 2021;10:e33495.
2. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behav Ther 2004;35:639–65.

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P37 – Placebo Effect in Randomized Trials of Major Depressive Disorder with Psychotic Features: A Systematic Review and Descriptive Meta-Analysis
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Nicholas Ainsworth*, MD; Argyrios Perivolaris, N/A; George Alexopoulos, MD; Kathleen Bingham, MD, PhD; Alastair Flint, MB, ChB; Patricia Marino, PhD; Nicholas Neufeld, MD, MSc; Anthony Rothschild, MD; Aristotle Voineskos, MD, PhD; Ellen Whyte, MD; Benoit Mulsant, MD, MS

Rôles CanMEDS :

1. Expert médical
2. Érudit
3. Professionnel

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand similarities and differences between the placebo effect in major depressive disorder (MDD) with psychotic features (MDD-Psy) versus non-psychotic MDD; 2) Describe how placebo response rates have changed over time in pharmacotherapy randomized controlled trials for MDD-Psy; and 3) Appreciate the impact of the placebo effect on the design and interpretation of clinical trials for MDD-Psy.

In the 1980s, the reported response rates of major depressive disorder with psychotic features (MDD-Psy) to placebo pills were close to 0%. To our knowledge, this placebo response rate has not been systematically reassessed. We undertook a systematic review of randomized controlled trials (RCTs) that have used a placebo or sham control group for MDD-Psy. We hypothesized that placebo response rates would increase over time, consistent with findings in non-psychotic MDD.

Methods: We searched Medline (inception to August 10, 2021) for studies comparing placebo (or sham) versus active interventions for MDD-Psy. Included studies were assessed for quality according to the Jadad criteria. We extracted response and dropout rates for each trial and calculated pooled rates across trials.

Results: Nine papers reporting 10 individual trials were included. Most studies were of moderate quality (median = 3; range = 0 to 5). Two ECT trials provided no response rates. In three RCTs published in the 1980s, 0 of 12 (0%) participants responded to placebo and 13 of 38 (34.2%) to medication. In contrast, in five RCTs published in the 2000s, 114 of 339 (33.6%) participants receiving placebo responded versus 149 of 373 (39.9%) participants receiving active intervention; drop-out rates were 71 of 236 (30.1%) for placebo versus 84 of 282 (29.8%) for active intervention.

Conclusion: As hypothesized, placebo response rates in RCTs for MDD-Psy increased markedly from the 1980s to the 2000s. Factors driving this effect likely include methodological issues, such as different diagnostic criteria for MDD-Psy. One needs to consider the recent high placebo response rates when interpreting the results of trials that do not include a “pure” placebo condition.

Références :

1. Furukawa TA, Cipriani A, Atkinson LZ, et al. Placebo response rates in antidepressant trials: a systematic review of published and unpublished double-blind randomised controlled studies. The Lancet Psychiatry 2016;3:1059–66. doi:10.1016/S2215-0366(16)30307-8.
2. Spiker DG, Kupfer DJ. Placebo response rates in psychotic and nonpsychotic depression. J Affect Disord 1988;14(1):21–3.

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P38 – Predicting Population Risk of Suicide Using Health Administrative Data
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Fatemeh Gholi Zadeh Kharrat*; Alain Lesage, MD, MSc; Geneviève Gariépy; Yuhong Guo; Jean-François Pelletier; Louis Rochette; Victoria Massamba; Éric Pelletier, MD; Pascale Lévesque; JianLi Wang

Rôles CanMEDS :

1. Professionnel
2. Expert médical
3. Promoteur de la santé

À la conclusion de cette activité, les participants seront en mesure de : 1) Be aware of suicide prediction tools; 2) Be aware of artificial intelligence and machine learning; and 3) Understand health administrative data.

Suicide is a complex multidimensional event and a significant challenge for prevention globally. In the last few years, there has been increased interest in suicide prediction tools to help target patients for preventive interventions. Artificial intelligence (AI) and machine learning (ML) have emerged to harness large-scale datasets to enhance risk detection. This study was conducted to develop the prediction tools, using supervised ML methods. The sample for this study included Quebec Chronic Disease Surveillance System (QICDSS) data from the Quebec Institute of Public Health (INSPQ), covering up to 98% of the population in Quebec and containing data on over 20,000 suicides. Additional data from the Canadian Urban Environmental Health Research (CANUE) was linked by postal code with the QICDSS data at the INSPQ to provide information about community-level predictors. We used a case-cohort study design. Cases included people aged 15 years and over from January 1, 2002, to December 31, 2010 (n = 9,440). The comparison cohort was a random sample of 1% of the Quebec population aged 15 years and over who were alive on December 31 of each year, from 2002 to 2010, identified from the QICDSS (n = 661,780). We examined predictor features among individual, health system, and community levels. Then, we computed operating characteristics, including sensitivity, specificity, and positive predictive value, for various thresholds. We assessed a model by generating the receiver operating characteristic curves to predict suicides; calibration measures how closely predicted outcomes agree with actual outcomes.

Références :

1. Gradus JL, Rosellini AJ, Horváth-Puhó E, et al. Prediction of sex-specific suicide risk using machine learning and single-payer health care registry data from Denmark. JAMA Psychiatry 2020;77(1):25–34.
2. Kessler RC, Bossarte RM, Luedtke A, et al. Suicide prediction models: a critical review of recent research with recommendations for the way forward. Mol Psychiatry 2020;25:168–79.

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P39 – Prevalence and Correlates of Cannabis Use Among Mental Health Treatment-Seeking Canadian Armed Forces and Royal Canadian Mounted Police Members and Veterans
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
J Don Richardson*, MD, FRCPC; Kate St. Cyr, MSc; Tri Le, BHSc; Maede Nouri, MSc; Callista Forchuk, MSc; Lisa King, Msc; Vanessa Soares, MD; Anthony Nazarov, PhD

Rôles CanMEDS :

1. Promoteur de la santé
2. Professionnel
3. Expert médical

À la conclusion de cette activité, les participants seront en mesure de : 1) Describe the prevalence of cannabis use among a mental health treatment-seeking sample of Canadian Armed Forces and RCMP members and veterans; 2) Compare symptom severity scores of several commonly used screening tools for mental health conditions by cannabis use type; and 3) Identify predictors of cannabis use status and describe how this might influence cannabis use screening practices in a clinical setting.

Mental health (MH) conditions, such as posttraumatic stress disorder (PTSD), are more prevalent among Canadian Armed Forces (CAF) members and veterans than the Canadian general population. (1) Despite the existence of PTSD treatment guidelines, diminished efficacy within veteran populations has been noted. Subsequently, some veterans turn to cannabis for MH symptom relief, but this proportion has not been well quantified. (4) This study aims to do the following: 1) estimate the prevalence of current cannabis use among an MH treatment-seeking Canadian veteran sample; 2) evaluate the association between cannabis use and PTSD, major depressive disorder (MDD), generalized anxiety disorder (GAD), and alcohol use disorder (AUD) symptom severity; and 3) identify predictors of cannabis use.

Methods: This study used retrospective data obtained at intake to a specialized outpatient clinic from 311 CAF and RCMP members and veterans. Current cannabis use is dichotomized as use/no use, and mean symptom severity scores are compared by cannabis use status, using analysis of variance (ANOVA). Predictors of cannabis use are identified with logistic regression analyses.

Results: A total of 41.8% (n = 130) of study participants reported current cannabis use, with about one-half indicating use for medical purposes. Current cannabis users had significantly greater MDD, GAD, and AUD symptom severity compared to non-users (p < 0.01); PTSD symptom severity did not differ by cannabis use status.

Significance: Over 40% of our study population reported current cannabis use and these people, on average, reported greater MDD, GAD, and AUD symptom severity than non-users. Potential explanations and clinical implications will be discussed.

Références :

1. Forbes D, Bisson JI, Monson CM, et al, editors. Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies, 3rd ed. The Guilford Press: New York (NY): 2020.
2. Frayne SM, Chiu VY, Iqbal S, et al. Medical care needs of returning veterans with PTSD: their other burden. J Gen Intern Med 2011;26:33–9.

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P40 – PRISM: Evaluation of a Shelter-Based Program on Attainment of Stable Housing and Functional Outcomes for People Experiencing Homelessness and Mental Illness
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Ghassen Soufi*, MD, CM; Brigitte Voisard, PhD(c); Eric Latimer, BASc, MSc, PhD; Vincent Laliberté, MA, MD, PhD

Rôles CanMEDS :

1. Promoteur de la santé
2. Collaborateur
3. Leader

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify key obstacles encountered by the homeless population with mental illness in accessing housing and health care services; 2) Describe positive functional and quality of life outcomes from engaging homeless populations with shelter-based services; and 3) Value the benefits of stable housing in patients’ personal recovery, quality of life, and functional outcome.

PRISM (Projet Réaffiliation Itinérance Santé Mentale – Mental Health and Homelessness Reaffiliation Project) is a shelter-based mental health service launched in Montreal, Canada, in 2013. PRISM admits people experiencing homelessness and severe mental illness and provides them with short-term residential services with various psychiatric services on site. The objective of the program is to help clients transition to permanent housing and connect them with long-term support services.

Methods: This prospective cohort study followed a group of clients admitted to PRISM during their admission and over a year after discharge from the program. The purpose of this approach was to explore the impact of the PRISM program on two categories of short- and long-term outcomes: 1) housing status and psychiatric follow-up trajectory and 2) and personal recovery, functional outcomes, and quality of life, as measured through interviews and quantitative questionnaires. Results: Fifty clients joined the study over a two-year recruitment period. Of the 43 clients who completed the program, 76.7% were discharged to stable housing modalities and 78% had been engaged with psychiatric follow up at program’s end. Housing stability was achieved for 63.5% of participants reached at one-year follow up. The Multnomah Community Ability Scale (MCAS) and Lehman’s Quality of Life Interview (QOLI) demonstrated a significant improvement in outcomes, both at program’s end and at one-year follow up.

Conclusion: PRISM is a shelter-based mental health service that bridges clients from precarious situations towards sustained stable housing and appropriate psychiatric follow up. Clients also benefitted from sustained functional and quality of life outcomes in long-term follow up.

Références :

1. Laliberté V, Roussel-Bergeron D, Latimer EA, et al. PRISM: a shelter-based partnership for people experiencing homelessness and severe mental illness. Psychiatr Serv 2022;73:467–9.
2. Stergiopoulos V, Dewa C, Durbin J, et al. Assessing the mental health service needs of the homeless: a level-of-care approach. J Health Care Poor Underserved 2010;21:1031–45.

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P41 – Profiles of Frequent Emergency Department Users with Mental Disorders
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Marie-Josée Fleury*, MD; Bahram Armoon, MD; Zhirong Cao, MSc; Guy Grenier, MD; Xiangfei Meng, MD

Rôles CanMEDS :

1. Érudit
2. Collaborateur
3. Expert médical

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify three profiles of frequent emergency department (ED) users; 2) Describe characteristics of the profile with three-year recurrent very frequent ED users; and 3) Describe preventing strategies related to each profile of frequent ED users.

This study aimed to 1) identify profiles of frequent emergency department (ED) users (three or more visits per year) among 5,409 patients with mental disorders (MDs), based on their patterns of ED use and clinical characteristics; 2) identify sociodemographic and service use correlates linked to frequent ED user profiles; and 3) assess mortality risk in a 12-month follow-up period, controlling for sex and age.

Methods: Using varied medico-administrative databases, this five-year study collected patient data for six Quebec EDs. Latent class analysis was used to distinguish profiles of frequent ED users for a three-year period, and bivariate analyses subsequently assessed associations between frequent ED user profiles and sociodemographic and service use correlates. Survival analysis was also applied to examine relations between profile memberships of frequent ED users and risk of mortality in the 12 months following the period of frequent ED use.

Results: Three profiles of frequent ED use were identified. Profile 1: three-year recurrent very frequent ED users (10 or more visits per year); Profile 2: two-year recurrent frequent ED users; and Profile 3: one-year frequent ED users. Profiles differed according to severity of health conditions; intensity of service use, particularly frequent hospitalizations; and risk of mortality, which was high in Profile 1, moderate in Profile 2, and low in Profile 3. Compared to one-year frequent ED users, three-year recurrent very frequent ED users and two-year recurrent frequent ED users had poorer health and higher mortality risk.

Conclusions: Targeted interventions may be improved, especially for recurrent frequent ED users and recurrent very frequent ED users.

Références :

1. Birmingham LE, Cheruvu VK, Frey JA, et al. Distinct subgroups of emergency department frequent users: a latent class analysis. Am J Emerg Med 2020;38(1):83–8.
2. Moe J, O’Sullivan F, McGregor MJ, et al. Identifying subgroups and risk among frequent emergency department users in British Columbia. J Am Coll Emerg Physicians Open 2021;2(1):e12346.

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P42 – Profiles, Correlates, and Outcomes Among Patients Experiencing an Onset of Mental Disorder, Based on Outpatient Care Received After Index Emergency Department Visits
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Marie-Josée Fleury*, PhD; Morgane Gabet, PhD(c); Zhirong Cao, PhD

Rôle CanMEDS :

1. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand profiles of patients with an onset of mental disorder (MD) following index emergency department (ED) visits; 2) Determine sociodemographic and clinical correlates of adequate follow up for those patients; and 3) Understand adverse health outcomes after an ED visit for patients with an onset of MD.

Data from administrative databases were collected for 2,541 patients with an onset of mental disorder (MD), following discharge from a Quebec emergency department (ED). Latent class analysis was performed to identify patient profiles based on adequacy of follow-up care after ED discharge. Bivariate analyses examined associations among class membership and sociodemographic and clinical correlates, high ED use (3 or more visits per year), hospitalizations and suicidal behaviours. Five classes of patients were identified. Class 1, the smallest, labelled “patient psychiatrist only,” included mainly young patients with serious MDs. Classes 2 and 3, roughly 20%, were labelled “high use of patient general practitioner (GP) and psychiatrist” and “low use of patient GP and psychiatrist,” respectively. Both included patients with complex MD, but Class 2 had more women and older patients with chronic physical illnesses. The two largest classes were labelled “no usual patient service provider” (Class 5) and “patient GP only” (Class 4). Class 5 included more younger men with substance-related disorders (SRDs). Results revealed that nearly 40% of patients experiencing an onset of MD received little or no outpatient care after ED discharge. Higher severity or complexity of MD and, to a lesser extent, no or low GP follow up may explain these adverse outcomes. More adequate, continuous care, including collaborative care, is needed for these vulnerable patients.

Références :

1. Gabet M, Cao Z, Fleury MF. Profiles, correlates and outcomes among patients experiencing an onset of mental disorder based on outpatient care received following index emergency department visits. Forthcoming. Can J Psychiatry 2022; March 15.
2. Anderson KK, Norman R, MacDougall A, et al. Effectiveness of early psychosis intervention: comparison of service users and nonusers in population-based health administrative data. Am J Psychiatry 2018;175:443–52.

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P43 – Psychiatric Follow Up for Women with a Severe Mental Disorder in the Perinatal Period: Are We Good Enough?
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Sebastien Brodeur*, MD, MSc; Josiane Courteau, PhD; Marie-Josée Poulin, MD; Alain Vanasse, MD, PhD; Marie-Josée Fleury, MD, MSc; Alain Lesage, MD, MSc; Emmanuel Stip, MD, MSc; Mireille Courteau, MSc; Maxime Huot-Lavoie; Laurent Béchard, PharmD, MSc; Marie-France Demers, BPharm, MSc; Marc-André Roy, MD, MSc

Rôles CanMEDS :

1. Collaborateur
2. Promoteur de la santé
3. Expert médical

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify the proportion of women with severe mental disorders who consulted a general practitioner (GP) one year before and after delivery; 2) Identify the proportion of women with severe mental disorders who consulted a psychiatrist one year before and after delivery; and 3) Acknowledge the lack of systematic follow up by psychiatrists for women with schizophrenia and bipolar disorder.

The perinatal period provides a high risk of psychiatric relapse and significant obstetrical complications for the mother and unborn child. Many clinicians are still unaware of the at-risk pregnancy status of women with schizophrenia (SCZ) and bipolar disorder (BD).

Objective: We studied the proportion of women with severe mental disorders who consulted a psychiatrist or general practitioner (GP) one year before and after delivery.

Methods: This retrospective cohort study included all female patients living in Quebec who gave birth between 2007 and 2016, with a diagnosis of SCZ or BD. Using medical administrative data, we calculated the proportion of these patients that had at least one contact with a psychiatrist and with a GP at different times before and after the date of birth.

Results: 8,666 women with severe mental disorder (SMD) gave birth during the study period (1,513 with SCZ and 7,153 with BD). A higher proportion of SCZ patients than BD patients was seen by a psychiatrist at least once in the year before (51.8% vs. 35.0%) and after delivery (52.8% vs. 32.4%). Medical follow up by a GP was similar for SCZ and BD one year before and one year after delivery. In the first month postpartum, only 33.8% of SCZ and 17.3% of BD patients visited a psychiatrist.

Discussion: Although screening for postpartum depression for any woman with or without a previous mental disorder is done systematically, our findings show that the psychiatric follow up of women with the most SMDs is lacking.

Références :

1. Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry 2020;19:313–27.
2. McAllister-Williams RH, Baldwin DS, Cantwell R, et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 2017;31:519–52.

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P44 – Psychosocial Group Interventions for Patients with Physical Disabilities: A Scoping Review of Implementation Considerations
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Rosalie Steinberg*, MD, MSc, FRCPC; Stephanie Posa, MSc; Noorin Pattni, BA; Sander Hitzig, PhD
Parrainè par le Section sur la médecine psychosomatique

Rôles CanMEDS :

1. Promoteur de la santé
2. Expert médical
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Review current research on psychological interventions for patients with physical disabilities; 2) Appreciate the effectiveness of psychosocial group therapy in addressing the mental health needs of patients with physical disabilities; and 3) Describe the main implementation considerations when delivering psychosocial group therapy in medical settings.

Given the prevalence of psychiatric disorders among individuals with physical disabilities, there is increased demand for mental health supports within medical settings. Group therapy is an effective way to improve health outcomes and manage resource use. Knowledge of group therapy interventions to address psychiatric needs in patients with physical disabilities has not yet been reviewed.

Methods: This scoping review adhered to Arksey and O’Malley’s methodological framework. Eligible studies contained quantitative, qualitative, or mixed methods research in which data were presented on participants with a physical disability, psychosocial group therapy, outcomes related to anxiety and/or depression and other related domains. Results were synthesized descriptively and thematically via content analysis and guided by the Consolidated Framework for Implementation Research (CFIR).

Results: A total of 55 studies were included (participants n = 4,767). The most common physical disabilities reported were multiple sclerosis (n = 31) and Parkinson’s disease (n = 13). Group cognitive-behavioural therapy (CBT) was the most common approach used and primarily facilitated by people with specific mental health training. Group therapy was delivered within community, inpatient, and outpatient medical settings, occurring within cohorts of 1 to 10 patients and typically occurring on a weekly basis. Most studies (n = 27) reported an adherence between 80% and 99%. Findings indicate that group therapy reduced anxiety and depression and improved general psychological health and coping.

Conclusion: Group therapies to address depression and anxiety are adaptable, effective, and readily adhered to. This review’s recommendations can help practitioners develop, implement, and evaluate group interventions for people with physical disability and comorbid psychiatric conditions within medical settings.

Références :

1. Cree RA, Okoro CA, Zack MM, et al. Frequent mental distress among adults, by disability status, disability type, and selected characteristics — United States, 2018. MMWR Morb Mortal Wkly Rep 2020;69:1238–43.
2. Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009;4(1):50–50.

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P45 – Psychosocial Well-Being and Quality of Life in Schizophrenia: An Exploratory Factor Analysis
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Joseph Voronov*, BSc; Zahra Khalesi, BSc; Louis Schmidt, PhD; Heather McNeely, PhD

Rôles CanMEDS :

1. Érudit
2. Promoteur de la santé

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify underlying psychosocial factors that impact quality of life (QOL) among patients with schizophrenia; 2) Evaluate the structure of psychosocial well-being within the framework of a distress-protection model; and 3) Inform clinical approaches while considering the impact of various distress and protective factors on QOL among patients with schizophrenia.

Schizophrenia is a chronic mental disorder that has been notoriously associated with poor quality of life (QOL). (1) Several studies have examined how psychosocial variables independently correspond to QOL outcomes in patients with schizophrenia, but few have looked at these variables collectively as part of an underlying factor. (2) The purpose of this study is to deepen our understanding of the structure of psychosocial well-being in people with schizophrenia and whether factors of this construct effectively predict QOL outcomes.

Methods: A total of 105 schizophrenia outpatients completed a battery of psychosocial and QOL measures. Relations between psychosocial well-being and subjective and objective QOL were investigated with factor and regression analyses.

Results: Exploratory factor analysis revealed two factors that explained 47.5% of total variance in QOL: introspective rumination (IR) and socio-emotional well-being (SEW). Higher levels of IR were significantly correlated with greater impairment on subjective (β = –0.28, p < 0.01, R2 = 0.08) and objective QOL (β = 0.64, p < 0.01, R2 = 0.38), while higher levels of SEW were significantly correlated with less impairment on subjective (β = 0.73, p < 0.01, R2 = 0.58) and objective QOL (β = -0.22, p < 0.05, R2 = 0.42).

Discussion: Results are discussed within the framework of a distress-protection model, in which IR served as a risk factor while SEW served as a protective factor. Establishing this set of factors as a conceptualization of psychosocial well-being in schizophrenia may allow clinicians to develop novel therapeutic interventions that target these areas.

Références :

1. Desalegn D, Girma S, Abdeta T. Quality of life and its association with psychiatric symptoms and socio-demographic characteristics among people with schizophrenia: a hospital-based cross-sectional study. PloS One 2020;15(2):e0229514.
2. Suttajit S, Pilakanta S. Predictors of quality of life among individuals with schizophrenia. Neuropsychiatr Dis Treat 2015;11:1371–9.

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P46 – Quick Takes: Bringing Medical Education Directly to Physicians’ Ears Through Podcasting
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
David Gratzer*, MD, FRCPC; Lawrie Korec, BA; Stephanie Sliekers, MA

Rôles CanMEDS :

1. Communicateur
2. Expert médical
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Better understand and appreciate the literature supporting podcasts for medical education; 2) Better understand and appreciate the benefits and problems of trying to use technology for medical education; and 3) Better understand and appreciate the future direction of medical education.

Engaging physicians in education is challenging. A growing literature suggests that doctors respond well to podcasts. That said, there is a paucity of this type of educational material available in mental health. Although podcasting is commonly used in areas like emergency medicine, little has been done in terms of creating such accessible professional learning and knowledge exchange in psychiatry. The primary goal of this project was to create a podcast series to educate time-limited psychiatrists. The podcasts focus on mental health issues relevant to physicians, such as the clinical implications of cannabis legalization. Podcasts are concise (15 minutes), while delivering quality information that physicians can immediately implement in their practices. Working with CAMH education, the podcasts take on current mental health issues with expert interviews, offering information in a Q&A format. The first podcast was emailed to Centre for Addiction and Mental Health (CAMH) physicians on October 2018. The work has been promoted through social media and launched on Portico Network. The podcast series is evaluated on an ongoing basis, using several metrics (including downloads), as well as learner feedback (through short surveys, which include the opportunity for comments). We now have over three years of data: we have released 17 podcasts and have data within CAMH (179 email opens on its launch day) and on Twitter (more than 200,000 impressions), as well as the total downloads (more than 10,000). By the time of the conference, we will have both qualitative and quantitative data to present on the 20 podcasts that will have been released.

Références :

1. Cadogan M, Thoma B, Chan TM, et al. Free Open Access Meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002–2013). Emerg Med J 2014;31(e1):e76–7.
2. Boulos MN, Maramba I, Wheeler S. Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education. BMC Med Educ 2006;6:41.

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P47 – Rates and Risk Factors for Death by Suicide During Inpatient Psychiatric Hospitalization in Ontario, Canada
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Juveria Zaheer*, MD, MSc; Weam Sieffien, MD; Paul Kurdyak, MD, PhD, FRCPC; Tomisin Iwajomo, MPH

Rôles CanMEDS :

1. Promoteur de la santé
2. Expert médical
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the rates and methods of inpatient suicide death in Ontario and their trends over time; 2) Understand and identify patient-related factors associated with suicide death in hospital; and 3) Understand and identify the hospital-related and geographical factors associated with suicide death in hospital.

Suicides occurring during the course of a psychiatric hospitalization are a tragic occurrence, representing a small but clinically important percentage of suicide deaths. (1) Patient factors significantly associated with inpatient suicide include history of deliberate self-harm, hopelessness, depressed mood, suicidal ideation, and family history of suicide, mood disorder, or schizophrenia diagnosis. (2) People who are admitted to hospital for psychiatric reasons are at higher risk for suicide than the general population; hospitalization is often considered a way to promote safety and recovery. Eliminating suicide in hospital settings should be a key focus of suicide prevention strategies. Canada- or Ontario-wide data are unavailable. Because suicide in hospital is a rare and multifactorial outcome, focusing only on patient-related or hospital/environmental factors is not sufficient to understand risk factors. The variability in rates across settings requires investigation of multiple sites and communities to provide a thorough understanding of rates and risk factors. This study focused on rates of inpatient suicide during psychiatric hospitalization in Ontario, from January 2006 to December 2017, using linked health administrative databases. The objectives of this study are determine the following: rates and methods of inpatient suicide death in Ontario and their trends over time, patient-related factors associated with suicide death in hospital, and 3) hospital-related and geographical factors associated with suicide. In addition to rates of suicide, this study reports descriptive information focusing on patient-, hospital- and geographical factors identified to have an association with inpatient suicide.

Références :

1. Sakinofsky I. Preventing suicide among inpatients. Can J Psychiatry 2014;59:131–40.
2. Walsh G, Sara G, Ryan CJ, et al. Meta-analysis of suicide rates among psychiatric in-patients. Acta Psychiatrica Scandinavica 2015;131:174–84.

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P48 – Real-World Effectiveness of Repeated Ketamine Infusions for Treatment-Resistant Bipolar Depression
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Farhan Fancy*, HBSc; Neslon Rodrigues, MSc; Joshua DiVincenzo, MSc; Edmond Chau, MD; Rickinder Sethi, MD; Muhammad Husain, MD; Hartej Gill, HBSc; Aniqa Tabassum, HBSc; Andrea Mckenzie, BSc; Lee Phan, MSc; Roger McIntyre, MD, FRCPC; Joshua Rosenblat, MD, MSc

Rôles CanMEDS :

1. Érudit
2. Professionnel
3. Promoteur de la santé

À la conclusion de cette activité, les participants seront en mesure de : 1) Learn about new effective treatment options to treat bipolar disorder through intravenous ketamine infusions; 2) Learn about the real-world effectiveness of repeated ketamine infusions for treating patients with bipolar disorder; and 3) Learn and appreciate the complexity of mood disorders and how they affect patients psychologically and socially.

Randomized clinical trials (RCTs) have demonstrated rapid and robust antidepressant effects with intravenous (IV) ketamine, including in bipolar disorder. Real-world effectiveness with repeated ketamine infusions in complex patient populations remains understudied. Herein, we describe the largest real-world clinic sample of patients with treatment- resistant bipolar depression receiving IV ketamine.

Methods: This study was conducted in a community clinic in Toronto, ON (Canadian Rapid Treatment Centre of Excellence; Braxia Health). In this open-label observational study, 66 patients with treatment-resistant bipolar depression (n = 66) received four sub-anesthetic doses of IV ketamine (0.5–0.75 mg per kg) over a two-week period. Symptoms of depression, anxiety, function, and suicidality were assessed twice weekly with validated self-report measures. Overall effects, as well as effects in key subgroups, were evaluated. This study received ethics approval and was registered prospectively (NCT04209296).

Results: Statistically and clinically significant antidepressant effects were observed in the overall sample, as measured by the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR16) with further reductions in depressive symptoms (p < 0.0001) with each additional infusion (n = 66; mean QIDS reduction of 6.08 +/- 1.39; p < 0.0001). Significant reductions of suicidal thoughts (QIDS-Suicide Item) and anxiety (Generalized Anxiety Disorder-7) were also observed, with subjective functional improvements on the Sheehan Disability Scale.

Conclusions: Real-world effectiveness of IV ketamine for bipolar depression was comparable to observed efficacy in RCTs, suggesting that previous RCT findings are generalizable to clinical practice in a difficult-to-treat population, including more resistant and complex patients.

Références :

1. Berman RM, Cappiello A, Anand A, et al. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry 2000;47:351–4.
2. Coyle CM, Laws KR. The use of ketamine as an antidepressant: a systematic review and meta-analysis. Hum Psychopharmacol 2015;30:152–63.

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P49 – Real-World Effectiveness of Repeated Ketamine Infusions for Treatment-Resistant Depression
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Joshua Rosenblat*, MD, MSc; Roger McInytre, MD, FRCPC

Rôles CanMEDS :

1. Expert médical
2. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the evidence for intravenous ketamine for mood disorders; 2) Appreciate the real-world effectiveness of ketamine in a clinic sample; and 3) Consider appropriate use of ketamine in psychiatry.

Replicated clinical trials have demonstrated rapid and robust antidepressant effects with intravenous (IV) ketamine. Real-world effectiveness with repeated ketamine infusions in complex patient populations remains understudied. We describe a clinical sample of patients with treatment-resistant unipolar depression receiving ketamine.

Methods: This study was conducted in a community clinic. In this open-label observational study, 310 patients with treatment-resistant unipolar depression received four subanesthetic doses of IV ketamine (0.5–0.75 mg/kg) over a two-week period. Symptoms of depression, anxiety, function, and suicidality were assessed with validated self-report measures. Overall effects, as well as effects in key subgroups, were evaluated. This study was registered with ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/NCT04209296

Results: Statistically and clinically significant antidepressant effects were observed in the overall sample, as measured by the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS), with further reductions in depressive symptoms with each additional infusion (Day 14 effect size = 0.7; p < 0.001 at all time points during the two-week acute course compared to baseline). Significant reductions of suicidal thoughts (QIDS-Suicide Item) and anxiety (Generalized Anxiety Disorder-7) were also observed, with subjective functional improvements on the Sheehan Disability Scale. Significant antidepressant effects were observed in all subgroups evaluated, including depression with mixed features and patients with a history of neurostimulation (p < 0.001 in all subgroups).

Conclusions: Real-world effectiveness of IV ketamine was comparable to observed efficacy in trials, suggesting that previous findings are generalizable in a difficult-to-treat population, including more resistant and complex subgroups.

Références :

1. McIntyre RS, Rosenblat JD, Nemeroff CB, et al. Synthesizing the evidence for ketamine and esketamine in treatment-resistant depression: an international expert opinion on the available evidence and implementation. Am J Psychiatry 2021;178:383–99.
2. Rosenblat JD, Lipsitz O, Di Vincenzo JD, et al. Real-world effectiveness of repeated ketamine infusions for treatment-resistant depression during the COVID-19 pandemic. Psychiatry Res 2021;303:114086.

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P50 – SARS-CoV-2 Vaccination Rates by Mental Health Diagnosis: A Population-Based Cross-Sectional Study in Ontario
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Paul Kurdyak*, MD, PhD, FRCPC; Michael Lebenbaum, MSc; Aditi Patrikar, MSc; Laura Rivera, MD; Damon Scales, MD, PhD; Astrid Guttmann, MD, MSc

Rôles CanMEDS :

1. Communicateur
2. Promoteur de la santé
3. Expert médical

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the importance of vaccines to prevent adverse outcomes associated with the COVID-19 pandemic; 2) Understand the decreased rate of vaccination among people with substance use and psychotic disorders; and 3) Consider efforts to increase the rate of vaccination among marginalized populations with specific mental disorders.

Since the onset of the pandemic, there has been concern about the impact of SARS-CoV-2 infection among people with mental illnesses. We analyzed the SARS-CoV-2 vaccination status of Ontarians with and without a history of mental illness.

Methods: We conducted a population-based cross-sectional study of all Ontarians aged 12 years and over who were alive as of September 17, 2021. Ontario residents had either a mental disorder (anxiety, mood, substance use, psychotic, or other disorder) within five years before January 1, 2021. Vaccine receipt as of September 17, 2021, was compared between people with and without a history of mental illness.

Results: The proportion of those who were not fully vaccinated (two doses) was higher for people with substance use disorders (38.5%) or psychotic disorders (34.0%) than for people with no mental disorders (23.7%); there was no difference in the proportion of people with anxiety disorders, mood disorders, and other disorders (23.0%). After adjustment, people with psychotic disorders (absolute risk reduction [aRR] 1.16; 95% confidence interval [CI] 1.15 to 1.17) and substance use disorders (aRR 1.34; 95%CI 1.34 to 1.46) were more likely to be partially or not vaccinated, relative to people with no mental disorders.

Discussion: Our study found that psychotic disorders and substance use disorders were associated with an increased rate of being less than fully vaccinated. Efforts to ensure such people have access to vaccinations, while challenging, are critical to ensuring the risk of mortality and other adverse consequences of SARS-CoV-2 infection are mitigated in this high-risk population.

Références :

1. Kozloff N, Mulsant BH, Stergiopoulos V, et al. The COVID-19 global pandemic: implications for people with schizophrenia and related disorders. Schizophr Bull 2020;46:752–7.
2. Teixeira AL, Krause TM, Ghosh L, et al. Analysis of COVID-19 infection and mortality among patients with psychiatric disorders, 2020. JAMA Netw Open 2021;4(11):e2134969-e.

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P51 – Schizophrenia and Correctional Involvement in Ontario: A Population-Based Matched Cohort Study
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Ruchi Vijh* MPH; Fiona G. Kouyoumdjian, MD, PhD; Tomisin Iwajomo, MPH; Sandy Simpson, MBChB, BMedSci; Roland Jones, MD, PhD; Claire de Oliveira PhD; Paul Kurdyak MD, PhD, FRCPC

Rôles CanMEDS :

1. Promoteur de la santé
2. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Describe differences in sociodemographic and clinical characteristics between people with schizophrenia with and without correctional involvement; 2) Describe differences in rates of health service use between people with schizophrenia with and without correctional involvement; and 3) Consider ways to address high rates of incarceration for people diagnosed with schizophrenia being overrepresented in correctional facilities.

This study compared people with schizophrenia who were released from correctional facilities in Ontario with people with schizophrenia but no correctional involvement on sociodemographic, clinical, and prior health service use characteristics.

Methods: All people with a diagnosis of schizophrenia who were released from a provincial correctional facility in Ontario in 2010 (n = 3,197) were matched (2:1) by age and sex to Ontario residents with a diagnosis of schizophrenia and no correctional involvement (n = 6,393). Covariates included sociodemographic (age, sex, rural residence, marginalization), clinical (duration of schizophrenia, comorbidity), and health service use (primary care physician and psychiatrist visits, hospitalizations, and emergency department visits) characteristics. The association between correctional involvement and prior health service use was measured.

Results: People with correctional involvement had higher material deprivation and instability, shorter duration of illness, and more psychosocial comorbidities than those with schizophrenia only. Adjusting for sociodemographic and clinical variables, people with correctional involvement had a higher rate of mental health–related prior primary care (incident rate ratio [IRR] 1.36, 95% confidence interval [CI] 1.25 to 1.48) but a lower rate of psychiatrist visits (IRR 0.73, 95%CI 0.67 to 0.80). People with correctional involvement had higher rates of both mental health–related emergency department visits (IRR 2.92, 95%CI 2.59 to 3.28) and mental health–related hospitalizations (IRR 1.87, 95%CI 1.71 to 2.04).

Discussion: Despite higher mental health–related comorbidities and higher rates of accessing acute mental health services among people with schizophrenia and correctional involvement, access to psychiatrists prior to incarceration is low.

Références :

1. Mahentharan M, Kouyoumdjian FG, de Oliveira C, et al. Prevalence and predictors of reincarceration after correctional center release: a population-based comparison of individuals with and without schizophrenia in Ontario, Canada: Prévalence et prédicteurs de la réincarcération après la libération d’un centre correctionnel : une comparaison dans la population-de personnes souffrant ou non de schizophrénie en Ontario, Canada. Can J Psychiatry 2021;66:376–84.
2. Sirdifield C, Gojkovic D, Brooker C, et al. A systematic review of research on the epidemiology of mental health disorders in prison populations: a summary of findings. J Forens Psychiatry Psychol 2009;20(S1):S78–S101.

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P52 – Social Innovation and Youth Participatory Action Research in YMHAC: A Youth-Led Intervention from MINDS of London-Middlesex
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Lily Yosieph*, MSc; Alec Cook, BSc(c); Renee Hunt, PhD

Rôles CanMEDS :

1. Communicateur
2. Promoteur de la santé

À la conclusion de cette activité, les participants seront en mesure de : 1) Describe the impact of youth leadership in a council centred on transitional-age youth (TAY) mental health and addictions issues; 2) Consider the importance of an informal peer guidebook for TAY who don’t know how to seek help, support one another, or find appropriate resources; and 3) Identify the experiences of TAY with the mental health care system in the London-Middlesex community.

In Canada, 18.5% of youth aged 15 to 24 years are affected by mental and substance use disorders. The Youth Mental Health and Addictions Council (YMHAC) promotes youth voice through informing and assisting the development of system-level change associated with optimizing the mental health and well-being of transitional age youth (TAY).

Objectives: YMHAC promotes youth voice to inform community mental health and addiction services and initiatives to drive youth-led system improvement. Through their participation, members of the council develop increased resilience and stronger and deeper quality relationships and establish or enhance their experience of meaning and purpose. One of the main objectives of the council is the development of a peer support guidebook, aimed at providing mental health literacy for youth looking to support their peers in their mental health journeys and through the mental health care system.

Methods: Youth Participatory Action Research (Y-PAR) is used withing the council to create, implement, and drive systems interventions. Y-PAR is centred on promoting youth as knowledge keepers and experts of their own experience. Members of the council created and developed the guidebook with a combination of academic research and their own experiences.

Results: We will present preliminary findings derived from the processes used to develop the peer support guidebook. Themes discussed will include substance abuse, self-harm, active listening, and peer support. Its efficacy in improving TAY well-being will be evaluated after dissemination.

Conclusion: The guidebook will be a useful tool in helping youth support one another and find appropriate resources. Results from the survey will further help to inform future youth-led councils through perceptions of the group’s dynamics and psychosocial variables, such as efficacy and resilience.

Références :

1. Pearson C, Janz T, Ali J. Mental and substance use disorders in Canada. Ottawa (ON): Statistics Canada; 2013.
2. Cammarota J, Fine M, editors. Revolutionizing education: youth participatory action research in motion. New York (NY): Routledge; 2010.

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P53 – Suicide in Muslims Around the World: A Scoping Review
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Jeanette Hui*, MSc, MD(c); Tanzima Islam, MScCH, MPH; Weam Sieffien, MD; Gina Nicoll, BSc; Natasha Saunders, MSc, MD; Zainab Furqan, MD; Arfeen Malick, MD, MSc; Javeed Sukhera, MD, PhD; Paul Kurdyak, MD, PhD, FRCPC; Ishrat Hussain, MD, PhD; Mark Sinyor, MD, MSc; Juveria Zaheer, MD, MSc

Rôles CanMEDS :

1. Promoteur de la santé
2. Érudit
3. Expert médical

À la conclusion de cette activité, les participants seront en mesure de : 1) Compare the suicide rates between Muslim communities in countries that are Muslim-majority versus Muslim-minority; 2) Describe the predisposing and precipitating factors of suicide among Muslim populations; and 3) Describe the sociocultural factors that affect mental health service use.

Suicide is one of the leading causes of death worldwide; however, due to stigma, discrimination, and religious sanctions, suicidality is often underreported and undiagnosed in Muslim-majority countries. There remains a significant lack of understanding of the risk factors specific to Muslims and it has been over 15 years since the last review of suicide in both Muslim-majority countries and Muslim-minority countries. We conducted a scoping review to evaluate the prevalence and risk factors associated with suicidality in Muslim communities around the world. A search was conducted across three databases (PsychInfo, Embase, and MEDLINE) up to December 2021 and 90 articles were included in our final review. We found that the prevalence of suicidal ideation and behaviours appears to be increasing in Muslim communities. Young, married females with a history of depression are at particularly high risk for suicidal ideation and are more likely to engage in non-fatal self-injurious behaviours via self-poisoning. In males, low socioeconomic status appears to be a significant antecedent of suicidal behaviour, with unemployment and lower levels of income and education described in association with individuals who have died by suicide. Emotional stress from interpersonal conflicts were commonly cited as predisposing factors for suicide death, while strong social bonds, coping skills, and religiosity acted as protective factors. In conclusion, suicidal ideation and behaviours are frequent in countries even where it is explicitly prohibited by religious tradition. Exploring the sociocultural aspects of suicide is critical to develop effective and culturally sensitive interventions to reduce the global prevalence of suicidality.

Références :

1. Lester D. Suicide and Islam. Arch Suicide Res 2006;10(1):77–97.
2. Shah A, Chandia M. The relationship between suicide and Islam: a cross-national study. J Inj Violence Res 2010;2(2):93–97.

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P54 – The Efficacy and Tolerability of Psilocybin in Participants with Treatment-Resistant Depression: A Phase 2, Randomized Feasibility Study
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Joshua Rosenblat*, MD, MSc; Roger McIntyre, MD, FRCPC

Rôles CanMEDS :

1. Érudit
2. Expert médical
3. Promoteur de la santé

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the rationale for studying psilocybin-assisted therapy for treatment-resistant depression; 2) Appreciate the challenges of conducting psilocybin research in Canada; and 3) Evaluate preliminary results of psilocybin trials.

Emerging evidence indicates that psilocybin rapidly reduces depressive symptoms in people with treatment-resistant depression (TRD). Our study will assess the feasibility, safety, and efficacy of single and repeat doses of psilocybin (25 mg) at point of care in people with TRD.

Methods: Participants will be randomized to immediate (n = 15) or delayed (n = 15) treatment. Participants in the delayed treatment group (waitlist control condition) will wait two weeks after enrollment before commencing study interventions. The study intervention combines a high dose of oral psilocybin (25 mg) with psychotherapy. Psychotherapy consists of a two-hour preparatory session, an eight-hour supportive dosing session, and two integration therapy sessions in the following week, after the dosing sessions. Participants will receive a single dose of psilocybin and be assessed weekly for 6 weeks and biweekly for 18 weeks. Participants who relapse will receive up to two repeated doses of psilocybin.

Results: This trial received Health Canada and research ethics approval in 2021, with recruitment opening November 2021. At the time of submission, 75 people were undergoing screening, with the first 13 participants enrolled and randomized. One new participant receives the intervention weekly. We anticipate enrollment to be completed after 30 weeks, with an additional six-month follow-up period. We anticipate completion prior to conference presentation and plan to present feasibility, efficacy, and safety data.

Conclusions: This study is the only psilocybin clinical trial in Canada actively enrolling participants at the time of submission. Establishing feasibility for psilocybin trials in Canada is of great significance.

Références :

1. McClure-Begley TD, Roth BL. The promises and perils of psychedelic pharmacology for psychiatry. Forthcoming. Nat Rev Drug Discov 2022;Mar 17.
2. Psilocybin for treatment-resistant depression. Available from: https://clinicaltrials.gov/ct2/show/NCT05029466

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P55 – The Impact of the COVID-19 Pandemic on Psychiatric Outpatient Mental Health and Cognitive-Behavioural Therapy Outcomes
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Jesse Renaud*, PhD; Gail Myhr, MD, CM

Rôle CanMEDS :

1. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Describe the impact of COVID-19 on the mental health of psychiatric outpatients; 2) Be aware of cognitive-behavioural therapy (CBT) outcomes during COVID-19; and 3) Be aware of patient perceptions of virtual CBT delivery.

Although initial research on the impact of the COVID-19 pandemic showed that many people experienced worsening mental health, it was anticipated that people would be resilient, and population mental health would improve over time. As the pandemic has worn on, it is unclear to what extent mental health continues to be negatively impacted. Vulnerable populations, including people with pre-existing psychiatric conditions, may be at greater risk of persistent or worsening mental health difficulties. Further, little is known about whether cognitive-behavioural therapy (CBT), a first-line treatment for many psychiatric disorders, remains effective given the shift to virtual delivery. This study examined the impact of COVID-19 on psychiatric outpatient mental health and the effectiveness of virtually delivered CBT. Data were collected from patients referred to the McGill University Health Centre CBT Unit during COVID-19 (n = 93) and compared to a comparable pre-pandemic reference sample (n = 119). Patients underwent a clinical interview to determine diagnosis and treatment suitability and self-report questionnaires were complete pre- and post-treatment. We found that approximately one-half the COVID-19 sample reported increased anxiety and depressive symptoms. However, among those patients who completed CBT, therapy outcomes remained overwhelmingly positive. Patients endorsed high levels of treatment satisfaction and had comparable improvements in symptoms and functioning. Overall, these results are consistent with early pandemic research showing that some people are at greater risk than others; however, interventions remain effective and patients’ treatment satisfaction suggests that virtual care may be an acceptable and effective mode of therapy delivery beyond the pandemic.

Références :

1. Murphy L, Markey K, O’Donnell C, et al. The impact of the COVID-19 pandemic and its related restrictions on people with pre-existent mental health conditions: a scoping review. Arch Psychiatr Nurs 2021;35:375–94.
2. Seo JH, Kim SJ, Kang JI.Impact of the COVID-19 pandemic on mental health service use among psychiatric outpatients in a tertiary hospital. J Affect Disord 2021;290:279–82

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P56 – The New Aripiprazole Once Monthly Initiation Regimen: A Case Series on Tolerability and Side Effects
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Vincent Peck*, MD, CM; Francois-Dominique Messier Harbec, MD

Rôles CanMEDS :

1. Érudit
2. Expert médical

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand pharmacokinetics’ differences depending on injection sites; 2) Evaluate the need to tailor injection sites secondary to patient characteristics or risk of extrapyramidal symptoms (EPS); and 3) Use judgement when using new protocols, despite acceptance by health authorities.

Purpose: Oral medication nonadherence is ubiquitous in clinical settings; thus, depot antipsychotics represent a superior alternative for patients who require this treatment. A new initiation regimen for aripiprazole monohydrate, which involves two day-one deltoid or gluteal injections to bypass the need for oral supplementation, was approved by Health Canada in March 2021, but data on safety or tolerability were lacking. Here, we report on 10 people treated with this alternative initiation regimen in various injection sites as part of an observational study about the new initiation regimen’s tolerability and side effects.

Methods: Ten patients needing treatment with antipsychotics at the McGill University Health Centre in Montreal, between April 2021 and June 2021 were evaluated. All patients gave signed written consent for clinical care. A retrospective chart review was performed to collect clinical information, including sociodemographics, psychiatric history, and treatment course.

Results: All patients displayed active psychotic symptoms, with most diagnosed with schizophrenia (n = 6). Eight patients received a mixed deltoid-gluteal administration, and two received a deltoid-deltoid option. Only one patient had significant extrapyramidal symptoms and was in the latter group, while other patients had no, or minimal, adverse events.

Conclusion: We hypothesize that tolerability may be influenced by the choice of administration sites and propose a mixed deltoid-gluteal option as possibly superior. Further research is needed to clarify the optimal administration sites for the two-injection start to help clinicians mitigate adverse effects.

Références :

1. Casey AB, Canal CE. Classics in chemical neuroscience: aripiprazole. ACS Chem Neurosci 2017;8:1135–46.
2. Raoufinia A, Peters-Strickland T, Nylander AG, et al. Aripiprazole once-monthly 400 mg: comparison of pharmacokinetics, tolerability, and safety of deltoid versus gluteal administration. Int J Neuropsychopharmacol 2017;20:295–304.

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P57 – The Reading of the Week: A Continuing Professional Development Program for Psychiatrists and Residents that Osler Would Have Liked
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
David Gratzer*, MD, FRCPC; Faisal Islam, PhD; Sanjeev Sockalingam, MD, MHPE, FRCPC

Rôles CanMEDS :

1. Communicateur
2. Expert médical
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Better understand and appreciate the literature supporting e-journal clubs for medical education; 2) Better understand and appreciate the benefits and problems of trying to use technology for medical education; and 3) Better understand and appreciate the future direction of medical education.

Osler started the first journal club more than a century ago. Though technology has advanced, then as now, continuing professional development (CPD) is challenging to deliver. This presentation discusses CPD with a particular focus on the Reading of the Week (ROTW), an innovative education program, aimed at Canadian psychiatrists and residents.

ROTW summarizes the latest literature and is emailed out weekly through formal partnerships with 13 Canadian postgraduate programs. The selections cover everything from public policy to practice, including studies from major journals. Readings include commentary, providing a larger context. Like Osler’s journal club, there is the opportunity to exchange ideas. The presentation – drawing heavily from a recent CJME paper – will discuss CPD and the readings. It will also consider the two formal evaluations of ROTW. In spring 2019, we aimed to assess outcomes for ROTW, using continuing medical education (CME) evaluation framework (Moore’s framework).

Results: A total of 332 people responded to the online survey (one-third of subscribers); 97% were satisfied with ROTW; 93% agreed that ROTW had improved their understanding of the current psychiatry research. In fall 2021, we conducted several focus groups as part of a qualitative analysis. Feedback included, “I have used the summaries to make better-informed clinical decisions.” Finally, the presentation will consider the practical implementation and impact of a unique CPD intervention aimed at addressing challenges related to remaining « up to date » amidst the vast amount of resources available in print and online.

Références :

1. Topf JM, Sparks MA, Phelan PJ, et al. The evolution of the journal club: from Osler to Twitter. Am J Kidney Dis 2017;69:827–36.
2. Ramani S, McMahon GT, Armstrong EG. Continuing professional development to foster behaviour change: from principles to practice in health professions education. Med Teach 2019;41:1045–105.

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P58 – The Role of Inflammation and Other Biological Mechanisms in Borderline Personality Disorder: A Systematic Review
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Philippe-Edouard Boursiquot*, MD, FRCPC; Soheil Zahediabghari, MD; Tin-Suet Joan Lee, BHSc; Fariha Chowdhury, BHSc(c); Kaitryn Campbell, MLIS, MSc, AHIP; Paul S. Links, MD, MSc, FRCPC

Rôles CanMEDS :

1. Érudit
2. Expert médical
3. Promoteur de la santé

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify different physical health problems associated with borderline personality disorder (BPD); 2) Appreciate that high impulsivity was found with insomnia, obesity, cardiovascular disease, and inflammation; and 3) Recognize that immunoreactivity could be associated with aggression and impulsivity in people with BPD and needs further study.

Physical health problems, such as sleep disturbance, pain, and obesity, as well as increased mortality, are associated with personality disorders. This systematic review addressed the prevalence of such medical problems in borderline personality disorder (BPD), examined the role of inflammation in this association, and inquired about other biological mechanisms. We searched Embase, PsycINFO, CINAHL, the Cochrane Library, Web of Science, as well as the grey literature in November 2020, seeking peer-reviewed primary studies, reviews, and meta-analyses of any design or type, in or translated into English. A total of 621 articles were identified for screening; 1 duplicate was removed, 550 articles were excluded, and 70 were reviewed. Of these, 39 studies met the inclusion criteria. An additional search was conducted in June 2021, with 26 articles identified for screening, 22 excluded, and 1 meeting the inclusion criteria. Ten studies addressed the prevalence of insomnia in BPD patients, with one study finding increased suicide risk in correlation with insomnia. Four studies discussed obesity, 7 pain, 1 stroke, 4 cardiovascular disease, 7 different physical health problems (e.g., polycystic ovarian syndrome), 4 inflammation, and 3 other mechanisms. All of these medical problems were associated with BPD; the role of inflammation was less studied. The co-occurrence of additional mental disorders may make inflammation more prominent. High impulsivity was found with insomnia, obesity, cardiovascular disease, and inflammation, making this construct pertinent to the association between BPD and such physical problems. Immunoreactivity could be associated with aggression and impulsivity in people with BPD and needs further research.

Références :

1. Dixon-Gordon KL, Whalen DJ, Layden BK, et al. A systematic review of personality disorders and health outcomes. Can Psychol 2015;56:168–90.
2. Oglodek EA, Szota AM, Just AJ, et al. A study of chemokines, chemokine receptors and interleukin-6 in patients with panic disorder, personality disorders and their co-morbidity. Pharmacol Rep 2016;68:756–63.

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P59 – Therapeutic Potential and Underlying Mechanism of Low-Field Magnetic Stimulation in Treating Demyelinating Diseases and Depressive Disorder
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Zitong Wang*, MSc; Rebekah Bruggen, MSc; Yanbo Zhang, PhD, MD; Xin-Min Li, PhD, MD

Rôles CanMEDS :

1. Collaborateur
2. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify the therapeutic potentials of low-field magnetic stimulation (LFMS); 2) Determine the beneficial effects of LFMS on pathological changes; 3) Describe the modulation of LFMS on the mammalian target of rapamycin (mTOR) signalling.

This study aimed to unravel the therapeutic potential of low-field magnetic stimulation (LFMS) and understand the underlying mechanism of how LFMS exerts its beneficial effects on myelin repair, oligodendrocyte maturation, and the recovery of cognitive impairment and mood dysregulation.

C57BL female mice were fed with 0.2% cuprizone diet for 12 weeks to induce chronic demyelinating model, followed by four weeks of cuprizone withdrawal with either sham or LFMS treatment. A series of behavioural and biochemical tests were implemented to evaluate the therapeutic potential and underlying mechanism of LFMS.

Along with restored weight gain, improved learning memory and ameliorated anxiety-like behaviour were observed in mice with LFMS treatment. Pathological data showed that the enhanced expression of mature oligodendrocyte biomarker glutathione-S-transferase and biomarkers for oligodendrocyte precursor cells, supporting that LFMS enhanced the recovery of OPCs number and promoted the maturation to oligodendrocyte. Immunoblotting data showed enhanced expression of transforming growth factor beta (TGF-β) and associated receptors and both canonical (Smads) and non-canonical (Erk/Akt) pathways, suggesting the complexity of TGF-β signalling pathway in response of LFMS treatment. Moreover, enhanced phosphorylation of the mammalian target of rapamycin (mTOR) after LFMS treatment suggested that LFMS may partly share pathways with ketamine, a revolutionary depression-treating drug that also acts on mTOR.

Current results revealed that LFMS has potential therapeutic value for treating cognitive impairment and mood dysregulation related to demyelination disorders and depressive disorders. The TGF-β signalling and mTOR are the key to disclosing the underlying mechanism of LFMS’ beneficial effects and its connection to ketamine.

Références :

1. Wang Z, Baharani A, Wei Z, et al. Low-field magnetic stimulation promotes myelin repair and cognitive recovery in chronic cuprizone mouse model. Clin Exp Pharmacol Physiol 2021;48:1090–102.
2. Dolgova N, Wei Z, Spink B, et al. Low-field magnetic stimulation accelerates the differentiation of oligodendrocyte precursor cells via non-canonical TGF-β signaling pathways. Mol Neurobiol 2021;58:855–66.

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P60 – Transition to Practice Competencies as Ranked by Senior Psychiatry Residents and Early Career Psychiatrists
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Michael Mak*, MD; Chase Thompson, MD; Tracy Sarmiento, MD; Adrienne Tan, MD

Rôles CanMEDS :

1. Érudit
2. Professionnel
3. Leader

À la conclusion de cette activité, les participants seront en mesure de : 1) Know which transition to practice (TTP) training competencies are required and recommended for Canadian training in psychiatry; 2) Understand which TTP competencies are prioritized as most important by senior residents and early-career psychiatrists (ECPs); and 3) Recognize reasons for discordance in the relative importance of TTP competencies between residents and ECPs.

Postgraduate psychiatry programs across Canada have now instituted Competency by Design curricula. ​The change to competency-based assessment has introduced specific phases to training, including the final transition to practice (TTP) stage, which is focused on skill development for independent practice. The Royal College has stipulated a series of TTP experiences. ​We sought to ascertain the needs and perceptions of the Royal College TTP training experiences from senior residents and early career physicians. Fourth- and fifth-year psychiatry residents and early career psychiatrists (ECPs) were asked to participate in a survey. Respondents rated the Royal College TTP competencies from least to most important. Survey responses were anonymized. The mean scores were then calculated for each competency, as per residents and psychiatrists. There were 28 resident and 16 ECP respondents. Residents and staff both rated ‘practice management,’ ‘business aspects of practice,’ and ‘management of adverse events’ as important. Both rated ‘social media training’ and ‘participation in a quality improvement initiative’ as less important. Differences: Staff rated ‘training in leading a clinical service’ as more important than residents did. Residents rated ‘instruction in regulatory college complaints’ and ‘evaluating costs of patient treatment across different settings’ as more important than ECPs did. Perhaps competencies like practice management and business aspects of practice were highly rated because of the relative brevity of such teaching topics in training. Despite increasing concerns regarding social media use, this was not reflected in the results. We wonder if this is because of the likely younger age of the respondents and their relative comfort in using social media.

Références :

1. Best LR, Sengupta A, Murphy RJL, et al. Transition to practice in radiation oncology: mind the gap. Radiother Oncol 2019;138:126–31.
2. Dijkstra IS, Pols J, Remmelts P, et al. Preparedness for practice: a systematic cross-specialty evaluation of the alignment between postgraduate medical education and independent practice. Med Teach 2015;37:153–61.

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éP61 – Transitioning from Youth to Adult Mental Health Care Services: Using the Ontario Health Quality Standard to Guide Evidence-Based, High-Quality Care
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Kristin Cleverley*, RN, PhD; Kim Corace, PhD, CPsych; Alene Toulany, MSc, MD
Parrainè par le Académie Canadienne de psychiatrie de l’enfant et l’adolescent

Rôles CanMEDS :

1. Leader
2. Érudit
3. Collaborateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Describe what Ontario health quality standards are, how they are developed, and how to access them; 2) Describe what high-quality care looks like, based on best available evidence, for youth (and caregivers) transitioning from child to adult health care; and 3) Identify key elements of high-quality care to enhance support for youth transitioning to adult mental health care services (and caregivers).

Mental illness and substance use are common in young people, and up to 70% need adult services after the age of 18 years. When transitioning to adult services, up to 50% of young people disengage from care altogether, resulting in poor outcomes and increased emergency department visits and hospitalizations. To address this, Ontario Health developed a provincial clinical standard on transitions from youth to adult health care services.

Methods: In mid-2021, quality standard development began, outlining key areas to support transitions from youth to adult health care services. This process included recruiting an advisory committee (including experts in psychiatry and psychology, mental health, and addictions), analyzing Ontario data, selecting and critically appraising guidelines, prioritizing outcomes and key topic areas, developing quality statements and indicators, identifying tools and resources, and consulting diverse stakeholders. Quality statements and indicators were developed through an environmental scan, guideline review, and stakeholder feedback. The advisory committee prioritized final topic areas.

Results: The quality standard outlines six key elements of high-quality care: early identification and transition readiness, information sharing and support, transition plans, coordinated transition, introduction to adult services, and transfer completion.

Conclusions: The Transitions From Youth to Adult Health Care Services quality standard provides an evidence-based resource outlining what high-quality care looks like, to help young people, their parents and caregivers, clinicians, and health care organizations prioritize improvement efforts and measure success.

Références :

1. Cleverley K, McCann E, O’Brien D, et al. Prioritizing core components of successful transitions from child to adult mental health care: a national Delphi survey with youth, caregivers, and health professionals. Forthcoming. Eur Child Adolesc Psychiatry 2021.,
2. Cleverley K, Lenters L, McCann E. “Objectively Terrifying”: a qualitative study of youth’s experiences of transitions out of child and adolescent mental health services at age 18. BMC Psychiatry 2020;20(1):147.

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P62 – UpReach: The Growth of a Novel Mentorship Program for Psychiatry Residents
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Gina Eom*, MD, PhD; Mari Kozak, MD; Ronald Leung, MD; Dalton Anderson, MD; Niloofar Izadi, MD; Bushra Khan, MD; Nate Charach, MD; Tian Tian (Phoebe) Bao, MD

Rôles CanMEDS :

1. Collaborateur
2. Communicateur
3. Professionnel

À la conclusion de cette activité, les participants seront en mesure de : 1) Learn the value of a voluntary, non-evaluative, informal space for learners; 2) Learn the principles of permaculture systems theory and how they can be implemented in medical education; and 3) Learn the challenges and opportunities arising from in-person limitations due to the pandemic.

The University of Toronto has the largest psychiatry residency program, training nearly one-half of Canada’s psychiatrists every year. Due to its sheer size and multiple training sites, fostering community and addressing fragmentation have continued to be annual themes in resident-led wellness assessments. UpReach is a novel mentorship program started in 2016 that arose out of the need for informal connection and burnout prevention. It has remained a successful program, demonstrating growth each year. The operational structure, principles, and philosophy will be discussed in this poster. Unique challenges from the COVID-19 pandemic and future directions based on evaluation will be discussed. We will highlight the development of this novel voluntary mentorship program, rooted in a specific philosophy, and will demonstrate how this philosophy has been woven through the program. We will discuss the program’s endurance, sustainability, and resilient features, as well. The implementation, make-up, and principles of the program will be showcased in this poster. Further, mechanisms of feedback, evaluation, and next steps towards improvement will be discussed. Data gathered from the last five years of this mentorship program demonstrate an exponential growth in the program, including the number of mentees and mentors. We will highlight how operational settings have been rooted in permaculture systems theory, and will present ongoing evaluation mechanisms and preliminary results.

Références :

1. Tawfik DS, Profit J, Morgenthaler TI, et al. Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors. Mayo Clin Proc 2018;93:1571–80.
2. Leszcz M, Maunder R, Hunter J. Psychological support for health care workers during the COVID-19 pandemic. CMAJ 2020;192:E660.

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P63 – Using Patient Interviews to Inform and Optimize the Design of a Canadian Phase IV Clinical Trial
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Erin MacKenzie*, PhD; Stine R Meehan, PhD; T. Michelle Brown, PhD; Dorothee Oberdhan, PhD; Caroline Ward, PhD; Francois Therrien, PharmD

Rôle CanMEDS :

1. Professionnel

À la conclusion de cette activité, les participants seront en mesure de : 1) Appreciate the importance of considering the patient’s perspective in the treatment of major depressive disorder and other illnesses; 2) Consider the value of obtaining patient input in clinical trial design; and 3) Understand how patient insights were used to inform the design of a Canadian Phase IV study.

Patients’ experiences, perspectives, and priorities should be meaningfully incorporated into drug development and evaluation. During the protocol development of a Canadian Phase IV study exploring life engagement in patients with major depressive disorder, a series of patient interviews was conducted to inform several elements of the study design, including the primary outcome measure.

Methods: Semistructured interviews were conducted with adult patients in the US. Patients were first asked to provide words describing good, average, and bad days, in order to use their own words for an exploratory measure in the Phase IV study. Next, patients were asked to discuss their feelings and behaviours when engaged with life and to review and discuss the relevance of ten items from the Inventory of Depressive Symptoms-Self Report scale (IDS-SR10). The IDS-SR10 was the proposed co-primary endpoint of the Phase IV study.

Results: A total of 20 patients were interviewed, with a mean age of 43 years and mean illness duration of 14.8 years. Patients’ words included “energetic” and “productive” for good days and “down” and “irritable” for bad days. Life engagement was deemed clinically important by all patients, and 19 of 20 (95%) indicated that all ten items were relevant to life engagement.

Conclusions: Patient interviews confirmed the clinical relevance of life engagement and informed the co-primary and exploratory endpoints of a Canadian Phase IV study. The Phase IV study is now ongoing and patient input obtained here is expected to increase the clinical meaningfulness and external validity of the results.

Références :

1. Rush AJ, Gullion CM, Basco MR, et al. The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychol Med 1996;26:477–86.
2. Thase M, et al. Efficacy of adjunctive brexpiprazole in adults with MDD: improvement of patient engagement based on selected items from the inventory of depressive symptomatology self-report (IDS-SR) scale. Poster session presented at the Psych Congress 32nd Annual Conference; 2019 October 3–6; San Diego (CA).

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P64 – Which Adolescents Have Unmet Mental Health Care Needs During the COVID-19 Pandemic in British Columbia?
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Lauren Gorfinkel*, MPH; Gaelen Snell, MPH; David Long, MD; Hasina Samji, PhD

Rôles CanMEDS :

1. Promoteur de la santé
2. Érudit
3. Communicateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the rate of accessing mental health support and unmet mental health needs among adolescents during the COVID-19 pandemic; 2) Understand which adolescent characteristics significantly predict accessing mental health support or unmet need during the COVID-19 pandemic; and 3) Understand which forms of mental health services (e.g., in person, phone, online chat, video call) are preferable to adolescents.

Despite the COVID-19 pandemic revealing clear vulnerabilities in youth mental health, (1,2) it is unknown whether high-risk groups are accessing services and which are left with unmet need. The current study therefore assessed access to mental health support or unmet mental health care needs among adolescents during the COVID-19 pandemic.

Methods: Adolescents (mean age 17.1 years, standard deviation [SD] 0.3) were sampled through schools across British Columbia, Canada, from February–June, 2021. Demographic characteristics, depression, anxiety, drinking, cannabis use, mental health service access, and unmet mental health care needs were assessed via school-administered computerized survey. Crude and adjusted modified Poisson regression models tested the association of mental health and demographic characteristics with accessing mental health services and reporting unmet need.

Results: The final analytic sample included 1,928 adolescents, of whom 40% accessed a mental health service and 41% experienced unmet need. The adjusted prevalence of accessing services was elevated among adolescents with anxiety (adjusted prevalence ratio [aPR] = 1.29, 95% confidence interval [CI] 1.10 to 1.51), alcohol use (aPR = 1.14, 95%CI 1.01 to 1.29), gender minority status (aPR = 1.28, 95%CI 1.03 to 1.58), and non-heterosexual orientation (aPR = 1.28, 95%CI 1.03 to 1.45). The adjusted prevalence of unmet need was elevated among adolescents with depression (aPR = 1.90, 95%CI 1.67 to 2.18), anxiety (aPR = 1.78, 95%CI 1.56 to 2.03), female gender (aPR = 1.43, 95%CI 1.31 to 1.58), gender minority status (aPR = 1.45, 95%CI 1.23 to 1.70), and non-heterosexual orientation (aPR = 1.15, 95%CI 1.07 to 1.23).

Conclusion: There has been substantial unmet need for mental health care among adolescents during the COVID-19 pandemic. Interventions should place particular emphasis on reaching females and adolescents with depression, who were more likely to experience unmet need than others but not access care.

Références :

1. Dumas TM, Ellis W, Litt DM. What does adolescent substance use look like during the COVID-19 pandemic? Examining changes in frequency, social contexts, and pandemic-related predictors. J Adolesc Health 2020;67:354–61.
2. Hawke LD, Barbic SP, Voineskos A, et al. Impacts of COVID-19 on youth mental health, substance use, and well-being: a rapid survey of clinical and community samples: Repercussions de la COVID-19 sur la sante mentale, l’utilisation de substances et le bien-etre des adolescents : un sondage rapide d’echantillons cliniques et communautaires. Can J Psychiatry 2020;65:701–9.

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P65 – Youth Screen-Time Usage Type as an Influential Factor for Self-Esteem and COVID-19–Related Anxiety
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Kimberly Belfry*, PhD; Shavon Stafford, BSc; Fariha Chowdhury, BSc; Jennifer Crawford, PhD; Soyeon Kim, PhD

Rôles CanMEDS :

1. Érudit
2. Promoteur de la santé

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand that the COVID-19 pandemic has influenced screen-time exposure in youth; 2) Be aware that COVID-19 anxiety and educational screen-time showed a positive association, while passive screen time and self-esteem was negatively associated; and 3) Understand that not all types of screen time are equal in terms of their corresponding negative mental health outcomes in youth.

The COVID-19 pandemic has markedly increased screen-time exposure among youth, which is a significant concern, given the links between youth screen time and negative mental health outcomes. However, less is known about the differential associations with COVID-19–related anxiety and self-esteem by screen time types (e.g., passively watching, social media, video games, or education). One hundred and seventeen youths aged 12 to 25 years (mean age = 16.8) in Ontario were asked to report screen time usage and complete the Rosenberg Self-Esteem Scale (RSE) and Coronavirus Anxiety Scale (CAS) at one of five time points (early-spring 2021, late-spring 2021, fall 2021, winter 2022, and spring 2022). On average, youths reported spending 1 to 3 hours daily on social media, less than 1 hour per day on video games, 1 to 3 hours daily on passive screen time, and 3 to 5 hours daily on education. No differences in usage rates were detected across the five time points, indicating that self-reported screen time was relatively stable. We hypothesized that educational screen time (e.g., virtual school) would be positively associated with COVID-19–related anxiety. While we did not detect a significant association (r[117] = 0.17, p = 0.07], this is perhaps reflective of data collection in the mid- to late-stages of the COVID-19 pandemic (winter and spring 2022) as in-person learnings were re-implemented. Only passive screen time (e.g., passively watching movies or videos) was associated with reduced self-esteem and remained significant after controlling for sex (r[117] = –0.26, p = 0.01]. We speculate that perhaps being passively exposed to (unrealistic) visual contents through movies and videos can influence self-esteem. Our findings indicate screen time exposure varies across screen time types and that self-esteem may be associated with passive screen time. This work highlights an ongoing need to evaluate mental health outcomes on a screen time-type-specific basis.

Références :

1. Twenge JM, Farley E. Not all screen time is created equal: associations with mental health vary by activity and gender. Soc Psychiatry Psychiatr Epidemiol 2021;56:207–17.
2. Twenge JM, Martin GN, Campbell WK. Decreases in psychological well-being among American adolescents after 2012 and links to screen time during the rise of smartphone technology. Emotion 2018;18:765.

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P66 – Youth-Centred Practice: A Toolkit for Service Providers from MINDS of London-Middlesex
Le jeudi 27 octobre au le samedi 29 octobre
08:00 – 18:00
Salle de réunion : e-Poster
Arlene MacDougall*, MD, MSc, FRCPC; Alec Cook, BSc(c); Renee Hunt, PhD

Rôles CanMEDS :

1. Érudit
2. Collaborateur
3. Communicateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Consider the importance of youth-centred practice in the care of transitional-aged youth (TAY) receiving mental health care; 2) Have a clear understanding of what constitutes youth-centred care in a mental health care setting; and 3) Describe the impact of youth participation and leadership in research which directly effects them.

The Mental Health INcubator for Disruptive Solutions (MINDS) of London-Middlesex is a social innovation lab focused on developing, testing, implementing, and evaluating disruptive solutions that promote the mental and emotional well-being of transitional-aged youth (TAY; aged 16 to 25).

Objectives: The Youth-Centred Practice (YCP) project’s goal is to translate the tacit knowledge of experienced mental health care providers, for the purpose of developing an operationalized definition of what constitutes YCP and to create and pilot training on being youth-centered for service providers. It is anticipated that the adoption of YCP by health care professionals will lead TAY to experience increased independence, efficacy, and resilience and allow them to develop stronger and deeper quality relationships with their health care providers.

Methods: Semi-structured interviews with 14 mental health care professionals with experience with and dedication to YCP were conducted.

Results: Exploration, coding, and theming of the interviews was conducted by two independent coders, and a full qualitative synthesis was completed. Five main themes were extracted and will be discussed.

Discussion/Conclusion: YCP is a prototype that seeks to improve mental health outcomes for youth by training service providers in youth-centredness. As a first step, YCP needed to be operationalized; the themes identified herein provide the basis for a concrete and nuanced definition of YCP. Future work will seek to develop a YCP training module aimed at increasing the mental health literacy of mental health care professionals working with youth.

Références :

1. Sanders J, Munford R. Youth-centred practice: positive youth development practices and pathways to better outcomes for vulnerable youth. Children and Youth Services Review 2014;46:160–7.
2. Illback RJ, Bates T. Transforming youth mental health services and supports in Ireland. Early Interv Psychiatry 2011;5(1):22–7.