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PE01 – A Review of Clinical Practice Guidelines for the Treatment of Borderline Personality Disorder in Anticipation of Medical Assistance in Dying
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Hira Aslam*, MSc

Rôles CanMEDS :

1. Expert médical
2. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the background of medical assistance in dying (MAiD) where mental illness is the sole underlying condition (MI-SUMC) in Canada; 2) Understand the role of clinical practice guidelines in determining MAiD eligibility; and 3) Appreciate the current state of evidence for borderline personality disorder treatment and how this interfaces with decision making for MAiD eligibility in Canada.

Countries permitting assisted dying for mental illness as the sole underlying condition (MI-SUMC) find that people with borderline personality disorder (BPD) constitute a significant proportion of people requesting MAiD (Thienpont et al., 2015). Anticipating changes to Canadian MAiD legislation, clinical practice guidelines will be important in the decision-making process for MAiD eligibility to ensure that evidence-based treatments have been exhausted in determining irremediability (Mehlum et al., 2020). Currently, no Canadian treatment guidelines for BPD exist. This study was a systematic review of international, English-language treatment guidelines for BPD with two primary objectives: First, to identify areas of consensus and disagreement in best practice for the treatment of this disorder; and second, to assess whether the guidelines offered insight into defining irremediable BPD and (or) its management. We performed a systematic review and found only five guidelines in English. Two authors independently performed data extraction on the core components of these treatment guidelines, which was synthesized into a narrative review. This yielded several conclusions: (1) psychological therapies were broadly considered the preferred treatment modality for BPD, but there was no consensus regarding whether any one intervention was preferable; (2) all guidelines felt pharmacotherapy might have a role in managing BPD, but the nature and extent of this were disputed; and (3) there was no guidance alluding to, defining, or commenting on the management of irremediable BPD. The implications of these findings for MAiD for MI-SUMC in Canada are discussed.

Références :

1. Mehlum L, Schmahl C, Berens A, et al. Euthanasia and assisted suicide in patients with personality disorders: a review of current practice and challenges. Borderline Personal Disord Emot Dysregul 2020;7(1):1–7.
2. Brodeur J, Links PS, Boursiquot PE, et al. Medical assistance in dying for patients with borderline personality disorder: considerations and concerns. Can J Psychiatry 2022;67(1):16–20.

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PE02 – Changes in Adult Psychiatric Inpatient Admissions and Length of Stay During the COVID-19 Pandemic: Results From a Large Urban Hospital Setting
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Angela Russolillo*, PhD; Michelle Carter, MSN; Pulkit Singh, MD; Julia Raudzus, MD

Rôles CanMEDS :

1. Érudit
2. Professionnel

À la conclusion de cette activité, les participants seront en mesure de : 1) Discuss changes in psychiatric admissions before and during COVID-19; 2) Identify factors related to the length of hospital stay before and during COVID-19; and 3) Discuss how systems of care must adapt to changing acute care use patterns for psychiatric populations.

The COVID-19 pandemic placed unprecedented stress and fear on people, which may have impacted patterns of seeking psychiatric care. We describe patient characteristics and compared admissions and length of stay (LOS) for psychiatric-related hospitalizations before and during the COVID-19 pandemic.
Methods: A retrospective analysis involving health administrative data among people in Vancouver with an acute psychiatric admission were compared between two periods: March 1, 2019, to December 31, 2019 (pre-COVID); and March 1, 2020, to December 31, 2020 (during-COVID). Multivariable negative binomial regression was used to model the association between diagnosis type and the two periods to hospital LOS.
Results: The cohort comprised 989 people who were predominately male (60.3%) and with a severe mental illness (schizophrenia or mood affective disorder; 72.7%). In the during-COVID period, admissions related to schizophrenia-related disorders were significantly higher (p = 0.007) and substance disorder admissions were significantly lower (p = 0.015) when compared to the pre-COVID period. In the multivariable analysis, anxiety disorders (relative risk [RR] 0.63, confidence interval [CI] 0.4 to 0.99) and adult personality (RR 0.52, CI 0.32 to 0.85) disorders were significantly associated with a shorter length of stay when compared to people without those disorders at the pre- and during-COVID periods.
Conclusion: We observed a significant difference in the type and length of admissions for various psychiatric disorders during the COVID-19 period. These findings will support how systems of care must adapt to changing use during the pandemic and inform pandemic-related strategies and interventions for psychiatric populations.

Références :

1. Hamlin M, Ymerson T, Carlsen HK, et al. Changes in psychiatric inpatient service use during the first and second waves of the COVID-19 pandemic. Front Psychiatr 2022;13:829374.
2. Seiler N, Ng M, Dawud M, et al. Demographic and clinical factors associated with psychiatric inpatient admissions during the COVID-19 pandemic. Australas Psychiatr 2022;30(2):229–234.

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PE03 – Characterizing the Relation Between Psychosis and Violence in the Forensic Psychiatry Population: A Scoping Review
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Angad Singh*, BHSc; William Pereira, BHSc; Sapriya Birk, BHSc; Rhys Linthorst, MD; Gary Chaimowitz, MB ChB; Andrew Olagunju, MBBS 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) Describe the prevalence and known risk factors for violence in the forensic population; 2) Better understand the relation between psychosis and violence in forensic psychiatry; and 3) Incorporate key factors that mediate the relation between psychosis and violence into risk assessment.

Violence is prevalent in forensic psychiatry and comprises an integral component of risk assessment. While many studies report that psychosis has an important role in precipitating violence, less is known about mediating variables that underlie their relationship. This scoping review characterizes the relation between psychosis and violence in forensic psychiatric studies and proposes recommendations for risk assessment and management.
Methods: Following PRISMA guidelines, we searched five databases, using keywords for violence, psychosis, and forensic psychiatry. After removing duplicates, our search yielded 914 articles that are currently undergoing data extraction. All articles are screened by two reviewers and conflicts are resolved by a third reviewer.
Results: Preliminary findings indicate that forensic patients with psychosis are more likely to be convicted of violent offences and may perpetrate further violence if not mitigated. Further, psychotic symptoms in conjunction with a constellation of personal and external factors underlie the association between psychosis and violence. Many variables, including specific psychotic symptoms, comorbid disorders, concurrent substance use, personality traits, neurobiological changes, environmental exposures, and demographic factors have been shown to mediate this relation. Importantly, these mediating variables differ based on the type of violence and between forensic and non-forensic patients with psychosis.
Conclusion: Psychosis is an important predictor of violence. Conducting a comprehensive assessment of psychotic symptoms in forensic patients requires an integration of other factors to contextualize symptoms. The audience will have learned about key factors that underlie the link between psychosis and violence and methods to incorporate them into risk assessment and management.

Références :

1. Buizza C, Strozza C, Sbravati G, et al. Positive and negative syndrome scale in forensic patients with schizophrenia spectrum disorders: a systematic review and meta-analysis. Ann Gen Psychiatry 2022;21(1):1–7.
2. Greer B, Taylor RW, Cella M, et al. The contribution of dynamic risk factors in predicting aggression: a systematic review including inpatient forensic and non-forensic mental health services. Aggress Violent Behav 2020;53:101433.

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PE04 – Contributions of CYP2D6 and CYP2C19 Gene Variants to Antidepressant Outcome and Pharmacokinetics: Current Evidence, Expert Recommendations, and a CANBIND-1 Report
Le jeudi 19 octobre
10:45 – 11:45 (N/A)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Farhana Islam*, MSc

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify pharmacokinetic genes, CYP2D6 and CYP2C19, as predictors of antidepressant treatment response, side effects, and serum levels; 2) Understand the new evidence from the CANBIND-1 study supporting the association between CYP2D6 and CYP2C19 gene variants and antidepressant outcome; and 3) Be able to apply clinical recommendations provided by international pharmacogenetic working groups.

Growing evidence suggests genetic variations in hepatic drug-metabolizing enzymes, CYP2C19 and CYP2D6, are a major source of interindividual differences in response, adverse effects, and serum levels for most antidepressants and, therefore, are promising genetic markers. We showed in the Canadian Biomarker Integration Network in Depression—Study 1 (CANBIND-1) sample, where patients with major depressive disorder (n = 178) received escitalopram (ESC) monotherapy for 16 weeks, CYP2C19 intermediate and poor metabolizers (IM+PMs), were less likely to improve over time compared to normal metabolizers (NMs). Follow-up mediation analyses revealed the significant relation between CYP2C19 metabolizer group and symptom improvement was mediated by ESC serum concentrations, which were significantly higher in CYP2C19 IM + PMs relative to NMs. For side effects, we found that CYP2D6 IM + PMs have higher odds of reporting treatment-emergent deterioration in sexual functioning compared to NMs. These findings provide further support for recommendations by the Clinical Pharmacogenetics Implementation Consortium, (CPIC®) which identifies CYP2C19 and CYP2D6 having the highest evidence for clinical implementation. Because the CYP2C19 metabolizer group is associated with variability in symptom improvement mediated by ESC serum concentrations, our findings also add to the evidence that dosing based on CYP2C19 genotyping could improve response in patients on ESC monotherapy.

Références :

1. Islam F, Marshe VS, Magarbeh L, et al. Effects of CYP2C19 and CYP2D6 gene variants on escitalopram and aripiprazole treatment outcome and serum levels: results from the CAN-BIND 1 study. Transl Psychiatry 2022;12(1):366.
2. Murphy LE, Fonseka TM, Bousman CA, et al. Gene-drug pairings for antidepressants andantipsychotics: level of evidence and clinical application. Mol Psychiatry 2022;27(1):593–605.

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PE05 – Cultural Humility Training: A Detailed Look at Existing Literature to Increase Cultural Safety in Today’s World
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
samah Ibrahim*, M.D; Shana Mesbah, M.D

Rôles CanMEDS :

1. Collaborateur
2. Communicateur
3. Professionnel

À la conclusion de cette activité, les participants seront en mesure de : 1) Deepen their understanding of key concepts in cultural humility, cultural safety, microaggression, and health inequities experienced by racialized patients; 2) Differentiate the different ways of teaching cultural safety and cultural awareness; and 3) Identify the needs regarding cultural safety in medical training.

Cultural competence has been the gold standard of health care practice with multicultural populations. However, given the limitations of the cultural competence framework, as an alternative, integrating cultural humility into postgraduate training for health care professionals in Canada is a necessary step for providing the highest quality of care to diverse populations.
Method: This systematic scoping review assessed the advances in integrating cultural humility into postgraduate education in Canada. We studied existing educational models and pertinent literature to identify key concepts related to this topic. The demographic region, year, participants, and evaluation method are extracted from these publications, consulted from July 2022 to January 2023. Data sources were PubMed, ScienceDirect, and MEDLINE.
Results: This paper discusses the integration of cultural humility in medical residency training in Canada. We discern cultural humility from the various ways of teaching different concepts. This review demonstrates that teaching related to cultural humility in the Canadian psychiatry residency curriculum is minimal. The search identified at least 32 articles specifically related to cultural humility in the training of health workers. Multiple studies underline the importance of implementing a curriculum around cultural humility, but the same studies highlighted the difficulty of it.
Conclusion: This literature review provides learners and health care professionals with tools to understand the different ways of thinking and methods used worldwide concerning cultural diversity that can be applied in Canada.

Références :

1. Corral I, Johnson TL, Shelton PG, et al. Psychiatry resident training in cultural competence: an educator’s toolkit. Psychiatr Q 2017;88:295-306.
2. Kirmayer LJ, Rousseau C, Guzder J, et al. Training clinicians in cultural psychiatry: a Canadian perspective. Acad Psychiatr 2008;32(4):313–319.

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PE07 – Increasing Engagement and Reducing Harm: Effective Cannabis and Mental Health Education For Youth
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Kiah Ellis-Durity*, 1

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Meaningfully engage with young people in ways that empower them by amplifying and centering youth leadership and expertise; 2) Demystify and destigmatize topics and discussions relating to cannabis and mental health; and 3) Consider the specific needs of youth who may be at higher risk of experiencing harm from cannabis use.

Participants will understand the benefits of engaging with youth in developing effective and relevant cannabis and mental health resources. Research shows that youth have the highest rates of cannabis use compared to other age groups. Youth are at an increased risk for harms related to use and have generally not received sufficient education on the effects of cannabis.
The Cannabis and Mental Health Project promotes awareness of the relation between mental health and cannabis. Using social media in innovative ways, the project employs evidence-based knowledge translation products to promote balanced, accessible, and youth-centered dialogues about cannabis and mental health.
The project engages with researchers, youth, service providers, educators, and those with lived experience to develop resources anchored in principles of harm reduction. We co-created a barrier-free online certificate course: The Cannabis and Mental Health Course and Mentor Guide for youth and youth workers, in partnership with YouthREX and MHCC.
Our reach has continued to grow, with 58,569 website users and 5,000 or more social media engagements. Evaluations on the efficacy and uptake of our course will be presented at the conference.
Centering lived experience and empowering marginalized voices is essential in our work. We support harder-to-reach youth, especially those who feel their realities aren’t reflected by mainstream public health approaches to cannabis and mental health. The Cannabis and Mental Health Project encourages others to incorporate lived experience and harm-reduction principles in related work, demonstrating the effectiveness of engaging youth in developing mental health and substance use resources.

Références :

1. Canadian Cannabis Survey 2022: Summary
2. Watson TM, Valleriani J, Hyshka E, et al. Cannabis legalization in the provinces and territories: missing opportunities to effectively educate youth? Can J Public Health 2019;110:472–475.

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PE08 – International Consensus Study of Antipsychotic Dosing 2023 Update: ICSAD-2
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Matthew McAdam*, MD; Ross Baldessarini, MD; Andrea Murphy, PharmD; David Gardner, PharmD

Rôles CanMEDS :

1. Collaborateur
2. Expert médical
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Learn expert dosing recommendations and clinical equivalencies for 26 antipsychotic drugs (15 oral, 7 long-acting injectable, and 4 short-acting injectable); 2) Understand methods used to derive antipsychotic dosing recommendations and how these lead to prominent dosing discrepancies across sources; and 3) Appreciate the role of Delphi survey methodology for establishing consensus.

Dosing discrepancies exist across methods of estimating dosing equivalencies and recommendations for antipsychotic drugs. We aimed to establish dosing recommendations and equivalencies via expert consensus for antipsychotics that have been approved recently and those with dosing discrepancies in the literature.
Using a two-step Delphi process for establishing consensus, we surveyed a broad international sample of research and clinical experts regarding 26 antipsychotic drugs to obtain dosing recommendations (starting, target range, and maximum doses), and estimates of clinical equivalencies.
Participants (N = 72) from 24 countries provided dosing recommendations for treatment of psychotic disorders for 15 oral formulations, 7 long-acting injectable (LAI) agents, and 4 short-acting injectable (SAI) agents. They estimated clinical equivalencies relative to oral olanzapine 20mg daily or intramuscular haloperidol 5mg. Overall consensus improved from Stage I to Stage II of the survey; however, consensus for SAIs remained low.
Randomized controlled fixed-dose antipsychotic trials are useful for establishing dosing guidance but are rare. Expert consensus remains a valuable method to obtain clinical equivalencies and dosing recommendations. These findings may support clinical practice, as well as research design and implementation.

Références :

1. Gardner DM, Murphy A, O’Donnell H, et al. International consensus study of antipsychotic dosing. Am J Psychiatry 2010;167:686–693.
2. Leucht S, Crippa A, Siafis S, et al. Dose response meta-analysis of antipsychotic drugs for acute schizophrenia. Am J Psychiatry 2020;177(4):342–353.

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PE09 – Online Therapy, Medication, or Both? Comparing the Effectiveness of Different Treatment Modalities for Generalized Anxiety Disorder
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Callum Stephenson*, Gutierrez G, Kumar A, Omrani M, Alavi N

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) Understand the accessibility and scalability benefits of implementing an online psychotherapy program; 2) Understand the differences and similarities between online psychotherapy, medication, and a combination of the two when treating anxiety disorders; and 3) Understand the importance of patient preference and lifestyle when building a treatment plan.

This study investigated the treatment efficacy of electronic cognitive-behavioural therapy (e-CBT) compared to and in conjunction with pharmacotherapy for generalized anxiety disorder (GAD). This study employed a quasi-experimental design, where patients selected their preferred treatment modality in consultation with their psychiatrist. Patients diagnosed with GAD were enrolled in one of three arms: e-CBT, medication, or combination. The twelve-week e-CBT program was delivered through a secure cloud-based digital mental health platform. The medications prescribed in the medication and combination arms followed standard clinical practice guidelines. The efficacy of each arm was evaluated with clinically validated questionnaires that measured depression, anxiety, and stress severity, as well as changes in quality of life. All three arms showed significant improvements in anxiety questionnaire scores after treatment. The medication and combination of arms provided substantial improvements in depression scores. The e-CBT and combination arms significantly improved quality of life scores, and the combination arm also significantly improved stress scores. No significant differences among the groups in depression, anxiety, or stress scores post-treatment. However, the combination arm had a significantly different improvement in quality-of-life scores. A combination of e-CBT and medication offers significant improvements, though not necessarily superior to either arm independently. The findings suggest all three options are viable interventions with similar benefits. When deciding on a treatment modality, it is recommended that the patient’s preferred treatment route, lifestyle, personality, and beliefs be considered.

Références :

1. Alavi N, Omrani M. Online cognitive behavioral therapy: an e-mental health approach to depression and anxiety. New York (NY): Springer International Publishing; 2019.
2. Carl E, Witcraft SM, Kauffman BY, et al. Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials. Cogn Behav Ther 2020;49(1):1–21.

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PE10 – Quality Measurement and Improvement for Schizophrenia Care: A Scoping Review
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Jennifer Anderson*, BSc; Dallas Seitz, MD PhD; David Crockford, MD; Rebecca Barry, MSc PhD; James Bolton, MD; Valerie Taylor, MD PhD; Don Addington, MBBS; Paul Kurdyak, MD PhD; Julia Kirkham, MD MSc

Rôles CanMEDS :

1. Érudit
2. Professionnel
3. Leader

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify the most common quality indicators for the measurement of schizophrenia care; 2) Describe areas of high and low quality of care in schizophrenia; and 3) Propose evidence-based interventions that may improve identified areas of low quality of care in schizophrenia.

People with schizophrenia routinely receive poor quality health care, such as inadequate routine screening for common cancers, lack of metabolic monitoring with antipsychotic medication use, or undertreatment for such comorbid conditions as cardiovascular disease. The complex underlying issues related to poor quality of care (QoC) in schizophrenia will require multifaceted solutions at each stakeholder level and rigorous evidence-based implementation strategies. Measuring QoC is a necessary first step for improving care. To inform efforts in the measurement and improvement of QoC for schizophrenia at the population level, this study seeks to identify 1) all established quality indicators (QIs) for the measurement of QoC, 2) areas of low and high QoC, and 3) interventions to target improvement of QoC in schizophrenia.
Methods: A scoping review following the Arksey and O’Malley framework and reported as per the PRISMA-ScR checklist is underway. Academic databases and grey literature sources were searched for studies reporting QIs, describing QoC, and/or quality improvement interventions for people with schizophrenia. Abstracts, then full texts, were reviewed for inclusion based on eligibility criteria.
Results: Academic databases identified 12,216 articles. After full-text screening, 748 academic and 97 grey literature sources were included. Data charting is in progress. Findings will be summarized and synthesized into categories based on the key dimensions of health care quality. Results for objectives 1 and 2 will be presented.
Conclusion: Results of this review will comprehensively address QoC, including measurement, persistent quality issues, and quality improvement interventions, in schizophrenia over the past two decades.

Références :

1. Druss BG. Improving medical care for persons with serious mental illness: challenges and solutions. J Clin Psychiatry 2007;68 Suppl 4:40–4.
2. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260(12):1743–1748.

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PE11 – Ryan Séguin Peer Support Program: A One-on-One Peer Support Program for Medical Students
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Alexander Simmons*, MD; Kelsey Mongrain, MD; Isabel Shore, MD; Xavier Prinja, BSc; Michael Reaume, MD, MSc

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the prevalence of depression, depressive symptoms, suicidal ideation, and burnout among medical students; 2) Understand the process involved in developing and implementing a one-on-one peer support program for medical students at the University of Ottawa; and 3) Understand the perceived barriers to seeking professional faculty of medicine services compared to peer support services among medical students.

Medical students experience high levels of burnout and face barriers to accessing support services; however, few studies have considered the feasibility and (or) effectiveness of one-on-one peer support programs for medical students. This presentation describes the development and implementation of such a program, the Ryan Séguin Peer Support Program, at the University of Ottawa (August 2018 to June 2020).
Method: Thirty-five medical students were selected to participate in a training course to develop the necessary skills to provide one-on-one support to their peers. The main responsibilities of peer supporters were to reach out to classmates, provide basic counselling, and refer at-risk students to professional services. Information on interactions between students and peer supporters was recorded in an electronic database. An end-of-year survey collected information on barriers to seeking help perceived by medical students.
Outcomes: A total of 303 interactions were recorded. Interactions took place in various formats, including in person, via telephone or video call, and via texting or online messaging. Interactions were initiated by both students and peer supporters. Respondents identified more barriers to seeking help from faculty of medicine services, compared to peer support services, including fear of impact on career (22.2% vs. 2.5%; P < 0.01) and belief the services would not be helpful (42.0% vs. 23.5%; P = 0.02).
Conclusion: We plan to quantify well being through both academic and mental health outcome measures. Future studies should also consider whether peer support services increase help-seeking behaviours and (or) the use of professional services.

Références :

1. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA 2016;316:2214–2236.
2. Creamer MC, Varker T, Bisson J, et al. Guidelines for peer support in high-risk organizations: an international consensus study using the Delphi method. J Trauma Stress 2012;25:134–141.

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PE12 – Subjective Cognitive Complaints Impact Treatment Response to Repetitive Transcranial Magnetic Stimulation Among Adults with Treatment-Resistant Depression
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Ayan Dey*, MD/PhD
Parrainé par la Section sur la neuropsychiatrie

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Develop a better appreciation of the relation between cognitive deficits and perceived disability in adults with treatment-resistant depression; 2) Explore the role of repetitive transcranial magnetic stimulation (rTMS) in treating cognitive deficits in adults with treatment-resistant depression; and 3) Explore the impact of residual cognitive deficits on rTMS treatment response in adults with treatment-resistant depression.

Persistent deficits in cognition are common among adults with major depressive disorder (MDD), with an estimated prevalence between 30% and 50% even among those who have achieved remission of depressive symptoms. (1) Unfortunately, cognitive dysfunction remains overlooked in the diagnosis and treatment of these conditions, despite the negative impact of the deficits on patient-reported outcomes of quality of life and self-rated disability. (2) Subtle cognitive deficits in depression patients may evade detection by traditional tests designed to screen for cognitive decline in older adults. One tool gaining popularity for the treatment of depression is repetitive transcranial magnetic stimulation (rTMS), especially among those who have not fully responded to pharmacological and psychotherapeutic interventions. This study investigates how the presence of patient-reported cognitive deficits impacts antidepressant response to rTMS among adults with MDD. In our sample of 349 adults referred for rTMS, 78.9% and 40.4% of patients reported having moderate to severe attentional deficits and memory complaints, respectively. The presence of subjective cognitive impairment was associated with worse self-reported functional impairment, as measured by the World Health Organization Disability Assessment Scale (p < 0.001). Those without persistent subjective attentional deficits were three times more likely to achieve remission following rTMS than those who reported those symptoms (35.9% vs. 12.8%; p = 0.012). Logistic regression revealed that subjective attentional deficits, but not memory complaints, negatively impacted the likelihood of achieving remission of depressive symptoms following an acute course of rTMS, after controlling for age and medical comorbidity.

Références :

1. Lam RW, Kennedy SH, Mclntyre RS, et al. Cognitive dysfunction in major depressive disorder: effects on psychosocial functioning and implications for treatment. Can J Psychiatry 2014;59(12):649–654.
2. Hammar Å, Ronold EH, Rekkedal GÅ. Cognitive impairment and neurocognitive profiles in major depression—a clinical perspective. Front Psychiatry 2022;13:764374.

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PE13 – The Impact of Patient Expectations on Clinical Outcomes Following Transcranial Magnetic Stimulation for Treatment-Resistant Depression
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Adriano Mollica*, MD; Matthew Burke, MD; Sean Nestor, MD, PhD; Peter Giacobbe, MD
Parrainé par la Section sur la TEC et neurostimulation

Rôles CanMEDS :

1. Érudit
2. Expert médical
3. Collaborateur

À la conclusion de cette activité, les participants seront en mesure de : 1) Discuss the current state of research on placebo effects in patients with treatment-resistant depression (TRD); 2) Discuss current methods for measuring or evaluating pretreatment expectations as a component of placebo or nocebo effects; and 3) Describe the influence of pretreatment expectations on antidepressant outcomes of an acute course of repetitive transcranial magnetic stimulation for TRD.

Expectations can influence a patient’s response to treatment; however, the extent to which pretreatment expectations influence depression outcomes for patients receiving repetitive transcranial magnetic stimulation (rTMS) is unknown.
Methods: A retrospective single-centre observational chart review of patients receiving open-label rTMS at Sunnybrook Health Sciences Centre between 2019 and 2021 for treatment-resistant depression (TRD) was undertaken. Depressive symptoms were evaluated with the Hamilton Rating Scale for Depression (HAMD-17). Treatment consisted of rTMS to the left dorsolateral prefrontal cortex (dlPFC) five days a week for four to six weeks. All patients completed the Stanford Expectancy of Treatment Scale (SETS), a measure of both positive (placebo) and negative (nocebo) expectations prior to starting any treatment. The relation between pretreatment expectations (average placebo score, average nocebo score, and the difference between the two [i.e., “positivity bias”]), depression remission and drop-out rates with rTMS were explored.
Results: We reviewed records for 130 patients with TRD (60% female, average age 41 years). Following an acute course of rTMS, 26% achieved remission. The likelihood of remission by four to six weeks of treatment was significantly higher for those with higher average positive pretreatment expectations and higher positivity bias (odds ratio [OR] 1.32; 95% confidence interval [CI] 1.05 to 1.66; p = 0.002). Results remained significant after adjusting for age, sex, degree of treatment resistance, TMS protocol, and baseline depression score (p = 0.016). Average nocebo scores were not significantly correlated with drop-out rate.
Conclusions: Positive, but not negative, pretreatment expectations appear to influence the antidepressant outcomes of an acute course of rTMS for TRD.

Références :

1. Burke MJ, Romanella SM, Mencarelli L, et al. Placebo effects and neuromodulation for depression: a meta-analysis and evaluation of shared mechanisms. Mol Psychiatry 2022;27(3):1658–1666.
2. Younger J, Gandhi V, Hubbard E, et al. Development of the Stanford Expectations of Treatment Scale (SETS): a tool for measuring patient outcome expectancy in clinical trials. Clin Trials 2012;9(6):767–776.

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PE14 – The Psychosocial Impact of Long-COVID: A Systematic Review
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Yevin Cha, BMSc., MD; Alyssa Canitelli, HBSc, MHSc; Matthew Tobis, BSc Kin; Ethan Jiang, BSc., MD; Andrew Olagunju*, MBBS, MSc, 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 long-term psychosocial outcomes in people with COVID-19 from studies that included negative comparators; 2) Identify potential risk factors for increased psychosocial sequelae after COVID-19; and 3) Understand the general limitations of studies investigating the psychosocial impact of long-COVID.

The World Health Organization (WHO) defined long COVID as occurring within three months of illness onset, with a duration of at least two months (WHO, 2021). However, the psychosocial impact of long-COVID has yet to be well characterized.
Objective: We aimed to characterize the long-term psychosocial impact of COVID-19 and assess the quality of included studies.
Methods: A systematic search of MEDLINE, Embase, PsycINFO, the WHO COVID-19 database, and Cinahl was conducted, and we formulated a descriptive synthesis of long-term psychosocial consequences after COVID-19 infection.
Preliminary Results: A total of 3,894 abstracts and 466 full texts were screened for eligibility, and 18 studies were included. Participants spanned 12 different countries and people of all ages were included. Depression and anxiety were commonly investigated, yet findings were not consistently worse in cases than control subjects. Conversely, chronic fatigue and sleep disturbance was frequently reported among case subjects. Long-term quality of life in cases was adversely impacted in three of four studies. Commonly cited risk factors for worse psychosocial outcomes included severity of the acute COVID-19 infection and female gender. Quality of most studies was moderate to strong; however, the nature of self-report questionnaires and low generalizability increased risk of bias and limited transferability of the findings.
Conclusion: Although some studies suggest COVID-19 infection can lead to long-term psychosocial sequelae, findings were not universal. Moreover, heterogeneity of studies limits direct comparisons and generalizability. Further research with negative comparators and risk factors is needed to guide public health recommendations.

Références :

1. World Health Organization. A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. Geneva (CH): 2021 [cited 2023 Dec 26]. Available from: https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1
2. Aiyegbusi OL, Hughes SE, Turner G, et al. Symptoms, complications and management of long COVID: a review. J R Soc Med 2021;114(9):428–442.

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PE15 – Trajectories and Risk of Hospitalization for Psychosis Following Psychostimulant Initiation in People with Psychotic Disorder: A Real-World Study
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Olivier Corbeil*, PharmD, MSc

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Summarize the most recent scientific data concerning safety issues related to the use of psychostimulants in psychotic disorders; 2) Analyze the results of a Quebec population-based study on the risk of hospitalization for psychosis with psychostimulants in psychotic disorders; and 3) Conceive the potential clinical implications of the results presented.

The use of psychostimulants in people with psychotic disorders and attention-deficit hyperactivity disorder (ADHD) is limited by a lack of evidence and long-standing concerns about an increased risk of psychotic events. This study examined whether psychostimulant initiation in these people was associated with an increased risk of hospitalization for psychosis.
Methods: This was a retrospective cohort study using RAMQ data, including all Quebecers who initiated a psychostimulant between January 2010 and December 2016, covered by the public drug insurance plan. The primary dependent variable was time to hospitalization for psychosis within one year of psychostimulant initiation. A control cohort was composed of control subjects matched for sex, year of birth, and date of first psychosis.
Results: A total of 2,226 people initiated a psychostimulant during the observation period, of whom 1,589 (71.6%) took methylphenidate. Compared with matched control subjects, substance use disorders, personality disorders, and psychotropic drug use were more common. After adjustment, the risk of hospitalization for psychosis was reduced in those receiving an antipsychotic and psychostimulant within one year of starting treatment (adjusted rate ratio 0.36, 95% confidence interval 0.25 to 0.54, p < 0.0001).
Conclusion: These results suggest that psychostimulant use in people with psychotic disorder may be safer than generally conveyed and justify that some patients may benefit from adequate and optimal treatment of comorbid ADHD to support their recovery.

Références :

1. Hollis C, Chen Q, Chang Z, et al. Methylphenidate and the risk of psychosis in adolescents and young adults: a population-based cohort study. Lancet Psychiatry 2019;6(8):651–658.
2. Moran LV, Ongur D, Hsu J, et al. Psychosis with methylphenidate or amphetamine in patients with ADHD. N Engl J Med 2019;380(12):1128–1138.

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PE16 – Treatment Consequences with the Emergence of New Synthetic Opioids: A Rapid Review
Le jeudi 19 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Fiona Choi*, PhD; Jane Kim, BSc; Michael Krausz, MD, PhD
Parrainé par la Section sur la toxicomanie

Rôles CanMEDS :

1. Érudit
2. Professionnel
3. Expert médical

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand how the current system of care is impacted by the emergence of new synthetic opioids; 2) Appraise the quality of available evidence; and 3) Build a framework for treatment strategies moving forward.

Emergency response to overdose, treatment strategies, and withdrawal management from new highly potent synthetic opioids (HPSO) are more complex, and the potential onset of severe withdrawal symptoms and increasing overdose risk calls for better evidence-based practices. The objective of this paper is to review evidence for different levels of care in response to HPSO, appraise the quality of evidence, and discuss the strategic responses needed to better address opiate use disorder and overdose. The literature search was performed with Medline and 46 papers were reviewed: 13 community care, 6 emergency care, 1 primary care, and 26 tertiary care levels. Briefly, different levels of the treatment system have responded to the emergence of HPSO; however, the responses have been reactive and limited evidence is available to support new approaches. For example, new formulations, such as extended-release buprenorphine, offer several advantages over existing pharmacotherapies and efforts should be made to fully explore their feasibility, and similar injectables, in the Canadian context. Evidence suggests baseline prevalence of opioid agonist therapy (OAT) dissatisfaction has increased, potentially due to the high rates of HPSO in the illicit drug supply making it more challenging to stabilize patients on OAT. To adequately respond to the crisis, care providers and treatment guidelines need to expand to address unmet service needs and incorporate patient-centred decision-making in the treatment approach. Most importantly, the value of well-documented results should not be neglected, so that solutions are evidence-based and constructive.

Références :

1. Mariani JJ, Mahony AL, Podell SC, et al. Open‐label trial of a single‐day induction onto buprenorphine extended‐release injection for users of heroin and fentanyl. Am J Addict 2021;30:470‐476.
2. Volkow ND, Jones EB, Einstein EB, et al. Prevention and treatment of opioid misuse and addiction: a review. JAMA Psychiatry 2019;76(2):208–216.