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PE17 – A Quality Improvement Project on a Six-Week Micro Mindfulness Pilot for Patients on an Acute Psychiatric Unit
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Tamara Hoppe*, FRCPC; Roisin Byrne, FRCPC
Parrainè par le Section sur la psychothérapie

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify potential benefits of evening mindfulness therapy for patients on acute inpatient psychiatric units; 2) Define micro-mindfulness in the context of acute inpatient psychotherapy; and 3) Learn how mindfulness therapy can potentially reduce nursing care burden in the evenings.

Psychiatric inpatient units offer little evening programming despite high patient needs and nursing demands. Mindfulness-based interventions (MBIs) have shown to benefit psychological and physical well being and psychiatric disorders (Kabat-Zinn, 1990). There is a paucity of research using MBIs for adult psychiatric inpatients, though existing studies have demonstrated benefits (Sams, 2018).

Objective: We assessed feasibility and acceptability of a novel MBI for adult inpatients.

Methods: Stakeholder engagement included a survey sent to inpatient unit nurses and a voice of customer (VOC) engagement with inpatients by the Advanced Practice Clinical Leader (APCL). A 20-minute “micro mindfulness” group was offered once weekly, after hours, run by study authors over six weeks. Each group included a brief introduction, followed by a guided meditation. Patient feedback was collected following the pilot.

Results: Seven nurses responded to the survey and ten inpatients participated in the VOC discussion. All nurses thought there was insufficient programming; 71% of nurses thought patients would attend; all nurses thought issues could arise due to insufficient evening programs. A total of 67% of patients felt understimulated in the evenings, and all patients were interested in more evening groups. Between 6 and 11 patients attended per group. Post-pilot feedback from patients was positive.

Conclusions: There was a perceived need from both patients and staff for enhanced evening programming on our adult general psychiatric inpatient unit. Our brief mindfulness program was feasible and acceptable, with broad benefits as reported by patients.

Références :

1. Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain and illness. New York (NY): Delacourt; 1990.
2. Sams DP, Handley ED, Alpert-Gillis LJ. Mindfulness-based group therapy: impact on psychiatrically hospitalized adolescents. Clin Child Psychol Psychiatry 2018 Oct;23(4):582-591.

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PE18 – An Investigation of Pharmacological Sleep Aids and Environmental Factors Affecting Sleep on a Brain Injury Rehabilitation Unit
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Tyler Pettes*, MD; Rebecca Wood, BSc; Elvina Chu, MD
Parrainè par le Section sur la neuropsychiatrie

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Recognize when to use pharmacological sleep aids in brain injury; 2) Characterize changes in sleep quality following brain injury; and 3) Consider the effects of caffeine and alcohol intake following brain injury.

Patients with brain injuries typically require significant neurorehabilitation, including pharmacological and psychoeducation-based interventions. This study compares sleep quality, prescribed sleep medication, and caffeine and alcohol consumption in patients with brain injury during admission for rehabilitation and after discharge.

Methods: This ongoing study collects data at two timepoints. Time point 1 (T1) is during admission to the inpatient unit and time point 2 (T2) is after discharge. Medication chart review was carried out alongside a structured patient interview consisting of self-perceived sleep quality and intake of caffeinated and alcoholic beverages. Medications were classified according to the American Hospital Formulary Service Pharmacologic-Therapeutic Classification System. Paired-samples t tests were conducted to evaluate polypharmacy, sleep quality, and caffeine consumption at T1 and T2.

Results: Eleven participants (mean age 49.5 years, range 25 to 74 years; 45% men) had a significant reduction in the number of medications prescribed at T1 (mean [SD] 14.5 [+/–3.5]) compared to T2 (mean [SD] 11.5 [+/–5]; t[10] = 4.8, p < 0.001). Despite a similar number of sleep aids prescribed at T1 (mean [SD] 0.8 [+/–0.8]) compared to T2 (mean SD 1.1 [+/–0.7]; t[10] = 1.9, p = 0.082), participants rated their sleep quality as worse in hospital compared to after discharge (mean 8.3 [+/–2], t[10] = 3.9, p = 0.003). Participants consumed more caffeinated beverages after 15:00h on the rehabilitation unit compared to after discharge (p = 0.002), and two participants regularly consumed alcohol within a week after discharge.

Conclusion: Following admission to a brain injury rehabilitation unit, patients had reductions in medication burden; however, prescribing of sleep medications continued despite self-reported sleep quality improving on discharge. Findings suggest that a closer clinical review of prescribed sleep medication and caffeine or alcohol intake in this patient population is warranted.

Références :

1. Merino R, Pérez A, Fierro J, et al. Prevalence of medication and off-label medication use in acquired brain injury at a neurorehabilitation Hospital. Eur J Clin Pharmacol 2019;75(7):985–994.
2. Cosano G, Giangreco M, Ussai S, et al. Polypharmacy and the use of medications in inpatients with acquired brain injury during post-acute rehabilitation: a cross-sectional study. Brain Inj 2016;30(3):353–362.

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PE19 – Predicting Which Cancer Patients Will See a Psychiatrist or Counsellor From Their Initial Oncology Consultation Document, Using Natural Language Processing
Le vendredi 20 octobre
10:45 – 11:45 (N/A)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
John-Jose Nunez*, MD, MSc, FRCPC; Bonnie Leung, MN-NP(F); Cheryl Ho, MD; Raymond Ng, PhD; Alan Bates, MD, PhD

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the basics of natural language models and language models; 2) Understand how language models can be used to predict clinically useful outcomes, such as referral to psychiatry; and 3) Understand how language models can predict psychiatry referral from a medical oncologist.

Patients with cancer often have unmet psychosocial needs. Early detection of who might require referral to a counsellor or psychiatrist may help improve patient care. This work investigated whether natural language processing (NLP) can predict which patients will see a counsellor or psychiatrist from a patient’s initial oncologist consultation document. NLP is the branch of artificial intelligence that uses language models to accomplish tasks using written text. A different application of NLP has recently been popularized through the ChatGPT online question-answering system. In this work, we used traditional and neural language models to predict whether patients will see a psychiatrist or counsellor based on their initial oncologist consultation document. We trained and evaluated our models with data from 47,625 general cancer patients at BC Cancer. The models performed similarly or better than similar predictive modelling applications in psychiatry. Our models predicted who would see a psychiatrist better than they could predict who would see a counsellor, achieving balanced accuracy of over 75% and around 70%, respectively. We examined what words or phrases our models used to make the predictions, finding symptom burden, certain cancers, and family history of cancer were positive predictors of future referral to psychosocial services. Our results suggest NLP can be used to predict which cancer patients require referral to a psychiatrist or counsellor from their initial oncologist consultation. Future research may be able to extend our work to anticipate the psychosocial needs of medical patients in other settings.

Références :

1. John DA, Kawachi I, Lathan CS, et al. Disparities in perceived unmet need for supportive services among patients with lung cancer in the cancer care outcomes research and surveillance consortium. Cancer 2014;120(20):3178–3191. doi:10.1002/cncr.28801
2. OpenAI. ChatGPT: optimizing language models for dialogue. Published November 30, 2022. Accessed 27 Jan, 2023. Available from: https://openai.com/blog/chatgpt/

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PE20 – Descriptive and Network Analyses of Psychiatric Symptoms and Neuroimaging Correlates in Parkinson Disease
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Alexander Levit*, MD/PhD; Fidel Vila-Rodriguez, MD, FRCPC, FAPA, PhD
Parrainè par le Section sur la neuropsychiatrie

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) Recognize prevalence patterns of psychiatric non-motor symptoms in early Parkinson disease (PD); 2) Identify neuroimaging correlates of psychiatric non-motor symptoms in early PD; and 3) Describe endophenotypes of PD with respect to neuropsychiatric symptoms.

Patients with Parkinson disease (PD) have high rates of comorbid depression, anxiety, and other psychiatric symptoms that progress over the course of the disease. Specific psychiatric symptom patterns may associate with subtypes of PD, and characterization of these patterns may support prognosis, anticipatory guidance, and treatment.

Objectives: We aimed to identify longitudinal associations among motor, psychiatric, and other nonmotor symptoms in PD and to identify neuroimaging correlates for nonmotor symptoms in PD.

Methods: The Parkinson Progression Marker Initiative (PPMI) is an observational natural history study of early-stage untreated PD (Hoehn and Yahr Stage 1-2). Descriptive statistics and network analyses were applied with a focus on clinician- and self-rated motor and nonmotor symptom data as well as SPECT dopamine transporter imaging.

Results: Presence of bradykinesia, rigidity, or postural instability at enrollment was more predictive of the progression of psychiatric symptoms than tremor-dominant presentation. By year five, dopamine transporter binding deficit on SPECT imaging was more strongly correlated with nonmotor symptoms than motor symptoms.

Conclusions: Symptom clusters in PD can inform clinical assessment, prognosis, and symptom management. Imaging may be an important biomarker for comorbid psychiatric symptoms.

Références :

1. Weintraub D, Caspell-Garcia C, Simuni T, et al. Neuropsychiatric symptoms and cognitive abilities over the initial quinquennium of Parkinson disease. Ann Clin Transl Neurol 2020;7(4):449–461.
2. Berg D, Borghammer P, Fereshtehnejad SM, et al. Prodromal Parkinson disease subtypes — key to understanding heterogeneity. Nat Rev Neurol 2021;17(6):349–361.

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PE21 – Digital Delivery of Trauma Therapy for Trauma-Affected Populations: Lived Experiences of Clients and Clinicians
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Sidney Yap*, BSc; Rashell Wozniak, MSc; Katherine Bright, PhD; Matthew R.G. Brown, PhD; Lisa Burback, MD; Andrew Greenshaw, PhD; Suzette Bremault-Phillips, PhD

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 why the shift to the digital delivery of trauma therapy was needed for trauma-affected populations; 2) Identify the strengths and weaknesses of the digital delivery of trauma therapy from the clinician perspective; and 3) Identify the strengths and weaknesses of the digital delivery of trauma therapy from the perspective of trauma-affected populations.

The COVID-19 pandemic significantly impacted the mental health of individuals globally. In response to increased mental health service demands and COVID-19–related restrictions, mental health clinicians rapidly shifted their services from in-person to digital delivery (e.g., teletherapy, telemedicine, eHealth, and mobile health).

This shift has been instrumental in maintaining continuity of care for trauma-affected populations (TAPs; public safety personnel, military members, veterans, and civilian frontline workers). Many TAPs are routinely exposed to potentially psychologically injurious high-risk situations. COVID-19 may compound these traumatic injuries, potentially negatively impacting their well being, mental health, occupational engagement, and relationships.

Little is understood regarding the impact of this rapid shift towards digital delivery. Through this study, we sought to better understand the experiences of TAPs who received and clinicians who delivered digital trauma therapy and identify related benefits and barriers.

Trauma-affected populations (n = 4) who have received and Canadian mental health clinicians (n = 19) who have delivered trauma therapies via digital means were recruited for this study. Data were collected through semistructured focus groups and interviews conducted and recorded through encrypted Zoom and followed an iterative process. Transcripts were coded with thematic analysis.

Overall, participants in both groups shared positive experiences receiving and delivering digital trauma therapies, with notable barriers of equal importance. The themes that arose from the thematic analysis included context, efficacy, safety, and recommendations.

The study findings support using digitally delivered trauma therapies for TAPs and may inform relevant policies and practices in a quasi-post-COVID world.

Références :

1. Carleton RN, Afifi TO, Turner S, et al. Mental disorder symptoms among public safety personnel in Canada. Can J Psychiatry 2018;63(1):54–64.
2. Jones C, Miguel-Cruz A, Smith-MacDonald L, et al. Virtual trauma-focused therapy for military members, veterans, and public safety personnel with posttraumatic stress injury: systematic scoping review. JMIR Mhealth Uhealth 2020;8(9):e22079.

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PE22 – Exploring the Effectiveness and Experiences of Treatment for Men with Borderline Personality Disorder
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Yevin Cha, BMSc., MD; Paul Links*, MD, FRCPC

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) Learn the various treatment outcomes of psychological therapies and psychopharmacologic treatment for men with borderline personality disorder (BPD); 2) Identify future research priorities and gaps in the literature on treatment and experiences of recovery for men with BPD; and 3) Understand the limitations of research on the effectiveness of treatment for men with BPD.

In clinical settings, people diagnosed with borderline personality disorder (BPD) typically are 75% female and 25% male, although this discrepancy in gender distribution is not found in the community. In the literature, little is known of the effectiveness and experiences of treatment of men with BPD.

Objective: We aimed to investigate the effectiveness and experience of treatment for men with BPD and outline future research priorities to better promote their recovery.

Methods: A systematic search of Ovid Medline and PsycINFO was conducted. We generated a narrative synthesis of the treatment effectiveness and experiences of men with BPD.

Results: The search yielded 1,305 abstracts and 34 full-text studies were screened. A total of 17 studies met inclusion criteria, and 7,114 men with BPD from nine countries were represented. Seven studies investigated psychological and five reported on pharmacological interventions. Five studies investigated the service use of men with BPD. Men were less likely to receive treatment compared to women and were more likely to drop out of treatment. Improvements in suicidality and violence, anger, and aggression were observed, with anger and aggression as the prominent outcomes investigated in most studies.

Discussion: Compared with women, men were less likely to access treatment for BPD or find treatment helpful. Our findings suggest psychotherapeutic interventions can be effective for men, although findings are limited by small sample sizes and heterogeneity of studies. Further research with larger sample sizes and qualitative studies are needed to better understand the treatment experience for men with BPD.

Références :

1. Bayes A, Parker G. Borderline personality disorder in men: a literature review and illustrative case vignettes. Psychiatry Res 2017;257:197–202.
2. Katsakou C, Pistrang N. Clients’ experiences of treatment and recovery in borderline personality disorder: a meta-synthesis of qualitative studies. Psycho Res 2017;28(6):1–18.

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PE23 – Frequency of Attention-Deficit Hyperactivity Disorder Assessment in a Tertiary Care Mood and Anxiety Program
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Nicholas Boucher*, MD; Amol Vaze, MD; Sabrina Paterniti, MD PhD

Rôles CanMEDS :

1. Communicateur
2. Expert médical
3. Professionnel

À la conclusion de cette activité, les participants seront en mesure de : 1) Describe the prevalence of attention-deficit hyperactivity disorder (ADHD) comorbidity in mood and anxiety disorders; 2) Recognize the clinical interest of screening/assessing ADHD among mood and anxiety disorders patients; and 3) Identify factors that may increase or decrease the likelihood of assessing ADHD in tertiary care.

The comorbidity between attention-deficit hyperactivity disorder (ADHD) and affective disorders is frequent and associated with poorer prognosis and treatment resistance. It is therefore relevant to assess for ADHD in all patients. This project evaluated the frequency and factors associated with the assessment of ADHD in a tertiary care mood and anxiety disorders program.

Methods: We reviewed 80 consecutive outpatient consultations undertaken by psychiatrists and psychiatry residents in our program. The following screenings/assessments were recognized: any questionnaire or questions about ADHD symptoms or a mention of need for further assessment. Current psychiatric diagnoses, previous diagnosis of ADHD, and current treatment with medications used in ADHD were recorded.

Results: Of the consultations, 42.5% had recorded some ADHD assessment. Factors associated with higher frequency of assessment were as follows: being a resident (69.2%, p = 0.03), previous diagnosis of ADHD (87.5%, p = 0.007), current treatment for ADHD (66.7%, p = 0.009), mention of ADHD in the referral (72.2%, p = 0.004) or by the patient (80%, p = 0.02), a diagnosis of substance use disorder (66.7%, p = 0.04), and a diagnosis of ADHD (88%, p < 0.001). A diagnosis of post-traumatic stress disorder was associated with a lower frequency of ADHD assessment (5.6%, 0.001).

Conclusions: The frequency of assessment for ADHD was low in our sample, perhaps contributing to treatment resistance. Increased education and use of standardized questionnaires would likely increase the frequency of diagnosis and, therefore, treatment, potentially improving prognosis.

Références :

1. Pallanti S, Salerno L. The burden of adult ADHD in comorbid psychiatric and neurological disorders. New York (NY): Springer; 2020.
2. Sternat T, Fotinos K, Fine A, et al. Low hedonic tone and attention-deficit hyperactivity disorder: risk factors for treatment resistance in depressed adults. Neuropsychiatr Dis Treat 2018;14:2379–2387.

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PE24 – Global Indigenous Gender Concepts, Gender-Based Violence, and Resilience: A Scoping Review
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Yang Bo Zhang*, BHSc; Angela Wei, BHSc; Emma Robertson; Jeremy Steen, BHSc; Christopher Mushquash, PhD; Christine Wekerle, 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) Identify relations between global Indigenous gender concepts and gender-based violence (GBV), contextualized in traditional governance, colonialism, and gender diversity; 2) Recognize the prevalence and mental health implications of GBV, patriarchal systems, and colonial wounds in those facing intersecting oppression; and 3) Appreciate the value of decolonization processes in providing trauma-informed, gender-inclusive, resilience-oriented care for Indigenous GBV survivors.

The legacy of colonialism includes ongoing trauma and disruption of traditional teachings on relationality. This has contributed to global Indigenous populations disproportionately exposed to gender-based violence (GBV). Gender analysis of GBV in Indigenous populations is explored to consider resilience.

Objectives: To our knowledge, there is no systematic research review on the intersecting experiences of Indigeneity and gender diversity, as contextualized within GBV and resilience. This study explores conceptualizations of gender and GBV in Indigenous communities globally. We consider issues of governance and whether culture is identified as a resilience pathway.

Methods: A systematic scoping review was conducted in MEDLINE, Embase, PsycINFO, and the Informit Indigenous Collection, using key words for Indigenous peoples, gender concepts, and GBV. Each article was screened and extracted by two reviewers.

Results: Searches yielded one mixed-method study and seven qualitative studies. North American studies identified positive precontact gender relationships, with colonial patriarchy contributing to GBV trends postcontact. Other studies also described patriarchal cultures contributing to GBV. Although research was limited, lack of understanding of Two-Spirit identities was linked with stigma. Traditional matriarchal governance structure and decolonization processes were identified as resilience pathways.

Conclusions: There is limited literature exploring relations between Indigenous gender concepts and GBV. All studies identified colonization-related violence and (or) patriarchal gender norms as a precursor for rigid or disrupted gender roles and GBV. Engagement with cultural practices was consistently identified as a key resilience process. Limited research is available on GBV victimization in males, Two-Spirit, and LGBTQ+ Indigenous persons.

Références :

1. McKinley CE, Lilly JM, Knipp H, et al. “A dad can get the money and the mom stays at home”: patriarchal gender role attitudes, intimate partner violence, historical oppression, and resilience among Indigenous peoples. Sex Roles 2021;85(9–10):499–514.
2. Ristock J, Zoccole A, Passante L, et al. Impacts of colonization on Indigenous Two-Spirit/LGBTQ Canadians’ experiences of migration, mobility and relationship violence. Sexualities 2019;22(5–6):767–784. https://doi.org/10.1177/1363460716681474

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PE25 – Impacts of Clinical Empathy on Self-Perceived Mental Health in Canadians with Chronic Illnesses
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Shira Gertsman*, BSc Ioana Cezara Ene, BHSc Sasha Palmert, MD Amy Liu, MD Mallika Makkar, MD Johanna Shapiro, PhD Connie Williams, MD PhD

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Name the three key components of “clinical empathy” and understand how they differ from common perceptions of the concept of « empathy »; 2) Describe how clinical empathy can directly and indirectly impact the mental health of patients with chronic illness; and 3) Name two practical ways clinicians can increase their enactment of clinical empathy in practice.

Clinical empathy is the ability of a physician to understand a patient’s illness experience, communicate this understanding, and act collaboratively to create a treatment plan. Although clinical empathy provides substantial benefits to both physicians and patients, medical students typically experience declining empathy throughout training. The primary objective of this study was to generate a model of clinical empathy and its outcomes, grounded in the perspectives of Canadians with chronic illnesses, to be used to inform empathy-focused curricular development in Canadian medical education.

Methods: Adults with chronic illness who recently saw a Canadian physician were recruited from online support groups. Participants took part in semi-structured virtual focus groups. Transcripts were coded with the constant comparative method and a theory was generated using constructivist grounded theory analysis.

Results: Twenty patients from across Canada participated in six focus groups. Perceived presence of physician empathy engendered positive internal processing by patients, leading to increased efficacy of health care delivery and enhanced mental health outcomes. Negative patient internal processing in response to perceived absence of empathy led to reduced quality and increased use of health care, disruptions in patients’ personal lives, and negative physical and mental health outcomes. Impact on mental health was the most prevalent theme, with patients describing exhaustion, hopelessness, helplessness, anxiety, depression, and suicidal ideation as downstream effects of clinical empathy deficiency.

Conclusion: Clinical empathy can have life-altering impacts on patients, and its absence may trigger or exacerbate mental illness. Any intervention to improve clinical empathy must be informed by patient perspectives.

Références :

1. Shapiro J. Walking a mile in their patients’ shoes: empathy and othering in medical students’ education. Philos Ethics Humanit Med 2008;3:10.
2. Batt-Rawden SA, Chisolm MS, Anton B, et al. Teaching empathy to medical students: an updated, systematic review. Acad Med 2013;88(8):1171–1177.

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PE26 – Integrating Cardiometabolic Bloodwork Monitoring in an Intensive Case Management Mental Health Community Clinic: A Quality Improvement Initiative
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Nicole Ilyin*, BScN, MN; Mallory McKey, BScN; Ava Meade, BScN; Karen Shin, MD, FRCPC

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) Identify the steps taken to implement the outlined cardiometabolic bloodwork monitoring intervention; 2) Describe the importance of cardiometabolic bloodwork monitoring in populations being prescribed antipsychotic medication; and 3) Support the integration of cardiometabolic bloodwork monitoring into practice.

Cardiometabolic bloodwork monitoring (CBM) allows for early detection and treatment of cardiometabolic side effects of antipsychotic medication used in the treatment of psychotic and mood disorders (DeJongh, 2021; Melamed et al., 2019).

Purpose: This quality improvement (QI) initiative was to increase the completion of CBM for clients on antipsychotic medications, followed by an intensive case management community clinic.

Methods: Data were collected retroactively from client files from February 2021 to January 2022, to determine the most recent dates when clients were tested for fasting or random glucose, HA1C, and a standard lipid panel. The QI initiative started in February 2022 and data were collected over a 12-month period.

A Plan-Do-Study-Act (PDSA) QI framework was implemented. Some key factors were identified as potential causes for poor completion of CBM, like the absence of monitoring infrastructure. A CBM infrastructure was created and implemented to support the integration of CBM into clients’ clinical care.

Results: Prior to the implementation of the CBM intervention, an average of 30% of the clinic’s clients completed CBM. After the QI intervention was implemented, 78% of the clients were offered CBM, with 54% of total clients completing it. These data were analyzed with run charts, which identified an astronomical data point of CBM completion in May 2022.

Conclusion: Through the implementation of a CBM intervention, a community population of clients with severe persistent mental illness receiving antipsychotic medication showed an increased rate of completing CBM, improving clinical care.

Références :

1. DeJongh BM. Clinical pearls for the monitoring and treatment of antipsychotic induced metabolic syndrome. Ment Health Clin 2021;11(6):311–319.
2. Melamed OC, Wong EN, LaChance L, et al. Interventions to improve metabolic risk screening among adult patients taking antipsychotic medication: a systematic review. Psychiatr Serv 2019;70:1138–1156.

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PE27 – Integrating Equity, Diversity, and Inclusion Into Child and Adolescent Psychiatry Training: Co-Creation of a Novel Educational Intervention
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Nikhita Singhal*, MD; Jenny Chum, MD; Catherine Deschênes, MD; Ayan Dey, MD, PhD; Oshan Fernando, PhD; Arfeen Malick, MD; Jude Sanon, MD; Yezarni Wynn, MD; Raj Rasasingham, MD; Chetana Kulkarni, MD

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Evaluate the current state of child and adolescent psychiatry training on equity, diversity, and inclusion principles; 2) Appreciate the value of involving people with lived experience in curriculum design; and 3) Consider innovative and evidence-informed approaches to teaching about topics related to equity, diversity, and inclusion.

The current social climate has brought attention to historic and systemic inequities impacting child and youth mental health. Despite this, equity, diversity, and inclusion (EDI) principles have not been a major component of Canadian child and adolescent psychiatry (CAP) training. We aim to address this gap by developing and evaluating a series of co-created evidence-informed virtual educational modules focused on EDI themes relevant to CAP.

Grounded in Kern’s six-step framework for curriculum development, our project comprises the following stages: (1) an environmental scan to better understand the current state of CAP EDI training (sampling program directors, current trainees, and recent graduates); (2) co-design and development of case-based online modules alongside youth advisors with lived experience; and (3) evaluation of the modules based on Kirkpatrick’s four-level model.

Results from our initial needs assessment surveys and follow-up interviews indicated a significant gap in EDI training across programs; barriers identified included soliciting local expertise and finding time within curricula. Information collected was reviewed and thematically analyzed to identify module topics and potential design elements. Specific topics of interest included cultural formulation, LBGTQ+ considerations, Indigenous issues, anti-Black racism, and refugee mental health.

The first two modules focus on cultural formulation and anti-Black racism. Evaluation outcomes from our initial pilot test among local CAP trainees will inform iterative refinement of these modules and development of the remaining modules in the series. We anticipate these may be adapted for broad applicability to enhance EDI education for various interdisciplinary health care professionals.

Références :

1. Fante-CoIeman T, Jackson-Best F. Barriers and facilitators to accessing mental healthcare in Canada for black youth: a scoping review. Adolescent Res Rev 2020;5(2):115–136.
2. Medlock M, Weissman A, Wong SS, et al. Racism as a unique social determinant of mental health: development of a didactic curriculum for psychiatry residents. MedEdPORTAL 2017;13:10618.

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PE28 – Longitudinal Associations of Depressive Symptom Severity, Suicidal Ideation, Psychopathology, Trauma, and Substance Use in a Precariously Housed Sample
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Lianne Cho*, BSc; Andrea Jones, MD PhD; Geoffrey Smith, PhD; Skye Barbic, OT, PhD; William Honer, MD

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify predictors of depressive symptom severity and suicidal ideation in a community-based, precariously housed sample; 2) Describe relative contributions of psychopathology, trauma, and substance use to depressive symptom severity and suicidal ideation; and 3) Consider multiple social and psychiatric factors when assessing the presence of depression and suicidal ideation in a community-based setting.

Cross-sectional research shows that precariously housed people have high rates of depression and suicidal ideation (SI). This study examined contributions of psychopathology, trauma, and substance use to depressive symptom severity (DSS) and SI over time in a community-based sample.

Methods: Participants (N = 393, 308 men, median age 42 years [interquartile range 33 to 50]) were recruited from a low-income neighbourhood in Vancouver, Canada. Beck Depression Inventory total scores assessed DSS. SI was defined by endorsement of ≥1 on the Maudsley Addiction Profile suicidality item. Mixed effects regression models were used to identify predictors of DSS and SI, respectively.

Results: More severe depressive symptoms were associated with a history of major depression (odds ratio [OR] 3.09, confidence interval [CI] 2.30 to 4.15, p < 0.0001), lifetime trauma (OR 1.14, CI 1.11 to 1.18, p < 0.0001), concurrent anxiety (OR 1.26, CI 1.24 to 1.28, p < 0.0001), psychosis symptom severity (OR 1.05, CI 1.03 to 1.06, p = 0.003), recent trauma (OR 1.33, CI 1.19 to 1.46, p = 0.009), and recent nonprescribed opioid use (OR 1.09, CI 1.06 to 1.12, p = 0.003). Among those who experienced moderate to severe depressive symptoms at least once during the year (n = 178), SI was associated with lifetime trauma (OR 1.10, CI 1.05 to 1.15, p = 0.033), history of psychotic disorder (OR 3.03, CI 2.02 to 4.55, p = 0.006), concurrent anxiety severity, (OR 1.27, CI 1.23 to 1.31, p < 0.0001), and concurrent moderate to severe depressive symptoms (OR 4.26, CI 3.49 to 5.20, p < 0.0001).

Conclusions: While living in precarious housing, multiple social and psychiatric factors were associated with higher risk for more severe depressive symptoms. The data also suggest that assessing a history of psychotic disorder in those with moderate to severe symptoms may help identify SI, which may allow for timely and effective intervention.

Références :

1. Gutwinski S, Schreiter S, Deutscher K, et al. The prevalence of mental disorders among homeless people in high-income countries: an updated systematic review and meta-regression analysis. PLoS Med 2021;18(8):e1003750.
2. Gentil L, Grenier G, Fleury MJ. Determinants of suicidal ideation and suicide attempt among former and currently homeless individuals. Soc Psychiatry Psychiatr Epidemiol 2021;56(5):747–757.

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PE29 – Preliminary Results from the Eye Movement Desensitization and Reprocessing: A Transdiagnostic Approach
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Sidney Yap*, BSc; Scot Purdon, PhD; Adam Abba-Aji, MD; Lisa Burback, MD; Olga Winkler, MD; Suzette Bremault-Phillips, PhD; Raman Dhaliwal, MSc; Katie O‘Shea, MSc; Andrew Greenshaw, PhD

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) Describe the preliminary results of the virtual eye movement desensitization and reprocessing (EMDR) study; 2) Describe the safety protocol used in the study and the preliminary safety outcomes; and 3) Describe study limitations and research gaps relevant to the future scale and spread of EMDR for suicidal ideation.

Approximately 800,000 suicides occur annually, with profound personal and societal consequences. Many more suffer with episodic or chronic suicidal ideation, and current treatment is limited by suboptimal access and cost effectiveness.

Eye movement desensitization and reprocessing (EMDR) is a trauma-focused psychotherapy effective for post-traumatic stress disorder (PTSD) and major depressive disorder and associated with reductions in suicidal ideation. Emerging evidence supports its use in people presenting with suicidal ideation in the context of depression and trauma-related mental health crisis; however, no studies have evaluated EMDR specifically targeting suicidal ideation, as opposed to a psychiatric disorder, in a transdiagnostic fashion.

This real-world single blind study evaluates the safety and efficacy of using synchronous online EMDR (12 sessions) for adults with suicidal ideation, compared to treatment as usual. Those with psychosis, mania, severe dissociative symptoms, ongoing trauma-focused psychotherapy, electroconvulsive therapy, or imminent suicidal plan were excluded. EMDR was focused on desensitizing and cognitively restructuring experiences and core beliefs associated with suicidal ideation, regardless of diagnosis. Outcome measures were completed at baseline, two months, and four months. Self-report measures of anxiety, depression, posttraumatic symptoms, emotional dysregulation, and suicidal thinking were compared between the groups. Promising preliminary study results, including safety and adverse events, will be presented. Given the high risk population, study safety precautions will also be highlighted. Results indicate that EMDR focused on experiences associated with suicidal ideation is a promising approach; however, results are preliminary, and study limitations and research gaps remain to be addressed.

Références :

1. Burback L, Dhaliwal R, Reeson M, et al. Trauma focused psychotherapy in patients with suicidal ideation: a scoping review. Submitted to Current Research in Behavioral Sciences. In revision.
2. Winkler O, Dhaliwal R, Greenshaw A, et al. Web-based eye movement desensitization and reprocessing for adults with suicidal ideation: protocol for a randomized controlled trial. JMIR Res Protoc 2021;10(11):e30711.

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PE30 – Psilocybin-Assisted Psychotherapy as a Potential Treatment for Eating Disorders: A Narrative Review of Preliminary Evidence
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Elena Koning*, MSc

Rôles CanMEDS :

1. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Expand knowledge about the potential role of psilocybin-assisted psychotherapy in disordered eating behaviours; 2) Consider the limitations of current evidence and the need for more rigorous trial design; and 3) Contribute to the development of therapeutic methods that target the neurobiological underpinnings of eating disorders.

Eating disorders (EDs) are a group of potentially severe mental disorders characterized by abnormal energy balance, cognitive dysfunction, and emotional distress. Cognitive inflexibility is a challenge to successful ED treatment and dysregulated serotonergic function has been implicated in this symptomatic dimension. Moreover, there are few effective treatment options and long-term remission of ED symptoms is difficult to achieve. There is emerging evidence for the use of psychedelic-assisted psychotherapy for a range of mental disorders. Psilocybin is a serotonergic psychedelic that has demonstrated therapeutic benefit to various psychiatric illnesses characterized by rigid thought patterns and treatment resistance. This paper presents a narrative review of the hypothesis that psilocybin may be an effective adjunctive treatment for people with EDs, based on biological plausibility, transdiagnostic evidence, and preliminary results. Limitations of the psychedelic-assisted psychotherapy model and proposed future directions for the application to EDs are also discussed. Although the literature to date is not sufficient to propose the incorporation of psilocybin in the treatment of disordered eating behaviours, preliminary evidence supports the need for more rigorous clinical trials as an important avenue for future investigation.

Références :

1. Fassino S, Abbate-Daga G. Resistance to treatment in eating disorders: a critical challenge. BMC Psychiatry 2013;13:282.
2. Kelly JR, Gillan CM, Prenderville J, et al. Psychedelic therapy’s transdiagnostic effects: a research domain criteria (RDoC) perspective. Front Psychiatry 2021;12:800072.

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PE32 – Rates of Disability Among Medical Students and Residents at Dalhousie University
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Katherine (Katie( Lines*, MD; Cheryl Murphy, MD

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Increase awareness regarding the potential number of medical students and residents at Dalhousie University who identify as having a disability; 2) Appreciate some of the experiences of medical learners with regards to discrimination, seeking accommodation, and the impact of disability on learning; and 3) Understand general attitudes and beliefs of medical learners about disability in medical training and practice.

There are no Canadian studies estimating the percentage of medical learners who identify as having a disability or elucidating the challenges they face. The primary objective of this study was to estimate the percentage of medical learners at Dalhousie University who identify as having a disability and to capture their experiences and attitudes towards disability in medical training and practice. The study was conducted by distributing a survey to all medical students and residents at Dalhousie via the RedCap portal, with a response rate of 13.5% (143 completed surveys). The results showed that 17.9% of medical learners reported having a disability, with the most common types being psychiatric (25.9%), chronic medical conditions (25.9%), learning (22.2%), sensory (14.8%), and pain conditions (14.8%). Additionally, the study found that many medical learners did not seek accommodations (47.2%), were not comfortable disclosing their disability (44%), feared not being able to complete medical training (56%), and experienced discrimination (48%). Despite these barriers, most respondents felt that medical learners with disabilities could be successful physicians (82%).

This study lays the foundation for deeper examination of the national rates of disability among medical learners. The knowledge gained from this research is crucial in providing tailored support and resources to this subset of medical learners.

Références :

1. Accommodating Residents with Disabilities | Resident Doctors of Canada. (n.d.). Retrieved July 18, 2021, from https://residentdoctors.ca/accommodating-residents-with-disabilities/
2. Equity & Inclusion Glossary of Terms – UBC Equity & Inclusion Office. (n.d.). Retrieved July 18, 2021, from https://equity.ubc.ca/resources/equity-inclusion-glossary-of-terms/

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PE33 – The Journey from Concealment to Disclosure of an Obsessive–Compulsive Disorder Diagnosis in the High School Setting: A Qualitative Study Exploring Youth Perspectives
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Tanisha Vallani*, NA; Zainab Naqqash, BA; Boyee Lin, BSc; Cynthia Lu, BA; Jehannine Austin, PhD FCAHS CGC; S. Evelyn Stewart, MD; Made in error Made in error, Made in error

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand the phases and associated key characteristics of disclosing a pediatric obsessive–compulsive disorder (OCD) diagnosis in the school setting and youth-based recommendations for improvement; 2) Understand the importance and implications of OCD-affected youth disclosing or concealing their diagnosis in the school setting; and 3) Understand the critical and unique role qualitative methodology plays in child and adolescent psychiatry research.

Pediatric obsessive–compulsive disorder (OCD) commonly impairs school functioning in terms of concentration, homework completion, certain subject material, executive function, and overall graduation rates. Disclosure of an OCD diagnosis in the high school setting may allow for earlier and more individualized school-based support and may subsequently improve functioning. Our study qualitatively explored the experiences of youth around disclosing their diagnosis in the high school setting and their recommendations for improvement.

Twelve participants, ranging from age 13 to 17 years, were recruited using maximum variance-based heterogeneous purposive sampling. Semi-structured interviews were conducted and analyzed inductively through interpretive description, to generate a theoretical model describing the journey from concealment of an OCD diagnosis to disclosure. The model was modified based on feedback obtained from three member-checking meetings. Four phases of youth disclosure were identified: managing negative internalized beliefs and stigma related to the diagnosis, internal bargaining to determine their individualized disclosure boundaries, trust building with school members, and empowerment by being treated as a person first. Participants’ recommendations for the school setting included meaningful education, safe spaces, deep reciprocal connections, and confidential personalized support.

The youth-based model we developed can help inform school disclosure strategies and optimize support to promote best outcomes for youth with OCD. Future research can explore the perspectives and experiences of youth with increasingly varied demographic and clinical factors and the perspectives of school staff and parents on disclosure and the proposed model.

Références :

1. Piacentini J, Bergman RL, Keller M, et al. Functional impairment in children and adolescents with obsessive-compulsive disorder. J Child Adolesc Psychopharmacol 2003;13(Suppl 1):61–69.
2. Negreiros J, Belschner L, Best JR, et al. Neurocognitive risk markers in pediatric obsessive–compulsive disorder. J Child Psychol Psychiatry 2019;61(5):605–613.

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PE34 – Towards Postcolonialism in Psychiatry: A Framework for Residency Training and Community Engagement
Le vendredi 20 octobre
10:45 – 11:45 (1 hr)
Salle de réunion : Junior Ballroom AB Foyer (3rd floor – North Tower)
Jacquelyn Paquet*, MD, PhD(c), BScN, BSc

Rôles CanMEDS :

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

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify past and current instances of colonialism in Canada and in medicine; 2) Identify the features of a postcolonial framework in medical education; and 3) Reflect on the current national, faculty, and departmental approach to reconciliation.

First Nations peoples in Canada have been affected by compounding detrimental inequities rooted in colonialism that have significantly impacted their health and well being. Colonialism framed as a social determinant of health compels us to address longstanding political, cultural, and economic inequities facing Indigenous peoples. The challenge of decolonizing current societal institutions founded on colonial norms or forms of knowledge is fraught with difficulties—but it must be addressed.

Objective: We sought to identify approaches to decolonizing psychiatry residency education to mitigate ongoing harms and promote culturally informed approaches to improve the mental well being of Indigenous people.

Results: Recognizing that psychiatry is not culture-neutral, we created a framework for integrating postcolonialism within residency education based on the Truth and Reconciliation Commission of Canada’s “calls to action.” (1) Topics and concepts to address throughout the curriculum were identified, and the importance of experiential learning and longitudinal clinical experiences were highlighted. Departmental, institutional, and national recommendations for incorporating postcolonial understanding within psychiatry were also provided, including the need for cultural humility and critical reflection to promote the development of historically and culturally informed collaborative relationships with First Nations people and communities.

Conclusions: A thoughtful educational approach to social justice, developed in collaboration with Indigenous communities, is needed to improve relationships between psychiatry and Indigenous peoples and ensure care delivery from a more culturally informed, sensitive, and holistic lens. We recognize an evolving, anticipatory postcolonial discourse. These beginning steps will undoubtedly transform over time as an understanding of deeply entrenched systems of power and privilege in mental health expands.

Références :

1. Truth and Reconciliation Commission of Canada. Honouring the truth, reconciling for the future: summary of the final report of the Truth and Reconciliation Commission of Canada. Manitoba (SK): Author; 2015.
2. Beavis ASW, Hojjati A, Kassam A, et al. What all students in healthcare training programs should learn to increase health equity: perspectives on postcolonialism and the health of Aboriginal peoples in Canada. BMC Med Educ 2015;15:155.