Le vendredi 20 octobre
14:30 – 15:30 (1 hr)
Salle de réunion : Port McNeill (4th floor – North Tower)
Sidney Kennedy*, MD, FRCPC, FRCPsych,; Sidney Kennedy, MD, FRCPC, FRCPsych; James MacKillop, PhD; Yelena Chorny, MD, MSc, CCFP(AM); Shannon Remers, MSc; Christian Schütz, MD, Ph.D., MPH, FRCP

Rôles CanMEDS :

1. Expert médical
2. Professionnel
3. Érudit

À la conclusion de cette activité, les participants seront en mesure de : 1) Recognize the gaps and challenges in treating concurrent disorders; 2) Appreciate the potential role of subtyping disorders to facilitate more personalized approaches to treatment; and 3) Be aware of advances in novel treatments and opportunities for future research.

In Canada, one in three people will be affected by mental illness in their lifetime. Among those experiencing major depressive disorder, up to 40% will also have a concurrent substance use disorder (SUD). People with concurrent disorders are likely to have greater symptom severity, and higher rates of morbidity, mortality, unemployment, homelessness, and other difficulties, compared to those with a single disorder. Despite the prevalence, people with concurrent disorders tend to be under-diagnosed and undertreated, reflecting the silo approach of identifying and treating single disorders. Notably, a lack of real-world data characterizing the unique needs of people with concurrent disorders or evidence of effective treatment approaches makes it challenging to establish standards of care and treatment guidelines. In this symposium, we will provide an overview of the problem and highlight gaps in the treatment of and research on concurrent disorders (Dr. Sidney Kennedy). In our second presentation, we will provide evidence of the clinical heterogeneity of patients seeking treatment for SUD and highlight important characteristics of those with concurrent disorders, including lower treatment retention, higher craving, and higher impulsivity (Dr. James MacKillop). Our third presentation will demonstrate how an inpatient program was redesigned to treat concurrent mood and substance use disorders at Homewood Health Centre and highlight key evaluation findings (Dr. Yelena Chorny and Ms. Shannon Remers). In our final presentation, we will highlight where the field is going in terms of promising practices and opportunities for future research (Dr. Christian Schütz).

S12a – Mental Health and Substance Use Disorders: We Need to Do Better
Sidney Kennedy, MD, FRCPC, FRCPsych

À la conclusion de cette activité, les participants seront en mesure de : 1) Recognize the gaps and challenges in treating concurrent disorders; 2) Understand limitations of the common approaches to treating concurrent disorders; and 3) Identify opportunities for improving the treatment of concurrent disorders.

People with severe mental illness and co-occurring substance use disorders (SUDs) continue to have lower response rates to various treatments, compared to those without concurrent disorders. According to results from the US National Epidemiologic Survey on Alcohol and Related Conditions, 40% of respondents with a lifetime history of major depressive disorder also had an SUD, while 20% of those with a lifetime SUD had at least one independent mood disorder (Grant et al., 2004). Greater awareness of the sequelae of concurrent disorders, including increased likelihood of relapse, has led to the development of various integrated treatment models. Most began by combining psychiatric and addiction medicine teams with the assumption that care was integrated. But inadequate resources, different professional backgrounds and philosophies, inadequate pre-treatment preparation of clients, paucity of clinical research to validate ‘best practice’ integrated models, limited attention to rigorous diagnostic assessments and delayed implementation of measurement-based care have all served as barriers to achieving better outcomes (Minkoff and Covell, 2022). This presentation will provide an overview of the current gaps and challenges in identifying and treating concurrent mood and SUD.

Références :

1. Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2004;61(8):807–816.
2. Minkoff K, Covell NH. Recommendations for integrated systems and services for people with co-occurring mental health and substance use conditions. Psychiatr Serv 2022;73:686–689.

S12b – Using Latent Profile Analysis to Identify Clinically Distinct Clusters of Substance Use Disorders and Other Psychiatric Disorders in Addiction Treatment Settings
James MacKillop, PhD

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand measurement-based care as a framework for improving personalized treatment for substance use disorders and co-occurring conditions; 2) Understand latent profile analysis as a statistical technique for identifying distinct clusters of patients; and 3) Interpret differences among latent clusters of patients in terms of clinical implications.

Substance use disorders (SUDs) are among the most common psychiatric conditions and are commonly comorbid with other conditions, including major depressive disorder, anxiety disorders, and post-traumatic stress disorder. Unfortunately, substantial proportions of patients do not achieve successful recovery following treatment, potentially because comorbid mental health conditions are inadequately assessed and treated. Personalized treatment has the potential to improve outcomes but is resource intensive and typically cannot be ideographically matched to each patient’s presenting concerns. A measurement-based care (MBC) approach uses routine assessments with brief high-quality measures to automate idiographic assessment. Moreover, MBC provides patient data that can inform common patterns of SUDs and comorbidities to create program-level care paths that address the most prevalent clinical presentations. This presentation will review findings from two published studies (Syan et al., 2020; Minhas et al., 2022) that used latent profile analysis of data from an MBC system to quantify underlying commonalities in symptom presentations. In addition, the presentation will report on three additional applications of this approach within three distinct clinical settings. In each case, the results highlight common patterns of comorbidity in SUD treatment settings and the potential value in directly addressing these comorbidities clinically.

Références :

1. Syan SK, Minhas M, Oshri A, et al. Predictors of premature treatment termination in a large residential addiction medicine program. J Subst Abuse Treat 2020;117:108077.
2. Minhas M, Cooper A, Sousa S, et al. Characterizing clinical heterogeneity in a large inpatient addiction treatment sample: confirmatory latent profile analysis and differential levels of craving and impulsivity. Subst Abuse: Research and Treatment 2022;16.

S12c – Treating Concurrent Mood, Anxiety, and Substance Use Disorders: How an Inpatient Program Was Redesigned to Treat Concurrent Disorders and Key Lessons Learned
Yelena Chorny, MD, MSc, CCFP(AM)

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand how standardized measurement supported the decision to create a concurrent treatment program; 2) Understand how a program was redesigned to treat concurrent substance use, mood, and anxiety disorders; and 3) Consider how to evaluate program changes.

Homewood Health Centre is a longstanding provider of substance use and mental health treatment services. The need for an enhanced approach to treating concurrent substance use, mood, and anxiety disorders was recognized based on client feedback, standardized assessment and outcome monitoring, and staff insight. On February 8, 2022, the Mood, Anxiety, and Concurrent Program (MACP) opened within Homewood’s Addiction Medicine Program (AMP). MACP is a nine-week inpatient program integrating the treatment of substance use, mood, and anxiety disorders with equal emphasis. Clients complete the cognitive-behavioural therapy (CBT) unified protocol and receive motivational enhancement and CBT-based interventions for substance use disorders. Retrospective secondary data will be used to evaluate the program, where clients complete measures at regular intervals to facilitate treatment planning and outcome measurement. Patient satisfaction and administrative data will also be reviewed. Analysis of the first six months of data shows improvements in measures of depression, anxiety, treatment retention, and patient satisfaction compared to those in Homewood’s substance use program. Updated data will be presented, including an evaluation of the program’s first full year. In this presentation, we will discuss our path to program design, summarize findings from the program evaluation, and reflect on implications for future program planning.

Références :

1. Lewis CC, Boyd M, Puspitasari A, et al. Implementing measurement-based care in behavioral health: a review. JAMA Psychiatry 2019;76(3):324–335.
2. Kelly TM, Daley DC. Integrated treatment of substance use and psychiatric disorders. Social Work in Public Health 2013;28(3–4)388–406.

S12d – Treating Concurrent Mood, Anxiety, and Substance Use Disorders: How an Inpatient Program Was Redesigned to Treat Concurrent Disorders and Key Lessons Learned
Shannon Remers, MSc

À la conclusion de cette activité, les participants seront en mesure de : 1) Understand how standardized measurement supported the decision to create a concurrent treatment program; 2) Understand how a program was redesigned to treat concurrent substance use, mood, and anxiety disorders; and 3) Consider how one might evaluate program changes.

See Abstract #4 (to correspond with Dr. Chorny as co-presenter)

Homewood Health Centre is a longstanding provider of substance use and mental health treatment services. The need for an enhanced approach to treating concurrent substance use, mood, and anxiety disorders was recognized based on client feedback, standardized assessment and outcome monitoring, and staff insight. On February 8, 2022, the Mood, Anxiety, and Concurrent Program (MACP) opened within Homewood’s Addiction Medicine Program (AMP). MACP is a nine-week inpatient program integrating the treatment of substance use, mood, and anxiety disorders with equal emphasis. Clients complete the cognitive-behavioural therapy (CBT) unified protocol and receive motivational enhancement and CBT-based interventions for substance use disorders. Retrospective secondary data will be used to evaluate the program, where clients complete measures at regular intervals to facilitate treatment planning and outcome measurement. Patient satisfaction and administrative data will also be reviewed. Analysis of the first six months of data shows improvements in measures of depression, anxiety, treatment retention, and patient satisfaction compared to those in Homewood’s substance use program. Updated data will be presented, including an evaluation of the program’s first full year. In this presentation, we will discuss our path to program design, summarize findings from the program evaluation, and reflect on implications for future program planning.

Références :

1. Lewis CC, Boyd M, Puspitasari A, et al. Implementing measurement-based care in behavioral health: a review. JAMA Psychiatry 2019;76(3):324–335.
2. Kelly TM, Daley DC. Integrated treatment of substance use and psychiatric disorders. Social Work in Public Health 2013;28(3-4)388–406.

S12e – Where Are We Going? Promising Practices and Future Research Opportunities to Advance the Treatment of Concurrent Disorders
Christian Schütz, MD, Ph.D., MPH, FRCP

À la conclusion de cette activité, les participants seront en mesure de : 1) Identify promising practices and advancements in treating concurrent disorders; 2) Understand current research gaps and emerging research findings for treating concurrent disorders; and 3) Understand how precision medicine may be applied to the treatment of concurrent disorders.

Increasing severity of mental disorders is associated with an increased likelihood of concurrent disorders. Further, substance use and use disorders have been on the rise. Psychiatrists need to be adequately equipped to address concurrent disorders; this starts with training. An example of training initiatives addressing current gaps includes the ongoing development of educational platforms for concurrent disorders. Optimization of the health care system to provide integrated care is needed to address the needs of people with concurrent disorders. We will present successful examples. Clinicians dealing with concurrent disorders need evidence on which to base their decisions. Recent results from studies focusing on trajectories and treatment responses will be summarized and discussed. Precision medicine holds promise as a future approach to treating concurrent disorders and has been developed to deal with complex chronic disorders, focusing on genomic etiologic factors. This approach appears in need of adaptation when applied to concurrent disorders. Because all treatment starts with a diagnosis, it seems important to focus on diagnosing or phenotyping, perhaps in the sense of “precision phenotyping.” All developments point towards increasing inclusiveness, integrating diverse groups of researchers and clinicians, and developing networks to accelerate progress. Promising projects will be discussed.

Références :

1. Hakobyan S, Vazirian S, Lee-Cheong S, et al. Concurrent disorder management guidelines. Systematic review. J Clin Med 2020;9(8):2406.
2. Scala JJ, Ganz AB, Snyder MP. Precision medicine approaches to mental health care. Physiology (Bethesda) 2023;38(2):0.