Poster – Research
P01 – “Somebody Pull Me Onto This Life Raft”: A Nested Mixed-Methods Cohort Study of Unmet Youth Mental Health Support Needs During COVID-19
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Caitlin Slomp*, MSc; Anna MacLellan, BA; John Best, PhD; Zainab Naqqash, BA; Boyee Lin, BS; Cynthia Lu, BA; Hasina Samji, PhD; S. Evelyn Stewart, MD

CanMEDS Roles:

1. Health Advocate

At the end of this session, participants will be able to: 1) Describe the prevalence of unmet mental health (MH) care needs among Canadian youth; 2) Identify barriers to accessing MH supports during COVID-19; and 3) Describe desired changes to MH supports in Canada from the perspectives of youth and their parents.

Canadian youth experienced profound mental health (MH) impacts and support access challenges throughout the COVID-19 pandemic (Stewart et al., 2023). Given the risk of long-term negative outcomes from unmet MH needs (Malla et al., 2018), it is critical to understand and target access barriers. We used a mixed-methods approach to explore MH needs and support access among Canadian youth during the COVID-19 pandemic.

Methods: The Personal Impacts of COVID-19 Survey (PICS) was administered to parents regarding their youth at baseline (November 2020 to July 2021) and follow-up time points (May to October 2022). Descriptive statistics were applied to key outcome measures: MH supports accessed, unmet MH support needs, and barriers to accessing MH supports. Concurrent qualitative interviews were conducted with select youth and parent proxies and analyzed for themes.

Results: Data from 507 baseline surveys and 88 follow-up surveys were analyzed. Use of MH supports among youth increased over time, though 19% reported an unmet need for formal MH support at follow up. Youth participants described difficulties with waitlists and finding the “right” therapist and a reliance on informal support throughout the pandemic. Parents described significant challenges navigating the MH system (knowing where to get help, limited availability, cost) that profoundly impacted their families’ ability to access care and mitigate negative MH outcomes.

Discussion: Canadian youth and their parents report persistent challenges accessing MH support. Increased clinician availability, school MH supports, parental education, and tools for accessing and navigating the MH system are needed to better support families.

References:

1. Stewart SE, Best J, Selles R, et al. Age-specific determinants of psychiatry outcomes after the first COVID-19 wave: baseline findings from a Canadian online cohort study. Child Adolesc Psychiatry Ment Health 2023;17(1):20.
2. Malla A, Shah J, Iyer S, et al. Youth mental health should be a top priority for health care in Canada. Can J Psychiatry 2018;63(4):216–222.

Poster – Research
P02 – A Literature Review of Workplace Violence in Health Care Settings and Effective Solutions
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Brendan Lyver*, HBSc; Rickinder Sethi, MD; Trevor Hanagan, N/A; Christian Schulz-Quach, MD

CanMEDS Roles:

1. Communicator
2. Professional
3. Leader

At the end of this session, participants will be able to: 1) Appreciate the scale of the workplace violence issue in health care settings; 2) Understand effective interventions to address workplace violence, such as agitation management and de-escalation; and 3) Appreciate the effectiveness of code white simulation training as a teaching method for health care providers.

Since the start of the COVID-19 pandemic, many health care institutions have contended with increasingly challenging patient and visitor behaviours taking the form of workplace violence (WPV). Research has reported that the annual rate of WPV-related non-fatal injuries is 10.4 per 10,000 full-time health care workers compared to 2.1 per 10 000 full-time workers for all other private industries combined. Meanwhile, reported WPV rates have more than doubled since the pandemic’s start. Literature has provided several solutions to address WPV, including agitation management, de-escalation, and simulated code white scenarios. Many studies have tried to avoid treating agitated patients with physical restraints and involuntary medication and engage in de-escalation techniques instead. Taking a patient-focused approach by determining the etiology of the patient’s agitation and their exposure to psychological trauma can be an effective method of de-escalation. Through the education of health care providers, the provision of decision aids, and restraint alternatives, health care institutions have successfully minimized their use of physical restraints. Immersive simulation-based training has demonstrated improvements in health care providers’ ability to assess and manage a patient’s needs and improve health care providers’ verbal de-escalation strategies. Although there are many aspects of addressing WPV in health care settings, providing health care workers with the necessary training to manage and de-escalate agitated patients is an effective starting point.

References:

1. Alostaz Z, Rose L, Mehta S, et al. Implementation of nonpharmacologic physical restraint minimization interventions in the adult intensive care unit: a scoping review. Intensive Crit Care Nurs 2022;69:103153.
2. Arnetz JE. The joint commission’s new and revised workplace violence prevention standards for hospitals: a major step forward toward improved quality and safety. Jt Comm J Qual Patient Saf 2022;48(4):241–245.

Poster – Research
P03 – A New Model of Care: A Co-Designed University-Hospital Partnership to Improve Access and Navigation of Acute Mental Health Services for Students
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Andrea Levinson*, MD MSc FRCPC; Andrea Levinson, MD MSc; Kristin Cleverley, RN, PhD, CPMHN; Christina Bartha, MSW, RSW; Sandy Welsh, PhD

CanMEDS Roles:

1. Leader
2. Collaborator
3. Medical Expert

At the end of this session, participants will be able to: 1) Identify key principles of authentic codesign in designing a new service, as it applies to this university-hospital partnership; 2) Learn about the implementation process of the Stepped Care 2.0 model; and 3) Understand key organizational barriers and facilitators arising from the design and implementation of an innovative university-hospital partnership.

In this presentation, attendees will learn about the University of Toronto mental health redesign, including a new hospital partnership to provide students with an acute mental health care navigation pathway. This project integrates Stepped Care 2.0, emerging evidence about mental health navigator roles, and innovative and inclusive approaches to the model’s codesign and evaluation. Presenters, which include student affairs professionals, mental health practitioners, faculty researchers, and senior university and hospital leaders, will illuminate the key processes, strengths, challenges, and potential opportunities for replicating the design and evaluation of this innovative model at their institutions. Early data and results will be shared, highlighting presenting concerns, transition readiness of students in this new service, key aspects around the consent process, and adoption of measurement-based care. The codesign aspects of the model will be discussed, as well as opportunities for student engagement moving forward.

References:

1. Wiens K, Bhattarai A, Dores A, et al. Mental health among Canadian postsecondary students: a mental health crisis? Can J Psychiatry 2020;65(1):30–5.
2. Cleverley K, Gore D, Nasir S, et al. Facilitating effective transitions from hospital to community for children and adolescent mental health services: overview of the transition support worker role and function. J Can Acad Child Adolesc Psychiatry 2018;27(4):228–235.

Poster – Research
P04 – A Scoping Review of Validation Studies for Commercially Available Smartphone Applications for Cognitive-Behavioural Therapy to Treat Insomnia
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Michael Mak*, MD; Armin Rahmani, MD

CanMEDS Roles:

1. Medical Expert
2. Health Advocate
3. Scholar

At the end of this session, participants will be able to: 1) Review the literature and identify digital cognitive-behavioural therapy for insomnia (dCBT-I) applications supported by validation studies; 2) Review the validation studies and highlight the study design; and 3) Identify gaps in dCBT-I validation and potential future areas of development.

Cognitive-behavioural therapy (CBT) remains the first-line treatment for insomnia disorder. Multiple studies have compared CBT for insomnia (CBT-I) with sedative hypnotics and found CBT-I to be equally as effective and durable, with relatively few adverse effects. Unfortunately, access to this intervention remains limited. Digital CBT-I (dCBT-I) aims to address the problem of scale in delivering CBT, traditionally a one-on-one affair.

Many smartphone applications claim to deliver evidence-based CBT-I. The goal of this study is to examine whether smartphone applications are delivering CBT-I through validated methods. We searched the two most popular smartphone application platforms, Google Play and Apple Store, using the search terms “sleep,” “insomnia,” and “CBT-I.” We searched for validation studies for these applications on Google Scholar and included studies conducted in the past ten years. Our second search consisted of reviewing PubMed and Google Scholar for validation studies for CBT-I applications. Our search terms were “CBT-I and smartphone,” “CBT-I and application,” and “CBT-I and digital.” We found a total of twelve applications that claimed to provide English CBT-I for adults. We then searched Google Scholar for validation studies for those applications and identified five studies that met inclusion criteria.

Most smartphone applications focused on insomnia do not follow CBT-I principles. Meditation, relaxing sounds, and relaxation techniques are popular approaches. Of the twelve dCBT-I applications commercially available on Google Play and Apple Store, only five are validated by studies published in peer reviewed journals.

References:

1. Kuhn E, Weiss BJ, Taylor KL, et al. CBT-I coach: a description and clinician perceptions of a mobile app for cognitive behavioral therapy for insomnia. J Clin Sleep Med 2016;12:597–606.
2. Seyffert M, Lagisetty P, Landgraf J, et al. M.A.M. Internet-delivered cognitive behavioral therapy to treat insomnia: a systematic review and meta-analysis. PLOS One 2016; 11:e0149139.

Poster – Research
P05 – Developing and Implementing Simulation for Psychiatric Training in Emergency Situations
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Yunlin Xue*, MD

CanMEDS Roles:

1. Communicator
2. Medical Expert
3. Leader

At the end of this session, participants will be able to: 1) Understand the role of simulation training in helping psychiatry residents bolster confidence in Code White and Blue; 2) Learn about the process of simulation design in psychiatry education; and 3) Consider the broader potentials of simulation training in psychiatric education.

Psychiatry residents are often first responders to agitated (Code White) and medically unwell (Code Blue) psychiatric patients. Training in a multisite residency program lacks standardization when a focus is placed on “on-the-job training.” There is often a lack of opportunities to encounter these situations for adequate training. This may compromise resident learning and ultimately patient safety. Simulation has been proven to effectively train medical learners and professionals for high-risk situations in other medical disciplines, with recent data showing similar benefits in psychiatric settings.

Objective: We aimed to improve and standardize training for psychiatry residents in Code Whites and Code Blues across six hospital sites.

Method: A committee of residents, simulation centre educators, and psychiatry staff codeveloped and implemented simulation scenarios on Code Whites and Code Blues. Nine residents engaged in a pilot study on a Code Blue (seizures) and Code White simulation, including prereadings, prebrief and debrief, and completion of entrustable professional activities (EPAs). Pre- and post-surveys were conducted to explore resident confidence, comfort, and knowledge when attending to psychiatric emergencies.

Results: A five-point Likert scale was used in pre- and post-surveys. Results indicated improvement in confidence and knowledge after completing the simulation. A total of 87.5% of residents found the debrief provided new insights and learning that they will apply in practice.

Conclusion: We hypothesize that simulation is a promising option for psychiatry residents to develop confidence, knowledge, and comfort in responding to psychiatric emergencies.

References:

1. Piot MA, Attoe C, Billon G, et al. Simulation training in psychiatry for medical education: a review. Front Psychiatry 2021;12:658967.
2. Beal MD, Kinnear J, Anderson CR, et al. The effectiveness of medical simulation in teaching medical students critical care medicine: a systematic review and meta-analysis. Simul Healthc 2017;12(2):104–116.

Poster – Research
P06 – Effectiveness of a Parent Psychoeducation Intervention to Improve Symptoms in Children with Common Mental Health Disorders: A Systematic Review
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Jenna Nensi*, N/A; Amrita Pannu, MBBS, MHPE; Yan Deng, MD, MSc; Sarosh Khalid-Khan, MD, DABPN, FRCPC

CanMEDS Roles:

1. Medical Expert
2. Communicator
3. Health Advocate

At the end of this session, participants will be able to: 1) Review parent psychoeducation to improve symptoms in children with common mental health disorders; 2) Identify the effectiveness of parent psychoeducation to guide treatment of youth with mental health disorders; and 3) Determine psychoeducation treatment recommendations of youth with mental health disorders.

Current practice guidelines for the treatment of youth with psychiatric disorders include integrating pharmacological treatment with psychosocial interventions. This systematic review will determine the effectiveness of psychoeducation as a treatment modality for parents of children with mental health disorders.

Method: The authors searched databases such as MEDLINE, Embase, PsycINFO, and EBM reviews. Using various keywords and subheadings, the search was divided into four concepts: psychoeducation, parenting, mental disorders, and child/adolescent psychiatry. Based on the predetermined inclusion and exclusion criteria, 19 journal articles were finalized from an initial result of 1,179 articles. Covidence Systematic Review was used for article screening and data extraction. Cochrane risk-of-bias in randomized trials (RoB 2) was used for risk-of-bias assessment. Due to the heterogeneity of the study measurement, the included studies were classified into different themes. Review Manager 5.0 was used to compare the effectiveness of psychoeducation versus the control group.

Outcomes: Because all the included studies were randomized controlled trials, we expected the risk-of-bias to be low to medium. We hypothesized that the participants who received psychoeducation would have more knowledge of the diseases than the control group and that patients in the study group have an improvement in mental health symptoms.

Conclusion: In summary, psychoeducation has been used as a treatment modality for parents of children with mental health disorders. Using the data collected from this systematic review, the effectiveness of parent psychoeducation will be measured to guide future treatment of youth with mental health disorders.

References:

1. Montoya A, Colom F, Ferrín M. Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review. Eur Psychiatry 2011;26:166–75.
2. Miklowitz DJ, Peris TS, Lord C. Helping families to understand and cope with psychiatric disorders in childhood-beyond basic facts. JAMA Psychiatry 2020;77(4):433–434.

Poster – Research
P07 – Efficacy and Safety of Aripiprazole Augmentation in Schizophrenia: A Meta-Analysis of Randomized Controlled Trials
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
David Kim*, Ph.D. Alasdair Barr, Ph.D. Randall White, M.D. William Honer, M.D. Ric Procyshyn, Pharm.D., Ph.D.

CanMEDS Roles:

1.  

At the end of this session, participants will be able to: 1) Understand how dopamine D2 receptor partial agonism may have additional clinical benefits in patients with schizophrenia; 2) Acknowledge the lack of evidence for dopamine D2 receptor partial agonists other than aripiprazole; and 3) Acknowledge the need for more studies to generalize our findings to treatment-resistant patients.

Background: Antipsychotic polypharmacy is a common practice in the treatment of schizophrenia, despite the need for more evidence for its efficacy and safety. A systematic review and meta-analysis was conducted to better understand the efficacy and safety of dopamine D2 receptor partial agonist augmentation in patients with schizophrenia.

Methods: Randomized controlled trials that compared the efficacy (overall, positive, negative, and depressive symptoms) and safety (trial discontinuation, akathisia, prolactin levels, and body weight) between antipsychotic monotherapy and D2 partial agonist augmentation (aripiprazole, brexpiprazole, and cariprazine) in patients with schizophrenia were included. Standardized mean differences (SMDs) and risk ratios (RRs) were calculated with random-effects models.

Results: Sixteen studies with 1,299 patients were included, all involving aripiprazole augmentation (mean dose = 11.4 mg/day; mean duration = 12.3 weeks). Compared with monotherapy, aripiprazole augmentation demonstrated a greater reduction in overall [n = 14, SMD = –0.45 (–0.70 to –0.19)] and negative symptoms (n = 9, SMD = –0.41 [-0.68 to –0.15]), but not positive (n = 7, SMD = –0.41 [–1.54 to 0.73]) or depressive symptoms (n = 4, SMD = –0.08 [–0.28 to 0.11]). Moreover, aripiprazole augmentation significantly reduced prolactin levels (n = 10, SMD = –1.24 [–1.69 to –0.80]), and there were no significant changes in the incidence of trial discontinuation or akathisia, or in body weight. Meta-regression analyses revealed that longer trial durations were associated with higher all-cause discontinuation rates (p = 0.029), and higher baseline prolactin levels were associated with greater reductions in their levels (p = 0.049).

Conclusions: Our meta-analysis suggests that aripiprazole augmentation is efficacious and safe in patients with schizophrenia. Future studies should examine the effects of other D2 partial agonists (brexpiprazole and cariprazine).

References:

1. Zheng W, Zheng YJ, Li XB, et al. Efficacy and safety of adjunctive aripiprazole in schizophrenia: meta-analysis of randomized controlled trials. J Clin Psychopharmacol 2016;36(6):628–636.
2. Galling B, Roldán A, Hagi K, et al. Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta-analysis and meta-regression analysis. World Psychiatry 2017;16(1):77–89.

Poster – Research
P08 – Impact of the COVID-19 Pandemic on the Health of People with Intellectual Disability: A Systematic Review
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Anupam Thakur*, MBBS, MD, MSc; Laura Koch, BSc; Sabrina Campanella, BSc; Amandi Perera, BSc

CanMEDS Roles:

1. Scholar
2. Health Advocate
3. Collaborator

At the end of this session, participants will be able to: 1) Understand the impact of COVID-19 on the mental health of adults with intellectual and developmental disabilities; 2) Discuss the impact of COVID-19 on the physical health of adults with intellectual and developmental disabilities; and 3) Discuss the psychosocial impact of the COVID-19 pandemic on adults with intellectual and developmental disabilities.

The COVID-19 pandemic has negatively impacted the physical, social, and mental well being of people with intellectual disability (ID), largely due to pre-existing health conditions, mental illness, cognitive challenges, social exclusion, and inequities in pandemic response plans.

Objectives: This systematic review explores the health and psychosocial impact of the COVID-19 pandemic on adults (aged 18 years and over) with ID.

Methods: A review protocol and search strategy following PRISMA guidelines were compiled and registered with PROSPERO. Following full-text screening by two independent reviewers, a total of 62 articles have been reviewed.

Results: Studies included in the review present data from various perspectives, such as formal and informal caregivers, and direct accounts from people with ID, as well as administrative health data. Preliminary findings highlight the vulnerability of people with ID to COVID-19, as this population experienced higher hospital and ICU admissions and increased mortality compared to people without ID. This population was more likely to become infected with COVID-19 if they lived in a congregate setting, had poor access to or difficulty wearing personal protective equipment, and required close-contact care. Overall, the pandemic has led to poor mental and physical health, loss of skills, increase in behaviours that challenge, and a loss of social supports and community engagement.

Conclusion: People with ID were disproportionately impacted by the COVID-19 pandemic. Responsive pandemic recovery solutions require the meaningful inclusion of the perspectives of people with ID and their caregivers, given their unique experiences throughout the past few years.

References:

1. Courtenay K, Perera B. COVID-19 and people with intellectual disability: impacts of a pandemic. Ir J Psychol Med 2020;37(3):231–236.
2. Koks-Leensen MCJ, Schalk BWM, Bakker-van Gijssel EJ, et al. Risk for severe COVID-19 outcomes among persons with intellectual disabilities, the Netherlands. Emerg Infect Dis 2023;29(1):118–126.

Poster – Research
P10 – Inflammatory Changes with Repetitive Transcranial Magnetic Stimulation: The Search for Biomarkers of Post-Traumatic Stress Disorder Treatment
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Raechelle Gibson, MD, PhD Meng Wang, MSc Christina Campbell, PT, MSc Alison Wilson, BA, BCOM Chantel Debert*, MD, MSc, FRCPC, CSCN

CanMEDS Roles:

1. Medical Expert
2. Scholar

At the end of this session, participants will be able to: 1) Describe the recent evidence for repetitive transcranial magnetic stimulation as a treatment for post-traumatic stress disorder (PTSD); 2) Identify potential sources of variability pertaining to inflammatory markers for people with PTSD; and 3) Consider future directions and barriers for the identification of biomarkers for PTSD.

Post-traumatic stress disorder (PTSD) is a mental illness associated with a considerable burden of psychiatric and medical comorbidities (Passos et al., 2015). While repetitive transcranial magnetic stimulation (rTMS) may be an effective treatment (McGirr et al., 2021), there are not yet biomarkers for PTSD to help refine treatment (Passos et al., 2015). We investigated whether there is a relation between serum inflammatory markers and PTSD and whether rTMS of the dorso-lateral prefrontal cortex (DLPFC) versus the DMPFC (dorso-medial prefrontal cortex) is associated with inflammatory changes.

Twenty-five adults with PTSD participated in a double-blind, concealed allocation, randomized controlled trial. Participants completed a one-week sham rTMS lead-in followed by a four-week rTMS treatment protocol of either the right DLPFC or DMPFC. Measures of PTSD, quality of life, depression, and 17 cytokines with roles in inflammation were collected at baseline, after sham rTMS, and after treatment rTMS. Analyses included Spearman correlation and partial rank-order correlation coefficients and linear mixed-effect regression. PTSD measures were not significantly correlated with inflammatory markers at baseline (p > 0.17). There was also no relation between cytokines and other measures of mental health at baseline (p > 0.11). Cytokine values did not significantly change over time, and rTMS did not influence changes in cytokines, with and without adjusting for age, sex, and the placebo effect. The relation between PTSD and inflammation is complex, with many potential sources of variance, such as the ictal interval from trauma and head injury; further investigations are needed to delineate the time course of these inflammatory changes.

References:

1. McGirr A, Devoe DJ, Raedler A, et al. Repetitive transcranial magnetic stimulation for the treatment of post-traumatic stress disorder: a systematic review and network meta-analysis. Can J Psychiatry 2021;66(9):763–773.
2. Passos IC, Vasconcelos-Moreno MP, Costa LG, et al. Inflammatory markers in post-traumatic stress disorder: a systematic review, meta-analysis, and meta-regression. Lancet Psychiatry 2015;2(11):1002–1012.

Poster – Research
P11 – Integrated Care Model for Addiction Services
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Abstract information

CanMEDS Roles:

1. Health Advocate
2. Collaborator
3. Scholar

At the end of this session, participants will be able to: 1) Discover ways to reduce emergency department recidivism; 2) Understand the improvement of access and flow; and 3) Understand the full spectrum of addiction services in one place, from high- to lower-intensity needs with no silos.

William Osler Health System Addiction Services focused on program re-design to meet the changing needs of the community. Harm reduction and abstinence-based programs were developed to address these needs. These programs created a full spectrum of services from high to lower intensity. The focus was to reduce emergency department (ED) recidivism and create an integrated care model with no barriers to services or wait times.

To address community need, our addiction services created low-barrier immediate access to comprehensive treatment. Self-referral access to care begins with a phone call to our centralized intake team. Calls are answered live by addiction clinicians who provide support, assessment, and referral throughout our program options. All services work together to provide individualized treatment plans based on clients’ stages of change and readiness. Outpatient services have a range of groups to meet client needs, including workshops, psycho-education, evidence-based cognitive-behavioural therapy skills, and process groups with open admission. We also offer aftercare, support groups, and family programming. A digital behaviour change program (Breaking Free) is integrated throughout the services.

All clinicians are concurrent disorder-capable, which is reflected in the development of all programming. This framework was introduced in 2021 and has continued to evolve. We will present data comparing the current vs. previous siloed approach. These data will compare ED revisit rates, volumes (number of clients served 1:1, aftercare, and in group settings), attendance, wait times, drop-out rates, and client perceptions of changes.

References:

1. Timko C, Schultz, NR, Britt J, et al. Transition from detoxification to substance use disorder treatment: facilitators and barriers. J Subst Abuse Treat 2016;70:64–72.
2. Priest KC, Englander H, McCarty D. “Now hospital leaders are paying attention”: a qualitative study of internal and external factors influencing addiction consult services. J Subst Abuse Treat 2020;110:59–65.

Poster – Research
P12 – Peripheral Insulin Sensitivity Modulates Effort-Based Behavioural Response to Intranasal Insulin in People with Mood Disorders
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Aniqa Tabassum*, HBSc; Rodrigo Mansur, MD, PhD

CanMEDS Roles:

1. Scholar
2. Collaborator
3. Leader

At the end of this session, participants will be able to: 1) Identify the implications of a bidirectional epidemiological association between mood and metabolic disorders; 2) Understand the role that insulin may play in modulating behaviour in overweight people with mood disorders; and 3) Recognize the underpinnings and implications of a potential neurobiological association between mood and metabolic disorders.

Mood disorders (i.e., major depressive disorder [MDD]) and bipolar disorder [BD]) and metabolic disorders (e.g., type 2 diabetes [T2D]) have a bidirectional epidemiologic association. To uncover mechanisms underlying the mood-metabolic disorders comorbidity, this study investigated the role of peripheral insulin resistance (IR) in effort-based reward behaviour in overweight (body mass index [BMI > 25.0) people with mood disorders. This randomized crossover trial assessed effort-based decision making in 17 participants (10 BD, 7 MDD) using the Effort-Expenditure for Rewards Task (EEfRT) in a functional MRI paradigm after intranasal insulin and placebo. Peripheral interventional radiology (IR) was calculated with the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Peripheral IR moderated the behavioural response to intranasal insulin (condition [insulin vs. placebo] by IR interaction: Wald χ2 = 10.907, p < 0.001). Insulin-resistant participants (HOMA-IR > 1.3) showed no differences in likelihood of choosing the hard over the easy task on the EEfRT between the conditions (insulin 38%, standard error [SE] = 6.8, placebo 41%, SE = 6.6). In contrast, insulin-sensitive participants (HOMA-IR < 1.3) were more likely to select the hard task in the placebo (67%, SE = 7.3) versus the insulin condition (49%, SE = 7.2). There were no effects of BMI and adjustments for age, sex, Montgomery-Asberg Depression Rating Scale (MADRS) scores and medications did not modify the moderating effect. Insulin-induced differences in reward-seeking behaviour between insulin sensitive and resistant people provides support for a neurobiological association between mood and metabolic disorders. The data collected from fMRI are expected to elucidate potential underlying differences in brain activity.

References:

1. Mansur RB, Brietzke E, McIntyre RS. Is there a “metabolic-mood syndrome”? A review of the relationship between obesity and mood disorders. Neurosci Biobehav Rev 2015;52:89–104.
2. Mansur RB, Subramaniapillai M, Zuckerman H, et al. Effort-based decision-making is affected by overweight/obesity in major depressive disorder. J Affect Disord 2019;256:221–227.

Poster – Research
P13 – Predicting Child and Youth Mental Health Service Use with Deep Learning Models
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Hirad Daneshvar, Ph.D. Candidate; Sajjad Rashidiani, MSc.; Judy Zhao, MSc.; Ahmad Mauluddin, MSc.; Omar Boursalie, Ph.D.; Laura Duncan, Ph.D.; Paulo Pires, Ph.D.; Roberto Sassi, MD. Ph.D.; Reza Samavi, Ph.D.; Thomas Doyle, Ph.D.

CanMEDS Roles:

1. Scholar

At the end of this session, participants will be able to: 1) Learn how to leverage pretrained knowledge in a deep learning model to improve questionnaire data analysis; 2) Learn how to use the hidden semantics available in the data; and 3) Explore clinical features associated with increased risk of emergency department presentation after outpatient mental health intake.

Predicting adverse outcomes in clinical settings with artificial intelligence (AI) is increasingly common but limited in the field of child and youth mental health. In this study, we investigate the application of deep learning in child and youth mental health service use. We used two sources: i) a set of mental health questionnaires for children and youth and their caregivers and ii) the youth’s history of medical service use (e.g., outpatient, inpatient, and emergency department [ED] visits). Data were extracted from a database of patients aged under 18 years who had their first outpatient mental health intake at the Ron Joyce Children’s Health Centre, McMaster Children’s Hospital, between April 01, 2002, and July 31, 2021. The dataset is heterogeneous as it contains information of different types. We show the effectiveness of deep learning models with questionnaire and service use data in predicting future ED visits. We developed three models: 1) a pre-trained BERT model to extract information from questionnaire and symptom scales and predict six-month ED visits after outpatient intake, achieving area under the receiver operating curve (ROC AUC) of 0.77; 2) a Graph Neural Network (GNN) that uses patient graphs extracted from the medical records to predict 30-day readmission rates with F1-measure of 0.65; and 3) another GNN model that uses questionnaire data to predict six-month ED visits, achieving ROC AUC of 0.78. Although preliminary, these risk predictive models demonsterate potential clinical usefulness and may eventually help inform clinical decisions to prevent negative outcomes.

References:

1. Dwyer D, Koutsouleris N. Annual research review: translational machine learning for child and adolescent psychiatry. J Child Psychol Psychiatr 2022;63(4):421–443.
2. Shatte AB, Hutchinson DM, Teague SJ. Machine learning in mental health: a scoping review of methods and applications. Psychol Med 2019;49(9):1426–1448.

Poster – Research
P14 – Resident Transition to Practice and Service Impact of a Restricted Registration Resident “Moonlighting” Pilot Project in a Community Hospital Mental Health Department
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Michael Tseng*, MD, PhD, FRCPC; Certina Ho, RPh, BScPhm, MISt, M

CanMEDS Roles:

1. Communicator
2. Professional
3. Scholar

At the end of this session, participants will be able to: 1) Identify the potential impact of a restricted registration resident (RRR) program on service delivery at a community hospital mental health department; 2) Describe the opportunities for improvements in residency training through participation in an RRR program; and 3) Relate lessons learned from the RRR pilot to the Royal College ‘Transition to Practice’ stage of the Competence by Design continuum.

“Restricted registration” (RR) is a College of Physicians and Surgeons of Ontario (CPSO) certificate offered to residents of all specialties across five Ontario medical schools that permits the provision of clinical services for remuneration outside their training program. In March 2021, the North York General Hospital Department of Psychiatry conducted a five-month RR pilot project, where two psychiatry residents were credentialed to provide coverage for 24-hour psychiatry on-call shifts involving child, geriatric, and adult inpatient rounds; consultation and liaison; and emergency department (ED) consultations. Supervision was provided by a staff psychiatrist (the most responsible physician).

This study examined the stakeholder perspectives of the restricted registration resident (RRR) pilot project, given the lack of literature in this area. Stakeholder (residents, supervisors, EDs, and inpatient staff) interviews were completed with a semistructured focus group guide.

The residents noted a significant improvement in Transition to Practice skills, including increased clinical and billing confidence, autonomy, and excellent remuneration. Supervisors found that resident performance met expectations and that they spent less time on-site, compared to non-RRR on-call shifts, with no medicolegal concerns. The ED crisis and inpatient teams noted improved disposition time through ED and inpatient support. Residents noted the workload could be considerable, while supervisors contemplated the effect of the RRR program on-call expectations.

Given the multisource positive feedback to our pilot, the RR program has been opened to qualified University of Toronto residents relevant to the Department of Psychiatry Transition to Practice curriculum. Interest from stakeholders remains promising, with continued opportunity for ongoing quality improvement.

References:

1. Benson NM, Beach SR. After hours: a survey of moonlighting practices in psychiatry residents. Acad Psychiatry 2019;43(1):18–22.
2. Robinson LA, Osborne LM, Hsu AJ, et al. Moonlighting by psychiatry residents: a survey of residents and training directors. Acad Psychiatry 2019;43(1):46–50.

Poster – Research
P15 – Semaglutide for the Treatment of Cognitive Dysfunction in Major Depressive Disorder
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Rodrigo Mansur*, MD, PhD; Joshua Di Vincenzo, MSc.; Andrea McKenzie, HBSc.; Aniqa Tabassum, HBSc.; Hartej Gill, PhD. Candidate; Sebastian Badulescu, HBSc.; Roger McIntyre, M.D.; Joshua Rosenblat, M.D., MSc.

CanMEDS Roles:

1. Scholar
2. Leader
3. Health Advocate

At the end of this session, participants will be able to: 1) Understand the rationale for using semaglutide and other antidiabetes drugs as a potential treatment for cognitive dysfunction in major depressive disorder and the current state of evidence supporting this use; 2) Learn about the design and methodology of the clinical trial, including the sample size, study population, randomization process, and primary and secondary outcome measures; and 3) Describe preliminary results of the trial, including mediators/predictors of cognitive function and depression severity and adverse events.

Evidence suggests glucagon-like peptide-1 (GLP-1) receptor agonists may have cognitive-enhancing effects. In a small randomized placebo-controlled trial, liraglutide was found to significantly improve cognition in patients with major depressive disorder (MDD) (Mansur et al., 2017). Similarly, an open-label trial found liraglutide to significantly improve all included measures of cognitive function in 50 people with type 2 diabetes mellitus, compared to the standard-of-care control group (Li et al., 2021). Further research is needed to confirm the cognitive-enhancing effects of GLP-1 agonists in MDD and to determine the optimal dosage and regimen. Semaglutide, a GLP-1 receptor agonist, is an effective antidiabetic and weight-loss agent. However, the efficacy and safety of oral semaglutide in people with MDD has not been ascertained. This double-blind, randomized, placebo-controlled trial evaluates the effects of 16 weeks of oral semaglutide on cognitive dysfunction in adults with MDD, with a target enrolment of 60 participants. The sample has been enriched for cognitive dysfunction; only people with impaired executive function at baseline are eligible. The primary outcome measure is change in Trail Making Task B score from baseline to Week 16. Cognitive function is assessed at baseline and weeks 4, 10, and 16, with an additional post-endpoint assessment at Week 20. To date, 23 participants have been enrolled. Secondary outcome measures include change in depressive symptoms, functional impairment, quality of life, and safety. This study will provide insights into the potential role of semaglutide as a treatment for cognitive dysfunction in MDD and will inform future clinical practice.

References:

1. Li Q, Jia M, Yan Z, et al. Activation of glucagon-like peptide-1 receptor ameliorates cognitive decline in type 2 diabetes mellitus through a metabolism-independent pathway. J Am Heart Assoc 2021;10(14):e020734. doi:10.1161/JAHA.120.020734
2. Mansur RB, Ahmed J, Cha DS, et al. Liraglutide promotes improvements in objective measures of cognitive dysfunction in individuals with mood disorders: a pilot, open-label study. J Affect Disord 2017;207:114–120.

Poster – Research
P16 – Talk-In, Walk Out: A Hospital-Based Single-Session Counselling Model
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Emma Blake*, MSW, RSW; Shabbir Amanullah, DPM, MD, FRCPsych, Shelly-Lynne Muldoon, MSW, RSW.

CanMEDS Roles:

1. Professional
2. Medical Expert

At the end of this session, participants will be able to: 1) Implement a single-session counselling model to an acute care outpatient hospital setting; 2) Value single-session therapy as an intervention strategy for treating acute patients; and 3) Adapt a new hybrid model of prebooked and same-day walk-in sessions.

Single-session counselling models have been implemented throughout Canada since the 1990s, with most clinics being offered through community-based mental health agencies or fee-for-service family counselling centres. Extensive waitlists for mental health counselling services are common, and offering a single-session or walk-in counselling model has become a popular intervention for managing waitlists. A comparison study revealed that walk-in clients improved quicker after a four-week follow-up and were less distressed than those accessing a traditional counselling model involving a waitlist (Stalker et al., 2016). Acute-care facilities that offer outpatient psychiatric and counselling services are not exempt from these waitlists. Young suggests that organizations must consider that, regardless of the satisfaction of a single session, it is vital that clients know further support may be available. (Young 2020) To manage an ever-growing counselling waitlist for outpatient referrals received from their outpatient psychiatry clinic, this hospital developed and implemented a walk-in counselling model that has changed the landscape of service delivery by increasing collaborative patient care between social work and psychiatry teams, reducing the overall wait time for outpatient counselling services and offering brief follow up to patients if appropriate. Rebranding as a “talk-in” clinic to adapt to the COVID-19 pandemic, this clinic has also implemented a new hybrid model to accommodate patient needs while maintaining the health and safety measures required to operate a clinic within a hospital setting.

References:

1. Stalker CA, Riemer M, Cait CA, et al. A comparison of walk-in counselling and the wait list model for delivering counselling services. J Mental Health 2016;25:403–9.
2. Young J. Putting single session thinking to work: conceptual, practical, training, and implementation ideas. Aust N Z J Fam Ther 2020;41:231–248.

Poster – Research
P17 – The Effect of Intranasal Insulin on Reward Response and Anhedonia in Mood Disorders
Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Andrea Mckenzie*, BSc Aniqa Tabassum Joshua Di Vincenzo Rodrigo Mansur

CanMEDS Roles:

1. Professional

At the end of this session, participants will be able to: 1) Gain knowledge about clinical characteristics and treatment approaches in major depressive disorder (MDD) and bipolar disorder (BD); 2) Learn more about clinical and biological markers specific to the assessment, diagnosis, and treatment of patients with MDD and BD; and 3) Learn more about the affects of the insulin-signalling pathway in mood disorders.

Anhedonia and reduced reward response are two hallmark features of mood disorders. Insulin signalling plays a crucial role in the measures of anhedonia and reward behaviours in people with both bipolar disorder (BD) and major depressive disorder (MDD). We hypothesized that people with MDD and BD will display decreased effort in reward response / increased anhedonia, measured by validated behavioural tasks and clinical scales and that the use of intranasal insulin may affect their response.

Methods: Ten eligible BD and seven MDD patients aged 18 to 60 years participated in an ongoing three-week double-blind crossover study with reward-based assessments and questionnaires focusing on behavioural / anhedonic measures. Each participant received an intranasal dose of Humulin R insulin (100 U/mL), and placebo spray, randomized between Week 2 and Week 3. The primary behavioural measurement was an effort-based decision-making task (effort-expenditure for rewards task [EEfRT]), performed inside an fMRI directly after the intranasal spray. This task is designed to measure willingness to exert greater effort to receive a larger reward. Other assessments included the Snaith-Hamilton Pleasure Scale (SHPS), Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Monetary Incentive Delay, Probabilistic Reward, and four-armed bandit tasks.

Results: Seventeen participants were included in this preliminary analysis. Results indicated that intranasal insulin modulated the reward response in people with mood disorders. There was an overall main effect of condition (insulin vs. placebo) on the likelihood of choosing the hard over the easy task on the EEfRT (Wald χ2 = 7.991; p = 0.005). Participants on the insulin condition chose the hard task on average 44% of trials (standard error [SE] = 4.9), whereas on placebo the average was 54% (SE = 5.8). There were no effects on reaction time nor of randomization order or diagnosis. Adjustments for age, sex, MADRS scores, and medications did not modify the main results.

Conclusion: Intranasal insulin was shown to modulate the reward response in people with MDD and BD. Further research will be done to investigate the effects of intranasal insulin in the reward responses of patients with mood disorders.

References:

1. Pan Z, Park C, Brietzke E, et al. Cognitive impairment in major depressive disorder. CNS Spectr 2019;24(1):22–29.
2. Hamer JA, Testani D, Mansur RB, et al. Brain insulin resistance: a treatment target for cognitive impairment and anhedonia in depression. Exp Neurol 2019;315:1–8.