Poster – Research
P18 – Bridging Research and Routine Clinical Care: Developing the BC Children’s Hospital Mental Health Research Registry
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Gordan Andjelic*, BA; Anna MacLellan, BA, MSc; Roberto Sassi, MD; S. Evelyn Stewart, MD

CanMEDS Roles:

1. Collaborator
2. Scholar

At the end of this session, participants will be able to: 1) Describe lessons learned and implications for full implementation and sustainability of a multiclinic research registry in pediatric mental health; 2) Identify strengths and potential barriers to conducting exclusively online recruitment and electronic consenting; and 3) Understand considerations pertaining to the development and establishment of a robust data access and governance process.

Psychiatric research registries have been in place in northern Europe for many decades but have yet to become the norm in Canadian psychiatry departments. Factors influencing the feasible development and sustainability of Canadian health care-related research registries include federal-provincial funding models, health authority privacy concerns, and research ethics board requirements.

Purpose: We will describe the development, implementation, and expansion of a youth-, parent-, and teacher-informed clinical database and research registry within a tertiary care facility department of psychiatry. In 2011, a research registry was integrated with the founding of an obsessive–compulsive disorder clinical research program. In the following decade, it was expanded across mental health subspecialty outpatient clinics, inpatient units, and a residential treatment facility at BC Children’s Hospital. Key decisions and implementation factors related to the use of a REDCap data storage platform, change management approaches, engagement of clinicians and families with lived experience, and determination of standard operating procedures for standardized data collection with new clinical assessments. Ongoing database management and quality maintenance procedures were established. Collaboration with provincial health services administrators, clinicians, and the university research ethics board was crucial in establishing access/governance processes. Differentiation between electronic medical record data and research data will be discussed in addition to future goals.

Conclusion: Many lessons were learned in the development and expansion of a psychiatry clinical database and parallel research registry over the past decade. This presentation aims to share gained knowledge that may inform interested researchers and clinicians.

References:

1. Munk-Jørgensen P, Okkels N, Golberg D, et al. Fifty years’ development and future perspectives of psychiatric register research. Acta Psychiatr Scand 2014;130(2):87–98.
2. Choinière M, Ware MA, Pagé MG, et al. Development and implementation of a registry of patients attending multidisciplinary pain treatment clinics: the Quebec pain registry. Pain Res Manag 2017;2017:8123812.

Poster – Research
P19 – Characteristics of People with Bipolar Disorder with and without Substance Use Disorders
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Jenna Baer*, Bsc.; Alexandria Coles, M.Sc.; David Castle, M.B., Ch.B, MRC Psyc; Tony George, M.D., FRCPC

CanMEDS Roles:

1. Scholar
2. Communicator
3. Collaborator

At the end of this session, participants will be able to: 1) Identify at least one difference in clinical presentation of people with comorbid bipolar disorder (BD) and substance use disorder (SUD) when compared to those with BD only; 2) Describe which medications (e.g., anticonvulsant mood stabilizers) have been found to be more effective in treating those with BD and comorbid SUD according to the literature; and 3) Explain the importance of understanding the intersection of BD and SUD comorbidity for treatment.

People with bipolar disorder (BD) have higher rates of substance use disorders (SUDs) compared to the general population. (1) Given that SUDs (e.g., cannabis, alcohol, stimulant, MDMA, and opioid use disorders) often begin in adolescence, it is important to understand the clinical and phenomenological characteristics and potential differences that can be targeted for treatment development. In our preliminary work, we have found that anticonvulsant mood stabilizers (e.g., lamotrigine, valproate) appear to have preferential effects on substance use and bipolar symptoms in people with co-occurring SUDs and BD, versus lithium. (2)

Methods: We conducted a systematic review of clinical characteristics of patients with BD. Eleven studies were found in PubMed, MEDLINE, and PsycINFO, including 3,030 participants with BD and co-occurring SUD and 2,851 participants with BD without SUD.

Results: These results suggest that co-occurring BD and SUD have the following clinical characteristics, compared to BD patients without SUD: more rapid cycling illness, dysphoric (mixed) mania, younger age of BD onset, more severe depressive symptoms and more time spent in the depressed versus (hypo)manic phase of illness, lower GAF scores, more suicidal ideation and attempts, more criminal justice system involvement, and more often users of cannabis, alcohol, cocaine and (or) opioids.

Conclusion: Because most studies were cross-sectional, well-controlled high-quality studies are needed to better understand this important comorbidity. Moreover, this work could have important implications for the diagnosis, treatment, and prevention of SUDs in youth with BD.

References:

1. Stokes PRA, Kalk NJ, Young AH. Bipolar disorder and addictions: the elephant in the room. Br J Psychiatry 2017;211:132–4.
2. Coles AS, Sasiadek J, George TP. Pharmacotherapies for co-occurring substance use and bipolar disorders: a systematic review. Bipolar Disord 2019;21:595–610.

Poster – Research
P20 – Diabetes Canada 2023 Clinical Practice Guideline Update: Executive Summary of the Mental Health Chapter
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
David Robinson*, MD FRCPC

CanMEDS Roles:

1. Health Advocate
2. Collaborator
3. Scholar

At the end of this session, participants will be able to: 1) Review the highlights of the mental health chapter of Diabetes Canada’s clinical practice guidelines; 2) Analyze psychotropic medications to see their effects on metabolic parameters; and 3) Examine the expanded range of psychiatric conditions that increase the risk of developing type 2 diabetes.

This presentation provides learners with an executive summary of the mental health chapter of Diabetes Canada’s clinical practice guidelines, which were updated for 2023. The lead author will present and highlight the practice applications for mental health care practitioners involved in the care of people with diabetes (principally type 2, but with some information provided on type 1). This presentation will focus principally on the expanded range of psychiatric conditions that put people at risk for developing diabetes, updated pharmacology recommendations, and a summary of the psychosocial approaches used in specialty clinics.

References:

1. Robinson DJ, Coons M, Haensel H, et al. Diabetes Canada 2018 clinical practice guidelines. Chapter 18: Diabetes and mental health. Can J Diabetes 2018;42(Suppl):S130–S141.
2. Robinson DJ, Hanson K, Jain A, et al. Diabetes Canada 2023 clinical practice guidelines. Chapter 18: Diabetes and mental health. Can J Diabetest 2023. In Press.

Poster – Research
P21 – Efficacy of Incorporating a Stepped-Care Approach into Electronic Cognitive-Behavioural Therapy for Depression
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Jasleen Jagayat* BSc, Anastasia Shao BA, Anchan Kumar MD, Amrita Pannu MD, Charmy Patel MSc, Amirhossein Shirazi MD PhD, Mohsen Omrani MD PhD, Nazanin Alavi MD FRCPC

CanMEDS Roles:

1. Scholar
2. Communicator

At the end of this session, participants will be able to: 1) Be able to compare online cognitive-behavioural therapy to traditional face-to-face therapy; 2) Be able to describe the role of a stepped-care model and the benefits of incorporating such a model into mental health care; and 3) Be able to consider using additional interventions in their care that can assist psychotherapy outcomes.

Depression is a leading cause of disability, annually affecting up to 300 million people worldwide, yet fewer than one-third of patients receive care. Electronic cognitive-behavioural therapy (eCBT) is an effective treatment for depression, and combining eCBT with supervised care could make therapy scalable with a stepped-care model: a care model that adapts care intensity based on the patient’s progression. This single-blinded randomized controlled trial investigated the efficacy of a stepped-care eCBT model for depression. Participants were randomized to either the eCBT–only group (n = 53) or the eCBT with stepped-care group (n = 26). Participants in the experimental group received additional interventions from their care provider based on their questionnaire scores and textual data. From lowest to highest intensity, the interventions included messages, phone calls, video calls, or a video call with a psychiatrist. The addition of stepped care was not significantly different from eCBT only. Changes in Patient Health Questionnaire (PHQ-9) scores (p = 0.20), quality of life (p = 0.45), and treatment adherence (p = 0.09) did not change significantly, but changes in Quick Inventory of Depressive Symptomatology (QIDS) scores did reflect significance (p = 0.03). Although there were no significant differences observed between the number of participants who completed the program between groups (p = 0.12), participants in the stepped-care group took part in more sessions than those who prematurely terminated participation in the eCBT group. By understanding the therapeutic needs of each patient, we hope to use these results to develop a decision-making process that can effectively triage patients.

References:

1. Nicholas J, Ringland KE, Graham AK, et al. Stepping up: predictors of ‘stepping’ within an iCBT stepped-care intervention for depression. Int J Environ Res Public Health 2019;16(23):4689.
2. Karyotaki E, Ebert DD, Donkin L, et al. Do guided Internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis. Clin Psychol Rev 2018;63:80–92.

Poster – Research
P22 – Implementing a Community of Practice for Mental Health Advocates in an Immigrant Urban Community in the Greater Toronto Area
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Sarosh Khalid-Khan*, MD

CanMEDS Roles:

1. Collaborator
2. Communicator
3. Health Advocate

At the end of this session, participants will be able to: 1) Gain knowledge of the benefit of implementing coaching sessions with mental health advocates in a Muslim immigrant community in Toronto; 2) Become aware of developing a community of practice with mental health advocates; and 3) Learn the role of mental health professionals in developing a community of practice with mental health advocates in a Muslim immigrant community.

Youth are at high risk of mental health disorders and youth suicide rates are going up globally. Muslim immigrant communities in dense urban settings are at increased risk of major mental health disorders due to decreased access to mental health treatments and stigma. Developing a community of practice of trained mental health advocates in these communities is important to increase confidence and self-sufficiency in knowledge of mental health disorders, decrease stigma, and increase help-seeking behaviours.

Objective: We assessed the effectiveness of a community of practice of mental health advocates facilitated by mental health professionals within Taskeen Wellness, a nonprofit organization.

Methods: After mental health advocates received training in common mental health disorders, they received weekly coaching sessions. Subsequently, a community of practice was formed with seven advocates and three mental health professionals, with biweekly sessions. Semistructured interviews were done individually with advocates. Some topics included advocates’ attitudes towards mental health and help-seeking behaviours. Purposive sampling methods were used. Transcripts were analyzed with reflexive thematic analysis.

Results: Mental health advocates developed a deeper understanding of common mental health disorders and were at ease discussing these topics. They gained an appreciation of mental health help-seeking behaviours and were more likely to encourage community members struggling with mental health issues to seek care. They developed problem-solving abilities within their group and did not need the help of professionals in the community of practice after a year.

References:

1. Randhawa G, Stein S. An exploratory study examining attitudes toward mental health and mental health services among young South Asians in the United Kingdom. J Muslim Mental Health 2007;2:21–37.
2. Barwick M, Peters J, Boydell K. Getting to uptake: do communities of practice support the implementation of evidence-based practice? J Can Acad Child Adolesc Psychiatry 2009;18:1.

Poster – Research
P23 – Incorporating a Physician Assistant into an Outpatient Mental Health Clinic to Improve Access to Care
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Karen Shin*, MD; Fathima Adamsahib, BSc, BScPA; Nicole Kirwan, BScN MN CPMHN(C); Venkat Bhat, MD

CanMEDS Roles:

1. Collaborator
2. Professional
3. Leader

At the end of this session, participants will be able to: 1) Describe the professional role of a physician assistant (PA) and how this role differs from a physician, a nurse practitioner, or other health discipline professionals; 2) Understand an effective method to incorporate a PA into an outpatient mental health setting to increase volumes for consultations and follow-up visits; and 3) Anticipate targets for increased in-person and virtual visits in an adult general outpatient clinic and a subspecialized mental health program.

Physician assistants (PAs) are a relatively new category of skilled health professionals in Canada. PAs support physicians in all health care settings and can increase access to care. With growing pressures on the mental health care system, and a need to improve structures, incorporating PAs is an important option to consider.

Purpose: The Ambulatory Mental Health Service at St. Michael’s Hospital incorporated a full-time PA into its outpatient department to increase patient volumes and start a new interventional program dedicated to providing repetitive transcranial magnetic stimulation, IV ketamine, and other novel treatments. The PA’s clinical volumes were reviewed to characterize the additional patient visits.

Methods: Patient registration data were reviewed for all PA visits between April 2021 and November 2022. The data were categorized according to the specific ambulatory clinic and the type of clinical visit: in person, by phone, or by video. Descriptive statistics were generated according to these categories.

Results: The PA provided care for 909 patient visits from April 2021 through March 2022. From April 2022 through November 2022, the PA provided care for 452 patient visits. There were a total of 34 in-person visits, 580 telephone visits, and 747 video visits over the 20-month period. Most of these visits were in the interventional program.

Conclusion: Through the implementation of a PA, over a thousand additional patients accessed outpatient mental health services, including difficult-to-obtain interventional treatments. The success of incorporating a PA into an outpatient setting to enhance patient volumes illustrates the importance of innovative clinical team structures.

References:

1. Mauldin SG, Morton-Rias D, Barnhill GC, et al. The role of PAs in providing mental health care. Journal of the American Academy of PAs 2020;33(12):34–41.
2. Smith JM, DeBakey ME. Physician assistants in psychiatry: helping to meet America’s mental health needs. Curr Psychiatr 2019;18(9):17.

Poster – Research
P24 – Personal Narratives of COVID-19 Impacts on Canadian Youth: A Qualitative Analysis of Related Life Domains
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Anna MacLellan, MSc; Caitlin Slomp, MSc; John Best, PhD; Zainab Naqqash, BA; Cynthia Lu, BA; Boyee Lin, BA; Hasina Samji, PhD; Evelyn Stewart, PhD*
Supported by the Child and Adolescent Psychiatry Section

CanMEDS Roles:

1. Health Advocate
2. Collaborator

At the end of this session, participants will be able to: 1) Be able to identify the five life domains of youth and family functioning that were most impacted by the COVID-19 pandemic; 2) Gain a better understanding of both negative and positive outcomes of the pandemic from diverse perspectives; and 3) Be able to identify individual protective and risk factors for youth outcomes during the pandemic.

The COVID-19 pandemic had widespread impacts on Canadians. Youths were particularly impacted during this time, as COVID-19 occurred during critical social, emotional, and developmental phases. The purpose of this study was to use personal narratives to better understand the far-reaching consequences of the pandemic on youth.

Method: Two cohorts were recruited to complete one-hour semi-structured interviews of 1) youth aged 8 to 18 years and 2) the parents of youth aged 8 to 18 years. Participants were purposively recruited as guided by baseline questionnaire data from a quantitative survey of COVID-19 impacts on Canadians. Interviews were audiotaped, transcribed, and analyzed with interpretive description methods.

Results: A total of 18 youth and 17 parents were interviewed, identifying five life domains impacted by COVID-19: 1) MH, 2) emotional, identity, and developmental; 3) educational, 4) familial, and 5) social. Youth reported being most impacted by social consequences of the pandemic, which subsequently influenced their MH and other life domains. Deteriorating social skills and increased behavioural problems during the pandemic were highlighted. Youth with and without pre-existing clinically significant MH problems experienced symptomatic worsening along with socio-emotional and identity changes. Many youths described transition struggles between at-home and in-person schooling models, with significant learning disruptions. Impacts on family and home life were mixed and seemingly influenced by such factors as location, size of home, and parents’ working status.

Discussion: Canadian youth experience persisting social, educational, and MH impacts as a result of COVID-19. Additional supports may be required in the postpandemic era to bridge the gaps created in these domains.

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. Scott SR, Rivera KM, Rushing E, et al. “I hate this”: a qualitative analysis of adolescent’s self-reported challenges during the COVID-19 pandemic. J Adolesc Health 2021;68(2):262–269.

Poster – Research
P25 – Physician Burnout in the Era of COVID-19
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Ahila Vithiananthan*, MD Imaan Javeed, MD

CanMEDS Roles:

1. Health Advocate
2. Leader
3. Collaborator

At the end of this session, participants will be able to: 1) Gain a further understanding regarding gender differences in the determinants and experience of burnout; 2) Reflect on burnout experience in relation to specialty choice and how this has been affected by the pandemic; and 3) Gain a further understanding of the factors leading to burnout during the pandemic.

Physicians work hard and often in challenging circumstances with limited resources. This has been especially difficult during the COVID-19 pandemic. Dedication to patient care can result in poor self-care and can lead to physician suicide, burnout, and suboptimal patient care. The prevalence of physician burnout has been growing recently and affects individuals differently. It is important to understand who is affected by burnout and how gender, specialty choice, and generational differences may affect how one perceives their quality of life and career. This presentation will also look at how COVID-19 has affected physician burnout and resulted in challenges to the healthcare system. This presentation will identify risk factors for burnout and strategies to address and mitigate this risk.

References:

1. Kurzthaler I, Kemmler G, Holzner B, et al. Physician’s burnout and the COVID-19 pandemic: a nationwide cross-sectional study in Austria. Front Psychiatr 2021;12:784131.
2. Alrawashdeh HM, Al-Tammemi AB, Alzawahreh MK, et al. Occupational burnout and job satisfaction among physicians in times of COVID-19 crisis: a convergent parallel mixed-method study. BMC Public Health 2021;21(1):811.

Poster – Research
P26 – Quick Takes: Bringing Medical Education Directly to Physicians’ Ears Through Podcasting
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
David Gratzer*, MD, FRCPC; Lawrie Korec, BA; Stephanie Sliekers, MA

CanMEDS Roles:

1. Communicator
2. Medical Expert
3. Scholar

At the end of this session, participants will be able to: 1) Better understand and appreciate the literature supporting podcasts for medical education; 2) Better understand and appreciate the benefits and problems of trying to use technology for medical education; and 3) Better understand and appreciate the future direction of medical education.

Engaging physicians in education is challenging. Growing literature suggests that doctors respond well to podcasts. That said, there is a paucity of this type of educational material available in mental health. While podcasting is commonly used in areas like emergency medicine, little has been done in terms of creating such accessible professional learning and knowledge exchange in psychiatry. The primary goal of this project is to create a podcast series to educate time-limited psychiatrists. The podcasts focus on mental health issues relevant to physicians, such as the clinical implications of cannabis legalization. Podcasts are concise (15 minutes) while delivering quality information that physicians can immediately implement in their practices. Working with CAMH Education, the podcasts take on current mental health issues with expert interviews, offering information in a question-and-answer format. The first podcast was emailed to CAMH physicians on October 2018. The work has been promoted through social media and launched on Portico Network. The podcast series is evaluated on an ongoing basis using several metrics (including downloads), as well as learner feedback (through short surveys, which include the opportunity for comments). We now have over four years of data: we have released 24 podcasts and have data within CAMH (179 email opens on its launch day) and on Twitter (more than 300,000 impressions), as well as the total downloads (more than 16,000). By the time of the conference, we will have both qualitative and quantitative data to present on the 30 podcasts that will have been released.

References:

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

Poster – Research
P27 – Safety Pods: An Innovative Approach to Restraint Reduction and Trauma-Informed Care
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Joshua Smalley*, MD, FRCPC Roxanna Sheppard, RN, BScN, CPMHN(c), CHE, M.Cert Emily Smith, RN, BScN, CPMHN(c) Sarah Giroux, RN, BN, CPMHN(c) Sarah Hendry, RN, BN, CPMHN(c), Paul Slodovnick, MD

CanMEDS Roles:

1. Leader
2. Medical Expert
3. Health Advocate

At the end of this session, participants will be able to: 1) Identify the role of safety pods as an alternative to traditional methods of physical restraint; 2) Reflect on how a quality improvement framework can be used to reduce physical restraint in an inpatient setting; and 3) Discuss approaches to implementing trauma-informed care when physical restraint is required.

Restraints on inpatient psychiatry units, while at times necessary as a means to protect patients and others from imminent harm, can inadvertently negatively impact patient physical and psychological health. As part of an ongoing commitment to restraint reduction and trauma-informed care, (TIC) the Children’s Hospital of Eastern Ontario (CHEO) introduced the UK Safety Pod to its inpatient psychiatry unit. This was completed as part of a quality improvement initiative targeting restraint reduction and TIC. A first in Canada, CHEO implemented this device in June 2022 to offset the negative effects of restraints, promote youth and staff safety, and reduce the use of both mechanical and ground restraints. The benefits of the UK Safety Pod are its shape, size, and construction, which allows for a more person-centred approach to restraints. The pod resembles a beanbag chair but with a sturdier and more supportive construction. Since implementation, some of the benefits witnessed so far include less traumatic interventions, reduced risk of injury, increased safety for unit staff, increased comfort during restraint, more dignified approach for patients, and creation of a safe and comforting space outside of restraints to support patients in their own de-escalation. Since implementation, staff have decreased the use of other riskier forms of restraint and the amount of time patients spend in restraints. The UK Safety Pod has positively contributed to supporting the unit’s overall goals in restraint reduction and increased TIC.

References:

1. Aguilera-Serrano C, Guzman-Parra J, Garcia-Sanchez JA, et al. Variables associated with the subjective experience of coercive measures in psychiatric inpatients: a systematic review. Can J Psychiatry 2018;63(2):129–144.
2. Barnett RH. The physiological impact of upper limb position in prone restraint. Med Sci Law 2013;53(3):161–5.

Poster – Research
P28 – Solriamfetol Demonstrates Sustained Effects in Improving Cognitive Function in Patients with Excessive Daytime Sleepiness Associated with Obstructive Sleep Apnea
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Eileen Leary*, PhD; Hans Van Dongen, PhD; Christopher Drake, PhD; Richard Bogan, MD; Judith Jaeger, PhD; Russell Rosenberg, PhD; Caroline Streicher, BA; Hannah Kwak, MHS; Jay Bates, PhD; Herriot Tabuteau, MD

CanMEDS Roles:

1. Medical Expert
2. Professional
3. Scholar

At the end of this session, participants will be able to: 1) Understand the clinical rationale for evaluating cognitive function in patients affected by excessive daytime sleepiness and obstructive sleep apnea; 2) Understand the results of the SHARP trial, which evaluated the impact of solriamfetol on cognition in patients with cognitive impairment and excessive daytime sleepiness associated with obstructive sleep apnea; and 3) Understand the experimental rationale for using the Repeatable Battery for the Assessment of Neuropsychological Status in measuring changes in cognition.

Obstructive sleep apnea (OSA) is a common disorder resulting in disrupted sleep and excessive daytime sleepiness (EDS). Cognitive impairment is a burdensome symptom in many patients. Solriamfetol is approved to improve wakefulness in adults with EDS associated with OSA, but its effect on cognitive impairment is unknown. The SHARP study evaluated whether solriamfetol improves cognitive function in patients with OSA-associated EDS and impaired cognition.

Methods: SHARP was a randomized double-blind placebo-controlled crossover trial in 59 patients with OSA, EDS, and cognitive impairment. All patients received solriamfetol for two weeks (75mg daily day for three days, then 150mg daily), and placebo for two weeks, separated by a one-week washout. The primary endpoint was change from baseline on the Digit Symbol Substitution Test equivalent of the Repeatable Battery for the Assessment of Neuropsychological Status (DSST-RBANS). Secondary endpoints included duration of effect and Patient Global Impression of Severity (PGI-S) of cognitive impairment.

Results: Solriamfetol improved performance on the DSST-RBANS compared to placebo (6.49 vs. 4.75, p = 0.009), with an effect size (Cohen’s d) of 0.36. The effect was evident in the solriamfetol-placebo difference at each timepoint: 2 hours (1.91, p = 0.033), 4 hours (1.38, p = 0.089), 6 hours (2.33, p = 0.004), and 8 hours (1.58, p = 0.022) post-dose. PGI-S scores were improved during treatment with solriamfetol compared to placebo (–0.90 vs. –0.61, p = 0.034). The most common adverse events were nausea (6.9%) and anxiety (3.4%).

Conclusions: Solriamfetol (150mg daily) improved cognition as measured by the DSST-RBANS, with sustained effects, and reduced perceived symptom severity in patients with OSA-associated EDS and impaired cognition.

References:

1. Werli KS, Otuyama LJ, Bertolucci PH, et al. Neurocognitive function in patients with residual excessive sleepiness from obstructive sleep apnea: a prospective, controlled study. Sleep Med 2016;26:6–11.
2. Benca RM, Krystal A, Chepke C, et al. Recognition and management of obstructive sleep apnea in psychiatric practice. J Clin Psychiatry 2023;84(2):22r14521.

Poster – Research
P29 – TikTok’s Sick Role Subculture and the Rise of Self-Diagnosis
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Ahila Vithiananthan*, MD Imaan Javeed, MD

CanMEDS Roles:

1. Communicator
2. Health Advocate
3. Collaborator

At the end of this session, participants will be able to: 1) Learn about the contributing factors of why teens avoid seeking professional help for their mental health; 2) Ascertain factors relating to why teens may want to appropriate mental health symptoms; and 3) Learn what the risks and outcomes of self-diagnosis are.

TikTok is a social media application released to the public in 2016 and has since influenced the way teens and young adults perceive their mental health. Although TikTok has helped to destigmatize mental health, it has also led to teens self-diagnosing with various mental health conditions. There has been concern that teens are using mental health to reach influencer status, and there has been a trend to appropriate illness for attention on social media. Individuals have been mislabelling occasional symptoms as identifying with severe mental illnesses. Recommendations to address this phenomenon include asking patients about their relation to social media, understanding the symptoms patients are expressing, and providing psychoeducation about mental health symptoms and diagnostic clarification.

References:

1. Harness J, Getzen H. TikTok’s sick-role subculture and what to do about it. J Am Acad Child Adolesc Psychiatry 2022;61(3):351–353.
2. Heyman I, Liang H, Hedderly T. COVID-19 related increase in childhood tics and tic-like attacks. Arch Dis Child 2021;106:420–421.

Poster – Research
P30 – Training Mental Health Advocates to Build Mental Health Awareness for Youth in an Immigrant Community in the Greater Toronto Area
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Sarosh Khalid-Khan*, MD; Faiza Khalid-Khan, MSW

CanMEDS Roles:

1. Collaborator
2. Communicator
3. Health Advocate

At the end of this session, participants will be able to: 1) Learn strategies to raise mental health awareness in an immigrant community in Toronto; 2) Become aware of change in attitudes after knowledge transfer in mental health advocates; and 3) Gain knowledge of content of mental health training modules for mental health advocates.

Immigrant communities in Canada often struggle due to lack of mental health awareness. With stressors of immigration, there is increased incidence of stigma and major mental illness. Providing mental health training to mental health advocates in immigrant communities is the first step towards building awareness. Taskeen Wellness, a non-profit organization, aims to increase mental health capacity in immigrant communities.

Objective: The aim of this study was to assess the effectiveness of modules on anxiety and mood disorders, attention-deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD) delivered to mental health advocates in two communities in Scarborough, Toronto.

Methods: Mental health advocate trainees were recruited. Workshops delivered for three cohorts of parents and youth; 16 people participated. Parent cohorts consisted of community leaders, volunteers, and health workers or ambassadors. The youth cohort consisted of undergraduates, high school students, and community volunteers. Participants filled out knowledge acquisition questionnaires before and after the workshops and provided qualitative feedback.

Results: All participants (100%) “strongly agreed” sessions increased understanding of mood disorders, anxiety disorders, ADHD, and PTSD; 75% of participants “strongly agreed” and 25% “agreed” sessions increased understanding of treatments for mood and anxiety disorders; 83.3% of participants “strongly agreed” that sessions increased knowledge of anxiety disorders. All participants found the workshop format “interactive and engaging,” and all of the participants found workshop content “relevant and useful.”

Conclusions: Stigma of mental illness in immigrant communities is rampant, although there is increased incidence of major mental illness due to the increased stress of immigration. Modules to train mental health advocates in common mental health disorders were effective.

References:

1. Agyekum B, Siakwah P, Boateng JK. Immigration, education, sense of community and mental well-being: the case of visible minority immigrants in Canada. J Urban 2021;14:222–236.
2. Este D, Simich L, Hamilton H, et al. Perceptions and understandings of mental health from three Sudanese communities in Canada. International Journal of Culture and Mental Health 2017;10(3):238–249.

Poster – Research
P31 – Transdiagnostic Online Eye Movement Desensitization and Reprocessing for Suicidal Ideation: Theory, Practice, and Lessons Learned
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Lisa Burback*, MD; Lisa Burback, MD; Olga Winkler, MD; Sidney Yap, MSc Psychiatry

CanMEDS Roles:

1. Scholar
2. Medical Expert
3. Health Advocate

At the end of this session, participants will be able to: 1) List and describe three theories of suicidal ideation and how they relate to using eye movement desensitization and reprocessing (EMDR) for suicidal ideation; 2) Appreciate the transdiagnostic potential, safety, and limitations of EMDR for addressing experiences related to suicidal ideation; and 3) List at least four strategies for targeting suicidal ideation with EMDR, depending on clinical context.

Suicide is a serious public health issue, accounting for 800,000 lives lost annually. Currently available evidence- based psychotherapeutic treatments for suicidal ideation usually focus on stabilization, coping strategies, cognitive interventions, and managing emotional dysregulation. Unfortunately, these approaches are limited by issues of access, acceptability, and efficacy. There is, therefore, an urgent need to explore new, cost-effective approaches that can be scaled. Trauma-focused therapies are associated with reductions in suicidal ideation but are often avoided in those with suicidal ideation, as they can be distressing. Online treatment of this high-risk population became necessary because of the COVID-19 pandemic, despite initial safety concerns. The Virtual Eye Movement Desensitization and Reprocessing (EMDR) for Adults with Suicidal Ideation Study is a real-world, nonblinded, randomized study evaluating the safety and efficacy of remotely delivered EMDR, compared to treatment as usual, for suicidal ideation and symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), emotional dysregulation, and dissociation. This workshop will present the rationale for the novel use of EMDR to target experiences associated with suicidal ideation, contextualized within current theories of suicide and the evolving evidence base. Innovative therapy elements, including reconceptualization of suicidal ideation subtypes, the transdiagnostic nature of the intervention, and intensive online delivery will be outlined, with interactive case examples and audience participation. Preliminary quantitative and qualitative study results will be presented, as well as cases that challenge current theories of suicide. Opportunities and challenges for implementation into systems of care will be discussed.

References:

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.

Poster – Research
P33 – Eye Tracking to Identify Potential Biomarkers for Adolescent Major Depressive Disorder
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Blake Noyes*, BScH; Linda Booij, PhD; Heidi Riek, BScH; Isabell Pitigoi, BScH; Jeff Huang, BScH; Don Brien, PhD; Brian Coe, PhD; Brian White, PhD; Sarosh Khalid-Khan, PhD; Doug Munoz, PhD

CanMEDS Roles:

1. Scholar

At the end of this session, participants will be able to: 1) Understand the use of eye tracking as a noninvasive technique to study neural functioning; 2) Understand the neural circuitry involved with saccades, blinks, and pupil changes; and 3) Identify differences in pupil size, saccade behaviour, and blink rate between people with major depressive disorder and control subjects.

Alhough numerous potential biomarkers for major depressive disorder (MDD) have been identified, there are yet to be any widely integrated into clinical practice (Strawbridge et al., 2017). In addition to inconsistencies within research, the invasiveness of traditional biomarker techniques, such as blood and genetic analysis, will pose challenges for clinical use. This problem may be addressed via eye tracking; a well-established, non-invasive technique to identify alterations in specific neural networks responsible for cognitive control, arousal, attention, and orienting responses. The goal of this ongoing study is to use video-based eye tracking to compare saccade behaviour, pupil size, and blink rate in people with MDD and healthy control subjects. The current sample includes 33 control subjects (mean age [M] 19.1 years, 30 women, Patient Health Questionnaire [PHQ] score = 2.6) recruited from the community and 14 people with MDD (M = 16.5 years, 10 female, PHQ score = 13.2) recruited from a local psychiatric outpatient program. All participants completed self-report questionnaires for mental health symptoms and the Interleaved Pro-Anti Saccade eye-tracking task (Munoz et al., 2004). Preliminary analyses showed that participants with MDD had slower saccadic reaction time and generated more direction errors when making pro- and anti-saccades, blinked more during important visual instructions, and had blunted pupil responses throughout the task compared to control participants. Data collection is ongoing. These results suggest that eye tracking may be a feasible technique to distinguish people with MDD from control subjects and identify potential eye movement biomarkers for future diagnostic purposes.

References:

1. Strawbridge R, Young AH, Cleare AJ. Biomarkers for depression: recent insights, current challenges and future prospects. Neuropsychiatr Dis Treat 2017;13:1245–1262.
2. Munoz DP, Everling S. Look away: the anti-saccade task and the voluntary control of eye movement. Nature reviews. Neuroscience 2004;5(3):218–228.

Poster – Research
P32 – Trazodone for Treating Insomnia: Abuse and Safety Risks
Friday, Oct. 20
15:45 – 16:45 (1 hr)
Meeting Room: Junior Ballroom AB Foyer (3rd floor – North Tower)
Margaret Moline*, PhD; Timothy R. Juday, PhD; Jocelyn Y. Cheng, MD; Jack Henningfield, PhD; August R. Buchhalter, PhD, MD; Mark A. Sembower, MS; Steve Pype, BS; Emerson M. Wickwire, PhD; Ric Procyshyn, B.Sc. (Pharm.), M.Sc

CanMEDS Roles:

1. Communicator
2. Professional
3. Medical Expert

At the end of this session, participants will be able to: 1) Increase awareness of the real-world risk of abuse of and dependence on trazodone; 2) Increase awareness about the other real-world safety risks of trazodone; and 3) Increase awareness of these risks compared to other medications used to treat insomnia.

Although unapproved by the FDA for treating insomnia, trazodone is commonly prescribed in the US, partly due to lack of scheduling, which gives the perception that it is safer than z-drugs or benzodiazepines. This study investigated trazodone abuse and dependence potential and safety risks.

Methods: Suspect cases involving trazodone or benzodiazepines (e.g., temazepam, triazolam, estazolam) frequently prescribed for insomnia were identified from national databases: FDA Adverse Events Reporting System (FAERS), National Forensic Laboratory Information System (NFLIS) for confiscation data, and the American Association of Poison Control Center’s National Poison Data System (AAPCC-NPDS). Drug-related risk of falls was assessed from claims databases.

Results: FAERS included 11,228 trazodone and 5,120 benzodiazepine reports. Of these, drug-abuse and drug-dependence cases with trazodone were lower than with benzodiazepines (drug abuse 6.4% vs. 12.6%, respectively; drug dependence 1.1% vs. 3.6%). Serious cases (81.8% and 83.9%) and deaths (35.4% and 36.0%) were similar between trazodone and benzodiazepines, respectively. NFLIS reported 612 of 1,575,874 (0.04%) drug seizure cases that included trazodone, whereas AAPCC-NPDS reported 22,225 of 1,446,011 (1.54%) total case mentions of trazodone/all pharmaceuticals and 8,445 trazodone-related single-exposure cases. Falls risk (one-year period) in Medicare beneficiaries aged 65 years and over and in commercially insured enrollees aged 18 years and over was reported for trazodone and benzodiazepines: Medicare 9.5%/11.3%; commercially-insured 4.6%/3.7%.

Conclusion: Trazodone has abuse/dependence potential and important safety risks. Given the limited data from well-controlled studies and its off-label use, re-evaluation of trazodone prescribing rates for treating patients with insomnia is warranted.

References:

1. Amari DT, Juday T, Frech FH, et al. Falls, healthcare resources and costs in older adults with insomnia treated with zolpidem, trazodone, or benzodiazepines. BMC Geriatrics 2022;22(1):484.
2. Amari DT, Juday T, Frech FH, et al. Fall risk, healthcare resource use, and costs among adult patients in the United States treated for insomnia with zolpidem, trazodone, or benzodiazepines: a retrospective cohort study. Adv Ther 2022;39:1324–1340.