Pub Date : 2024-09-23DOI: 10.1177/07067437241281068
Matthew Crocker, Anjie Huang, Kinwah Fung, Therese A Stukel, Alene Toulany, Natasha Saunders, Paul Kurdyak, Lucy C Barker, Tanya S Hauck, Martin Rotenberg, Emily Hamovitch, Simone N Vigod
Objective: With increased utilization of virtual care in mental health, examining its appropriateness in various clinical scenarios is warranted. This study aimed to compare the risk of adverse psychiatric outcomes following virtual versus in-person mental health follow-up care after a psychiatric emergency department (ED) visit.
Methods: Using population-based health administrative data in Ontario (2021), we identified 28,232 adults discharged from a psychiatric ED visit who had a follow-up mental health visit within 14 days postdischarge. We compared those whose first follow-up visit was virtual (telephone or video) versus in-person on their risk for experiencing either a repeat psychiatric ED visit, psychiatric hospitalization, intentional self-injury, or suicide in the 15-90 days post-ED visit. Cox proportional hazard models generated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), adjusted for age, income quintile, psychiatric hospitalization, and intentional self-injury in the 2 years prior to ED visit. We stratified by sex and diagnosis at index ED visits based on the International Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) coding.
Results: About 65% (n = 18,354) of first follow-up visits were virtual, while 35% (n = 9,878) were in-person. About 13.9% and 14.6% of the virtual and in-person groups, respectively, experienced the composite outcome, corresponding to incidence rates of 60.9 versus 74.2 per 1000 person-years (aHR 0.95, 95% CI 0.89 to 1.01). Results were similar for individual elements of the composite outcome, when stratifying by sex and index psychiatric diagnosis, when varying exposure (7 days) and outcome periods (60 and 30 days), and comparing "only" virtual versus "any" in-person follow-up during the 14-day follow-up.
Conclusions and relevance: These results support virtual care as a modality to increase access to follow-up after an acute care psychiatric encounter across a wide range of diagnoses. Prospective trials to discern whether this is due to the comparable efficacy of virtual and in-person care, or due solely to appropriate patient selection may be warranted.
{"title":"Virtual Versus In-Person Follow-up After a Psychiatric Emergency Visit: A Population-Based Cohort Study: Suivi virtuel opposé à en personne après une visite à l'urgence psychiatrique : une étude de cohorte dans la population.","authors":"Matthew Crocker, Anjie Huang, Kinwah Fung, Therese A Stukel, Alene Toulany, Natasha Saunders, Paul Kurdyak, Lucy C Barker, Tanya S Hauck, Martin Rotenberg, Emily Hamovitch, Simone N Vigod","doi":"10.1177/07067437241281068","DOIUrl":"https://doi.org/10.1177/07067437241281068","url":null,"abstract":"<p><strong>Objective: </strong>With increased utilization of virtual care in mental health, examining its appropriateness in various clinical scenarios is warranted. This study aimed to compare the risk of adverse psychiatric outcomes following virtual versus in-person mental health follow-up care after a psychiatric emergency department (ED) visit.</p><p><strong>Methods: </strong>Using population-based health administrative data in Ontario (2021), we identified 28,232 adults discharged from a psychiatric ED visit who had a follow-up mental health visit within 14 days postdischarge. We compared those whose first follow-up visit was virtual (telephone or video) versus in-person on their risk for experiencing either a repeat psychiatric ED visit, psychiatric hospitalization, intentional self-injury, or suicide in the 15-90 days post-ED visit. Cox proportional hazard models generated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), adjusted for age, income quintile, psychiatric hospitalization, and intentional self-injury in the 2 years prior to ED visit. We stratified by sex and diagnosis at index ED visits based on the International Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) coding.</p><p><strong>Results: </strong>About 65% (<i>n</i> = 18,354) of first follow-up visits were virtual, while 35% (<i>n</i> = 9,878) were in-person. About 13.9% and 14.6% of the virtual and in-person groups, respectively, experienced the composite outcome, corresponding to incidence rates of 60.9 versus 74.2 per 1000 person-years (aHR 0.95, 95% CI 0.89 to 1.01). Results were similar for individual elements of the composite outcome, when stratifying by sex and index psychiatric diagnosis, when varying exposure (7 days) and outcome periods (60 and 30 days), and comparing \"only\" virtual versus \"any\" in-person follow-up during the 14-day follow-up.</p><p><strong>Conclusions and relevance: </strong>These results support virtual care as a modality to increase access to follow-up after an acute care psychiatric encounter across a wide range of diagnoses. Prospective trials to discern whether this is due to the comparable efficacy of virtual and in-person care, or due solely to appropriate patient selection may be warranted.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1177/07067437241274201
Natalia Macrynikola, Sarah Chang, John Torous
Objectives: Digital mental health interventions have shown promise for alleviating various forms of psychopathology, including depression and anxiety. However, the mechanisms of such interventions remain largely unexplored. The purpose of this study was to investigate a potential mechanistic process through which one hybrid digital mental health intervention (i.e., the Digital Clinic) might operate. We hypothesized that emotion regulation (ER) self-efficacy at the treatment midpoint may mediate the relationship between alliance (i.e., therapeutic alliance and digital alliance) and outcome (i.e., co-morbid symptoms of depression and anxiety) at the treatment endpoint.
Methods: Data used in this study came from the Digital Clinic, a brief transdiagnostic telehealth treatment program augmented by a dual-purpose digital phenotyping and intervention smartphone app. Recruited primarily from primary care, participants were 82 adults (73% White, 64% cisgender women, mean age 41) receiving outpatient treatment in the northeastern United States. All constructs were measured with validated scales, including The Working Alliance Inventory-Short Revised (WAI-SR) for therapeutic alliance, the Digital Working Alliance Inventory (DWAI) for digital alliance, the PROMIS Self-Efficacy for Managing Emotions Short Form scale for ER self-efficacy, and the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS) for co-morbid symptoms of depression and anxiety.
Results: Significant reductions in co-morbid symptoms of depression and anxiety and significant increases in ER self-efficacy were found from baseline to treatment endpoint. Therapeutic and digital alliance at the midpoint each predicted reductions in co-morbid symptoms of depression and anxiety at the endpoint through ER self-efficacy, controlling for baseline scores.
Conclusions: Findings suggest that ER self-efficacy may be a proximal predictor of clinical improvement that may be enhanced by therapeutic and digital alliance. Future controlled research is essential to improve knowledge of the mechanisms of digital mental health interventions and to enhance their effectiveness.
{"title":"Emotion Regulation Self-Efficacy as a Mechanism of Alliance and Outcomes in a Brief, Transdiagnostic Digital Mental Health Intervention: L'auto-efficacité de la régulation des émotions en tant que mécanisme d'alliance et de résultats dans une brève intervention transdiagnostique numérique en santé mentale.","authors":"Natalia Macrynikola, Sarah Chang, John Torous","doi":"10.1177/07067437241274201","DOIUrl":"https://doi.org/10.1177/07067437241274201","url":null,"abstract":"<p><strong>Objectives: </strong>Digital mental health interventions have shown promise for alleviating various forms of psychopathology, including depression and anxiety. However, the mechanisms of such interventions remain largely unexplored. The purpose of this study was to investigate a potential mechanistic process through which one hybrid digital mental health intervention (i.e., the Digital Clinic) might operate. We hypothesized that emotion regulation (ER) self-efficacy at the treatment midpoint may mediate the relationship between alliance (i.e., therapeutic alliance and digital alliance) and outcome (i.e., co-morbid symptoms of depression and anxiety) at the treatment endpoint.</p><p><strong>Methods: </strong>Data used in this study came from the Digital Clinic, a brief transdiagnostic telehealth treatment program augmented by a dual-purpose digital phenotyping and intervention smartphone app. Recruited primarily from primary care, participants were 82 adults (73% White, 64% cisgender women, mean age 41) receiving outpatient treatment in the northeastern United States. All constructs were measured with validated scales, including The Working Alliance Inventory-Short Revised (WAI-SR) for therapeutic alliance, the Digital Working Alliance Inventory (DWAI) for digital alliance, the PROMIS Self-Efficacy for Managing Emotions Short Form scale for ER self-efficacy, and the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS) for co-morbid symptoms of depression and anxiety.</p><p><strong>Results: </strong>Significant reductions in co-morbid symptoms of depression and anxiety and significant increases in ER self-efficacy were found from baseline to treatment endpoint. Therapeutic and digital alliance at the midpoint each predicted reductions in co-morbid symptoms of depression and anxiety at the endpoint through ER self-efficacy, controlling for baseline scores.</p><p><strong>Conclusions: </strong>Findings suggest that ER self-efficacy may be a proximal predictor of clinical improvement that may be enhanced by therapeutic and digital alliance. Future controlled research is essential to improve knowledge of the mechanisms of digital mental health interventions and to enhance their effectiveness.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Generalized anxiety disorder (GAD) is a prevalent anxiety disorder characterized by uncontrollable worry, trouble sleeping, muscle tension, and irritability. Cognitive behavioural therapy (CBT) is one of the first-line treatments that has demonstrated high efficacy in reducing symptoms of anxiety. Electronically delivered CBT (e-CBT) has been a promising adaptation of in-person treatment, showing comparable efficacy with increased accessibility and scalability. Finding further scalable interventions that can offer benefits to patients requiring less intensive interventions can allow for better resource allocation. Some studies have indicated that weekly check-ins can also lead to improvements in GAD symptoms. However, there is a lack of research exploring the potential benefits of online check-ins for patients with GAD.
Objective: This study aims to investigate the effects of weekly online asynchronous check-ins on patients diagnosed with GAD and compare it with a group receiving e-CBT.
Methods: Participants (n e-CBT = 45; n check-in = 51) with GAD were randomized into either an e-CBT or a mental health check-in program for 12 weeks. Participants in the e-CBT program completed pre-designed modules and homework assignments through a secure online delivery platform where they received personalized feedback from a trained care provider. Participants in the mental health check-in condition had weekly asynchronous messaging communication with a care provider where they were asked structured questions with a different weekly theme to encourage conversation.
Results: Both treatments demonstrated statistically significant reductions in GAD-7-item questionnaire (GAD-7) scores over time, but when comparing the groups there was no significant difference between the treatments. The number of participants who dropped out and baseline scores on all questionnaires were comparable for both groups.
Conclusions: The findings support the effectiveness of e-CBT and mental health check-ins for the treatment of GAD.
Plain language summary title: Comparing the Effectiveness of Electronically Delivered Therapy (e-CBT) to Weekly Online Mental Health Check-ins for Generalized Anxiety Disorder-A Randomized Controlled Trial.
{"title":"Comparing the Efficacy of Electronically Delivered Cognitive Behavioral Therapy (e-CBT) to Weekly Online Mental Health Check-Ins for Generalized Anxiety Disorder-A Randomized Controlled Trial: Comparaison de l'efficacité de la thérapie cognitivo-comportementale délivrée par voie électronique (e-TCC) aux contrôles hebdomadaires en ligne de santé mentale pour le trouble d'anxiété généralisée - un essai randomisé contrôlé.","authors":"Melinaz Barati Chermahini, Jazmin Eadie, Anika Agarwal, Callum Stephenson, Niloufar Malakouti, Niloofar Nikjoo, Jasleen Jagayat, Vineeth Jarabana, Amirhossein Shirazi, Anchan Kumar, Tessa Gizzarelli, Gilmar Gutierrez, Ferwa Khan, Charmy Patel, Megan Yang, Mohsen Omrani, Nazanin Alavi","doi":"10.1177/07067437241261933","DOIUrl":"10.1177/07067437241261933","url":null,"abstract":"<p><strong>Background: </strong>Generalized anxiety disorder (GAD) is a prevalent anxiety disorder characterized by uncontrollable worry, trouble sleeping, muscle tension, and irritability. Cognitive behavioural therapy (CBT) is one of the first-line treatments that has demonstrated high efficacy in reducing symptoms of anxiety. Electronically delivered CBT (e-CBT) has been a promising adaptation of in-person treatment, showing comparable efficacy with increased accessibility and scalability. Finding further scalable interventions that can offer benefits to patients requiring less intensive interventions can allow for better resource allocation. Some studies have indicated that weekly check-ins can also lead to improvements in GAD symptoms. However, there is a lack of research exploring the potential benefits of online check-ins for patients with GAD.</p><p><strong>Objective: </strong>This study aims to investigate the effects of weekly online asynchronous check-ins on patients diagnosed with GAD and compare it with a group receiving e-CBT.</p><p><strong>Methods: </strong>Participants (<i>n</i> e-CBT = 45; <i>n</i> check-in = 51) with GAD were randomized into either an e-CBT or a mental health check-in program for 12 weeks. Participants in the e-CBT program completed pre-designed modules and homework assignments through a secure online delivery platform where they received personalized feedback from a trained care provider. Participants in the mental health check-in condition had weekly asynchronous messaging communication with a care provider where they were asked structured questions with a different weekly theme to encourage conversation.</p><p><strong>Results: </strong>Both treatments demonstrated statistically significant reductions in GAD-7-item questionnaire (GAD-7) scores over time, but when comparing the groups there was no significant difference between the treatments. The number of participants who dropped out and baseline scores on all questionnaires were comparable for both groups.</p><p><strong>Conclusions: </strong>The findings support the effectiveness of e-CBT and mental health check-ins for the treatment of GAD.</p><p><strong>Plain language summary title: </strong>Comparing the Effectiveness of Electronically Delivered Therapy (e-CBT) to Weekly Online Mental Health Check-ins for Generalized Anxiety Disorder-A Randomized Controlled Trial.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11351059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-05-15DOI: 10.1177/07067437241255095
Melissa Wong, Alex Kiss, Nathan Herrmann, Krista L Lanctôt, Damien Gallagher
Objective: Depression in later life is associated with a two-fold increased risk of dementia. It is not clear to what extent potentially modifiable risk factors account for this association.
Method: Older adults (age 50 + ) with objective health measures (n = 14,014) from the Canadian Longitudinal Study on Aging were followed for a mean duration of 35 months. Linear regression analyses were used to determine if clinically significant depression (Centre for Epidemiologic Studies Depression scale score (CESD) ≥ 10) was associated with global cognitive decline, assessed with a neuropsychological battery during follow-up, and if modifiable risk factors mediated this association.
Results: Depression was associated with an excess of risk factors for cognitive decline including: vascular disease, hypertension, diabetes, apnoea during sleep, higher body mass index, smoking, physical inactivity and lack of social participation. In regression analyses depression remained independently associated with cognitive decline over time (beta -0.060, P = 0.038) as did cerebrovascular disease (beta -0.197, P < 0.001), HbA1C (beta -0.059, P < 0.001), visual impairment (beta -0.070, P = 0.007), hearing impairment (beta -0.098, P < 0.001) and physical inactivity (beta -0.075, P = 0.014). In mediation analyses, we found that cerebrovascular disease (z = -3.525, P < 0.001), HbA1C (z = -4.976, P < 0.001) and physical inactivity (z = -3.998, P < 0.001) partially mediated the association between depression and cognitive decline.
Conclusions: In this large sample of Canadian older adults incorporating several objective health measures, older adults with depression were at increased risk of cognitive decline and had an excess of potentially modifiable risk factors. Clinicians should pay particular attention to control of diabetes, physical inactivity and risk factors for cerebrovascular disease in older adults presenting with depression as they can contribute to accelerated cognitive decline and may be addressed during routine clinical care.
目的:晚年抑郁与痴呆症风险增加两倍有关。目前尚不清楚潜在的可改变风险因素在多大程度上导致了这种关联:方法:对加拿大老龄化纵向研究(Canadian Longitudinal Study on Aging)中具有客观健康指标的老年人(50 岁以上)(n = 14,014 人)进行了平均为期 35 个月的跟踪调查。通过线性回归分析,确定临床上明显的抑郁症(流行病学研究中心抑郁量表评分(CESD)≥10)是否与随访期间用神经心理学电池评估的总体认知能力下降有关,以及可改变的风险因素是否介导了这种关联:抑郁症与认知能力下降的多种风险因素有关,包括:血管疾病、高血压、糖尿病、睡眠呼吸暂停、体重指数较高、吸烟、缺乏运动和缺乏社会参与。在回归分析中,随着时间的推移,抑郁症仍与认知能力下降独立相关(贝塔值-0.060,P = 0.038),脑血管疾病(贝塔值-0.197,P = 0.007)和听力障碍(贝塔值-0.098,P = 0.014)也是如此。在中介分析中,我们发现脑血管疾病(z = -3.525,P z = -4.976,P z = -3.998,P 结论)和听力障碍(z = -0.197,P P = 0.007,P P = 0.014)对老年人的心理健康有重要影响:在这一包含多种客观健康测量指标的加拿大老年人大样本中,患有抑郁症的老年人认知能力下降的风险增加,而且潜在的可改变风险因素过多。临床医生应特别注意控制患有抑郁症的老年人的糖尿病、缺乏运动和脑血管疾病的风险因素,因为这些因素可能导致认知能力加速衰退,可在常规临床护理中加以解决。
{"title":"Modifiable Risk Factors Associated With Cognitive Decline in Late Life Depression: Findings From the Canadian Longitudinal Study on Aging: Facteurs de risque modifiables associés au déclin cognitif dans la dépression en fin de vie : constatations de l'Étude longitudinale canadienne sur le vieillissement.","authors":"Melissa Wong, Alex Kiss, Nathan Herrmann, Krista L Lanctôt, Damien Gallagher","doi":"10.1177/07067437241255095","DOIUrl":"10.1177/07067437241255095","url":null,"abstract":"<p><strong>Objective: </strong>Depression in later life is associated with a two-fold increased risk of dementia. It is not clear to what extent potentially modifiable risk factors account for this association.</p><p><strong>Method: </strong>Older adults (age 50 + ) with objective health measures (<i>n</i> = 14,014) from the Canadian Longitudinal Study on Aging were followed for a mean duration of 35 months. Linear regression analyses were used to determine if clinically significant depression (Centre for Epidemiologic Studies Depression scale score (CESD) ≥ 10) was associated with global cognitive decline, assessed with a neuropsychological battery during follow-up, and if modifiable risk factors mediated this association.</p><p><strong>Results: </strong>Depression was associated with an excess of risk factors for cognitive decline including: vascular disease, hypertension, diabetes, apnoea during sleep, higher body mass index, smoking, physical inactivity and lack of social participation. In regression analyses depression remained independently associated with cognitive decline over time (beta -0.060, <i>P</i> = 0.038) as did cerebrovascular disease (beta -0.197, <i>P</i> < 0.001), HbA1C (beta -0.059, <i>P</i> < 0.001), visual impairment (beta -0.070, <i>P</i> = 0.007), hearing impairment (beta -0.098, <i>P</i> < 0.001) and physical inactivity (beta -0.075, <i>P</i> = 0.014). In mediation analyses, we found that cerebrovascular disease (<i>z</i> = -3.525, <i>P</i> < 0.001), HbA1C (<i>z</i> = -4.976, <i>P</i> < 0.001) and physical inactivity (<i>z</i> = -3.998, <i>P</i> < 0.001) partially mediated the association between depression and cognitive decline.</p><p><strong>Conclusions: </strong>In this large sample of Canadian older adults incorporating several objective health measures, older adults with depression were at increased risk of cognitive decline and had an excess of potentially modifiable risk factors. Clinicians should pay particular attention to control of diabetes, physical inactivity and risk factors for cerebrovascular disease in older adults presenting with depression as they can contribute to accelerated cognitive decline and may be addressed during routine clinical care.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11351061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-05-24DOI: 10.1177/07067437241253631
Nada Charfi, Amal Bouaziz, Sana Omri, Imen Gassara, Rim Feki, Najeh Smaoui, Lobna Zouari, Mohamed Maâlej, Jihène Ben Thabet, Manel Maâlej Bouali
Objectives: Our aims were to assess cognitive impairment in bipolar patients in remission compared with healthy controls, and to study its connection to clinical and therapeutic factors.
Methodology: This was a case-control study of patients with bipolar disorder (BD) in remission and matched healthy controls. It was carried out at the Hédi Chaker University Hospital in Sfax, Tunisia. The Screen for Cognitive Impairment in Psychiatry (SCIP) scale was used to assess cognitive function in patients and controls. This scale comprises subtests for verbal learning with immediate (VLT-I) and delayed (VLT-D) recall, working memory (WMT), verbal fluency (VFT) and information processing speed (PST).
Results: We recruited 61 patients and 40 controls. Compared with controls, patients had significantly lower scores on the overall SCIP scale and on all SCIP subtests (p < 0.001 throughout) with moderate to high effects. In multivariate analysis, the presence of psychotic characteristics correlated with lower scores on the overall SCIP (p = 0.001), VLT-I (p = 0.001) and VLT-D (p = 0.007), WMT (p = 0.002) and PST (p = 0.008). Bipolar II correlated with lower LTV-I scores (p = 0.023). Age of onset and duration of the disorder were negatively correlated with PST scores (p < 10-3 and p = 0.007, respectively). Predominantly manic polarity correlated with lower VFT scores (p = 0.007).
Conclusions: Our study showed that bipolar patients in remission presented significantly more marked cognitive impairments, affecting various cognitive domains, than the controls. These cognitive impairments appear to be linked to clinical and therapeutic factors that are themselves considered to be factors of poor prognosis in BD.
目的我们的目的是评估处于缓解期的双相情感障碍患者与健康对照组相比是否存在认知障碍,并研究认知障碍与临床和治疗因素的关系:这是一项病例对照研究,研究对象为躁狂症(BD)缓解期患者和匹配的健康对照组。研究在突尼斯斯法克斯的赫迪-查克大学医院(Hédi Chaker University Hospital)进行。研究采用精神病学认知功能障碍筛查量表(SCIP)来评估患者和对照组的认知功能。该量表包括立即回忆(VLT-I)和延迟回忆(VLT-D)的言语学习、工作记忆(WMT)、言语流畅性(VFT)和信息处理速度(PST)等子测试:我们招募了 61 名患者和 40 名对照组患者。与对照组相比,患者在 SCIP 总量表和所有 SCIP 分测验(p p = 0.001)、VLT-I(p = 0.001)和 VLT-D (p = 0.007)、WMT(p = 0.002)和 PST(p = 0.008)上的得分都明显较低。躁郁症 II 与较低的 LTV-I 分数相关(p = 0.023)。发病年龄和病程与 PST 评分呈负相关(分别为 p -3 和 p = 0.007)。以躁狂为主的极性与较低的 VFT 评分相关(p = 0.007):我们的研究表明,与对照组相比,处于缓解期的双相情感障碍患者的认知功能明显受损,影响到各个认知领域。这些认知障碍似乎与临床和治疗因素有关,而这些因素本身就被认为是导致躁狂症预后不良的因素。
{"title":"Evaluation des Troubles Cognitifs Chez des Patients Tunisiens Atteints de Trouble Bipolaire en Rémission : Étude Cas-Témoins: Assessment of Cognitive Impairment in Tunisian Patients With Bipolar Disorder in Remission: A Case-Control Study.","authors":"Nada Charfi, Amal Bouaziz, Sana Omri, Imen Gassara, Rim Feki, Najeh Smaoui, Lobna Zouari, Mohamed Maâlej, Jihène Ben Thabet, Manel Maâlej Bouali","doi":"10.1177/07067437241253631","DOIUrl":"10.1177/07067437241253631","url":null,"abstract":"<p><strong>Objectives: </strong>Our aims were to assess cognitive impairment in bipolar patients in remission compared with healthy controls, and to study its connection to clinical and therapeutic factors.</p><p><strong>Methodology: </strong>This was a case-control study of patients with bipolar disorder (BD) in remission and matched healthy controls. It was carried out at the Hédi Chaker University Hospital in Sfax, Tunisia. The Screen for Cognitive Impairment in Psychiatry (SCIP) scale was used to assess cognitive function in patients and controls. This scale comprises subtests for verbal learning with immediate (VLT-I) and delayed (VLT-D) recall, working memory (WMT), verbal fluency (VFT) and information processing speed (PST).</p><p><strong>Results: </strong>We recruited 61 patients and 40 controls. Compared with controls, patients had significantly lower scores on the overall SCIP scale and on all SCIP subtests (<i>p</i> < 0.001 throughout) with moderate to high effects. In multivariate analysis, the presence of psychotic characteristics correlated with lower scores on the overall SCIP (<i>p</i> = 0.001), VLT-I (<i>p</i> = 0.001) and VLT-D (<i>p</i> = 0.007), WMT (<i>p</i> = 0.002) and PST (<i>p</i> = 0.008). Bipolar II correlated with lower LTV-I scores (<i>p</i> = 0.023). Age of onset and duration of the disorder were negatively correlated with PST scores (<i>p</i> < 10<sup>-3</sup> and <i>p</i> = 0.007, respectively). Predominantly manic polarity correlated with lower VFT scores (<i>p</i> = 0.007).</p><p><strong>Conclusions: </strong>Our study showed that bipolar patients in remission presented significantly more marked cognitive impairments, affecting various cognitive domains, than the controls. These cognitive impairments appear to be linked to clinical and therapeutic factors that are themselves considered to be factors of poor prognosis in BD.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11351062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-06-10DOI: 10.1177/07067437241259896
Katherine Beck, Allan H Young
{"title":"Commentary on the Canadian Network for Mood and Anxiety Treatments 2023 Clinical Guidelines for Management of Major Depressive Disorder in Adults - Capturing the State of the Art.","authors":"Katherine Beck, Allan H Young","doi":"10.1177/07067437241259896","DOIUrl":"10.1177/07067437241259896","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11351063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-05-06DOI: 10.1177/07067437241245384
Raymond W Lam, Sidney H Kennedy, Camelia Adams, Anees Bahji, Serge Beaulieu, Venkat Bhat, Pierre Blier, Daniel M Blumberger, Elisa Brietzke, Trisha Chakrabarty, André Do, Benicio N Frey, Peter Giacobbe, David Gratzer, Sophie Grigoriadis, Jeffrey Habert, M Ishrat Husain, Zahinoor Ismail, Alexander McGirr, Roger S McIntyre, Erin E Michalak, Daniel J Müller, Sagar V Parikh, Lena S Quilty, Arun V Ravindran, Nisha Ravindran, Johanne Renaud, Joshua D Rosenblat, Zainab Samaan, Gayatri Saraf, Kathryn Schade, Ayal Schaffer, Mark Sinyor, Claudio N Soares, Jennifer Swainson, Valerie H Taylor, Smadar V Tourjman, Rudolf Uher, Michael van Ameringen, Gustavo Vazquez, Simone Vigod, Daphne Voineskos, Lakshmi N Yatham, Roumen V Milev
Background: The Canadian Network for Mood and Anxiety Treatments (CANMAT) last published clinical guidelines for the management of major depressive disorder (MDD) in 2016. Owing to advances in the field, an update was needed to incorporate new evidence and provide new and revised recommendations for the assessment and management of MDD in adults.
Methods: CANMAT convened a guidelines editorial group comprised of academic clinicians and patient partners. A systematic literature review was conducted, focusing on systematic reviews and meta-analyses published since the 2016 guidelines. Recommendations were organized by lines of treatment, which were informed by CANMAT-defined levels of evidence and supplemented by clinical support (consisting of expert consensus on safety, tolerability, and feasibility). Drafts were revised based on review by patient partners, expert peer review, and a defined expert consensus process.
Results: The updated guidelines comprise eight primary topics, in a question-and-answer format, that map a patient care journey from assessment to selection of evidence-based treatments, prevention of recurrence, and strategies for inadequate response. The guidelines adopt a personalized care approach that emphasizes shared decision-making that reflects the values, preferences, and treatment history of the patient with MDD. Tables provide new and updated recommendations for psychological, pharmacological, lifestyle, complementary and alternative medicine, digital health, and neuromodulation treatments. Caveats and limitations of the evidence are highlighted.
Conclusions: The CANMAT 2023 updated guidelines provide evidence-informed recommendations for the management of MDD, in a clinician-friendly format. These updated guidelines emphasize a collaborative, personalized, and systematic management approach that will help optimize outcomes for adults with MDD.
{"title":"Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes.","authors":"Raymond W Lam, Sidney H Kennedy, Camelia Adams, Anees Bahji, Serge Beaulieu, Venkat Bhat, Pierre Blier, Daniel M Blumberger, Elisa Brietzke, Trisha Chakrabarty, André Do, Benicio N Frey, Peter Giacobbe, David Gratzer, Sophie Grigoriadis, Jeffrey Habert, M Ishrat Husain, Zahinoor Ismail, Alexander McGirr, Roger S McIntyre, Erin E Michalak, Daniel J Müller, Sagar V Parikh, Lena S Quilty, Arun V Ravindran, Nisha Ravindran, Johanne Renaud, Joshua D Rosenblat, Zainab Samaan, Gayatri Saraf, Kathryn Schade, Ayal Schaffer, Mark Sinyor, Claudio N Soares, Jennifer Swainson, Valerie H Taylor, Smadar V Tourjman, Rudolf Uher, Michael van Ameringen, Gustavo Vazquez, Simone Vigod, Daphne Voineskos, Lakshmi N Yatham, Roumen V Milev","doi":"10.1177/07067437241245384","DOIUrl":"10.1177/07067437241245384","url":null,"abstract":"<p><strong>Background: </strong>The Canadian Network for Mood and Anxiety Treatments (CANMAT) last published clinical guidelines for the management of major depressive disorder (MDD) in 2016. Owing to advances in the field, an update was needed to incorporate new evidence and provide new and revised recommendations for the assessment and management of MDD in adults.</p><p><strong>Methods: </strong>CANMAT convened a guidelines editorial group comprised of academic clinicians and patient partners. A systematic literature review was conducted, focusing on systematic reviews and meta-analyses published since the 2016 guidelines. Recommendations were organized by lines of treatment, which were informed by CANMAT-defined levels of evidence and supplemented by clinical support (consisting of expert consensus on safety, tolerability, and feasibility). Drafts were revised based on review by patient partners, expert peer review, and a defined expert consensus process.</p><p><strong>Results: </strong>The updated guidelines comprise eight primary topics, in a question-and-answer format, that map a patient care journey from assessment to selection of evidence-based treatments, prevention of recurrence, and strategies for inadequate response. The guidelines adopt a personalized care approach that emphasizes shared decision-making that reflects the values, preferences, and treatment history of the patient with MDD. Tables provide new and updated recommendations for psychological, pharmacological, lifestyle, complementary and alternative medicine, digital health, and neuromodulation treatments. Caveats and limitations of the evidence are highlighted.</p><p><strong>Conclusions: </strong>The CANMAT 2023 updated guidelines provide evidence-informed recommendations for the management of MDD, in a clinician-friendly format. These updated guidelines emphasize a collaborative, personalized, and systematic management approach that will help optimize outcomes for adults with MDD.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11351064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1177/07067437241271708
N Racine, T Pitt, S Premji, S W McDonald, S B Patten, S Tough, S Madigan
Objective: Knowing the prevalence of mental health difficulties in young children is critical for early identification and intervention. In the current study, we examine the agreement among three different data sources estimating the prevalence of diagnoses for attention deficit hyperactivity disorder (ADHD) and emotional disorders (i.e., anxiety or mood disorder) for children between birth and 9 years of age.
Methods: Data from a prospective pregnancy cohort was linked with provincial administrative health data for children in Alberta, Canada. We report the positive agreement, negative agreement, and Cohen's Kappa of parent-reported child diagnoses provided by a health professional ("parent report"), exceeding a clinical cut-off on a standardized questionnaire completed by parents (the Behavior Assessment System for Children, 3rd edition ["BASC-3"]), and cumulative inpatient, outpatient, or physician claims diagnoses ("administrative data").
Results: Positive and negative agreement for administrative data and parent-reported ADHD diagnoses were 70.8% and 95.6%, respectively, and 30.5% and 94.9% for administrative data and the BASC-3, respectively. For emotional disorders, administrative data and parent-reported diagnoses had a positive agreement of 35.7% and negative agreement of 96.30%. Positive and negative agreement for emotional disorders using administrative data and the BASC-3 were 20.0% and 87.4%, respectively. Kappa coefficients were generally low, indicating poor chance-corrected agreement between these data sources.
Conclusions: The data sources highlighted in this study provide disparate agreement for the prevalence of ADHD and emotional disorder diagnoses in young children. Low Kappa coefficients suggest that parent-reported diagnoses, clinically elevated symptoms using a standardized questionnaire, and diagnoses from administrative data serve different purposes and provide discrete estimates of mental health difficulties in early childhood.Plain Language Title: Prevalence of child mental health disorders according to different data sources in Canada.
{"title":"Prevalence of Common Child Mental Health Disorders Using Administrative Health Data and Parent Report in a Prospective Community-Based Cohort from Alberta, Canada: Prévalence des troubles communs de santé mentale de l'enfant à l'aide des données de santé administratives et des rapports des parents dans une cohorte prospective communautaire d'Alberta, Canada.","authors":"N Racine, T Pitt, S Premji, S W McDonald, S B Patten, S Tough, S Madigan","doi":"10.1177/07067437241271708","DOIUrl":"https://doi.org/10.1177/07067437241271708","url":null,"abstract":"<p><strong>Objective: </strong>Knowing the prevalence of mental health difficulties in young children is critical for early identification and intervention. In the current study, we examine the agreement among three different data sources estimating the prevalence of diagnoses for attention deficit hyperactivity disorder (ADHD) and emotional disorders (i.e., anxiety or mood disorder) for children between birth and 9 years of age.</p><p><strong>Methods: </strong>Data from a prospective pregnancy cohort was linked with provincial administrative health data for children in Alberta, Canada. We report the positive agreement, negative agreement, and Cohen's Kappa of parent-reported child diagnoses provided by a health professional (\"parent report\"), exceeding a clinical cut-off on a standardized questionnaire completed by parents (the Behavior Assessment System for Children, 3rd edition [\"BASC-3\"]), and cumulative inpatient, outpatient, or physician claims diagnoses (\"administrative data\").</p><p><strong>Results: </strong>Positive and negative agreement for administrative data and parent-reported ADHD diagnoses were 70.8% and 95.6%, respectively, and 30.5% and 94.9% for administrative data and the BASC-3, respectively. For emotional disorders, administrative data and parent-reported diagnoses had a positive agreement of 35.7% and negative agreement of 96.30%. Positive and negative agreement for emotional disorders using administrative data and the BASC-3 were 20.0% and 87.4%, respectively. Kappa coefficients were generally low, indicating poor chance-corrected agreement between these data sources.</p><p><strong>Conclusions: </strong>The data sources highlighted in this study provide disparate agreement for the prevalence of ADHD and emotional disorder diagnoses in young children. Low Kappa coefficients suggest that parent-reported diagnoses, clinically elevated symptoms using a standardized questionnaire, and diagnoses from administrative data serve different purposes and provide discrete estimates of mental health difficulties in early childhood.<b>Plain Language Title:</b> Prevalence of child mental health disorders according to different data sources in Canada.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1177/07067437241271738
Anthony A Stephenson, Martin D Abel, Juraj Sprung, Robert J Morgan, Darrell R Schroeder, Toby N Weingarten
{"title":"Urinary Retention Following Electro-Convulsive Therapy Under General Mask Anesthesia.","authors":"Anthony A Stephenson, Martin D Abel, Juraj Sprung, Robert J Morgan, Darrell R Schroeder, Toby N Weingarten","doi":"10.1177/07067437241271738","DOIUrl":"https://doi.org/10.1177/07067437241271738","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-16DOI: 10.1177/07067437241271713
Shannon V Reaume, Joel A Dubin, Christopher Perlman, Mark A Ferro
Objective: This epidemiological study estimated the lifetime prevalence of chronic physical illness (i.e., an illness that lasted or was expected to last ≥6 months) and 6-month prevalence of mental disorder and multimorbidity (i.e., ≥1 physical illness and ≥1 mental disorder) in youth. Associations between physical illness and mental disorder were quantified, including the number of illnesses. Secondary objectives examined factors associated with mental disorder, after controlling for physical illness.
Methods: Data come from 10,303 youth aged 4-17 years in the 2014 Ontario Child Health Study (OCHS). Physical illness was measured using a list of chronic conditions developed by Statistics Canada. Mental disorders were measured using the OCHS Emotional Behavioural Scales. The Health Utility Index Mark III assessed overall functional health.
Results: Weighted prevalence estimates showed 550,090 (27.8%) youth had physical illness, 291,986 (14.8%) had mental disorder, and 108,435 (5.4%) had multimorbidity. Physical illness was not associated with mental disorder. However, youth with 2 physical illnesses, as compared to no physical illnesses, had increased odds of having any mental (OR = 1.75 [1.08, 2.85]), mood (OR = 2.50 [1.39, 4.48]) and anxiety disorders (OR = 2.40 [1.33, 4.31]). Mean functional health scores demonstrated a dose-response association across health status categories, with the highest scores among healthy youth and the lowest scores among multimorbid youth (all p < .05).
Conclusion: Chronic physical illness and mental disorders are prevalent in youth. Youths with 2 physical illnesses have a higher likelihood of mental disorders. Higher functional health scores protected against all mental disorders. Mental health interventions for youth should promote strong overall functional health.
{"title":"An Epidemiological Study of Physical-Mental Multimorbidity in Youth: Une étude épidémiologique de la morbidité physique-mentale chez les jeunes.","authors":"Shannon V Reaume, Joel A Dubin, Christopher Perlman, Mark A Ferro","doi":"10.1177/07067437241271713","DOIUrl":"https://doi.org/10.1177/07067437241271713","url":null,"abstract":"<p><strong>Objective: </strong>This epidemiological study estimated the lifetime prevalence of chronic physical illness (i.e., an illness that lasted or was expected to last ≥6 months) and 6-month prevalence of mental disorder and multimorbidity (i.e., ≥1 physical illness and ≥1 mental disorder) in youth. Associations between physical illness and mental disorder were quantified, including the number of illnesses. Secondary objectives examined factors associated with mental disorder, after controlling for physical illness.</p><p><strong>Methods: </strong>Data come from 10,303 youth aged 4-17 years in the 2014 Ontario Child Health Study (OCHS). Physical illness was measured using a list of chronic conditions developed by Statistics Canada. Mental disorders were measured using the OCHS Emotional Behavioural Scales. The Health Utility Index Mark III assessed overall functional health.</p><p><strong>Results: </strong>Weighted prevalence estimates showed 550,090 (27.8%) youth had physical illness, 291,986 (14.8%) had mental disorder, and 108,435 (5.4%) had multimorbidity. Physical illness was not associated with mental disorder. However, youth with 2 physical illnesses, as compared to no physical illnesses, had increased odds of having any mental (OR = 1.75 [1.08, 2.85]), mood (OR = 2.50 [1.39, 4.48]) and anxiety disorders (OR = 2.40 [1.33, 4.31]). Mean functional health scores demonstrated a dose-response association across health status categories, with the highest scores among healthy youth and the lowest scores among multimorbid youth (all <i>p </i>< .05).</p><p><strong>Conclusion: </strong>Chronic physical illness and mental disorders are prevalent in youth. Youths with 2 physical illnesses have a higher likelihood of mental disorders. Higher functional health scores protected against all mental disorders. Mental health interventions for youth should promote strong overall functional health.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}