Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie最新文献

BackgroundRelapse rates in major depressive disorder (MDD) remain high even after treatment to remission. Identifying predictors of relapse is, therefore, crucial for improving maintenance strategies and preventing future episodes. Remote data collection and sensing technologies may allow for more comprehensive and longitudinal assessment of potential predictors.MethodsThe Canadian Biomarker Integration Network in Depression Wellness Monitoring for MDD (CBN-WELL) study was a prospective, multicentre observational study with an aim to identify biomarkers associated with relapse in patients on maintenance treatment for MDD. Participants had a DSM-5-TR diagnosis of MDD in remission and a Montgomery-Åsberg Depression Rating Scale (MADRS) score ≤14. Participants remained on their baseline medication regimens and were followed bimonthly for up to 2 years. Relapse criteria included MADRS > 22 for 2 consecutive weeks, suicidality or hospitalization, and initiation or change in medication for worsening symptoms. Data collection included clinical assessments, self-report questionnaires, and remote monitoring using wrist-worn actigraphs and smartphones.ResultsA total of 96 participants had follow-up data. Of these, 28.9% experienced a depressive relapse during the study period, with an average time to relapse of 211 days. Baseline depressive severity, as measured by MADRS, was higher in participants who relapsed compared to those who did not, but few other baseline clinical measures differentiated these groups.ConclusionsIndividuals with MDD in remission continued to have high relapse rates despite maintenance treatment. The paucity of clinical factors that predict relapse underscores the need for biomarkers. The CBN-WELL database can be used for future research to integrate multiple predictive factors and to identify objective measures to predict relapse in individuals.

ObjectiveThis research aims to investigate the relapse rates of major depressive disorder (MDD) within primary care and evaluate the efficacy of relapse prevention therapies. Despite primary care being the common point of contact for MDD patients, there are limited studies around this.MethodsWe included randomized controlled trials and observational studies examining MDD relapse incidence and the effect of pharmacological and non-pharmacological interventions in preventing relapse in primary care. Databases; Medline via Ovid, EMBASE, The Cochrane Library, PsycInfo (ebsco), and Clinical Trials.gov were searched from their inception until September 7, 2022. Joanna Briggs Institute (JBI) appraisal instrument for methodological quality assessment was used. A proportional data analysis estimated the MDD relapse incidence. Therapy effectiveness results were shown as odds ratios with 95% confidence intervals, with heterogeneity explored via subgroup analysis.ResultsOut of the reviewed studies, 35 met the eligibility criteria. Quality appraisal scores varied between 73% and 96%. MDD relapse incidence was divided into subgroups, revealing that both pharmacotherapy and non-pharmacotherapy led to a similar decrease in relapse rates with combination therapies showing further reduction in relapse. Subgroup analyses by study design, follow-up length, date of study and quality of study also yielded noteworthy findings.ConclusionOur findings showed that MDD relapse rates in primary care settings can be effectively reduced by pharmacotherapy, non-pharmacotherapy, or combination therapy. Some psychological interventions might also reduce relapse likelihood. More studies are needed on individual and combined treatments over longer periods to understand their long-term impacts on MDD relapse in primary care.Plain Language Summary TitleHow Often Depression Returns and How Well Treatments Work in Primary Care: A Review of Studies.

ObjectivesTraumatic experiences constitute a risk factor for developing different psychopathologies, such as post-traumatic stress disorder (PTSD), complex PTSD (CPTSD), and positive symptoms of psychosis. However, on the symptom level, it is still unclear how CPTSD and positive symptoms of psychosis associate with each other. The present study aimed to shed light on these dynamics by investigating the symptoms network of CPTSD and positive symptoms of psychosis.MethodsA network analysis was performed on CPTSD and psychosis symptoms among a Canadian community sample with a history of traumatic life events (n = 747). Measures included the international trauma questionnaire and the mPRIME screen.ResultsIn total, 4.8% of the sample reached the criteria of probable PTSD and 7% fulfilled the criteria of probable CPTSD. PTSD and CPTSD groups had a significantly higher severity of positive symptoms of psychosis compared to the no-disorder group. Network analysis revealed 3 distinct communities of symptoms of PTSD, disturbances in self-organization, and psychosis. Affective dysregulation served as the bridging symptom between the communities. Hearing one's own thoughts aloud was the most central symptom in the network.ConclusionsFindings show that positive symptoms of psychosis can be considered trauma-related responses. Furthermore, interventions targeting affective dysregulation as well as the experience and distress associated with hearing one's own thoughts aloud may contribute to symptom reduction and improved functioning.

BackgroundThe Canadian Network for Mood and Anxiety Treatments (CANMAT) publishes clinical practice guidelines for mood and anxiety disorders. This CANMAT guideline aims to provide comprehensive clinical guidance for the pregnancy and postpartum (perinatal) management of mood, anxiety and related disorders.MethodsCANMAT convened a core editorial group of interdisciplinary academic clinicians and persons with lived experience (PWLE), and 3 advisory panels of PWLE and perinatal health and perinatal mental health clinicians. We searched for systematic reviews of prevention and treatment interventions for perinatal depressive, bipolar, anxiety, obsessive-compulsive and post-traumatic stress disorders (January 2013-October 2023). We prioritized evidence from reviews of randomized controlled trials (RCTs), except for the perinatal safety of medications where reviews of large high-quality observational studies were prioritized due to the absence of RCT data. Targeted searches for individual studies were conducted when systematic reviews were limited or absent. Recommendations were organized by lines of treatment based on CANMAT-defined levels of evidence quality, supplemented by editorial group consensus to balance efficacy, safety, tolerability and feasibility considerations.ResultsThe guideline covers 10 clinical sections in a question-and-answer format that maps onto the patient care journey: case identification; organization and delivery of care; non-pharmacological (lifestyle, psychosocial, psychological), pharmacological, neuromodulation and complementary and alternative medicine interventions; high-risk clinical situations; and mental health of the father or co-parent. Equity, diversity and inclusion considerations are provided.ConclusionsThis guideline's detailed evidence-based recommendations provide clinicians with key information to promote the delivery of effective and safe perinatal mental healthcare. It is hoped that the guideline will serve as a valuable tool for clinicians in Canada and around the world to help optimize clinical outcomes in the area of perinatal mental health.Plain Language Summary TitleThe Canadian Network for Mood and Anxiety Treatments 2024 Guideline for Helping People with Mood, Anxiety and Related Disorders During Pregnancy and Postpartum.

ObjectiveTo examine the patterns in the supply and use of psychiatric services in 3 Canadian provinces: British Columbia, Manitoba, and Ontario.MethodsWe conducted a repeated cross-sectional analysis spanning fiscal years 2012/13 to 2021/22, using patient- and psychiatrist-level data aggregated into administrative health regions. Descriptive statistics and linear regression were used to assess patterns and relationships between the per capita number of psychiatrists ("supply") and measures of use of psychiatric services ("utilization"), including any psychiatrist contact, psychiatric consultation (1-2 visits with the same psychiatrist), and ongoing psychiatric care (3 or more visits with the same psychiatrist).ResultsThe number of psychiatrists per capita remained stable within the 3 provinces during the study period. In 2021/22, Vancouver had the highest number in British Columbia (45 psychiatrists per 100,000 individuals), compared to 14 per 100,000 in lower-supply regions. Toronto had the highest number in Ontario (38 per 100,000), compared to 9 in lower supply regions. Winnipeg had the highest number in Manitoba (25 per 100,000), compared to 7 in the lower supply regions. In 2021/22, the per capita number of psychiatrists was moderately correlated with any psychiatrist contact (R² = 0.290) and ongoing psychiatric care (R² = 0.411), but weakly correlated with psychiatric consultation (R² = 0.005). The relationship between supply and utilization diminishes with higher levels of regional supply.ConclusionsPsychiatrists were unevenly distributed within and across provinces. While more psychiatrists are needed, the moderate and diminishing relationships between their numbers and utilization suggest that increasing this number alone is unlikely to fully address unmet needs for mental healthcare. Strategies to improve access will need to directly target uneven distributions. Further research is needed to understand the factors influencing psychiatrists' practice choices and ways to better support them in increasing their access to care.

Plain Language SummaryThis is a commentary of the CANMAT guidelineKey points about the CANMAT perinatal guidelines are commented on. The process of developing the guidelines was robust and there can be a high level of confidence in their recommendations. An important aspect is that services for women with perinatal mood and anxiety disorders need to put in place so that the range on evidence based treatments can be implemented.

BackgroundMore than one in five women deal with a psychiatric disorder during the perinatal period. Whereas perinatal depression is well documented, there is still little research on the full range of perinatal psychiatric disorders and their clinical evolution across this whole period. The present study investigated the susceptibility to psychiatric illness during pregnancy and up to one year postpartum. We aimed to identify the most frequent disorders and comorbidities arising in each perinatal period. We outlined the clinical trajectories of these disorders in terms of evolution across past history, pregnancy and postpartum.MethodThrough a retrospective longitudinal design, data were collected in 2019-2020 from the medical records of the cohort of 964 women who required care in a tertiary perinatal psychiatry clinic located in Quebec City (Canada) between 2004 and 2020. Incidence rates of the full range of psychiatric disorders were estimated per period and their evolution across time identified clinical trajectories.ResultsDuring pregnancy, 34 different disorders were newly diagnosed with incidence rates ranging from 0.1% to 15.5% (45.6% of women having had at least one disorder diagnosed during pregnancy) whereas, during postpartum, 36 disorders were newly diagnosed with incidence rates ranging from 0.1% to 31.0% (67.5% of women having had at least one disorder diagnosed during postpartum). For most disorders, rates were significantly higher in postpartum than in pregnancy. A woman could develop multiple disorders during a given perinatal period: this comorbidity involved various combinations of diagnoses in 28% of women during pregnancy and 38% during postpartum. We outlined 52 different clinical trajectories from past history to postpartum, underlining the heterogeneity of the perinatal course.ConclusionsPregnancy is a susceptible period for women with past psychiatric histories whereas postpartum could trigger a new illness in women without a past history or pregnancy-onset psychiatric disorder.

Objectives: Older women with cardiovascular risk factors and subjective memory complaints are at greater risk for Alzheimer’s disease (AD). We examined the changes in AD peripheral biomarkers, including phosphorylated-tau (p-tau), Aβ40, Aβ42, and Aβ42/40 ratio, in a randomized controlled trial of Kundalini yoga (KY) versus memory enhancement training (MET) in aging women at risk for AD.

Methods: We recruited women (50+ years) with subjective memory complaints and high cardiovascular risk as defined by the ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Participants were randomized into KY versus MET, each lasting for 12 weeks, with a 24-week follow-up. We obtained blood samples at baseline and week 24 and measured Aβ 40, Aβ 42, and p-Tau. Participants completed the Memory Functioning Questionnaire (MFQ) to assess subjective memory at baseline and follow-up.

Results: A total of 79 patients (KY = 40; MET = 39) were randomized, and biomarker data were available for 56 participants (KY = 24; MET = 32) at baseline and the 24-week follow-up. There were no group differences in AD biomarkers at baseline or at 24-week follow-up, and there were no significant changes in AD biomarkers from baseline to 24-week follow-up. Higher baseline levels of Aβ40 and Aβ42 were significantly associated with an improvement in subjective memory (MFQ Frequency of Forgetting and Seriousness of Forgetting) at follow-up. There was no significant association of the Aβ42/40 ratio and p-tau with changes in subjective memory.

Conclusions: Our findings indicate that peripheral Aβ40 and Aβ42 levels are associated with improvement in memory self-awareness, particularly the reported frequency and perceived severity of forgetting. These levels may serve as potential biomarkers, reflecting underlying biological effects that could be utilized in future assessments. Further research is needed to determine how to successfully utilize peripheral biomarkers and subjective memory complaints to identify at-risk populations.