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

BackgroundFirst Episode Mania (FEM) in Bipolar 1 Disorder (BD-1) often presents as a psychiatric emergency requiring rapid symptom control. While electroconvulsive therapy (ECT) is recommended for severe or treatment-resistant mania, its role in FEM has not been well studied, particularly in India, where ECT is widely practiced. This study aimed to examine the indications, parameters, acute response, safety, and first recurrence outcomes associated with ECT in FEM.MethodsWe conducted a retrospective chart review of patients admitted with FEM at the National Institute of Mental Health and Neurosciences (NIMHANS), India, between 2008 and 2011. Of 213 patients with FEM, 81 (38%) received ECT along with pharmacotherapy; 63 with complete records were included in this study. Data on sociodemographic and clinical features, ECT parameters, indications, response, and recurrence were extracted. Response was defined as ≥ 75% improvement in manic symptoms, and remission as complete absence of symptoms for ≥ 8 weeks.ResultsECT was initiated within a mean of 8.7 days of admission, most often for aggression (66.7%), urgent need for improvement (51.6%), or augmentation of pharmacotherapy (27.4%). Patients received an average of 5-6 sessions, predominantly bitemporal (90.5%). Side effects were minimal, limited to transient oral injuries, prolonged seizures, or mild cognitive complaints in < 10%. Response was seen in 90.5%, with a mean time for remission of around 1 month. Among 45 patients with follow-up data, recurrence occurred in 24.4% within a year.DiscussionECT was frequently used in FEM, driven by clinical severity and need for rapid response. It was found to be safe, and associated with high response rates. These findings suggest ECT may be a valuable early intervention in FEM, warranting prospective controlled studies.

ObjectiveEmergency telepsychiatry programs have demonstrated value in urban settings but remain under-studied in terms of their impact on access and flow. This pragmatic study assessed patients seen by a novel emergency telepsychiatry service over 4 years in Winnipeg, Canada, during a time of rapid system change. Outcomes were compared to a cohort of hospitalized individuals who received an in-person emergency psychiatric assessment during the same time period.MethodTelepsychiatry assessments between January 1, 2018 and December 31, 2021 were logged and linked with administrative data to examine variables pre-consult, during the episode of care, and post-consult. For individuals admitted to hospital following the telepsychiatry assessment, we generated a comparison group of individuals admitted following in-person consult at the eligible sites. Emergency Department length of stay (ED LOS), hospital admission diagnosis and days in hospital were compared between groups.ResultsA total of 558 telepsychiatry consults were logged during the study period of which 520 (93.1%) were successfully linked to administrative data. The volume of telepsychiatry consults decreased over time in parallel with changes to in-person staffing and referring facility designation. Rate of admission following the telepsychiatry assessment was 50% or lower across all years. For comparison, 222 telepsychiatry and 756 in-person visits resulting in psychiatric hospital admission were identified. Telepsychiatry-triggered hospitalizations were more likely to be for individuals presenting during daytime (0801-1700 h) and with mood/suicidal chief complaints at triage (P < 0.001). No differences in overall ED LOS, admission diagnosis, or days in hospital were observed.ConclusionTelepsychiatry services in urban ED settings have the potential to offer access to timely consults in the absence of in-person care. This model can optimize resources and offer flexibility in the face of rapidly evolving and unanticipated health system changes.

Plain Language Summary TitleSex Differences in an Addiction Treatment Program at an Urban Mental Health HospitalPlain Language SummaryOur study examined whether there are sex differences in patients treated in an addiction recovery program after leaving the hospital. The program, called the Intensive Recovery Discharge Team, is run by the Centre for Addiction and Mental Health (CAMH) in Toronto. It offers short-term support for patients recovering from substance use disorders after being discharged from the hospital. Services include mental health care, medication management, and help connecting to outpatient treatment. We reviewed the health records of 716 patients to see if there were differences between females and males in their characteristics at the time of referral, as well as in how many appointments they attended and whether they returned to the program after relapse. Our results suggest that female patients were younger and more likely to have other mental health conditions than male patients. While female patients received less referrals than male patients, this difference could be explained by the difference in age. However, once in the program, there were no differences between females and males in how many appointments were booked, missed, or attended. This suggests that females are just as likely as males to stay engaged in treatment when they do have an opportunity to receive it. This difference in referral and re-referral, whether it is due to younger age or other barriers, may make it harder for females to access addiction care after being discharged from the hospital. More research is needed to understand why this is, and how to ensure equitable access to addiction care after leaving the hospital.

BackgroundMental health concerns are common among undergraduates and have been linked to lifestyle factors. This study examined the relationship between recreational screen time at university entry and mental health over the academic year, and the potential moderating role of self-esteem.MethodsData from the longitudinal Queen's U-Flourish Survey (2021/2022) included measures of screen time unrelated to academic work (leisure and social) and validated screening measures for anxiety (GAD-7), depression (PHQ-9), insomnia (SCI-8), disordered eating (SCOFF), and low well-being (SWEMWBS). Multivariable log-binomial regression was used to examine associations between screen time and mental health.ResultsAt entry to university, a higher proportion of males (n = 394) than females (n = 1,135) reported averaging 4 +  hours/day of leisure screen time (57.4% vs. 45.3%, P < 0.001), while a greater proportion of females reported 4 +  hours of social screen time (32.2% vs. 25.2%, P = 0.01). Higher screen time was associated with increased risk of clinically significant levels of symptoms and reduced well-being at school entry, with greater effects for leisure compared to social screen time. Students reporting 7-9 and 10 +  hours/day of leisure screen time were more likely to screen positive for anxiety (by 20% and 39%), depression (39%; 47%), insomnia (22%; 55%), and low well-being (45%; 68%) compared to students averaging ≤3 hours/day. Effects were comparable between males and females, except greater leisure screen time was associated with increased risk of disordered eating among females only. Associations between screen time and screening positive at the end of the academic year were largely attenuated. Leisure screen time ≥3 hours/day was most strongly associated with anxiety and depression among students with higher self-esteem.ConclusionsRecreational screen time ≥3 hours/day is common among first-year undergraduates and associated with higher levels of anxiety and depressive symptoms and lower well-being. It should be considered in campus mental health promotion and prevention efforts.

ObjectiveTo examine the usage of a standardized screening tool bundle in guiding care recommendations within a regional coordinated access service (1Call1Click.ca) for children, youth and their families seeking mental health, addictions, and substance use health (MHASUH) care. To explore how the screening tools align with each other and with Level of Need, an assigned designation used to indicate acuity, needs, and guide service recommendations.MethodBetween May 31, 2021, and December 31, 2023, 8,280 clients aged 6-21 were administered the CASH screening tool bundle (CASH is an acronym for the included screening tools, the CRAFFT, Ask Suicide Questions {ASQ}, HEADS-ED (Over 6 and Under 6) and assigned a Level of Need (used to describe acuity and guide referrals). We describe the most common needs, correlations between Level of Need and each screening tool, and agreement between the HEADS-ED Domains of Suicidality and Drugs and alcohol with the ASQ and CRAFFT screening tools.ResultsWe observe a significant moderate correlation (r(8,280) = .507, p < .001) between the total HEADS-ED score and the assigned Level of Need and significant differences in HEADS-ED total score between each Level of Need (F(4, 8,275) = 766.810, p < .001). Additionally, ASQ and CRAFFT results align with the Suicidality and Drugs and alcohol domains of the HEADS-ED. Referrals were accepted by services at a rate of 94.4%.ConclusionThe CASH screening tool bundle is effective for screening child and youth MHASUH concerns. The HEADS-ED can give a non-specialist healthcare provider an overview of the nature and acuity of child and youth MHASUH and guide the application of more specialized tools included in the bundle. Used as described in this manuscript, the standardized screening bundle is a useful means for assessing needs and guiding referrals to specialized care, including in-depth specialized assessments.

Psychotherapy Research in the Era of Digital Health and AIThe integration of digital health technologies and artificial intelligence (AI) into psychotherapy research represents a transformative shift in mental health care. Traditional psychotherapy relies heavily on face-to-face interactions, limiting accessibility, scalability, and opportunities for continuous monitoring of patient progress. Emerging digital tools, including teletherapy platforms, mobile applications, virtual reality (VR) and AI-powered conversational agents are increasingly being evaluated as adjuncts or alternatives to conventional therapy, opening new frontiers in both research and clinical practice.

BackgroundThe gut microbiome has been proposed as a potential modifiable target to treat mental illness. This double-blind randomized control trial investigated fecal microbiota transplant (FMT) in bipolar disorder (BD) to assess efficacy, safety, and feasibility. The primary outcome evaluated the effectiveness of standard approved therapy for BD depression + FMT in individuals not responding to standard treatment, measured by change in the Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to week 24. Secondary outcomes included FMT's impact on anxiety, global function, side-effects, and safety. The feasibility of this novel intervention was also assessed. Microbial analysis utilized whole-genome shotgun metagenomic sequencing, comparing outcomes between allogenic (donor) and autologous (participants own) FMT.MethodsA total of 35 participants (28 women and 7 men) with at least moderate depressive-phase BD (MADRS) were randomized to receive either allogenic FMT (n = 17) or autologous FMT (n = 18) via colonoscopy and were followed for 24 weeks.ResultsMADRS scores significantly improved from baseline to the last visit in both treatment arms. There was no significant difference between allogenic FMT (16.74-point improvement) and autologous FMT (15.4-point improvement) regarding clinical efficacy (t = -0.47, p-value = .64, 95% confidence interval [CI] = -7.3-4.6). Microbiota analysis showed that allogenic FMT let to a bacterial profile similar to the healthy donor and increased bacterial diversity at the 6-month mark, whereas those receiving autologous FMT did not. The intervention was well tolerated with no significant adverse events. Recruitment, randomization, and retention metrics support feasibility of a larger trial.ConclusionFeasibility and tolerability data indicate further investigation into microbial manipulation in BD is warranted. The absence of efficacy differences between the two types of FMT, despite microbial change, highlights the importance of a true placebo in future studies, as well as the importance of understanding exactly what bacteria are linked to improvements. ClinicalTrials.gov, NCT0327922.