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

BackgroundApproximately one-third of adults with major depressive disorder (MDD) experience limited response or intolerable side effects with existing pharmacotherapies. As such, innovative treatments targeting novel biological pathways are under investigation. One promising area of research is the gut microbiome and its influence on mood through the microbiota-gut-brain axis. Clinical studies have begun evaluating microbiome-targeted interventions such as probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT) as potential treatments for MDD. The Canadian Network for Mood and Anxiety Treatments (CANMAT) convened a task force to evaluate the evidence for microbiome-targeted interventions in adults with MDD and to provide updated clinical recommendations.MethodsA systematic review of randomized controlled trials (RCTs) and meta-analyses was conducted, assessing interventions such as probiotics, prebiotics, synbiotics, and FMT in adults with MDD. The CANMAT methodology was used to determine levels of evidence and treatment line recommendations, which were presented in a question-and-answer format.ResultsTwenty-three RCTs and eight meta-analyses were included. Probiotics have been the most extensively studied and have demonstrated modest improvements in depressive symptoms, particularly when used in an adjunctive manner. However, recent high-quality trials yielded mixed results. Evidence for prebiotics and FMT was limited and inconclusive, while synbiotics were assessed in only one small RCT. Most interventions were well tolerated, with few serious adverse events.ConclusionsProbiotics may be cautiously considered as third-line adjunctive treatments for MDD, though findings remain inconsistent. There is currently insufficient evidence to recommend prebiotics, synbiotics, or FMT in clinical practice. Further large-scale, well-controlled trials are needed to clarify efficacy, safety, and optimal patient subgroups.

Objectives: This study examines the safety and efficacy of a fecal transplant alternative, Microbial Ecosystem Therapeutic-2 (MET-2), in improving symptoms of depression. The primary objective of this study is to assess changes in depressive symptoms before, during, and after administration of MET-2 in comparison to placebo. Mood-related symptoms such as anxiety and anhedonia, gastrointestinal symptoms, and safety of the therapeutic were also assessed using both self-report and clinician-rated measures.

Methods: Twenty-nine participants (n = 29) experiencing a major depressive episode were recruited from the Kingston and Toronto areas. Participants orally consumed MET-2, an encapsulated microbial therapeutic containing 40 different strains of bacteria, or placebo alternative, once daily for 6 weeks with a 2-week follow-up. Participants underwent a series of clinical assessments used to measure mood, anxiety, and gastrointestinal symptoms.

Results: There was a significant improvement in depressive symptomology over time as determined by Montgomery-Åsberg Depression Rating Scale scores (p < 0.0001); however there was no significant difference between placebo and MET-2 groups (p = 0.338). No serious adverse events were reported. The findings of this study are the first to provide evidence for the role of oral microbial therapeutics, such as MET-2, as treatment for symptoms of depression.

Conclusions: Though there are positive trends suggesting a greater improvement in depressive symptomology among the MET-2 group compared to the placebo group, a larger sample size is needed for more conclusive results.

Clinicaltrials: gov NCT04602715.

Objective: To evaluate the feasibility and preliminary efficacy of a digital dialectical behaviour therapy (d-DBT) skills intervention in suicidal psychiatric inpatients.

Methods: A parallel arm, assessor-blinded, randomized controlled trial (RCT) was conducted to compare d-DBT to standard care among psychiatric inpatients. Participants included adults admitted for suicidality (i.e., suicidal ideation or suicide attempt). The intervention group received a d-DBT intervention encompassing 5 online modules completed over 5 to 10 days, covering mindfulness, emotion regulation, and distress tolerance skills. Participants received an initial orientation but no formal therapy sessions. Daily check-ins were available for technical-related queries. Feasibility outcomes included recruitment, adherence (≥3 modules completed), retention, and acceptability (client satisfaction questionnaire-8). Efficacy outcomes included suicidality (Columbia-Suicide Severity Rating Scale [C-SSRS] total score), psychological distress (K10), emotion regulation (Difficulties in Emotion Regulation Scale-16 [DERS-16]), and clinical global impression (CGI). Linear regression models analysed group differences.

Results: A total of 65 participants were recruited, of which 42 were randomized, with high d-DBT adherence rates in the intervention arm (75%). The d-DBT intervention demonstrated significant reductions in C-SSRS scores (Cohen's -1.0) compared to standard of care. No significant group differences were observed in K10, DERS-16, or CGI. High acceptability and satisfaction were reported among participants randomized to d-DBT. Challenges and limitations included maintaining follow-up postdischarge and the small sample size.

Conclusion: d-DBT is feasible to implement through an RCT and may reduce suicidality and improve mental health among psychiatric inpatients. The study highlights the importance of developing accessible, evidence-based interventions for this population. Future research should focus on long-term efficacy and expanding the intervention's appeal and accessibility.

Objective: Bipolar disorder (BD) often goes unrecognized and untreated for several years leading to serious consequences. We have recently developed a manualized telehealth-based group psychoeducational and resilience enhancement program for individuals at high risk for bipolar disorder (PREP-BD). The primary objective of this study was to assess the feasibility of implementing PREP-BD to enhance help-seeking intentions among high-risk individuals.

Method: The intervention consisted of eight weekly, 60-minute group psychoeducation sessions conducted via Zoom. Participants (N = 21), aged 17 to 24 years, who met the bipolar at-risk criteria, were assigned to one of four cohorts. Primary outcomes for this feasibility trial included sign-up rate, completion rate, and acceptability as measured by the Client Satisfaction Questionnaire (CSQ-8). Preliminary efficacy was assessed using validated measures of help-seeking intentions, resilience, quality of life, and stigma, with pre- and post-intervention comparisons.

Results: Our findings indicate excellent feasibility as evidenced by timely recruitment, 100% sign-up rate, and 76.19% completion rate (defined as attending at least 75% of group sessions). The intervention showed preliminary improvements in help-seeking intentions, particularly for a hypomanic scenario. Quality of life also demonstrated significant improvement, while resilience and self-stigma showed non-significant trends toward improvement.

Conclusion: Our findings suggest the feasibility of implementing psychoeducation as an early identification strategy in individuals at risk for BD. Future randomized controlled trials are needed to investigate the effectiveness of PREP-BD.

Background: This paper reports a pilot trial of culturally adapted CBT (CaCBT) for Canadian South Asians. The primary objective of this study was to assess the feasibility and acceptability of online CaCBT to treat anxiety and depression in Canadian South Asian individuals. The secondary objective was to measure changes in depression, anxiety, and disability.

Methods: An assessor-blind randomized clinical trial was conducted at 3 sites in Canada (Greater Toronto Area, Ottawa, and Vancouver). One hundred forty-six participants were randomly allocated to 1 of 2 groups: Ca-CBT (experimental group) or standard cognitive behavioural therapy (CBT) (control group) in a 1:1 ratio. The primary outcome, feasibility, was measured through engagement, recruitment, and participant retention. Acceptability was measured through the Verona Service Satisfaction Scale. Working Alliance Inventory was used to measure therapeutic engagement. Secondary outcomes included depression (Hospital Anxiety and Depression Scale-HADS), somatic symptoms (Bradford Somatic Inventory-BSI), and disability (WHO Disability Assessment Schedule 2.0 (WHODAS). Assessments were carried out at baseline, at the end of therapy (12 weeks from baseline), and at follow-up (36 weeks from baseline).

Results: We were able to recruit participants within the given timeframe with excellent retention rates in both arms. Most participants in the intervention group, 56 (74.7%), attended ≥ 8 sessions, and 11 (14.7%) attended 5 to 7 sessions. Eight (10.7%) participants from the intervention group and 9 (12.0%) from the control group dropped out of therapy (<5 sessions). Participants in the intervention group reported higher levels of satisfaction (P = 0.001) and therapeutic engagement (P < 0.001) compared with the control group. Participants in both groups benefited from CBT.

Conclusions: This is the first report of online CaCBT for depression and anxiety for Canadian South Asians. The intervention is acceptable and feasible. Culturally adapted CBT is as effective as standard CBT in reducing the symptoms of depression and anxiety.

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.

BackgroundTrials of deep brain stimulation (DBS) to the subcallosal cingulate gyrus (SCG) for treatment-resistant depression (TRD) have yielded mixed results. While open-label studies suggest effectiveness, randomized controlled trials (RCTs) have not consistently supported these findings. The study compared the efficacy of active versus sham SCG stimulation for TRD.MethodsParticipants (n = 35) in a major depressive episode and treatment resistance completed a 6-month double blind, crossover RCT, with an 18-month open-label phase. A Balaam design was applied with participants randomized to 1 of 4 stimulation groups over two 3-month phases. The primary outcome was a change in Hamilton Depression Rating Scale (HDRS) score at 6 months, with response defined as ≥50% reduction in HDRS-17 scores.ResultsWhile all groups showed improvement at 3 and 6 months, no significant differences were found among them. The OFF-OFF group had a numerically lower HDRS-17 score compared to the ON-ON group at the end of the RCT. No unexpected adverse events occurred. During the open-label phase, participants showed sustained reduction in HDRS-17 scores at 12, 18, and 24 months post-implantation, with successive observed-case response rates of 65.7%, 69%, and 73.1%, respectively. Improvements in life functioning were also noted.ConclusionsThis trial represents the largest single-centre, sham-controlled study of SCG DBS for TRD in the literature. Although the RCT showed no significant group differences, most participants achieved response during the open-label phase. Safety outcomes aligned with previous trials. Future RCTs should integrate insights from the past decade of DBS for TRD research to optimize outcomes. Key considerations include selecting DBS contact locations that ensure engagement of critical white matter tracts, employing novel and sufficiently long clinical trial designs to account for the non-specific effects of the DBS procedure, as well as incorporating biomarkers to guide DBS programming.