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

Objectives: The impact of comorbid posttraumatic stress disorder (PTSD) symptoms on the anti-depressive outcomes of repetitive transcranial magnetic stimulation (rTMS) for civilians with major depressive disorder (MDD) is poorly studied. We aimed to understand whether proximal PTSD symptoms would interact with distal traumas in impacting depression outcomes from rTMS treatment.

Methods: A retrospective analysis was performed on 133 patients with MDD receiving open-label high-frequency rTMS to the left dorsolateral prefrontal cortex for 4 weeks. Probable PTSD was defined as scoring ≥ 4 on the Primary Care PTSD Screen for DSM-5. Distal traumas were quantified using the Adverse Childhood Experiences (ACE-10) questionnaire. Primary outcomes were improvement in Hamilton Rating Scale for Depression 17 item scale (HAMD-17) scores from baseline to 4 weeks as well as remission (HAMD-17 ≤ 7) and response (greater than 50% improvement from baseline).

Results: 29/133 had probable PTSD. Patients with probable PTSD had more ACEs, as well as higher depression, anxiety and medical comorbidity scores. Neither probable PTSD status nor its interaction with ACEs significantly impacted depression outcomes. However, having more ACEs was associated with greater odds of remission and response.

Conclusions: Our findings suggest neither co-morbid PTSD symptoms nor distal childhood adversities should preclude patients with MDD from receiving rTMS for depression.Plain Language Summary TitleRepetitive transcranial magnetic stimulation for civilian patients with depression and posttraumatic stress symptoms.

Objective: Major depressive disorder (MDD) is associated with cognitive impairments that persist despite successful treatment. Transcranial magnetic stimulation is a noninvasive treatment for MDD that is associated with small procognitive effects on working memory and executive function. We hypothesized that pairing stimulation with N-methyl-D-aspartate (NMDA) receptor agonism would enhance the effects of stimulation and its procognitive effects.

Method: The effect of NMDA receptor agonism (D-cycloserine, 100 mg) on cognitive performance was tested in two randomized double-blind placebo-controlled trials: (1) acute effects of in the absence of stimulation (n = 20 healthy participants) and (2) a treatment study of individuals with MDD (n = 50) randomized to daily intermittent theta-burst stimulation (iTBS) with placebo or D-cycloserine for 2 weeks. Cognitive function was measured using the THINC-it battery, comprised of the Perceived Deficits Questionnaire, the Choice Reaction Time, the Trail Making Test, the Digit Symbol Substitution Test, and the 1-Back tests.

Results: D-cycloserine had no acute effect on cognition compared to placebo. iTBS + D-cycloserine was associated with significant improvements in subjective cognitive function and correct responses on the 1-Back when compared to iTBS + placebo. Improvements in subjective cognition paralleled depressive symptoms improvement, however 1-Back improvements were not attributable to improvement in depression.

Conclusions: An intersectional strategy pairing iTBS with NMDA receptor agonism may restore cognitive function in MDD.

Objective: Lithium, despite its evidence base and range of indications, is often underutilized due to safety concerns associated with high-dose prescriptions and consequent necessity for regular blood monitoring. Emerging evidence suggests its potential benefits at lower doses, especially for its pro-cognitive effects and positive safety profile. While accessible as a supplement, empirical human evidence on neuropsychiatric effects is lacking. This study aimed to provide preliminary evidence regarding the utilization and perceived effects of low-dose lithium supplements (LiS) in the community.

Methods: Cross-sectional, opportunistic survey of 211 participants aged ≥18 years who disclosed taking over-the-counter lithium supplements. The survey assessed sample demographics, supplement details, overall perspectives, and personal experiences related to the use of LiS.

Results: The most common form of LiS taken was aspartate at 10 mg once per day, although lithium orotate and ionic lithium were also frequently used. The most common beliefs regarding the benefits of using lithium as a supplement concern efficacy for anxiety, but the most common improvements experienced was in the domain of cognition, closely followed by anxiety and mood. Mood was most commonly reported as the greatest improvement. Side effects and withdrawal phenomena were more prevalent than anticipated.

Conclusion: This study revealed a diverse range of lithium supplements taken, in terms of dosage, formulation, frequency, and duration of intake. Anecdotal evidence highlighted prevalent perceived benefits and adverse effects. The study is, however, limited notably by its cross-sectional opportunistic design; more robust evidence, especially from controlled trials, is needed to fully establish the specific benefits and drawbacks associated with different forms and doses of accessible lithium supplements.Plain Language Summary TitleA survey exploring people's experiences with lithium bought as a supplement.

ObjectivePatients with intellectual and developmental disabilities (IDDs) and psychiatric disorders are at higher risk for prolonged hospitalisations. The aim of this study was to examine the prevalence of IDD among long-stay inpatients in Ontario psychiatric beds, and compare the demographic and clinical profiles of long-stay inpatients with and without IDD.MethodsThis Ontario population-based cross-sectional study used linked health administrative databases. All patients over 18 years of age occupying a non-forensic psychiatric inpatient bed in Ontario on September 30th, 2023 were included in the analysis. We examined prevalence of IDD among patients with a length of stay (LOS) ≥ 365 days ('long-stay patients'). Standardised differences were used to compare demographic, clinical, functional, and health care utilisation characteristics between patients with and without IDD.ResultsOf the 1,466 long-stay patients in an Ontario non-forensic psychiatric inpatient bed, 22.0% had IDD. They were younger (mean age 44.3 vs. 47.6) and a higher proportion were male (64.3% vs. 50.1%). In the 2 years prior to admission, a higher proportion of long-stay patients with IDD had a psychotic disorder (73.3% vs. 54.0%), and they had a higher median number of ED visits (5 vs. 3). Long-stay inpatients with IDD were more likely to have difficulty with activities of daily living (39.8% vs. 15.0%), moderate/severe cognitive impairment (63.0% vs. 29.9%) and fewer social contacts in place to support discharge (59.3% vs. 48.6%). While in hospital, a greater proportion of long-stay patients with IDD were subject to restraints (12.4% vs. 8.0%) and seclusion (20.2% vs. 11.2%).ConclusionsAdults with IDD account for more than one in five long-stay psychiatric inpatients and have unique needs including greater cognitive impairment and difficulty caring for themselves. Successful transitions out of hospital require specialised resources and cross-sectoral collaboration.

BackgroundAnticonvulsants are an essential treatment for bipolar disorder; however, there is relatively little known about their use in older age bipolar disorder (OABD). In this paper, which leverages a large international dataset, we aim to 1) describe the use of anticonvulsants in OABD compared to younger age bipolar disorder (YABD; ages <50 years old) and 2) explore any demographic/clinical correlates.MethodsA secondary analysis was conducted on the international data from the Global Aging and Geriatric Experiments in Bipolar Disorder project. The main objective was to report the prevalence of anticonvulsant use in OABD over 50 years old (mean age = 62.27) and the most prescribed anticonvulsant. Additional analysis explored any demographic and clinical correlates associated with anticonvulsant use. Generalized linear mixed models were used for this analysis.ResultsOf the 2,691 participants with bipolar disorder who had anticonvulsant prescribing data, 34.4% (n = 926) used anticonvulsants at the time of study. Rates of anticonvulsant prescribing did not significantly differ between OABD and YABD groups (36.7% (n = 666) vs. 29.7% (n = 260)). Anticonvulsant prescribing patterns for OABD and YABD did not significantly differ, with valproate as the most prescribed anticonvulsant. OABD anticonvulsant users had less lithium use, more antidepressant use, more rapid cycling, more mood episodes and more cardiovascular comorbidities compared to nonusers.ConclusionAnticonvulsant use was similar in OABD and YABD. A number of important clinical correlates of anticonvulsant use were identified.

Co-occurring alcohol use disorder (AUD) and major depressive disorder (MDD) are common and complex conditions that significantly impact patient outcomes. The bidirectional relationship between alcohol use and depression complicates diagnosis and treatment, as alcohol exacerbates depressive symptoms and vice versa. Integrated treatment addressing both disorders simultaneously has shown better outcomes compared to sequential treatments. This article provides evidence-based clinical guidance for managing patients with co-occurring AUD and MDD, focusing on pharmacotherapy, psychotherapy and integrated care models. Pharmacologically, selective serotonin reuptake inhibitors and tricyclic antidepressants are commonly used to treat depression in individuals with AUD, while naltrexone and acamprosate are first-line medications for AUD. Combining antidepressants with AUD medications improves treatment efficacy. Psychotherapeutic interventions such as Cognitive-Behavioural Therapy (CBT) and Motivational Interviewing are essential components of treatment, focusing on addressing both alcohol use and depressive symptoms. Behavioural activation has also proven effective in treating depression while reducing alcohol cravings. Integrated care models, where both disorders are addressed simultaneously, yield the best outcomes and involve coordinated pharmacotherapy, psychotherapy and ongoing follow-up care. A case example of a 33-year-old woman with AUD and MDD highlights the success of an integrated treatment approach, where a combination of sertraline, naltrexone and CBT led to significant improvements in both mood and alcohol use. Clinicians are advised to differentiate between alcohol-induced depression and primary MDD, consider potential medication interactions, and incorporate ongoing psychotherapy and monitoring for optimal patient outcomes. This approach emphasizes the importance of addressing both conditions concurrently to achieve better long-term recovery outcomes for patients with co-occurring AUD and MDD.

ObjectivesTo understand the mental health distress, demographics and service utilization patterns among South Asian and non-South Asian youth accessing integrated youth services (IYS) in British Columbia (BC), Canada.MethodsThis study used data from youth accessing services at the BC-IYS (Foundry) between April 2018 and October 2023. Descriptive statistics summarized demographic and service utilization data, with categorical variables compared using chi-squared tests and continuous variables using t-tests. A linear regression model examined the relationship between ethnicity (South Asian vs. non-South Asian) and mental health distress measured by Kessler Distress Scale (K10), stratified by gender [cisgender and transgender and non-conforming (TGNC)].ResultsThe study included 30,016 youth, among whom 5.5% (n = 1,652) were South Asian. South Asian youth had higher distress levels (Average K10 score: 32.1 vs. 31.3, P < 0.001) and lower mental health service utilization within the past year (57.1% vs. 48.4%) compared to non-south Asian youth. They were also more likely to use virtual services (30.2% vs. 19.4%). For gender, 94.5% of South Asian youth identified as cisgender and 5.1% as TGNC, compared to 14% TGNC in non-South Asians (P < 0.001). Regression analyses showed a significant association between ethnicity and mental health distress. This was amplified within the TGNC strata for South Asian participants compared to non-South Asian youth (B = 2.00, 95% CI, 0.35 to 3.66, P = 0.018). Younger age was associated with higher levels of mental health distress among South Asian youth in both gender strata: cisgender (B = -0.07, 95% CI, -0.10 to -0.03, P < 0.001) and TGNC (B = -0.14, 95% CI, -0.21 to -0.06, P < 0.001).ConclusionThis study reveals that South Asian youth accessing services from the BC-IYS experience higher levels of mental distress compared to non-South Asian youth. The findings highlight the need for culturally sensitive mental health services, education and policies to improve outcomes for South Asian youth in BC.Plain Language Summary TitleUnderstanding the Needs of South Asian Youth Accessing Integrated Youth Services in British Columbia, Canada.

BackgroundThe objectives of this study were (1) to describe the symptoms noted by family physicians during help-seeking visits for early psychosis, relative to a validated screening tool for early psychosis in primary care, and (2) to examine the referral disposition of patients meeting the screening tool cut-off.MethodsWe constructed a retrospective cohort of Ontario residents aged 14-35 years with an incident diagnosis of non-affective psychotic disorder between 2005-2015 in health administrative data, and at least one visit in the Electronic Medical Record Primary Care database during the 6 months prior to the date of psychotic disorder diagnosis (n = 572). We abstracted symptoms of psychosis noted by the family physician in the electronic medical records and compared these to the Primary Care Checklist (PCCL) for early psychosis.ResultsThe most frequent PCCL items noted were "tension or nervousness" (13.3%), "depressive mood" (12.5%), "increased stress or deterioration in functioning" (7.5%), and "sleep difficulties" (6.6%). The PCCL cut-off was met by 187 patients (33%) across 327 visits (8%). A greater proportion of visits meeting the PCCL cut-off had psychosis noted as the main presenting issue (55.4% vs. 6.8%) and resulted in referral to mental health services (33.3% vs. 6.0%) than those not meeting the cut-off. However, two in three visits where the screening cut-off for early psychosis was met did not result in a referral to mental health services.DiscussionThe findings of this study suggest that family physicians may benefit from a screening tool when early psychosis is suspected to improve identification and guide referral practices.