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

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.

AimsThe approval of new drugs for bipolar disorder (BD) may have caused a shift in prescribing trends among patients with BD. The objective of the study was to describe prescribing trends amongst individuals with BD in Alberta, Canada.MethodsThis study used provincial administrative health data from Alberta, Canada. Individuals with at least one ICD-9 or ICD-10 code for BD were identified from three databases - Provider claims, Hospital Discharge Abstract Database and the Ambulatory Care Classification System. Within this cohort, we identified prevalent, new and combination use of commonly prescribed BD drugs through prescription information from the Pharmaceutical Information Network database.ResultsBetween April 1, 1994, and March 31, 2021, 136,628 individuals had at least 1 code of BD with 9,466,407 prescriptions dispensed between January 1, 2008 to March 31, 2021. New users of all drugs declined over time, especially from 2019 to 2021. Among all BD drugs, antidepressants were the most commonly prescribed in both prevalent and new users throughout the study period. Among recommended treatments for BD, quetiapine was one of the most prescribed drugs amongst prevalent users. An overall decline was noted in prescribing of lithium, divalproex and carbamazepine among prevalent and new users. Most individuals were prescribed a single drug for BD treatment. The most common combination therapy for prevalent users was an antidepressant with a second-generation antipsychotic (SGA).ConclusionsOverall, we uncovered a concerning trend in the prescribing patterns for BD treatment, with antidepressants and SGAs being prescribed frequently and a decline in prescribing of lithium and other mood stabilizers. This study emphasizes the need for initiatives promoting evidence-based guidelines and better alignment with best practices for managing BD in outpatient settings.Plain Language Summary TitlePrescribing Trends for Bipolar Disorder Drugs in Alberta, Canada Between 2008 to 2021.

ObjectiveOpioid use is a major public health issue and associated with a broad range of comorbid mental disorders. Globally, there is considerable variability in reported rates of mental disorders among individuals with opioid use disorder (OUD), limiting timely intervention and evidence-based treatment among this population. We estimate the prevalence of specific mental disorders among individuals with a concurrent OUD using population-level administrative data in British Columbia, Canada.MethodA population-based retrospective observational study using individual-level linked health administrative data in British Columbia, Canada. Individuals with an OUD and concurrent mental disorder between January 1, 2013, and August 31, 2021, were included and followed from their first indication of OUD until censoring (death, administrative loss to follow-up, or August 31, 2021). We reported annual period (2013-2021) prevalence rates and age-standardized prevalence rates per 100,000 population (stratified by sex).ResultsThe population included 73,855 individuals (female 40.6%, median age, 36 [27-48]) with an OUD and concurrent mental disorder. During the observation period anxiety disorders were the most prevalent (91.7%) mental disorders followed by depression (73.6%), bipolar disorder (35.3%), schizophrenia spectrum disorders (20.4%), and personality disorders (19.5%). Among the population, the annual period prevalence of any mental disorder increased from 35,603 in 2013 to 60,940 in 2021, with an average annual percent difference of 7.0%, driven by increases in schizophrenia spectrum disorders and attention deficit/hyperactivity disorder. Overall, the annual age-standardized prevalence of any mental disorder was higher among males.ConclusionsOur findings demonstrate a steadily growing prevalence of people with OUD and a concurrent mental disorder and emphasize the need for access to mental disorder treatment among this population. Estimating specific mental disorder prevalence is a pragmatic step toward informing clinical guidelines, service needs, and health system planning.

ObjectivesCommunity treatment orders (CTOs) for people with severe mental illnesses are used across most of Canada. Our previous systematic review of 10 years ago found that the evidence-base was limited to small studies, with only one including controls. This review updates the evidence using studies conducted in Canada over the last decade.MethodsA systematic search of PubMed/Medline, Embase, CINAHL, and PsycINFO for any Canadian study of outcomes following CTO placement from March 2015 to January 2025.ResultsWe identified four articles from three studies. Adding these studies to the previous search gave a total of nine articles from seven studies. None could be included in a meta-analysis. There were reductions in readmission rates and bed-days following CTO placement, while psychiatric symptom, outpatient attendance, treatment adherence participation in psychiatric services and housing all improved. In one study, perceived coercion was no greater in the CTO cases than the controls and being on an order preferable to being in hospital. However, many of the studies were small and only two included controls, of which solely one adjusted for potential confounders using either matching or adjusted analyses. The certainty of evidence was therefore rated as very low.ConclusionsThe evidence-base for the use of CTOs in Canada remains limited. This research gap contrasts with other countries that have conducted large studies using randomized or matched controls and adjusted analyses. There is a need for larger studies with more standardized reporting methods to allow for the pooling of results.Protocol Registration NumberProspectively registered with PROSPERO registration number CRD42024615480.

ObjectiveDignity is an important construct in vulnerable persons; however, there is limited research examining dignity in patients with mental illness. Our study aims to examine self-reported dignity-related distress among psychiatric inpatients using the patient dignity inventory (PDI) and investigate the relationship between this distress and demographic and clinical variables, including suicidality.MethodsBetween June 2021 and July 2022, 97 participants were recruited from two hospitals in Winnipeg, Canada. Participants were patients admitted to acute psychiatric wards, 18 years or older, and provided informed consent. Participants completed a series of standardized self-report measures including the PDI and validated measures of depression, alcohol use, and suicidal behaviour. Demographic and clinical information was also obtained from patient charts. General linear models were used to investigate the relationship between dignity-related distress and demographic and clinical variables.ResultsThe majority of the study sample had moderate to high depression symptomatology (57.7%), previous psychiatric hospitalizations (67.4%), and previous suicide attempts (52.6%). Dignity-related distress was not associated with gender, sexual orientation, age, marital status, or education. Higher levels of dignity-related distress were associated with mental disorder comorbidities (P < 0.01), greater depressive symptoms (P < 0.001), and higher risk alcohol use behaviours (P < 0.001). Increasing levels of dignity-related distress were associated with greater intensity of suicidal ideation (P < 0.001) having at least one previous suicide attempt (P < 0.001), and having a high desire to die during that attempt (P < 0.001).ConclusionAmong psychiatric inpatients, impairment in their sense of dignity was associated with greater clinical severity including both a history of suicide attempt and current suicidal ideation. Further investigation may lead to targeted interventions to mitigate dignity-related distress and improve patient outcomes.

ObjectiveThis exploratory correlational study explored the demographic, clinical, and offence-type characteristics of people with documented past-year contact with the criminal justice system (CJS) in Toronto, Canada who died by suicide. We aimed to compare demographic and clinical factors among individuals with CJS contact who died by suicide to those without recorded CJS contact who died by suicide.MethodsCoroners' final death reports from all recorded suicide deaths in Toronto between 1 January 1998 and 31 December 2020 were retrieved by research staff and coded at the Office of the Chief Coroner (OCC) of Ontario. A series of bivariate analyses and binary logistic regression analyses were performed to compare demographic and clinically relevant characteristics between these groups. Descriptive statistics relating to demographic, clinical, and offence-type characteristics were reported.ResultsA total of 5,288 people died by suicide, of whom 251 (4.7% of all suicides) had recorded CJS contact prior to death. Assault, physical assault, impaired driving, serious/death threats, and sexual assault were the most common criminal charges among those in the CJS contact group. When compared with the no recorded CJS contact group, the CJS contact group was slightly younger (M = 40.0, SD = ±13.4 vs. M = 47.5, SD = ±18.1, p < 0.001), had a higher proportion of males (85.6% vs. 69.9%, p < 0.001), more commonly experienced interpersonal (36.3% vs. 14.5%, p < 0.001) and/or relationship break-up/breakdown stressors (16.7% vs. 7.5%, p < 0.001), and substance misuse or substance use disorders (37.5% vs. 18%, p < 0.001).ConclusionsOur findings highlight that younger men with interpersonal stressors and/or substance misuse characterize suicide decedents with recorded CJS contact in Toronto, Canada. Suicide prevention efforts and strategies should consider the profile differences among those navigating the CJS.Plain Language Summary TitleCriminal Justice System Contacts among Suicide Decedents in Toronto.