Publisher: Sage Publications   (Total: 1085 journals)

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Showing 1 - 200 of 1085 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 6)
Abstracts in Anthropology     Full-text available via subscription   (Followers: 21)
Academic Pathology     Open Access   (Followers: 5)
Accounting History     Hybrid Journal   (Followers: 17, SJR: 0.527, CiteScore: 1)
Acta Radiologica     Hybrid Journal   (Followers: 2, SJR: 0.754, CiteScore: 2)
Acta Radiologica Open     Open Access   (Followers: 3)
Acta Sociologica     Hybrid Journal   (Followers: 37, SJR: 0.939, CiteScore: 2)
Action Research     Hybrid Journal   (Followers: 49, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 344, SJR: 1.397, CiteScore: 2)
Adaptive Behavior     Hybrid Journal   (Followers: 9, SJR: 0.288, CiteScore: 1)
Administration & Society     Hybrid Journal   (Followers: 14, SJR: 0.675, CiteScore: 1)
Adoption & Fostering     Hybrid Journal   (Followers: 23, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 8, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 224, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 41)
Advances in Dental Research     Hybrid Journal   (Followers: 8, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 30, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 134, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 10)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 45, SJR: 0.599, CiteScore: 1)
Advances in Tumor Virology     Open Access   (Followers: 3, SJR: 0.108, CiteScore: 0)
AERA Open     Open Access   (Followers: 10)
Affilia     Hybrid Journal   (Followers: 4, SJR: 0.496, CiteScore: 1)
Agrarian South : J. of Political Economy     Hybrid Journal   (Followers: 2)
Air, Soil & Water Research     Open Access   (Followers: 13, SJR: 0.214, CiteScore: 1)
Alexandria : The J. of National and Intl. Library and Information Issues     Full-text available via subscription   (Followers: 66)
AlterNative : An Intl. J. of Indigenous Peoples     Full-text available via subscription   (Followers: 13, SJR: 0.194, CiteScore: 0)
Alternative Law J.     Hybrid Journal   (Followers: 10, SJR: 0.176, CiteScore: 0)
Alternatives : Global, Local, Political     Hybrid Journal   (Followers: 12, SJR: 0.351, CiteScore: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 22, SJR: 0.982, CiteScore: 2)
American Economist     Hybrid Journal   (Followers: 7)
American Educational Research J.     Hybrid Journal   (Followers: 214, SJR: 2.913, CiteScore: 3)
American J. of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 18, SJR: 0.67, CiteScore: 2)
American J. of Cosmetic Surgery     Hybrid Journal   (Followers: 6)
American J. of Evaluation     Hybrid Journal   (Followers: 17, SJR: 0.646, CiteScore: 2)
American J. of Health Promotion     Hybrid Journal   (Followers: 33, SJR: 0.807, CiteScore: 1)
American J. of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 42, SJR: 0.65, CiteScore: 1)
American J. of Law & Medicine     Full-text available via subscription   (Followers: 11, SJR: 0.204, CiteScore: 1)
American J. of Lifestyle Medicine     Hybrid Journal   (Followers: 5, SJR: 0.431, CiteScore: 1)
American J. of Medical Quality     Hybrid Journal   (Followers: 11, SJR: 0.777, CiteScore: 1)
American J. of Men's Health     Open Access   (Followers: 8, SJR: 0.595, CiteScore: 2)
American J. of Rhinology and Allergy     Hybrid Journal   (Followers: 9, SJR: 0.972, CiteScore: 2)
American J. of Sports Medicine     Hybrid Journal   (Followers: 197, SJR: 3.949, CiteScore: 6)
American Politics Research     Hybrid Journal   (Followers: 33, SJR: 1.313, CiteScore: 1)
American Review of Public Administration     Hybrid Journal   (Followers: 19, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 308, SJR: 6.333, CiteScore: 6)
American String Teacher     Full-text available via subscription   (Followers: 2)
Analytical Chemistry Insights     Open Access   (Followers: 25, SJR: 0.224, CiteScore: 1)
Angiology     Hybrid Journal   (Followers: 3, SJR: 0.849, CiteScore: 2)
Animation     Hybrid Journal   (Followers: 13, SJR: 0.197, CiteScore: 0)
Annals of Clinical Biochemistry     Hybrid Journal   (Followers: 11, SJR: 0.634, CiteScore: 1)
Annals of Otology, Rhinology & Laryngology     Hybrid Journal   (Followers: 15, SJR: 0.807, CiteScore: 1)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 53, SJR: 1.096, CiteScore: 2)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 46, SJR: 1.225, CiteScore: 3)
Annals of the ICRP     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Anthropocene Review     Hybrid Journal   (Followers: 9, SJR: 3.341, CiteScore: 7)
Anthropological Theory     Hybrid Journal   (Followers: 42, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Hybrid Journal   (Followers: 11)
Antiviral Chemistry and Chemotherapy     Open Access   (Followers: 2, SJR: 0.635, CiteScore: 2)
Antyajaa : Indian J. of Women and Social Change     Hybrid Journal  
Applied Biosafety     Hybrid Journal   (Followers: 1, SJR: 0.131, CiteScore: 0)
Applied Psychological Measurement     Hybrid Journal   (Followers: 23, SJR: 1.17, CiteScore: 1)
Applied Spectroscopy     Full-text available via subscription   (Followers: 26, SJR: 0.489, CiteScore: 2)
Armed Forces & Society     Hybrid Journal   (Followers: 21, SJR: 0.29, CiteScore: 1)
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 42, SJR: 0.305, CiteScore: 1)
Asia Pacific Media Educator     Hybrid Journal   (Followers: 1, SJR: 0.23, CiteScore: 0)
Asia-Pacific J. of Management Research and Innovation     Full-text available via subscription   (Followers: 3)
Asia-Pacific J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.558, CiteScore: 1)
Asian and Pacific Migration J.     Full-text available via subscription   (Followers: 104, SJR: 0.324, CiteScore: 1)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2, SJR: 0.305, CiteScore: 0)
Asian J. of Comparative Politics     Hybrid Journal   (Followers: 4)
Asian J. of Legal Education     Full-text available via subscription   (Followers: 4)
Asian J. of Management Cases     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
ASN Neuro     Open Access   (Followers: 2, SJR: 1.534, CiteScore: 3)
Assessment     Hybrid Journal   (Followers: 17, SJR: 1.519, CiteScore: 3)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 16, SJR: 0.578, CiteScore: 1)
Australasian Psychiatry     Hybrid Journal   (Followers: 9, SJR: 0.433, CiteScore: 1)
Australian & New Zealand J. of Psychiatry     Hybrid Journal   (Followers: 20, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 527, SJR: 0.612, CiteScore: 1)
Australian J. of Career Development     Hybrid Journal   (Followers: 4)
Australian J. of Education     Hybrid Journal   (Followers: 42, SJR: 0.403, CiteScore: 1)
Australian J. of Management     Hybrid Journal   (Followers: 13, SJR: 0.497, CiteScore: 1)
Autism     Hybrid Journal   (Followers: 326, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 11)
Behavior Modification     Hybrid Journal   (Followers: 12, SJR: 0.877, CiteScore: 2)
Behavioral and Cognitive Neuroscience Reviews     Hybrid Journal   (Followers: 26)
Bible Translator     Hybrid Journal   (Followers: 13)
Biblical Theology Bulletin     Hybrid Journal   (Followers: 18, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 49)
Biochemistry Insights     Open Access   (Followers: 7)
Bioinformatics and Biology Insights     Open Access   (Followers: 12, SJR: 1.141, CiteScore: 2)
Biological Research for Nursing     Hybrid Journal   (Followers: 7, SJR: 0.685, CiteScore: 2)
Biomarker Insights     Open Access   (Followers: 1, SJR: 0.81, CiteScore: 2)
Biomarkers in Cancer     Open Access   (Followers: 10)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 12)
Biomedical Informatics Insights     Open Access   (Followers: 8)
Bioscope: South Asian Screen Studies     Hybrid Journal   (Followers: 3, SJR: 0.235, CiteScore: 0)
BMS: Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique     Hybrid Journal   (Followers: 4, SJR: 0.226, CiteScore: 0)
Body & Society     Hybrid Journal   (Followers: 25, SJR: 1.531, CiteScore: 3)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Brain and Neuroscience Advances     Open Access  
Breast Cancer : Basic and Clinical Research     Open Access   (Followers: 10, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 8)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 199, SJR: 0.323, CiteScore: 1)
British J. of Pain     Hybrid Journal   (Followers: 26, SJR: 0.579, CiteScore: 2)
British J. of Politics and Intl. Relations     Hybrid Journal   (Followers: 32, SJR: 0.91, CiteScore: 2)
British J. of Visual Impairment     Hybrid Journal   (Followers: 13, SJR: 0.337, CiteScore: 1)
British J.ism Review     Hybrid Journal   (Followers: 17)
Building Acoustics     Hybrid Journal   (Followers: 4, SJR: 0.215, CiteScore: 1)
Building Services Engineering Research & Technology     Hybrid Journal   (Followers: 3, SJR: 0.583, CiteScore: 1)
Bulletin of Science, Technology & Society     Hybrid Journal   (Followers: 8)
Business & Society     Hybrid Journal   (Followers: 12)
Business and Professional Communication Quarterly     Hybrid Journal   (Followers: 8, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 16, SJR: 0.279, CiteScore: 0)
Business Perspectives and Research     Hybrid Journal   (Followers: 3)
Cahiers Élisabéthains     Hybrid Journal   (Followers: 1, SJR: 0.111, CiteScore: 0)
Calcutta Statistical Association Bulletin     Full-text available via subscription   (Followers: 1)
California Management Review     Hybrid Journal   (Followers: 30, SJR: 2.209, CiteScore: 4)
Canadian J. of Kidney Health and Disease     Open Access   (Followers: 6, SJR: 1.007, CiteScore: 2)
Canadian J. of Nursing Research (CJNR)     Hybrid Journal   (Followers: 13)
Canadian J. of Occupational Therapy     Hybrid Journal   (Followers: 134, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 28, SJR: 1.769, CiteScore: 3)
Canadian J. of School Psychology     Hybrid Journal   (Followers: 11, SJR: 0.266, CiteScore: 1)
Canadian Pharmacists J. / Revue des Pharmaciens du Canada     Hybrid Journal   (Followers: 3, SJR: 0.536, CiteScore: 1)
Cancer Control     Open Access   (Followers: 1)
Cancer Growth and Metastasis     Open Access   (Followers: 1)
Cancer Informatics     Open Access   (Followers: 4, SJR: 0.64, CiteScore: 1)
Capital and Class     Hybrid Journal   (Followers: 7, SJR: 0.282, CiteScore: 1)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiovascular and Thoracic Open     Open Access  
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 8, SJR: 0.44, CiteScore: 1)
Cartilage     Hybrid Journal   (Followers: 5, SJR: 0.889, CiteScore: 3)
Cell and Tissue Transplantation and Therapy     Open Access   (Followers: 2)
Cell Transplantation     Open Access   (Followers: 4, SJR: 1.023, CiteScore: 3)
Cephalalgia     Hybrid Journal   (Followers: 7, SJR: 1.581, CiteScore: 3)
Child Language Teaching and Therapy     Hybrid Journal   (Followers: 31, SJR: 0.501, CiteScore: 1)
Child Maltreatment     Hybrid Journal   (Followers: 9, SJR: 1.22, CiteScore: 3)
Child Neurology Open     Open Access   (Followers: 6)
Childhood     Hybrid Journal   (Followers: 19, SJR: 0.894, CiteScore: 2)
Childhood Obesity and Nutrition     Open Access   (Followers: 11)
China Information     Hybrid Journal   (Followers: 7, SJR: 0.767, CiteScore: 2)
China Report     Hybrid Journal   (Followers: 10, SJR: 0.221, CiteScore: 0)
Chinese J. of Sociology     Full-text available via subscription   (Followers: 4)
Christianity & Literature     Full-text available via subscription   (Followers: 8)
Chronic Illness     Hybrid Journal   (Followers: 6, SJR: 0.672, CiteScore: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9, SJR: 0.808, CiteScore: 2)
Chronic Stress     Open Access  
Citizenship, Social and Economics Education     Full-text available via subscription   (Followers: 6, SJR: 0.145, CiteScore: 0)
Cleft Palate-Craniofacial J.     Hybrid Journal   (Followers: 7, SJR: 0.757, CiteScore: 1)
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 16, SJR: 0.49, CiteScore: 1)
Clinical and Translational Neuroscience     Open Access  
Clinical Case Studies     Hybrid Journal   (Followers: 3, SJR: 0.364, CiteScore: 1)
Clinical Child Psychology and Psychiatry     Hybrid Journal   (Followers: 45, SJR: 0.73, CiteScore: 2)
Clinical EEG and Neuroscience     Hybrid Journal   (Followers: 6, SJR: 0.552, CiteScore: 2)
Clinical Ethics     Hybrid Journal   (Followers: 10, SJR: 0.296, CiteScore: 1)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3, SJR: 0.537, CiteScore: 2)
Clinical Medicine Insights : Blood Disorders     Open Access   (SJR: 0.314, CiteScore: 2)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6, SJR: 0.686, CiteScore: 2)
Clinical Medicine Insights : Case Reports     Open Access   (Followers: 1, SJR: 0.283, CiteScore: 1)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3, SJR: 0.425, CiteScore: 2)
Clinical Medicine Insights : Ear, Nose and Throat     Open Access   (Followers: 1)
Clinical Medicine Insights : Endocrinology and Diabetes     Open Access   (Followers: 33, SJR: 0.63, CiteScore: 2)
Clinical Medicine Insights : Oncology     Open Access   (Followers: 3, SJR: 1.129, CiteScore: 3)
Clinical Medicine Insights : Pediatrics     Open Access   (Followers: 3)
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 9)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 2, SJR: 0.776, CiteScore: 0)
Clinical Medicine Insights : Therapeutics     Open Access   (Followers: 1, SJR: 0.172, CiteScore: 0)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 2)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Nursing Research     Hybrid Journal   (Followers: 29, SJR: 0.471, CiteScore: 1)
Clinical Pathology     Open Access   (Followers: 3)
Clinical Pediatrics     Hybrid Journal   (Followers: 22, SJR: 0.487, CiteScore: 1)
Clinical Psychological Science     Hybrid Journal   (Followers: 11, SJR: 3.281, CiteScore: 5)
Clinical Rehabilitation     Hybrid Journal   (Followers: 70, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 22, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 25, SJR: 0.36, CiteScore: 1)
Common Law World Review     Full-text available via subscription   (Followers: 18)
Communication & Sport     Hybrid Journal   (Followers: 8, SJR: 0.385, CiteScore: 1)
Communication and the Public     Hybrid Journal   (Followers: 1)
Communication Disorders Quarterly     Hybrid Journal   (Followers: 15, SJR: 0.458, CiteScore: 1)
Communication Research     Hybrid Journal   (Followers: 20, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 9, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 230, SJR: 3.772, CiteScore: 3)
Compensation & Benefits Review     Hybrid Journal   (Followers: 8)
Competition & Change     Hybrid Journal   (Followers: 11, SJR: 0.843, CiteScore: 2)
Competition and Regulation in Network Industries     Full-text available via subscription   (Followers: 8, SJR: 0.143, CiteScore: 0)
Concurrent Engineering     Hybrid Journal   (Followers: 3, SJR: 0.642, CiteScore: 2)
Conflict Management and Peace Science     Hybrid Journal   (Followers: 35, SJR: 2.441, CiteScore: 1)
Contemporary Drug Problems     Full-text available via subscription   (Followers: 3, SJR: 0.609, CiteScore: 2)
Contemporary Education Dialogue     Hybrid Journal   (Followers: 5, SJR: 0.102, CiteScore: 0)
Contemporary Issues in Early Childhood     Full-text available via subscription   (Followers: 6, SJR: 0.766, CiteScore: 1)
Contemporary Review of the Middle East     Full-text available via subscription   (Followers: 12)
Contemporary Sociology : A J. of Reviews     Full-text available via subscription   (Followers: 34, SJR: 0.195, CiteScore: 0)
Contemporary Voice of Dalit     Full-text available via subscription   (Followers: 1)
Contexts     Hybrid Journal   (Followers: 6)
Contributions to Indian Sociology     Hybrid Journal   (Followers: 4, SJR: 0.376, CiteScore: 0)
Convergence The Intl. J. of Research into New Media Technologies     Hybrid Journal   (Followers: 51, SJR: 0.521, CiteScore: 1)

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Similar Journals
Journal Cover
Canadian Journal of Psychiatry
Journal Prestige (SJR): 1.769
Citation Impact (citeScore): 3
Number of Followers: 28  
Hybrid Journal Hybrid journal   * Containing 2 Open Access Open Access article(s) in this issue *
ISSN (Print) 0706-7437 - ISSN (Online) 1497-0015
Published by Sage Publications Homepage  [1085 journals]
  • Open for Business
    • Authors: Rustom Sethna, Emmanuel Persad
      Pages: 891 - 891
      Abstract: The Canadian Journal of Psychiatry, Volume 64, Issue 12, Page 891-891, December 2019.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-12-01T08:00:00Z
      DOI: 10.1177/0706743719887023
  • Decoding Microbiome Research for Clinical Psychiatry
    • Authors: Jane A. Foster
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-11-28T10:09:36Z
      DOI: 10.1177/0706743719890725
  • Lithium, an Infrequently Used Medication
    • Authors: Scott B. Patten, Jeanne V. A. Williams
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-11-28T10:07:35Z
      DOI: 10.1177/0706743719890714
  • The Burden Is Even Greater, The Solution Needs Rethinking
    • Authors: Vikram Patel
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-11-28T10:05:11Z
      DOI: 10.1177/0706743719890712
  • Brain-Wide Functional Dysconnectivity in Schizophrenia: Parsing Diathesis,
           Resilience, and the Effects of Clinical Expression
    • Authors: Shuixia Guo, Ningning He, Zhening Liu, Zeqiang Linli, Haojuan Tao, Lena Palaniyappan
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Background:The functional dysconnectivity observed from functional magnetic resonance imaging (fMRI) studies in schizophrenia is also seen in unaffected siblings indicating its association with the genetic diathesis. We intended to apportion resting-state dysconnectivity into components that represent genetic diathesis, clinical expression or treatment effect, and resilience.Methods:fMRI data were acquired from 28 schizophrenia patients, 28 unaffected siblings, and 60 healthy controls. Based on Dosenbach’s atlas, we extracted time series of 160 regions of interest. After constructing functional network, we investigated between-group differences in strength and diversity of functional connectivity and topological properties of undirected graphs.Results:Using analysis of variance, we found 88 dysconnectivities. Post hoc t tests revealed that 62.5% were associated with genetic diathesis and 21.6% were associated with clinical expression. Topologically, we observed increased degree, clustering coefficient, and global efficiency in the sibling group compared to both patients and controls.Conclusion:A large portion of the resting-state functional dysconnectivity seen in patients represents a genetic diathesis effect. The most prominent network-level disruption is the dysconnectivity among nodes of the default mode and salience networks. Despite their predisposition, unaffected siblings show a pattern of resilience in the emergent connectomic topology. Our findings could potentially help refine imaging genetics approaches currently used in the pursuit of the pathophysiology of schizophrenia.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-11-28T10:03:31Z
      DOI: 10.1177/0706743719890174
  • Physical Activity as a Predictor of Clinical Trial Outcomes in Bipolar
           Depression: A Subanalysis of a Mitochondrial-Enhancing Nutraceutical
           Randomized Controlled Trial
    • Authors: Melanie M. Ashton, Mohammadreza Mohebbi, Alyna Turner, Wolfgang Marx, Michael Berk, Gin S. Malhi, Chee H. Ng, Sue M. Cotton, Seetal Dodd, Jerome Sarris, Malcolm Hopwood, Brendon Stubbs, Olivia M. Dean
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:Individuals with bipolar disorder (BD) generally engage in low levels of physical activity (PA), and yet few studies have investigated the relationship between PA and change in BD symptom severity. The aim of this subanalysis of an adjunctive nutraceutical randomized controlled trial for the treatment of bipolar depression was to explore the relationship between PA, the active adjunctive treatments (a nutraceutical “mitochondrial cocktail”), and clinical outcomes.Methods:Participants with bipolar depression were randomized to receive N-acetylcysteine alone, N-acetylcysteine with a combination of nutraceuticals (chosen for the potential to increase mitochondrial activity), or placebo for 16 weeks. Participants (n = 145) who completed the International Physical Activity Questionnaire–Short Form (IPAQ-SF; measured at Week 4) were included in this exploratory subanalysis. Assessments of BD symptoms, functioning, and quality of life were completed at monthly visits up until Week 20. Generalised Estimating Equations were used to explore whether IPAQ-SF scores were a moderator of treatment received on outcomes of the study.Results:Week-4 PA was not related to changes in Montgomery Åsberg Depression Rating Scale scores across the study until Week 20. However, participants who engaged in more PA and who received the combination treatment were more likely to have a reduction in scores on the Bipolar Depression Rating Scale (P = 0.03). However, this was not consistent in all domains explored using the IPAQ-SF. Participants who engaged in higher levels of PA also experienced greater improvement in social and occupational functioning and less impairment in functioning due to their psychopathology and improvement in quality of life at Week 20, irrespective of treatment.Conclusions:This study provides novel evidence of the association between PA and reduction in BD symptoms in a nutraceutical clinical trial. However, further research assessing the potential synergistic effects of PA in BD is required.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-11-28T10:01:10Z
      DOI: 10.1177/0706743719889547
  • Pathways to Recovery among Homeless People with Mental Illness: Is
           Impulsiveness Getting in the Way'
    • Authors: Marichelle C. Leclair, Ashley J. Lemieux, Laurence Roy, Michael S. Martin, Eric A. Latimer, Anne G. Crocker
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:This study investigates the association between impulsiveness and six dimensions of recovery among homeless people with mental illness.Method:The sample was composed of 418 participants of a randomized controlled trial of Housing First, a recovery-oriented program that provides immediate access to permanent housing. The reliable change index method was used to provide an estimate of the statistical and clinical significance of the change from baseline to 24 months (i.e., clinically meaningful improvement), on outcomes that pertain to recovery dimensions: psychiatric symptoms (clinical), physical health and substance use problems (physical), residential stability (functional), arrests (criminological), community integration (social), and hope and personal confidence (existential). We tested for the effect of impulsiveness, assessed with the Barratt Impulsiveness Scale–11, on clinically meaningful improvement on each specific outcome, adjusting for age, gender and intervention assignment, as both intervention arms were included in the analysis.Results:For every increase in total impulsiveness score by one standard deviation, the odds of experiencing clinically meaningful improvement decreased by 29% (OR = 0.71, 95% CI, 0.55 to 0.91) on the clinical dimension and by 53% (OR = 0.47, 95% CI, 0.32 to 0.68) on the existential dimension. However, changes in outcomes pertaining to physical, functional, criminological, and social dimensions were not significantly influenced by impulsiveness.Conclusions:Findings highlight the importance of addressing impulsiveness in the context of recovery-oriented interventions for homeless people with mental illness. Further research may be required to improve interventions that are responsive to unique needs of impulsive individuals to support clinical and existential recovery.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-11-25T03:05:29Z
      DOI: 10.1177/0706743719885477
  • Burden of Mental, Neurological, Substance Use Disorders and Self-Harm in
           North America: A Comparative Epidemiology of Canada, Mexico, and the
           United States
    • Authors: Daniel Vigo, Laura Jones, Graham Thornicroft, Rifat Atun
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:To estimate the burden of mental, neurological, substance use disorders and self-harm (MNSS) in Canada, Mexico, and the United States.Method:We extracted 2017 data from the Global Burden of Disease online database. Based on a previously developed framework to classify and aggregate the burden of specific disorders and symptoms, we reestimated the MNSS burden to include suicide, alcohol use, drug use, specific neurological, and painful somatic symptom disorders. We analyzed age–sex-specific patterns within and between countries.Results:The MNSS burden is the largest of all disorder groupings. It is lowest in Mexico, intermediate in Canada, and highest in the United States. Exceptions are alcohol use, bipolar, conduct disorders, and epilepsy, which are highest in Mexico; and painful somatic syndromes and headaches, which are highest in Canada. The burden of drug use disorders in the United States is twice the burden in Canada, and 7 times the burden in Mexico. MNSS become the most burdensome of all disorder groups by age 10, staying at the top until age 60, and show a distinct pattern across the lifetime. The top three MNSS disorders for men are a combination of substance use disorders and self-harm (United States), with the addition of painful somatic syndromes (Canada), and headaches (Mexico). For women, the top three are headaches and depression (all countries), drug use (United States), neurocognitive disorders (Mexico), and painful somatic syndromes (Canada).Conclusion:MNSS are the most burdensome disease grouping and should be prioritized for funding in Canada, Mexico, and the United States.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-11-20T08:01:00Z
      DOI: 10.1177/0706743719890169
  • Psychiatry and the Opioid Crisis in Canada
    • Authors: Grainne E. Neilson, Alison Freeland, Christian G. Schütz
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      A position statement developed by the Canadian Psychiatric Association’s Professional Standards and Practice Committee and approved by the CPA’s Board of Directors on April 18, 2019.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-11-18T12:27:44Z
      DOI: 10.1177/0706743719861118
  • Temporal Associations of Screen Time and Anxiety Symptoms Among
    • Authors: Elroy Boers, Mohammad H. Afzali, Patricia Conrod
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      There are indications that screen time is associated with symptoms of anxiety in adolescents, but from a longitudinal perspective, the magnitude, specificity, and temporal precedence in this association are relatively under-explored. To address this gap, over the course of 4 years, we annually surveyed adolescents assessing their usage of various types of screen time per day and symptoms of anxiety.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-11-05T04:04:22Z
      DOI: 10.1177/0706743719885486
  • Attitudes of Psychiatry Residents in Canadian Universities toward
           Neuroscience and Its Implication in Psychiatric Practice
    • Authors: Taghreed Hassan, Benjamin Prasad, Benjamin P. Meek, Mandana Modirrousta
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Despite recent advances in neuroscience highlighting its potential applications in the assessment and treatment of psychiatric disorders, the training of psychiatrists in neuroscience is lacking. However, it is not clear to what extent Canadian trainees are interested in further learning and using neuroscience in their daily clinical practice. This study explored the attitudes of Canadian psychiatry trainees with regard to neuroscience education and training by asking them to assess their own understanding of neuroscience and the perceived relevance of neuroscience knowledge to effective psychiatric practice.Methods:An online questionnaire was sent to psychiatry residents at Canadian universities. This questionnaire consisted of self-assessments of neuroscience knowledge, attitudes toward neuroscience education, preferences in learning modalities, and interest in specific neuroscience topics.Results:One hundred and eleven psychiatry residents from psychiatry residency programs at Canadian universities responded to this survey. Participants represented trainees from all 5 years of residency. Almost half of all trainees (49.0%) reported their knowledge of neuroscience to be either “inadequate” or “less than adequate,” and only 14.7% of trainees reported that they feel “comfortable” or “very comfortable” discussing neuroscience findings with their patients. 63.7% of Canadian trainees rated the quantity of neuroscience education in their residency program as either less than adequate or inadequate, and 46.1% rated the quality of their neuroscience education as “poor” or “very poor.” The vast majority of participants (>70%) felt that additional neuroscience education would be moderately-to-hugely helpful in finding personalized treatments, discovering future treatments, destigmatizing patients with psychiatric illness, and understanding mental illness.Conclusions:Canadian trainees generally feel that their neuroscience knowledge and the neuroscience education they receive during their psychiatry residencies is inadequate. However, as the first step for any change, the majority of future Canadian psychiatrists are very motivated and have a positive attitude toward neuroscience learning.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-10-25T04:00:06Z
      DOI: 10.1177/0706743719881539
  • A Prospective Study of Childhood Predictors of Traumatic Brain Injuries
           Sustained in Adolescence and Adulthood
    • Authors: Guido I. Guberman, Marie-Pier Robitaille, Peter Larm, Alain Ptito, Frank Vitaro, Richard E. Tremblay, Sheilagh Hodgins
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Traumatic brain injuries (TBIs) are sustained by approximately 17% of males in the general population, many of whom subsequently present mental disorders, cognitive, and physical problems. Little is known about predictors of TBIs and how to prevent them. The present study aimed to determine whether inattention–hyperactivity and/or all externalizing problems presented by boys at age 10 predict subsequent TBIs to age 34 after taking account of previous TBIs and family social status (FSS).Method:742 Canadian males were followed, prospectively, from age 6 to 34. Diagnoses of TBIs were extracted from health files, parents-reported sociodemographic and family characteristics at participants’ age 6, and teachers-rated participants’ behaviors at age 10. Separate logistic regression models predicted TBIs sustained from age 11 to 17 and from age 18 to 34. For each age period, two models were computed, one included previous TBIs, inattention–hyperactivity, FSS, and interaction terms, the second included previous TBIs, externalizing problems, FSS, and interaction terms.Results:In models that included inattention–hyperactivity, TBIs sustained from age 11 to 17 were predicted by age 10 inattention–hyperactivity (odds ratio [OR] = 1.46, 1.05 to 2.05) and by TBIs prior to age 11 (OR = 3.50, 1.48 to 8.24); TBIs sustained from age 18 to 34 were predicted by age 10 inattention–hyperactivity (OR = 1.31, 1.01 to 170). In models that included all externalizing problems, TBIs from age 11 to 17 were predicted by prior TBIs (OR = 3.66, 1.51 to 8.39); TBIs sustained from age 18 to 34 were predicted by age 10 externalizing problems (OR = 1.45, 1.12 to 1.86). Neither FSS nor interaction terms predicted TBIs in any of the models.Conclusions:Among males, using evidence-based treatments to reduce inattention–hyperactivity and externalizing problems among boys could, potentially, decrease the risk of TBIs to age 34. Further, boys who sustain TBIs in childhood require monitoring to prevent recurrence in adolescence.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-10-18T06:38:40Z
      DOI: 10.1177/0706743719882171
  • The Perinatal Mental Health of Indigenous Women: A Systematic Review and
    • Authors: Sawayra Owais, Mateusz Faltyn, Ashley V. D. Johnson, Chelsea Gabel, Bernice Downey, Nick Kates, Ryan J. Van Lieshout
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Although Indigenous women are exposed to high rates of risk factors for perinatal mental health problems, the magnitude of their risk is not known. This lack of data impedes the development of appropriate screening and treatment protocols, as well as the proper allocation of resources for Indigenous women. The objective of this systematic review and meta-analysis was to compare rates of perinatal mental health problems among Indigenous and non-Indigenous women.Methods:We searched Medline, EMBASE, PsycINFO, CINAHL, and Web of Science from their inceptions until February 2019. Studies were included if they assessed mental health in Indigenous women during pregnancy and/or up to 12 months postpartum.Results:Twenty-six articles met study inclusion criteria and 21 were eligible for meta-analysis. Indigenous identity was associated with higher odds of mental health problems (odds ratio [OR] 1.62; 95% confidence interval [CI], 1.25 to 2.11). Odds were higher still when analyses were restricted to problems of greater severity (OR 1.95; 95% CI, 1.21 to 3.16) and young Indigenous women (OR 1.86; 95% CI, 1.51 to 2.28).Conclusion:Indigenous women are at increased risk of mental health problems during the perinatal period, particularly depression, anxiety, and substance misuse. However, resiliency among Indigenous women, cultural teachings, and methodological issues may be affecting estimates. Future research should utilize more representative samples, adapt and validate diagnostic and symptom measures for Indigenous groups, and engage Indigenous actors, leaders, and related allies to help improve the accuracy of estimates, as well as the well-being of Indigenous mothers, their families, and future generations.Trial Registration:PROSPERO-CRD42018108638.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-10-11T03:52:15Z
      DOI: 10.1177/0706743719877029
  • Look Before You Leap: Representativeness of Those Completing Self-Reports
           in Early Psychosis Research
    • Authors: Srividya N. Iyer, Sally Mustafa, Sherezad Abadi, Ridha Joober, Ashok Malla
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-09-27T03:09:07Z
      DOI: 10.1177/0706743719879356
  • Psychotherapies for Adolescents with Subclinical and Borderline
           Personality Disorder: A Systematic Review and Meta-Analysis
    • Authors: Jennifer Wong, Anees Bahji, Sarosh Khalid-Khan
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Background:Evidence regarding the efficacy of psychotherapy in adolescents with borderline personality disorder (BPD) symptomatology has not been previously synthesized.Objective:To conduct a systematic review and meta-analysis of the randomized controlled trials (RCTs) in order to assess the efficacy of psychotherapies in adolescents with BPD symptomatology.Methods:Seven electronic databases were systematically searched using the search terms BPD, adolescent, and psychotherapy from database inception to July 2019. Titles/abstracts and full-texts were screened by one reviewer; discrepancies were resolved via consensus. We extracted data on BPD symptomatology, including BPD symptoms, suicide attempts, nonsuicidal self-injury, general psychopathology, functional recovery, and treatment retention. Data were pooled using random-effects models.Results:Of 536 papers, seven trials (643 participants) were eligible. Psychotherapy led to significant short-term improvements in BPD symptomatology posttreatment (g = −0.89 [−1.75, −0.02]) but not in follow-up (g = 0.06 [−0.26, 0.39]). There was no significant difference in treatment retention between the experimental and control groups overall (odds ratio [OR] 1.02, 95% confidence interval [CI], 0.92 to 1.12, I 2 = 52%). Psychotherapy reduced the frequency of nonsuicidal self-injury (OR = 0.34, 95% CI, 0.16 to 0.74) but not suicide attempts (OR = 1.03, 95% CI, 0.46 to 2.30).Conclusions:There is a growing variety of psychotherapeutic interventions for adolescents with BPD symptomatology that appears feasible and effective in the short term, but efficacy is not retained in follow-up—particularly for frequency of suicide attempts.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-09-27T03:08:48Z
      DOI: 10.1177/0706743719878975
  • Identifying Trajectories and Predictors of Response to Psychotherapy for
           Post-Traumatic Stress Disorder in Adults: A Systematic Review of
    • Authors: Michelle Dewar, Alison Paradis, Christophe A. Fortin
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:There exists considerable individual variability in the development and progression of pathological stress reactions after experiencing trauma, as well as in individuals’ response to psychological interventions. Yet until recently, such individual differences had not been considered when evaluating the efficacy of therapeutic interventions for post-traumatic stress disorder (PTSD). This systematic review aims to examine the emerging literature on this subject and, specifically, to identify trajectories and predictors of psychotherapeutic response in adults with PTSD.Method:Four databases were searched using specific keywords without date or language restrictions. For each study, independent reviewers systematically evaluated whether it met eligibility criteria and assessed risk of bias. For included studies, reviewers completed data extraction using standard formats. Those examining how subgroups of adults respond to therapy for clinical PTSD using trajectory modeling were deemed eligible. Demographic, PTSD, clinical, and trauma-related factors associated to particular trajectories were also examined.Results:Of the 1,727 papers identified, 11 were included in this analysis. Of these studies, six focused on military-related traumas and five on civilian ones. Although studies found between two and five trajectories, most supported a three-trajectory model of response categorized as responders, nonresponders, and subclinical participants. Over 22 predictors of treatment trajectories were examined. Comorbid depression, anxiety, and alcohol abuse were the strongest predictors of poor therapeutic response. Age, combat exposure, social support, and hyperarousal were moderate predictors.Conclusion:This review provides valuable insight into the treatment of PTSD, as it supports the heterogeneous trajectories of psychotherapeutic responses and provides avenues for the development of interventions that consider individual-level factors in treatment response.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-09-19T11:56:04Z
      DOI: 10.1177/0706743719875602
  • mGluR5 Facilitates Long-Term Synaptic Depression in a Stress-Induced
           Depressive Mouse Model
    • Authors: Xiangzhi Jiang, Wei Lin, Yuanyuan Cheng, Dongming Wang
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Background:Glutamatergic system has been known to play a role in the pathogenesis of major depression disorder by inducing N-methyl-d-aspartate receptor-dependent long-term depression (LTD) or metabotropic glutamate receptors (mGluR)-dependent LTD. Here, we characterized the LTD in a chronic social defeat stress (CSDS)-induced depressive mouse model.Methods:CSDS was used to induce the depressive-like behaviors in C57BL/6 male mice, which were assessed using sucrose preference test and social interaction test. The synaptic strength including LTD and long-term potentiation (LTP) induced by paired-pulse low frequency stimulation (PP-LFS) was measured using whole-cell recording technique.Results:CSDS induced depressive-like behaviors and facilitated PP-LFS-induced LTD in hippocampal CA3-CA1 pathway in the susceptible mice. Interestingly, mGluR5 but not N-methyl-d-aspartate receptor mediated the PP-LFS-induced LTD. In addition, mGluR5 agonist dihydroxyphenylglycine promoted PP-LFS-induced LTD specifically in susceptible mice, which was diminished by activating the BDNF/TrkB signaling pathway.Conclusions:Our results suggest that mGluR5-dependent LTD might be responsible for the development of depressive-like behaviors in CSDS-induced depression mice model.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-09-17T04:12:54Z
      DOI: 10.1177/0706743719874162
  • Evaluation de la douleur et de l’anxiété lors de soins dentaires chez
           les patients hospitalisés en psychiatrie
    • Authors: O Bollore, A Ourrad, P Andrianisaina, M Terbeche, C Laidi, W Yekhlef, V Moulier, D Januel
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectif :La santé bucco-dentaire des patients en psychiatrie est problématique, puisque le recours au chirurgien-dentiste demeure inférieur de 25 % à la population générale. En partant de ce postulat, nous avons souhaité comprendre en quoi l’anxiété et la douleur du patient peuvent impacter la prise en charge bucco-dentaire et le bon déroulement des soins.Méthode :Cette étude a été menée sur 100 patients hospitalisés en psychiatrie. Grâce à différentes échelles, nous avons évalué leur niveau d’anxiété et de douleur, mais aussi leur coopération aux soins.Résultats :L’anxiété ne constitue pas un frein à la prise en charge, et diminue significativement après les soins. Le comportement durant les soins bucco-dentaires des patients hospitalisés en psychiatrie semble similaire à celui de la population générale.Conclusion :Notre étude permet de mieux appréhender les soins dentaires en psychiatrie et devrait contribuer à placer les soins dentaires au centre de la prise en charge somatique en psychiatrie.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-09-16T03:48:52Z
      DOI: 10.1177/0706743719874177
  • Hypoactivity in the Paraterminal Gyrus Following Bilateral Anterior

         This is an Open Access Article Open Access Article

    • Authors: Trevor A. Hurwitz, Christopher R. Honey, Kevin R. McLeod, Anujan Poologaindran, Annie J. Kuan
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Bilateral anterior capsulotomy (BAC) is one of the ablative neurosurgical procedures used to treat major depressive disorder or obsessive-compulsive disorder when all other therapies fail. Tristolysis, a reduction in sadness, is the most striking clinical effect of BAC and is seen in the first 1 to 2 weeks after surgery. This retrospective study measured regional cerebral blood flow (rCBF) following surgery to identify which cortical regions were impacted and could account for this clinical effect.Methods:All patients had their capsulotomies done in Vancouver by the same team. Pre- and postoperative single-photon emission computed tomography perfusion scans were analyzed for 10 patients with major depressive disorder and 3 with obsessive-compulsive disorder. rCBF was measured semiquantitatively by calculating the ratio between an identified region of interest and a whole brain reference area.Results:Decreased rCBF was found in the paraterminal gyri. Increased rCBF was found in the dorsolateral prefrontal cortices and in the left lateral temporal lobe.Conclusions:BAC causes hypoactivity in the paraterminal gyri and is the most likely explanation for its tristolytic effect, suggesting that the paraterminal gyrus is the limbic cortical locus for the emotion of sadness. Increased activity in the dorsolateral prefrontal cortices may be occurring via connectional diaschisis, and suppression by overactive paraterminal gyri during depression may account for some of the neurocognitive deficits observed during depressive episodes.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-09-13T10:44:53Z
      DOI: 10.1177/0706743719874181
  • Mental Health among Canadian Postsecondary Students: A Mental Health
    • Authors: Kathryn Wiens, Asmita Bhattarai, Ashley Dores, Pardis Pedram, Jeanne V. A. Williams, Andrew G. M. Bulloch, Scott B. Patten
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Recent reports express concerns about a mental health crisis among postsecondary students. These assertions, however, often arise from surveys conducted in postsecondary settings that lack the broader context of a referent group. The objectives of this study were (1) to assess the mental health status of postsecondary students 18 to 25 years old from 2011 to 2017 and (2) to compare the mental health status of postsecondary students to nonstudents.Methods:Prevalence was estimated for a set of mental health outcomes using seven annual iterations of the Canadian Community Health Survey (2011 to 2017). Logistic regression was used to derive odds ratio estimates comparing mental health status among postsecondary students and nonstudents, adjusting for age and sex. Random effects metaregression and meta-analyses techniques were used to evaluate trends in prevalence and odds ratio estimates over time.Results:Over the study period, the prevalence of perceived low mental health, diagnosed mood and anxiety disorders, and past-year mental health consultations increased among female students, whereas binge drinking decreased among male students. With the exception of perceived stress, the odds of experiencing each mental health outcome were lower among postsecondary students compared to nonstudents.Conclusions:These findings do not support the idea that postsecondary students have worse mental health than nonstudents of similar age. The perception of a crisis may arise from greater help-seeking behavior, diminishing stigma, or increasing mental health literacy. Regardless, the observance of these trends provide an opportunity to address a previously latent issue.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-09-05T04:25:04Z
      DOI: 10.1177/0706743719874178
  • Vulnérabilité au Trouble Bipolaire: La Piste de la Vitamine D
    • Authors: Naifar Manel, Maalej Bouali Manel, Guidara Wassim, Ellouze Ahmed Slim, Jmal Khalil, Sana Omri, Meriam Messedi, Lobna Zouari, Aida Elleuch, Maalej Mohamed, Khansa Chaabouni, Charfi Nada, Mouna Turki, Ben Thabet Jihène, Ayadi Fatma
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectifs :L’étiopathogénie du trouble bipolaire (TB) demeure non encore bien élucidée. Récemment, il a été prouvé que la 25-hydroxy-vitamine D(25OHD) a un rôle anti-inflammatoire et neuroprotecteur.Nos objectifs étaient de mesurer les concentrations plasmatiques de la 25OHD chez des patients atteints de TB en décompensation aigue et de les comparer à celles de patients souffrant de schizophrénie (SCZ) ou de trouble schizo-affectif (TSA) et à celles de témoins sainsMéthodes :Il s’agissait d’une étude transversale de type cas-témoins qui a inclus des patients de sexe masculin hospitalisés pour une décompensation de leur maladie et chez qui les diagnostics de TB, SCZ, ou de TSA ont été retenus selon les critères du (DSM-5). Le groupe témoin a été constitué de sujets sains non apparentés, appariés selon l’age et le sexe.Résultats :La concentration de la 25OHD était significativement plus élevée uniquement chez les patients atteints de TB par rapport aux témoins. la 25OHD était aussi corrélée positivement à l’échelle PANSS (r = 0.282, p < 0.001) et aux différents scores de l’échelle MOCA (r = 0.326, p = 0.006) ainsi qu’aux dimensions concernant la capacité d’abstraction, d’attention et la mémoire .A l’analyse multivariée, la décompensation aigue du TB était liée de manière indépendante à l’élévation de la 25OHD plasmatique (p = 0.012; OR = 1.157, [1.032 -1.297]).Conclusion :Notre étude a montré que la décompensation aigue des TB était associée à une élévation de la synthèse de la 25OHD plasmatique. Toutefois, la pertinence du dosage de la vitamine D comme biomarqueur de cette maladie mérite d’être vérifiée par d’autres études.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-08-22T02:58:50Z
      DOI: 10.1177/0706743719870513
  • Fréquence et Type de Délits Commis Par des Hommes Atteints de Troubles
           Mentaux Graves Selon l’âge D’apparition Des Comportements Antisociaux
    • Authors: Mélanie Lapalme, Karine Forget, Yann Le Corff, Gilles Côté
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectif:Il y a des différences importantes quant à la fréquence et au type de délit commis par les personnes atteintes de troubles mentaux graves (TMG), selon que leurs comportements antisociaux ont débuté en bas âge ou à l’âge adulte. Cependant, les personnes ayant manifesté des comportements antisociaux précoces ne forment pas un groupe homogène. La présente étude a pour objectif de vérifier si la précocité des comportements antisociaux peut expliquer cette hétérogénéité.Méthode:137 hommes atteints d’un TMG sous trois statuts légaux distincts ont été recrutés. Ils ont été séparés en 3 groupes selon la précocité des comportements antisociaux.Résultats:Les participants du groupe enfance commettent plus de délits violents et sont plus nombreux à présenter un trouble de l’usage de drogues que ceux du groupe adulte. Le groupe adolescence se distingue du groupe adulte par une fréquence plus élevée de trouble de l’usage d’alcool. Aucune différence ne s’avère significative entre les groupes enfance et adolescence, mais la plupart des délits rapportés sont plus nombreux dans le groupe enfance.Conclusions:Les résultats suggèrent que l’âge d’apparition des comportements antisociaux devrait être pris en compte dans l’évaluation du risque et la prise en charge des personnes atteintes d’un TMG.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-08-21T05:53:45Z
      DOI: 10.1177/0706743719870509
  • Epidemiology of Interpersonal Trauma among Women and Men Psychiatric
           Inpatients: A Population-Based Study
    • Authors: Evgenia Gatov, Nicole Koziel, Paul Kurdyak, Natasha R. Saunders, Maria Chiu, Michael Lebenbaum, Simon Chen, Simone N. Vigod
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Small clinical samples suggest that psychiatric inpatients report a lifetime history of interpersonal trauma. Since past experiences of trauma may complicate prognosis and treatment trajectories, population-level knowledge is needed about its prevalence and correlates among inpatients.Methods:Using health-administrative databases comprising all adult psychiatric inpatients in Ontario, Canada (2009 to 2016, n = 160,436, 49% women), we identified those who reported experiencing physical, sexual, and/or emotional trauma in their lifetime, 1 year, and 30 days preceding admission. We described the prevalence of each type of trauma, comparing women and men using modified Poisson regression, and identified individual-level characteristics associated with lifetime trauma history using multivariable logistic regression.Results:31.7% of inpatients reported experiencing trauma prior to admission. Lifetime prevalence was higher in women (39.6% vs. 24.1%; age-adjusted prevalence ratio [aPR] = 1.68; 95% CI, 1.65 to 1.71), including sexual (22.7% vs. 8.4%; aPR = 2.81; 95% CI, 2.73 to 2.89), emotional (33.3% vs. 19.4%; aPR = 1.76; 95% CI, 1.72 to 1.79), and physical trauma (24.2% vs. 14.8%; aPR = 1.68; 95% CI, 1.65 to 1.72). Factors most prominently associated with lifetime trauma were witnessing parental substance use (adjusted odds ratio [aOR] = 8.68; 95% CI, 8.39 to 8.99), female sex (aOR = 2.29; 95% CI, 2.23 to 2.35), and number of recent stressful life events (aOR = 1.62; 95% CI, 1.59 to 1.65).Conclusions:These results suggest that trauma-informed approaches are essential to consider in the design and delivery of inpatient psychiatric services for both women and men.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-07-02T04:41:48Z
      DOI: 10.1177/0706743719861374
  • Persistent Depressive Disorder: Commentary on Parker and Malhi
    • Authors: Daniel N. Klein
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-06-27T03:09:21Z
      DOI: 10.1177/0706743719860823
  • Temporal Changes in the Cross-Sectional Associations between Cannabis Use,
           Suicidal Ideation, and Depression in a Nationally Representative Sample of
           Canadian Adults in 2012 Compared to 2002
    • Authors: Jillian E. Halladay, Catharine Munn, Michael Boyle, Susan M. Jack, Katholiki Georgiades
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Background:With the recent legalization of nonmedical cannabis in Canada, it is important to document previous associations between cannabis use and major depressive episode and suicidal ideation, as well as the extent to which these associations have changed over time.Methods:This study uses pooled data from the 2002 and 2012 Canadian Community Health Survey’s Mental Health Component, which are repeated cross-sectional surveys of nationally representative samples of Canadians 15 to 60 years of age (n = 43,466). Binary logistic regression was performed, applying weighting and bootstrapping, to examine the association between at least monthly use of cannabis and past 12-month suicidal ideation and major depressive episode (MDE).Results:At least monthly nonmedical cannabis use was associated with an increased odds of MDE and suicidal ideation, and both associations strengthened in 2012 compared to 2002. Canadians using cannabis at least once a month in 2012 had 1.59 (95% confidence interval [CI], 1.11 to 2.27) times the odds of experiencing suicidal ideation and 1.55 (95% CI, 1.12 to 2.13) times the odds of experiencing MDE compared to those who used cannabis at least once a month in 2002. This temporal change remained after controlling for other substance use.Conclusions:Monthly cannabis use was consistently related to both suicidal ideation and MDE, and these associations were stronger in 2012 compared to 2002. The findings of this study provide a baseline for the association between cannabis use and suicide and depression in the Canadian population that should be reevaluated now that nonmedical cannabis has been legalized.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-06-10T04:53:49Z
      DOI: 10.1177/0706743719854071
  • Identifying Individuals with Eating Disorders Using Health Administrative
    • Authors: Paul Kurdyak, Claire de Oliveira, Tomi Iwajomo, Susan Bondy, Kathryn Trottier, Patricia Colton
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Eating disorders are common and have a high public health burden. However, existing clinically relevant data sources are scarce, limiting the capacity to accurately measure the burden of eating disorders. This study tests the feasibility of generating a large clinically relevant cohort of individuals with eating disorders using health administrative data.Methods:We developed 3 clinically relevant eating disorder prevalence cohorts using health administrative data from Ontario, Canada, between 1990 and 2014. Cohort 1 included patients with a hospitalization where an eating disorder diagnosis was the primary diagnosis, cohort 2 included patients with a hospitalization where an eating disorder diagnosis was any diagnosis, and cohort 3 included cohort 2 plus any patient with an emergency department visit with an eating disorder diagnosis.Results:Cohort 1 had 7268 patients, cohort 2 had 13,197 patients, and cohort 3 had 17,373 patients. As cohort size increased, the proportion of eating disorder patients with diagnoses of bulimia nervosa and eating disorder not otherwise specified increased. Although the cohorts differed according to demographic and clinical characteristics, these differences were small compared to the degree to which they differed from the Ontario population.Discussion:It is feasible to use health administrative data to measure the clinically relevant burden of eating disorders. The cohorts differed significantly in the eating disorder diagnostic composition. Eating disorders have a high burden, but poor data availability has resulted in fewer public health–related eating disorders studies in comparison to other mental disorders. The use of administrative data can address this evidence gap.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-05-03T02:38:28Z
      DOI: 10.1177/0706743719844183
  • Personality Trait Predictive Utility and Stability in Transcranial
           Magnetic Stimulation (rTMS) for Major Depression: Dissociation of
           Neuroticism and Self-Criticism
    • Authors: Daniel C. Kopala-Sibley, Gabrielle B. Chartier, Shiv Bhanot, Jaeden Cole, Peter Y. Chan, Marcelo T. Berlim, Alexander McGirr
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Background:Cost-efficient and non-invasive predictors of antidepressant response to repetitive transcranial magnetic stimulation (rTMS) are required. The personality vulnerabilities—neuroticism and self-criticism—are associated with antidepressant outcomes in other modalities; however, self-criticism has not been examined in response to rTMS, and the literature on neuroticism and rTMS is inconsistent.Methods:This naturalistic, 4-week study involved daily dorsolateral prefrontal cortex (DLFPC) rTMS for major depression (15 unipolar, 2 bipolar). Participants completed the Big Five Inventory (neuroticism) and the Depressive Experiences Questionnaire (self-criticism) at baseline and at the end of treatment. Changes in depressive symptoms, as rated by the clinician, were quantified using the 21-item Hamilton Depression Rating Scale. Given the inconsistencies in data regarding the stability of neuroticism in patients receiving rTMS, we performed a systematic review and quantitative meta-analysis of trials examining rTMS and neuroticism.Results:rTMS significantly improved depressive symptoms, and this was predicted by higher levels of self-criticism but not neuroticism. Self-criticism was stable over the 4 weeks of rTMS; however, neuroticism decreased, and this was not related to decreases in depressive symptoms. Our quantitative meta-analysis of 4 rTMS trials in major depression (n = 52 patients) revealed decreases in neuroticism, with a moderate effect size.Limitations:Our results are limited by a small sample size, and the absence of a sham-rTMS group. Our meta-analysis included only 4 trials.Conclusion:Highly self-critical patients appear to benefit more from rTMS than less self-critical patients. Neuroticism, a conceptually similar but distinct personality domain, does not appear to predict antidepressant response, yet this vulnerability factor for depression decreases after rTMS.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-05-02T03:10:35Z
      DOI: 10.1177/0706743719839705
  • The Mentally Ill Physician: Issues in Assessment, Treatment and Advocacy
    • Authors: Michael F. Myers, Alison Freeland
      First page: 823
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      This position paper has been substantially revised in collaboration with the Canadian Psychiatric Association’s Professional Standards and Practice Committee and approved for republication by the CPA’s Board of Directors on April 8, 2019. The original position paper, now an historical document, was first approved by the Board of Directors on October 4, 1996.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-08-20T07:09:28Z
      DOI: 10.1177/0706743719856002
  • Clinical Utility of the Limited Prosocial Emotions Specifier in the
           Childhood-Onset Subtype of Conduct Disorder
    • Authors: Michèle Déry, Vincent Bégin, Jean Toupin, Caroline Temcheff
      First page: 838
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Clinicians may specify the diagnosis of conduct disorder (CD) as “with limited prosocial emotions” (LPE). This specifier is thought to identify youths with particularly severe and stable symptomatology. However, few studies have examined the clinical usefulness of the LPE specifier among children with childhood-onset CD. The current study examines whether the LPE specifier distinguishes children with particularly severe and persistent symptoms among those with childhood-onset CD. The study also aims to test whether the LPE specifier aids in identifying children with subclinical CD whose conduct problems are at risk of increasing.Method:Two hundred sixty-four children showing at least one CD symptom before age 10 were divided based on the presence of CD and the specifier. Children with and without the specifier were compared on number of CD symptoms (assessed at study inception) and trajectory of conduct problems (assessed over 4 years). The analyses controlled for oppositional defiant and attention deficit hyperactivity symptomatology.Results:Compared with children with CD but without LPE, children with CD and the LPE specifier did not differ on likelihood of endorsing most symptoms nor on total numbers of symptoms. Moreover, they did not show a more stable pattern of conduct problems across the 4 years. Children with subclinical CD with and without the LPE specifier were also similar in terms of their symptoms, severity, and evolution of their problems.Conclusions:Among youths with childhood-onset CD, the specifier appears to offer limited value in identifying those with particularly severe and stable CD symptomatology.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-11-07T03:55:32Z
      DOI: 10.1177/0706743719885469
  • Child Sexual Abuse among a Representative Sample of Quebec High School
           Students: Prevalence and Association with Mental Health Problems and
           Health-Risk Behaviors

         This is an Open Access Article Open Access Article

    • Authors: Martine Hébert, Laetitia Mélissande Amédée, Martin Blais, Amélie Gauthier-Duchesne
      First page: 846
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:The objective of this study was to estimate the prevalence of child sexual abuse in a representative sample of Quebec high school youths and document its associations with mental health problems and health-risk behaviors.Method:Data were drawn from the Quebec Youths’ Romantic Relationships Survey, which involved a one-stage stratified cluster sampling of 34 Quebec high schools from Grades 10 to 12. A total of 8,194 youths (mean age = 15.35) were recruited. The survey assessed child sexual abuse, mental health problems (psychological distress, post-traumatic stress symptoms, suicidality), health services utilization, and health-risk behaviors (alcohol, drug, and cannabis use). Gender-stratified multivariate analyses were used to assess associations between child sexual abuse and mental health problems and health-risk behaviors while controlling for confounding demographic variables and other forms of child maltreatment experienced in childhood.Results:A total of 14.9% of girls and 3.9% of boys reported having experienced child sexual abuse. Child sexual abuse was independently associated with an increased risk of psychological distress, greater health services utilization, and increased health-risk behaviors, after controlling for other forms of childhood maltreatment experienced.Conclusions:Child sexual abuse is prevalent among youths in Quebec and is associated with an increased risk of a host of negative consequences. Continued efforts in the development of early detection strategies as well as prevention and intervention programs are warranted.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-07-12T10:18:39Z
      DOI: 10.1177/0706743719861387
  • Integrating Evidence-Supported Psychotherapy Principles in Mental Health
           Case Management: A Capacity-Building Pilot
    • Authors: Paula Ravitz, Suze Berkhout, Andrea Lawson, Tatjana Kay, Susan Meikle
      First page: 855
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:Mental health case managers comprise a large workforce who help patients who struggle with complex mental illnesses and unmet needs with respect to the social determinants of health. This mixed-methods capacity-building pilot examined the feasibility, experiences, and outcomes of training community-based mental health case managers to integrate evidence-based psychotherapy principles into their case conceptualization and management practices.Methods:Case-based, once-weekly, group consultations and training in applied therapeutic principles from mentalizing, interpersonal psychotherapy, motivational interviewing, and other evidence-based psychotherapies were provided to case managers over 8 months. A trauma-informed and culturally sensitive approach was emphasized to improve therapeutic alliances and to foster adaptive expertise and an appreciation of individual patient differences.Results:Qualitative analyses of focus groups and individualized interviews identified a shift toward being more reflective rather than reactive, with improved empathy, patient engagement, morale, and confidence resulting from the training (N = 16). Self-reported pre–post counseling self-efficacy changes revealed significant improvements overall, driven by improved microskills and an ability to deal with challenging client behaviors (N = 10; P < 0.05).Conclusions:This pilot demonstrated that case-based consultations and training of mental health case managers within a community-of-practice in trauma-informed, culturally sensitive application of evidence-supported psychotherapy principles were feasible and acceptable with scalable potential to improve case managers’ counseling self-efficacy, reflective capacity, empathy, and morale. Further research in this area is needed with a larger sample, and patient and health systems outcomes.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-10-04T03:22:49Z
      DOI: 10.1177/0706743719877031
  • FKBP5 Genotype Linked to Combined PTSD-Depression Symptom in Chinese
           Earthquake Survivors
    • Authors: Gen Li, Li Wang, Kunlin Zhang, Chengqi Cao, Xing Cao, Ruojiao Fang, Ping Liu, Shu Luo, Xiangyang Zhang
      First page: 863
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Background:Post-traumatic stress disorder (PTSD) and depression are common mental disorders in individuals experiencing traumatic events. To date, few studies have studied the relationship between genetic basis and phenotypic heterogeneity of traumatized individuals. The present study examined the effects of four FKBP5 SNPs (rs1360780, rs3800373, rs9296158, and rs9470080) in four postdisaster groups (low symptom, predominantly depressive, predominantly PTSD, and combined PTSD-depression symptom groups) as identified by latent profile analysis.Methods:A total of 1,140 adults who experienced the 2008 Wenchuan earthquake participated in our study. Earthquake-related trauma, PTSD, and depressive symptoms were measured using standard psychometric instruments. The four FKBP5 SNPs were genotyped using a custom-by-design 2 × 48-Plex SNP scan™ Kit.Results:After adjusting for covariates, the main and gene–environment interaction effects of rs9470080 were all significant when the combined PTSD-depression group was compared with the low symptoms, predominantly depression and predominantly PTSD groups. rs9470080 TT genotype carriers had a higher risk of developing high co-occurring PTSD and depression symptoms than the C allele carriers. However, when trauma exposure was severe, the TT genotype carriers and C allele carriers did not differ in the risk of developing high co-occurring PTSD and depressive symptoms. The other three SNPs demonstrated no significant effects. Moreover, the rs3800373-rs9296158-rs1360780-rs9470080 haplotype A-G-C-T was found significantly associated with combined PTSD-depression symptoms.Conclusion:Our findings support the genetic basis of phenotypic heterogeneity in people exposed to trauma. Furthermore, the results reveal the possibility that the variants of FKBP5 gene may be associated with depression-PTSD comorbidity.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-09-12T12:14:28Z
      DOI: 10.1177/0706743719870505
  • Understanding Engagement with a Physical Health Service: A Qualitative
           Study of Patients with Severe Mental Illness
    • Authors: Osnat C. Melamed, Indira Fernando, Sophie Soklaridis, Margaret K. Hahn, Kirk W. LeMessurier, Valerie H. Taylor
      First page: 872
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Individuals with severe mental illness (SMI) are disproportionally affected by medical comorbidities, resulting in poor physical health and premature death. Despite this, care for chronic medical conditions is suboptimal, and there is limited research that explores this phenomenon from the patient’s perspective. The aim of this study was to identify barriers and facilitators of engagement with a physical health service experienced by individuals with SMI.Methods:Adults with SMI were recruited from a large psychiatric hospital and offered referral to a physical health service focused on the prevention and treatment of obesity and diabetes. Interviews were conducted at referral, 3, and 6 months. Data from 56 interviews of 24 participants were analyzed using the framework method to identify factors influencing engagement.Results:Barriers to engagement were identified at individual, medical program, and health system levels. Factors influencing the individual experience included difficulty in care coordination, affective symptomatology, and ability to bond with providers. Factors at the program level included difficulty adjusting to the clinic environment and the inability to achieve treatment goals. Factors at the system level included challenges in attending multiple appointments in a fragmented health system, lack of social support, and financial constraints.Conclusions:This qualitative study suggests that traditional models of medical care for chronic conditions pose challenges for many individuals with SMI and contribute to health disparities. Adaptation of medical care to populations with SMI and close collaboration between medical and mental health services are necessary to improve medical care and, subsequently, health outcomes.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-07-15T04:31:26Z
      DOI: 10.1177/0706743719862980
  • Reflections on the Life and Career of Émigré German-Canadian
           Psychiatrist Sebastian Klaus Littmann (1931-1986)
    • Authors: Frank W. Stahnisch, Benjamin W. Hunt, Stephen Pow
      First page: 881
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:This article explores the life and career of Sebastian K. Littmann. He was a foundational figure of the University of Calgary’s Department of Psychiatry in his role as its second chair and, before this, as an influential administrator at Toronto’s Queen Street Mental Health Centre and Clarke Institute during a transitional period in the 1970s-1980s. According to McGill University’s Heinz Lehmann, this transitional period was when the field of psychiatry underwent an identity crisis that threatened to dissolve the discipline and see its functions increasingly filled by counsellors, neurologists, and primary physicians. Littmann’s professional background and training in Edinburgh was followed by periods of community work in New York, which—by the time he immigrated to Canada—predisposed him to favour a humane and community-based approach to psychiatric work; this approach encompassed the cultural variations that were increasingly characterizing North America’s urban social landscape. His compassionate and progressive approach to treatment was remarkable in light of his troubled and deprived upbringing in Nazi-era Germany.Conclusions:The present sketch of Littmann’s personal and professional biography serves to highlight the ways that major historical events and large-scale migration movements, which affected Central Europe, impacted the development of Canadian psychiatry and, by extension, individual Canadians in the twentieth century.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2019-03-26T04:12:37Z
      DOI: 10.1177/0706743719839706
  • Où en sommes-nous' An Overview of Successes and Challenges after 30
           Years of Early Intervention Services for Psychosis in Quebec
    • Authors: Bastian Bertulies-Esposito, Marie Nolin, Srividya N. Iyer, Ashok Malla, Phil Tibbo, Nicola Otter, Manuela Ferrari, Amal Abdel-Baki
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Introduction:Over the last 30 years, early intervention services (EIS) for first-episode psychosis (FEP) were gradually implemented in the province of Quebec. Such implementation occurred without provincial standards/guidelines and policy commitment to EIS until 2017. Although the literature highlights essential elements for EIS, studies conducted elsewhere reveal that important EIS components are often missing. No thorough review of Quebec EIS practices has ever been conducted, a gap we sought to address.Methods:Adopting a cross-sectional descriptive study design, an online survey was distributed to 18 EIS that existed in Quebec in 2016 to collect data on clinical, administrative, training, and research variables. Survey responses were compared with existing EIS service delivery recommendations.Results:Half of Quebec’s population had access to EIS, with some regions having no programs. Most programs adhered to essential components of EIS. However, divergence from expert recommendations occurred with respect to variables such as open referral processes and patient–clinician ratio. Nonurban EIS encountered additional challenges related to their geography and lower population densities, which impacted their team size/composition and intensity of follow-up.Conclusions:Most Quebec EIS offer adequate services but lack resources and organizational support to adhere to some core components. Recently, the provincial government has created EIS guidelines, invested in the development of new programs and offered implementation support from the National Centre of Excellence in Mental Health. These changes, along with continued mentoring and networking of clinicians and researchers, can help all Quebec EIS to attain and maintain recommended quality standards.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719895193
  • Systematic Review and Meta-Analyses of Psychotherapies for Adolescents
           with Subclinical and Borderline Personality Disorder: A Reply to the
           Commentary by Jørgensen, Storebø, and Simonsen
    • Authors: Jennifer Wong, Anees Bahji, Sarosh Khalid-Khan
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719898328
  • An Examination of Comorbid Generalized Anxiety Disorder and Chronic Pain
           on Substance Misuse in a Canadian Population-Based Survey
    • Authors: Elena Bilevicius, Jordana L Sommer, Matthew T Keough, Renée El-Gabalawy
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:Chronic pain and generalized anxiety disorder (GAD) are co-occurring, and both conditions are independently associated with substance misuse. However, limited research has examined the impact of comorbid GAD and chronic pain on substance misuse. The aim of this article was to examine the associations between comorbid GAD and chronic pain conditions compared to GAD only with nonmedical opioid use, drug abuse/dependence, and alcohol abuse/dependence in a Canadian, population-based sample.Methods:Data came from the 2012 Canadian Community Health Survey–Mental Health (N = 25,113). Multiple logistic regressions assessed the associations between comorbid GAD and chronic pain conditions (migraine, back pain, and arthritis) on substance misuse.Results:Comorbid GAD + back pain and GAD + migraine were associated with increased odds of nonmedical opioid use compared to GAD only. However, the relationship was no longer significant after controlling for additional chronic pain conditions. No significant relationship was found between GAD + chronic pain conditions with drug or alcohol abuse/dependence.Conclusions:Comorbid GAD + back pain and GAD + migraine have a unique association with nonmedical opioid use in Canadians compared to GAD only, and chronic pain multimorbidity may be driving this relationship. Results emphasize the need for screening for substance misuse and prescription access in the context of GAD and comorbid chronic pain.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719895340
  • Validation of the French Version of the Auditory Hallucination Rating
           Scale in a Sample of Hallucinating Patients with Schizophrenia
    • Authors: Clément Dondé, Frédéric Haesebaert, Emmanuel Poulet, Marine Mondino, Jérôme Brunelin
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:The aim of this study was to validate the French version of the 7-item Auditory Hallucination Rating Scale (AHRS) so as to facilitate fine-grained assessment of auditory hallucinations (AH) in native French-speaking patients with schizophrenia (SZ) in clinical settings and studies.Method:Patients (N = 66) were diagnosed with SZ according to the Diagnostic and Statistical Manual of Mental Disorders. The French version of the AHRS was developed using a forward–backward translation procedure. Psychometric properties of the French version of the AHRS were tested including (i) construct validity with a confirmatory one-factor analysis, (ii) internal validity with Pearson correlations and Cronbach α coefficients, and (iii) external validity by correlations with the Scale for Assessment of Positive Symptoms (SAPS-H1), the Positive and Negative Syndrome Scale (PANSS-P3; concurrent), the PANSS-Negative subscale and age of subjects (divergent), and inter-rater intraclass correlation coefficients (ICCs).Results:(i) The confirmatory one-factor analysis found a root mean square error of approximation (RMSEA) = 0.00, 90% confidence interval = [0.000 to 0.011], and a comparative fit index = 0.994. (ii) Correlations between AHRS total score and individual items were mostly ≥0.4. Cronbach α coefficient was 0.61. (iii) Correlations with PANSS-P3 and SAPS-H1 were 0.42 and 0.53, respectively. In a subset of participants (N = 16), ICC values were extremely high and significant for AHRS total and individual item scores (ICCs range 0.899 to 0.996)Conclusion:The French version of the AHRS is a psychometrically acceptable instrument for the evaluation of AH severity in French-speaking patients with SZ.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719895641
  • Economic Burden of Depression and Associated Resource Use in Manitoba,
    • Authors: Julie-Anne Tanner, Jennifer Hensel, Paige E. Davies, Lisa C. Brown, Bryan M. Dechairo, Benoit H. Mulsant
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:To characterize the health-care utilization and economic burden associated with depression in Manitoba, Canada.Methods:Patient-level data were retrieved from the Manitoba Centre for Health Policy administrative, clinical, and laboratory databases for the study period of January 1, 1996, through December 31, 2016. Patients were assigned to the depression cohort based on diagnoses recorded in hospitalizations and outpatient physician claims, as well as antidepressant prescription drug claims. A comparison cohort of nondepressed subjects, matched with replacement for age, gender, place of residence (urban vs. rural), and index date, was created. Demographics, comorbidities, intentional self-harm, mortality, health-care utilization, prescription drug utilization, and costs of health-care utilization and social services were compared between depressed patients and matched nondepressed patients, and incidence rate ratios and hazard ratios were reported.Results:There were 190,065 patients in the depression cohort and 378,177 patients in the nondepression cohort. Comorbidities were 43% more prevalent among depressed patients. Intentional self-harm, all-cause mortality, and suicide mortality were higher among patients with depression than the nondepression cohort. Health-care utilization—including hospitalizations, physician visits, physician-provided psychotherapy, and prescription drugs—was higher in the depression than the nondepression cohort. Mean health-care utilization costs were 3.5 times higher among depressed patients than nondepressed patients ($10,064 and $2,832, respectively). Similarly, mean social services costs were 3 times higher ($1,522 and $510, respectively). Overall, depression adds a total average cost of $8,244 (SD = $40,542) per person per year.Conclusions:Depression contributes significantly to health burden and per patient costs in Manitoba, Canada. Extrapolation of the results to the entire Canadian health-care system projects an excess of $12 billion annually in health system spending.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719895342
  • Prevalence and Correlates of Sexting Behaviors in a Provincially
           Representative Sample of Adolescents
    • Authors: Soyeon Kim, Alexa Martin-Storey, Alexander Drossos, Samantha Barbosa, Katholiki Georgiades
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:To examine the prevalence and correlates of sending and receiving sexts (i.e., sexually explicit images) in a provincially representative sample of adolescents in Canada.Methods:Data from the 2014 Ontario Child Health Study, a provincial survey of households with children in Ontario, which includes a sample of 2,537 adolescents aged 14 to 17 years (mean age = 15.42, male = 51.6%) were used to address the research objectives.Results:The past 12 months prevalence of sending and receiving sexts was 14.4% and 27.0%, respectively. In unadjusted logistic regression analyses, non-White adolescents and those living in low-income households were less likely to send or receive sexts compared to White and non-low-income adolescents. Adolescents who disclosed their sexual and/or gender minority identities were 3 to 4 times more likely to send and receive sexts than youth who had not disclosed these identities. Higher levels of mental health problems generally observed among adolescents who sent or received sexts. In fully adjusted models, low income and ethnic minority status were associated with reduced odds of sending and receiving sexts, while sexual and/or gender minority disclosure status was associated with increased odds. Social anxiety was associated with reduced odds of sending and receiving sexts, while conduct disorder was associated with elevated odds.Conclusion:The prevalence of sexting behavior was higher among adolescents who disclosed their sexual or gender minority identities. Sexting behaviors were associated with higher levels of mental health problems. Identifying vulnerable populations and the potential mental health ramifications associated with sexting behavior is vital to mitigating negative sequelae.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719895205
  • Cannabinoids for the Neuropsychiatric Symptoms of Dementia: A Systematic
           Review and Meta-Analysis
    • Authors: Anees Bahji, Arthi Chinna Meyyappan, Emily R. Hawken
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Background:In 2016, the global number of individuals living with dementia was 43.8 million, representing a 117% increase from 1990—mainly due to increases in aging and population growth. Up to 90% of individuals with dementia experience neuropsychiatric symptoms (NPS). However, the limitations of current treatments for NPS have drivent he search for safer pharmacotherapies—including cannabinoids.Aim:To assess the efficacy and acceptability of cannabinoids for the treatment of NPS in individuals with dementia.Design:Systematic review and meta-analysis of clinical trials.Setting and participants:Of 6,902 papers, 9 were eligible (n = 205, 44% female, 78 ± 7 years, 85% Alzheimer disease). Trials were in North America and Europe and explored tetrahydrocannabinol (n = 3), dronabinol (n = 5), or nabilone (n = 1).Measurement:Titles/abstracts were independently screened by one reviewer and reviewed by a second. Full-text screening was by two reviewers with discrepancies resolved via a third reviewer. We extracted data on the standardized mean difference (SMD) for several NPS instruments, trial completion, and adverse events. Data were pooled using random-effects models.Findings:Cannabinoids led to significant improvements across NPS instruments, including the Cohen Mansfield Agitation Inventory (SMD = −0.80; 95% confidence interval [CI], −1.45 to −0.16), the Neuropsychiatric Inventory (SMD = −0.61; CI, −1.07 to −0.15), and nocturnal actigraphy (SMD = −1.05; CI, −1.56 to −0.54h). Cannabinoids were well-tolerated, with an overall trial completion rate of 93% (193/205) and no serious treatment-related adverse events. Treatment efficacy was associated with baseline dementia severity and dose, but not dementia subtype, age, or sex. The overall study quality was rated as low.Conclusions:There is preliminary evidence for the efficacy and tolerability of cannabinoids as treatments for NPS. Population-based studies are needed to characterize their real-world effectiveness and acceptability.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719892717
  • Classical Schizophrenia: Liddle and the Core of Schizophrenia
    • Authors: William T. Carpenter
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719895200
  • Cannabidiol as a Treatment for Mood Disorders: A Systematic Review
    • Authors: Jairo Vinícius Pinto, Gayatri Saraf, Christian Frysch, Daniel Vigo, Kamyar Keramatian, Trisha Chakrabarty, Raymond W. Lam, Márcia Kauer-Sant’Anna, Lakshmi N. Yatham
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:To review the current evidence for efficacy of cannabidiol in the treatment of mood disorders.Methods:We systematically searched PubMed, Embase, Web of Science, PsychInfo, Scielo,, and The Cochrane Central Register of Controlled Trials for studies published up to July 31, 2019. The inclusion criteria were clinical trials, observational studies, or case reports evaluating the effect of pure cannabidiol or cannabidiol mixed with other cannabinoids on mood symptoms related to either mood disorders or other health conditions. The review was reported in accordance with guidelines from Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol.Results:Of the 924 records initially yielded by the search, 16 were included in the final sample. Among them, six were clinical studies that used cannabidiol to treat other health conditions but assessed mood symptoms as an additional outcome. Similarly, four tested cannabidiol blended with Δ-9-tetrahydrocannabinol in the treatment of general health conditions and assessed affective symptoms as secondary outcomes. Two were case reports testing cannabidiol. Four studies were observational studies that evaluated the cannabidiol use and its clinical correlates. However, there were no clinical trials investigating the efficacy of cannabidiol, specifically in mood disorders or assessing affective symptoms as the primary outcome. Although some articles point in the direction of benefits of cannabidiol to treat depressive symptoms, the methodology varied in several aspects and the level of evidence is not enough to support its indication as a treatment for mood disorders.Conclusions:There is a lack of evidence to recommend cannabidiol as a treatment for mood disorders. However, considering the preclinical and clinical evidence related to other diseases, cannabidiol might have a role as a treatment for mood disorders. Therefore, there is an urgent need for well-designed clinical trials investigating the efficacy of cannabidiol in mood disorders.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719895195
  • A Cross-Sectional Study of the Relationship between Previous Military
           Experience and Mental Health Disorders in Currently Serving Public Safety
           Personnel in Canada
    • Authors: Dianne L. Groll, Rosemary Ricciardelli, R. Nicholas Carleton, Greg Anderson, Heidi Cramm
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:There is an increased incidence of some mental health disorders such as post-traumatic stress disorder (PTSD) in some members of the military and in some public safety personnel (PSP) such as firefighters, police officers, paramedics, and dispatchers. Upon retirement from the armed forces, many individuals go on to second careers as PSP. Individuals with prior military experience may be at even greater risk than nonveterans for developing mental health disorders. The present study was designed to examine the relationship between prior military service and symptoms of mental health disorders in PSP.Methods:This is a cross-sectional, observational study. Data for this study were collected from an anonymous, web-based, self-report survey of PSP in Canada. Invitations to participate were sent to PSP via their professional organizations. Indications of mental disorder(s) and symptom severity were assessed using well-validated self-report screening measures.Results:Of the survey respondents who provided this information, 631 (6.8%) had prior armed forces experience; however, not all responses were complete. Ex-military PSP reported significantly more exposure to traumatic events and were approximately 1.5 times more likely to screen positive for indications of PTSD, mood, anxiety, or acute stress disorders and to have contemplated suicide than those without prior armed forces experience.Conclusions:In our study, individuals in PSP with prior service experience in the armed forces were more likely to screen positive for indicators of some mental health disorders. Accordingly, mental health practitioners should inquire about previous service in the armed forces when screening, assessing, and treating PSP.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719895341
  • Adolescent Mental Health Following Exposure to Positive and Harsh
           Parenting in Childhood
    • Authors: Mila Kingsbury, Ewa Sucha, Ian Manion, Stephen E. Gilman, Ian Colman
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:The purpose of the present study was to assess longitudinal associations between positive and harsh parenting in childhood and adolescent mental and behavioral difficulties.Methods:Data were drawn from Canada’s population-based National Longitudinal Survey of Children and Youth (data collected from 1994 to 2009, analyzed 2018). The sample included 9,882 adolescents aged 12/13 years old. Parents self-reported positive and harsh parenting when children were 6/7, 8/9, and 10/11 years old. Symptoms of depression/anxiety, hyperactivity, physical aggression, social aggression, and suicidal ideation were self-reported by adolescents at age 12/13. Linear regression was used to examine the associations between parenting behaviors at each age and adolescent psychiatric symptoms, adjusted for children’s baseline symptoms.Results:Harsh parenting at 10/11 was associated with elevated symptoms of early-adolescent physical aggression, social aggression, and suicidal ideation for boys only, and for all children at earlier ages. Beginning at age 8/9, harsh discipline was associated with elevated symptoms of depression/anxiety for boys only. Overall, positive parenting at age 6/7 was protective against depression/anxiety, physical aggression, and social aggression. Significant sex differences emerged beginning at age 8/9, with positive parenting associated with higher symptoms of depression/anxiety for boys only. Positive parenting at age 10/11 was associated with increased depression/anxiety, physical aggression, social aggression, and suicidal ideation among boys, but decreased symptoms of physical aggression, social aggression, and suicidal ideation among girls.Conclusions:Results suggest that the impact of positive and harsh parenting may depend on age and sex, with harsh parenting being more detrimental to boys as they approach adolescence.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719889551
  • Light Therapy for Patients With Bipolar Depression: Systematic Review and
           Meta-Analysis of Randomized Controlled Trials
    • Authors: Raymond W. Lam, Minnie Y. Teng, Young-Eun Jung, Vanessa C. Evans, John F. Gottlieb, Trisha Chakrabarty, Erin E. Michalak, Jill K. Murphy, Lakshmi N. Yatham, Dorothy K. Sit
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Bipolar disorder (BD) is challenging to treat, and fewer treatments are available for depressive episodes compared to mania. Light therapy is an evidence-based nonpharmacological treatment for seasonal and nonseasonal major depression, but fewer studies have examined its efficacy for patients with BD. Hence, we reviewed the evidence for adjunctive light therapy as a treatment for bipolar depression.Methods:We conducted a systematic review of databases from inception to June 30, 2019, for randomized, double-blind, placebo-controlled trials of light therapy in patients with BD (CRD42019128996). The primary outcome was change in clinician-rated depressive symptom score; secondary outcomes included clinical response, remission, acceptability, and treatment-emergent mood switches. We quantitatively pooled outcomes using meta-analysis with random-effects models.Results:We identified seven trials representing 259 patients with BD. Light therapy was associated with a significant improvement in Hamilton Depression Rating Scale score (standardized mean difference = 0.43, 95% confidence interval [CI], 0.04 to 0.82, P = 0.03). There was also a significant difference in favor of light therapy for clinical response (odds ratio [OR] = 2.32; 95% CI, 1.12 to 4.81; P = 0.024) but not for remission. There was no difference in affective switches between active light and control conditions (OR = 1.30; 95% CI, 0.38 to 4.44; P = 0.67). Study limitations included different light treatment parameters, small sample sizes, short treatment durations, and variable quality across trials.Conclusion:There is positive but nonconclusive evidence that adjunctive light therapy reduces symptoms of bipolar depression and increases clinical response. Light therapy is well tolerated with no increased risk of affective switch.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719892471
  • The Global Burden of Disease Methodology Has Been Good for Mental
           Disorders: But Not Good Enough
    • Authors: Nanna Weye, Maria K. Christensen, Natalie C Momen, Kim Moesgaard Iburg, Oleguer Plana-Ripoll, John J McGrath
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719893591
  • Barriers to Brain Stimulation Therapies for Treatment-Resistant
           Depression: Beyond Cost Effectiveness
    • Authors: David S. Goldbloom, David Gratzer
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719893584
  • Community Treatment Order Outcomes in Quebec: A Unique Jurisdiction
    • Authors: Daniel Frank, E Fan, Angelos Georghiou, Vedat Verter
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:We study compulsory community treatment orders (CTOs) for patients with severe and persistent mental illness (SPMI). Focusing on a unique jurisdiction in Canada that allows for long duration CTOs with strict enforcement procedures, our objectives are to determine whether extended duration CTOs are effective and to determine whether associated hospitalization costs are reduced.Method:A mirror image, naturalistic design was employed using patients as their own controls to enhance external validity. No inclusive or exclusive criteria were employed for the 367 SPMI clinic patients who were studied over a 5-year period. Detailed documentation of the dates of all CTOs, long-acting antipsychotic injections (LAIs), emergency visits, hospitalizations, duration of hospitalizations, crimes and/or police involvement were collected. To study the relation between CTO and injection adherence, we use a mixed-effect linear regression model. To study the effect of injection adherence and hospitalization, we use survival analysis via Kaplan–Meier and Cox survival models.Results:CTO and non-CTO patients did not differ with respect to demographics, but CTO patients were significantly more severely ill. Following a CTO, adherence to LAIs increased over time (P < 0.001). The average time the patients spent in the community, that is, outside the hospital, was significantly longer under a CTO, and the duration of hospitalizations was decreased.Conclusions:LAI adherence and outpatient office visits were enhanced by extended duration CTOs, as was time out of the hospital. The shorter duration of hospital stays implies cost savings. These must be weighed against their undesirable coercive nature.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719892718
  • Protocol for Clozapine Rechallenge in a Case of Clozapine-Induced
    • Authors: G. Shivakumar, N. Thomas, M. Sollychin, A. Takács, S. Kolamunna, P. Melgar, F. Connally, C. Neil, C. Bousman, M. Jayaram, C. Pantelis
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Protocol for clozapine rechallenge in patients with a history of clozapine-induced myocarditis.Method:Clozapine-related cardiovascular adverse effects including myocarditis and cardiomyopathy have limited its widespread use in treatment-resistant schizophrenia. Here, we present a case of clozapine-induced myocarditis and successful cautious rechallenge. Ms. AA, a young female patient with severe psychosis developed myocarditis during her initial clozapine titration phase, which was thus discontinued. Subsequent response to other medications was poor, and she remained significantly disabled. We reviewed blood-based biomarkers identified during the emergence of her index episode of myocarditis and developed a successful clozapine rechallenge protocol, based on careful monitoring of changes in these indices and a very slow clozapine re-titration.Results and Conclusions:This protocol may have utility in the management of patients with a history of clozapine-induced myocarditis.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719892709
  • Who Benefits from Physician Wellness'
    • Authors: Nicholas D. Lawson
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719890729
  • Systematic Review and Meta-Analyses of Psychotherapies for Adolescents
           With Subclinical and Borderline Personality Disorder: Methodological
    • Authors: Mie Sedoc Jørgensen, Ole Jakob Storebø, Erik Simonsen
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719893893
  • Burden of Mental, Neurological, Substance Use Disorders and Self-Harm:
           Counting the Cards, or Shuffling the Deck'
    • Authors: Scott B. Patten
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719892706
  • Primary Care Practitioner Training in Child and Adolescent Psychiatry
           (PTCAP): A Cluster-Randomized Trial
    • Authors: Stacey D. Espinet, Sandra Gotovac, Sommer Knight, Larry Wissow, Merrick Zwarenstein, Lorelei Lingard, Margaret Steele
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs’ pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves.Methods:The study design was a pilot, cluster-randomized, multicenter trial. Practices were randomly assigned to intervention (n practices = 7; n PCPs = 42) or to wait-list control (n practices = 6; n PCPs = 34). The intervention involved 8 hr of training in practice guidelines and brief therapeutic skills for depression, anxiety, attention deficit hyperactivity disorder, and behavioral disorders with case discussion and video examples, while the control practiced as usual. A linear random-effects model controlling for clustering and baseline was carried out on the individual-level data to examine between-group differences in the primary (i.e., confidence) and secondary (i.e., attitude and knowledge) outcomes at 1-week follow-up.Results:Findings were a statistically significant difference in the primary outcomes. Compared to the control group, the intervention group indicated significantly greater confidence in managing diagnosable conditions (d = 1.81) and general concerns (d = 1.73), as well as in making necessary referrals (d = 1.27) and obtaining consults (d = 0.74). While the intervention did not significantly impact secondary outcomes (attitudes and knowledge), regression analysis indicated that the intervention may have increased confidence, in part, by ameliorating the adverse impact of negative mental health care attitudes.Conclusion:PTCAP enhances PCPs’ child/youth mental health care confidence in managing both general and diagnosable concerns. However, an 8-hr session focused on applying brief therapeutic skills was insufficient to significantly change attitudes and knowledge. Formal testing of PTCAP may be warranted, perhaps using more intensive training and including outcome assessments capable of determining whether increased PCP confidence translates to more effective management and better patient outcomes.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719890161
  • Cost–Utility Analysis of Electroconvulsive Therapy and Repetitive
           Transcranial Magnetic Stimulation for Treatment-Resistant Depression in
    • Authors: Kyle P. Fitzgibbon, Donna Plett, Brian C. F. Chan, Rebecca Hancock-Howard, Peter C. Coyte, Daniel M. Blumberger
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:To evaluate the cost-effectiveness of repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT), and combining both treatments in a stepped care pathway for patients with treatment-resistant depression (TRD) in Ontario.Methods:A cost–utility analysis evaluated the lifetime costs and benefits to society of rTMS and ECT as first-line treatments for TRD using a Markov model, which simulates the costs and health benefits of patients over their lifetime. Health states included acute treatment, maintenance treatment, remission, and severe depression. Treatment efficacy and health utility data were extracted and synthesized from randomized controlled trials and meta-analyses evaluating these techniques. Direct costing data were obtained from national and provincial costing databases. Indirect costs were derived from government records. Scenario, threshold, and probabilistic sensitivity analyses were performed to test robustness of the results.Results:rTMS dominated ECT, as it was less costly and produced better health outcomes, measured in quality-adjusted life years (QALYs), in the base case scenario. rTMS patients gained an average of 0.96 additional QALYs (equivalent to approximately 1 year in perfect health) over their lifetime with costs that were $46,094 less than ECT. rTMS remained dominant in the majority of scenario and threshold analyses. However, results from scenarios in which the model’s maximum lifetime allowance of rTMS treatment courses was substantially limited, the dominance of rTMS over ECT was attenuated. The scenario that showed the highest QALY gain (1.19) and the greatest cost-savings ($46,614) was when rTMS nonresponders switched to ECT.Conclusion:From a societal perspective utilizing a lifetime horizon, rTMS is a cost-effective first-line treatment option for TRD relative to ECT, as it is less expensive and produces better health outcomes. The reduced side effect profile and greater patient acceptability of rTMS that allow it to be administered more times than ECT in a patient’s lifetime may contribute to its cost-effectiveness.
      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743719890167
  • Antipsychotic Drug-Induced Movement Disorders: A Forgotten Problem'
    • Authors: Tamara Pringsheim, Thomas R. E. Barnes
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      DOI: 10.1177/0706743718772526
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