Publisher: Sage Publications   (Total: 1090 journals)

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Showing 1 - 200 of 1090 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 6)
Abstracts in Anthropology     Full-text available via subscription   (Followers: 24)
Academic Pathology     Open Access   (Followers: 5)
Accounting History     Hybrid Journal   (Followers: 17, SJR: 0.527, CiteScore: 1)
Acta Radiologica     Hybrid Journal   (Followers: 1, SJR: 0.754, CiteScore: 2)
Acta Radiologica Open     Open Access   (Followers: 2)
Acta Sociologica     Hybrid Journal   (Followers: 39, SJR: 0.939, CiteScore: 2)
Action Research     Hybrid Journal   (Followers: 51, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 362, 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: 24, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 8, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 241, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 44)
Advances in Dental Research     Hybrid Journal   (Followers: 9, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 31, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 136, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 11)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 46, 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: 5, 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: 67)
Allergy & Rhinology     Open Access   (Followers: 4)
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: 11, SJR: 0.176, CiteScore: 0)
Alternatives : Global, Local, Political     Hybrid Journal   (Followers: 12, SJR: 0.351, CiteScore: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 24, SJR: 0.982, CiteScore: 2)
American Economist     Hybrid Journal   (Followers: 8)
American Educational Research J.     Hybrid Journal   (Followers: 230, SJR: 2.913, CiteScore: 3)
American J. of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 19, SJR: 0.67, CiteScore: 2)
American J. of Cosmetic Surgery     Hybrid Journal   (Followers: 8)
American J. of Evaluation     Hybrid Journal   (Followers: 17, SJR: 0.646, CiteScore: 2)
American J. of Health Promotion     Hybrid Journal   (Followers: 34, SJR: 0.807, CiteScore: 1)
American J. of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 43, SJR: 0.65, CiteScore: 1)
American J. of Law & Medicine     Full-text available via subscription   (Followers: 12, SJR: 0.204, CiteScore: 1)
American J. of Lifestyle Medicine     Hybrid Journal   (Followers: 6, SJR: 0.431, CiteScore: 1)
American J. of Medical Quality     Hybrid Journal   (Followers: 12, SJR: 0.777, CiteScore: 1)
American J. of Men's Health     Open Access   (Followers: 9, 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: 216, 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: 21, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 337, SJR: 6.333, CiteScore: 6)
American String Teacher     Full-text available via subscription   (Followers: 2)
Analytical Chemistry Insights     Open Access   (Followers: 26, SJR: 0.224, CiteScore: 1)
Angiology     Hybrid Journal   (Followers: 3, SJR: 0.849, CiteScore: 2)
Animation     Hybrid Journal   (Followers: 14, SJR: 0.197, CiteScore: 0)
Annals of Clinical Biochemistry     Hybrid Journal   (Followers: 10, SJR: 0.634, CiteScore: 1)
Annals of Otology, Rhinology & Laryngology     Hybrid Journal   (Followers: 17, SJR: 0.807, CiteScore: 1)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 54, SJR: 1.096, CiteScore: 2)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 49, SJR: 1.225, CiteScore: 3)
Annals of the ICRP     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Anthropocene Review     Hybrid Journal   (Followers: 8, SJR: 3.341, CiteScore: 7)
Anthropological Theory     Hybrid Journal   (Followers: 42, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Hybrid Journal   (Followers: 13)
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: 28, SJR: 0.489, CiteScore: 2)
Armed Forces & Society     Hybrid Journal   (Followers: 24, SJR: 0.29, CiteScore: 1)
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 43, 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: 8, 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: 5)
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: 18, SJR: 0.433, CiteScore: 1)
Australian & New Zealand J. of Psychiatry     Hybrid Journal   (Followers: 29, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 531, 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: 338, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 12)
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: 20, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 52)
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: 11)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 13)
Biomedical Informatics Insights     Open Access   (Followers: 9)
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: 27, 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: 11, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 8)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 218, SJR: 0.323, CiteScore: 1)
British J. of Pain     Hybrid Journal   (Followers: 28, SJR: 0.579, CiteScore: 2)
British J. of Politics and Intl. Relations     Hybrid Journal   (Followers: 33, SJR: 0.91, CiteScore: 2)
British J. of Visual Impairment     Hybrid Journal   (Followers: 14, SJR: 0.337, CiteScore: 1)
British J.ism Review     Hybrid Journal   (Followers: 18)
BRQ Business Review Quarterly     Open Access   (Followers: 1)
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: 13)
Business and Professional Communication Quarterly     Hybrid Journal   (Followers: 8, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 17, 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: 32, 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: 142, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 27, SJR: 1.769, CiteScore: 3)
Canadian J. of School Psychology     Hybrid Journal   (Followers: 12, 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: 8, 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: 9, 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: 8, SJR: 1.581, CiteScore: 3)
Cephalalgia Reports     Open Access   (Followers: 2)
Child Language Teaching and Therapy     Hybrid Journal   (Followers: 35, SJR: 0.501, CiteScore: 1)
Child Maltreatment     Hybrid Journal   (Followers: 9, SJR: 1.22, CiteScore: 3)
Child Neurology Open     Open Access   (Followers: 5)
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: 11, SJR: 0.221, CiteScore: 0)
Chinese J. of Sociology     Full-text available via subscription   (Followers: 5)
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: 8, SJR: 0.757, CiteScore: 1)
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32, 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: 11, 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: 10)
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: 3)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Nursing Research     Hybrid Journal   (Followers: 31, 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: 12, SJR: 3.281, CiteScore: 5)
Clinical Rehabilitation     Hybrid Journal   (Followers: 75, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 21, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 26, 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: 17, SJR: 0.458, CiteScore: 1)
Communication Research     Hybrid Journal   (Followers: 21, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 9, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 263, SJR: 3.772, CiteScore: 3)
Compensation & Benefits Review     Hybrid Journal   (Followers: 8)
Competition & Change     Hybrid Journal   (Followers: 12, 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: 40, 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: 8, 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: 35, SJR: 0.195, CiteScore: 0)
Contemporary Voice of Dalit     Full-text available via subscription   (Followers: 1)
Contexts     Hybrid Journal   (Followers: 6)

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Similar Journals
Journal Cover
Canadian Journal of Psychiatry
Journal Prestige (SJR): 1.769
Citation Impact (citeScore): 3
Number of Followers: 27  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0706-7437 - ISSN (Online) 1497-0015
Published by Sage Publications Homepage  [1090 journals]
  • Resilience in the Time of Pandemic
    • Authors: G. Camelia Adams
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-07-28T09:33:28Z
      DOI: 10.1177/0706743720946170
  • Patterns of Mental Health Care in Remote Areas: Kimberley (Australia),
           Nunavik (Canada), and Lapland (Finland): Modèles de soins de santé
           mentale dans les régions éloignées: Kimberley (Australie), Nunavik
           (Canada) et Laponie (Finlande)
    • Authors: Jose A. Salinas-Perez, Mencia R. Gutierrez-Colosia, Mary Anne Furst, Petra Suontausta, Jacques Bertrand, Nerea Almeda PhD, John Mendoza, Daniel Rock, Minna Sadeniemi, Graça Cardoso, Luis Salvador-Carulla
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Mental health (MH) care in remote areas is frequently scarce and fragmented and difficult to compare objectively with other areas even in the same country. This study aimed to analyze the adult MH service provision in 3 remote areas of Organization for Economic Cooperation and Development countries in the world.Methods:We used an internationally agreed set of systems indicators, terminology, and classification of services (Description and Evaluation of Services and DirectoriEs for Long Term Care). This instrument provided a standard description of MH care provision in the Kimberley region (Australia), Nunavik (Canada), and Lapland (Finland), areas characterized by an extremely low population density and high relative rates of Indigenous peoples.Results:All areas showed high rates of deprivation within their national contexts. MH services were mostly provided by the public sector supplemented by nonprofit organizations. This study found a higher provision per inhabitant of community residential care in Nunavik in relation to the other areas; higher provision of community outreach services in the Kimberley; and a lack of day services except in Lapland. Specific cultural-based services for the Indigenous population were identified only in the Kimberley. MH care in Lapland was self-sufficient, and its care pattern was similar to other Finnish areas, while the Kimberley and Nunavik differed from the standard pattern of care in their respective countries and relied partly on services located outside their boundaries for treating severe cases.Conclusion:We found common challenges in these remote areas but a huge diversity in the patterns of MH care. The implementation of care interventions should be locally tailored considering both the environmental characteristics and the existing pattern of service provision.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-07-28T09:33:26Z
      DOI: 10.1177/0706743720944312
  • COVID-19 and Depressive Symptoms: A Community-based Study in Quebec,
    • Authors: Norbert Schmitz, Paul Holley, Xiangfei Meng, Laura Fish, Jack Jedwab
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-07-23T09:04:09Z
      DOI: 10.1177/0706743720943812
  • The Feasibility of a Harry Potter–based Cognitive Behavioural Therapy
           Skills Curriculum on Suicidality and Well-being in Middle Schoolers
    • Authors: Paula Conforti, Rabia Zaheer, Benjamin I. Goldstein, Anthony J. Levitt, Ayal Schaffer, Mark Fefergrad, Amy H. Cheung, Mark Sinyor
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-07-23T04:23:14Z
      DOI: 10.1177/0706743720944046
  • A Dangerous “Cocktail”: The COVID-19 Pandemic and the Youth Opioid
           Crisis in North America: A Response to Vigo et al. (2020)
    • Authors: Ranmalie Jayasinha, Stephanie Nairn, Patricia Conrod
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-07-23T04:23:07Z
      DOI: 10.1177/0706743720943820
  • Breathing-focused Yoga as Augmentation for Unipolar and Bipolar
           Depression: A Randomized Controlled Trial: Le yoga axé sur la respiration
           comme traitement d’appoint pour la dépression unipolaire et bipolaire:
           Un essai randomisé contrôlé
    • Authors: Arun V. Ravindran, Martha S. McKay, Tricia da Silva, Claudia Tindall, Tiffany Garfinkel, Angela Paric, Lakshmi Ravindran
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Patients with depression frequently experience persistent residual symptoms even with optimal interventions. These patients often use complementary treatments, including yoga, as a preferred alternative or adjunctive treatment. There is evidence for the benefit of yoga for depression, but this has not been rigorously evaluated, particularly in bipolar depression. We aimed to determine the feasibility and benefit of manualized breathing-focused yoga in comparison to psychoeducation as augmentation to pharmacotherapy for improving residual symptoms of depression in unipolar and bipolar patients.Methods:Using a randomized single-blind crossover design, 72 outpatients with unipolar or bipolar depression were augmented with the two 8-week interventions at separate times, as add-ons to current first-line antidepressants and mood stabilizers. The primary outcome measure was the Montgomery-Åsberg Depression Rating Scale (MADRS). Due to the high dropout of participants after crossover at Week 8, analysis focused on between-group comparisons of yoga and psychoeducation during the initial 8 weeks of the study.Results:There was a significant decline in depressive symptoms, as measured by the MADRS, following 8 weeks of yoga. However, there was no significant difference in MADRS ratings between intervention groups. Similar improvements in self-rated depressive symptoms and well-being were also observed across time.Conclusions:Both yoga and psychoeducation may improve residual symptoms of unipolar and bipolar depression as add-on to medications. In-class group sessions and long study durations may reduce feasibility for this population. Larger trials with parallel group design and shorter duration may be more feasible.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-07-17T11:19:26Z
      DOI: 10.1177/0706743720940535
  • Trends in Suicide Mortality in Canada by Sex and Age Group, 1981 to 2017:
           A Population-Based Time Series Analysis: Tendances de la mortalité par
           suicide au Canada selon le sexe et le groupe d’âge, 1981 – 2017 : Une
           analyse de séries chronologiques dans la population
    • Authors: Mélanie Varin, Heather M. Orpana, Elia Palladino, Nathaniel J. Pollock, Melissa M. Baker
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:Suicide is a complex global public health issue. The objective of this study was to assess time trends in suicide mortality in Canada by sex and age group.Methods:We extracted data from the Canadian Vital Statistics Death Database for all suicide deaths among individuals aged 10 years and older based on International Statistical Classification of Diseases and Related Health Problems, Ninth Revision (E950-959; 1981 to 1999) and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (X60-X84, Y87·0; 2000 to 2017) for a 37-year period, from 1981 to 2017. We calculated annual age-standardized, sex-specific, and age group-specific suicide mortality rates, and used Joinpoint Regression for time trend analysis.Results:The age-standardized suicide mortality rate in Canada decreased by 24.0% from 1981 to 2017. From 1981 to 2007, there was a significant annual average decrease in the suicide rate by 1.1% (95% confidence interval, −1.3 to −0.9), followed by no significant change between 2007 and 2017. From 1981 to 2017 and from 1990 to 2017, females aged 10 to 24 and 45 to 64 years old, respectively, had a significant increase in suicide mortality rates. However, males had the highest suicide mortality rates in all years in the study; the average male-to-female ratio was 3.4:1.Conclusion:The 3-decade decline in suicide mortality rates in Canada paralleled the global trend in rate reductions. However, since 2008, the suicide rate in Canada was relatively unchanged. Although rates were consistently higher among males, we found significant rate increases among females in specific age groups. Suicide prevention efforts tailored for adult males and young and middle-aged females could help reduce the suicide mortality rate in Canada.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-07-14T10:27:04Z
      DOI: 10.1177/0706743720940565
  • Impacts of COVID-19 on Youth Mental Health, Substance Use, and Well-being:
           A Rapid Survey of Clinical and Community Samples: Répercussions de la
           COVID-19 sur la santé mentale, l’utilisation de substances et le
           bien-être des adolescents : un sondage rapide d’échantillons cliniques
           et communautaires
    • Authors: Lisa D. Hawke, Skye Pamela Barbic, Aristotle Voineskos, Peter Szatmari, Kristin Cleverley, Em Hayes, Jacqueline Relihan, Mardi Daley, Darren Courtney, Amy Cheung, Karleigh Darnay, Joanna L. Henderson
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:The current novel coronavirus disease of 2019 (COVID-19) pandemic presents a time-sensitive opportunity to rapidly enhance our knowledge about the impacts of public health crises on youth mental health, substance use, and well-being. This study examines youth mental health and substance use during the pandemic period.Methods:A cross-sectional survey was conducted with 622 youth participants across existing clinical and community cohorts. Using the National Institute of Mental Health-developed CRISIS tool and other measures, participants reported on the impacts of COVID-19 on their mental health, substance use, and other constructs.Results:Reports of prepandemic mental health compared to intrapandemic mental health show a statistically significant deterioration of mental health across clinical and community samples (P < 0.001), with greater deterioration in the community sample. A total of 68.4% of youth in the clinical sample and 39.9% in the community sample met screening criteria for an internalizing disorder. Substance use declined in both clinical and community samples (P < 0.001), although 23.2% of youth in the clinical sample and 3.0% in the community sample met screening criteria for a substance use disorder. Participants across samples report substantial mental health service disruptions (48.7% and 10.8%) and unmet support needs (44.1% and 16.2%). Participants report some positive impacts, are using a variety of coping strategies to manage their wellness, and shared a variety of ideas of strategies to support youth during the pandemic.Conclusions:Among youth with histories of mental health concerns, the pandemic context poses a significant risk for exacerbation of need. In addition, youth may experience the onset of new difficulties. We call on service planners to attend to youth mental health during COVID-19 by bolstering the accessibility of services. Moreover, there is an urgent need to engage young people as coresearchers to understand and address the impacts of the pandemic and the short, medium, and long terms.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-07-14T10:25:44Z
      DOI: 10.1177/0706743720940562
  • A Combined Analysis of Genetically Correlated Traits Identifies Genes and
           Brain Regions for Insomnia: Une analyse combinée de traits
           génétiquement corrélés identifie les gènes et les régions du cerveau
           pour l’insomnie
    • Authors: Kezhi Liu, Ling Zhu, Minglan Yu, Xuemei Liang, Jin Zhang, Youguo Tan, Chaohua Huang, Wenying He, Wei Lei, Jing Chen, Xiaochu Gu, Bo Xiang
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Aims:Previous studies have inferred that there is a strong genetic component in insomnia. However, the etiology of insomnia is still unclear. This study systematically analyzed multiple genome-wide association study (GWAS) data sets with core human pathways and functional networks to detect potential gene pathways and networks associated with insomnia.Methods:We used a novel method, multitrait analysis of genome-wide association studies (MTAG), to combine 3 large GWASs of insomnia symptoms/complaints and sleep duration. The i-Gsea4GwasV2 and Reactome FI programs were used to analyze data from the result of MTAG analysis and the nominally significant pathways, respectively.Results:Through analyzing data sets using the MTAG program, our sample size increased from 113,006 subjects to 163,188 subjects. A total of 17 of 1,816 Reactome pathways were identified and showed to be associated with insomnia. We further revealed 11 interconnected functional and topologically interacting clusters (Clusters 0 to 10) that were associated with insomnia. Based on the brain transcriptome data, it was found that the genes in Cluster 4 were enriched for the transcriptional coexpression profile in the prenatal dorsolateral prefrontal cortex (P = 7 × 10−5), inferolateral temporal cortex (P = 0.02), medial prefrontal cortex (P < 1 × 10−5), and amygdala (P < 1 × 10−5), and detected RPA2, ORC6, PIAS3, and PRIM2 as core nodes in these 4 brain regions.Conclusions:The findings provided new genes, pathways, and brain regions to understand the pathology of insomnia.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-07-10T09:29:52Z
      DOI: 10.1177/0706743720940547
  • Patient-level Characteristics and Inequitable Access to Inpatient
           Electroconvulsive Therapy for Depression: A Population-based
           Cross-sectional Study: Caractéristiques au niveau du patient et accès
           inéquitable à la thérapie électroconvulsive pour patients
    • Authors: Tyler S. Kaster, Daniel M. Blumberger, Tara Gomes, Rinku Sutradhar, Zafiris J. Dasklakis, Duminda N. Wijeysundera, Simone N. Vigod
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:A variety of patient characteristics drive the use of electroconvulsive therapy (ECT) in depression. However, the extent to which each characteristic influences the receipt of ECT, and whether they are appropriate, is unknown. The aim of this study is to identify patient-level characteristics associated with receiving inpatient ECT for depression.Method:We identified all psychiatric inpatients with a major depressive episode admitted to hospital ≥3 days in Ontario, Canada (2009 to 2017). The association between patient-level characteristics at admission and receipt of inpatient ECT was determined using logistic regression, where a generalized estimating equations approach accounted for repeat admissions.Results:The cohort included 53,174 inpatients experiencing 75,429 admissions, with 6,899 admissions involving ECT (9.2%). Among demographic factors, age was most associated with ECT—younger adults had reduced (OR = 0.30, 95%CI, 0.24 to 0.37; 18 to 25 years) while older adults had increased (OR = 3.08, 95%CI, 2.41 to 3.93; 85+ years) odds compared to middle-aged adults (46 to 55 years). The likelihood of ECT was greater for individuals who were married/partnered, had postsecondary education, and resided in the highest neighborhood income quintile. Among clinical factors, illness polarity was most associated with receiving ECT—bipolar depression had reduced odds of receiving ECT (OR = 0.62, 95%CI, 0.57 to 0.69) The likelihood of receiving ECT was greater in psychotic depression, more depressive symptoms, and incapable to consent to treatment and was reduced with comorbid substance use disorders and several medical comorbidities.Conclusions:Nearly 1 in 10 admissions for depression in Ontario, Canada, involve ECT. Many clinical factors associated with receiving inpatient ECT were concordant with clinical guidelines; however, nonclinical factors associated with its use warrant investigation of their impact on equitable access to ECT.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-07-02T10:41:52Z
      DOI: 10.1177/0706743720935647
  • Our Digital Moment: Innovations and Opportunities in Digital Mental Health
    • Authors: David Gratzer, John Torous, Raymond W. Lam, Scott B. Patten, Stanley Kutcher, Steven Chan, Daniel Vigo, Kathleen Pajer, Lakshmi N. Yatham
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-30T05:07:59Z
      DOI: 10.1177/0706743720937833
  • The Spread of COVID-19 in the Italian Population: Anxiety, Depression, and
           Post-traumatic Stress Symptoms
    • Authors: Lorys Castelli, Marialaura Di Tella, Agata Benfante, Annunziata Romeo
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-26T11:31:57Z
      DOI: 10.1177/0706743720938598
  • Assessing Adherence to Responsible Reporting of Suicide Guidelines in the
           Canadian News Media: A 1-year Examination of Day-to-day Suicide Coverage:
           Évaluer la conformité au journalisme responsable en matière de
           directives sur le suicide dans les médias canadiens d’information: Un
           examen d’une année de la couverture quotidienne du suicide
    • Authors: Lara Antebi, Victoria Carmichael, Rob Whitley
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:This study aims to examine routine day-to-day suicide reporting in the Canadian media, giving a descriptive overview of the tone and content of news articles. The primary objective is to assess adherence to responsible reporting of suicide recommendations in news articles about suicide. A secondary objective is to categorize these articles according to their focus. A tertiary objective is to compare guideline adherence across the different categories of articles.Methods:We collected news articles containing the keyword “suicide” from 47 Canadian news sources between April 1, 2019, and March 31, 2020. Articles were read and coded for their adherence to responsible reporting of suicide recommendations. Articles were also allotted into categories according to their focus and primary suicide discussed. Frequency counts and percentages of adherence were calculated for all key variables—both overall and by category of article. Chi-square tests were also conducted to assess for variations in adherence by category of article.Results:The procedures resulted in 1,330 coded articles. On the one hand, there was high overall adherence to several recommendations. For example, over 80% of articles did not give a monocausal explanation, glamourize the death, appear on the front page, include sensational language, or use discouraged words. On the other hand, there was low adherence to other recommendations, especially those related to putatively protective content. For example, less than 25% included help-seeking information, quoted an expert, or included educational content. Cross-category analysis indicated that articles about events/policies/research and Indigenous people had the highest proportions of adherence, while articles about murder-suicide and high-profile suicides had the lowest adherence.Conclusions:While a substantial proportion of articles generally adhere to suicide reporting recommendations, several guidelines are frequently underapplied, especially those concerning putatively helpful content. This indicates room for improvement in the responsible reporting of suicide.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-26T11:30:37Z
      DOI: 10.1177/0706743720936462
  • Quality of Life Impacts of Bright Light Treatment, Fluoxetine, and the
           Combination in Patients with Nonseasonal Major Depressive Disorder: A
           Randomized Clinical Trial
    • Authors: Emma Morton, Erin E. Michalak, Anthony Levitt, Robert D. Levitan, Amy Cheung, Rachel Morehouse, Rajamannar Ramasubbu, Lakshmi N. Yatham, Edwin M. Tam, Raymond W. Lam
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Bright light therapy is increasingly recommended (alone or in combination with antidepressant medication) to treat symptoms of nonseasonal major depressive disorder (MDD). However, little is known about its impacts on quality of life (QoL), a holistic, patient-valued outcome.Methods:This study utilizes secondary outcome data from an 8-week randomized, controlled, double blind trial comparing light monotherapy (n = 32), fluoxetine monotherapy (n = 30), and the combination of these (n = 27) to placebo (n = 30). QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Treatment-related differences in QoL improvements were assessed using a repeated measures analysis of variance. The influence of potential predictors of QoL (demographic variables and change in depressive symptoms) were investigated via hierarchical linear regression.Results:Q-LES-Q-SF scores significantly improved across all treatment conditions; however, no significant differences were observed between treatment arms. QoL remained poor relative to community norms by the end of the trial period: Across conditions, 70.6% of participants had significantly impaired QoL at the 8-week assessment. Reduction in depressive scores was a significant predictor of improved QoL, with the final model accounting for 54% of variance in QoL change scores.Conclusion:The findings of this study emphasize that improvement in QoL and reduction in depressive symptoms in MDD, while related, cannot be taken to be synonymous. Adjunctive therapies may be required to address unmet QoL needs in patients with MDD receiving antidepressant or light therapies. Further research is required to explore additional predictors of QoL in order to better refine treatments for MDD.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-23T04:40:12Z
      DOI: 10.1177/0706743720936470
  • Management of COVID-19 Response in a Secure Forensic Mental Health Setting
    • Authors: Alexander I. F. Simpson, Sumeeta Chatterjee, Padraig Darby, Roland M. Jones, Margaret Maheandiran, Stephanie R. Penney, Tania Saccoccio, Vicky Stergiopoulos, Treena Wilkie
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:The coronavirus disease 2019 (COVID-19) pandemic presents major challenges to places of detention, including secure forensic hospitals. International guidance presents a range of approaches to assist in decreasing the risk of COVID-19 outbreaks as well as responses to manage outbreaks of infection should they occur.Methods:We conducted a literature search on pandemic or outbreak management in forensic mental health settings, including gray literature sources, from 2000 to April 2020. We describe the evolution of a COVID-19 outbreak in our own facility, and the design, and staffing of a forensic isolation unit.Results:We found a range of useful guidance but no published experience of implementing these approaches. We experienced outbreaks of COVID-19 on two secure forensic units with 13 patients and 10 staff becoming positive. One patient died. The outbreaks lasted for 41 days on each unit from declaration to resolution. We describe the approaches taken to reduction of infection risk, social distancing and changes to the care delivery model.Conclusions:Forensic secure settings present major challenges as some proposals for pandemic management such as decarceration or early release are not possible, and facilities may present challenges to achieve sustained social distancing. Assertive testing, cohorting, and isolation units are appropriate responses to these challenges.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-23T04:36:52Z
      DOI: 10.1177/0706743720935648
  • COVID-19 Impacts on Child and Youth Anxiety and Depression: Challenges and
    • Authors: Darren Courtney, Priya Watson, Marco Battaglia, Benoit H. Mulsant, Peter Szatmari
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-22T10:47:29Z
      DOI: 10.1177/0706743720935646
  • Medical Assistance in Dying. A Review of Court Decisions on the issue of
           MAiD and Psychiatric Illness
    • Authors: Derryck H. Smith
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-19T08:58:16Z
      DOI: 10.1177/0706743720935650
  • Psychiatry and COVID-19: The Role of Chlorpromazine
    • Authors: Emmanuel Stip
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-15T08:42:03Z
      DOI: 10.1177/0706743720934997
  • Changes in Suicide and Resilience-related Google Searches during the Early
           Stages of the COVID-19 Pandemic
    • Authors: Mark Sinyor, Matthew J. Spittal, Thomas Niederkrotenthaler
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-11T12:00:01Z
      DOI: 10.1177/0706743720933426
  • The Role of the Medical School Training on Physician Opioid Prescribing
           Practices: Evidence from Ontario, Canada
    • Authors: Claire de Oliveira, Tomisin Iwajomo, Tara Gomes, Paul Kurdyak
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Background:Recent research found that physicians who completed medical school training at top-ranked U.S. medical schools prescribed fewer opioids than those trained at lower ranked schools, suggesting that physician training may play a role in the opioid epidemic. We replicated this analysis to understand whether this finding holds for Ontario, Canada.Methods:We used data on all opioid prescriptions written by Ontario physicians between 2013 and 2017 from the Narcotics Monitoring System. Using the Corporate Provider Database and ICES Physician Database, which contain medical school of training, we linked patients who filled opioid prescriptions with their respective prescribing physician. Available data on Canadian medical school rankings were obtained from Maclean’s news magazine. We used regression analysis to assess the relationship between number of opioid prescriptions and medical school ranking.Results:Compared to the United States, average annual number of opioid prescriptions per physician was lower in Ontario (236 vs. 78). Unlike the United States, we found little evidence that physicians trained at lower ranked medical schools prescribed more than their top-ranked school counterparts after controlling for specialty and location of practice. However, primary care physicians trained at non-English-speaking foreign schools prescribed the most opioids even after excluding opioid maintenance therapy–related prescriptions.Conclusion:The role of medical school training on opioid prescribing patterns among Ontario physicians differs from that in the United States likely due to greater homogeneity of curricula among Canadian schools. Ensuring physicians trained abroad receive additional pain management/addiction training may help address part of the opioid epidemic in Ontario.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-08T11:23:35Z
      DOI: 10.1177/0706743720931240
  • “Nothing Hurts Less Than Being Dead”: Psychological Pain in Case
           Descriptions of Psychiatric Euthanasia and Assisted Suicide from the
    • Authors: Aiste Lengvenyte, Robertas Strumila, Philippe Courtet, Scott Y. H. Kim, Emilie Olié
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:Euthanasia and assisted suicide (EAS) of individuals with mental disorders is a growing practice in several countries, including the Netherlands. Here, we aimed to identify the most frequent dimensions of and associated factors to psychological pain, which has been associated with suicidality, in individuals undergoing psychiatric EAS.Methods:An exploratory retrospective content analysis of the English translation of 66 digital case records of individuals who died by EAS in the Netherlands between 2011 and 2014 was performed. Nine standard psychological pain dimensions (irreversibility, loss of control, emptiness, emotional flooding, freezing, social distancing, narcissistic wounds, confusion, and self-estrangement), illness, and sociodemographic variables were evaluated by 2 independent raters using a premade data abstraction form (Kohen κ> 0.8 in all cases).Results:The mean number of dimensions was 4.64 ± 1.20 (median = 5), out of 9. The most frequent dimensions were irreversibility, loss of control, emptiness, and emotional flooding, in decreasing order. Past treatment refusal and the mention of social connections in case descriptions were related to the higher number of psychological pain dimensions (4.89 ± 1.24 vs. 4.31 ± 1.07, P = 0.03 and 5.05 ± 1.17 vs. 4.43 ± 1.17, P = 0.03, respectively). Emotional flooding was the only dimension specifically associated with specific psychiatric conditions, namely posttraumatic phenomena and personality disorders.Conclusions:Numerous psychological pain dimensions were detected in case descriptions of individuals who underwent EAS before the procedure. Subjective nature of the study precludes definite conclusions but suggest that future studies should explore psychological pain and the role of interventions targeting it in patients requesting EAS.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-05T12:44:52Z
      DOI: 10.1177/0706743720931237
  • High Rates of Genetic Diagnosis in Psychiatric Patients with and without
           Neurodevelopmental Disorders: Toward Improved Genetic Diagnosis in
           Psychiatric Populations
    • Authors: Joyce So, Venuja Sriretnakumar, Jessica Suddaby, Brianna Barsanti-Innes, Hanna Faghfoury, Timothy Gofine
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:There is a paucity of literature on genetic diagnosis in psychiatric populations, particularly the vulnerable population of patients with concomitant neurodevelopmental disorder (NDD). In this cross-sectional study, we investigated the genetic diagnostic rate in 151 adult psychiatric patients from two centers in Ontario, Canada, including a large subset (73.5%) with concurrent NDD, and performed phenotypic analysis to determine the strongest predictors for the presence of a genetic diagnosis.Method:Patients 16 years of age or older and affected with a psychiatric disorder plus at least one of NDD, neurological disorder, congenital anomaly, dysmorphic features, or family history of NDD were recruited through the genetics clinics between 2012 and 2016. Patients underwent genetic assessment and testing according to clinical standards. Chi-squared test was used for phenotypic comparisons. Multivariate logistic regression analysis was performed to determine which phenotypic features were predictive of genetic diagnosis types.Results:Overall, 45.7% of patients in the total cohort were diagnosed with genetic disorders with the vast majority of diagnoses (89.9%) comprising single gene and chromosomal disorders. There were management and treatment implications for almost two-thirds (63.8%) of diagnosed patients. Presence of a single gene disorder or chromosomal diagnosis was predicted by differing combinations of neurological, NDD, and psychiatric phenotypes.Conclusion:The results of this study highlight the frequency and impact of genetic diagnosis in psychiatric populations, particularly those with concomitant NDD. Genetic assessment should be considered in psychiatric patients, particularly those with multiple brain phenotypes (psychiatric, neurodevelopmental, neurological).
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-04T10:52:54Z
      DOI: 10.1177/0706743720931234
  • Feasibility and Preliminary Results of Effectiveness of Social Media-based
           Intervention on the Psychological Well-being of Suspected COVID-19 Cases
           during Quarantine
    • Authors: Lepeng Zhou, Ri-hua Xie, Xiaoxian Yang, Sumin Zhang, Difei Li, Yinglan Zhang, Jingping Liu, Smita Pakhale, Daniel Krewski, Shi Wu Wen
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-06-02T10:33:02Z
      DOI: 10.1177/0706743720932041
  • Health Service Use among Individuals with Depression and Psychological
           Distress: A Population-Based Cohort Study in Ontario, Canada
    • Authors: Maria Chiu, Farah E. Saxena, Paul Kurdyak, Andrew S. Wilton, Simone N. Vigod
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:Relatively little is known about how health-care utilization differs among individuals with psychological distress compared to those with major depressive disorder (MDD).Methods:Ontario participants of the Canadian Community Health Survey Cycle 1.2 (2002) were linked to health administrative data to follow their health-care utilization patterns for up to 15 years. Based on their survey responses, we classified individuals hierarchically into Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria MDD, psychological distress (Kessler-6: 8 to 24), or an unexposed group with neither condition. We compared the rates of outpatient and acute care mental and nonmental health-related visits across the 3 groups over time using Poisson regression.Results:Among the 668 individuals with MDD, 430 with psychological distress, and 9,089 in the unexposed group, individuals with MDD and psychological distress had higher rates of health-care utilization than the unexposed overall and across time. The rates of psychiatrist visits for the MDD group were significantly higher than the other groups initially but declined over the follow-up. Conversely, the rates of psychiatrist visits among the psychological distress group increased over time and converged with that of the MDD group by the end of follow-up (rate ratioMDD vs. psychological distress at 1 year: 4.20 [1.97 to 11.40]; at 15 years: 1.53 [0.54 to 4.08]). Acute care visits were similar between the MDD and psychological distress groups at all time points.Conclusions:Individuals with psychological distress required mental health care rivalling that of individuals with MDD over time, suggesting that even a cross-sectional assessment of significant psychological distress is a serious clinical concern.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-27T11:14:06Z
      DOI: 10.1177/0706743720927826
  • The Lack of Adequate Scientific Evidence Regarding Physician-assisted
           Death for People with Psychiatric Disorders Is a Danger to Patients
    • Authors: Mark Sinyor, Ayal Schaffer
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-26T11:17:56Z
      DOI: 10.1177/0706743720928658
  • Long-term Outcomes of Intensive Inpatient Care for Severe, Resistant
           Obsessive-Compulsive Disorder
    • Authors: Srinivas Balachander, Aakash Bajaj, Nandita Hazari, Ajay Kumar, Nitin Anand, M. Manjula, Paulomi M. Sudhir, Anish V. Cherian, Janardhanan C. Narayanaswamy, T. S. Jaisoorya, Suresh Bada Math, Thennarasu Kandavel, Shyam Sundar Arumugham, Y. C. Janardhan Reddy
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:A substantial proportion of severely ill patients with obsessive-compulsive disorder (OCD) do not respond to serotonin reuptake inhibitors (SRIs) and are unable to practice cognitive behavioral therapy (CBT) on an out-patient basis. We report the short-term (at discharge) and long-term (up to 2 years) outcome of a multimodal inpatient treatment program that included therapist-assisted intensive CBT with adjunctive pharmacotherapy for severely ill OCD patients who are often resistant to SRIs and are either unresponsive or unable to practice outpatient CBT.Methods:A total of 420 patients, admitted between January 2012 and December 2017 were eligible for the analysis. They were evaluated using the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the Clinical Global Impression (CGI) scale. All patients received 4 to 5 therapist-assisted CBT sessions per week along with standard pharmacotherapy. Naturalistic follow-up information at 3, 6, 12, and 24 months were recorded.Results:At baseline, patients were mostly severely ill (YBOCS = 29.9 ± 4.5) and nonresponsive to ≥2 SRIs (83%). Mean duration of inpatient stay was 42.7 ± 25.3 days. At discharge, there was a significant decline in the mean YBOCS score (29.9 ± 4.5 vs. 18.1 ± 7.7, P < .001, Cohen’s d = 1.64); 211/420 (50%) were responders (≥35% YBOCS reduction and CGI-I≤2) and an additional 86/420 (21%) were partial responders (25% to 35% YBOCS reduction and CGI-I≤3). Using latent class growth modeling of the follow-up data, 4 distinct classes were identified, which include “remitters” (14.5%), “responders” (36.5%), “minimal responders” (34.7%), and “nonresponders” (14.6%). Shorter duration of illness, better insight, and lesser contamination/washing symptoms predicted better response in both short- and long-term follow-up.Conclusion:Intensive, inpatient-based care for OCD may be an effective option for patients with severe OCD and should be considered routinely in those who do not respond with outpatient treatment.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-26T11:16:36Z
      DOI: 10.1177/0706743720927830
  • What Does “Irremediability” in Mental Illness Mean'
    • Authors: Karandeep Sonu Gaind
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-22T10:51:36Z
      DOI: 10.1177/0706743720928656
  • Mood Disorders in Late Life: A Population-based Analysis of Prevalence,
           Risk Factors, and Consequences in Community-dwelling Older Adults in
    • Authors: Rachel Strauss, Paul Kurdyak, Richard H. Glazier
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Mental health issues in late life are a growing public health challenge as the population aged 65 and older rapidly increases worldwide. An updated understanding of the causes of mood disorders and their consequences in late life could guide interventions for this underrecognized and undertreated problem. We undertook a population-based analysis to quantify the prevalence of mood disorders in late life in Ontario, Canada, and to identify potential risk factors and consequences.Method:Individuals aged 65 or older participating in 4 cycles of a nationally representative survey were included. Self-report of a diagnosed mood disorder was used as the outcome measure. Using linked administrative data, we quantified associations between mood disorder and potential risk factors such as demographic/socioeconomic factors, substance use, and comorbidity. We also determined associations between mood disorders and 5-year outcomes including health service utilization and mortality.Results:The prevalence of mood disorders was 6.1% (4.9% among males, 7.1% among females). Statistically significant associations with mood disorders included younger age, female sex, food insecurity, chronic opioid use, smoking, and morbidity. Individuals with mood disorders had increased odds of all consequences examined, including placement in long-term care (adjusted odds ratio [OR] =2.28; 95% confidence interval [CI], 1.71 to 3.02) and death (adjusted OR = 1.35; 95% CI, 1.13 to 1.63).Conclusions:Mood disorders in late life were strongly correlated with demographic and social/behavioral factors, health care use, institutionalization, and mortality. Understanding these relationships provides a basis for potential interventions to reduce the occurrence of mood disorders in late life and their consequences.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-21T01:58:22Z
      DOI: 10.1177/0706743720927812
  • Antidepressant Use around Conception, Prepregnancy Depression, and Risk of
           Ectopic Pregnancy
    • Authors: Elizabeth Wall-Wieler, Thalia K. Robakis, Carolyn E. Cesta, Reem Masarwa, Deirdre J. Lyell, Can Liu, Robert W. Platt, Suzan L. Carmichael
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:To compare the risk of ectopic pregnancy among women with and women without antidepressant prescriptions around conception and examine whether this risk differs by prepregnancy depression status.Methods:We conducted a cohort study of all pregnancies between November 1, 2008, and September 30, 2015, identified in the nationwide (American) IBM® MarketScan® Databases. At least one day’s supply of antidepressants in the 3 weeks after a woman’s last menstrual period defined active antidepressant use around conception. At least one depression diagnosis in the year before the last menstrual period defined prepregnancy depression. Relative risk (RR) of ectopic pregnancy was estimated using unadjusted and inverse probability of treatment (IPT)-weighted log-binomial models.Results:Of the 1,703,245 pregnancies, 106,788 (6.3%) women had a prepregnancy depression diagnosis. Among women with a depression diagnosis, 40,287 (37.7%) had an active antidepressant prescription around conception; the IPT-weighted risk of ectopic pregnancy was similar among women who did and did not fill an antidepressant prescription around conception (IPT-weighted RR = 1.01; 95% CI, 0.93 to 1.10). Overall, the risk of ectopic pregnancy was higher among women who had a prepregnancy depression diagnosis than women who did not have a prepregnancy depression diagnosis (IPT-weighted RR = 1.09; 95% CI, 1.04 to 1.15).Conclusions:This study’s findings suggest that women who have a prepregnancy depression diagnosis are at a slightly increased risk of ectopic pregnancy, and among women who have a prepregnancy depression diagnosis, the use of antidepressants around conception does not increase the risk of ectopic pregnancy.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-21T01:50:36Z
      DOI: 10.1177/0706743720927829
  • Irremediable Psychiatric Suffering in the Context of Physician-assisted
           Death: A Scoping Review of Arguments
    • Authors: Sisco M. P. van Veen, Andrea M. Ruissen, Guy A. M. Widdershoven
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:Physician-assisted death (PAD), also known as medical assistance in dying, of patients with a psychiatric disorder (PPD) is a global issue of debate. In most jurisdictions that allow PAD, irremediable suffering is a legal requirement, how to apply the concept of irremediability to PPD remains challenging. The aim of this article is to identify the main arguments concerning irremediability in the debate about PAD of PPD and give directions for further moral deliberation and empirical research.Methods:Systematic searches in MEDLINE, Embase, and PsycINFO were combined with 4 additional search strategies. All conceptual-ethical articles, quantitative and qualitative empirical studies, guidelines, case reports, and commentaries that met the inclusion criteria were included, and a qualitative data synthesis was used to identify recurring themes within the literature. The study protocol was preregistered at the Open Science Framework under registration code: thjg8.Results:A total of 50 articles met the inclusion criteria. Three main arguments concerning irremediability were found in the debate about PAD of PPD: uncertainty, hope, and treatment refusal.Conclusions:Uncertainty about irremediability is inevitable, so which level of certainty is morally required should be the subject of moral deliberation. Whether PAD induces or resolves hopelessness is an empirical claim that deserves clarification. Treatment refusal in search of PAD raises questions about treatment efficacy in this patient group and about decision-making in the context of the physician–patient relationship. Going forward, more attention should be given to epidemiological research and to specific challenges posed by different psychiatric disorders.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-19T04:46:27Z
      DOI: 10.1177/0706743720923072
  • Preservation of Gray Matter Volume in Early Stage of Bipolar Disorder: A
           Case for Early Intervention
    • Authors: Kamyar Keramatian, Wayne Su, Gayatri Saraf, Trisha Chakrabarty, Lakshmi N. Yatham
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:It has been proposed that different stages of the bipolar disorder might have distinct neurobiological changes. However, the evidence for this has not been consistent, as the studies in early stages of the illness are limited by small sample sizes. The purpose of this study was to investigate the gray matter volume changes in bipolar patients who recently recovered from their first episode of mania (FEM).Methods:Using a whole-brain voxel-based analysis, we compared the regional gray matter volumes of 61 bipolar patients who have recovered from their FEM in the past 3 months with 43 age- and gender-matched healthy participants. We also performed a series of subgroup analyses to determine the effects of hospitalization during the FEM, history of depressive episodes, and exposure to lithium.Results:No statistically significant difference was found between gray matter volumes of FEM patients and healthy participants, even at a more liberal threshold (P < 0.001, uncorrected for multiple comparisons). Voxel-based subgroup analyses did not reveal significant gray matter differences except for a trend toward decreased gray matter volume in left lateral occipital cortex (P < 0.001, uncorrected) in patients with a previous history of depression.Conclusion:This study represents the largest structural neuroimaging investigation of FEM published to date. Early stage of bipolar disorder was not found to be associated with significant gray matter volume changes. Our findings suggest that there might be a window of opportunity for early intervention strategies to prevent or delay neuroprogression in bipolar disorder.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-18T10:40:52Z
      DOI: 10.1177/0706743720927827
  • Cannabidiol for Mood Disorders: A Call for More Research
    • Authors: Francesco Bartoli, Bianca Bachi, Angela Calabrese, Federico Moretti, Cristina Crocamo, Giuseppe Carrà
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-14T09:35:35Z
      DOI: 10.1177/0706743720926798
  • Mental Health of Communities during the COVID-19 Pandemic
    • Authors: Daniel Vigo, Scott Patten, Kathleen Pajer, Michael Krausz, Steven Taylor, Brian Rush, Giuseppe Raviola, Shekhar Saxena, Graham Thornicroft, Lakshmi N. Yatham
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-11T03:55:44Z
      DOI: 10.1177/0706743720926676
  • A Randomized Sham-controlled Trial of 1-Hz and 10-Hz Repetitive
           Transcranial Magnetic Stimulation (rTMS) of the Right Dorsolateral
           Prefrontal Cortex in Civilian Post-traumatic Stress Disorder
    • Authors: Kawai Leong, Peter Chan, Larry Ong, Amy Zwicker, Sharon Willan, Raymond W. Lam, Alexander McGirr
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Despite effective psychological and pharmacological treatments, there is a large unmet burden of illness in post-traumatic stress disorder (PTSD). Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive intervention and a putative treatment strategy for PTSD. The evidence base to date suggests that rTMS targeting the dorsolateral prefrontal cortex (DLPFC), in particular the right DLPFC, leads to improvements in PTSD symptoms. However, optimal stimulation parameters have yet to be determined. In this study, we examine the efficacy of high- and low-frequency rTMS of the right DLPFC using a randomized, double-blind, sham-controlled design in civilian PTSD.Methods:We conducted a 2-week single-site randomized sham-controlled trial of rTMS targeting the right DLPFC. We recruited civilians aged 19 to 70 with PTSD and randomized subjects with allocation concealment to daily 1-Hz rTMS, 10-Hz rTMS, or sham rTMS. The primary outcome was improvement in Clinician Administered PTSD Scale–IV (CAPS-IV). Secondary outcomes included change in depressive and anxiety symptoms.Results:We recruited 31 civilians with PTSD. One 1-Hz-treated patient developed transient suicidal ideation. Analyses revealed significant improvement in CAPS-IV symptoms in the 1-Hz group relative to sham (Hedges’ g = −1.07) but not in the 10-Hz group. This was not attributable to changes in anxious or depressive symptomatology. Ten-Hz stimulation appeared to improve depressive symptoms compared to sham.Conclusion:Low-frequency rTMS is efficacious in the treatment of civilian PTSD. Our data suggest that high-frequency rTMS of the right DLPFC is worthy of additional investigation for the treatment of depressive symptoms comorbid with PTSD.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-07T05:12:15Z
      DOI: 10.1177/0706743720923064
  • Alcohol Use Disorder and the Persistence/Recurrence of Major Depression
    • Authors: Vivian N. Onaemo, Timothy O. Fawehinmi, Carl D’Arcy
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:This study aims to determine the role of alcohol use disorder and other potential risk factors on persistence/recurrence of major depression in a Canadian population sample.Methods:Data were drawn from the National Population Health Survey (1994/1995 to 2010/2011), a prospective epidemiologic survey of individuals 12 years and older, living in 10 Canadian provinces (N = 17,276). Participants were reinterviewed every 2 years for 9 cycles. This study population was a cohort of individuals who at baseline met the diagnosis of a major depressive episode (MDE) in the previous 12 months (n = 908). After the 6-year (cycle 4) and 16-year (cycle 9) follow-up period, 124 of 718 participants and 79 of 461 participants met the criteria for MDE, respectively. Persistence or recurrence of major depression was defined as meeting a diagnosis of MDE after 6 years and 16 years. Modified Poisson regression models were used to assess the role of alcohol dependence and other risk factors on the persistence/recurrence of major depression using Stata 14.Results:Alcohol use disorder was significantly correlated with a 6-year (odds ratio [OR]: 3.03; 95% confidence interval [CI], 1.68 to 5.48; P < .0001) and 16-year (OR, 3.17; 95% CI, 1.15 to 8.77, P = 0.003) persistence/recurrence of major depression. Other factors associated with the persistence/recurrence of major depression include female sex, childhood traumatic events, chronic pain restricting activities, daily smoking, and low self-esteem.Conclusions:Comorbid alcohol use disorder was found to be a strong risk factor for the persistence or recurrence of major depression.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-04T04:37:56Z
      DOI: 10.1177/0706743720923065
  • Driving Under the Influence of Cannabis in Canada, 2015 to 2018
    • Authors: Laura A. Rivera, Scott B. Patten
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-04T04:35:55Z
      DOI: 10.1177/0706743720922655
  • Guidelines for Training in Cultural Psychiatry
    • Authors: Laurence J. Kirmayer, Kenneth Fung, Cécile Rousseau, Hung Tat Lo, Peter Menzies, Jaswant Guzder, Soma Ganesan, Lisa Andermann, Kwame McKenzie
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      This position paper has been substantially revised by the Canadian Psychiatric Association (CPA)’s Section on Transcultural Psychiatry and the Standing Committee on Education and approved for republication by the CPA’s Board of Directors on February 8, 2019. The original position paper1 was first approved by the CPA Board on September 28, 2011.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-04-29T07:41:40Z
      DOI: 10.1177/0706743720907505
  • Pharmacological Treatment of Mood Disorders and Comorbid Addictions: A
           Systematic Review and Meta-Analysis
    • Authors: Paul R. A. Stokes, Tahir Jokinen, Sami Amawi, Mutahira Qureshi, Muhammad Ishrat Husain, Lakshmi N. Yatham, John Strang, Allan H. Young
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Addiction comorbidity is an important clinical challenge in mood disorders, but the best way of pharmacologically treating people with mood disorders and addictions remains unclear. The aim of this study was to assess the efficacy of pharmacological treatments for mood and addiction symptoms in people with mood disorders and addiction comorbidity.Methods:A systematic search of placebo-controlled randomized controlled trials investigating the effects of pharmacological treatments in people with bipolar disorder (BD) or major depressive disorder (MDD), and comorbid addictions was performed. Treatment-related effects on mood and addiction measures were assessed in a meta-analysis, which also estimated risks of participant dropout and adverse effects.Results:A total of 32 studies met systematic review inclusion criteria. Pharmacological therapy was more effective than placebo for improving manic symptoms (standardized mean difference [SMD] = −0.15; 95% confidence interval [95% CI], −0.29 to −0.02; P = 0.03) but not BD depressive symptoms (SMD = −0.09; 95% CI, −0.22 to 0.03; P = 0.15). Quetiapine significantly improved manic symptoms (SMD = −0.23; 95% CI, −0.39 to −0.06; P = 0.008) but not BD depressive symptoms (SMD = −0.07; 95% CI, −0.23 to 0.10; P = 0.42). Pharmacological therapy was more effective than placebo for improving depressive symptoms in MDD (SMD = −0.16; 95% CI, −0.30 to −0.03; P = 0.02). Imipramine improved MDD depressive symptoms (SMD = −0.58; 95% CI, −1.03 to −0.13; P = 0.01) but Selective serotonin reuptake Inhibitors (SSRI)-based treatments had no effect (SMD = −0.06; 95% CI, −0.30 to 0.17; P = 0.60). Pharmacological treatment improved the odds of alcohol abstinence in MDD but had no effects on opiate abstinence.Conclusions:Pharmacological treatments were significantly better than placebo in improving manic symptoms, MDD depressive symptoms, and alcohol abstinence but were not better for bipolar depression symptoms. Importantly, quetiapine was not more effective than placebo in improving bipolar depression symptoms nor were SSRI’s for the treatment of MDD depression. Our findings highlight the need for further high-quality clinical trials of treatments for mood disorders and comorbid addictions.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-04-17T04:33:52Z
      DOI: 10.1177/0706743720915420
  • Resident-Level Predictors of Dementia Pharmacotherapy at Long-Term Care
           Admission: The Impact of Different Drug Reimbursement Policies in Ontario
           and Saskatchewan
    • Authors: Laura C. Maclagan, Susan E. Bronskill, Michael A. Campitelli, Shenzhen Yao, Christoffer Dharma, David B. Hogan, Nathan Herrmann, Joseph E. Amuah, Colleen J. Maxwell
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:Cholinesterase inhibitors (ChEIs) and memantine are approved for Alzheimer disease in Canada. Regional drug reimbursement policies are associated with cross-provincial variation in ChEI use, but it is unclear how these policies influence predictors of use. Using standardized data from two provinces with differing policies, we compared resident-level characteristics associated with dementia pharmacotherapy at long-term care (LTC) admission.Methods:Using linked clinical and administrative databases, we examined characteristics associated with dementia pharmacotherapy use among residents with dementia and/or significant cognitive impairment admitted to LTC facilities in Saskatchewan (more restrictive reimbursement policies; n = 10,599) and Ontario (less restrictive; n = 93,331) between April 1, 2009, and March 31, 2015. Multivariable logistic regression models were utilized to assess resident demographic, functional, and clinical characteristics associated with dementia pharmacotherapy.Results:On admission, 8.1% of Saskatchewan residents were receiving dementia pharmacotherapy compared to 33.2% in Ontario. In both provinces, residents with severe cognitive impairment, aggressive behaviors, and recent antipsychotic use were more likely to receive dementia pharmacotherapy; while those who were unmarried, admitted in later years, had a greater degree of frailty, and recent hospitalizations were less likely. The direction of the association for older age, rural residency, medication number, and anticholinergic therapy differed between provinces.Conclusions:While more restrictive criteria for dementia pharmacotherapy coverage in Saskatchewan resulted in fewer residents entering LTC on dementia pharmacotherapy, there were relatively few differences in the factors associated with use across provinces. Longitudinal studies are needed to assess how differences in prevalence and characteristics associated with use impact patient outcomes.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-04-10T09:29:26Z
      DOI: 10.1177/0706743720909293
  • The Role of the Medical Expert in the Retrospective Assessment of
           Testamentary Capacity
    • Authors: Kenneth Shulman, Nathan Herrmann, Hayley Peglar, Daniel Dochylo, Clare Burns, Carmelle Peisah
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:Physicians and other mental health experts are increasingly called on to assist the courts with the determination of testamentary capacity. We aim to improve the understanding of the retrospective assessment of testamentary capacity for medical experts in order to provide more useful reports for the court’s determinations and to provide a methodology for the retrospective assessment of testamentary capacity.Method:Medical experts with experience in the retrospective assessment of testamentary capacity collaborated with lawyers who practice estate litigation. The medical literature on the assessment of testamentary capacity was reviewed and integrated. The medical experts provided a clinical perspective, while the lawyers ensured that the case law and legal perspective were integrated into this review.Results:The focus and limitations of the medical expert are outlined including the need to be objective, nonpartisan, and fair. For the benefit of the court, the medical expert should describe the nature and severity of relevant medical, psychiatric, and cognitive disorders, and how they may impact on the specific criteria for testamentary capacity as defined by the leading case of Banks v Goodfellow. Medical experts should opine only on the issue of vulnerability to influence and defer to the court to determine the facts of the case regarding any influence that may have been exerted.Conclusions:Although the ultimate determination of testamentary capacity is a legal one, medical experts can help the court achieve the most informed legal decision by providing relevant information on clinical issues that may impact the criteria for testamentary capacity.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-04-01T04:21:26Z
      DOI: 10.1177/0706743720915007
  • Medical Assistance In Dying
    • Authors: Gary Chaimowitz, Alison Freeland, Grainne E. Neilson, Nickie Mathew, Raj Rasasingham, Natasha Snelgrove, Melanie Wong
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-03-31T07:51:26Z
      DOI: 10.1177/0706743720919299
  • The United Nations Convention on the Rights of Persons with Disabilities
    • Authors: Mathieu Dufour, Richard O’Reilly, Manon Charbonneau, Gary A. Chaimowitz
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-03-31T07:51:19Z
      DOI: 10.1177/0706743720919291
  • Pregnancy and Delivery Outcomes Following Benzodiazepine Exposure: A
           Systematic Review and Meta-analysis
    • Authors: Sophie Grigoriadis, Lisa Graves, Miki Peer, Lana Mamisashvili, Myuri Ruthirakuhan, Parco Chan, Mirna Hennawy, Supriya Parikh, Simone Natalie Vigod, Cindy-Lee Dennis, Meir Steiner, Cara Brown, Amy Cheung, Hiltrud Dawson, Neil Rector, Melanie Guenette, Margaret Richter
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Understanding the effects of benzodiazepines (BZDs) on maternal/fetal health remains incomplete despite their frequent use. This article quantifies the effects of antenatal BZD exposure on delivery outcomes.Methods:Data Sources:Medline, PsycINFO, CINAHL, Embase, and the Cochrane Library were searched till June 30, 2018.Study Selection:English-language cohort studies comparing antenatal BZD exposure to an unexposed group on any delivery outcome were eligible. In all, 23,909 records were screened, 56 studies were assessed, and 14 studies were included.Data Extraction:Two reviewers independently assessed quality and extracted data. Estimates were pooled using random effects meta-analysis. Sub-analyses examined several potential moderators including timing of exposure.Results:There were 9 outcomes with sufficient data for meta-analysis. Antenatal BZD exposure was significantly associated with increased risk of 6 outcomes initially: spontaneous abortion (pooled odds ratio = 1.86; 95% confidence interval [CI], 1.43 to 2.42), preterm birth (1.96; 95% CI, 1.25 to 3.08), low birth weight (2.24; 95% CI, 1.41 to 3.88), low Apgar score (2.19; 95% CI, 1.94 to 2.47), Neonatal Intensive Care Unit (NICU) admission (2.61; 95% CI, 1.64 to 4.14), and induced abortion (2.04; 95% CI, 1.23 to 3.40). There was significant heterogeneity between studies for most outcomes without consistent moderators. Birth weight (mean difference [MD]: −151.35 g; 95% CI, −329.73 to 27.03), gestational age (−0.49 weeks; 95% CI, −1.18 to 0.19), and small for gestational age (SGA; 1.42; 95% CI, 1.00 to 2.01) did not show significant associations although after adjusting for publication bias, gestational age, and SGA became significant, totaling 8 significant outcomes.Conclusions:Antenatal BZD exposure appears to be statistically associated with increased risk of several adverse perinatal outcomes. Although confounds cannot be ruled out, NICU admission does appear clinically relevant and consistent with the antidepressant literature.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-03-09T10:23:40Z
      DOI: 10.1177/0706743720904860
  • Pharmacogenetic Testing Options Relevant to Psychiatry in Canada
    • Authors: Abdullah Al Maruf, Mikayla Fan, Paul D. Arnold, Daniel J. Müller, Katherine J. Aitchison, Chad A. Bousman
      First page: 521
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:To identify and assess pharmacogenetic testing options relevant to psychiatry in Canada.Method:Searches of published literature, websites, and Standard Council of Canada’s Laboratory Directory were conducted to identify pharmacogenetic tests available in Canada. Identified tests were assessed on 8 key questions related to analytical validity, accessibility, test ordering, delivery of test results, turnaround time, cost, clinical trial evidence, and gene/allele content.Results:A total of 13 pharmacogenetic tests relevant to psychiatry in Canada were identified. All tests were highly accessible, and most were conducted in accredited laboratories. Both direct-to-consumer and clinician-gated testing were identified, with turnaround times and cost ranging from 2 to 40 days and CAD$199 to CAD$2310, respectively. Two tests were supported by randomized controlled trials. All tests met minimum gene and allele panel recommendations for psychiatry, but no 2 panels were identical. No test was unequivocally superior to all other tests.Conclusions:Pharmacogenetic testing in Canada is readily available but highly variable in terms of ordering procedures, delivery of results, turnaround times, cost, and gene/allele content. As such, it is important for psychiatrists and other health-care providers to understand the differences between the available tests to ensure appropriate selection and implementation within their practice.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-02-17T01:11:48Z
      DOI: 10.1177/0706743720904820
  • Youth Mental Health Services: Promoting Wellness or Treating Mental
    • Authors: Ashok Malla, Alyssa Frampton, Bilal Issaoui Mansouri
      First page: 531
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-04-22T09:14:49Z
      DOI: 10.1177/0706743720920033
  • 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
      First page: 536
      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
      PubDate: 2020-01-08T09:18:37Z
      DOI: 10.1177/0706743719895193
  • Associations between Trauma Exposure and Physical Conditions among Public
           Safety Personnel
    • Authors: Jordana L. Sommer, Renée El-Gabalawy, Tamara Taillieu, Tracie O. Afifi, R. Nicholas Carleton
      First page: 548
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      BackgroundTrauma exposure is associated with adverse health-related correlates, including physical comorbidities, and is highly prevalent among public safety personnel (PSP). The current study (1) examined the association between context of index trauma exposure (part of job vs. other) and physical conditions and (2) established the prevalence of physical conditions according to PSP category (e.g., police, paramedic) and index trauma type (e.g., serious accident, physical assault) in a large Canadian sample of PSP.MethodsPSP completed an online survey between September 2016 and January 2017. Multivariable logistic regressions examined associations between context of index trauma exposure (i.e., part of job vs. other) and physical condition categories. Cross-tabulations with chi-square analyses examined whether the prevalence of physical conditions significantly differed according to PSP category and index trauma type.ResultsThere were 5,267 PSP included in the current study. Results from the most stringent model of logistic regressions demonstrated that, compared to PSP who experienced their index trauma in any other context, PSP who experienced it as part of their job had reduced odds of “other” physical conditions (adjusted odds ratio = 0.73, 95% confidence interval, 0.57 to 0.94, P < 0.05). Results also revealed significant differences in the prevalence of physical conditions across all PSP categories and select index trauma types.ConclusionResults highlight the relevance of trauma exposure outside of an occupational context among PSP and may have implications for the positive impact of stress inoculation and resiliency training programs for PSP.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-04-10T04:41:28Z
      DOI: 10.1177/0706743720919278
  • A Novel Emergency Telepsychiatry Program in a Canadian Urban Setting:
           Identifying and Addressing Perceived Barriers for Successful
    • Authors: Jennifer Hensel, Reid Graham, Corinne Isaak, Naweed Ahmed, Jitender Sareen, James Bolton
      First page: 559
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objectives:To report on the perceived barriers surrounding the use of telepsychiatry for emergency assessments and our approach to overcoming those barriers to achieve successful implementation of a program to increase access to emergency psychiatric assessment in a Canadian urban setting.Methods:We conducted a survey of emergency care staff to inform the implementation of an emergency telepsychiatry program in the urban setting of Winnipeg, Manitoba, where hospitals have variable on-site emergency psychiatric coverage. We analyzed survey responses for perceived barriers we would need to address in implementation. We employed implementation strategies for each barrier and scaled the program to three sites over the first year. Data from the first year were collected including number of telepsychiatry assessments, reasons for referral, wait time, and percentage of patient transfers avoided.Results:Survey respondents (N = 111) had little prior exposure to telepsychiatry, but the majority were open to its use for emergency psychiatric assessments in the region. We identified three categories of perceived barriers: clinical, logistical/technical, and readiness barriers. Implementation planning addressed each barrier, and a hub-and-spoke program was launched. After the first year, the program had one hub serving three spokes, and 243 emergency telepsychiatry assessments had been completed. After 12 months, we were avoiding 65% of patient transfers.Conclusions:By conducting a user survey to identify perceived barriers, and addressing these during implementation, we successfully scaled our emergency telepsychiatry program across our region. Our report of this experience may benefit others attempting to implement a similar program.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-01-23T09:28:23Z
      DOI: 10.1177/0706743719900465
  • Cost–Utility Analysis of Mindfulness-Based Cognitive Therapy Versus
           Antidepressant Pharmacotherapy for Prevention of Depressive Relapse in a
           Canadian Context
    • Authors: Tina Pahlevan, Christine Ung, Zindel Segal
      First page: 568
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Objective:Patients suffering from major depressive disorder (MDD) experience impaired functioning and reduced quality of life, including an elevated risk of episode return. MDD is associated with high societal burden due to increased healthcare utilization, productivity losses, and suicide-related costs, making the long-term management of this illness a priority. The purpose of this study is to evaluate the cost-effectiveness of mindfulness-based cognitive therapy (MBCT), a first-line preventative psychological treatment, compared to maintenance antidepressant medication (ADM), the current standard of care.Method:A cost–utility analysis was conducted over a 24-month time horizon to model differences between MBCT and ADM in cost and quality-adjusted life years (QALY). The analysis was conducted using a decision tree analytic model. Intervention efficacy, utility, and costing data estimates were derived from published sources and expert consultation.Results:MBCT was found to be cost-effective compared to maintenance ADM over a 24-month time horizon. Antidepressant pharmacotherapy resulted in 1.10 QALY and $17,255.37 per patient on average, whereas MBCT resulted in 1.18 QALY and $15,030.70 per patient on average. This resulted in a cost difference of $2,224.67 and a QALY difference of 0.08, in favor of MBCT. Multiple sensitivity analyses supported these findings.Conclusions:From both a societal and health system perspective, utilizing MBCT as a first-line relapse prevention treatment is potentially cost-effective in a Canadian setting. Future economic evaluations should consider combined treatment (e.g., ADM and psychotherapy) as a comparator and longer time horizons as the literature advances.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-02-07T01:05:57Z
      DOI: 10.1177/0706743720904613
  • Post-traumatic Stress Disorder, Depression, Anxiety Symptoms and Help
           Seeking in Psychiatric Staff
    • Authors: Michael C. Seto, Nicole C. Rodrigues, Elke Ham, Bonnie Kirsh, N. Zoe Hilton
      First page: 577
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.
      Background And Methods:In this study, we surveyed 761 psychiatric hospital staff (69% women, 71% full-time, 56% nursing) regarding their exposure to trauma in the workplace; symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety; help seeking; and perceived barriers for help seeking.Results:Significant proportions of staff met the screening cutoffs for probable PTSD (16%), depression (20%), and anxiety (16%). Comorbidity was high, with approximately half of those meeting the screening cutoff for PTSD also meeting the cutoffs for depression or anxiety. Only PTSD symptoms were uniquely associated with exposure to trauma in the workplace, but both PTSD and depression symptoms significantly predicted help seeking. Staff who met one or more screening cutoffs perceived more barriers to help seeking such as difficulty with accessing services.Conclusion:Implications for supporting psychiatric staff exposed to trauma are discussed.
      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-03-31T04:09:04Z
      DOI: 10.1177/0706743720916356
  • Re: Maruf AA, Fan M, Arnold PD, Muller DJ, Aitchison KJ, Bousman CA.
           Pharmacogenetic Testing Options Relevant to Psychiatry in Canada. Canadian
           Journal of Psychiatry [Revue canadienne de psychiatrie] 2020. doi:
    • Authors: Martin Dawes, Hagit Katzov-Eckert, Andrea Paterson, Diana Dawes
      First page: 584
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-13T10:25:15Z
      DOI: 10.1177/0706743720925735
  • Reply to Dawes et al.
    • Authors: Abdullah Al Maruf, Mikayla Fan, Paul D. Arnold, Daniel J. Müller, Katherine Aitchison, Chad A. Bousman
      First page: 586
      Abstract: The Canadian Journal of Psychiatry, Ahead of Print.

      Citation: The Canadian Journal of Psychiatry
      PubDate: 2020-05-19T10:14:18Z
      DOI: 10.1177/0706743720925736
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