1
|
Kemp JM, Taylor VH, Kanagasabai T. Access to healthcare and depression severity in vulnerable groups the US: NHANES 2013-2018. J Affect Disord 2024; 352:473-478. [PMID: 38401808 DOI: 10.1016/j.jad.2024.02.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/17/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Access to healthcare is essential for managing chronic diseases, yet it often poses a barrier, contributing to a significant burden of conditions like depression. This study aimed to investigate the association between healthcare access and depression severity in contemporary free-living adults in the US, with a focus on identifying vulnerable populations. METHOD Data from the National Health and Nutrition Examination Survey cycles 2013-2018 were utilized, involving 13,689 participants aged 20 years or older. Multivariable multinomial logistic regression models were conducted, adjusting for various confounding variables. RESULTS Approximately 17 % of US adults lacked access to healthcare, while 24 % experienced varying levels of depression severity, with 8 % having moderate-to-severe depression. More males faced challenges accessing healthcare, while more females reported diverse levels of depression. Both healthcare access and depression severity were associated with low educational attainment, low familial income, lacking spousal support, lacking health insurance coverage, and worse self-reported overall health. We found a higher vulnerability to moderate-to-severe depression among females (OR (95 % CI): 1.20 (0.91, 1.59)), individuals identifying as the Other ethnic group (1.69 (1.02, 2.79)), and those living without a spouse (1.57 (1.10, 2.26)). LIMITATIONS Our cross-sectional study cannot establish causality, and potential biases related to self-reported data exist. CONCLUSIONS Access to healthcare emerged as a crucial predictor of moderate-to-severe depression among females, individuals of the Other ethnic group, and those without a spouse. Longitudinal research is needed to confirm and enhance our understanding of factors that shape the relationship between healthcare access and depression in free-living US adults.
Collapse
Affiliation(s)
- James M Kemp
- Department of Public Health, St. Lawrence University, Canton, NY, USA
| | - Valerie H Taylor
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | |
Collapse
|
2
|
Ho NCW, Bethlehem RA, Seidlitz J, Nogovitsyn N, Metzak P, Ballester PL, Hassel S, Rotzinger S, Poppenk J, Lam RW, Taylor VH, Milev R, Bullmore ET, Alexander-Bloch AF, Frey BN, Harkness KL, Addington J, Kennedy SH, Dunlop K. Atypical brain aging and its association with working memory performance in major depressive disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2024:S2451-9022(24)00110-1. [PMID: 38679324 DOI: 10.1016/j.bpsc.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Patients with major depressive disorder (MDD) can present with altered brain structure and deficits in cognitive function similar to aging. Yet, the interaction between age-related brain changes and brain development in MDD remains understudied. In a cohort of adolescents and adults with and without MDD, we assessed brain aging differences and associations through a newly developed tool quantifying normative neurodevelopmental trajectories. METHODS 304 MDD participants and 236 non-depressed controls were recruited and scanned from three studies under the Canadian Biomarker Integration Network for Depression. Volumetric data were used to generate brain centile scores, which were examined for: a) differences in MDD relative to controls; b) differences in individuals with versus without severe childhood maltreatment; and c) correlations with depressive symptom severity, neurocognitive assessment domains, or escitalopram treatment response. RESULTS Brain centiles were significantly lower in the MDD group compared to controls. It was also significantly correlated with working memory in controls, but not the MDD group. No significant associations were observed in depression severity or antidepressant treatment response with brain centiles. Likewise, childhood maltreatment history did not significantly affect brain centiles. CONCLUSIONS Consistent with prior work on machine learning models that predict "brain age", brain centile scores differed in people diagnosed with MDD, and MDD was associated with differential relationships between centile scores and working memory. The results support the notion of atypical development and aging in MDD, with implications on neurocognitive deficits associated with aging-related cognitive function.
Collapse
Affiliation(s)
- Natalie C W Ho
- Keenan Research Centre for Biomedical Research, Unity Health Toronto, Toronto, Canada; Centre for Depression & Suicide Studies, Unity Health Toronto, Toronto, Canada; Faculty of Arts and Sciences, University of Toronto, Toronto, Canada
| | | | - Jakob Seidlitz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA; Department of Child and Adolescent Psychiatry and Behavioral Science, The Children's Hospital of Philadelphia, Philadelphia, USA; Lifespan Brain Institute, The Children's Hospital of Philadelphia, Philadelphia, USA; Institute of Translational Medicine & Therapeutics, University of Pennsylvania, Philadelphia, USA
| | - Nikita Nogovitsyn
- Centre for Depression & Suicide Studies, Unity Health Toronto, Toronto, Canada
| | - Paul Metzak
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Pedro L Ballester
- Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Canada
| | - Stefanie Hassel
- Department of Psychiatry, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
| | - Susan Rotzinger
- Keenan Research Centre for Biomedical Research, Unity Health Toronto, Toronto, Canada; Centre for Depression & Suicide Studies, Unity Health Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare, Hamilton, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jordan Poppenk
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada; Department of Psychology, Queen's University, Kingston, Canada; School of Computing, Queen's University, Kingston, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
| | - Roumen Milev
- Department of Psychology, Queen's University, Kingston, Canada; Department of Psychiatry, Queen's University, Kingston, Canada; Providence Care Hospital, Kingston, Canada
| | | | - Aaron F Alexander-Bloch
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA; Department of Child and Adolescent Psychiatry and Behavioral Science, The Children's Hospital of Philadelphia, Philadelphia, USA; Lifespan Brain Institute, The Children's Hospital of Philadelphia, Philadelphia, USA; Institute of Translational Medicine & Therapeutics, University of Pennsylvania, Philadelphia, USA
| | - Benicio N Frey
- Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare, Hamilton, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, Canada; Department of Psychiatry, Queen's University, Kingston, Canada
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
| | - Sidney H Kennedy
- Keenan Research Centre for Biomedical Research, Unity Health Toronto, Toronto, Canada; Centre for Depression & Suicide Studies, Unity Health Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Katharine Dunlop
- Keenan Research Centre for Biomedical Research, Unity Health Toronto, Toronto, Canada; Centre for Depression & Suicide Studies, Unity Health Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| |
Collapse
|
3
|
Islam F, Magarbeh L, Elsheikh SSM, Kloiber S, Espinola CW, Bhat V, Frey BN, Milev R, Soares CN, Parikh SV, Placenza F, Hassel S, Taylor VH, Leri F, Blier P, Uher R, Farzan F, Lam RW, Turecki G, Foster JA, Rotzinger S, Kennedy SH, Müller DJ. Influence of CYP2C19, CYP2D6, and ABCB1 Gene Variants and Serum Levels of Escitalopram and Aripiprazole on Treatment-Emergent Sexual Dysfunction: A Canadian Biomarker Integration Network in Depression 1 (CAN-BIND 1) Study. Can J Psychiatry 2024; 69:183-195. [PMID: 37796764 PMCID: PMC10874600 DOI: 10.1177/07067437231203433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Treatment-emergent sexual dysfunction is frequently reported by individuals with major depressive disorder (MDD) on antidepressants, which negatively impacts treatment adherence and efficacy. We investigated the association of polymorphisms in pharmacokinetic genes encoding cytochrome-P450 drug-metabolizing enzymes, CYP2C19 and CYP2D6, and the transmembrane efflux pump, P-glycoprotein (i.e., ABCB1), on treatment-emergent changes in sexual function (SF) and sexual satisfaction (SS) in the Canadian Biomarker Integration Network in Depression 1 (CAN-BIND-1) sample. METHODS A total of 178 adults with MDD received treatment with escitalopram (ESC) from weeks 0-8 (Phase I). At week 8, nonresponders were augmented with aripiprazole (ARI) (i.e., ESC + ARI, n = 91), while responders continued ESC (i.e., ESC-Only, n = 80) from weeks 8-16 (Phase II). SF and SS were evaluated using the sex effects (SexFX) scale at weeks 0, 8, and 16. We assessed the primary outcomes, SF and SS change for weeks 0-8 and 8-16, using repeated measures mixed-effects models. RESULTS In ESC-Only, CYP2C19 intermediate metabolizer (IM) + poor metabolizers (PMs) showed treatment-related improvements in sexual arousal, a subdomain of SF, from weeks 8-16, relative to CYP2C19 normal metabolizers (NMs) who showed a decline, F(2,54) = 8.00, p < 0.001, q = 0.048. Specifically, CYP2C19 IM + PMs reported less difficulty with having and sustaining vaginal lubrication in females and erection in males, compared to NMs. Furthermore, ESC-Only females with higher concentrations of ESC metabolite, S-desmethylcitalopram (S-DCT), and S-DCT/ESC ratio in serum demonstrated more decline in SF (r = -0.42, p = 0.004, q = 0.034) and SS (r = -0.43, p = 0.003, q = 0.034), respectively, which was not observed in males. ESC-Only females also demonstrated a trend for a correlation between S-DCT and sexual arousal change in the same direction (r = -0.39, p = 0.009, q = 0.052). CONCLUSIONS CYP2C19 metabolizer phenotypes may be influencing changes in sexual arousal related to ESC monotherapy. Thus, preemptive genotyping of CYP2C19 may help to guide selection of treatment that circumvents selective serotonin reuptake inhibitor-related sexual dysfunction thereby improving outcomes for patients. Additionally, further research is warranted to clarify the role of S-DCT in the mechanisms underlying ESC-related changes in SF and SS. This CAN-BIND-1 study was registered on clinicaltrials.gov (Identifier: NCT01655706) on 27 July 2012.
Collapse
Affiliation(s)
- Farhana Islam
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Leen Magarbeh
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Samar S. M. Elsheikh
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Stefan Kloiber
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Caroline W. Espinola
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Claudio N. Soares
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Sagar V. Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Franca Placenza
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Stefanie Hassel
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Valerie H. Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Francesco Leri
- Department of Psychology and Neuroscience, University of Guelph, Guelph, Ontario, Canada
| | - Pierre Blier
- The Royal Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Faranak Farzan
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada
| | - Jane A. Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sidney H. Kennedy
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Daniel J. Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Clinic of Würzburg, Würzburg, Germany
| |
Collapse
|
4
|
Moinul D, Hao C, Dimitropoulos G, Taylor VH. Patient Perceptions of Microbiome-Based Therapies as Novel Treatments for Mood Disorders: A Mixed Methods Study: Perceptions des patients sur les thérapies basées sur le microbiome pour les troubles de l'humeur : une étude à méthodes mixtes. Can J Psychiatry 2024:7067437241234954. [PMID: 38414430 DOI: 10.1177/07067437241234954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Medications are critical for treating major depressive disorder (MDD) and bipolar disorder (BD). Unfortunately, 30% to 40% of individuals do not respond well to current pharmacotherapy. Given the compelling growing body of research on the gut-brain axis, this study aims to assess patient perspectives regarding microbiome-based therapies (MBT) such as probiotics, prebiotics, dietary changes, or fecal microbiota transplantation (FMT) in the management of MDD and BD. METHODS This single-centred observational study used quantitative and qualitative assessments to examine patient perceptions of MBT. Participants diagnosed with MDD or BD completed an anonymous questionnaire obtaining demographics, prior medication history, and symptom burden. Self-assessment questionnaires specific to each diagnosis were also used: Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR), Altman Self-Rating Mania Scale (ASRM), and General Anxiety Disorder Questionnaire (GAD-7). A logistic regression model analysed the association of MBT acceptance with disorder type, QIDS-SR, and GAD-7 scores. A bootstrap method assessed the proportion of MBT acceptance. The qualitative assessment consisted of 30-minute interviews to elicit perceptions and attitudes towards MBT. RESULTS The qualitative assessment achieved information power with n = 20. Results from the 63-item MBT questionnaire (n = 43) showed probiotics (37.2%) as the top choice, followed by FMT (32.6%), dietary change (25.6%), and prebiotics (4.6%). A majority of participants (72.1%) expressed willingness to try MBT for their mood disorder, however, logistic regression analysis did not identify statistically significant predictors for MBT acceptance among disorder type, QIDS-SR, and GAD-7. CONCLUSION There is an increased focus on the gut microbiota's role in mood disorders' etiology and treatment. Promising research and patient interest underscore the necessity for exploring and educating on patient perspectives and the factors influencing attitudes towards MBT.
Collapse
Affiliation(s)
- Dina Moinul
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chenhui Hao
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Valerie H Taylor
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
5
|
Minian N, Mehra K, Lingam M, Dragonetti R, Veldhuizen S, Zawertailo L, deRuiter WK, Melamed OC, Moineddin R, Thorpe KE, Taylor VH, Hahn M, Selby P. Healthcare providers' perspectives on implementing a brief physical activity and diet intervention within a primary care smoking cessation program: a qualitative study. BMC Prim Care 2024; 25:16. [PMID: 38184559 PMCID: PMC10770944 DOI: 10.1186/s12875-023-02259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/24/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Post-smoking-cessation weight gain can be a major barrier to quitting smoking; however, adding behavior change interventions for physical activity (PA) and diet may adversely affect smoking cessation outcomes. The "Picking up the PACE (Promoting and Accelerating Change through Empowerment)" study assessed change in PA, fruit/vegetable consumption, and smoking cessation by providing a clinical decision support system for healthcare providers to utilize at the intake appointment, and found no significant change in PA, fruits/vegetable consumption, or smoking cessation. The objective of this qualitative study was to explore the factors affecting the implementation of the intervention and contextualize the quantitative results. METHODS Twenty-five semi-structured interviews were conducted with healthcare providers, using questions based on the National Implementation Research Network's Hexagon Tool. The data were analyzed using the framework's standard analysis approach. RESULTS Most healthcare providers reported a need to address PA and fruit/vegetable consumption in patients trying to quit smoking, and several acknowledged that the intervention was a good fit since exercise and diet could improve smoking cessation outcomes. However, many healthcare providers mentioned the need to explain the fit to the patients. Social determinants of health (e.g., low income, food insecurity) were brought up as barriers to the implementation of the intervention by a majority of healthcare providers. Most healthcare providers recognized training as a facilitator to the implementation, but time was mentioned as a barrier by many of healthcare providers. Majority of healthcare providers mentioned allied health professionals (e.g., dieticians, physiotherapists) supported the implementation of the PACE intervention. However, most healthcare providers reported a need for individualized approach and adaptation of the intervention based on the patients' needs when implementing the intervention. The COVID-19 pandemic was found to impact the implementation of the PACE intervention based on the Hexagon Tool indicators. CONCLUSION There appears to be a need to utilize a flexible approach when addressing PA and fruit/vegetable consumption within a smoking cessation program, based on the context of clinic, the patients' it is serving, and their life circumstances. Healthcare providers need support and external resources to implement this particular intervention. NAME OF THE REGISTRY Clinicaltrials.gov. TRIAL REGISTRATION NUMBER NCT04223336. DATE OF REGISTRATION 7 January 2020 Retrospectively registered. URL OF TRIAL REGISTRY RECORD: https://classic. CLINICALTRIALS gov/ct2/show/NCT04223336 .
Collapse
Affiliation(s)
- Nadia Minian
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, IMHPR, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Kamna Mehra
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
| | - Mathangee Lingam
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
| | - Rosa Dragonetti
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Scott Veldhuizen
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Laurie Zawertailo
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, IMHPR, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Wayne K deRuiter
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
| | - Osnat C Melamed
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Toronto, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Margaret Hahn
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada
- Banting and Best Diabetes Centre, University of Toronto, Toronto, Canada
| | - Peter Selby
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Campbell Family Mental Health Research Institute, IMHPR, Centre for Addiction and Mental Health, Toronto, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
| |
Collapse
|
6
|
Phaterpekar T, Nunez JJ, Morton E, Liu YS, Cao B, Frey BN, Milev RV, Müller DJ, Rotzinger S, Soares CN, Taylor VH, Uher R, Kennedy SH, Lam RW. Machine Learning Prediction of Quality of Life Improvement During Antidepressant Treatment of Patients With Major Depressive Disorder: A STAR*D and CAN-BIND-1 Report. J Clin Psychiatry 2023; 85:23m14864. [PMID: 37967350 DOI: 10.4088/jcp.23m14864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Background: Quality of life (QoL) is an important patient-centric outcome to evaluate in treatment of major depressive disorder (MDD). This work sought to investigate the performance of several machine learning methods to predict a return to normative QoL in patients with MDD after antidepressant treatment. Methods: Several binary classification algorithms were trained on data from the first 2 weeks of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (n = 651, conducted from 2001 to 2006) to predict week 9 normative QoL (score ≥ 67, based on a community normative sample, on the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form [Q-LES-Q-SF]) after treatment with citalopram. Internal validation was performed using a STAR*D holdout dataset, and external validation was performed using the Canadian Biomarker Integration Network in Depression-1 (CAN-BIND-1) dataset (n = 175, study conducted from 2012 to 2017) after treatment with escitalopram. Feature importance was calculated using SHapley Additive exPlanations (SHAP). Results: Random Forest performed most consistently on internal and external validation, with balanced accuracy (area under the receiver operator curve) of 71% (0.81) on the STAR*D dataset and 69% (0.75) on the CAN-BIND-1 dataset. Random Forest Classifiers trained on Q-LES-Q-SF and Quick Inventory of Depressive Symptomatology-Self-Rated variables had similar performance on both internal and external validation. Important predictive variables came from psychological, physical, and socioeconomic domains. Conclusions: Machine learning can predict normative QoL after antidepressant treatment with similar performance to that of prior work predicting depressive symptom response and remission. These results suggest that QoL outcomes in MDD patients can be predicted with simple patient-rated measures and provide a foundation to further improve performance and demonstrate clinical utility. Trial Registration: ClinicalTrials.gov identifiers NCT00021528 and NCT01655706.
Collapse
Affiliation(s)
- Tejas Phaterpekar
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Drs Phaterpekar and Nunez contributed equally to this work
| | - John-Jose Nunez
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Drs Phaterpekar and Nunez contributed equally to this work
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Yang S Liu
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Kingston, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Claudio N Soares
- Departments of Psychiatry and Psychology, Queen's University, Kingston, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| |
Collapse
|
7
|
Slyepchenko A, Uher R, Ho K, Hassel S, Matthews C, Lukus PK, Daros AR, Minarik A, Placenza F, Li QS, Rotzinger S, Parikh SV, Foster JA, Turecki G, Müller DJ, Taylor VH, Quilty LC, Milev R, Soares CN, Kennedy SH, Lam RW, Frey BN. A standardized workflow for long-term longitudinal actigraphy data processing using one year of continuous actigraphy from the CAN-BIND Wellness Monitoring Study. Sci Rep 2023; 13:15300. [PMID: 37714910 PMCID: PMC10504311 DOI: 10.1038/s41598-023-42138-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
Monitoring sleep and activity through wearable devices such as wrist-worn actigraphs has the potential for long-term measurement in the individual's own environment. Long periods of data collection require a complex approach, including standardized pre-processing and data trimming, and robust algorithms to address non-wear and missing data. In this study, we used a data-driven approach to quality control, pre-processing and analysis of longitudinal actigraphy data collected over the course of 1 year in a sample of 95 participants. We implemented a data processing pipeline using open-source packages for longitudinal data thereby providing a framework for treating missing data patterns, non-wear scoring, sleep/wake scoring, and conducted a sensitivity analysis to demonstrate the impact of non-wear and missing data on the relationship between sleep variables and depressive symptoms. Compliance with actigraph wear decreased over time, with missing data proportion increasing from a mean of 4.8% in the first week to 23.6% at the end of the 12 months of data collection. Sensitivity analyses demonstrated the importance of defining a pre-processing threshold, as it substantially impacts the predictive value of variables on sleep-related outcomes. We developed a novel non-wear algorithm which outperformed several other algorithms and a capacitive wear sensor in quality control. These findings provide essential insight informing study design in digital health research.
Collapse
Affiliation(s)
- Anastasiya Slyepchenko
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Stefanie Hassel
- Department of Psychiatry, Cumming School of Medicine, and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Craig Matthews
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada
| | - Patricia K Lukus
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Alexander R Daros
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anna Minarik
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Franca Placenza
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Qingqin S Li
- Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, 08560, USA
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gustavo Turecki
- Douglas Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Daniel J Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Cumming School of Medicine, and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University and Providence Care Hospital, Kingston, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University and Providence Care Hospital, Kingston, ON, Canada
| | - Sidney H Kennedy
- Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada.
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
| |
Collapse
|
8
|
Taylor VH, Kumar V. Can we manage gut microbiome imbalances in patients with bipolar disorder with pharmacotherapy? Expert Opin Pharmacother 2023; 24:1957-1961. [PMID: 38073530 DOI: 10.1080/14656566.2023.2288287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION A novel new area of exploration in the treatment of bipolar disorder is the gut brain axis. Studies have shown significant differences between the gut microbiome in those with bipolar disorder and those without the illness, as well as documented microbiome changes associated with the effects of bipolar pharmacotherapy and targeted microbial interventions. Although we have evidence suggesting the bi-directional relationship between the gut microbiome and psychiatric disorders, we are still unable to utilize this understanding clinically. AREAS COVERED We need to better understand the factors that impact the microbiome in this illness and vice versa. EXPERT OPINION Additionally, changes in gut microbiome in bipolar disorder might be used for biomarker identification with a potential to help in diagnosis and monitoring of the condition. It is an important area for further research and may provide improved therapeutic outcomes.
Collapse
Affiliation(s)
- Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Vivek Kumar
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
9
|
Nunez JJ, Liu YS, Cao B, Frey BN, Ho K, Milev R, Müller DJ, Rotzinger S, Soares CN, Taylor VH, Uher R, Kennedy SH, Lam RW. Response trajectories during escitalopram treatment of patients with major depressive disorder. Psychiatry Res 2023; 327:115361. [PMID: 37523890 DOI: 10.1016/j.psychres.2023.115361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
Depression is a leading global cause of disability, yet about half of patients do not respond to initial antidepressant treatment. This treatment difficulty may be in part due to the heterogeneity of depression and corresponding response to treatment. Unsupervised machine learning allows underlying patterns to be uncovered, and can be used to understand this heterogeneity by finding groups of patients with similar response trajectories. Prior studies attempting this have clustered patients using a narrow range of data primarily from depression scales. In this work, we used unsupervised machine learning to cluster patients receiving escitalopram therapy using a wide variety of subjective and objective clinical features from the first eight weeks of the Canadian Biomarker Integration Network in Depression-1 trial. We investigated how these clusters responded to treatment by comparing changes in symptoms and symptom categories, and by using Principal Component Analysis (PCA). Our algorithm found three clusters, which broadly represented non-responders, responders, and remitters. Most categories of features followed this response pattern except for objective cognitive features. Using PCA with our clusters, we found that subjective mood state/anhedonia is the core feature of response with escitalopram, but there exists other distinct patterns of response around neurovegetative symptoms, activation, and cognition.
Collapse
Affiliation(s)
- John-Jose Nunez
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - Yang S Liu
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, Canada; Department of Computing Science, University of Alberta, Edmonton, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Keith Ho
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| |
Collapse
|
10
|
Sajjadian M, Uher R, Ho K, Hassel S, Milev R, Frey BN, Farzan F, Blier P, Foster JA, Parikh SV, Müller DJ, Rotzinger S, Soares CN, Turecki G, Taylor VH, Lam RW, Strother SC, Kennedy SH. Prediction of depression treatment outcome from multimodal data: a CAN-BIND-1 report. Psychol Med 2023; 53:5374-5384. [PMID: 36004538 PMCID: PMC10482706 DOI: 10.1017/s0033291722002124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/04/2022] [Accepted: 06/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prediction of treatment outcomes is a key step in improving the treatment of major depressive disorder (MDD). The Canadian Biomarker Integration Network in Depression (CAN-BIND) aims to predict antidepressant treatment outcomes through analyses of clinical assessment, neuroimaging, and blood biomarkers. METHODS In the CAN-BIND-1 dataset of 192 adults with MDD and outcomes of treatment with escitalopram, we applied machine learning models in a nested cross-validation framework. Across 210 analyses, we examined combinations of predictive variables from three modalities, measured at baseline and after 2 weeks of treatment, and five machine learning methods with and without feature selection. To optimize the predictors-to-observations ratio, we followed a tiered approach with 134 and 1152 variables in tier 1 and tier 2 respectively. RESULTS A combination of baseline tier 1 clinical, neuroimaging, and molecular variables predicted response with a mean balanced accuracy of 0.57 (best model mean 0.62) compared to 0.54 (best model mean 0.61) in single modality models. Adding week 2 predictors improved the prediction of response to a mean balanced accuracy of 0.59 (best model mean 0.66). Adding tier 2 features did not improve prediction. CONCLUSIONS A combination of clinical, neuroimaging, and molecular data improves the prediction of treatment outcomes over single modality measurement. The addition of measurements from the early stages of treatment adds precision. Present results are limited by lack of external validation. To achieve clinically meaningful prediction, the multimodal measurement should be scaled up to larger samples and the robustness of prediction tested in an external validation dataset.
Collapse
Affiliation(s)
- Mehri Sajjadian
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Keith Ho
- University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
- Unity Health Toronto, St. Michael's Hospital, 193 Yonge Street, 6th floor, Toronto, ON, M5B 1M4, Canada
| | - Stefanie Hassel
- Department of Psychiatry and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, ON, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Pierre Blier
- The Royal's Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Department of Psychiatry, University of Ottawa, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada
| | - Jane A. Foster
- Department of Psychiatry & Behavioural Neurosciences, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Sagar V. Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J. Müller
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Claudio N. Soares
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Gustavo Turecki
- Department of Psychiatry, Douglas Institute, McGill University, Montreal, QC, Canada
| | - Valerie H. Taylor
- Department of Psychiatry, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Stephen C. Strother
- Rotman Research Center, Baycrest, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
- Krembil Research Centre, University Health Network, University of Toronto, Toronto, Canada
| |
Collapse
|
11
|
Abstract
Obesity is a common comorbidity associated with mental illness. It is important to understand the many ways weight gain and obesity can impact the cause and course of mental illness in women, with a special focus on vulnerable life stages. Women seem disproportionally impacted by the weight gain side effects of medications, and issues such as weight gain are more likely to impact symptoms of mental illness, impacting self-esteem. This article summarizes the existing literature on the associations between women's mental health and obesity. Understanding this association will lead to better health outcomes.
Collapse
Affiliation(s)
- Jennifer V A Kemp
- Department of Psychiatry, University of Calgary, Foothills Campus, Calgary, Alberta, Canada; Matheson Centre for Mental Health Research & Education, University of Calgary, Foothills Campus, 3280 Hospital Drive Northwest, 1D-57, Calgary, Alberta T2N 4Z6, Canada
| | - Vivek Kumar
- Department of Psychiatry, University of Calgary, Foothills Campus, Calgary, Alberta, Canada; Matheson Centre for Mental Health Research & Education, University of Calgary, Foothills Campus, 3280 Hospital Drive Northwest, 1D-57, Calgary, Alberta T2N 4Z6, Canada
| | - April Saleem
- Department of Pathology and Molecular Medicine, Gastrointestinal Disease Research Unit, Queen's University, 76 Stuart Street, Sheth Lab (Floor 3), Kingston, Ontario K7L 2V7, Canada
| | - Gabrielle Hashman
- Department of Psychiatry, University of Calgary, Foothills Campus, Calgary, Alberta, Canada; Matheson Centre for Mental Health Research & Education, University of Calgary, Foothills Campus, 3280 Hospital Drive Northwest, 1D-57, Calgary, Alberta T2N 4Z6, Canada; Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Mashael Hussain
- Department of Psychiatry, University of Calgary, Foothills Campus, Calgary, Alberta, Canada; Matheson Centre for Mental Health Research & Education, University of Calgary, Foothills Campus, 3280 Hospital Drive Northwest, 1D-57, Calgary, Alberta T2N 4Z6, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Foothills Campus, Calgary, Alberta, Canada.
| |
Collapse
|
12
|
Pila E, Sabiston CM, Christensen RAG, Huellemann KL, Hallward L, Taylor VH, Arbour-Nicitopoulos KP, Wharton S. Consequences of daily self-weighing: a pilot study in higher-weight women with a history of breast cancer. Psychol Health 2023:1-22. [PMID: 37592811 DOI: 10.1080/08870446.2023.2247426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Self-monitoring weight is commonly recommended for higher-weight women with a history of breast cancer, despite evidence demonstrating potentially negative psychological consequences of frequent self-weighing. The extent to which higher-weight women with breast cancer experience emotional and behavioral consequences in response to daily self-weighing is unknown. In this pilot study, women (n = 51) with a history of breast cancer in a behavioral weight management program completed a weeklong daily diary protocol. Participants were asked to self-weigh every morning and report on subsequent weight-related shame and guilt, and end-of-day engagement in compensatory exercise, diet, and purging behaviors. Women reported higher levels of guilt on days when their body weight was higher than usual, and when there was more discrepancy between their current vs. goal weight. Additionally, women engaged in higher levels of compensatory diet behavior on days when they experienced more weight-related guilt than usual. Based on these preliminary findings, daily self-weighing may be associated with harmful emotional and behavioral consequences among higher-weight women with a history of breast cancer.
Collapse
Affiliation(s)
- Eva Pila
- School of Kinesiology, Western University, London, Canada
| | - C M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - R A G Christensen
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - K L Huellemann
- School of Kinesiology, Western University, London, Canada
| | - L Hallward
- School of Kinesiology, Western University, London, Canada
| | - V H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | | | - S Wharton
- Wharton Medical Clinic, Toronto, Canada
| |
Collapse
|
13
|
Tourjman SV, Buck G, Jutras-Aswad D, Khullar A, McInerney S, Saraf G, Pinto JV, Potvin S, Poulin MJ, Frey BN, Kennedy SH, Lam RW, MacQueen G, Milev R, Parikh SV, Ravindran A, McIntyre RS, Schaffer A, Taylor VH, van Ameringen M, Yatham LN, Beaulieu S. Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Report: A Systematic Review and Recommendations of Cannabis use in Bipolar Disorder and Major Depressive Disorder. Can J Psychiatry 2023; 68:299-311. [PMID: 35711159 PMCID: PMC10192829 DOI: 10.1177/07067437221099769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Given the increasing acceptability and legalization of cannabis in some jurisdictions, clinicians need to improve their understanding of the effect of cannabis use on mood disorders. OBJECTIVE The purpose of this task force report is to examine the association between cannabis use and incidence, presentation, course and treatment of bipolar disorder and major depressive disorder, and the treatment of comorbid cannabis use disorder. METHODS We conducted a systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials from inception to October 2020 focusing on cannabis use and bipolar disorder or major depressive disorder, and treatment of comorbid cannabis use disorder. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to evaluate the quality of evidence and clinical considerations were integrated to generate Canadian Network for Mood and Anxiety Treatments recommendations. RESULTS Of 12,691 publications, 56 met the criteria: 23 on bipolar disorder, 21 on major depressive disorder, 11 on both diagnoses and 1 on treatment of comorbid cannabis use disorder and major depressive disorder. Of 2,479,640 participants, 12,502 were comparison participants, 73,891 had bipolar disorder and 408,223 major depressive disorder without cannabis use. Of those with cannabis use, 2,761 had bipolar disorder and 5,044 major depressive disorder. The lifetime prevalence of cannabis use was 52%-71% and 6%-50% in bipolar disorder and major depressive disorder, respectively. Cannabis use was associated with worsening course and symptoms of both mood disorders, with more consistent associations in bipolar disorder than major depressive disorder: increased severity of depressive, manic and psychotic symptoms in bipolar disorder and depressive symptoms in major depressive disorder. Cannabis use was associated with increased suicidality and decreased functioning in both bipolar disorder and major depressive disorder. Treatment of comorbid cannabis use disorder and major depressive disorder did not show significant results. CONCLUSION The data indicate that cannabis use is associated with worsened course and functioning of bipolar disorder and major depressive disorder. Future studies should include more accurate determinations of type, amount and frequency of cannabis use and select comparison groups which allow to control for underlying common factors.
Collapse
Affiliation(s)
- Smadar V. Tourjman
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada
| | - Gabriella Buck
- Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Quebec, Canada
| | - Atul Khullar
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Shane McInerney
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gayatri Saraf
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jairo V. Pinto
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephane Potvin
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Quebec, Canada
| | | | - Benicio N. Frey
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
| | - Sagar V. Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Arun Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roger S. McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Valerie H. Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Michael van Ameringen
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
14
|
Magarbeh L, Hassel C, Choi M, Islam F, Marshe VS, Zai CC, Zuberi R, Gammal RS, Men X, Scherf-Clavel M, Enko D, Frey BN, Milev R, Soares CN, Parikh SV, Placenza F, Strother SC, Hassel S, Taylor VH, Leri F, Blier P, Farzan F, Lam RW, Turecki G, Foster JA, Rotzinger S, Kloiber S, Kennedy JL, Kennedy SH, Bousman CA, Müller DJ. ABCB1 Gene Variants and Antidepressant Treatment Outcomes: A Systematic Review and Meta-Analysis Including Results from the CAN-BIND-1 Study. Clin Pharmacol Ther 2023. [PMID: 36681895 DOI: 10.1002/cpt.2854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/06/2023] [Indexed: 01/23/2023]
Abstract
The P-glycoprotein efflux pump, encoded by the ABCB1 gene, has been shown to alter concentrations of various antidepressants in the brain. In this study, we conducted a systematic review and meta-analysis to investigate the association between six ABCB1 single-nucleotide polymorphisms (SNPs; rs1045642, rs2032582, rs1128503, rs2032583, rs2235015, and rs2235040) and antidepressant treatment outcomes in individuals with major depressive disorder (MDD), including new data from the Canadian Biomarker and Integration Network for Depression (CAN-BIND-1) cohort. For the CAN-BIND-1 sample, we applied regression models to investigate the association between ABCB1 SNPs and antidepressant treatment response, remission, tolerability, and antidepressant serum levels. For the meta-analysis, we systematically summarized pharmacogenetic evidence of the association between ABCB1 SNPs and antidepressant treatment outcomes. Studies were included in the meta-analysis if they investigated at least one ABCB1 SNP in individuals with MDD treated with at least one antidepressant. We did not find a significant association between ABCB1 SNPs and antidepressant treatment outcomes in the CAN-BIND-1 sample. A total of 39 studies were included in the systematic review. In the meta-analysis, we observed a significant association between rs1128503 and treatment response (T vs. C-allele, odds ratio = 1.30, 95% confidence interval = 1.15-1.48, P value (adjusted) = 0.024, n = 2,526). We did not find associations among the six SNPs and treatment remission nor tolerability. Our findings provide limited evidence for an association between common ABCB1 SNPs and antidepressant outcomes, which do not support the implementation of ABCB1 genotyping to inform antidepressant treatment at this time. Future research, especially on rs1128503, is recommended.
Collapse
Affiliation(s)
- Leen Magarbeh
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Claudia Hassel
- Department of Life Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Medical Genetics, University of Calgary, Calgary, Alberta, Canada
| | - Maximilian Choi
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Farhana Islam
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Victoria S Marshe
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Center for Translational and Computational Neuroimmunology, Columbia University Medical Center, New York, New York, USA
| | - Clement C Zai
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Rayyan Zuberi
- Department of Medical Genetics, University of Calgary, Calgary, Alberta, Canada
| | - Roseann S Gammal
- Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Xiaoyu Men
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Maike Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Dietmar Enko
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Providence Care, Kingston, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Franca Placenza
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | | | - Stefanie Hassel
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Francesco Leri
- Department of Psychology and Neuroscience, University of Guelph, Guelph, Ontario, Canada
| | - Pierre Blier
- The Royal Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Faranak Farzan
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada
| | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stefan Kloiber
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - James L Kennedy
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Chad A Bousman
- Department of Medical Genetics, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| |
Collapse
|
15
|
Ballester PL, Suh JS, Ho NCW, Liang L, Hassel S, Strother SC, Arnott SR, Minuzzi L, Sassi RB, Lam RW, Milev R, Müller DJ, Taylor VH, Kennedy SH, Reilly JP, Palaniyappan L, Dunlop K, Frey BN. Gray matter volume drives the brain age gap in schizophrenia: a SHAP study. Schizophrenia (Heidelb) 2023; 9:3. [PMID: 36624107 PMCID: PMC9829754 DOI: 10.1038/s41537-022-00330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023]
Abstract
Neuroimaging-based brain age is a biomarker that is generated by machine learning (ML) predictions. The brain age gap (BAG) is typically defined as the difference between the predicted brain age and chronological age. Studies have consistently reported a positive BAG in individuals with schizophrenia (SCZ). However, there is little understanding of which specific factors drive the ML-based brain age predictions, leading to limited biological interpretations of the BAG. We gathered data from three publicly available databases - COBRE, MCIC, and UCLA - and an additional dataset (TOPSY) of early-stage schizophrenia (82.5% untreated first-episode sample) and calculated brain age with pre-trained gradient-boosted trees. Then, we applied SHapley Additive Explanations (SHAP) to identify which brain features influence brain age predictions. We investigated the interaction between the SHAP score for each feature and group as a function of the BAG. These analyses identified total gray matter volume (group × SHAP interaction term β = 1.71 [0.53; 3.23]; pcorr < 0.03) as the feature that influences the BAG observed in SCZ among the brain features that are most predictive of brain age. Other brain features also presented differences in SHAP values between SCZ and HC, but they were not significantly associated with the BAG. We compared the findings with a non-psychotic depression dataset (CAN-BIND), where the interaction was not significant. This study has important implications for the understanding of brain age prediction models and the BAG in SCZ and, potentially, in other psychiatric disorders.
Collapse
Affiliation(s)
- Pedro L. Ballester
- grid.25073.330000 0004 1936 8227Neuroscience Graduate Program, McMaster University, Hamilton, ON Canada
| | - Jee Su Suh
- grid.25073.330000 0004 1936 8227Neuroscience Graduate Program, McMaster University, Hamilton, ON Canada
| | - Natalie C. W. Ho
- grid.17063.330000 0001 2157 2938Faculty of Arts & Science, University of Toronto, Toronto, ON Canada ,grid.415502.7Keenan Research Centre for Biomedical Science, Unity Health Toronto, Toronto, Canada
| | - Liangbing Liang
- grid.39381.300000 0004 1936 8884Graduate Program in Neuroscience, Western University, London, ON Canada ,grid.39381.300000 0004 1936 8884Robarts Research Institute, Western University, London, ON Canada
| | - Stefanie Hassel
- grid.22072.350000 0004 1936 7697Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Stephen C. Strother
- grid.17063.330000 0001 2157 2938Rotman Research Institute, Baycrest, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Medical Biophysics, University of Toronto, Toronto, ON Canada
| | - Stephen R. Arnott
- grid.17063.330000 0001 2157 2938Rotman Research Institute, Baycrest, Toronto, ON Canada
| | - Luciano Minuzzi
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, Hamilton, ON Canada ,grid.416721.70000 0001 0742 7355Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Roberto B. Sassi
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Raymond W. Lam
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Roumen Milev
- grid.410356.50000 0004 1936 8331Departments of Psychiatry and Psychology, Queen’s University, and Providence Care, Kingston, ON Canada
| | - Daniel J. Müller
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Valerie H. Taylor
- grid.22072.350000 0004 1936 7697Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Sidney H. Kennedy
- grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Centre for Mental Health, University Health Network, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Krembil Research Institute, University Health Network, Toronto, ON Canada ,grid.415502.7Centre for Depression and Suicide Studies, and Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - James P. Reilly
- grid.25073.330000 0004 1936 8227Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON Canada
| | - Lena Palaniyappan
- grid.39381.300000 0004 1936 8884Robarts Research Institute, Western University, London, ON Canada ,grid.39381.300000 0004 1936 8884Department of Medical Biophysics, Western University, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada ,grid.39381.300000 0004 1936 8884Department of Psychiatry, Western University, London, ON Canada ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, Douglas Mental Health University Institute, McGill, Douglas, QC Canada
| | - Katharine Dunlop
- grid.415502.7Keenan Research Centre for Biomedical Science, Unity Health Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,Centre for Depression & Suicide Studies, Unity Health Toronto, Toronto, ON Canada
| | - Benicio N. Frey
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, Hamilton, ON Canada ,grid.416721.70000 0001 0742 7355Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| |
Collapse
|
16
|
Soklaridis S, Black G, LeBlanc C, MacKinnon KR, Holroyd-Leduc J, Clement F, Schrewe B, Ross HJ, Calleja S, Stergiopoulos V, Taylor VH, Kuper A. Academic Productivity of Equity-Deserving Physician Scholars During COVID-19: A Scoping Review. Acad Med 2023; 98:123-135. [PMID: 36576772 PMCID: PMC9779983 DOI: 10.1097/acm.0000000000004971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The COVID-19 pandemic presented new barriers and exacerbated existing inequities for physician scholars. While COVID-19's impact on academic productivity among women has received attention, the pandemic may have posed additional challenges for scholars from a wider range of equity-deserving groups, including those who hold multiple equity-deserving identities. To examine this concern, the authors conducted a scoping review of the literature through an intersectionality lens. METHOD The authors searched peer-reviewed literature published March 1, 2020, to December 16, 2021, in Ovid MEDLINE, Ovid Embase, and PubMed. The authors excluded studies not written in English and/or outside of academic medicine. From included studies, they extracted data regarding descriptions of how COVID-19 impacted academic productivity of equity-deserving physician scholars, analyses on the pandemic's reported impact on productivity of physician scholars from equity-deserving groups, and strategies provided to reduce the impact of the COVID-19 pandemic on academic productivity of physician scholars from equity-deserving groups. RESULTS Of 11,587 unique articles, 44 met inclusion criteria, including 15 nonempirical studies and 29 empirical studies (22 bibliometrics studies, 6 surveys, and 1 qualitative study). All included articles focused on the gendered impact of the pandemic on academic productivity. The majority of their recommendations focused on how to alleviate the burden of the pandemic on women, particularly those in the early stages of their career and/or with children, without consideration of scholars who hold multiple and intersecting identities from a wider range of equity-deserving groups. CONCLUSIONS Findings indicate a lack of published literature on the pandemic's impact on physician scholars from equity-deserving groups, including a lack of consideration of physician scholars who experience multiple forms of discrimination. Well-intentioned measures by academic institutions to reduce the impact on scholars may inadvertently risk reproducing and sustaining inequities that equity-deserving scholars faced during the pandemic.
Collapse
Affiliation(s)
- Sophie Soklaridis
- S. Soklaridis is a senior scientist, Department of Education, Centre for Addiction and Mental Health, and associate professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-5119-8473
| | - Georgia Black
- G. Black is a research analyst, Department of Education, Centre for Addiction and Mental Health, Department of Education, Toronto, Ontario, Canada
| | - Constance LeBlanc
- C. LeBlanc is professor, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; ORCID: http://orcid.org/0000-0003-0553-3335
| | - Kinnon R. MacKinnon
- K.R. MacKinnon is assistant professor, School of Social Work, York University, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-2039-6746
| | - Jayna Holroyd-Leduc
- J. Holroyd-Leduc is professor and head, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Clement
- F. Clement is professor, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Brett Schrewe
- B. Schrewe is clinical assistant professor, Department of Pediatrics, University of British Columbia, Victoria, British Columbia, Canada; ORCID: http://orcid.org/0000-0001-9743-2894
| | - Heather J. Ross
- H.J. Ross is division head of cardiology, Peter Munk Cardiac Centre, and professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-4384-3027
| | - Sabine Calleja
- S. Calleja is a librarian, Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-5297-0736
| | - Vicky Stergiopoulos
- V. Stergiopoulos is a clinician scientist, Centre for Addiction and Mental Health, and professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-3941-9434
| | - Valerie H. Taylor
- V.H. Taylor is professor, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Ayelet Kuper
- A. Kuper is a scientist and associate director, Wilson Centre, University Health Network/University of Toronto, and associate professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-6399-6958
| |
Collapse
|
17
|
Collaton J, Dennis CL, Taylor VH, Grigoriadis S, Oberlander TF, Frey BN, Van Lieshout R, Guintivano J, Meltzer-Brody S, Kennedy JL, Vigod SN. The PPD-ACT app in Canada: feasibility and a latent class analysis of participants with postpartum depression recruited to a psychiatric genetics study using a mobile application. BMC Psychiatry 2022; 22:735. [PMID: 36434566 PMCID: PMC9700884 DOI: 10.1186/s12888-022-04363-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 11/02/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) and postpartum psychosis (PPP) are linked to negative consequences for women and families. Virtual applications present a solution to the challenge of recruiting large samples for genetic PPD/PPP research. This study aimed to evaluate the feasibility of a protocol for enrolling Canadian women with PPD and PPP to a large international psychiatric genetics study using a mobile application (PPD-ACT), and identify clinically distinct subtypes of PPD in the recruited sample. METHODS From April 2017-June 2019, Canadian women provided phenotypic data through the PPD-ACT app. Requests for a genetic sample were made from those with a current or past PPD episode based on an Edinburgh Postnatal Depression Scale (EPDS) score > 12 with onset in pregnancy or 0-3 months postpartum, and from those self-reporting lifetime PPP. Latent class analysis (LCA) was used to identify clinically distinct PPD subgroups based on participant responses to the EPDS scale. RESULTS We identified 797 PPD cases, 404 of whom submitted DNA. There were 109 PPP cases, with 66 submitting DNA. PPD cases (86.7% White, mean 4.7 +/- 7.0 years since their episode) came from across Canadian provinces/territories. LCA identified two PPD classes clinically distinct by symptom severity: [1] moderate-severity (mean EPDS = 18.5+/- 2.5; 8.6% with suicidality), and [2] severe (mean EPDS = 24.5+/- 2.1; 52.8% with suicidality). CONCLUSIONS A mobile application rapidly collected data from individuals with moderate and severe symptoms of PPD, an advantage for genetics where specificity is optimal, as well as from women with a history of PPP, supporting future work using this approach.
Collapse
Affiliation(s)
- Joanna Collaton
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Hospital and Research Institute, 76 Grenville Street, Toronto, ON Canada
| | - Cindy-Lee Dennis
- grid.417199.30000 0004 0474 0188Women’s College Hospital and Research Institute, 76 Grenville Street, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON Canada
| | - Valerie H. Taylor
- grid.417199.30000 0004 0474 0188Women’s College Hospital and Research Institute, 76 Grenville Street, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Sophie Grigoriadis
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.413104.30000 0000 9743 1587Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Tim F. Oberlander
- grid.17091.3e0000 0001 2288 9830BC Women’s Hospital and Health Centre, University of British Columbia, Vancouver, BC Canada
| | - Benicio N. Frey
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ,grid.416721.70000 0001 0742 7355Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton ON, Hamilton, ON L8N 4A6 Canada
| | - Ryan Van Lieshout
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ,grid.416721.70000 0001 0742 7355Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton ON, Hamilton, ON L8N 4A6 Canada
| | - Jerry Guintivano
- grid.410711.20000 0001 1034 1720University of North Carolina, Chapel Hill, NC USA
| | | | - James L. Kennedy
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Simone N. Vigod
- grid.417199.30000 0004 0474 0188Women’s College Hospital and Research Institute, 76 Grenville Street, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| |
Collapse
|
18
|
Ali M, Suh JS, Ramonas M, Hassel S, Arnott SR, Strother SC, Minuzzi L, Sassi RB, Lam RW, Milev R, Müller DJ, Taylor VH, Kennedy SH, Frey BN. A detailed manual segmentation procedure for the hypothalamus for 3T T1-weighted MRI. MethodsX 2022; 9:101864. [PMID: 36193115 PMCID: PMC9526169 DOI: 10.1016/j.mex.2022.101864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/13/2022] [Indexed: 10/31/2022] Open
Abstract
The hypothalamus is a small grey matter structure which plays a crucial role in many physiological functions. Some studies have found an association between hypothalamic volume and psychopathology, which stresses the need for a standardized method to maximize segmentation accuracy. Here, we provide a detailed step-by-step method outlining the procedures to manually segment the hypothalamus using anatomical T1w images from 3T scanners, which many neuroimaging studies collect as a standard anatomical reference image. We compared volumes generated by manual segmentation and those generated by an automatic algorithm, observing a significant difference between automatically and manually segmented hypothalamus volumes on both sides (left: U = 222842, p-value < 2.2e-16; right: U = 218520, p- value < 2.2e-16).•Significant difference exists between existing automatic segmentation methods and the manual segmentation procedure.•We discuss potential drift effects, segmentation quality issues, and suggestions on how to mitigate them.•We demonstrate that the present manual segmentation procedure using standard T1-weighted MRI may be significantly more accurate than automatic segmentation outputs.
Collapse
Affiliation(s)
- Mohammad Ali
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Jee Su Suh
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Milita Ramonas
- Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Stefanie Hassel
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Luciano Minuzzi
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Roberto B Sassi
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, and Providence Care Hospital, Kingston, ON, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sidney H Kennedy
- Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto ON, Canada
| | - Benicio N Frey
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | | |
Collapse
|
19
|
Agarwal SM, Stogios N, Ahsan ZA, Lockwood JT, Duncan MJ, Takeuchi H, Cohn T, Taylor VH, Remington G, Faulkner GEJ, Hahn M. Pharmacological interventions for prevention of weight gain in people with schizophrenia. Cochrane Database Syst Rev 2022; 10:CD013337. [PMID: 36190739 PMCID: PMC9528976 DOI: 10.1002/14651858.cd013337.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Antipsychotic-induced weight gain is an extremely common problem in people with schizophrenia and is associated with increased morbidity and mortality. Adjunctive pharmacological interventions may be necessary to help manage antipsychotic-induced weight gain. This review splits and updates a previous Cochrane Review that focused on both pharmacological and behavioural approaches to this problem. OBJECTIVES To determine the effectiveness of pharmacological interventions for preventing antipsychotic-induced weight gain in people with schizophrenia. SEARCH METHODS The Cochrane Schizophrenia Information Specialist searched Cochrane Schizophrenia's Register of Trials on 10 February 2021. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that examined any adjunctive pharmacological intervention for preventing weight gain in people with schizophrenia or schizophrenia-like illnesses who use antipsychotic medications. DATA COLLECTION AND ANALYSIS At least two review authors independently extracted data and assessed the quality of included studies. For continuous outcomes, we combined mean differences (MD) in endpoint and change data in the analysis. For dichotomous outcomes, we calculated risk ratios (RR). We assessed risk of bias for included studies and used GRADE to judge certainty of evidence and create summary of findings tables. The primary outcomes for this review were clinically important change in weight, clinically important change in body mass index (BMI), leaving the study early, compliance with treatment, and frequency of nausea. The included studies rarely reported these outcomes, so, post hoc, we added two new outcomes, average endpoint/change in weight and average endpoint/change in BMI. MAIN RESULTS Seventeen RCTs, with a total of 1388 participants, met the inclusion criteria for the review. Five studies investigated metformin, three topiramate, three H2 antagonists, three monoamine modulators, and one each investigated monoamine modulators plus betahistine, melatonin and samidorphan. The comparator in all studies was placebo or no treatment (i.e. standard care alone). We synthesised all studies in a quantitative meta-analysis. Most studies inadequately reported their methods of allocation concealment and blinding of participants and personnel. The resulting risk of bias and often small sample sizes limited the overall certainty of the evidence. Only one reboxetine study reported the primary outcome, number of participants with clinically important change in weight. Fewer people in the treatment condition experienced weight gains of more than 5% and more than 7% of their bodyweight than those in the placebo group (> 5% weight gain RR 0.27, 95% confidence interval (CI) 0.11 to 0.65; 1 study, 43 participants; > 7% weight gain RR 0.24, 95% CI 0.07 to 0.83; 1 study, 43 participants; very low-certainty evidence). No studies reported the primary outcomes, 'clinically important change in BMI', or 'compliance with treatment'. However, several studies reported 'average endpoint/change in body weight' or 'average endpoint/change in BMI'. Metformin may be effective in preventing weight gain (MD -4.03 kg, 95% CI -5.78 to -2.28; 4 studies, 131 participants; low-certainty evidence); and BMI increase (MD -1.63 kg/m2, 95% CI -2.96 to -0.29; 5 studies, 227 participants; low-certainty evidence). Other agents that may be slightly effective in preventing weight gain include H2 antagonists such as nizatidine, famotidine and ranitidine (MD -1.32 kg, 95% CI -2.09 to -0.56; 3 studies, 248 participants; low-certainty evidence) and monoamine modulators such as reboxetine and fluoxetine (weight: MD -1.89 kg, 95% CI -3.31 to -0.47; 3 studies, 103 participants; low-certainty evidence; BMI: MD -0.66 kg/m2, 95% CI -1.05 to -0.26; 3 studies, 103 participants; low-certainty evidence). Topiramate did not appear effective in preventing weight gain (MD -4.82 kg, 95% CI -9.99 to 0.35; 3 studies, 168 participants; very low-certainty evidence). For all agents, there was no difference between groups in terms of individuals leaving the study or reports of nausea. However, the results of these outcomes are uncertain given the very low-certainty evidence. AUTHORS' CONCLUSIONS There is low-certainty evidence to suggest that metformin may be effective in preventing weight gain. Interpretation of this result and those for other agents, is limited by the small number of studies, small sample size, and short study duration. In future, we need studies that are adequately powered and with longer treatment durations to further evaluate the efficacy and safety of interventions for managing weight gain.
Collapse
Affiliation(s)
- Sri Mahavir Agarwal
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Zohra A Ahsan
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Jonathan T Lockwood
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Markus J Duncan
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Hiroyoshi Takeuchi
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Tony Cohn
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Gary Remington
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Guy E J Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Margaret Hahn
- Complex Care and Recovery, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| |
Collapse
|
20
|
Islam F, Marshe VS, Magarbeh L, Frey BN, Milev RV, Soares CN, Parikh SV, Placenza F, Strother SC, Hassel S, Taylor VH, Leri F, Blier P, Uher R, Farzan F, Lam RW, Turecki G, Foster JA, Rotzinger S, Kennedy SH, Müller DJ. Effects of CYP2C19 and CYP2D6 gene variants on escitalopram and aripiprazole treatment outcome and serum levels: results from the CAN-BIND 1 study. Transl Psychiatry 2022; 12:366. [PMID: 36068210 PMCID: PMC9448818 DOI: 10.1038/s41398-022-02124-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Cytochrome P450 drug-metabolizing enzymes may contribute to interindividual differences in antidepressant outcomes. We investigated the effects of CYP2C19 and CYP2D6 gene variants on response, tolerability, and serum concentrations. Patients (N = 178) were treated with escitalopram (ESC) from weeks 0-8 (Phase I), and at week 8, either continued ESC if they were responders or were augmented with aripiprazole (ARI) if they were non-responders (<50% reduction in Montgomery-Åsberg Depression Rating Scale from baseline) for weeks 8-16 (Phase II). Our results showed that amongst patients on ESC-Only, CYP2C19 intermediate and poor metabolizers (IM + PMs), with reduced or null enzyme function, trended towards significantly lower symptom improvement during Phase II compared to normal metabolizers (NMs), which was not observed in ESC + ARI. We further showed that CYP2D6 NMs and IM + PMs had a higher likelihood of reporting a treatment-related central nervous system side effect in ESC-Only and ESC + ARI, respectively. The differences in the findings between ESC-Only and ESC + ARI may be due to the altered pharmacokinetics of ESC by ARI coadministration in ESC + ARI. We provided evidence for this postulation when we showed that in ESC-Only, CYP2C19 and CYP2D6 IM + PMs demonstrated significantly higher ESC concentrations at Weeks 10 and 16 compared to NMs. In contrast, ESC + ARI showed an association with CYP2C19 but not with CYP2D6 metabolizer group. Instead, ESC + ARI showed an association between CYP2D6 metabolizer group and ARI metabolite-to-drug ratio suggesting potential competition between ESC and ARI for CYP2D6. Our findings suggest that dosing based on CYP2C19 and CYP2D6 genotyping could improve safety and outcome in patients on ESC monotherapy.
Collapse
Affiliation(s)
- Farhana Islam
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada
| | - Victoria S. Marshe
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON Canada
| | - Leen Magarbeh
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada
| | - Benicio N. Frey
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ,grid.416721.70000 0001 0742 7355St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Roumen V. Milev
- grid.410356.50000 0004 1936 8331Department of Psychiatry, Queen’s University, Providence Care, Kingston, ON Canada
| | - Claudio N. Soares
- grid.410356.50000 0004 1936 8331Department of Psychiatry, Queen’s University, Providence Care, Kingston, ON Canada
| | - Sagar V. Parikh
- grid.214458.e0000000086837370Department of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Franca Placenza
- grid.231844.80000 0004 0474 0428Centre for Mental Health, University Health Network, Toronto, ON Canada
| | - Stephen C. Strother
- grid.17063.330000 0001 2157 2938Rotman Research Institute, Baycrest Medical Centre, and Medical Biophysics, University of Toronto, Toronto, ON Canada
| | - Stefanie Hassel
- grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB Canada
| | - Valerie H. Taylor
- grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB Canada
| | - Francesco Leri
- grid.34429.380000 0004 1936 8198Department of Psychology and Neuroscience, University of Guelph, Guelph, ON Canada
| | - Pierre Blier
- grid.414622.70000 0001 1503 7525The Royal Institute of Mental Health Research, Ottawa, ON Canada
| | - Rudolf Uher
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University, Halifax, NS Canada
| | - Faranak Farzan
- grid.61971.380000 0004 1936 7494Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC Canada
| | - Raymond W. Lam
- grid.17091.3e0000 0001 2288 9830University of British Columbia and Vancouver Coastal Health Authority, Vancouver, BC Canada
| | - Gustavo Turecki
- grid.14709.3b0000 0004 1936 8649McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, QC Canada
| | - Jane A. Foster
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ,grid.416721.70000 0001 0742 7355St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada ,grid.231844.80000 0004 0474 0428Centre for Mental Health, University Health Network, Toronto, ON Canada
| | - Susan Rotzinger
- grid.17063.330000 0001 2157 2938Department of Psychiatry, St Michael’s Hospital, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Sidney H. Kennedy
- grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Centre for Mental Health, University Health Network, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, St Michael’s Hospital, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.415502.7Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON Canada
| | - Daniel J. Müller
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.411760.50000 0001 1378 7891Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Clinic of Würzburg, Würzburg, Germany
| |
Collapse
|
21
|
Hussain-Shamsy N, Somerton S, Stewart DE, Grigoriadis S, Metcalfe K, Oberlander TF, Schram C, Taylor VH, Dennis CL, Vigod SN. The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy. BMC Med Inform Decis Mak 2022; 22:130. [PMID: 35562801 PMCID: PMC9099318 DOI: 10.1186/s12911-022-01870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background People with moderate to severe depression in pregnancy must weigh potential risks of untreated or incompletely treated depression against the small, but uncertain risks of fetal antidepressant drug exposure. Clinical support alone appears insufficient for helping individuals with this complex decision. A patient decision aid (PDA) has the potential to be a useful tool for this population. The objective of our work was to use internationally recognized guidelines from the International Patient Decision Aids Standards Collaboration to develop an evidence-based PDA for antidepressant use in pregnancy. Methods A three-phased development process was used whereby, informed by patient and physician perspectives and evidence synthesis, a steering committee commissioned a web-based PDA for those deciding whether or not to start or continue antidepressant treatment for depression in pregnancy (Phase 1). A prototype was developed (Phase 2) and iteratively revised based on feedback during field testing based on a user-centred process (Phase 3). Results We developed a web-based PDA for people deciding whether to start or continue antidepressant use for depression in pregnancy. It has five interactive sections: (1) information on depression and treatment; (2) reasons to start/continue an antidepressant and to start/stop antidepressant medication; (3) user assessment of values regarding each issue; (4) opportunity to reflect on factors that contribute to decision making; and (5) a printable PDF that summarizes the user’s journey through the PDA. Conclusions This tool, which exclusively focuses on depression treatment with Selective Serotonin Reuptake Inhibitors and Serotonin–Norepinephrine Reuptake Inhibitors, can be used by individuals making decisions about antidepressant use to treat depression during pregnancy. Limitations of the PDA are that it is not for other conditions, nor other medications that can be used for depression, and in its pilot form cannot be used by women who do not speak English or who have a visual impairment. Pending further study, it has the potential to enhance quality of care and patient experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01870-1.
Collapse
Affiliation(s)
- Neesha Hussain-Shamsy
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada
| | - Sarah Somerton
- Garry Hurvitz Centre for Brain and Mental Health, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada
| | - Donna E Stewart
- Centre for Mental Health, University Health Network, Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON, Canada.,Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada
| | - Sophie Grigoriadis
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre and Research Institute, 2075 Bayview Avenue, Toronto, ON, Canada.,Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Kelly Metcalfe
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada
| | - Tim F Oberlander
- BC Children's Hospital, 4500 Oak Street, Vancouver, BC, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada
| | - Carrie Schram
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada
| | - Simone N Vigod
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada. .,Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada. .,Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
| |
Collapse
|
22
|
Nogovitsyn N, Addington J, Souza R, Placsko TJ, Stowkowy J, Wang J, Goldstein BI, Bray S, Lebel C, Taylor VH, Kennedy SH, MacQueen G. Childhood trauma and amygdala nuclei volumes in youth at risk for mental illness. Psychol Med 2022; 52:1192-1199. [PMID: 32940197 DOI: 10.1017/s0033291720003177] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adults with significant childhood trauma and/or serious mental illness may exhibit persistent structural brain changes within limbic structures, including the amygdala. Little is known about the structure of the amygdala prior to the onset of SMI, despite the relatively high prevalence of trauma in at-risk youth. METHODS Data were gathered from the Canadian Psychiatric Risk and Outcome study. A total of 182 youth with a mean age of 18.3 years completed T1-weighted MRI scans along with clinical assessments that included questionnaires on symptoms of depression and anxiety. Participants also completed the Childhood Trauma and Abuse Scale. We used a novel subfield-specific amygdala segmentation workflow as a part of FreeSurfer 6.0 to examine amygdala structure. RESULTS Participants with higher trauma scores were more likely to have smaller amygdala volumes, particularly within the basal regions. Among various types of childhood trauma, sexual and physical abuse had the largest effects on amygdala subregions. Abuse-related differences in the right basal region mediated the severity of depression and anxiety symptoms, even though no participants met criteria for clinical diagnosis at the time of assessment. CONCLUSION The experience of physical or sexual abuse may leave detectable structural alterations in key regions of the amygdala, potentially mediating the risk of psychopathology in trauma-exposed youth.
Collapse
Affiliation(s)
- Nikita Nogovitsyn
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Roberto Souza
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Thea J Placsko
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jacqueline Stowkowy
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - JianLi Wang
- Work & Mental health Research Unit, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Departments of Psychiatry and Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Signe Bray
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Child & Adolescent Imaging Research (CAIR) Program, Calgary, Alberta, Canada
| | - Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Child & Adolescent Imaging Research (CAIR) Program, Calgary, Alberta, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
- Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Glenda MacQueen
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
23
|
Eboreime E, Shalaby R, Mao W, Owusu E, Vuong W, Surood S, Bales K, MacMaster FP, McNeil D, Rittenbach K, Ohinmaa A, Bremault-Phillips S, Hilario C, Greiner R, Knox M, Chafe J, Coulombe J, Xin-Min L, McLean C, Rathwell R, Snaterse M, Spurvey P, Taylor VH, McLean S, Urichuk L, Tzeggai B, McCabe C, Grauwiler D, Jordan S, Brown E, Fors L, Savard T, Grunau M, Kelton F, Stauffer S, Cao B, Chue P, Abba-Aji A, Silverstone P, Nwachukwu I, Greenshaw A, Agyapong VIO. Reducing readmission rates for individuals discharged from acute psychiatric care in Alberta using peer and text message support: Protocol for an innovative supportive program. BMC Health Serv Res 2022; 22:332. [PMID: 35279142 PMCID: PMC8917368 DOI: 10.1186/s12913-022-07510-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/13/2022] [Indexed: 12/21/2022] Open
Abstract
Background Individuals discharged from inpatient psychiatry units have the highest readmission rates of all hospitalized patients. These readmissions are often due to unmet need for mental health care compounded by limited human resources. Reducing the need for hospital admissions by providing alternative effective care will mitigate the strain on the healthcare system and for people with mental illnesses and their relatives. We propose implementation and evaluation of an innovative program which augments Mental Health Peer Support with an evidence-based supportive text messaging program developed using the principles of cognitive behavioral therapy. Methods A pragmatic stepped-wedge cluster-randomized trial, where daily supportive text messages (Text4Support) and mental health peer support are the interventions, will be employed. We anticipate recruiting 10,000 participants at the point of their discharge from 9 acute care psychiatry sites and day hospitals across four cities in Alberta. The primary outcome measure will be the number of psychiatric readmissions within 30 days of discharge. We will also evaluate implementation outcomes such as reach, acceptability, fidelity, and sustainability. Our study will be guided by the Consolidated Framework for Implementation Research, and the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Data will be extracted from administrative data, surveys, and qualitative methods. Quantitative data will be analysed using machine learning. Qualitative interviews will be transcribed and analyzed thematically using both inductive and deductive approaches. Conclusions To our knowledge, this will be the first large-scale clinical trial to assess the impact of a daily supportive text message program with and without mental health peer support for individuals discharged from acute psychiatric care. We anticipate that the interventions will generate significant cost-savings by reducing readmissions, while improving access to quality community mental healthcare and reducing demand for acute care. It is envisaged that the results will shed light on the effectiveness, as well as contextual barriers and facilitators to implementation of automated supportive text message and mental health peer support interventions to reduce the psychological treatment and support gap for patients who have been discharged from acute psychiatric care. Trial registration clinicaltrials.gov, NCT05133726. Registered 24 November 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07510-8.
Collapse
|
24
|
Minian N, Lingam M, Moineddin R, Thorpe KE, Veldhuizen S, Dragonetti R, Zawertailo L, Taylor VH, Hahn M, deRuiter WK, Melamed OC, Selby P. Impact of a Clinical Decision Support System for Addressing Physical Activity and/or Healthy Eating during Smoking Cessation Treatment: Hybrid Type I Randomized Controlled Trial (Preprint). J Med Internet Res 2022; 24:e37900. [PMID: 36178716 PMCID: PMC9568810 DOI: 10.2196/37900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/29/2022] [Accepted: 07/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background People who smoke have other risk factors for chronic diseases, such as low levels of physical activity and poor diet. Clinical decision support systems (CDSSs) might help health care practitioners integrate interventions for diet and physical activity into their smoking cessation programming but could worsen quit rates. Objective The aims of this study are to assess the effects of the addition of a CDSS for physical activity and diet on smoking cessation outcomes and to assess the implementation of the study. Methods We conducted a pragmatic hybrid type I effectiveness-implementation trial with 232 team-based primary care practices in Ontario, Canada, from November 2019 to May 2021. We used a 2-arm randomized controlled trial comparing a CDSS addressing physical activity and diet to treatment as usual and used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to measure implementation outcomes. The primary outcome was self-reported 7-day tobacco abstinence at 6 months. Results We enrolled 5331 participants in the study. Of these, 2732 (51.2%) were randomized to the intervention group and 2599 (48.8%) to the control group. At the 6-month follow-up, 29.7% (634/2137) of respondents in the intervention arm and 27.3% (552/2020) in the control arm reported abstinence from tobacco. After multiple imputation, the absolute group difference was 2.1% (95% CI −0.5 to 4.6; F1,1000.42=2.43; P=.12). Mean exercise minutes changed from 32 (SD 44.7) to 110 (SD 196.1) in the intervention arm and from 32 (SD 45.1) to 113 (SD 195.1) in the control arm (group effect: B=−3.7 minutes; 95% CI −17.8 to 10.4; P=.61). Servings of fruit and vegetables changed from 2.64 servings to 2.42 servings in the intervention group and from 2.52 servings to 2.45 servings in the control group (incidence rate ratio for intervention group=0.98; 95% CI 0.93-1.02; P=.35). Conclusions A CDSS for physical activity and diet may be added to a smoking cessation program without affecting the outcomes. Further research is needed to improve the impact of integrated health promotion interventions in primary care smoking cessation programs. Trial Registration ClinicalTrials.gov NCT04223336
https://www.clinicaltrials.gov/ct2/show/NCT04223336 International Registered Report Identifier (IRRID) RR2-10.2196/19157
Collapse
Affiliation(s)
- Nadia Minian
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Mathangee Lingam
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Scott Veldhuizen
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosa Dragonetti
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, ON, Canada
| | - Margaret Hahn
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
| | - Wayne K deRuiter
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Osnat C Melamed
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic is associated with increased levels of stress, anxiety and depression in the population. These are associated with unhealthy eating patterns and sedentary behaviour. In turn, this may increase risk of obesity or aggravate it. This narrative review discusses the link between adverse mental health states and weight related behaviours. We present emerging evidence for this phenomenon during the COVID-19 pandemic in individuals with and without pre-existing obesity. RECENT FINDINGS A sizeable proportion of the population exhibits deterioration in mental health during the pandemic and those affected often report unhealthy weight-related behaviours such as "junk food" consumption and physical inactivity. Women, individuals with obesity, and those with pre-existing mental health conditions seem to be particularly at risk for overeating in response to stress (i.e. emotional eating). A number of psychological interventions including cognitive behavioural therapy and self-compassion may be effective in improving mental health and emotional eating patterns among the general population and particularly in individuals living with obesity. There is a need to complement efforts to improve mental health in the general population during the COVID-19 pandemic with targeted action to improve physical activity levels and healthy eating particularly among groups at-risk. This may be achieved by reducing disruptions to specialist and primary healthcare services and facilitating access to psychological interventions that address stress-related eating behaviours. Additional studies that examine such interventions, especially those that are delivered remotely, are urgently needed.
Collapse
Affiliation(s)
- Osnat C Melamed
- Centre for Addiction and Mental Health, 100 Stokes St, Toronto, Ontario, M6J 1H4, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Peter Selby
- Centre for Addiction and Mental Health, 100 Stokes St, Toronto, Ontario, M6J 1H4, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
26
|
Vaccarino AL, Beaton D, Black SE, Blier P, Farzan F, Finger E, Foster JA, Freedman M, Frey BN, Gilbert Evans S, Ho K, Javadi M, Kennedy SH, Lam RW, Lang AE, Lasalandra B, Latour S, Masellis M, Milev RV, Müller DJ, Munoz DP, Parikh SV, Placenza F, Rotzinger S, Soares CN, Sparks A, Strother SC, Swartz RH, Tan B, Tartaglia MC, Taylor VH, Theriault E, Turecki G, Uher R, Zinman L, Evans KR. Common Data Elements to Facilitate Sharing and Re-use of Participant-Level Data: Assessment of Psychiatric Comorbidity Across Brain Disorders. Front Psychiatry 2022; 13:816465. [PMID: 35197877 PMCID: PMC8859302 DOI: 10.3389/fpsyt.2022.816465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/12/2022] [Indexed: 11/24/2022] Open
Abstract
The Ontario Brain Institute's "Brain-CODE" is a large-scale informatics platform designed to support the collection, storage and integration of diverse types of data across several brain disorders as a means to understand underlying causes of brain dysfunction and developing novel approaches to treatment. By providing access to aggregated datasets on participants with and without different brain disorders, Brain-CODE will facilitate analyses both within and across diseases and cover multiple brain disorders and a wide array of data, including clinical, neuroimaging, and molecular. To help achieve these goals, consensus methodology was used to identify a set of core demographic and clinical variables that should be routinely collected across all participating programs. Establishment of Common Data Elements within Brain-CODE is critical to enable a high degree of consistency in data collection across studies and thus optimize the ability of investigators to analyze pooled participant-level data within and across brain disorders. Results are also presented using selected common data elements pooled across three studies to better understand psychiatric comorbidity in neurological disease (Alzheimer's disease/amnesic mild cognitive impairment, amyotrophic lateral sclerosis, cerebrovascular disease, frontotemporal dementia, and Parkinson's disease).
Collapse
Affiliation(s)
| | - Derek Beaton
- Data Science and Advanced Analytics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Dr. Sandra Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Pierre Blier
- Mood Disorders Research Unit, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Farnak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Morris Freedman
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada
| | | | - Keith Ho
- Department of Psychiatry, University Health Network, Toronto, ON, Canada
| | | | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, ON, Canada
| | | | | | - Mario Masellis
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care, Kingston, ON, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Franca Placenza
- Department of Psychiatry, University Health Network, Toronto, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | | | - Stephen C Strother
- Indoc Research, Toronto, ON, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Richard H Swartz
- Hurvitz Brain Sciences Research Program, Dr. Sandra Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Brian Tan
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases University of Toronto, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Gustavo Turecki
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Lorne Zinman
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
27
|
Legatto T, Taylor VH, Kidane B, Anvari M, Hensel JM. The Impact of Psychiatric History and Peri-operative Psychological Distress on Weight Loss Outcomes 1 Year After Bariatric Surgery. Obes Surg 2021; 32:325-333. [PMID: 34783959 DOI: 10.1007/s11695-021-05781-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/31/2021] [Accepted: 11/08/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND To determine if self-reported baseline psychological distress moderates the association between lifetime psychiatric diagnosis and weight loss 1 year after bariatric surgery. An exploratory analysis assessed change in psychological distress from baseline on weight loss at 1 year. METHODS A retrospective cohort study using data from the Ontario Bariatric Registry for all individuals undergoing surgery between January 1, 2012, and December 31, 2018, with a complete baseline psychological assessment and 1-year post-operative weight recorded (N = 11,159). Multiple linear regressions assessed the relationship between psychiatric diagnosis and percentage of excess body mass index loss (%EBMIL) at 1-year post-surgery, controlling for baseline body mass index, socio-demographics, medical co-morbidities, and surgical complications. Baseline psychological distress, measured with the EQ-5D-5L anxiety/depression rating, was examined as a moderator of this relationship. %EBMIL was separately regressed on change in psychological distress from baseline to 1 year, controlling for psychiatric diagnosis. RESULTS In the adjusted model, psychiatric diagnosis was associated with lower %EBMIL at 1 year (B = - 1.00, P = .008). Baseline psychological distress was not a moderator, but had a significant main effect on %EBMIL (B = - .84, P = .001). Those who experienced a decrease in psychological distress at 1 year, or remained low throughout, fared better than those who increased or had persistently high symptoms. CONCLUSIONS These findings support use of a self-report assessment for psychological distress prior to bariatric surgery. Addressing active psychological distress prior to and/or following surgery may increase the likelihood of successful outcomes.
Collapse
Affiliation(s)
- Taylor Legatto
- Department of Psychiatry, University of Manitoba, Psychealth, 771 Bannatyne Ave, Winnipeg, MB, R3E 3N4, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Biniam Kidane
- Department of Surgery, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada
| | - Mehran Anvari
- Department of Surgery, McMaster University, Hamilton, ON, L8N 4A6, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Psychealth, 771 Bannatyne Ave, Winnipeg, MB, R3E 3N4, Canada.
| |
Collapse
|
28
|
Ballester PL, Suh JS, Nogovitsyn N, Hassel S, Strother SC, Arnott SR, Minuzzi L, Sassi RB, Lam RW, Milev R, Müller DJ, Taylor VH, Kennedy SH, Frey BN. Accelerated brain aging in major depressive disorder and antidepressant treatment response: A CAN-BIND report. Neuroimage Clin 2021; 32:102864. [PMID: 34710675 PMCID: PMC8556529 DOI: 10.1016/j.nicl.2021.102864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Previous studies suggest that major depressive disorder (MDD) may be associated with volumetric indications of accelerated brain aging. This study investigated neuroanatomical signs of accelerated aging in MDD and evaluated whether a brain age gap is associated with antidepressant response. METHODS Individuals in a major depressive episode received escitalopram treatment (10-20 mg/d) for 8 weeks. Depression severity was assessed at baseline and at weeks 8 and 16 using the Montgomery-Asberg Depression Rating Scale (MADRS). Response to treatment was characterized by a significant reduction in the MADRS (≥50%). Nonresponders received adjunctive aripiprazole treatment (2-10 mg/d) for a further 8 weeks. The brain-predicted age difference (brain-PAD) at baseline was determined using machine learning methods trained on 3377 healthy individuals from seven publicly available datasets. The model used features from all brain regions extracted from structural magnetic resonance imaging data. RESULTS Brain-PAD was significantly higher in older MDD participants compared to younger MDD participants [t(147.35) = -2.35, p < 0.03]. BMI was significantly associated with brain-PAD in the MDD group [r(155) = 0.19, p < 0.03]. Response to treatment was not significantly associated with brain-PAD. CONCLUSION We found an elevated brain age gap in older individuals with MDD. Brain-PAD was not associated with overall treatment response to escitalopram monotherapy or escitalopram plus adjunctive aripiprazole.
Collapse
Affiliation(s)
- Pedro L Ballester
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Jee Su Suh
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Nikita Nogovitsyn
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Stefanie Hassel
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen C Strother
- Rotman Research Institute, Baycrest, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, ON, Canada
| | | | - Luciano Minuzzi
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Roberto B Sassi
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, and Providence Care, Kingston, ON, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sidney H Kennedy
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Mental Health, University Health Network, Toronto, ON, Canada; Krembil Research Institute, University Health Network, Toronto, ON, Canada; Centre for Depression and Suicide Studies, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Benicio N Frey
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
| | | |
Collapse
|
29
|
Hofmeister M, Clement F, Patten S, Li J, Dowsett LE, Farkas B, Mastikhina L, Egunsola O, Diaz R, Cooke NCA, Taylor VH. The effect of interventions targeting gut microbiota on depressive symptoms: a systematic review and meta-analysis. CMAJ Open 2021; 9:E1195-E1204. [PMID: 34933877 PMCID: PMC8695538 DOI: 10.9778/cmajo.20200283] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite their popularity, the efficacy of interventions targeting gut microbiota to improve depressive symptoms is unknown. Our objective is to summarize the effect of microbiome-targeting interventions on depressive symptoms. METHODS We conducted a systematic review and meta-analysis. We searched MEDLINE, Embase, PsycINFO, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews and the Cochrane Controlled Register of Trials from inception to Mar. 5, 2021. We included studies that evaluated probiotic, prebiotic, synbiotic, paraprobiotic or fecal microbiota transplant interventions in an adult population (age ≥ 18 yr) with an inactive or placebo comparator (defined by the absence of active intervention). Studies must have measured depressive symptoms with a validated scale, and used a randomized controlled trial study design. We conducted a random effects meta-analysis of change scores, using standardized mean difference as the measure of effect. RESULTS Sixty-two studies formed the final data set, with 50 included in the meta-analysis. Probiotic, prebiotic, and synbiotic interventions on depressive symptoms showed statistically significant benefits. In the single studies evaluating each of fecal microbiota transplant and paraprobiotic interventions, neither showed a statistically significant benefit. INTERPRETATION Despite promising findings of benefit of probiotic, prebiotic and synbiotic interventions for depressive symptoms in study populations, there is not yet strong enough evidence to favour inclusion of these interventions in treatment guidelines for depression. Critical questions about species administered, dosage and timing relative to other antidepressant medications remain to be answered. STUDY REGISTRATION PROSPERO no. 143178.
Collapse
Affiliation(s)
- Mark Hofmeister
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Fiona Clement
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Scott Patten
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Joyce Li
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Laura E Dowsett
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Brenlea Farkas
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Liza Mastikhina
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Oluwaseun Egunsola
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Ruth Diaz
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Noah C A Cooke
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Valerie H Taylor
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta.
| |
Collapse
|
30
|
Tarride JE, Doumouras AG, Hong D, Paterson JM, Tibebu S, Nguyen F, Perez R, Taylor VH, Xie F, Boudreau V, Pullenayegum E, Urbach DR, Anvari M. Comparison of 4-Year Health Care Expenditures Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy. JAMA Netw Open 2021; 4:e2122079. [PMID: 34499137 PMCID: PMC8430456 DOI: 10.1001/jamanetworkopen.2021.22079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Data on the long-term health care expenditures associated with bariatric surgery consisting of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy are lacking. OBJECTIVE To compare 4-year health care expenditures after RYGB vs sleeve gastrectomy, identify factors independently associated with 4-year health care expenditures, and compare the procedures in terms of subsequent hospitalizations, bariatric procedures, and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS In this propensity score-matched cohort study, all residents of Ontario, Canada, who underwent publicly funded surgery with RYGB (n = 6301) or sleeve gastrectomy (n = 926) from March 1, 2010, to March 31, 2015, and consented to participate in the Ontario Bariatric Registry were eligible for the study. Follow-up was completed on March 31, 2019, and data were analyzed from May 5, 2020, to May 20, 2021. INTERVENTIONS RYGB and sleeve gastrectomy. MAIN OUTCOMES AND MEASURES Publicly funded health care expenditures, subsequent hospitalizations, bariatric procedures, and mortality during the 4 years after RYGB or sleeve gastrectomy. RESULTS The 1:1 matched study cohorts consisted of 1624 patients (812 per cohort) with a mean (SD) age of 48.0 (10.6) years, and 1242 women (76.5%). The mean body mass index (calculated as weight in kilograms divided by height in square meters) was 51.9 (8.3) for the RYGB cohort and 51.9 (8.9) for the sleeve gastrectomy cohort. The 4-year cumulative costs were not statistically significantly different between RYGB and sleeve gastrectomy (mean [SD], $33 682 [$31 169] vs $33 948 [$32 633], respectively; P = .86). Having a history of coronary artery disease was associated with a 35% increase in overall health care expenditures; chronic kidney disease, a 54% increase; and mental health admissions, a 67% increase. There were no statistically significant differences in all-cause mortality between RYGB and sleeve gastrectomy (1.5% vs 2.2%, respectively; P = .26) or the total number of hospitalizations (754 vs 669, respectively; P = .11) during the 4-year follow-up period. However, nonelective hospitalizations occurred more frequently with RYGB vs sleeve gastrectomy (472 vs 339, respectively; P = .002). Roux-en-Y gastric bypass was associated with relatively fewer subsequent bariatric procedures during the 4-year follow-up period (9 vs 40, respectively; P < .001). CONCLUSIONS AND RELEVANCE In this Canadian population-based study, key results indicated that 4-year health care expenditures, all-cause mortality, and number of hospital admissions associated with RYGB did not significantly differ from those for sleeve gastrectomy. The rate of subsequent bariatric surgery was lower with RYGB. This study identified important patient-level drivers of health care expenditures that need to be further investigated.
Collapse
Affiliation(s)
- Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
- Programs for Assessment of Technology in Health, The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Aristithes G. Doumouras
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Centre for Minimal Access Surgery, St Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Centre for Minimal Access Surgery, St Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - J. Michael Paterson
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Valerie H. Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Vanessa Boudreau
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Centre for Minimal Access Surgery, St Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Eleanor Pullenayegum
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David R. Urbach
- Women’s College Hospital Research Institute, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital Research Institute, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mehran Anvari
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Centre for Minimal Access Surgery, St Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| |
Collapse
|
31
|
Bharwani A, Szamosi JC, Taylor VH, Lee Y, Bala A, Mansur R, Subramaniapillai M, Surette M, McIntyre RS. Changes in the gut microbiome associated with infliximab in patients with bipolar disorder. Brain Behav 2021; 11:e2259. [PMID: 34152099 PMCID: PMC8413825 DOI: 10.1002/brb3.2259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 05/04/2021] [Accepted: 06/07/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Available information exists supporting the gut-brain axis, but additional information is needed to explore how the gut microbiome changes when exposed to mood disorder treatments. We sought to explore the effects of a novel treatment for bipolar disorder (BD), infliximab, on the gut microbiome. METHODS Participants with a primary diagnosis of BD (n = 15) who participated in a 12-week, randomized placebo-controlled trial evaluating the efficacy of adjunctive infliximab in the treatment of BD were recruited and followed. Stool samples were collected prior to randomization and at 12 weeks. 16S rRNA sequencing was employed in order to analyze the gut microbial community profile. RESULTS A total of 17 participants were randomized to infliximab (n = 9; mean [SD] age, 47.6 [10.3] years; 8 female) or to placebo (n = 8; mean [SD] age, 45.9 [10.7] years; 7 female) but two participants from the infliximab group were lost to follow-up post randomization. Across all time points, there were no differences in the diversity on either Shannon or Simpson's Diversity indices. Comparison of Aitchison distances revealed a lack of clustering of the microbiota by time point, but did reveal a small overall effect of treatment that was not significantly different at individual time points. There were also no effects of either time or treatment on differential abundance at either the amplicon sequence variant or genus level. CONCLUSIONS These observations indicate that no community-wide changes in the microbiota diversity and profile were detected after the use of infliximab treatment.
Collapse
Affiliation(s)
- Aadil Bharwani
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jake C Szamosi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Asem Bala
- Department of Psychiatry, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Rodrigo Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Michael Surette
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
32
|
Cooke NCA, Bala A, Allard JP, Hota S, Poutanen S, Taylor VH. The safety and efficacy of fecal microbiota transplantation in a population with bipolar disorder during depressive episodes: study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2021; 7:142. [PMID: 34261526 PMCID: PMC8278713 DOI: 10.1186/s40814-021-00882-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/07/2021] [Indexed: 12/29/2022] Open
Abstract
Background Bipolar disorder (BD) is a chronic, debilitating illness with significant medical morbidity, often secondary to current treatments, and a high recurrence rate. This burden of disease reflects limitations in the tolerability and efficacy of current treatments. There is a compelling body of evidence linking the gut microbiota to mental illness, and while microbial manipulation via probiotic use has been studied as a therapeutic in BD, targeted trials of fecal microbiota transplantation (FMT) have not been conducted in this population. Methods and design We describe a pilot randomized controlled trial of FMT in participants with BD depression to assess the feasibility, efficacy, safety, and tolerability of this intervention. Individuals between 18 and 65 years of age will be enrolled in the study if they meet diagnostic criteria for a major depressive episode of at least moderate severity in the context of a BD diagnosis and have not responded to treatment for BD. Participants will be randomized 1:1 to receive either screened and processed donor stool (allogenic FMT) or their own stool (autologous FMT) via colonoscopy and monitored for 24 weeks post intervention. Depressive and manic symptoms, treatment acceptability, and gastrointestinal and other side effects are assessed at baseline (prior to randomization) and weekly. Stool samples to assess microbiome composition are obtained at baseline and 3 and 6 months. Discussion Currently, FMT represents a novel therapeutic option for treating BD depression. This protocol allows for the assessment of the feasibility, efficacy, acceptability, and safety of an intervention aimed at changing the microbiome in those with BD. Results from this pilot study will guide the development of larger trials of FMT for BD depression and may give more insight into how the gut microbiome are altered in those with BD depression. Trial registration Clinical Trials Gov NCT03279224
Collapse
Affiliation(s)
- Noah C A Cooke
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Asem Bala
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Johane P Allard
- Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Susy Hota
- Infection Prevention and Control Department, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan Poutanen
- Departments of Microbiology and Medicine, University Health Network and Sinai Health, University of Toronto, Toronto, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
33
|
Lee Y, Mansur RB, Brietzke E, Kapogiannis D, Delgado-Peraza F, Boutilier JJ, Chan TC, Carmona NE, Rosenblat JD, Lee J, Maletic V, Vinberg M, Suppes T, Goldstein BI, Ravindran AV, Taylor VH, Chawla S, Nogueras-Ortiz C, Cosgrove VE, Kramer NE, Ho R, Raison CA, McIntyre RS. Peripheral inflammatory biomarkers define biotypes of bipolar depression. Mol Psychiatry 2021; 26:3395-3406. [PMID: 33658605 PMCID: PMC8413393 DOI: 10.1038/s41380-021-01051-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/25/2021] [Accepted: 02/12/2021] [Indexed: 12/27/2022]
Abstract
We identified biologically relevant moderators of response to tumor necrosis factor (TNF)-α inhibitor, infliximab, among 60 individuals with bipolar depression. Data were derived from a 12-week, randomized, placebo-controlled clinical trial secondarily evaluating the efficacy of infliximab on a measure of anhedonia (i.e., Snaith-Hamilton Pleasure Scale). Three inflammatory biotypes were derived from peripheral cytokine measurements using an iterative, machine learning-based approach. Infliximab-randomized participants classified as biotype 3 exhibited lower baseline concentrations of pro- and anti-inflammatory cytokines and soluble TNF receptor-1 and reported greater pro-hedonic improvements, relative to those classified as biotype 1 or 2. Pretreatment biotypes also moderated changes in neuroinflammatory substrates relevant to infliximab's hypothesized mechanism of action. Neuronal origin-enriched extracellular vesicle (NEV) protein concentrations were reduced to two factors using principal axis factoring: phosphorylated nuclear factorκB (p-NFκB), Fas-associated death domain (p-FADD), and IκB kinase (p-IKKα/β) and TNF receptor-1 (TNFR1) comprised factor "NEV1," whereas phosphorylated insulin receptor substrate-1 (p-IRS1), p38 mitogen-activated protein kinase (p-p38), and c-Jun N-terminal kinase (p-JNK) constituted "NEV2". Among infliximab-randomized subjects classified as biotype 3, NEV1 scores were decreased at weeks 2 and 6 and increased at week 12, relative to baseline, and NEV2 scores increased over time. Decreases in NEV1 scores and increases in NEV2 scores were associated with greater reductions in anhedonic symptoms in our classification and regression tree model (r2 = 0.22, RMSE = 0.08). Our findings provide preliminary evidence supporting the hypothesis that the pro-hedonic effects of infliximab require modulation of multiple TNF-α signaling pathways, including NF-κB, IRS1, and MAPK.
Collapse
Affiliation(s)
- Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Rodrigo B. Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen’s University School of Medicine; Centre for Neuroscience Studies, Queen’s University, Kingston, ON, K7L 3N6, Canada
| | - Dimitrios Kapogiannis
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health (NIA/NIH), Baltimore, MD, 20814, USA
| | - Francheska Delgado-Peraza
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health (NIA/NIH), Baltimore, MD, 20814, USA
| | - Justin J. Boutilier
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, 53706, USA
| | - Timothy C.Y. Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, M5S 3G8, Canada
| | - Nicole E. Carmona
- Department of Psychology, Ryerson University, Toronto, ON, M5B 2K3, Canada
| | - Joshua D. Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - JungGoo Lee
- Department of Psychiatry, College of Medicine, Haeundae Paik Hospital; Paik Institute for Clinical Research; Department of Health Science and Technology, Graduate School, Inje University, Busan, 47392, Republic of Korea
| | - Vladimir Maletic
- Department of Neuropsychiatry and Behavioral Sciences, University of South Carolina School of Medicine, Greer, SC, 29203, USA
| | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Psychiatric Research Unit, Psychiatric Centre North Zealand, Dyrehavevej 48, 3400 Hillerød, Denmark
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA,VA Palo Alto Health Care System, 3801 Miranda Ave. (151T), Palo Alto, CA, 94304, USA
| | - Benjamin I. Goldstein
- Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada,Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, M5T 1R7, Canada,Department of Pharmacology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Arun V. Ravindran
- Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Valerie H. Taylor
- Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada,Department of Psychiatry, Foothills Medical Centre, University of Calgary, AB, T2N 2T9, Canada
| | - Sahil Chawla
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health (NIA/NIH), Baltimore, MD, 20814, USA
| | - Carlos Nogueras-Ortiz
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health (NIA/NIH), Baltimore, MD, 20814, USA
| | - Victoria E. Cosgrove
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Nicole E. Kramer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Roger Ho
- Department of Psychological Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Charles A. Raison
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada,Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada,Department of Pharmacology, University of Toronto, Toronto, ON, M5S 1A8, Canada,Brain and Cognition Discovery Foundation, Toronto, ON, L5C 4E7, Canada
| |
Collapse
|
34
|
Affiliation(s)
- Katrina Hui
- Department of Psychiatry (Hui, Vigod, Zaheer), University of Toronto; Department of Psychiatry (Sukhera), Schulich School of Medicine & Dentistry, Western University; Women's College Hospital and Women's College Research Institute (Vigod), Toronto, Ont.; Department of Psychiatry (Taylor), University of Calgary, Calgary, Alta.; Institute for Mental Health Policy Research (Zaheer), Centre for Addiction and Mental Health, Toronto, Ont
| | - Javeed Sukhera
- Department of Psychiatry (Hui, Vigod, Zaheer), University of Toronto; Department of Psychiatry (Sukhera), Schulich School of Medicine & Dentistry, Western University; Women's College Hospital and Women's College Research Institute (Vigod), Toronto, Ont.; Department of Psychiatry (Taylor), University of Calgary, Calgary, Alta.; Institute for Mental Health Policy Research (Zaheer), Centre for Addiction and Mental Health, Toronto, Ont
| | - Simone Vigod
- Department of Psychiatry (Hui, Vigod, Zaheer), University of Toronto; Department of Psychiatry (Sukhera), Schulich School of Medicine & Dentistry, Western University; Women's College Hospital and Women's College Research Institute (Vigod), Toronto, Ont.; Department of Psychiatry (Taylor), University of Calgary, Calgary, Alta.; Institute for Mental Health Policy Research (Zaheer), Centre for Addiction and Mental Health, Toronto, Ont
| | - Valerie H Taylor
- Department of Psychiatry (Hui, Vigod, Zaheer), University of Toronto; Department of Psychiatry (Sukhera), Schulich School of Medicine & Dentistry, Western University; Women's College Hospital and Women's College Research Institute (Vigod), Toronto, Ont.; Department of Psychiatry (Taylor), University of Calgary, Calgary, Alta.; Institute for Mental Health Policy Research (Zaheer), Centre for Addiction and Mental Health, Toronto, Ont
| | - Juveria Zaheer
- Department of Psychiatry (Hui, Vigod, Zaheer), University of Toronto; Department of Psychiatry (Sukhera), Schulich School of Medicine & Dentistry, Western University; Women's College Hospital and Women's College Research Institute (Vigod), Toronto, Ont.; Department of Psychiatry (Taylor), University of Calgary, Calgary, Alta.; Institute for Mental Health Policy Research (Zaheer), Centre for Addiction and Mental Health, Toronto, Ont.
| |
Collapse
|
35
|
Melamed OC, LaChance LR, O'Neill BG, Rodak T, Taylor VH. Interventions to Improve Metabolic Risk Screening Among Children and Adolescents on Antipsychotic Medication: A Systematic Review. J Child Adolesc Psychopharmacol 2021; 31:63-72. [PMID: 33512274 DOI: 10.1089/cap.2020.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Antipsychotic use among youth is common and is associated with metabolic side effects such as weight gain. Guidelines recommend periodic screening of metabolic measures in youth prescribed antipsychotics; however, a guideline-to-practice gap exists. We systematically reviewed the literature to synthesize the knowledge from interventions that aim to improve antipsychotic metabolic screening. We described the interventions' effect on screening rates, the strategies used for improvement, and study quality. Methods: We conducted a systematic review of studies that attempted to improve antipsychotic metabolic risk screening practices among pediatric populations published between 2004 and August 2019. We included studies with an improvement intervention that compared screening rates before and after the intervention. We extracted data about study characteristics, screening rates in pre- and postintervention groups, strategies used to influence screening practices, and assessed studies' risk of bias. This review was prospectively registered with PROSPERO #CRD42018088241. Results: We identified six studies that demonstrated modest improvements in median metabolic screening rates for waist circumference (0%-16%), glucose (9%-39%), and lipids (11%-37%). Median postintervention screening rates were higher for weight and blood pressure (84% and 72.5%) compared with glucose and lipids (39% and 37%). Interventions used a variety of improvement strategies to address patient-, provider-, and organization-level barriers for screening, including increasing patient and provider knowledge regarding antipsychotic side effects, fostering social clinical environments that promote screening, and organizational commitment for screening antipsychotic-treated youth. All interventions were deemed at high risk of bias due to uncontrolled design and lack of adjustment for confounders. Conclusions: Included studies reported partial success in improving antipsychotic screening rates but were of poor methodological quality. Common improvement strategies may affect provider behavior to conduct metabolic screening, but these need to be tailored to local resources and organization structure. Future studies need to use rigorous methodology and theory-informed improvement strategies aligned with organizational actions to prioritize safe and judicious practice of antipsychotics among pediatric populations.
Collapse
Affiliation(s)
- Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura R LaChance
- St. Mary's Hospital, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Braden G O'Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,North York General Hospital, Toronto, Ontario, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
36
|
Swainson J, McGirr A, Blier P, Brietzke E, Richard-Devantoy S, Ravindran N, Blier J, Beaulieu S, Frey BN, Kennedy SH, McIntyre RS, Milev RV, Parikh SV, Schaffer A, Taylor VH, Tourjman V, van Ameringen M, Yatham LN, Ravindran AV, Lam RW. The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder: Recommandations Du Groupe De Travail Du Réseau Canadien Pour Les Traitements De L'humeur Et De L'anxiété (Canmat) Concernant L'utilisation De La Kétamine Racémique Chez Les Adultes Souffrant De Trouble Dépressif Majeur. Can J Psychiatry 2021; 66:113-125. [PMID: 33174760 PMCID: PMC7918868 DOI: 10.1177/0706743720970860] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Patients with major depressive disorder often have limited response to first-line and second-line medications; hence, novel pharmacological treatments are needed for treatment-resistant depression (TRD). Ketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist, has demonstrated rapid antidepressant effects in patients with TRD. The Canadian Network for Mood and Anxiety Treatments (CANMAT) convened a task force to review the evidence for efficacy and safety of racemic ketamine and to provide recommendations for its use in clinical practice. METHODS A systematic review was conducted with computerized search of electronic databases up to January 31, 2020 using combinations of search terms, inspection of bibliographies, and review of other ketamine guidelines and consensus statements. The level of evidence and lines of treatment were assigned according to CANMAT criteria. Recommendations were given in question-answer format. RESULTS Intravenous (IV) racemic ketamine given as a single infusion has Level 1 evidence for efficacy in adults with TRD. The evidence for multiple infusions, given as an acute series or as ongoing maintenance treatment, is limited to Level 3. Adverse events associated with ketamine infusions include behavioral (e.g., dissociative symptoms) and physiological (e.g., hypertension) events. There is only Level 3 or 4 evidence for non-IV formulations of racemic ketamine. Consensus recommendations are given for clinical administration of IV ketamine including patient selection, facility and personnel issues, monitoring, and maintaining response. CONCLUSIONS Single-dose IV racemic ketamine is a third-line recommendation for adults with TRD. The need for repeated and maintenance ketamine infusions should be carefully assessed on a case-by-case basis with consideration of potential risks and benefits. Because of limited evidence for efficacy and risk for misuse and diversion, the use of oral and other formulations of racemic ketamine should be limited to specialists with ketamine-prescribing expertise and affiliations with tertiary or specialized centers.
Collapse
Affiliation(s)
- Jennifer Swainson
- Department of Psychiatry, 12357University of Alberta, Edmonton, Alberta, Canada
| | - Alexander McGirr
- Department of Psychiatry, 70401University of Calgary, Alberta, Canada
| | - Pierre Blier
- Department of Psychiatry, 12365University of Ottawa, Ontario, Canada
| | - Elisa Brietzke
- Department of Psychiatry, 104820Queen's University, Kingston, Ontario, Canada
| | | | - Nisha Ravindran
- Department of Psychiatry, 12366University of Toronto, Ontario, Canada
| | - Jean Blier
- Department of Anesthesiology and Pain Medicine, 12365University of Ottawa, Ontario, Canada
| | - Serge Beaulieu
- Department of Psychiatry, 12367McGill University, Montreal, Quebec, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, 62703McMaster University, Hamilton, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, 12366University of Toronto, Ontario, Canada
| | - Roger S McIntyre
- Department of Psychiatry, 12366University of Toronto, Ontario, Canada
| | - Roumen V Milev
- Department of Psychiatry, 104820Queen's University, Kingston, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, 12266University of Michigan, Ann Arbor, Michigan, USA
| | - Ayal Schaffer
- Department of Psychiatry, 12366University of Toronto, Ontario, Canada
| | - Valerie H Taylor
- Department of Psychiatry, 70401University of Calgary, Alberta, Canada
| | - Valérie Tourjman
- Department of Psychiatry, 12368Université de Montréal, Québec, Canada
| | - Michael van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, 62703McMaster University, Hamilton, Ontario, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Arun V Ravindran
- Department of Psychiatry, 12366University of Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
37
|
Stogios N, Smith E, Asgariroozbehani R, Hamel L, Gdanski A, Selby P, Sockalingam S, Graff-Guerrero A, Taylor VH, Agarwal SM, Hahn MK. Exploring Patterns of Disturbed Eating in Psychosis: A Scoping Review. Nutrients 2020; 12:E3883. [PMID: 33353080 PMCID: PMC7768542 DOI: 10.3390/nu12123883] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022] Open
Abstract
Disturbed eating behaviours have been widely reported in psychotic disorders since the early 19th century. There is also evidence that antipsychotic (AP) treatment may induce binge eating or other related compulsive eating behaviours. It is therefore possible that abnormal eating patterns may contribute to the significant weight gain and other metabolic disturbances observed in patients with psychosis. In this scoping review, we aimed to explore the underlying psychopathological and neurobiological mechanisms of disrupted eating behaviours in psychosis spectrum disorders and the role of APs in this relationship. A systematic search identified 35 studies that met our eligibility criteria and were included in our qualitative synthesis. Synthesizing evidence from self-report questionnaires and food surveys, we found that patients with psychosis exhibit increased appetite and craving for fatty food, as well as increased caloric intake and snacking, which may be associated with increased disinhibition. Limited evidence from neuroimaging studies suggested that AP-naïve first episode patients exhibit similar neural processing of food to healthy controls, while chronic AP exposure may lead to decreased activity in satiety areas and increased activity in areas associated with reward anticipation. Overall, this review supports the notion that AP use can lead to disturbed eating patterns in patients, which may contribute to AP-induced weight gain. However, intrinsic illness-related effects on eating behaviors remain less well elucidated, and many confounding factors as well as variability in study designs limits interpretation of existing literature in this field and precludes firm conclusions from being made.
Collapse
Affiliation(s)
- Nicolette Stogios
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Emily Smith
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Roshanak Asgariroozbehani
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Laurie Hamel
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
| | - Alexander Gdanski
- Department of Human Biology, University of Toronto, Toronto, ON M5S 3J6, Canada;
| | - Peter Selby
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Sanjeev Sockalingam
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Bariatric Surgery Program, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Ariel Graff-Guerrero
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Valerie H. Taylor
- Department of Psychiatry, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Margaret K. Hahn
- Centre for Addiction and Mental Health (CAMH), Toronto, ON M6J 1H3, Canada; (N.S.); (E.S.); (R.A.); (L.H.); (P.S.); (S.S.); (A.G.-G.); (S.M.A.)
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| |
Collapse
|
38
|
Doucet E, Hall K, Miller A, Taylor VH, Ricupero M, Haines J, Brauer P, Gudzune KA, House JD, Dhaliwal R. Emerging insights in weight management and prevention: implications for practice and research. Appl Physiol Nutr Metab 2020; 46:288-293. [PMID: 33086027 DOI: 10.1139/apnm-2020-0585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recent advances in foundational research on energy balance and weight loss shed new light on earlier findings. Emerging evidence and insights around mental illness and client-centred, weight-inclusive approaches have implications for practitioners. This paper provides an overview of opinions from invited experts who presented at the Canadian Nutrition Society Thematic Conference in January 2019. Novelty: Weight loss involves an interplay of multiple factors, not diet alone. There is no "best diet" or treatment approach for weight loss. Future research should involve minimizing weight loss countermeasures and new health system-based approaches aimed at improving health.
Collapse
Affiliation(s)
- Eric Doucet
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kevin Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Andrea Miller
- Nutrition & Dietetics, Private Practice, 74 Kearney Drive, Ajax, ON L1T 2T7, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Cumming School of Medicine, Foothills Hospital, University of Calgary, AB T2N 2T9, Canada
| | - Maria Ricupero
- Nutrition & Dietetics, Private Practice, 136 Geoffrey St., Toronto ON M6R 1P5, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Paula Brauer
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - James D House
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Rupinder Dhaliwal
- Metabolic Syndrome Canada, 1164 Trailhead Place, Kingston, ON K7M 9H3, Canada
| |
Collapse
|
39
|
Minian N, Lingam M, Moineddin R, Thorpe KE, Veldhuizen S, Dragonetti R, Zawertailo L, Taylor VH, Hahn M, deRuiter WK, Melamed O, Selby P. Impact of a Web-Based Clinical Decision Support System to Assist Practitioners in Addressing Physical Activity and/or Healthy Eating for Smoking Cessation Treatment: Protocol for a Hybrid Type I Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e19157. [PMID: 32990250 PMCID: PMC7556369 DOI: 10.2196/19157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background Modifiable risk factors such as tobacco use, physical inactivity, and poor diet account for a significant proportion of the preventable deaths in Canada. These factors are also known to cluster together, thereby compounding the risks of morbidity and mortality. Given this association, smoking cessation programs appear to be well-suited for integration of health promotion activities for other modifiable risk factors. The Smoking Treatment for Ontario Patients (STOP) program is a province-wide smoking cessation program that currently encourages practitioners to deliver Screening, Brief Intervention, and Referral to treatment for patients who are experiencing depressive symptoms or consume excessive amounts of alcohol via a web-enabled clinical decision support system. However, there is no available clinical decision support system for physical inactivity and poor diet, which are among the leading modifiable risk factors for chronic diseases. Objective The aim of this study is to assess whether adding a computerized/web-enabled clinical decision support system for physical activity and diet to a smoking cessation program affects smoking cessation outcomes. Methods This study is designed as a hybrid type 1 effectiveness/implementation randomized controlled trial to evaluate a web-enabled clinical decision support system for supporting practitioners in addressing patients’ physical activity and diet as part of smoking cessation treatment in a primary care setting. This design was chosen as it allows for simultaneous testing of the intervention, its delivery in target settings, and the potential for implementation in real-world situations. Intervention effectiveness will be measured using a two-arm randomized controlled trial. Health care practitioners will be unblinded to their patients’ treatment allocation; however, patients will be blinded to whether their practitioner receives the clinical decision support system for physical activity and/or fruit/vegetable consumption. The evaluation of implementation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results Recruitment for the primary outcome of this study is ongoing and will be completed in November 2020. Results will be reported in March 2021. Conclusions The findings of the study will provide much needed insight into whether adding a computerized/web-enabled clinical decision support system for physical activity and diet to a smoking cessation program affects smoking cessation outcome. Furthermore, the implementation evaluation would provide insight into the feasibility of online-based interventions for physical activity and diet in a smoking cessation program. Addressing these risk factors simultaneously could have significant positive effects on chronic disease and cancer prevention. Trial Registration ClinicalTrials.gov NCT04223336; https://clinicaltrials.gov/ct2/show/NCT04223336 International Registered Report Identifier (IRRID) DERR1-10.2196/19157
Collapse
Affiliation(s)
- Nadia Minian
- Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Mathangee Lingam
- Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Scott Veldhuizen
- Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosa Dragonetti
- Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Margaret Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
| | - Wayne K deRuiter
- Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Osnat Melamed
- Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
40
|
Restivo MR, Hall GB, Frey BN, McKinnon MC, Taylor VH. Neural correlates of verbal recognition memory in obese adults with and without major depressive disorder. Brain Behav 2020; 10:e01848. [PMID: 32964681 PMCID: PMC7749585 DOI: 10.1002/brb3.1848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Obesity and major depressive disorder (MDD) independently contribute to memory impairment. Little is known about shared neural mechanisms that may result in the cognitive impairment experienced by these populations. This study's aim was to determine how obesity impacts neural activity during a verbal recognition memory task in individuals both with and without MDD. METHODS Functional magnetic resonance imaging was employed to examine whether differences in neural activation patterns would be seen across three groups during the Warrington's Recognition Memory Test. Three study groups are reported: 20 subjects with obesity but without MDD (bariatric controls), 23 subjects with past or current MDD and obesity, and 20 normal BMI controls (healthy controls). RESULTS Three-group conjunction analyses indicated that overlapping neural regions were activated during both encoding and retrieval processes across all groups. However, second-level 2-group t-contrasts indicated that neural activation patterns differed when comparing healthy and bariatric controls, and when comparing bariatric controls and bariatric MDD participants. DISCUSSION Results indicate that obesity in conjunction with MDD confers a subtle impact on neural functioning. Given high rates of obesity and MDD comorbidity, and the role of cognition on ability to return to premorbid level of functioning, this association should inform treatment decisions.
Collapse
Affiliation(s)
- Maria R. Restivo
- Women’s College Research InstituteWomen’s College HospitalTorontoONCanada
| | - Geoffrey B. Hall
- Department of Psychology, Neuroscience & BehaviourMcMaster UniversityHamiltonONCanada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Margaret C. McKinnon
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | | |
Collapse
|
41
|
Tarride JE, Doumouras AG, Hong D, Paterson JM, Tibebu S, Perez R, Ma J, Taylor VH, Xie F, Boudreau V, Pullenayegum E, Urbach DR, Anvari M. Association of Roux-en-Y Gastric Bypass With Postoperative Health Care Use and Expenditures in Canada. JAMA Surg 2020; 155:e201985. [PMID: 32697298 DOI: 10.1001/jamasurg.2020.1985] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Results of previous studies are mixed regarding the economic implications of a Roux-en-Y gastric bypass (RYGB). Objective To assess the 5-year incremental health care use and expenditures after RYGB. Design, Setting, and Participants This population-based cohort study conducted in Ontario, Canada, used a difference-in-differences approach to compare health care use and expenditures between patients who underwent a publicly funded RYGB from March 1, 2010, to March 31, 2013, and propensity score-matched control individuals who did not undergo a surgical bariatric procedure. The study period allowed for a minimum 60 months of follow-up because, at that time, the most recent date for which administrative data on health care and expenditures were available was March 31, 2018. Data sources included the Ontario Bariatric Registry linked to several Ontario health administrative databases and the Electronic Medical Record Administrative Data Linked Database. Health care use and expenditures data for 5 years before and 5 years after the index date (procedure date for RYGB group; random date for controls) were analyzed. Data analyses were performed March 12, 2019, to March 10, 2020. Intervention RYGB procedure. Main Outcomes and Measures The primary outcome was total health care expenditures. Results The final propensity score-matched cohorts comprised 1587 individuals in the RYGB group (mean [SD] age, 47 [10.2] years) and 1587 controls (mean [SD] age, 47 [12.2] years); each group had 1228 women (77.4%) and a mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 46. Mean total health care expenditures (2017 Canadian dollars) per patient in the RYGB group increased from CAD $15 594 (95% CI, CAD $14 743 to CAD $16 614) (US $12 008 [95% CI, US $11 353 to US $12 794]) in the 5 years before the procedure to CAD $30 389 (95% CI, CAD $28 789 to CAD $32 232) (US $23 401 [95% CI, US $22 169 to US $24 821]) over the 5 years after the procedure, a difference of CAD $14 795 (95% CI, CAD $13 172 to CAD $16 480) (US $11 393 [95% CI, US $10 143 to US $12 691]). For the control group, mean total health care expenditures per individual increased from CAD $16 109 (95% CI, CAD $14 727 to CAD $17 591) (US $12 405 [95% CI, US $11 341 to US $13 546]) 5 years before the index date to CAD $20 073 (95% CI, CAD $18 147 to CAD $22 169) (US $15 457 [95% CI, US $13 974 to US $17 071]) 5 years after the date, a difference of CAD $3964 (95% CI, CAD $2250 to CAD $5875) (US $3053 [95% CI, US $1733 to US $4524]). Overall, the difference-in-differences estimate of the net cost of RYGB was CAD $10 831 (95% CI, CAD $8252 to CAD $13 283) (US $8341 [95% CI, $6355 to $10 229]) over the 5-year period. This amount excluded the mean (SD) cost associated with the index date: CAD $6501 (CAD $1087) (US $5006 [US $837]) for the RYGB cohort and CAD $9 (CAD $72) (US $7 [US $55]) for the controls. The cost differential was primarily associated with increased hospitalizations in the first months immediately after RYGB. Expenditures leveled off in year 3 after the index date; differences in total expenditures between the RYGB and control cohorts were not statistically significantly different in years 4 and 5. Conclusions and Relevance Health care expenditures in the 3 years after publicly funded RYGB were higher in patients who underwent the procedure than in control individuals, but the costs were similar thereafter. This finding suggests the need to decrease hospital and emergency department readmissions after surgical bariatric procedures because such use is associated with increased spending.
Collapse
Affiliation(s)
- Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.,Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Aristithes G Doumouras
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.,Centre for Minimal Access Surgery, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.,Centre for Minimal Access Surgery, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - J Michael Paterson
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Vanessa Boudreau
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.,Centre for Minimal Access Surgery, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Eleanor Pullenayegum
- Dalla Lana School of Public Health, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, Toronto, Ontario, Canada
| | - David R Urbach
- Women's College Hospital Research Institute, Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mehran Anvari
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.,Centre for Minimal Access Surgery, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| |
Collapse
|
42
|
Melamed OC, Hahn MK, Agarwal SM, Taylor VH, Mulsant BH, Selby P. Physical health among people with serious mental illness in the face of COVID-19: Concerns and mitigation strategies. Gen Hosp Psychiatry 2020; 66:30-33. [PMID: 32645586 PMCID: PMC7831754 DOI: 10.1016/j.genhosppsych.2020.06.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 01/25/2023]
Abstract
COVID-19 can worsen the physical health of individuals with serious mental illness, a vulnerable group already facing physical health disparities. COVID-19 is further reducing access to physical health care due to shutdown of services deemed "non-urgent" and overcrowding of emergency services. Management of chronic diseases, highly prevalent in this group, is undermined due to exacerbation of psychiatric disorders, reduction in availability of social support, and worsening of negative social determinants of health. In this commentary, we discuss the challenges experienced by this group and offer mitigation strategies to reduce: (1) inequalities in access to physical health care; and (2) disruptions to the management of chronic physical conditions in the face of COVID-19. Recommendations include coordinated efforts by health authorities, primary and mental health care organizations, researchers, policymakers, and other stakeholders. These efforts should ensure equitable access to physical health care and implementation of innovative programs to protect the physical health of people with serious mental illness during and following the pandemic.
Collapse
Affiliation(s)
- Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - Margaret K Hahn
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
43
|
Minian N, Corrin T, Lingam M, deRuiter WK, Rodak T, Taylor VH, Manson H, Dragonetti R, Zawertailo L, Melamed OC, Hahn M, Selby P. Identifying contexts and mechanisms in multiple behavior change interventions affecting smoking cessation success: a rapid realist review. BMC Public Health 2020; 20:918. [PMID: 32532233 PMCID: PMC7291527 DOI: 10.1186/s12889-020-08973-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 05/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background Smoking continues to be a leading cause of preventable chronic disease-related morbidity and mortality, excess healthcare expenditure, and lost work productivity. Tobacco users are disproportionately more likely to be engaging in other modifiable risk behaviours such as excess alcohol consumption, physical inactivity, and poor diet. While hundreds of interventions addressing the clustering of smoking and other modifiable risk behaviours have been conducted worldwide, there is insufficient information available about the context and mechanisms in these interventions that promote successful smoking cessation. The aim of this rapid realist review was to identify possible contexts and mechanisms used in multiple health behaviour change interventions (targeting tobacco and two or more additional risk behaviours) that are associated with improving smoking cessation outcome. Methods This realist review method incorporated the following steps: (1) clarifying the scope, (2) searching for relevant evidence, (3) relevance confirmation, data extraction, and quality assessment, (4) data analysis and synthesis. Results Of the 20,423 articles screened, 138 articles were included in this realist review. Following Michie et al.’s behavior change model (the COM-B model), capability, opportunity, and motivation were used to identify the mechanisms of behaviour change. Universally, increasing opportunities (i.e. factors that lie outside the individual that prompt the behaviour or make it possible) for participants to engage in healthy behaviours was associated with smoking cessation success. However, increasing participant’s capability or motivation to make a behaviour change was only successful within certain contexts. Conclusion In order to address multiple health behaviours and assist individuals in quitting smoking, public health promotion interventions need to shift away from ‘individualistic epidemiology’ and invest resources into modifying factors that are external from the individual (i.e. creating a supportive environment). Trial registration PROSPERO registration number: CRD42017064430
Collapse
Affiliation(s)
- Nadia Minian
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - Tricia Corrin
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Mathangee Lingam
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Wayne K deRuiter
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, 1403 - 29 Street NW, Calgary, Alberta, T2N 2T9, Canada
| | - Heather Manson
- Public Health Ontario, 480 University Avenue, Toronto, Ontario, M5G 1V2, Canada
| | - Rosa Dragonetti
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - Laurie Zawertailo
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Osnat C Melamed
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Margaret Hahn
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada. .,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| |
Collapse
|
44
|
Abstract
Objectives: Compelling animal data exists examining the impact of the gut microbiome on
the brain, but work is required to translate these findings in a clinical
population. We sought to do this by exploring the effects of antidepressant
medications on the gut microbiota, and establishing a baseline Major
Depressive Disorder (MDD) gut phenotype. Methods: Participants with a primary diagnosis of MDD (n = 15) who were nonmedicated
were recruited and followed over 6 months. Stool samples were collected
prior to treatment initiation and 3 and 6 months following treatment. 16S
rRNA sequencing was employed in order to analyze the gut microbial community
profile. Symptom severity was measured by the Beck Depression Inventory.
Alpha diversity metrics revealed no significant difference in the community
diversity across any of the time-points. Results: Comparison of within-group versus between-group distances revealed a lack of
clustering of samples based on time-point, suggesting no significant change
in the microbiota across treatment duration. When analyzed based on
treatment response, however, patients in the responder group exhibited
greater phylogenetic diversity than non-responders (Mann-Whitney
U = 5, p = 0.026). At 3-months, 35
Operational Taxonomic Units (OTUs) were significantly different between
groups and at 6-months, 42 OTUs were significantly different between
responders and non-responders. Conclusions: These observations indicate that antidepressant medications alter the gut
microbiota of patients with MDD, with disparate effects in responders versus
non responders. This supports the concept of a microbiota phenotype
associate with treatment response in MDD.
Collapse
Affiliation(s)
- Aadil Bharwani
- The Brain-Body Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Asem Bala
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Michael Surette
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - John Bienenstock
- The Brain-Body Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital, University of Toronto, Ontario, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Foothills Medical Centre, University of Calgary, Alberta, Canada
| |
Collapse
|
45
|
Melamed OC, Wong EN, LaChance LR, Kanji S, Taylor VH. Interventions to Improve Metabolic Risk Screening Among Adult Patients Taking Antipsychotic Medication: A Systematic Review. Psychiatr Serv 2019; 70:1138-1156. [PMID: 31522630 DOI: 10.1176/appi.ps.201900108] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Antipsychotic use is associated with elevated cardiometabolic risk. Guidelines for metabolic risk screening of individuals taking antipsychotics have been issued, but with little uptake into clinical practice. This review systematically assessed interventions that address this guideline-to-practice gap and described their quality, improvement strategies, and effect on screening rates. METHODS Studies of interventions that addressed metabolic risk screening of adult patients taking antipsychotics, published from inception to July 2018, were selected from MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Reviews databases. Information was extracted on study characteristics; improvement strategies at the provider, patient, and system levels; and screening rates in the intervention and comparison groups. RESULTS The review included 30 complex interventions that used between one and nine unique improvement strategies. Social influence to shift provider and health organization culture to encourage metabolic risk screening was a common strategy, as were clinical prompts and monitoring tools to capture provider attention. Most studies were deemed at high risk of bias. Relative to comparison groups, the interventions were associated with an increase in median screening rates for glucose (28% to 65%), lipids (22% to 61%), weight (19% to 67%), and blood pressure (22% to 80%). CONCLUSIONS This knowledge synthesis points to shortcomings of current interventions to improve antipsychotic metabolic risk screening, both in quality and in outcomes. Findings may be used to inform the design of future programs. Additional interventions are needed to address the current guideline-to-practice gap, in which approximately one-third of patients are unscreened for metabolic risk.
Collapse
Affiliation(s)
- Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| | - Erin N Wong
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| | - Laura R LaChance
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| | - Sarah Kanji
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| | - Valerie H Taylor
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| |
Collapse
|
46
|
Melamed OC, Fernando I, Soklaridis S, Hahn MK, LeMessurier KW, Taylor VH. Understanding Engagement with a Physical Health Service: A Qualitative Study of Patients with Severe Mental Illness. Can J Psychiatry 2019; 64:872-880. [PMID: 31303027 PMCID: PMC7003111 DOI: 10.1177/0706743719862980] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Individuals with severe mental illness (SMI) are disproportionally affected by medical comorbidities, resulting in poor physical health and premature death. Despite this, care for chronic medical conditions is suboptimal, and there is limited research that explores this phenomenon from the patient's perspective. The aim of this study was to identify barriers and facilitators of engagement with a physical health service experienced by individuals with SMI. METHODS Adults with SMI were recruited from a large psychiatric hospital and offered referral to a physical health service focused on the prevention and treatment of obesity and diabetes. Interviews were conducted at referral, 3, and 6 months. Data from 56 interviews of 24 participants were analyzed using the framework method to identify factors influencing engagement. RESULTS Barriers to engagement were identified at individual, medical program, and health system levels. Factors influencing the individual experience included difficulty in care coordination, affective symptomatology, and ability to bond with providers. Factors at the program level included difficulty adjusting to the clinic environment and the inability to achieve treatment goals. Factors at the system level included challenges in attending multiple appointments in a fragmented health system, lack of social support, and financial constraints. CONCLUSIONS This qualitative study suggests that traditional models of medical care for chronic conditions pose challenges for many individuals with SMI and contribute to health disparities. Adaptation of medical care to populations with SMI and close collaboration between medical and mental health services are necessary to improve medical care and, subsequently, health outcomes.
Collapse
Affiliation(s)
- Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Indira Fernando
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sophie Soklaridis
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Margaret K Hahn
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | | | - Valerie H Taylor
- Department of Psychiatry, University of Toronto, Ontario, Canada.,Department of Psychiatry, Women's College Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Calgary, Alberta, Canada
| |
Collapse
|
47
|
Kanji S, Wong E, Akioyamen L, Melamed O, Taylor VH. Correction: Exploring pre-surgery and post-surgery substance use disorder and alcohol use disorder in bariatric surgery: a qualitative scoping review. Int J Obes (Lond) 2019; 43:2348. [PMID: 31511607 DOI: 10.1038/s41366-019-0448-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the original Article, Leo Akioyamen's surname was misspelled as "Aikiyomen." This has been updated in the XML, PDF and HTML versions of this Article.
Collapse
Affiliation(s)
- S Kanji
- Women's College Research Institute, Toronto, ON, Canada
| | - E Wong
- Women's College Research Institute, Toronto, ON, Canada
| | - L Akioyamen
- Women's College Research Institute, Toronto, ON, Canada
| | - O Melamed
- Women's College Research Institute, Toronto, ON, Canada
| | - V H Taylor
- Women's College Research Institute, Toronto, ON, Canada. .,University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
48
|
Wharton S, Kuk JL, Petrova L, Rye PI, Taylor VH, Christensen RAG. Effectiveness of a Community-Based Weight Management Program for Patients Taking Antidepressants and/or Antipsychotics. Obesity (Silver Spring) 2019; 27:1539-1544. [PMID: 31441235 DOI: 10.1002/oby.22567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/28/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to compare weight loss (WL) outcomes for patients taking antidepressants and/or antipsychotics with those not taking psychiatric medication. METHODS A total of 17,519 adults enrolled in a lifestyle WL intervention at the Wharton Medical Clinics in Ontario, Canada, were analyzed. Sex-stratified multivariable linear regression analysis was used to examine the association of taking antidepressants, antipsychotics, both, or neither with WL when adjusting for age, initial weight, and treatment time. RESULTS Twenty-three percent of patients were taking at least one psychiatric medication. Patients lost a significant amount of weight (P < 0.0001) regardless of psychiatric medication use. Women taking psychiatric medications lost a similar amount of weight as women who were not (P > 0.05). Conversely, men taking antidepressants lost only slightly less weight than men taking both classes or neither class of psychiatric medication (3.2 ± 0.3 kg vs. 5.6 ± 0.9 kg and 4.3 ± 0.1 kg; P < 0.05). However, taking psychiatric medications that cause weight gain was associated with similar significant decreases in weight as taking medications that are weight neutral or associated with WL for both sexes (P > 0.05). CONCLUSIONS Results of this study suggest that those who participate in a weight management program can lose significant amounts of weight regardless of psychiatric medication use.
Collapse
Affiliation(s)
- Sean Wharton
- Wharton Medical Clinic, Toronto, Ontario, Canada
- Department of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Jennifer L Kuk
- Department of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Lana Petrova
- Wharton Medical Clinic, Toronto, Ontario, Canada
| | - Peter I Rye
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Valerie H Taylor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
49
|
Affiliation(s)
- Valerie H. Taylor
- From the Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alta., Canada
| |
Collapse
|
50
|
Agarwal SM, Ahsan ZA, Lockwood JT, Duncan MJ, Takeuchi H, Cohn T, Taylor VH, Remington G, Faulkner GEJ, Hahn M. Pharmacological interventions for prevention of weight gain in people with schizophrenia. Hippokratia 2019. [DOI: 10.1002/14651858.cd013337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| | - Zohra A Ahsan
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| | - Jonathan T Lockwood
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| | - Markus J Duncan
- University of British Columbia; School of Kinesiology; 2146 Health Sciences Mall Room 4606 Vancouver Canada
| | - Hiroyoshi Takeuchi
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| | - Tony Cohn
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| | - Valerie H Taylor
- Women's College Hospital, University of Toronto; Department of Psychiatry; 7th Floor, Women's College Hospital 76 Grenville Street Toronto Ontario Canada M5S 1B2
| | - Gary Remington
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| | - Guy E J Faulkner
- University of British Columbia; School of Kinesiology; 2146 Health Sciences Mall Room 4606 Vancouver Canada
| | - Margaret Hahn
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada M5T 1R8
| |
Collapse
|