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Garel N, Tate S, Nash K, Lembke A. Trends in hallucinogen-associated emergency department visits and hospitalizations in California, USA, from 2016 to 2022. Addiction 2024; 119:960-964. [PMID: 38213013 DOI: 10.1111/add.16432] [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: 10/09/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND AND AIMS Hallucinogens encompass a diverse range of compounds of increasing scientific and public interest. Risks associated with hallucinogen use are under-researched and poorly understood. We aimed to compare the trends in hallucinogen-associated health-care use with alcohol- and cannabis-associated health-care use. DESIGN, SETTING AND CASES We conducted an ecological study with publicly available data on International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes associated with emergency department (ED) visits and hospitalizations from the California Department of Healthcare Access and Information (HCAI). HCAI includes primary and secondary ICD-10 codes reported with ED or hospital discharge from every non-federal health-care facility licensed in California, United States, from 2016 to 2022. MEASUREMENTS ICD-10 codes were classified as hallucinogen-, cannabis- or alcohol-associated if they were from the corresponding category in the ICD-10 block 'mental and behavioral disorders due to psychoactive substance use'. FINDINGS Observed hallucinogen-associated ED visits increased by 54% between 2016 and 2022, from 2260 visits to 3476 visits, compared with a 20% decrease in alcohol-associated ED visits and a 15% increase in cannabis-associated ED visits. The observed hallucinogen-associated hospitalizations increased by 55% during the same period, from 2556 to 3965 hospitalizations, compared with a 1% increase in alcohol-associated hospitalizations and a 1% increase in cannabis-associated hospitalizations. This rise in hallucinogenic ED visits was significantly different from the trend in cannabis-associated (P < 0.001) and alcohol-associated (P = 0.005) ED visits. The hallucinogen-associated hospitalizations trend also significantly differed when compared with cannabis- (P < 0.001) and alcohol-associated (P < 0.001) hospitalizations. CONCLUSIONS Hallucinogen-associated emergency department visits and hospitalizations in California, USA, showed a large relative but small absolute increase between 2016 and 2022.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven Tate
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristin Nash
- William G. Nash Foundation, San Anselmo, CA, USA
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Guay É, Brouillette MJ, Drury J, Garel N, Greenway K. Rapid Improvement of Post-Partum Depression With Subanesthetic Racemic Ketamine. J Clin Psychopharmacol 2024; 44:196-198. [PMID: 38421927 DOI: 10.1097/jcp.0000000000001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Émilie Guay
- Department of Psychiatry, McGill University, Montreal, Canada
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Greenway KT, Garel N, Dinh-Williams LAL, Beaulieu S, Turecki G, Rej S, Richard-Devantoy S. Music as an Intervention to Improve the Hemodynamic Response of Ketamine in Depression: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2354719. [PMID: 38315489 PMCID: PMC10845001 DOI: 10.1001/jamanetworkopen.2023.54719] [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] [Received: 09/20/2023] [Accepted: 12/13/2023] [Indexed: 02/07/2024] Open
Abstract
This randomized clinical trial explores whether music improves the hemodynamic response of ketamine among patients with treatment-resistant depression in Canada.
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Affiliation(s)
- Kyle T. Greenway
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
- Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
| | - Nicolas Garel
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Lê-Anh L. Dinh-Williams
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
- Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
| | - Serge Beaulieu
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
- Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Gustavo Turecki
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
- Douglas Mental Health University Institute, Montréal, Québec, Canada
- Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Soham Rej
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
- Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
- McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group, Lady Davis Research Institute and Jewish General Hospital, Montreal, Quebec, Canada
| | - Stephane Richard-Devantoy
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
- Douglas Mental Health University Institute, Montréal, Québec, Canada
- Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
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Garel N, Greenway KT, Dinh-Williams LAL, Thibault-Levesque J, Jutras-Aswad D, Turecki G, Rej S, Richard-Devantoy S. Intravenous ketamine for benzodiazepine deprescription and withdrawal management in treatment-resistant depression: a preliminary report. Neuropsychopharmacology 2023; 48:1769-1777. [PMID: 37532888 PMCID: PMC10579413 DOI: 10.1038/s41386-023-01689-y] [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: 03/24/2023] [Revised: 06/29/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
We present the first evidence that sub-anesthetic ketamine infusions for treatment resistant depression (TRD) may facilitate deprescription of long-term benzodiazepine/z-drugs (BZDRs). Long-term BZDR prescriptions are potentially harmful yet common, partly because of challenging withdrawal symptoms. Few pharmacological interventions have evidence for facilitating BZDR discontinuation, and none in patients actively suffering from TRD. In this ambi-directional cohort study, discontinuation of long-term (>6 month) BZDRs was attempted in 22 patients with severe unipolar or bipolar TRD receiving a course of six subanesthetic ketamine infusions over four weeks. We investigated the rates of successful BZDRs deprescription, trajectories of acute psychological withdrawal symptoms, and subsequent BZDRs abstinence during a mean follow-up of 1 year (primary outcome). Clinically significant deteriorations in depression, anxiety, sleep, and/or suicidality during the acute BZDR discontinuation phase were measured by repeated standardized scales and analyzed by latent growth curve models and percent correct classification analysis. Of the 22 eligible patients, all enrolled in this study and 91% (20/22) successfully discontinued all BZDRs by the end of the 4-week intervention, confirmed by urinary analyses. Less than 25% of discontinuers experienced any significant worsening of anxiety, depression, sleep difficulties, or suicidality during treatment. During follow-up (mean [range] duration, 12 [3-24] months), 64% (14/22) of patients remained abstinent from any BZDRs. These preliminary results suggest that ketamine infusions for TRD may facilitate the deprescription of BZDRs, even in patients with active depressive symptoms and significant comorbidity. Further investigation is warranted into this potential novel application of ketamine.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada.
| | - Kyle T Greenway
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada
| | - Lê-Anh L Dinh-Williams
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada
| | | | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Gustavo Turecki
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, QC, H4H 1R3, Canada
| | - Soham Rej
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group, Lady Davis Research Institute and Jewish General Hospital, Montreal, QC, Canada
| | - Stephane Richard-Devantoy
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, QC, H4H 1R3, Canada
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Garel N, Drury J, Thibault Lévesque J, Goyette N, Lehmann A, Looper K, Erritzoe D, Dames S, Turecki G, Rej S, Richard-Devantoy S, Greenway KT. The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression. Front Psychiatry 2023; 14:1268832. [PMID: 37795512 PMCID: PMC10546328 DOI: 10.3389/fpsyt.2023.1268832] [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: 07/28/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Background Subanesthetic ketamine has accumulated meta-analytic evidence for rapid antidepressant effects in treatment-resistant depression (TRD), resulting in both excitement and debate. Many unanswered questions surround ketamine's mechanisms of action and its integration into real-world psychiatric care, resulting in diverse utilizations that variously resemble electroconvulsive therapy, conventional antidepressants, or serotonergic psychedelics. There is thus an unmet need for clinical approaches to ketamine that are tailored to its unique therapeutic properties. Methods This article presents the Montreal model, a comprehensive biopsychosocial approach to ketamine for severe TRD refined over 6 years in public healthcare settings. To contextualize its development, we review the evidence for ketamine as a biomedical and as a psychedelic treatment of depression, emphasizing each perspectives' strengths, weaknesses, and distinct methods of utilization. We then describe the key clinical experiences and research findings that shaped the model's various components, which are presented in detail. Results The Montreal model, as implemented in a recent randomized clinical trial, aims to synergistically pair ketamine infusions with conventional and psychedelic biopsychosocial care. Ketamine is broadly conceptualized as a brief intervention that can produce windows of opportunity for enhanced psychiatric care, as well as powerful occasions for psychological growth. The model combines structured psychiatric care and concomitant psychotherapy with six ketamine infusions, administered with psychedelic-inspired nonpharmacological adjuncts including rolling preparative and integrative psychological support. Discussion Our integrative model aims to bridge the biomedical-psychedelic divide to offer a feasible, flexible, and standardized approach to ketamine for TRD. Our learnings from developing and implementing this psychedelic-inspired model for severe, real-world patients in two academic hospitals may offer valuable insights for the ongoing roll-out of a range of psychedelic therapies. Further research is needed to assess the Montreal model's effectiveness and hypothesized psychological mechanisms.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Jessica Drury
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | | | - Nathalie Goyette
- McGill Group for Suicide Studies, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Alexandre Lehmann
- International Laboratory for Brain, Music and Sound Research, Montreal, QC, Canada
- Department of Otolaryngology, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Karl Looper
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - David Erritzoe
- Division of Psychiatry, Department of Brain Sciences, Centres for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, United Kingdom
| | - Shannon Dames
- Health Sciences and Human Services, Vancouver Island University, Nanaimo, BC, Canada
| | - Gustavo Turecki
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- McGill Group for Suicide Studies, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Soham Rej
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
| | - Stephane Richard-Devantoy
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- McGill Group for Suicide Studies, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Kyle T. Greenway
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Division of Psychiatry, Department of Brain Sciences, Centres for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, United Kingdom
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Garel N, Nazon M, Naghi K, Willis E, Looper K, Rej S, Greenway KT. Ketamine for depression: a potential role in requests for Medical Aid in Dying? Int Clin Psychopharmacol 2023; 38:352-355. [PMID: 37159173 DOI: 10.1097/yic.0000000000000462] [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: 05/10/2023]
Abstract
Medical Aid in Dying (MAiD) is the act of a healthcare provider ending a patient's life, at their request, due to unbearable suffering from a grievous and incurable disease. Access to MAiD has expanded in the last decade and, more recently, it has been made available for psychiatric illnesses in a few countries. Recent studies have found that such psychiatric requests are rapidly increasing and primarily involve mood disorders as the primary condition. Nevertheless, MAiD for psychiatric disorders is associated with significant controversy and debate, especially regarding the definition and determination of irremediability - that a given patient lacks any reasonable prospect for recovery. In this article, we report the case of a Canadian patient who was actively requesting Medical Assistance in Dying for severe and prolonged treatment-resistant depression until she experienced remarkable benefits from a course of intravenous ketamine infusions. To our knowledge, this is the first report of ketamine or any other intervention yielding remission in a patient who would have otherwise likely been eligible for MAiD for depression. We discuss implications for the evaluation of similar requests and, more specifically, why a trial of ketamine warrants consideration.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry, Faculty of Medicine, McGill University, Ludmer Research and Training Building
| | | | - Kamran Naghi
- Department of Psychiatry, Jewish General Hospital
| | - Elena Willis
- Department of Psychiatry, Jewish General Hospital
| | - Karl Looper
- Department of Psychiatry, Faculty of Medicine, McGill University, Ludmer Research and Training Building
- Department of Psychiatry, Jewish General Hospital
| | - Soham Rej
- Department of Psychiatry, Faculty of Medicine, McGill University, Ludmer Research and Training Building
- Department of Psychiatry, Jewish General Hospital
- Department of Psychiatry, McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group, Lady Davis Research Institute and Jewish General Hospital, Montreal, Quebec, Canada
| | - Kyle T Greenway
- Department of Psychiatry, Faculty of Medicine, McGill University, Ludmer Research and Training Building
- Department of Psychiatry, Jewish General Hospital
- Department of Psychiatry, McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group, Lady Davis Research Institute and Jewish General Hospital, Montreal, Quebec, Canada
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Garel N, Thibault Lévesque J, Sandra DA, Lessard-Wajcer J, Solomonova E, Lifshitz M, Richard-Devantoy S, Greenway KT. Imprinting: expanding the extra-pharmacological model of psychedelic drug action to incorporate delayed influences of sets and settings. Front Hum Neurosci 2023; 17:1200393. [PMID: 37533588 PMCID: PMC10390742 DOI: 10.3389/fnhum.2023.1200393] [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] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/22/2023] [Indexed: 08/04/2023] Open
Abstract
Background Psychedelic drug experiences are shaped by current-moment contextual factors, commonly categorized as internal (set) and external (setting). Potential influences of past environments, however, have received little attention. Aims To investigate how previous environmental stimuli shaped the experiences of patients receiving ketamine for treatment-resistant depression (TRD), and develop the concept of "imprinting" to account for such time-lagged effects across diverse hallucinogenic drugs. Methods Recordings of treatment sessions and phenomenological interviews from 26 participants of a clinical trial investigating serial intravenous ketamine infusions for TRD, conducted from January 2021 to August 2022, were retrospectively reviewed. A broad literature search was undertaken to identify potentially underrecognized examples of imprinting with both serotonergic and atypical psychedelics, as well as analogous cognitive processes and neural mechanisms. Results In naturalistic single-subject experiments of a 28-year-old female and a 34-year-old male, subjective ketamine experiences were significantly altered by varying exposures to particular forms of digital media in the days preceding treatments. Higher levels of media exposure reduced the mystical/emotional qualities of subsequent psychedelic ketamine experiences, overpowering standard intention-setting practices and altering therapeutic outcomes. Qualitative data from 24 additional patients yielded eight further spontaneous reports of past environmental exposures manifesting as visual hallucinations during ketamine experiences. We identified similar examples of imprinting with diverse psychoactive drugs in past publications, including in the first-ever report of ketamine in human subjects, as well as analogous processes known to underly dreaming. Conclusions/interpretation Past environmental exposures can significantly influence the phenomenology and therapeutic outcomes of psychedelic experiences, yet are underrecognized and understudied. To facilitate future research, we propose expanding the contextual model of psychedelic drug actions to incorporate imprinting, a novel concept that may aid clinicians, patients, and researchers to better understand psychedelic drug effects. Clinical trial registration ClinicalTrials.gov, identifier NCT04701866.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Dasha A. Sandra
- Department of Psychology, McGill University, Montreal, QC, Canada
| | | | - Elizaveta Solomonova
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Neurophilosophy Lab, Department of Philosophy, McGill University, Montreal, QC, Canada
| | - Michael Lifshitz
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Stéphane Richard-Devantoy
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, LaSalle, QC, Canada
| | - Kyle T. Greenway
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
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Garel N, Rigas C, Ben M'rad M, Bodenstein K, Joober R, Sekhon H, Rej S. Mindfulness-based intervention for benzodiazepine deprescription in hemodialysis patients with anxiety and depressive symptoms. J Psychiatry Neurosci 2023; 48:E149-E150. [PMID: 37172961 PMCID: PMC10185346 DOI: 10.1503/jpn.220216] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Affiliation(s)
- Nicolas Garel
- From McGill University, Psychiatry residency & Clinician Investigator programs, Montréal, Que. (Garel); McGill University, Department of Psychiatry, Montréal, Que. (Rigas, Ben m'rad, Bodenstein); the Haut-Richelieu Hospital, Nephrology Department, Saint-Jean-sur-Richelieu, Que. (Ben m'rad); McGill University, Douglas Mental Health University Institute, Montréal, Que. ( Joober); McGill University, Jewish General Hospital ( Sekhon); McGill University, Jewish General Hospital, Montréal, Que. (Rej)
| | - Christina Rigas
- From McGill University, Psychiatry residency & Clinician Investigator programs, Montréal, Que. (Garel); McGill University, Department of Psychiatry, Montréal, Que. (Rigas, Ben m'rad, Bodenstein); the Haut-Richelieu Hospital, Nephrology Department, Saint-Jean-sur-Richelieu, Que. (Ben m'rad); McGill University, Douglas Mental Health University Institute, Montréal, Que. ( Joober); McGill University, Jewish General Hospital ( Sekhon); McGill University, Jewish General Hospital, Montréal, Que. (Rej)
| | - Mona Ben M'rad
- From McGill University, Psychiatry residency & Clinician Investigator programs, Montréal, Que. (Garel); McGill University, Department of Psychiatry, Montréal, Que. (Rigas, Ben m'rad, Bodenstein); the Haut-Richelieu Hospital, Nephrology Department, Saint-Jean-sur-Richelieu, Que. (Ben m'rad); McGill University, Douglas Mental Health University Institute, Montréal, Que. ( Joober); McGill University, Jewish General Hospital ( Sekhon); McGill University, Jewish General Hospital, Montréal, Que. (Rej)
| | - Katie Bodenstein
- From McGill University, Psychiatry residency & Clinician Investigator programs, Montréal, Que. (Garel); McGill University, Department of Psychiatry, Montréal, Que. (Rigas, Ben m'rad, Bodenstein); the Haut-Richelieu Hospital, Nephrology Department, Saint-Jean-sur-Richelieu, Que. (Ben m'rad); McGill University, Douglas Mental Health University Institute, Montréal, Que. ( Joober); McGill University, Jewish General Hospital ( Sekhon); McGill University, Jewish General Hospital, Montréal, Que. (Rej)
| | - Ridha Joober
- From McGill University, Psychiatry residency & Clinician Investigator programs, Montréal, Que. (Garel); McGill University, Department of Psychiatry, Montréal, Que. (Rigas, Ben m'rad, Bodenstein); the Haut-Richelieu Hospital, Nephrology Department, Saint-Jean-sur-Richelieu, Que. (Ben m'rad); McGill University, Douglas Mental Health University Institute, Montréal, Que. ( Joober); McGill University, Jewish General Hospital ( Sekhon); McGill University, Jewish General Hospital, Montréal, Que. (Rej)
| | - Harmehr Sekhon
- From McGill University, Psychiatry residency & Clinician Investigator programs, Montréal, Que. (Garel); McGill University, Department of Psychiatry, Montréal, Que. (Rigas, Ben m'rad, Bodenstein); the Haut-Richelieu Hospital, Nephrology Department, Saint-Jean-sur-Richelieu, Que. (Ben m'rad); McGill University, Douglas Mental Health University Institute, Montréal, Que. ( Joober); McGill University, Jewish General Hospital ( Sekhon); McGill University, Jewish General Hospital, Montréal, Que. (Rej)
| | - Soham Rej
- From McGill University, Psychiatry residency & Clinician Investigator programs, Montréal, Que. (Garel); McGill University, Department of Psychiatry, Montréal, Que. (Rigas, Ben m'rad, Bodenstein); the Haut-Richelieu Hospital, Nephrology Department, Saint-Jean-sur-Richelieu, Que. (Ben m'rad); McGill University, Douglas Mental Health University Institute, Montréal, Que. ( Joober); McGill University, Jewish General Hospital ( Sekhon); McGill University, Jewish General Hospital, Montréal, Que. (Rej)
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Payette O, Lespérance P, Jodoin VD, Longpré-Poirier C, Elkrief L, Richard M, Garel N, Miron JP. Intravenous ketamine for treatment-resistant depression patients who have failed to respond to transcranial magnetic stimulation: A case series. J Affect Disord 2023; 333:18-20. [PMID: 37075822 DOI: 10.1016/j.jad.2023.04.019] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/18/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND For individuals with treatment-resistant depression (TRD), transcranial magnetic stimulation (TMS) has become a well-established approach. In the past decade, intravenous (IV) racemic ketamine has also emerged as a potential treatment for TRD. Currently, little data is available on the clinical effects of IV racemic ketamine in TRD patients who experienced TMS-failure. METHODS Twenty-one (21) TRD patients who had failed to respond to a standard course of high-frequency left-dorsolateral prefrontal cortex TMS were subsequently scheduled to received IV racemic ketamine infusions. The IV racemic ketamine protocol consisted of 0,5 mg/kg infusions over 60 min, 3 times a week over 2 weeks. RESULTS Treatment was safe with minimal side-effects. Mean baseline MADRS score was 27.6 ± 6.4 (moderate depression), decreasing down to 18.6 ± 8.9 (mild depression) post-treatment. Mean percent improvement was 34.5 % ± 21.1 from baseline to post-treatment. Paired sample t-test showed significant MADRS score decrease pre- to post-treatment [t(20) = 7.212, p < .001]. Overall, four (4) patients (19.0 %) responded and two (2) of those achieved remission (9.5 %). LIMITATIONS Limitations of this case series include its retrospective and uncontrolled open-label nature, the lack of self-rating and standardized adverse events questionnaires, as well as follow-ups beyond the immediate treatment period. CONCLUSIONS Novel ways to increase the clinical effects of ketamine are being explored. We discuss potential combination approaches of ketamine with other modalities to augment its effects. Given the global burden of TRD, novel approaches are needed to curb the current mental health epidemic around the world.
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Affiliation(s)
- Olivier Payette
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada
| | | | - Laurent Elkrief
- Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Maxime Richard
- Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Nicolas Garel
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada
| | - Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada.
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Rosenblat JD, Husain MI, Lee Y, McIntyre RS, Mansur RB, Castle D, Offman H, Parikh SV, Frey BN, Schaffer A, Greenway KT, Garel N, Beaulieu S, Kennedy SH, Lam RW, Milev R, Ravindran AV, Tourjman V, Ameringen MV, Yatham LN, Taylor V. The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Report: Serotonergic Psychedelic Treatments for Major Depressive Disorder. Can J Psychiatry 2023; 68:5-21. [PMID: 35975555 PMCID: PMC9720483 DOI: 10.1177/07067437221111371] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Serotonergic psychedelics are re-emerging as potential novel treatments for several psychiatric disorders including major depressive disorder. The Canadian Network for Mood and Anxiety Treatments (CANMAT) convened a task force to review the evidence and provide a consensus recommendation for the clinical use of psychedelic treatments for major depressive disorder. METHODS A systematic review was conducted to identify contemporary clinical trials of serotonergic psychedelics for the treatment of major depressive disorder and cancer-related depression. Studies published between January 1990 and July 2021 were identified using combinations of search terms, inspection of bibliographies and review of other psychedelic reviews and consensus statements. The levels of evidence for efficacy were graded according to the Canadian Network for Mood and Anxiety Treatments criteria. RESULTS Only psilocybin and ayahuasca have contemporary clinical trials evaluating antidepressant effects. Two pilot studies showed preliminary positive effects of single-dose ayahuasca for treatment-resistant depression (Level 3 evidence). Small randomized controlled trials of psilocybin combined with psychotherapy showed superiority to waitlist controls and comparable efficacy and safety to an active comparator (escitalopram with supportive psychotherapy) in major depressive disorder, with additional randomized controlled trials showing efficacy specifically in cancer-related depression (Level 3 evidence). There was only one open-label trial of psilocybin in treatment-resistant unipolar depression (Level 4 evidence). Small sample sizes and functional unblinding were major limitations in all studies. Adverse events associated with psychedelics, including psychological (e.g., psychotomimetic effects) and physical (e.g., nausea, emesis and headaches) effects, were generally transient. CONCLUSIONS There is currently only low-level evidence to support the efficacy and safety of psychedelics for major depressive disorder. In Canada, as of 2022, psilocybin remains an experimental option that is only available through clinical trials or the special access program. As such, Canadian Network for Mood and Anxiety Treatments considers psilocybin an experimental treatment and recommends its use primarily within clinical trials, or, less commonly, through the special access program in rare, special circumstances.
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Affiliation(s)
- Joshua D Rosenblat
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,7978Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - M Ishrat Husain
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute Toronto, Ontario, Canada
| | - Yena Lee
- 7978Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,7978Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Rodrigo B Mansur
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,7978Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - David Castle
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute Toronto, Ontario, Canada
| | - Hilary Offman
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,Depression Program, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Benicio N Frey
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, McMaster University, Psychiatry & Behavioural Neurosciences, Hamilton, Ontario, Canada
| | - Ayal Schaffer
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Nicolas Garel
- McGill University, Psychiatry, Montreal, Quebec, Canada
| | | | - Sidney H Kennedy
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,7978Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roumen Milev
- Department of Psychiatry, Providence Care, Queen's University, Kingston, ON, Canada
| | - Arun V Ravindran
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute Toronto, Ontario, Canada
| | - Valerie Tourjman
- Institut universitaire en santé mentale de Montréal, Psychiatry, Montreal, Quebec, Canada
| | - Michael Van Ameringen
- McMaster University Medical Centre, Anxiety Disorders Clinic, Hamilton, Ontario, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Valerie Taylor
- Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,7978Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
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11
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Garel N, McAnulty C, Greenway KT, Lesperance P, Miron JP, Rej S, Richard-Devantoy S, Jutras-Aswad D. Efficacy of ketamine intervention to decrease alcohol use, cravings, and withdrawal symptoms in adults with problematic alcohol use or alcohol use disorder: A systematic review and comprehensive analysis of mechanism of actions. Drug Alcohol Depend 2022; 239:109606. [PMID: 36087563 DOI: 10.1016/j.drugalcdep.2022.109606] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Alcohol use disorder is highly prevalent and has important economical, societal, psychiatric, and medical consequences. All currently approved therapeutic approaches targeting alcohol dependence have relatively modest effects and high relapse rates. Recent evidence suggests that ketamine may be an effective intervention to treat alcohol use disorder and alcoholic withdrawal. This systematic review aimed to assess the current level of evidence for this intervention. METHODS This systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on the international database of systematic reviews PROSPERO. Medline(Ovid), CINAHL Complete(EBSCOhost), PsycINFO(Ovid), EBM Reviews(Ovid), EMBASE(Ovid), and Google Scholar were searched for studies using ketamine to treat harmful alcohol use, craving, or withdrawal states in humans. Studies of any methodology that evaluated ketamine in isolation or combination with other interventions were included. The risk of bias was assessed using specific Cochrane critical appraisal tools. RESULTS Of 1922 abstracts identified, 8 full-text articles were eligible for inclusion, yielding a total sample size of 634 participants. Five studies investigated the impact of ketamine on alcohol use and/or cravings and/or withdrawal in outpatient settings. Three studies looked at the effect of adding ketamine to conventional treatment of withdrawal symptoms in participants admitted to intensive care unit for severe alcohol withdrawal. Results on primary outcomes were mixed within and across trials. CONCLUSIONS Despite promising results, the current evidence does not permit definitive conclusions about the efficacy of ketamine in alcohol use disorders or withdrawal. Future studies are warranted.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada
| | - Christina McAnulty
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada
| | - Kyle T Greenway
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada
| | - Paul Lesperance
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada
| | - Jean-Philippe Miron
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada
| | - Soham Rej
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada; McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group, Lady Davis Research Institute and Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada
| | - Stephane Richard-Devantoy
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada; Douglas Mental Health Research Institute, McGill Group for Suicide Studies, 6875 Boulevard LaSalle, Montréal, Québec H4H 1R3, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada.
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12
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Affiliation(s)
- Nicolas Garel
- From the Psychiatry residency program, PGY4, McGill University, Montreal, Canada (Garel, Greenway); the Department of Psychiatry, McGill University, Montreal, Canada (Tabbane); and the Douglas Mental Health University Institute, Montreal, Canada (Joober)
| | - Kyle T. Greenway
- From the Psychiatry residency program, PGY4, McGill University, Montreal, Canada (Garel, Greenway); the Department of Psychiatry, McGill University, Montreal, Canada (Tabbane); and the Douglas Mental Health University Institute, Montreal, Canada (Joober)
| | - Karim Tabbane
- From the Psychiatry residency program, PGY4, McGill University, Montreal, Canada (Garel, Greenway); the Department of Psychiatry, McGill University, Montreal, Canada (Tabbane); and the Douglas Mental Health University Institute, Montreal, Canada (Joober)
| | - Ridha Joober
- From the Psychiatry residency program, PGY4, McGill University, Montreal, Canada (Garel, Greenway); the Department of Psychiatry, McGill University, Montreal, Canada (Tabbane); and the Douglas Mental Health University Institute, Montreal, Canada (Joober)
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13
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Garel N, Greenway K, Joober R. The antipsychotic potential of cannabidiol: clinical implications for patients with psychosis and comorbid cannabis use disorder. J Psychiatry Neurosci 2021; 46:E164-E165. [PMID: 33464779 PMCID: PMC7955839 DOI: 10.1503/jpn.200114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Nicolas Garel
- From McGill University, Psychiatry residency program (Garel, Greenway); and McGill University, Douglas Mental Health University Institute, (Joober), Montreal, Que., Canada
| | - Kyle Greenway
- From McGill University, Psychiatry residency program (Garel, Greenway); and McGill University, Douglas Mental Health University Institute, (Joober), Montreal, Que., Canada
| | - Ridha Joober
- From McGill University, Psychiatry residency program (Garel, Greenway); and McGill University, Douglas Mental Health University Institute, (Joober), Montreal, Que., Canada
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14
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Affiliation(s)
- Nicolas Garel
- From the psychiatry residency program (Garel) and the Douglas Mental Health University Institute (Bloom, Joober), McGill University, Montreal, Que., Canada
| | - David Bloom
- From the psychiatry residency program (Garel) and the Douglas Mental Health University Institute (Bloom, Joober), McGill University, Montreal, Que., Canada
| | - Ridha Joober
- From the psychiatry residency program (Garel) and the Douglas Mental Health University Institute (Bloom, Joober), McGill University, Montreal, Que., Canada
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15
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Greenway KT, Garel N, Jerome L, Feduccia AA. Integrating psychotherapy and psychopharmacology: psychedelic-assisted psychotherapy and other combined treatments. Expert Rev Clin Pharmacol 2020; 13:655-670. [DOI: 10.1080/17512433.2020.1772054] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kyle T. Greenway
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Nicolas Garel
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Lisa Jerome
- Data Services, MAPS Public Benefit Corporation
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16
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Affiliation(s)
- Nicolas Garel
- From the Department of Psychiatry, McGill University (Garel, Joober); and the Douglas Mental Health University Institute, (Joober) Montreal, Que, Canada
| | - Ridha Joober
- From the Department of Psychiatry, McGill University (Garel, Joober); and the Douglas Mental Health University Institute, (Joober) Montreal, Que, Canada
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17
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Garel N, Joober R. Treatment of first-episode psychosis in patients with autism-spectrum disorder and intellectual deficiency. J Psychiatry Neurosci 2019; 44:E31-E32. [PMID: 31657537 PMCID: PMC6821509 DOI: 10.1503/jpn.190081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Nicolas Garel
- From the psychiatry residency program, McGill University (Garel); and McGill University, Douglas Mental Health University Institute (Joober), Montreal, Que., Canada
| | - Ridha Joober
- From the psychiatry residency program, McGill University (Garel); and McGill University, Douglas Mental Health University Institute (Joober), Montreal, Que., Canada
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Abstract
Background:
Despite increased attention and recognition of autism spectrum
disorders, many patients suffering from these disorders remain undiagnosed or are diagnosed
late due to their subtle clinical presentation. The challenge for clinicians working in the field
of mental health is not in screening and diagnosing young children showing typical signs of
autism spectrum disorders, but rather in identifying patients at the high-functioning end of
the spectrum whose intellectual abilities mask their social deficits.
Objective:
Because therapeutic interventions differ radically once the diagnosis of ASD has
been made, it is important to understand the trajectory of those adolescents and identify clues
that could help raise the diagnosis of ASD earlier.
Methods:
Records of eight adolescents with a late diagnosis of ASD were retrospectively
reviewed to identify relevant clinical features that were overlooked in childhood and early
adolescence.
Results:
The patients were previously misdiagnosed with multiple mental health disorders.
These cases showed striking similarities in terms of developmental history, reasons for
misdiagnosis, and the clinical picture at the time of ASD recognition. The cases were
characterized by complex and fluctuating symptomatology, including depression, anxiety,
behavioural problems, self-injurious behaviour and suicidal thoughts. Their Autism
Spectrum Disorder (ASD) went previously undiagnosed due to the individual’s intelligence
and learning abilities, which masked their social deficits and developmental irregularities.
Signs of ASD were continuously present since childhood in all the eight cases. Once the
developmental histories and the psychiatric evaluation of these adolescents were done by
psychiatrists with appropriate knowledge of autism, the diagnosis of ASD was made.
Conclusion:
The ASD hypothesis should be raised in the presence of confusing symptoms
that do not respond to usual treatment and are accompanied by an irregular developmental
background. It is indeed a difficult diagnosis to make; however, the focused clinician can
note subtle signs of ASD despite the intellectual learning of social codes. Family history,
developmental irregularities, rigidity, difficulty in spontaneously understanding emotions,
discomfort in groups and the need to be alone are significant indicators to recognize. Once
the diagnosis has been considered, it must be confirmed or rejected by an experienced
multidisciplinary team. The challenge for clinicians working in the field of mental health is
not in screening and diagnosing young children showing typical signs of ASD, but rather in
identifying patients who are at high-functioning end of the spectrum whose intellectual
abilities mask their social deficits.
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Affiliation(s)
| | - Patricia Garel
- Sainte-Justine University Health Center, University of Montreal, Montreal, Quebec, Canada
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Boeing A, Boulton M, Bräunl T, Frisch B, Lopes S, Morgan A, Ophelders F, Pangeni S, Reid R, Vinsen K, Garel N, Lee CS, Masek M, Attwood A, Fazio M, Gandossi A. WAMbot: Team MAGICian's entry to the Multi Autonomous Ground-robotic International Challenge 2010. J FIELD ROBOT 2012. [DOI: 10.1002/rob.21434] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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