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van Reekum EA, Woo JJ, Petropoulos JA, Samaan Z, Mbuagbaw L. Association between the COVID-19 pandemic and psychiatric symptoms in people with preexisting obsessive-compulsive, eating, anxiety, and mood disorders: a systematic review and meta-analysis of before-after studies. Psychiatry Clin Neurosci 2023; 77:583-591. [PMID: 37565691 DOI: 10.1111/pcn.13582] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
AIM To determine whether the coronavirus disease 2019 (COVID-19) pandemic was associated with a change in psychiatric symptoms in people with preexisting obsessive-compulsive, eating, anxiety, and mood disorders compared to their prepandemic levels. METHODS We searched MEDLINE, CINAHL, PsycINFO, and Embase from inception until February 16, 2022. Studies were included if they reported prepandemic and during-pandemic psychiatric symptoms, using validated scales, in people with preexisting mood, anxiety, eating, or obsessive-compulsive disorders. Two reviewers independently screened studies, extracted data, and assessed evidence certainty. Random-effects meta-analyses were conducted. Effect sizes were reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS Eighteen studies from 10 countries were included. Of the 4465 included participants, 68% were female and the average age was 43 years. Mood and obsessive-compulsive disorders were the most studied disorders. During-pandemic psychiatric measurements were usually collected during nationwide lockdown. Obsessive-compulsive symptoms worsened among people with obsessive-compulsive and related disorders, with a moderate effect size (N = 474 [six studies], SMD = -0.45 [95% CI, -0.82 to -0.08], I2 = 83%; very low certainty). We found a small association between the COVID-19 pandemic and reduced anxiety symptoms in people with mood, anxiety, obsessive-compulsive, and eating disorders (N = 3738 [six studies], SMD = 0.11 [95% CI, 0.02-0.19], I2 = 63%; very low certainty). No change in loneliness, depressive, or problematic eating symptoms was found. CONCLUSION People with obsessive-compulsive and related disorders may benefit from additional monitoring during the COVID-19 pandemic and possibly future pandemics. Other psychiatric symptoms were stable in people with the specific disorders studied. Overall, evidence certainty was very low.
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Affiliation(s)
- Emma A van Reekum
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Julia J Woo
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jo-Anne Petropoulos
- Health Sciences Library, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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van Reekum EA, Stogios N, Burton L, Spivak H, Hahn M, Agarwal SM. Favourable cognitive changes observed with metabolic improvements in a patient with severe mental illness. J Psychiatry Neurosci 2023; 48:E330-E333. [PMID: 37673434 PMCID: PMC10495163 DOI: 10.1503/jpn.230052] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Affiliation(s)
- Emma A van Reekum
- From the Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ont. (van Reekum); the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (van Reekum); the Schizophrenia Division, Centre for Addiction and Mental Health, Toroto, Ont. (Stogios, Burton, Hahn, Agarwal); the Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Stogios, Hahn, Agarwal); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Spivak, Hahn, Agarwal); the Banting and Best Diabetes Centre, University of Toronto, Toronto, Ont. (Hahn, Agarwal)
| | - Nicolette Stogios
- From the Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ont. (van Reekum); the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (van Reekum); the Schizophrenia Division, Centre for Addiction and Mental Health, Toroto, Ont. (Stogios, Burton, Hahn, Agarwal); the Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Stogios, Hahn, Agarwal); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Spivak, Hahn, Agarwal); the Banting and Best Diabetes Centre, University of Toronto, Toronto, Ont. (Hahn, Agarwal)
| | - Leah Burton
- From the Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ont. (van Reekum); the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (van Reekum); the Schizophrenia Division, Centre for Addiction and Mental Health, Toroto, Ont. (Stogios, Burton, Hahn, Agarwal); the Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Stogios, Hahn, Agarwal); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Spivak, Hahn, Agarwal); the Banting and Best Diabetes Centre, University of Toronto, Toronto, Ont. (Hahn, Agarwal)
| | - Harold Spivak
- From the Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ont. (van Reekum); the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (van Reekum); the Schizophrenia Division, Centre for Addiction and Mental Health, Toroto, Ont. (Stogios, Burton, Hahn, Agarwal); the Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Stogios, Hahn, Agarwal); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Spivak, Hahn, Agarwal); the Banting and Best Diabetes Centre, University of Toronto, Toronto, Ont. (Hahn, Agarwal)
| | - Margaret Hahn
- From the Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ont. (van Reekum); the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (van Reekum); the Schizophrenia Division, Centre for Addiction and Mental Health, Toroto, Ont. (Stogios, Burton, Hahn, Agarwal); the Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Stogios, Hahn, Agarwal); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Spivak, Hahn, Agarwal); the Banting and Best Diabetes Centre, University of Toronto, Toronto, Ont. (Hahn, Agarwal)
| | - Sri Mahavir Agarwal
- From the Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ont. (van Reekum); the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (van Reekum); the Schizophrenia Division, Centre for Addiction and Mental Health, Toroto, Ont. (Stogios, Burton, Hahn, Agarwal); the Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Stogios, Hahn, Agarwal); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Spivak, Hahn, Agarwal); the Banting and Best Diabetes Centre, University of Toronto, Toronto, Ont. (Hahn, Agarwal)
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van Reekum EA, Rosic T, Sergeant A, Sanger N, Rodrigues M, Rebinsky R, Panesar B, Deck E, Kim N, Woo J, D'Elia A, Hillmer A, Dufort A, Sanger S, Thabane L, Mbuagbaw L, Samaan Z. Delirium and other neuropsychiatric manifestations of COVID-19 infection in people with preexisting psychiatric disorders: a systematic review. J Med Case Rep 2021; 15:586. [PMID: 34903299 PMCID: PMC8667019 DOI: 10.1186/s13256-021-03140-6] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/03/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Psychiatric disorders increase risk of neuropsychiatric disease and poor outcomes, yet little is known about the neuropsychiatric manifestations of COVID-19 in the psychiatric population. The primary objective is to synthesize neuropsychiatric outcomes of COVID-19 in people with preexisting psychiatric disorders. METHODS Data were collected during an ongoing review of the impact of pandemics on people with existing psychiatric disorders. All study designs and gray literature were included. Medline, PsychInfo, CINAHL, EMBASE, and MedRx were searched from inception to September 1 2020. Risk of bias was assessed using a published tool that can accommodate all study types. Two independent authors screened the studies and extracted data. Data were narratively synthesized, as there were insufficient data to meta-analyze. Evidence was appraised according to GRADE. RESULTS Four case reports were included, comprising 13 participants from three countries. Many large-sample, relevant papers were omitted for not reporting psychiatric history, despite reporting other comorbidities. Included participants (n = 13) were hospitalized with COVID-19 and appeared to meet criteria for delirium. Myoclonus, rigidity, and alogia were also reported. The most commonly reported preexisting psychiatric diagnoses were mood disorders, schizophrenia, and alcohol use disorder. CONCLUSIONS People with preexisting psychiatric disorders may experience delirium, rigidity, myoclonus, and alogia during COVID-19 infection; although higher quality and longitudinal data are needed to better understand these phenomena. Relevant COVID-19 literature does not always report psychiatric history, despite heightened neuropsychiatric vulnerability within this population. TRIAL REGISTRATION PROSPERO (CRD42020179611).
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Affiliation(s)
- Emma A van Reekum
- Department of Psychiatry and Behavioural Neurosciences, Clinician Investigator Program, McMaster University, Hamilton, Canada
| | - Tea Rosic
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Anjali Sergeant
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Nitika Sanger
- Medical Science Graduate Program, McMaster University, Hamilton, Canada
| | - Myanca Rodrigues
- Health Research Methodology Graduate Program, McMaster University, Hamilton, Canada
| | - Reid Rebinsky
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Balpreet Panesar
- Neuroscience Graduate Program, McMaster University, Hamilton, Canada
| | - Eve Deck
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Nayeon Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Julia Woo
- Department of Psychiatry and Behavioural Neurosciences, Clinician Investigator Program, McMaster University, Hamilton, Canada
| | - Alessia D'Elia
- Neuroscience Graduate Program, McMaster University, Hamilton, Canada
| | - Alannah Hillmer
- Neuroscience Graduate Program, McMaster University, Hamilton, Canada
| | - Alexander Dufort
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | | | - Lehana Thabane
- Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Canada
- St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.
- Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Canada.
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Chai D, Rosic T, Panesar B, Sanger N, van Reekum EA, Marsh DC, Worster A, Thabane L, Samaan Z. Patient-Reported Goals of Youths in Canada Receiving Medication-Assisted Treatment for Opioid Use Disorder. JAMA Netw Open 2021; 4:e2119600. [PMID: 34351402 PMCID: PMC8343465 DOI: 10.1001/jamanetworkopen.2021.19600] [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: 11/14/2022] Open
Abstract
IMPORTANCE In the literature on opioid use disorder (OUD), opioid abstinence is used as an outcome measure for individuals receiving medication-assisted treatment (MAT), without consideration of patient-reported goals (PRGs). OBJECTIVES To identify common PRGs for youths receiving MAT for OUD and assess whether these patients achieve their stated goals. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study examined data from 152 individuals aged 16 to 25 years (noninclusive) recruited between May 22, 2018, and March 11, 2020, from 45 outpatient MAT clinics in the Pharmacogenetics of Opioid Substitution Treatment Response study. Youths receiving MAT for OUD were included and were followed up for 3 months. EXPOSURES Medication-assisted treatment for OUD. MAIN OUTCOMES AND MEASURES The frequency of each PRG; the success of goal attainment, compared between those who reported specific PRGs and those who did not; and associations between reporting certain goals and achieving them. RESULTS Among the 152 youths in the study, 82 were male (53.9%), and the mean (SD) age was 22.8 (1.8) years. Ten overarching goals were identified, with the most common being to taper the dose of or stop MAT (96 [63.2%]), avoid use of recreational substances (71 [46.7%]), manage OUD symptoms (25 [16.4%]), live a normal life (14 [9.2%]), improve mental health (11 [7.2%]), and gain employment (8 [5.3%]). Overall, individuals who reported PRGs had similar odds of achieving them as those who did not for the goals of taper dose of or stop MAT (OR, 1.98; 95% CI, 0.88-4.46; P = .10), avoid recreational substances (OR, 1.34; 95% CI, 0.65-2.74; P = .43), manage OUD symptoms (β coefficient, -0.93; 95% CI, -4.24 to 2.38; P = .58), and improve mental health (β coefficient, -0.76; 95% CI, -6.31 to 4.78; P = .79). Furthermore, multivariable logistic regression showed that goals to taper the dose of or stop MAT (odds ratio, 1.90; 95% CI, 0.78-4.63; P = .16) or avoid recreational substances (odds ratio, 1.27; 95% CI, 0.60-2.67; P = .53) were not associated with achieving these respective outcomes. CONCLUSIONS AND RELEVANCE This study suggests that youths have highly variable PRGs regarding MAT for OUD and that reporting a goal may not mean one is at higher odds of achieving it. There is a need to develop treatment plans that effectively incorporate PRGs. In addition, the finding that most youths aim to minimize or stop their MAT dose warrants the creation of a tapering protocol to guide clinicians. Because a diagnosis of OUD has substantial psychosocial implications in this population, clinicians must ensure that these dimensions of care are part of routine clinical practice.
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Affiliation(s)
- Darren Chai
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tea Rosic
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Balpreet Panesar
- Neurosciences Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Nitika Sanger
- Medical Sciences Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Emma A. van Reekum
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David C. Marsh
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Canadian Addiction Treatment Centres, Markham, Ontario, Canada
- Institute for Clinical Evaluative Sciences North, Sudbury, Ontario, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Research Institute at St Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Clinician Investigator Program, Mood Disorders Program, St Joseph’s Healthcare, Hamilton, Ontario, Canada
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Woo JJ, van Reekum EA, Rosic T, Samaan Z. Children and Youth Who Use Cannabis for Pain Relief: Benefits, Risks, and Perceptions. Adolesc Health Med Ther 2020; 11:53-61. [PMID: 32547283 PMCID: PMC7247732 DOI: 10.2147/ahmt.s254264] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/24/2020] [Indexed: 12/16/2022]
Abstract
We provide up-to-date perspectives on the benefits and risks of medical cannabis for pain management in children and youth. To date, only two studies (a case report and a small observational study) have examined the effects of medical cannabis on pain in children and youth. No controlled trial has commented on long-term safety of medical cannabis. Findings from the recreational cannabis literature reveal significant potential short- and long-term risks of regular cannabis use, including impaired driving, depression, suicidality, psychosis, and tolerance. Despite this, many children and youth are self-medicating with cannabis, and perceive regular cannabis use to be safe. There is a need for better education and counselling of patients regarding the benefits and risks of medical cannabis use.
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Affiliation(s)
- Julia J Woo
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Tea Rosic
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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van Reekum EA, Rosic T, Hudson J, Sanger N, Marsh DC, Worster A, Thabane L, Samaan Z. Social functioning outcomes in men and women receiving medication-assisted treatment for opioid use disorder. Biol Sex Differ 2020; 11:20. [PMID: 32326982 PMCID: PMC7181574 DOI: 10.1186/s13293-020-00298-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/27/2019] [Accepted: 04/08/2020] [Indexed: 02/07/2023] Open
Abstract
Background Social functioning (SF), the ability to engage with life and fulfill roles may be a salient “patient important outcome” in addiction treatment. It is not known if medication-assisted treatment (MAT) impacts SF in opioid use disorder (OUD). There is a growing evidence to suggest that men and women are impacted differently by OUD. This study is the largest to date to study sex differences in OUD and explore associations between MAT and SF. Methods Data were collected from 2736 participants with OUD, enrolled in MAT for varying lengths of time, in outpatient clinics across Ontario. SF was defined according to the Maudsley Addiction Profile’s domains of (1) employment, (2) criminal activity, and (3) interpersonal conflict. Using logistic regression analysis, we examined sociodemographic and clinical factors associated with domains of SF. Results There were 1544 men (56%) and 1192 women (44%) in this study, and ages varied from 17 to 76 years for men and 18 to 69 years for women. At study entry, participants had been on MAT for a median of 2 years. Compared to men, women reported more psychological (mean MAP score 14/40, SD = 9.55, versus 11/40, SD = 8.64; p < 0.001) and physical symptoms (mean MAP score 17/40, SD = 7.70 versus 14/40, SD = 7.74; p < 0.001). More women reported unemployment(74% versus 58%; p < 0.0001) and interpersonal conflict (46% versus 35%; p < 0.0001). Men were more likely than women to report criminal activity (11%, versus 8%; p = 0.001). Psychological symptoms increased the risk of worse SF, across domains, for men and for women. Every year on MAT was associated with a 7% increase in the odds of women engaging with criminal activity (OR = 1.07, 95% CI 1.02, 1.12, p = 0.006). Conclusions Men and women had different SF profiles and psychological symptoms scores while on MAT. The length of time on MAT increased the risk of criminal activity in women, and overall, duration of MAT was not associated with improvement in SF. This may suggest that MAT alone may not support continual improvements in SF in OUD.
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Affiliation(s)
- Emma A van Reekum
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Tea Rosic
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jacqueline Hudson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Nitika Sanger
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, ON, Canada.,Canadian Addiction Treatment Centres, Markham, ON, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Biostatistics Unit, Research Institute at St Joseph's Healthcare, Hamilton, ON, Canada.,Departments of Pediatrics/Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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