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Chiorean A, Jones BDM, Murong M, Gonzalez-Torres C, Kloiber S, Ortiz A, Rosenblat JD, Mulsant BH, Husain MI. Prescribed psychostimulants and other pro-cognitive medications in bipolar disorder: A systematic review and meta-analysis of recurrence of manic symptoms. Bipolar Disord 2024. [PMID: 38670627 DOI: 10.1111/bdi.13440] [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] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Clinicians are often hesitant to prescribe psychostimulants in bipolar disorder (BD) due to concerns of inducing (hypo)mania, despite limited published evidence on associations between prescribed psychostimulant use and recurrence of mood episodes in BD. The current systematic review and meta-analysis evaluated the emergence of (hypo)manic symptoms in patients with BD receiving prescribed psychostimulants or other pro-cognitive medications in euthymic or depressive states. METHODS A systematic search was performed of MEDLINE, Embase, and PsychINFO from inception to April 5, 2023 and search of Clinicaltrials.gov and Clinicaltrialsregister.eu for unpublished data. References of included studies were hand-searched. Randomized trials and prospective longitudinal studies that evaluated psychostimulants and non-stimulant medications recommended for the treatment of ADHD by the Canadian ADHD practice guidelines were included. The review was reported in line with PRISMA guidelines and was preregistered on PROSPERO (CRD42022358588). RESULTS After screening 414 unique records, we included 27 studies, of which five reported data that was quantitatively synthesized (n = 1653). The use of psychostimulants in BD was not associated with increased scores on the Young Mania Rating Scale in patients who were in a euthymic or depressed state (SMD IV -0.17; 95% CI, -0.40 to 0.06) compared to placebo. There was a high degree of study-level heterogeneity (I2 = 80%). A qualitative synthesis of studies revealed a limited risk of medication-induced manic symptoms. CONCLUSIONS Our review provides preliminary evidence to suggest psychostimulants and non-stimulant ADHD medications have a limited risk of precipitating (hypo)mania symptoms. More extensive studies evaluating the safety and efficacy of these medications are warranted.
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Affiliation(s)
- Andreea Chiorean
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada
| | - Brett D M Jones
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada
| | - Mijia Murong
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada
| | - Christina Gonzalez-Torres
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada
| | - Stefan Kloiber
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada
| | - Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada
| | - Joshua D Rosenblat
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction & Mental Health (CAMH), Toronto, Ontario, Canada
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Cohen LJ, Liang Y, Peterkin D, McGibbon K, Rappa F, Rogers ML, You S, Chistopolskaya K, Enikolopov S, Barzilay S, Menon V, Husain MI, Dudeck M, Streb J, Çinka E, Yilmaz FK, Kuśmirek O, Valvassori SS, Blum Y, Galynker I. Relationship Between Severity and Length of Exposure to COVID-19 Parameters and Resulting Government Responses and the Suicide Crisis Syndrome (SCS). Disaster Med Public Health Prep 2024; 18:e68. [PMID: 38618875 DOI: 10.1017/dmp.2023.235] [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] [Indexed: 04/16/2024]
Abstract
OBJECTIVE The COVID-19 pandemic has had a globally devastating psychosocial impact. A detailed understanding of the mental health implications of this worldwide crisis is critical for successful mitigation of and preparation for future pandemics. Using a large international sample, we investigated in the present study the relationship between multiple COVID-19 parameters (both disease characteristics and government responses) and the incidence of the suicide crisis syndrome (SCS), an acute negative affect state associated with near-term suicidal behavior. METHODS Data were collected from 5528 adults across 10 different countries in an anonymous web-based survey between June 2020 and January 2021. RESULTS Individuals scoring above the SCS cut-off lived in countries with higher peak daily cases and deaths during the first wave of the pandemic. Additionally, the longer participants had been exposed to markers of pandemic severity (eg, lockdowns), the more likely they were to screen positive for the SCS. Findings reflected both country-to-country comparisons and individual variation within the pooled sample. CONCLUSION Both the pandemic itself and the government interventions utilized to contain the spread appear to be associated with suicide risk. Public policy should include efforts to mitigate the mental health impact of current and future global disasters.
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Affiliation(s)
- Lisa J Cohen
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Yinan Liang
- Department of Psychology, University of Georgia, GA, USA
| | - Devon Peterkin
- Teachers College, Department of Psychology, Columbia University, NY, USA
| | - Kamryn McGibbon
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Frank Rappa
- Department of Psychology, Binghamton University, NY, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, TX, USA
| | - Sungeun You
- Department of Psychology, Chungbuk National University, Cheongju, Korea
| | - Ksenia Chistopolskaya
- Eramishantsev Moscow, Department of Psychiatry, City Clinical Hospital, Moscow, Russia
| | | | - Shira Barzilay
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India
| | - M Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, ON, Canada
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Elif Çinka
- Department of Health Management, University of Health Sciences, İstanbul, Turkey
| | - Fatma Kantas Yilmaz
- Department of Health Management, University of Health Sciences, İstanbul, Turkey
| | | | - Samira S Valvassori
- Program of Health Sciences, Universidade do Extremo Sul Catarinense, Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Criciuma, Brazil
| | - Yarden Blum
- Department of Psychology, The College of Management Academic Studies, Rishon LeZion, Israel
| | - Igor Galynker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
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Xue S, Massazza A, Akhter-Khan SC, Wray B, Husain MI, Lawrance EL. Mental health and psychosocial interventions in the context of climate change: a scoping review. Npj Ment Health Res 2024; 3:10. [PMID: 38609540 PMCID: PMC10956015 DOI: 10.1038/s44184-024-00054-1] [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] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 01/09/2024] [Indexed: 04/14/2024]
Abstract
The evidence on the impacts of climate change on mental health and wellbeing is growing rapidly. The objective of this scoping review is to understand the extent and type of existing mental health and psychosocial interventions aimed at addressing the mental health and psychosocial impacts of climate change. A scoping review methodology was followed. MEDLINE, PsycINFO, and Web of Science databases were searched from inception to May 2022. Comprehensive gray literature search, including expert consultation, was conducted to identify interventions for which peer-reviewed academic literature may not yet be available. Data on intervention type, setting, climate stressor, mental health outcome, evaluation, and any other available details were extracted, and results were summarized narratively. Academic literature search identified 16 records and gray literature search identified a further 24 records. Altogether, 37 unique interventions or packages of interventions were identified. The interventions act at the levels of microsystem, mesosystem, exosystem, and macrosystem through diverse mechanisms. While most interventions have not been formally evaluated, promising preliminary results support interventions in low- and middle-income-country settings disproportionately affected by climate disasters. Interventions from multidisciplinary fields are emerging to reduce psychological distress and enhance mental health and wellbeing in the context of climate change. This scoping review details existing evidence on the interventions and summarizes intervention gaps and lessons learned to inform continued intervention development and scale-up interventions.
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Affiliation(s)
- Siqi Xue
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Alessandro Massazza
- Centre for Global Mental Health, The London School of Hygiene & Tropical Medicine, London, UK
| | - Samia C Akhter-Khan
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
| | - Britt Wray
- Department of Psychiatry and Behavioral Sciences of Stanford Medicine, Stanford, US
| | - M Ishrat Husain
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Emma L Lawrance
- Institute of Global Health Innovation, Imperial College London, London, UK
- Grantham Institute - Climate Change and the Environment, Imperial College London, London, UK
- Mental Health Innovations, London, UK
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Das A, Hendershot CS, Husain MI, Knyahnytska Y, Elsaid S, Le Foll B, Kloiber S. Perceptions, Experiences, and Patterns of Cannabis Use in Individuals with Mood and Anxiety Disorders in the Context of Cannabis Legalization and Medical Cannabis Program in Canada - A Qualitative Study. Pharmacopsychiatry 2024. [PMID: 38467156 DOI: 10.1055/a-2264-1047] [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] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Perceptions of cannabis as a potential medical treatment for mood and anxiety disorders have been increasing in the context of legalizations, availability, and medical cannabis programs, though current evidence predominately indicates risks and negative effects of cannabis use (CU) on mental health outcomes. This study aims to understand motivations, perceptions, effects, and patterns of CU in individuals with mood and anxiety disorders. METHODS Thirty-six adult patients diagnosed with mood or anxiety disorders, obsessive-compulsive disorder, or posttraumatic stress disorder who were currently using cannabis completed an in-depth qualitative interview on individual motivations, perceptions, experiences, effects, and patterns of their CU. The thematic analysis focused on phases of CU and sources of cannabis products and information. RESULTS Reported motivations for initiation of CU included curiosity, peer pressure, and dissatisfaction with conventional treatments. Factors such as psychotropic effects and coping with mental health symptoms and insomnia contributed to the continuation of CU. More negative effects, including cognitive dysfunction, worsening of mood, and anxiety symptoms, were acknowledged with ongoing CU. Concerning findings included common initiation of CU before age 18, combined medical and recreational CU, rare consultation of medical professionals on CU, and potential effects and harms. DISCUSSION Findings indicate individual complexity of motivations, perceptions, and patterns of CU in the study population. The reported potential beneficial effects of specific cannabis products should be further investigated. Findings emphasize patient-provider dialogue on both CU and conventional treatments. Information from this study can contribute to and inform the development of education, prevention, and intervention strategies.
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Affiliation(s)
- Ankita Das
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Christian S Hendershot
- Department of Psychiatry and Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, NC, USA
| | - M Ishrat Husain
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yuliya Knyahnytska
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Sonja Elsaid
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Bernard Le Foll
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
| | - Stefan Kloiber
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
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Sayrafizadeh N, Ledwos N, Husain MI, Castle DJ. Aggressive behaviours associated with MDMA and psychedelics: a narrative review. Acta Neuropsychiatr 2024:1-13. [PMID: 38329106 DOI: 10.1017/neu.2024.3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Monoamine neurotransmitters play a role in aggression, especially when altered by illicit substances. However, some literature suggests that not all illicit substances may lead to aggression, notably psychedelics. This narrative review investigates the associations between serotonergic psychedelics and MDMA on aggressive behaviour. METHODS PubMed and PsycINFO were searched for original, peer-reviewed articles evaluating the effects of serotonergic psychedelics and 3,4-methyl enedioxy methamphetamine (MDMA) on violent and aggressive behaviour using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS After removing duplicates, a total of 555 articles were screened, with 16 meeting the inclusion criteria. One additional article was obtained through reference screening bringing the total to 17 articles. Of these 17 articles, 14 studies focused on MDMA and three on serotonergic psychedelics. Findings were mixed, with some results demonstrating increased aggression following psychedelics and others suggesting protective effects. Limitations in the current literature include varied definitions of psychedelics, lack of standardised objective outcome measures and failure to control for confounding. CONCLUSION As psychedelic research continues to expand, further assessment on the effects of serotonergic psychedelics and MDMA on aggressive behaviour is required.
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Affiliation(s)
- Negar Sayrafizadeh
- Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Nicole Ledwos
- Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - M Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - David J Castle
- Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Kim HK, Melamed OC, Sloan M, Husain MI, Rodie DJ, Perivolaris A, Kurdyak P, Oslin DW, Geist R, Selby P, Mulsant BH. A computer-assisted telephone collaborative care intervention provided by lay providers for the treatment of comorbid depression and at-risk drinking: Analysis of a randomized controlled trial. J Subst Use Addict Treat 2024; 157:209207. [PMID: 37939903 DOI: 10.1016/j.josat.2023.209207] [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] [Received: 02/20/2023] [Revised: 06/08/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Virtual collaborative care for people with comorbid depression and at-risk drinking lacks strong evidence. Our aim was to assess the impact of 12 months of telephone collaborative care (tCC) versus enhanced usual care (eUC) on depression and drinking. METHODS We performed a secondary analysis of the Primary care Assessment and Research of a Telephone intervention for Neuropsychiatric conditions with Education and Resources study (PARTNERs), a blinded randomized controlled trial. We examined 144 participants with comorbid depression and at-risk drinking, of which 129 were from the original sample whose data have been published, and 15 were studied since the original report had been published. PARTNERs compared eUC consisting of usual care plus assessment of symptoms at baseline, and 4, 8, and 12 months later vs. tCC consisting of eUC plus telephone-based coaching and symptom monitoring provided by a lay mental health technician to patients supervised by a psychiatrist. The study assessed depression response and remission using logistic regression; we assessed trajectory of drinking using Generalized-estimating equations (GEE). Baseline factors associated with likelihood of not exceeding number of drinks at 12 months were identified using decision trees. RESULTS tCC produced a faster decline in the number of drinks than eUC (Wald Χ2 = 9.47, p = 0.02). However, drinking and depression outcomes did not differ significantly between the two groups at the end of treatment. Higher alcohol consumption at baseline (≥18 standard drinks per week in the tCC group and ≥11 standard drinks per week in the eUC group) was associated with a higher likelihood of having at-risk drinking after 12 months of treatment. CONCLUSIONS Our findings suggest that, compared to eUC, tCC may accelerate drinking reductions in patients with comorbid depression and at-risk drinking. Both treatments were equally effective at the end of treatment for both depression and drinking outcomes.
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Affiliation(s)
- Helena K Kim
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Osnat C Melamed
- Department of Family and community Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada; Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Sloan
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada; Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - David J Rodie
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | | | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - David W Oslin
- University of Pennsylvania and the Department of Veteran Affairs, Philadelphia, PA, USA
| | - Rose Geist
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Family and community Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
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Ortiz A, Park Y, MacLean S, Husain MI, Sanches M, Ravindran A, Mulsant BH. A History of Suicide Attempt Is Associated with Increased Sympathetic Activation in Bipolar Disorder. Can J Psychiatry 2024; 69:126-137. [PMID: 37583363 PMCID: PMC10789230 DOI: 10.1177/07067437231194334] [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: 08/17/2023]
Abstract
OBJECTIVE Suicide risk in bipolar disorder (BD) is estimated to be up to 20 times higher than in the general population. While there is a large body of evidence suggesting that increased sympathetic activation is associated with disease and death, there is a paucity of research on the role of autonomic nervous system (ANS) dysfunction in patients with BD who have attempted suicide. METHODS Fifty-three participants with BD used a wearable device to assess the association between history of suicide attempt, current suicidal ideation, and ANS dysfunction, including measures of heart rate variability (HRV) and respiratory rate. Data were analyzed in a series of unadjusted and adjusted bivariate models of association controlling for relevant variables. RESULTS A history of suicide attempts was significantly associated with an increase in respiratory rate (p < 0.01). These results remained significant after adjusting for age, BMI, and current mood state. There was no association between current suicidal ideation and heart rate or respiratory rate. In the frequency domain, HRV parameters suggest reduced parasympathetic (i.e., vagal) activity in participants with a history of suicide attempts and in those with current suicidality, suggesting changes in sympathicovagal balance in BD. CONCLUSIONS Our results suggest that changes in the ANS in patients with BD and a history of suicide attempt are not restricted to pure vagally mediated HRV parameters, but rather signal a general ANS dysregulation. This ANS imbalance may be contributing to illness burden and cardiovascular disease. Further research on the relationship between ANS and suicidality in BD is needed.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Yunkyung Park
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Stephane MacLean
- Institute for Mental Health Research, The Royal Ottawa Hospital, Ottawa, Ontario, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Marcos Sanches
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Arun Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Gonzalez-Torres C, Mulsant BH, Husain MI, Alda M, Young RC, Ortiz A. Challenges in defining treatment-resistant mania in adults: A systematic review. Bipolar Disord 2024; 26:7-21. [PMID: 37963496 PMCID: PMC10922285 DOI: 10.1111/bdi.13383] [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] [Indexed: 11/16/2023]
Abstract
OBJECTIVES To review the definitions of treatment-resistant mania (TRM) in the literature and propose criteria for an operationalized definition. METHODS A systematic search of five databases (MEDLINE, EMBASE, PsychInfo, Cochrane Central, and CINAHL) and data extraction of eligible articles. RESULTS In total, 47 articles addressing the concept of TRM were included, comprising 16 case reports, 11 case series, 3 randomized clinical trials, 8 open-label clinical trials, 1 experimental study, 7 narrative reviews, and 1 systematic review. While reviews discussed several challenges in defining TRM, definitions varied substantially based on different criteria for severity of mania, duration of mania, and use of specific therapeutic agents with minimal dosages and duration of treatment. Only a handful of the reviewed articles operationalized these criteria. CONCLUSION While the concept of TRM has been discussed in the literature for over three decades, we could not find an agreed-upon operationalized definition based on specific criteria. We propose and discuss a possible definition that could be used by clinicians to guide their practice and by researchers to assess the prevalence of TRM and develop and test interventions targeting TRM.
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Affiliation(s)
- Christina Gonzalez-Torres
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M. Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Robert C. Young
- Department of Psychiatry, Weil Cornell Medicine, New York, New York, US
| | - Abigail Ortiz
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Husain MI, Foster JA, Mason BL, Chen S, Zhao H, Wang W, Rotzinger S, Rizvi S, Ho K, Lam R, MacQueen G, Milev R, Frey BN, Müller D, Turecki G, Jha M, Trivedi M, Kennedy SH. Pro-inflammatory markers are associated with response to sequential pharmacotherapy in major depressive disorder: a CAN-BIND-1 report. CNS Spectr 2023; 28:739-746. [PMID: 37218291 DOI: 10.1017/s109285292300233x] [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] [Indexed: 05/24/2023]
Abstract
OBJECTIVE There is limited literature on associations between inflammatory tone and response to sequential pharmacotherapies in major depressive disorder (MDD). METHODS In a 16-week open-label clinical trial, 211 participants with MDD were treated with escitalopram 10-20 mg daily for 8 weeks. Responders continued escitalopram while non-responders received adjunctive aripiprazole 2-10 mg daily for 8 weeks. Plasma levels of pro-inflammatory markers-C-reactive protein, interleukin (IL)-1β, IL-6, IL-17, interferon-gamma (IFN)-Γ, tumor necrosis factor (TNF)-α, and Chemokine C-C motif ligand-2 (CCL-2)-measured at baseline, and after 2, 8 and 16 weeks were included in logistic regression analyzes to assess associations between inflammatory markers and treatment response. RESULTS Pre-treatment IFN-Γ and CCL-2 levels were significantly associated with a lower of odds of response to escitalopram at 8 weeks. Increases in CCL-2 levels from weeks 8 to 16 in escitalopram non-responders were significantly associated with higher odds of non-response to adjunctive aripiprazole at week 16. CONCLUSION Higher pre-treatment levels of IFN-Γ and CCL-2 were associated with non-response to escitalopram. Increasing levels of these pro-inflammatory markers may be associated with non-response to adjunctive aripiprazole. These findings require validation in independent clinical populations.
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Affiliation(s)
- M Ishrat Husain
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jane A Foster
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Brittany L Mason
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sheng Chen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Haoyu Zhao
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
| | - Sakina Rizvi
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
| | - Raymond Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Daniel Müller
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gustavo Turecki
- The Douglas Hospital, Montreal, QC, Canada
- Department of Psychiatry. McGill University, Toronto, ON, Canada
| | - Manish Jha
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States
| | - Madhukar Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
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10
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Koshimori Y, Cusimano MD, Vieira EL, Rusjan PM, Kish SJ, Vasdev N, Moriguchi S, Boileau I, Chao T, Nasser Z, Ishrat Husain M, Faiz K, Braga J, Meyer JH. Astrogliosis marker 11C-SL25.1188 PET in traumatic brain injury with persistent symptoms. Brain 2023; 146:4469-4475. [PMID: 37602426 PMCID: PMC10629767 DOI: 10.1093/brain/awad279] [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: 10/14/2022] [Revised: 06/22/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Traumatic brain injury (TBI) is common but little is known why up to a third of patients have persisting symptoms. Astrogliosis, a pathophysiological response to brain injury, may be a potential therapeutic target, but demonstration of astrogliosis in the brain of humans with TBI and persistent symptoms is lacking. Astroglial marker monoamine oxidase B (MAO-B) total distribution volume (11C-SL25.1188 VT), an index of MAO-B density, was measured in 29 TBI and 29 similarly aged healthy control cases with 11C-SL25.1188 PET, prioritizing prefrontal cortex (PFC) and cortex proximal to cortical convexity. Correlations of PFC 11C-SL25.1188 VT with psychomotor and processing speed; and serum blood measures implicated in astrogliosis were determined. 11C-SL25.1188 VT was greater in TBI in PFC (P = 0.00064) and cortex (P = 0.00038). PFC 11C-SL25.1188 VT inversely correlated with Comprehensive Trail Making Test psychomotor and processing speed (r = -0.48, P = 0.01). In participants scanned within 2 years of last TBI, PFC 11C-SL25.1188 VT correlated with serum glial fibrillary acid protein (r = 0.51, P = 0.037) and total tau (r = 0.74, P = 0.001). Elevated 11C-SL25.1188 VT argues strongly for astrogliosis and therapeutics modifying astrogliosis towards curative phenotypes should be tested in TBI with persistent symptoms. Given substantive effect size, astrogliosis PET markers should be applied to stratify cases and/or assess target engagement for putative therapeutics targeting astrogliosis.
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Affiliation(s)
- Yuko Koshimori
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, and Campbell Family Mental Health Research Institute, CAMH, Toronto, M5T 1R8, Canada
| | - Michael D Cusimano
- Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, M5B 1W8, Canada
| | - Erica L Vieira
- Molecular Neurobiology and Campbell Family Mental Health Research Institute, CAMH, Toronto, M5T 1R8Canada
- Department of Psychiatry, University of Toronto, Toronto, M5T 1R8Canada
| | - Pablo M Rusjan
- Douglas Research Centre and Department of Psychiatry, McGill University, Montreal, H3A 1A1, Canada
| | - Stephen J Kish
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, and Campbell Family Mental Health Research Institute, CAMH, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, Toronto, M5T 1R8Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Neil Vasdev
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, and Campbell Family Mental Health Research Institute, CAMH, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, Toronto, M5T 1R8Canada
| | - Sho Moriguchi
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, and Campbell Family Mental Health Research Institute, CAMH, Toronto, M5T 1R8, Canada
| | - Isabelle Boileau
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, and Campbell Family Mental Health Research Institute, CAMH, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, Toronto, M5T 1R8Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Thomas Chao
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, V6T 2A1, Canada
| | - Zahra Nasser
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, and Campbell Family Mental Health Research Institute, CAMH, Toronto, M5T 1R8, Canada
| | - M Ishrat Husain
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, and Campbell Family Mental Health Research Institute, CAMH, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, Toronto, M5T 1R8Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Khunsa Faiz
- Department of Diagnostic Radiology, Hamilton Health Sciences, McMaster University, Hamilton, L8S 4K1, Canada
| | - Joeffre Braga
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, and Campbell Family Mental Health Research Institute, CAMH, Toronto, M5T 1R8, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Jeffrey H Meyer
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, and Campbell Family Mental Health Research Institute, CAMH, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, Toronto, M5T 1R8Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada
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11
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Haikazian S, Chen-Li DCJ, Johnson DE, Fancy F, Levinta A, Husain MI, Mansur RB, McIntyre RS, Rosenblat JD. Psilocybin-assisted therapy for depression: A systematic review and meta-analysis. Psychiatry Res 2023; 329:115531. [PMID: 37844352 DOI: 10.1016/j.psychres.2023.115531] [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: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
The aim of this review was to determine the effect of psilocybin on depressive symptoms in patients diagnosed with life-threatening illnesses or major depressive disorder. Systematic searches were conducted to search for randomized clinical trials and open-label trials that evaluated depression symptoms after psilocybin therapy. Data was pooled using a random-effects model. The primary outcome was the standardized mean difference (SMD) in depression severity, determined by calculating the change in depression ratings from baseline to the primary endpoint in the psilocybin arm versus the control arm. The literature search yielded 1734 studies, and 13 studies (n = 686) were included in either qualitative and/or quantitative analyses. The meta-analysis included 9 studies (pooled n = 596) and yielded a large effect size in favour of psilocybin (SMD = -0.78; p<0.001). Risk ratios for response and remission were large and significant in favour of psilocybin. A review of open-label trials showed robust decreases in depressive symptoms following psilocybin administration. These findings provide preliminary evidence for antidepressant efficacy with psilocybin-assisted psychotherapy, however, further studies are needed to evaluate safety and efficacy and to optimize treatment protocols.
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Affiliation(s)
- Sipan Haikazian
- Mood Disorders Psychopharmacology Unit, Poul Hansen Depression Centre, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - David C J Chen-Li
- Mood Disorders Psychopharmacology Unit, Poul Hansen Depression Centre, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Danica E Johnson
- Mood Disorders Psychopharmacology Unit, Poul Hansen Depression Centre, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Farhan Fancy
- Mood Disorders Psychopharmacology Unit, Poul Hansen Depression Centre, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Anastasia Levinta
- Mood Disorders Psychopharmacology Unit, Poul Hansen Depression Centre, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - M Ishrat Husain
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Poul Hansen Depression Centre, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Depression Centre, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Poul Hansen Depression Centre, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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12
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Patel A, Daros AR, Irwin SH, Lau P, Hope IM, Perkovic SJM, Laposa JM, Husain MI, Levitan RD, Kloiber S, Quilty LC. Associations between rumination, depression, and distress tolerance during CBT treatment for depression in a tertiary care setting. J Affect Disord 2023; 339:74-81. [PMID: 37392943 DOI: 10.1016/j.jad.2023.06.063] [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: 12/15/2022] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Rumination is strongly associated with depressive symptom severity and course. However, changes in rumination during outpatient cognitive behavioral therapy (CBT), and their links to baseline features such as distress tolerance and clinical outcomes, have received limited attention. METHODS 278 outpatients with depression received group or individual CBT. Measures of rumination, distress tolerance, and depression symptom severity were assessed at baseline and periodically during treatment. Mixed effect and regression-based models evaluated changes over time, and associations between rumination, distress tolerance and depression severity. RESULTS Depression and rumination decreased throughout acute treatment. Rumination reduction was concurrently associated with depressive symptom reduction. Lower levels of rumination at each time point prospectively predicted lower depressive symptoms at the next time point. Distress tolerance measured at baseline was positively associated with depression symptom severity; the indirect effect on post-treatment depression symptoms via rumination measured mid-treatment was nonsignificant when rumination at baseline was accounted for. Changes in and associations between depression and rumination were replicated in sensitivity analyses; although changes in depression and rumination were smaller in magnitude in patients receiving treatment during COVID-19. LIMITATIONS Additional assessment points would permit a more nuanced assessment of the role rumination may play in mediating the associations between distress tolerance and depression severity. Additional investigation of treatments in community settings may also further our understanding of variability in rumination during depression treatment. CONCLUSIONS The current study provides unique real-world support for variability in rumination as a key indicator of change over the course of CBT for depression.
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Affiliation(s)
- Alina Patel
- Campbell Family Mental Health Research Institute, CAMH, Canada; University of Toronto, Canada
| | | | | | - Parky Lau
- Toronto Metropolitan University, Canada
| | - Ingrid M Hope
- Campbell Family Mental Health Research Institute, CAMH, Canada
| | | | - Judith M Laposa
- Campbell Family Mental Health Research Institute, CAMH, Canada; University of Toronto, Canada
| | - M Ishrat Husain
- Campbell Family Mental Health Research Institute, CAMH, Canada; University of Toronto, Canada
| | - Robert D Levitan
- Campbell Family Mental Health Research Institute, CAMH, Canada; University of Toronto, Canada
| | - Stefan Kloiber
- Campbell Family Mental Health Research Institute, CAMH, Canada; University of Toronto, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, CAMH, Canada; University of Toronto, Canada.
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13
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Ishrat Husain M, Rodie DJ, Perivolaris A, Sanches M, Crawford A, Fitzgibbon KP, Levinson A, Geist R, Kurdyak P, Mitchell B, Oslin D, Sunderji N, Mulsant BH. A Collaborative-Care Telephone-Based Intervention for Depression, Anxiety, and at-Risk Drinking in Primary Care: The PARTNERs Randomized Clinical Trial. Can J Psychiatry 2023; 68:732-744. [PMID: 36855791 PMCID: PMC10517649 DOI: 10.1177/07067437231156243] [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: 03/02/2023]
Abstract
BACKGROUND Collaborative care (CC) could improve outcomes in primary care patients with common mental conditions. We assessed the effectiveness of a transdiagnostic model of telephone-based CC (tCC) delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking. METHODS PARTNERS was a pragmatic trial in 502 primary care adults presenting with depressive symptoms, anxiety symptoms, or at-risk drinking randomized to (1) usual care by primary care providers (PCPs) enhanced with the results of computer-assisted telephone-based assessments (at baseline and 4, 8, and 12 months later) (enhanced usual care [eUC]) or (2) tCC consisting of eUC plus frequent telephone coaching and psychoeducation provided by mental health technicians who also communicated to the PCP recommendations from a psychiatrist for evidence-based pharmacotherapy, psychotherapy, or, when indicated, referrals to mental health services. The primary analysis compared the change on the 9-item Patient Health Questionnaire (PHQ-9) in participants presenting with depression (n = 366) randomized to tCC versus eUC. Secondary analyses compared changes on the Generalized Anxiety Disorder-7 scale (GAD-7) in those presenting with anxiety (n = 298); or change in the number of weekly drinks in those presenting with at-risk drinking (n = 176). RESULTS There were no treatment or time×treatment effects between tCC and eUC on PHQ-9 scores for patients with depression during the 12-month follow-up. However, there was a treatment effect (tCC > eUC) on GAD-7 scores in those with anxiety and a time×treatment interaction effect on the number of weekly drinks (tCC > eUC) in those with at-risk drinking. CONCLUSION Implementing transdiagnostic tCC for common mental disorders using lay providers appears feasible in Canadian primary care. While tCC was not better than eUC for depression, there were some benefits for those with anxiety or at-risk drinking. Future studies will need to confirm whether tCC differentially benefits patients with depression, anxiety, or at-risk drinking.
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Affiliation(s)
- M. Ishrat Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David J. Rodie
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Marcos Sanches
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Andrea Levinson
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rose Geist
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - David Oslin
- Department of Psychiatry, University of Pennsylvania and the Department of Veteran Affairs, Philadelphia, PA, USA
| | - Nadiya Sunderji
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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14
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Jones BDM, Fernandes BS, Husain MI, Ortiz A, Rajji TK, Blumberger DM, Butters MA, Gildengers AG, Shablinski T, Voineskos A, Mulsant BH. A cross-sectional study of cognitive performance in bipolar disorder across the lifespan: the cog-BD project. Psychol Med 2023; 53:6316-6324. [PMID: 36464659 PMCID: PMC10520592 DOI: 10.1017/s0033291722003622] [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: 08/16/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neuroprogressive models of the trajectory of cognitive dysfunction in patients with bipolar disorder (BD) have been proposed. However, few studies have explored the relationships among clinical characteristics of BD, cognitive dysfunction, and aging. METHODS We conducted a cross-sectional analysis in euthymic participants with the MATRICS Cognitive Consensus Battery, the Trail Making Test B, the Stroop Test, and the Wechsler Test of Adult Reading. Age- and gender-equated control participants without a mental disorder ['Healthy Controls' - HC)] were assessed similarly. We compared cognitive performance both globally and in seven domains in four groups: younger BD (age ⩽49 years; n = 70), older BD (age ⩾50 years; n = 48), younger HC (n = 153), and older HC (n = 44). We also compared the BD and HC groups using age as a continuous measure. We controlled for relevant covariates and applied a Bonferroni correction. RESULTS Our results support both an early impairment ('early hit') model and an accelerated aging model: impairment in attention/vigilance, processing speed, and executive function/working memory were congruent with the accelerated aging hypothesis whereas impairment in verbal memory was congruent with an early impairment model. BD and HC participants exhibited similar age-related decline in reasoning/problem solving and visuospatial memory. There were no age- or diagnosis-related differences in social cognition. CONCLUSION Our findings support that different cognitive domains are affected differently by BD and aging. Longitudinal studies are needed to explore trajectories of cognitive performance in BD across the lifespan.
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Affiliation(s)
- Brett D. M. Jones
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brisa S. Fernandes
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - M. Ishrat Husain
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Abigail Ortiz
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K. Rajji
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Toronto Dementia Research Alliance, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel M. Blumberger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Meryl A. Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Tatiana Shablinski
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle Voineskos
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H. Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Toronto Dementia Research Alliance, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Husain MI, Yatham LN. Treatment options for acute bipolar depression: an urgent unmet clinical need. Lancet Psychiatry 2023; 10:655-657. [PMID: 37595995 DOI: 10.1016/s2215-0366(23)00255-9] [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] [Received: 06/29/2023] [Accepted: 07/12/2023] [Indexed: 08/20/2023]
Affiliation(s)
- M Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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16
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Wong S, Yu AY, Fabiano N, Finkelstein O, Pasricha A, Jones BDM, Rosenblat JD, Blumberger DM, Mulsant BH, Husain MI. Beyond Psilocybin: Reviewing the Therapeutic Potential of Other Serotonergic Psychedelics in Mental and Substance Use Disorders. J Psychoactive Drugs 2023:1-17. [PMID: 37615379 DOI: 10.1080/02791072.2023.2251133] [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: 08/25/2023]
Abstract
There has been a resurgence of interest in the use of psychedelic therapies for several mental and substance use disorders. Psilocybin, a "classic" serotonergic psychedelic, has emerged as one of the primary compounds of interest in clinical research. While research on psilocybin's potential mental health benefits has grown, data on the safety and efficacy of other serotonergic psychedelics remain limited. A comprehensive scoping review on the use of mescaline, ibogaine, ayahuasca, N,N-dimethyltryptamine (DMT), and lysergic acid diethylamide (LSD) in the treatment of mental and substance disorders was conducted. Independent reviewers screened titles, abstracts, and full texts and conducted data extraction. Seventy-seven studies met the inclusion criteria. There were 43 studies of LSD, 24 studies of ayahuasca, 5 studies of DMT, 5 studies of ibogaine, and 5 studies of mescaline. Commonly reported benefits included improved mood and anxiety symptoms, improved insight, reduced substance use, improved relationships, and decreased vegetative symptoms. Commonly reported adverse effects were psychological, neurological, physical, and gastrointestinal in nature. Serious adverse events (homicide and suicide) were reported in published studies of LSD. In conclusion, there is only low-level evidence to support the safety and efficacy of non-psilocybin serotonergic psychedelics in individuals with mental and substance use disorders.
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Affiliation(s)
- Stanley Wong
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - An Yi Yu
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Fabiano
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Ofer Finkelstein
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Aryan Pasricha
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Brett D M Jones
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Joshua D Rosenblat
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Mood Disorder Psychopharmacology Unit, Unity Health Network, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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17
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Abstract
Introduction: Physical activity has been shown to have a multitude of mental health benefits. However, there is limited evidence on the specific mental health benefits of boxing. We conducted a scoping review of academic and grey literature to map research of boxing exercises as an intervention in mental health and to identify gaps in knowledge. Methods: The authors utilized the PRISMA-ScR methodological approach and guidelines from the Joanna Briggs Institute and a structured search was completed from inception until August 08, 2022. Results: We identified 16 documents that used non-contact boxing as an exercise intervention that improved various mental health difficulties. Non-contact boxing exercises, usually in a high-intensity-interval training group setting, provided significant reduction in symptoms of anxiety, depression, PTSD and negative symptoms of schizophrenia. Non-contact boxing provided a cathartic release of anger and stress, with evidence of improved mood, self-esteem, confidence, concentration, metabolic burden, strength and coordination. Conclusions: Preliminary evidence indicates that non-contact boxing exercises are a promising intervention to improve mental health burden. Further well designed randomized controlled trials using group, non-contact boxing exercises as an intervention for common mental disorders are warranted to confirm its benefits for mental health.
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Affiliation(s)
- Johny Bozdarov
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health(CAMH), Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Brett D. M. Jones
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health(CAMH), Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Zafiris J. Daskalakis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health(CAMH), Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - M. Ishrat Husain
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health(CAMH), Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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18
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Husain MO, Khoso AB, Kiran T, Chaudhry N, Husain MI, Asif M, Ansari M, Rajput AH, Dawood S, Naqvi HA, Nizami AT, Tareen Z, Rumi J, Sherzad S, Khan HA, Bhatia MR, Siddiqui KMS, Zadeh Z, Mehmood N, Talib U, de Oliveira C, Naeem F, Wang W, Voineskos A, Husain N, Foussias G, Chaudhry IB. Culturally adapted psychosocial interventions (CaPSI) for early psychosis in a low-resource setting: study protocol for a large multi-center RCT. BMC Psychiatry 2023; 23:444. [PMID: 37328751 PMCID: PMC10276384 DOI: 10.1186/s12888-023-04904-8] [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: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Psychosis treatment guidelines recommend cognitive behaviour therapy (CBT) and family intervention (FI), for all patients with first episode psychosis (FEP), though guidance borrows heavily from literature in adults from high income countries. To our knowledge, there are few randomized controlled trials (RCTs) examining the comparative effect of these commonly endorsed psychosocial interventions in individuals with early psychosis from high-income countries and no such trials from low and middle-income countries (LMICs). The present study aims to confirm the clinical-efficacy and cost-effectiveness of delivering culturally adapted CBT (CaCBT) and culturally adapted FI (CulFI) to individuals with FEP in Pakistan. METHOD A multi-centre, three-arm RCT of CaCBT, CulFI, and treatment as usual (TAU) for individuals with FEP (n = 390), recruited from major centres across Pakistan. Reducing overall symptoms of FEP will be the primary outcome. Additional aims will include improving patient and carer outcomes and estimating the economic impact of delivering culturally appropriate psychosocial interventions in low-resource settings. This trial will assess the clinical-efficacy and cost-effectiveness of CaCBT and CulFI compared with TAU in improving patient (positive and negative symptoms of psychosis, general psychopathology, depressive symptoms, quality of life, cognition, general functioning, and insight) and carer related outcomes (carer experience, wellbeing, illness attitudes and symptoms of depression and anxiety). CONCLUSIONS A successful trial may inform the rapid scale up of these interventions not only in Pakistan but other low-resource settings, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority groups with FEP. TRIAL REGISTRATION NCT05814913.
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Affiliation(s)
- M O Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - A B Khoso
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - T Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - N Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - M I Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - M Asif
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - M Ansari
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | - A H Rajput
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | - S Dawood
- Centre for Clinical Psychology, University of the Punjab, Lahore, Pakistan
| | - H A Naqvi
- Department of Psychiatry, Dow University Health Sciences, Karachi, Pakistan
| | - A T Nizami
- Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Z Tareen
- Department of Psychiatry, Balochistan Institute of Psychiatry & Behavioural Sciences, Quetta, Pakistan
| | - J Rumi
- Department of Psychiatry, Balochistan Institute of Psychiatry & Behavioural Sciences, Quetta, Pakistan
| | - S Sherzad
- Department of Psychiatry, Balochistan Institute of Psychiatry & Behavioural Sciences, Quetta, Pakistan
| | - H A Khan
- Department of Psychiatry, Balochistan Institute of Psychiatry & Behavioural Sciences, Quetta, Pakistan
| | - M R Bhatia
- Department of Psychiatry, Peoples University of Medical and Health Sciences, Shaheed Benazirabad, Pakistan
| | | | - Z Zadeh
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - N Mehmood
- Institute for Mental Health, Karwan-E-Hayat, Karachi, Pakistan
| | - U Talib
- Institute for Mental Health, Karwan-E-Hayat, Karachi, Pakistan
| | - C de Oliveira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - F Naeem
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - W Wang
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - A Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - N Husain
- Mersey Care NHS Foundation Trust, Prescott, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - G Foussias
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - I B Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychiatry, Ziauddin University, Karachi, Pakistan
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19
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Hedemann TL, Asif M, Aslam H, Maqsood A, Bukhsh A, Kiran T, Ahsan U, Shahzad S, Zaheer J, Lane S, Chaudhry N, Husain MI, Husain MO. Clinicians', patients' and carers' perspectives on borderline personality disorder in Pakistan: A mixed methods study protocol. PLoS One 2023; 18:e0286459. [PMID: 37267274 DOI: 10.1371/journal.pone.0286459] [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: 08/23/2022] [Accepted: 05/12/2023] [Indexed: 06/04/2023] Open
Abstract
Borderline Personality Disorder (BPD) is a condition characterised by significant social and occupational impairment and high rates of suicide. In high income countries, mental health professionals carry negative attitudes towards patients with BPD, find it difficult to work with patients with BPD, and even avoid seeing these patients. Negative attitudes and stigma can cause patients to fear mistreatment by health care providers and create additional barriers to care. Patients' self-stigma and illness understanding BPD also affects treatment engagement and outcomes; better knowledge about mental illness predicts intentions to seek care. The perspectives of mental health clinicians and patients on BPD have not been researched in the Pakistani setting and likely differ from other settings due to economic, cultural, and health care system differences. Our study aims to understand the attitudes of mental health clinicians towards patients with BPD in Pakistan using a self-report survey. We also aim to explore explanatory models of illness in individuals with BPD and their family members/carers using a Short Explanatory Model Interview (SEMI). The results of this study are important as we know attitudes and illness understanding greatly impact care. Results of this study will help guide BPD-specific training for mental health clinicians who care for patients with BPD and help inform approaches to interventions for patients with BPD in Pakistan.
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Affiliation(s)
| | - Muqaddas Asif
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Huma Aslam
- Department of Psychiatry and Behavioral Sciences, Allama Iqbal Medical College and Jinnah Hospital, Lahore, Pakistan
| | | | - Ameer Bukhsh
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Umair Ahsan
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Salman Shahzad
- Institute of Clinical Psychology, University of Karachi, Karachi, Pakistan
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Steven Lane
- University of Liverpool, Liverpool, United Kingdom
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - M Omair Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
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20
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Braga J, Lepra M, Kish SJ, Rusjan PM, Nasser Z, Verhoeff N, Vasdev N, Bagby M, Boileau I, Husain MI, Kolla N, Garcia A, Chao T, Mizrahi R, Faiz K, Vieira EL, Meyer JH. Neuroinflammation After COVID-19 With Persistent Depressive and Cognitive Symptoms. JAMA Psychiatry 2023:2805366. [PMID: 37256580 PMCID: PMC10233457 DOI: 10.1001/jamapsychiatry.2023.1321] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Importance Persistent depressive symptoms, often accompanied by cognitive symptoms, commonly occur after COVID-19 illness (hereinafter termed COVID-DC, DC for depressive and/or cognitive symptoms). In patients with COVID-DC, gliosis, an inflammatory change, was suspected, but measurements of gliosis had not been studied in the brain for this condition. Objective To determine whether translocator protein total distribution volume (TSPO VT), a marker of gliosis that is quantifiable with positron emission tomography (PET), is elevated in the dorsal putamen, ventral striatum, prefrontal cortex, anterior cingulate cortex, and hippocampus of persons with COVID-DC. Design, Setting, and Participants This case-control study conducted at a tertiary care psychiatric hospital in Canada from April 1, 2021, to June 30, 2022, compared TSPO VT of specific brain regions in 20 participants with COVID-DC with that in 20 healthy controls. The TSPO VT was measured with fluorine F 18-labeled N-(2-(2-fluoroethoxy)benzyl)-N-(4-phenoxypyridin-3-yl)acetamide ([18F]FEPPA) PET. Main Outcomes and Measures The TSPO VT was measured in the dorsal putamen, ventral striatum, prefrontal cortex, anterior cingulate cortex, and hippocampus. Symptoms were measured with neuropsychological and psychological tests, prioritizing outcomes related to striatal function. Results The study population included 40 participants (mean [SD] age, 32.9 [12.3] years). The TSPO VT across the regions of interest was greater in persons with COVID-DC (mean [SD] age, 32.7 [11.4] years; 12 [60%] women) compared with healthy control participants (mean [SD] age, 33.3 [13.9] years; 11 [55%] women): mean (SD) difference, 1.51 (4.47); 95% CI, 0.04-2.98; 1.51 divided by 9.20 (17%). The difference was most prominent in the ventral striatum (mean [SD] difference, 1.97 [4.88]; 95% CI, 0.36-3.58; 1.97 divided by 8.87 [22%]) and dorsal putamen (mean difference, 1.70 [4.25]; 95% CI, 0.34-3.06; 1.70 divided by 8.37 [20%]). Motor speed on the finger-tapping test negatively correlated with dorsal putamen TSPO VT (r, -0.53; 95% CI, -0.79 to -0.09), and the 10 persons with the slowest speed among those with COVID-DC had higher dorsal putamen TSPO VT than healthy persons by 2.3 (2.30 divided by 8.37 [27%]; SD, 2.46; 95% CI, 0.92-3.68). Conclusions and Relevance In this case-control study, TSPO VT was higher in patients with COVID-DC. Greater TSPO VT is evidence for an inflammatory change of elevated gliosis in the brain of an individual with COVID-DC. Gliosis may be consequent to inflammation, injury, or both, particularly in the ventral striatum and dorsal putamen, which may explain some persistent depressive and cognitive symptoms, including slowed motor speed, low motivation or energy, and anhedonia, after initially mild to moderate COVID-19 illness.
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Affiliation(s)
- Joeffre Braga
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Mariel Lepra
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Stephen J Kish
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Pablo M Rusjan
- Douglas Research Centre, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Zahra Nasser
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Natasha Verhoeff
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Neil Vasdev
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Michael Bagby
- Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Isabelle Boileau
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - M Ishrat Husain
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Kolla
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Armando Garcia
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health Toronto, Ontario, Canada
| | - Thomas Chao
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, Canada
| | - Romina Mizrahi
- Douglas Research Centre, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Khunsa Faiz
- Department of Diagnostic Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Erica L Vieira
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health Toronto, Ontario, Canada
| | - Jeffrey H Meyer
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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21
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Ortiz A, Park Y, Gonzalez-Torres C, Alda M, Blumberger DM, Burnett R, Husain MI, Sanches M, Mulsant BH. Predictors of adherence to electronic self-monitoring in patients with bipolar disorder: a contactless study using Growth Mixture Models. Int J Bipolar Disord 2023; 11:18. [PMID: 37195477 DOI: 10.1186/s40345-023-00297-5] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/14/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Several studies have reported on the feasibility of electronic (e-)monitoring using computers or smartphones in patients with mental disorders, including bipolar disorder (BD). While studies on e-monitoring have examined the role of demographic factors, such as age, gender, or socioeconomic status and use of health apps, to our knowledge, no study has examined clinical characteristics that might impact adherence with e-monitoring in patients with BD. We analyzed adherence to e-monitoring in patients with BD who participated in an ongoing e-monitoring study and evaluated whether demographic and clinical factors would predict adherence. METHODS Eighty-seven participants with BD in different phases of the illness were included. Patterns of adherence for wearable use, daily and weekly self-rating scales over 15 months were analyzed to identify adherence trajectories using growth mixture models (GMM). Multinomial logistic regression models were fitted to compute the effects of predictors on GMM classes. RESULTS Overall adherence rates were 79.5% for the wearable; 78.5% for weekly self-ratings; and 74.6% for daily self-ratings. GMM identified three latent class subgroups: participants with (i) perfect; (ii) good; and (iii) poor adherence. On average, 34.4% of participants showed "perfect" adherence; 37.1% showed "good" adherence; and 28.2% showed poor adherence to all three measures. Women, participants with a history of suicide attempt, and those with a history of inpatient admission were more likely to belong to the group with perfect adherence. CONCLUSIONS Participants with higher illness burden (e.g., history of admission to hospital, history of suicide attempts) have higher adherence rates to e-monitoring. They might see e-monitoring as a tool for better documenting symptom change and better managing their illness, thus motivating their engagement.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
| | - Yunkyung Park
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Christina Gonzalez-Torres
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Daniel M Blumberger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Rachael Burnett
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Marcos Sanches
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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22
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Rogers ML, McMullen L, Liang Y, Perez N, Richards JA, Akülker G, Barzilay S, Bilici R, Blum Y, Chistopolskaya K, Dudeck M, Husain MI, Kuśmirek O, Luiz JM, Menon V, Pilecka B, Sadovnichaya V, Titze L, Valvassori SS, You S, Galynker I. Cross-national presence and sociodemographic correlates of the suicide crisis syndrome. J Affect Disord 2023; 329:1-8. [PMID: 36828142 DOI: 10.1016/j.jad.2023.02.076] [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: 10/29/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The Suicide Crisis Syndrome (SCS) has been proposed as an acute, pre-suicidal mental state that precedes imminent suicidal behavior; however, its cross-national applicability and sociodemographic correlates have not yet been determined. The present study assessed the presence and severity of the SCS in ten countries and examined several potential sociodemographic correlates (i.e., age, gender, marital status, race/ethnicity) of the SCS. METHODS 5528 community-based adults across 10 participating countries provided information on their SCS symptoms and sociodemographic characteristics in an anonymous online survey obtained via convenience sampling during the first year of the COVID-19 pandemic. RESULTS The SCS occurred cross-nationally, with rates ranging from 3.6% (Israel) to 16.2% (Poland). Those in the United States, South Korea, Poland, and Turkey had the highest severity of symptoms. Participants who were older, identified as cisgender men, and married tended to have lower rates of the SCS than their respective counterparts. There were minimal differences in the SCS by race/ethnicity. LIMITATIONS These data were both cross-sectional and collected via convenience sampling, limiting generalizability of findings and information about the SCS's predictive utility. CONCLUSIONS These findings support the cross-national presence of the SCS during the COVID-19 pandemic. Sociodemographic correlates aligned with those of suicidal behavior more generally, providing additional evidence for the concurrent/predictive validity of the SCS.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA.
| | - Lauren McMullen
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Yinan Liang
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Nazareth Perez
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Jenelle A Richards
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | | | - Shira Barzilay
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | | - Yarden Blum
- Department of Psychology, College of Management, Rishon LeZion, Israel
| | | | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
| | - M Ishrat Husain
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Oskar Kuśmirek
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Jhoanne M Luiz
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Vikas Menon
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | | | - Larissa Titze
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
| | - Samira S Valvassori
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Sungeun You
- Department of Psychology, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
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23
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Song J, Kambari Y, Amaev A, Ueno F, Torres Carmona E, De Luca V, Pollock B, Flint A, Ishrat Husain M, Graff-Guerrero A, Gerretsen P. Psilocybin to promote synaptogenesis in the brains of patients with mild cognitive impairment. Med Hypotheses 2023. [DOI: 10.1016/j.mehy.2023.111068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Affiliation(s)
- Joshua D Rosenblat
- Department of Psychiatry, University of Toronto, Toronto (Rosenblat, Leon-Carlyle, Husain, McIntyre); Braxia Health, Canadian Centre for Rapid Treatment Excellence, Mississauga, Ont., Canada (Rosenblat, Leon-Carlyle, Ali, McIntyre); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Husain); Brain and Cognition Discovery Foundation (BCDF), Toronto (McIntyre)
| | - Marisa Leon-Carlyle
- Department of Psychiatry, University of Toronto, Toronto (Rosenblat, Leon-Carlyle, Husain, McIntyre); Braxia Health, Canadian Centre for Rapid Treatment Excellence, Mississauga, Ont., Canada (Rosenblat, Leon-Carlyle, Ali, McIntyre); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Husain); Brain and Cognition Discovery Foundation (BCDF), Toronto (McIntyre)
| | - Shaun Ali
- Department of Psychiatry, University of Toronto, Toronto (Rosenblat, Leon-Carlyle, Husain, McIntyre); Braxia Health, Canadian Centre for Rapid Treatment Excellence, Mississauga, Ont., Canada (Rosenblat, Leon-Carlyle, Ali, McIntyre); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Husain); Brain and Cognition Discovery Foundation (BCDF), Toronto (McIntyre)
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto (Rosenblat, Leon-Carlyle, Husain, McIntyre); Braxia Health, Canadian Centre for Rapid Treatment Excellence, Mississauga, Ont., Canada (Rosenblat, Leon-Carlyle, Ali, McIntyre); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Husain); Brain and Cognition Discovery Foundation (BCDF), Toronto (McIntyre)
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto (Rosenblat, Leon-Carlyle, Husain, McIntyre); Braxia Health, Canadian Centre for Rapid Treatment Excellence, Mississauga, Ont., Canada (Rosenblat, Leon-Carlyle, Ali, McIntyre); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Husain); Brain and Cognition Discovery Foundation (BCDF), Toronto (McIntyre)
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25
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Husain MI, Umer M, Asif M, Khoso AB, Kiran T, Ansari M, Aslam H, Bhatia MR, Dogar FA, Husain MO, Khan HA, Mufti AA, Mulsant BH, Naeem F, Naqvi HA, de Oliveira C, Siddiqui MS, Tamizuddin A, Wang W, Zaheer J, Husain N, Chaudhry N, Chaudhry IB. Culturally adapted psychoeducation for bipolar disorder in a low-resource setting: protocol for a multicentre randomised controlled trial - ERRATUM. BJPsych Open 2023; 9:e11. [PMID: 36810130 PMCID: PMC9970177 DOI: 10.1192/bjo.2023.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Husain MI, Chaudhry IB, Khoso AB, Kiran T, Khan N, Ahmad F, Hodsoll J, Husain MO, Naqvi HA, Nizami AT, Chaudhry N, Khan HA, Minhas F, Meyer JH, Ansari MA, Mulsant BH, Husain N, Young AH. Effect of Adjunctive Simvastatin on Depressive Symptoms Among Adults With Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e230147. [PMID: 36808239 PMCID: PMC9941891 DOI: 10.1001/jamanetworkopen.2023.0147] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
IMPORTANCE Immune-metabolic disturbances have been implicated in the pathophysiology of major depressive disorder and may be more prominent in individuals with treatment-resistant depression (TRD). Preliminary trials suggest that lipid-lowering agents, including statins, may be useful adjunctive treatments for major depressive disorder. However, no adequately powered clinical trials have assessed the antidepressant efficacy of these agents in TRD. OBJECTIVE To assess the efficacy and tolerability of adjunctive simvastatin compared with placebo for reduction of depressive symptoms in TRD. DESIGN, SETTING, AND PARTICIPANTS This 12-week, double-blind, placebo-controlled randomized clinical trial was conducted in 5 centers in Pakistan. The study involved adults (aged 18-75 years) with a Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) major depressive episode that had failed to respond to at least 2 adequate trials of antidepressants. Participants were enrolled between March 1, 2019, and February 28, 2021; statistical analysis was performed from February 1 to June 15, 2022, using mixed models. INTERVENTION Participants were randomized to receive standard care plus 20 mg/d of simvastatin or placebo. MAIN OUTCOMES AND MEASURES The primary outcome was the difference between the 2 groups in change in Montgomery-Åsberg Depression Rating Scale total scores at week 12. Secondary outcomes included changes in scores on the 24-item Hamilton Rating Scale for Depression, the Clinical Global Impression scale, and the 7-item Generalized Anxiety Disorder scale and change in body mass index from baseline to week 12. C-reactive protein and plasma lipids were measured at baseline and week 12. RESULTS A total of 150 participants were randomized to simvastatin (n = 77; median [IQR] age, 40 [30-45] years; 43 [56%] female) or placebo (n = 73; median [IQR] age, 35 [31-41] years; 40 [55%] female). A significant baseline to end point reduction in Montgomery-Åsberg Depression Rating Scale total score was observed in both groups and did not differ significantly between groups (estimated mean difference for simvastatin vs placebo, -0.61; 95% CI, -3.69 to 2.46; P = .70). Similarly, there were no significant group differences in any of the secondary outcomes or evidence for differences in adverse effects between groups. A planned secondary analysis indicated that changes in plasma C-reactive protein and lipids from baseline to end point did not mediate response to simvastatin. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, simvastatin provided no additional therapeutic benefit for depressive symptoms in TRD compared with standard care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03435744.
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Affiliation(s)
- M. Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Imran B. Chaudhry
- Department of Psychiatry, Ziauddin University, Karachi, Sindh, Pakistan
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | - Ameer B. Khoso
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | - Nawaz Khan
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | - Farooq Ahmad
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | - John Hodsoll
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - M. Omair Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Haider A. Naqvi
- Department of Psychiatry, Dow University of Health Sciences, Karachi, Pakistan
| | - Asad T. Nizami
- Institute of Psychiatry, Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | | | - Fareed Minhas
- Institute of Psychiatry, Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Jeffrey H. Meyer
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Moin A. Ansari
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | - Benoit H. Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Jidong DE, Husain MI, Ike TJ, Husain N, Taru MY, Nnaemeka NC, Francis C, Jack DB, Mwankon SB, Xue S, Pwajok JY, Nyam PP, Murshed M. Bipolar disorders in Nigeria: a mixed-methods study of patients, family caregivers, clinicians, and the community members' perspectives. Int J Bipolar Disord 2023; 11:2. [PMID: 36609729 PMCID: PMC9825686 DOI: 10.1186/s40345-022-00276-2] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Bipolar Disorders (BDs) are chronic mental health disorders that often result in functional impairment and contribute significantly to the disability-adjusted life years (DALY). BDs are historically under-researched compared to other mental health disorders, especially in Sub-Saharan Africa and Nigeria. DESIGN We adopted a mixed-methods design. Study 1 examined the public knowledge of BDs in relation to sociodemographic outcomes using quantitative data whilst Study 2 qualitatively assessed the lived experiences of patients with BDs, clinicians, and family caregivers. METHODS In Study 1, a non-clinical sample of n = 575 participants responded to a compact questionnaire that examined their knowledge of BDs and how they relate to certain sociodemographic variables. One-way ANOVA was used to analyse quantitative data. Study 2 interviewed N = 15 participants (n = 5 patients with BDs; n = 7 clinicians; n = 3 family caregivers). These semi-structured interviews were audio-recorded, transcribed, and thematically analysed. RESULTS In Study 1, findings showed no statistically significant differences, suggesting low awareness of BDs, especially among vulnerable populations such as young people and older adults. However, there was a trajectory in increased knowledge of BDs among participants between the ages of 25-44 years and part-time workers compared to other ages and employment statuses. In Study 2, qualitative findings showed that BDs are perceived to be genetically and psycho-socially induced by specific lived experiences of patients and their family caregivers. Although psychotropic medications and psychotherapy are available treatment options in Nigeria, cultural and religious beliefs were significant barriers to treatment uptake. CONCLUSIONS This study provides insight into knowledge and beliefs about BDs, including the lived experiences of patients with BDs, their caregivers and clinicians in Nigeria. It highlights the need for further studies assessing Nigeria's feasibility and acceptability of culturally adapted psychosocial interventions for patients with BDs.
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Affiliation(s)
- Dung Ezekiel Jidong
- grid.12361.370000 0001 0727 0669Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ UK
| | - M. Ishrat Husain
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Tarela J. Ike
- grid.26597.3f0000 0001 2325 1783Department of Criminology & Sociology, Teesside University, Middlesbrough, UK
| | - Nusrat Husain
- grid.5379.80000000121662407Department of Psychiatry, University of Manchester, Manchester, UK
| | - Maigari Yusufu Taru
- grid.411946.f0000 0004 1783 4052Department of Psychiatry, Jos University Teaching Hospital, Jos, Nigeria
| | - Nwoga Charles Nnaemeka
- grid.411946.f0000 0004 1783 4052Department of Psychiatry, Jos University Teaching Hospital, Jos, Nigeria
| | - Christopher Francis
- grid.12361.370000 0001 0727 0669Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ UK
| | - David B. Jack
- Global Mental Health, Dung Jidong Foundation, Jos, Nigeria
| | - Shadrack B. Mwankon
- grid.12361.370000 0001 0727 0669Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ UK
| | - Siqi Xue
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Juliet Y. Pwajok
- grid.412989.f0000 0000 8510 4538Department of Psychology, University of Jos, Jos, Nigeria
| | - Pam P. Nyam
- grid.12361.370000 0001 0727 0669Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ UK
| | - Maisha Murshed
- grid.12361.370000 0001 0727 0669Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ UK
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Rogers ML, Richards JA, Cao E, Krumerman M, Barzilay S, Blum Y, Chistopolskaya K, Çinka E, Dudeck M, Husain MI, Yilmaz FK, Kravtsova NA, Kuśmirek O, Menon V, Peper-Nascimento J, Pilecka B, Titze L, Valvassori SS, You S, Galynker I. Associations between long-term and near-term stressful life events, suicide crisis syndrome, and suicidal ideation. International Journal of Stress Management 2023. [DOI: 10.1037/str0000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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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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Ledwos N, Rodas JD, Husain MI, Feusner JD, Castle DJ. Therapeutic uses of psychedelics for eating disorders and body dysmorphic disorder. J Psychopharmacol 2023; 37:3-13. [PMID: 36515406 DOI: 10.1177/02698811221140009] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinical use of psychedelics has gained considerable attention, with promising benefits across a range of mental disorders. Current pharmacological and psychotherapeutic treatments for body dysmorphic disorder (BDD) and eating disorders (EDs) have limited efficacy. As such, other treatment options such as psychedelic-assisted therapies are being explored in these clinical groups. AIMS This systematic review evaluates evidence related to the therapeutic potential of psychedelics in individuals diagnosed with BDD and EDs. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of all study designs published to the end of February 2022 that identified changes in ED/BDD symptom severity from psychedelics using validated measures to assess symptom changes. RESULTS Our search detected a total of 372 studies, of which five met inclusion criteria (two exploratory studies, two case reports, and one prospective study). These were included in the data evaluation. Effects of psychedelics on BDD and various ED symptoms were identified mostly through thematic analyses and self-reports. CONCLUSIONS Our findings highlight that more research is needed to determine the safety and efficacy of psychedelics in BDD and EDs and we suggest avenues for future exploration.
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Affiliation(s)
- Nicole Ledwos
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Justyne D Rodas
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - M Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jamie D Feusner
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - David J Castle
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Karat BG, Narikuzhy S, Bonato S, Sanches M, Ahmed S, Liang L, Husain MI, Husain MO, Farooq S, Ayub M, Kidd SA, Mckenzie K, Ali F, Naeem F. The Effectiveness of Cognitive Behavioral Therapy Interventions on Depression and Anxiety in the Adult East Asian and Related Diaspora Populations: a Meta-analysis. Int J Cogn Ther 2022. [DOI: 10.1007/s41811-022-00153-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Husain MI, Umer M, Asif M, Khoso AB, Kiran T, Ansari M, Aslam H, Bhatia MR, Dogar FA, Husain MO, Khan HA, Mufti AA, Mulsant BH, Naeem F, Naqvi HA, de Oliviera C, Siddiqui MS, Tamizuddin A, Wang W, Zaheer J, Husain N, Chaudhry N, Chaudhry IB. Culturally adapted psychoeducation for bipolar disorder in a low-resource setting: protocol for a multicentre randomised controlled trial. BJPsych Open 2022; 8:e206. [PMID: 36426568 PMCID: PMC9707505 DOI: 10.1192/bjo.2022.598] [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] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Bipolar disorder is a source of marked disability, morbidity and premature death. There is a paucity of research on personalised psychosocial interventions for bipolar disorder, especially in low-resource settings. A pilot randomised controlled trial (RCT) of a culturally adapted psychoeducation intervention for bipolar disorder (CaPE) in Pakistan reported higher patient satisfaction, enhanced medication adherence, knowledge and attitudes regarding bipolar disorder, and improvement in mood symptom scores and health-related quality of life measures compared with treatment as usual (TAU). AIMS The current protocol describes a larger multicentre RCT to confirm the clinical and cost-effectiveness of CaPE in Pakistan. Trial registration: NCT05223959. METHOD A multicentre individual, parallel-arm RCT of CaPE in 300 Pakistani adults with bipolar disorder. Participants over the age of 18, with a diagnosis of bipolar I or II disorder who are currently euthymic, will be recruited from seven sites: Karachi, Lahore, Multan, Rawalpindi, Peshawar, Hyderabad and Quetta. Time to recurrence will be the primary outcome assessed using the Longitudinal Interval Follow-up Evaluation (LIFE). Secondary measures will include mood symptoms, quality of life and functioning, adherence to psychotropic medications, and knowledge and attitudes regarding bipolar disorder. RESULTS This trial will assess the effectiveness of the CaPE intervention compared with TAU in reducing the time to recurrence for people with bipolar disorder currently in remission in Pakistan and determine the effect on clinical outcomes, quality of life and functioning. CONCLUSIONS A successful trial might lead to rapid implementation of CaPE in clinical practice, not only in Pakistan, but also in other low-resource settings, including those in high-income countries, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority group patients with bipolar disorder.
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Affiliation(s)
- M Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Madeha Umer
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Muqaddas Asif
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Ameer B Khoso
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Moin Ansari
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | - Huma Aslam
- Department of Psychiatry and Behavioral Sciences, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
| | - Moti Ram Bhatia
- Department of Psychiatry, Peoples University of Medical and Health Sciences for Women, Nawabshah-Shaheed Benazirabad, Pakistan
| | | | - M Omair Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Hazrat A Khan
- Balochistan Institute of Psychiatry and Behavioral Sciences, Quetta, Pakistan
| | | | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Farooq Naeem
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Haider A Naqvi
- Department of Psychiatry, DOW University of Health Sciences, Karachi, Pakistan
| | - Claire de Oliviera
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Asad Tamizuddin
- Institute of Psychiatry, WHO Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan
| | - Wei Wang
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nusrat Husain
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK; and Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Imran B Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan; Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK; and Department of Psychiatry, Ziauddin University, Karachi, Pakistan
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Husain MI, Umer M, Mulsant BH. Can the revival of serotonergic psychedelic drugs as treatments for mental disorders help to characterize their risks and benefits? Expert Opin Drug Saf 2022; 21:721-724. [PMID: 35387542 DOI: 10.1080/14740338.2022.2063274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Madeha Umer
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Ainsworth NJ, Husain MI, Mulsant BH. From challenge to opportunity: COVID-19 and the evolution of virtual mental health care. Fam Syst Health 2021; 39:659-661. [PMID: 34914461 DOI: 10.1037/fsh0000648] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The transition to virtual care (telehealth) during the COVID-19 pandemic has led to both challenges and opportunities in delivering effective mental health care that meets the needs of patients and families. The negative mental and physical health effects of isolation and loneliness associated with the pandemic present a challenge for community mental and behavioral health care. However, the advantages that virtual care provides for the delivery of mental health services, particularly the potential for improved access, also benefit both providers and patients. Ongoing barriers to wider adoption and utilization of virtual mental health care need to be addressed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - M Ishrat Husain
- Geriatric Mental Health Services, Centre for Addiction and Mental Health
| | - Benoit H Mulsant
- Geriatric Mental Health Services, Centre for Addiction and Mental Health
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Ortiz A, Maslej MM, Husain MI, Daskalakis ZJ, Mulsant BH. Apps and gaps in bipolar disorder: A systematic review on electronic monitoring for episode prediction. J Affect Disord 2021; 295:1190-1200. [PMID: 34706433 DOI: 10.1016/j.jad.2021.08.140] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/18/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term clinical monitoring in bipolar disorder (BD) is an important therapeutic tool. The availability of smartphones and wearables has sparked the development of automated applications to remotely monitor patients. This systematic review focus on the current state of electronic (e-) monitoring for episode prediction in BD. METHODS We systematically reviewed the literature on e-monitoring for episode prediction in adult BD patients. The systematic review was done according to the guidelines for reporting of systematic reviews and meta-analyses (PRISMA) and was registered in PROSPERO on April 29, 2020 (CRD42020155795). We conducted a search of Web of Science, MEDLINE, EMBASE, and PsycINFO (all 2000-2020) databases. We identified and extracted data from 17 published reports on 15 relevant studies. RESULTS Studies were heterogeneous and most had substantial methodological and technical limitations. Models varied widely in their performance. Published metrics were too heterogeneous to lend themselves to a meta-analysis. Four studies reported sensitivity (range: 0.21 - 0.95); and two reported specificity for prediction of mood episodes (range: 0.36 - 0.99). Two studies reported accuracy (range: 0.64 - 0.88) and four reported area under the curve (AUC; range: 0.52-0.95). Overall, models were better in predicting manic or hypomanic episodes, but their performance depended on feature type. LIMITATIONS Our conclusions are tempered by the lack of appropriate information impeding our ability to synthesize the available evidence. CONCLUSIONS Given the clinical variability in BD, predicting mood episodes remains a challenging task. Emerging e-monitoring technology for episode prediction in BD requires more development before it can be adopted clinically.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Marta M Maslej
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, United States
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
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Naeem F, Tuck A, Mutta B, Dhillon P, Thandi G, Kassam A, Farah N, Ashraf A, Husain MI, Husain MO, Vasiliadis HM, Sanches M, Munshi T, Abbott M, Watters N, Kidd SA, Ayub M, McKenzie K. Protocol for a multi-phase, mixed methods study to develop and evaluate culturally adapted CBT to improve community mental health services for Canadians of south Asian origin. Trials 2021; 22:600. [PMID: 34488853 PMCID: PMC8419942 DOI: 10.1186/s13063-021-05547-4] [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: 01/07/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Canadians of South Asian (SA) origin comprise the largest racialized group in Canada, representing 25.6% of what Statistics Canada terms “visible minority populations”. South Asian Canadians are disproportionately impacted by the social determinants of health, and this can result in high rates of mood and anxiety disorders. These factors can negatively impact mental health and decrease access to care, thereby increasing mental health inequities. Cognitive Behavioural Therapy (CBT) in its current form is not suitable for persons from the non-western cultural backgrounds. Culturally adapted Cognitive Behavioural Therapy (CaCBT) is an evidence-based practice. CaCBT is more effective than standard CBT and can reduce dropouts from therapy compared with standard CBT. Thus, CaCBT can increase access to mental health services and improve outcomes for immigrant, refugee and ethno-cultural and racialized populations. Adapting CBT for growing SA populations in Canada will ensure equitable access to effective and culturally appropriate interventions. Methods The primary aim of the study is to develop and evaluate CaCBT for Canadian South Asian persons with depression and anxiety and to gather data from stakeholders to develop guidelines to culturally adapt CBT. This mixed methods study will use three phases: (1) cultural adaptation of CBT, (2) pilot feasibility of CaCBT and (3) implementation and evaluation of CaCBT. Phase 1 will use purposive sampling to recruit individuals from four different groups: (1) SA patients with depression and anxiety, (b) caregivers and family members of individuals affected by anxiety and depression, (c) mental health professionals and (d) SA community opinion leaders. Semi-structured interviews will be conducted virtually and analysis of interviews will be informed by an ethnographic approach. Phase 2 will pilot test the newly developed CaCBT for feasibility, acceptability and effectiveness via quantitative methodology and a randomized controlled trial, including an economic analysis. Phase 3 will recruit therapists to train and evaluate them in the new CaCBT. Discussion The outcome of this trial will benefit health services in Canada, in terms of helping to reduce the burden of depression and anxiety and provide better care for South Asians. We expect the results to help guide the development of better services and tailor existing services to the needs of other vulnerable groups. Trial registration ClinicalTrials.gov NCT04010890. Registered on July 8, 2019
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Affiliation(s)
- Farooq Naeem
- Department of Psychiatry, University of Toronto, Toronto, Canada. .,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada.
| | - Andrew Tuck
- Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Baldev Mutta
- Punjabi Community Health Services, Toronto, Canada
| | | | - Gary Thandi
- Moving Forward Family Services, Vancouver, Canada
| | | | - Nimo Farah
- Somerset West Community Health Centre, Ottawa, Canada
| | - Aamna Ashraf
- Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - M Omair Husain
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Science, Université de Sherbrooke, Research Center Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Montreal, Canada
| | - Marcos Sanches
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Tariq Munshi
- Department of Psychiatry, University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
| | | | | | - Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | | | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada.,Wellesley Institute, Toronto, Canada
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Husain MO, Chaudhry IB, Khan Z, Khoso AB, Kiran T, Bassett P, Husain MI, Upthegrove R, Husain N. Depression and suicidal ideation in schizophrenia spectrum disorder: a cross-sectional study from a lower middle-income country. Int J Psychiatry Clin Pract 2021; 25:245-251. [PMID: 34261408 DOI: 10.1080/13651501.2021.1914664] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Depression has long been considered a significant feature of schizophrenia and is associated with more frequent psychotic episodes, increased service utilisation, substance misuse, poor quality of life and completed suicide. However, there is a distinct lack of literature on this comorbidity from low- and middle-income countries or non-western cultural backgrounds. METHODS This is a cross-sectional analysis of baseline data from a large randomised controlled trial, examining the prevalence of depression and suicidal ideation in patients with schizophrenia spectrum disorder. A total of 298 participants were recruited from inpatient and outpatient psychiatric units in Karachi, Pakistan. Participants completed the Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndrome Scale (PANSS), Euro Qol (EQ-5D) and Social Functioning Scale (SFS). RESULTS Data indicate that 36% of participants in the study were depressed and 18% endorsed suicidal ideation. Depression was associated with higher positive symptom scores and reduced quality of life, but no significant difference in negative symptoms and social functioning. CONCLUSIONS Depression and suicidal ideation are prevalent in Pakistani patients diagnosed with schizophrenia spectrum disorder. Evaluation of depressive symptoms in this group may help identify individuals at higher risk of completed suicide, allowing for targeted interventions to improve outcomes.Key pointsTo our knowledge, this is the first study describing the prevalence of depression and suicidal ideation in individuals with schizophrenia from Pakistan.Our data indicate that 36% of individuals with schizophrenia in our sample were depressed and 18% endorsed suicidal ideation.Depression in schizophrenia was associated with poorer quality of life and higher positive symptom burden.This study adds to the scarce literature from low- and middle-income countries where the burden of mental illness is great and where the majority of suicide deaths occur.Addressing social inequality, food insecurity, high rates of unemployment and low levels of literacy in these settings may have a profound effect on population mental health and suicide risk.
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Affiliation(s)
- M Omair Husain
- Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Pakistan Institute of Living and Learning, Karachi, Pakistan.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Imran B Chaudhry
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Department of Psychiatry, Ziauddin Hospital, Karachi, Pakistan
| | - Zainib Khan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Ameer B Khoso
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - M Ishrat Husain
- Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Jones BDM, Razza LB, Weissman CR, Karbi J, Vine T, Mulsant LS, Brunoni AR, Husain MI, Mulsant BH, Blumberger DM, Daskalakis ZJ. Magnitude of the Placebo Response Across Treatment Modalities Used for Treatment-Resistant Depression in Adults: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2125531. [PMID: 34559231 PMCID: PMC8463940 DOI: 10.1001/jamanetworkopen.2021.25531] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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: 01/29/2023] Open
Abstract
IMPORTANCE The placebo effect in depression clinical trials is a substantial factor associated with failure to establish efficacy of novel and repurposed treatments. However, the magnitude of the placebo effect and whether it differs across treatment modalities in treatment-resistant depression (TRD) is unclear. OBJECTIVE To examine the magnitude of the placebo effect in patients with TRD across different treatment modalities and its possible moderators. DATA SOURCES Searches were conducted on MEDLINE, Web of Science, and PsychInfo from inception to June 21, 2021. STUDY SELECTION Randomized clinical trials (RCTs) were included if they recruited patients with TRD and randomized them to a placebo or sham arm and a pharmacotherapy, brain stimulation, or psychotherapy arm. DATA EXTRACTION AND SYNTHESIS Independent reviewers used standard forms for data extraction and quality assessment. Random-effects analyses and standard pairwise meta-analyses were performed. MAIN OUTCOMES AND MEASURES The primary outcome was the Hedges g value for the reported depression scales. Secondary outcomes included moderators assessed via meta-regression and response and remission rates. Heterogeneity was assessed with the I2 test, and publication bias was evaluated using the Egger test and a funnel plot. Cochrane Risk of Bias Tool was used to estimate risks. RESULTS Fifty RCTs were included involving various types of placebo or sham interventions with a total of 3228 participants (mean [SD] age, 45.8 [6.0] years; 1769 [54.8%] female). The pooled placebo effect size for all modalities was large (g = 1.05; 95% CI, 0.91-1.1); the placebo effect size in RCTs of specific treatment modalities did not significantly differ. Similarly, response and remission rates associated with placebo were comparable across modalities. Heterogeneity was large. Three variables were associated with a larger placebo effect size: open-label prospective treatment before double-blind placebo randomization (β = 0.35; 95% CI, 0.11 to 0.59; P = .004), later year of publication (β = 0.03; 95% CI, 0.003 to 0.05; P = .03), and industry-sponsored trials (β = 0.34; 95% CI, 0.09 to 0.58; P = .007). The number of failed interventions was associated with the probability a smaller placebo effect size (β = -0.12; 95% CI, -0.23 to -0.01, P = .03). The Egger test result was not significant for small studies' effects. CONCLUSIONS AND RELEVANCE This analysis may provide a benchmark for past and future clinical RCTs that recruit patients with TRD standardizing an expected placebo effect size.
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Affiliation(s)
- Brett D. M. Jones
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lais B. Razza
- Department of Internal Medicine, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Laboratory of Neurosciences, Instituto Nacional de Biomarcadores em Neuropsiquiatria, Department and Institute of Psychiatry, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil
| | - Cory R. Weissman
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jewel Karbi
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tya Vine
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Andre R. Brunoni
- Department of Internal Medicine, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Laboratory of Neurosciences, Instituto Nacional de Biomarcadores em Neuropsiquiatria, Department and Institute of Psychiatry, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil
| | - M. Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Daniel M. Blumberger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Ortiz A, Bradler K, Moorti P, MacLean S, Husain MI, Sanches M, Goldstein BI, Alda M, Mulsant BH. Reduced heart rate variability is associated with higher illness burden in bipolar disorder. J Psychosom Res 2021; 145:110478. [PMID: 33820643 DOI: 10.1016/j.jpsychores.2021.110478] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/16/2021] [Accepted: 03/27/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with premature death and ischemic heart disease is the main cause of excess mortality. Heart rate variability (HRV) predicts mortality in patients with or without cardiovascular disease. While several studies have analyzed the association between HRV and BD, none has analyzed the association of HRV with illness burden in BD. METHODS 53 participants with BD I and II used a wearable device to assess the association between HRV and factors characterizing illness burden, including illness duration, number and type of previous episode(s), duration of the most severe episode, history of suicide attempts or psychotic symptoms during episodes, and co-morbid psychiatric disorders. We ran unadjusted models and models controlling statistically for age, sex, pharmacotherapy, baseline functional cardiovascular capacity, BMI, years of education, and marital status. We also explored the association between HRV and an overall illness burden index (IBI) integrating all these factors using a weighted geometric mean. RESULTS Adjusted and unadjusted models had similar results. Longer illness duration, higher number of depressive episodes, longer duration of most severe manic/hypomanic episode, co-morbid anxiety disorders, and family history of suicide were associated with reduced HRV, as was bipolar depression severity in the participants experiencing a depressive episode. Finally, a higher IBI score was associated with lower HRV. CONCLUSIONS High illness burden is associated with reduced HRV in BD. While the IBI needs to be validated in a larger sample, it may provide an overall measure that captures illness burden in BD.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | | | - Pooja Moorti
- Institute for Mental Health Research, The Royal Ottawa Hospital, Ottawa, ON, Canada
| | - Stephane MacLean
- Institute for Mental Health Research, The Royal Ottawa Hospital, Ottawa, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marcos Sanches
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada; National Institute of Mental Health, Klecany, Czech Republic
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
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40
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Carvalho AF, Maes M, Solmi M, Brunoni AR, Lange S, Husain MI, Kurdyak P, Rehm J, Koyanagi A. Is dynapenia associated with the onset and persistence of depressive and anxiety symptoms among older adults? Findings from the Irish longitudinal study on ageing. Aging Ment Health 2021; 25:468-475. [PMID: 31829040 DOI: 10.1080/13607863.2019.1699021] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of the current study was to assess the associations between dynapenia and the onset and persistence of depression and anxiety among older adults. METHODS This prospective cohort study enrolled community-living older adults (N = 5271; 51.1% females) aged ≥ 50 years (mean age = 63.2, standard deviation = 9.0) from The Irish Longitudinal Study on Aging (TILDA), Ireland. At baseline, participants completed a handgrip assessment. Depression was defined by a score ≥ 16 in the Center of Epidemiology Studies Depression (CES-D) tool and anxiety was considered when participants scored ≥ 8 on the anxiety section of the Hospital Anxiety and Depression Scale (HADS). Outcomes were incident and persistent depression and anxiety at two years follow-up. Multivariable logistic regression models were built for each outcome. RESULTS After controlling for age, sex, education, marital status, employment status, smoking, body mass index, number of chronic conditions, physical activity, and cognitive function, low handgrip strength indicative of dyapenia (< 30 Kg for men and < 20 Kg for women) was associated with a greater likelihood for incident depressive (OR = 1.44; 95%CI: 1.08-1.92) as well as for persistent depressive (OR = 1.61; 95% CI: 1.01-2.58) and anxiety (OR = 1.61; 95% CI: 1.20-2.14) symptoms. CONCLUSIONS Dynapenia was associated with a higher odds of developing depressive symptoms as well as a greater likelihood to persistent depressive and anxiety symptoms among older adults. Our data suggest that interventions targeting muscle strength may prevent the onset of late-life depression and also may hold promise as novel therapeutic opportunities for depression and anxiety in later life.
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Affiliation(s)
- Andre F Carvalho
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Michael Maes
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil.,National Institute of Biomarkers in Neuropsychiatry (INBioN), Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil.,Department of Clinical Medicine, University Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Shannon Lange
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - M Ishrat Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Jürgen Rehm
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain.,ICREA, Barcelona, Spain
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Carvalho AF, Solmi M, Husain MI, Berk M, Vieta E. The rebirth of lithium as the archetypal mood stabilizer. Bipolar Disord 2021; 23:211-212. [PMID: 33188648 DOI: 10.1111/bdi.13031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH, Toronto, ON, Canada.,Barwon Health, School of Medicine, Deakin University, Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH, Toronto, ON, Canada
| | - Michael Berk
- Barwon Health, School of Medicine, Deakin University, Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry, Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Jones BDM, Husain MI, Mulsant BH. The use of sequential pharmacotherapy for the treatment of acute major depression: a scoping review. Expert Opin Pharmacother 2021; 22:1005-1014. [PMID: 33612048 DOI: 10.1080/14656566.2021.1878144] [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] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Major Depressive Disorder (MDD) is a chronic, relapsing, and remitting disorder affecting over 250 million persons each year worldwide. More than 50% of the patients do not respond to their initial antidepressant treatment and may benefit from sequential pharmacotherapy for the acute treatment of their MDD. Although guidelines outline options for next-step treatments, there is a paucity of evidence to select specific second- or third-step treatments. AREAS COVERED This scoping review synthesizes and discusses available evidence for sequential pharmacotherapy for MDD. MEDLINE was searched from inception to 7 July 2020; 4490 studies were identified. We selected meta-analyses and reports on clinical trials that were judged to inform the sequential selection of pharmacotherapy for MDD. EXPERT OPINION Most relevant published trials are focused on, and support, the use of augmentation pharmacotherapy. There is also some support for other strategies such as combining or switching antidepressants. In the future, more studies need to directly compare these sequential options. To provide more personalized treatment within the framework of precision psychiatry, these studies should include an assessment of moderators and mediators ('mechanism') of antidepressant response.
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Affiliation(s)
- Brett D M Jones
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Canada.,General Adult Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
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43
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Jones BDM, Weissman CR, Razza LB, Husain MI, Brunoni AR, Daskalakis ZJ. Protocol for a systematic review and meta-analysis of the placebo response in treatment-resistant depression: comparison of multiple treatment modalities. BMJ Open 2021; 11:e041349. [PMID: 33593773 PMCID: PMC7888315 DOI: 10.1136/bmjopen-2020-041349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The high placebo response in depression treatment trials is a major contributing factor for randomised control trial failure to establish efficacy of novel or repurposed treatments in treatment-resistant depression (TRD) and major depressive disorder in general. Though there have been a number of meta-analyses and primary research studies evaluating the placebo response in non-TRD, placebo response in TRD is poorly understood. It is important to understand the placebo response of TRD as treatments are only moderately effective and up to 1/3 of patients will experience TRD. METHODS AND ANALYSIS We will conduct a search of electronic databases (MEDLINE and PsychINFO) from inception to 24th January 2020 including randomised, placebo-controlled trials of pharmacological, somatic and psychological interventions for adults with TRD. TRD will be defined as a failure to respond to at least two interventions of adequate dose or duration. We will also search reference lists from review articles. We will perform several meta-analyses to quantify the placebo response for each treatment modality. Regression analysis will explore potential contributing demographic and clinical variables to the placebo response. We will use Cochrane risk of bias tool. ETHICS AND DISSEMINATION There is no research ethics board approval required. The dissemination plan is to publish results in a peer-reviewed academic journal. PROSPERO REGISTRATION NUMBER 190 465.
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Affiliation(s)
- Brett D M Jones
- Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Cory R Weissman
- Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lais B Razza
- Department of Internal Medicine, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil
| | - M Ishrat Husain
- Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Andre R Brunoni
- Department of Internal Medicine, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil
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Xue S, Husain MI, Zhao H, Ravindran AV. Cannabis Use and Prospective Long-Term Association with Anxiety: A Systematic Review and Meta-Analysis of Longitudinal Studies: Usage du cannabis et association prospective à long terme avec l'anxiété: une revue systématique et une méta-analyse d'études longitudinales. Can J Psychiatry 2021; 66:126-138. [PMID: 32909828 PMCID: PMC7918873 DOI: 10.1177/0706743720952251] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Cannabis use is proposed as a risk factor for psychosis and is associated with depressive disorders. However, the relationship between recreational cannabis use and its longitudinal implications on anxiety conditions is less studied. The aim of this investigation is to systematically evaluate published literature and perform a meta-analysis of the data. METHODS A systematic search was performed of MEDLINE, Embase, and PsychINFO from inception to May 31, 2020, in addition to a hand search. Longitudinal studies that evaluated the relationship of cannabis use and development of anxiety were included. Where applicable, adjusted odds ratios (ORs) were extracted, pooled, and evaluated using random-effects meta-analysis. RESULTS After screening of unique abstracts (n = 6835), the final evaluation included 24 studies, of which 10 reported ORs that were analyzed quantitatively. Cannabis use was significantly associated with increased odds of developing any anxiety conditions (OR = 1.25; 95% CI, 1.01 to 1.54). Cannabis use was not significantly associated with developing generalized anxiety disorder, panic disorder, or social anxiety disorder. Review of studies not reporting OR revealed mixed results but are suggestive of a link between cannabis use and increased rates/severity of anxiety. CONCLUSIONS Published evidence suggests that cannabis use is likely associated with increased risk of anxiety in the long term but variability of study designs precludes declaration of a causal relationship. Awareness of this association is of relevance for both clinical practice and mental health policy implementation.
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Affiliation(s)
- Siqi Xue
- Department of Psychiatry, 7938University of Toronto, Ontario, Canada
| | - M Ishrat Husain
- Department of Psychiatry, 7938University of Toronto, Ontario, Canada.,7978Centre for Addictions and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Haoyu Zhao
- 7978Centre for Addictions and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Arun V Ravindran
- Department of Psychiatry, 7938University of Toronto, Ontario, Canada.,7978Centre for Addictions and Mental Health (CAMH), Toronto, Ontario, Canada
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45
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Kim HK, Carvalho AF, Gratzer D, Wong AHC, Gutzin S, Husain MI, Mulsant BH, Stergiopoulos V, Daskalakis ZJ. The Impact of COVID-19 on Psychiatric Emergency and Inpatient Services in the First Month of the Pandemic in a Large Urban Mental Health Hospital in Ontario, Canada. Front Psychiatry 2021; 12:563906. [PMID: 33967842 PMCID: PMC8102788 DOI: 10.3389/fpsyt.2021.563906] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 03/30/2021] [Indexed: 12/24/2022] Open
Abstract
The World Health Organization characterized COVID-19 (coronavirus disease 2019) as a pandemic on March 11, 2020 (WHO). Within a couple of days, all Canadian provinces announced the implementation of social distancing measures. We evaluated the immediate effect of COVID-19 on psychiatric emergency and inpatient services in Canada's largest psychiatric hospital in the first month of the pandemic. We extracted data from the electronic medical records of the Center for Addiction and Mental Health in Toronto, Canada. We compared emergency department visits, inpatient occupancy rates, and length of stay in March 2019 and March 2020, and during the first and second half of March 2020. There was a decrease in the number of emergency department visits and inpatient occupancy rates in March 2020 compared to March 2019. There was also a significant decrease in the number of emergency department visits and inpatient occupancy rates in the second half of March 2020 compared to the first half. Our findings suggest that the pandemic was followed by a rapid decrease in the usage of psychiatric emergency and inpatient services in a large mental health hospital. Future studies will need to assess whether this decrease will be followed by a return to baseline or an increase in need for these services.
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Affiliation(s)
- Helena K Kim
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - David Gratzer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Albert H C Wong
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Shayla Gutzin
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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46
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Xue S, Husain MI, Ortiz A, Husain MO, Daskalakis ZJ, Mulsant BH. COVID-19: Implications for bipolar disorder clinical care and research. SAGE Open Med 2020; 8:2050312120981178. [PMID: 33403113 PMCID: PMC7739076 DOI: 10.1177/2050312120981178] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/24/2020] [Indexed: 01/12/2023] Open
Abstract
The COVID-19 pandemic has posed significant challenges to health care globally, and individuals with bipolar disorder are likely disproportionally affected. Based on review of literature and collective clinical experience, we discuss that without special intervention, individuals with bipolar disorder will experience poorer physical and mental health outcomes due to interplay of patient, provider and societal factors. Some risk factors associated with bipolar disorder, including irregular social rhythms, risk-taking behaviours, substantial medical comorbidities, and prevalent substance use, may be compounded by lockdowns, social isolation and decrease in preventive and maintenance care. We further discuss implications for clinical research of bipolar disorders during the pandemic. Finally, we propose mitigation strategies on working with individuals with bipolar disorder in a clinical and research context, focusing on digital medicine strategies to improve quality of and accessibility to service.
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Affiliation(s)
- Siqi Xue
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - M Omair Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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47
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Naeem F, Husain MO, Husain MI, Javed A. Digital psychiatry in low- and middle-income countries post-COVID-19: Opportunities, challenges, and solutions. Indian J Psychiatry 2020; 62:S380-S382. [PMID: 33227054 PMCID: PMC7659769 DOI: 10.4103/psychiatry.indianjpsychiatry_843_20] [Citation(s) in RCA: 8] [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] [Received: 07/10/2020] [Revised: 07/28/2020] [Accepted: 08/31/2020] [Indexed: 11/04/2022] Open
Abstract
Health systems are adapting to the unique challenges posed by the COVID-19 pandemic. Social distancing has forced clinicians to provide their services through online platforms in high income countries. Similar trends have been noticed in Low and middle-income countries (LAMIC). Digital health can help LAMIC address traditional barriers to care by overcoming issues related to stigma, discrimination, staffing, and physical and geographical resource constraints. Mobile phone subscriptions exceed 80% of the population in many LAMICs. Mobile platforms represent a viable resource in overcoming the significant mental health gap in LAMIC. This paper discusses the enormous potential that digital health has to transform healthcare delivery in LAMICs, as well as numerous challenges to implementation. We also discuss the need to develop national digital health strategies and suggest solutions to some of the barriers.
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Affiliation(s)
- Farooq Naeem
- Centre for Addiction and Mental Health, University of Toronto and Staff Psychiatrist, Toronto, Canada
| | - M Omair Husain
- Centre for Addiction and Mental Health, University of Toronto and Staff Psychiatrist, Toronto, Canada
| | - M Ishrat Husain
- Centre for Addiction and Mental Health, University of Toronto and Staff Psychiatrist, Toronto, Canada
| | - Afzal Javed
- Department of Psychiatry, Warwick Medical School, University of Warwick, Coventry, England
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48
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Jones BDM, Daskalakis ZJ, Carvalho AF, Strawbridge R, Young AH, Mulsant BH, Husain MI. Inflammation as a treatment target in mood disorders: review. BJPsych Open 2020; 6:e60. [PMID: 32498754 PMCID: PMC7345526 DOI: 10.1192/bjo.2020.43] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 03/11/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mood disorders, i.e. major depressive disorder (MDD) and bipolar disorders, are leading sources of disability worldwide. Currently available treatments do not yield remission in approximately a third of patients with a mood disorder. This is in part because these treatments do not target a specific core pathology underlying these heterogeneous disorders. In recent years, abnormal inflammatory processes have been identified as putative pathophysiological mechanisms and treatment targets in mood disorders, particularly among individuals with treatment-resistant conditions. AIMS In this selective review, we aimed to summarise recent advances in the field of immunopsychiatry, including emerging pathophysiological models and findings from treatment ttrials of immunomodulatory agents for both MDD and bipolar disorders. METHOD We performed a literature review by searching Medline for clinical trials of immunomodulating agents as monotherapy or adjunctive treatments in MDD and bipolar disorders. Included studies are randomised controlled trials (RCTs), cluster RCTs or cross-over trials of immunomodulating agents that had an active comparator or a placebo-arm. RESULTS Current evidence shows an association between inflammation and mood symptoms. However, there is conflicting evidence on whether this link is causal. CONCLUSIONS Future studies should focus on identifying specific neurobiological underpinnings for the putative causal association between an activated inflammatory response and mood disorders. Results of these studies are needed before further treatment trials of immunomodulatory agents can be justified.
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Affiliation(s)
- Brett D. M. Jones
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Canada
| | - Zafiris J. Daskalakis
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Canada
| | - Andre F. Carvalho
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Canada
| | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Canada
| | - M. Ishrat Husain
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Canada
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49
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Affiliation(s)
- M Ishrat Husain
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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50
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Husain MI, Waheed W, Husain N. Self-harm in British South Asian women: psychosocial correlates and strategies for prevention. Ann Gen Psychiatry 2006; 5:7. [PMID: 16716216 PMCID: PMC1538599 DOI: 10.1186/1744-859x-5-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 05/22/2006] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To review the rates of self-harm in British South Asian women, look into the factors that contribute to these high rates of self-harm and discuss possible strategies for prevention and provision of culturally sensitive service for South Asian women who harm themselves. METHOD Review. RESULTS South Asian women are significantly more likely to self harm between ages 16-24 years than white women. Across all age groups the rates of self harm are lower in South Asian men as compared to South Asian women. These women are generally younger, likely to be married and less likely to be unemployed or use alcohol or other drugs. They report more relationship problems within the family. South Asian women are less likely to attend the ER with repeat episode since they hold the view that mainstream services do not meet their needs. CONCLUSION South Asian women are at an increased risk of self harm. Their demographic characteristics, precipitating factors and clinical management are different than whites. There is an urgent need for all those concerned with the mental health services for ethnic minorities to take positive action and eradicate the barriers that prevent British South Asians from seeking help. There is a need to move away from stereotypes and overgeneralisations and start from the user's frame of reference, taking into account family dynamics, belief systems and cultural constraints.
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Affiliation(s)
- MI Husain
- St. George's, University of London, London, UK
| | - W Waheed
- Department of Psychiatry, The University of Manchester, Manchester, UK
- Lancashire Care NHS Trust, Preston, UK
| | - Nusrat Husain
- Department of Psychiatry, The University of Manchester, Manchester, UK
- Lancashire Care NHS Trust, Preston, UK
- Department of Psychiatry, The University of Toronto, Toronto, Canada
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