Treatment-resistant major depressive disorder: Canadian expert consensus on definition and assessment

Background: Treatment-resistant depression (TRD) is a debilitating chronic mental illness that confers increased morbidity and mortality, decreases the quality of life, impairs occupational, social, and offspring development, and translates into increased costs on the healthcare system. The goal of this study is to reach an agreement on the concept, definition, staging model, and assessment of TRD. Methods: This study involved a review of the literature and a modified Delphi process for consensus agreement. The Appraisal of Guidelines for Research & Evaluation II guidelines were followed for the literature appraisal. Literature was assessed for quality and strength of evidence using the grading, assessment, development, and evaluations system. Canadian national experts in depression were invited for the modified Delphi process based on their prior clinical and research expertize. Survey items were considered to have reached a consensus if 80% or more of the experts supported the statement. Results: Fourteen Canadian experts were recruited for three rounds of surveys to reach a consensus on a total of 27 items. Experts agreed that a dimensional definition for treatment resistance was a useful concept to describe the heterogeneity of this illness. The use of staging models and clinical scales was recommended in evaluating depression. Risk factors and comorbidities were identified as potential predictors for treatment resistance. Conclusions: TRD is a meaningful concept both for clinical practice and research. An operational definition for TRD will allow for opportunities to improve the validity of predictors and therapeutic options for these patients

A new suicide risk assessment tool in Nova Scotia, Canada

Suicide is a major public health concern. In Canada, suicide is the ninth leading cause of death in all ages, with a rate of 10.3 deaths per 100,000 people. In Nova Scotia, Canada, 137 suicides were reported in 2016 [1]. Suicide risk assessment (SRA) and management are clinical competencies required for patient care. Strategies used for SRA include the use of formal self-report measures [2], personalized clinical interview however vital information about suicide risk may be missed during that unstructured assessment [3] and structured tool to supplement the clinical interview

Proportion of animals that achieved schedule-induced polydipsia (drinking at least 15 ml per 2-hr session on 3 consecutive days) collapsed across MK-801 treatment in experiment 2.

*<p>Significantly more isolation-reared animals (collapsed across treatment) achieved schedule-induced polydipsia than group-reared animals, Chi-square test, p<0.01.</p

The effects of social isolation on schedule induced polydipsia (SIP).

<p>(A) Isolation rearing (IR) housing significantly increased drinking in the schedule induced polydipsia paradigm across days. Mean (±SEM) daily water drinking during the 2-hr testing session for IR and group reared (GR) groups in the experimental paradigm are shown. IR animals were not different from GR animals on Day 1 of testing (F<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0056105#pone.0056105-deLeon1" target="_blank">[1]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0056105#pone.0056105-Beninger1" target="_blank">[14]</a> = 2.8, p = 0.12) but on Day 21 drank more water than the GR group (F<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0056105#pone.0056105-deLeon1" target="_blank">[1]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0056105#pone.0056105-Beninger1" target="_blank">[14]</a> = 6.2, p = 0.04). (B) Intermittent food presentation increased time spent at the drinking spout. Mean (±SEM) duration (ms) spent at the drinking spout during the inter-pellet interval (1 min; measured in 5-s bins) for IR and GR groups. Both groups increased spout time to a maximum within 10-s following pellet delivery and decreased time toward the end of the interval. This pattern was more pronounced in the IR group suggesting increased drinking behavior. *Two-way analysis of variance, significant interaction of day×housing (F[20,260] = 2.76, p = 0.047).</p

Experimental design: number of rats assigned to each group for each experiment.

<p>Abbreviations: GR, group reared; IR, isolation reared; n/a, no animals in these groups; SIP, schedule-induced polydipsia.</p

The effects of social isolation and MK-801 treatment on schedule induced polydipsia (SIP).

<p>(A) Isolation rearing (IR) significantly increased drinking in schedule induced polydipsia paradigm across days. Daily mean water drinking during the 2-hr testing session for MK-801 and Saline treated IR (A) and group reared (B; GR) animals in the experimental and control paradigms are shown. (C) IR and (D) GR treated groups receiving one pellet a minute (experimental paradigm) showed the postprandial drinking characteristic of SIP, as evidenced by the total duration of time spent at the drinking spout. Note the difference in the scale on the y-axis in (C) and (D) as the GR animals drank less. Spout time for experimental groups increased immediately after pellet delivery, increased to a maximum at 15-s and then declined toward the end of the 60-s interval. Animals in the control paradigm did not show this pattern. IR rats showed a longer duration at the spout throughout the inter-pellet interval consistent with increased drinking behavior. *Analysis of variance revealed a significant main effect for housing (F<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0056105#pone.0056105-deLeon1" target="_blank">[1]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0056105#pone.0056105-Cassano1" target="_blank">[36]</a> = 5.50, p = 0.025).</p