67 research outputs found

    Poor Perception of Body Weight Category amongst the Overweight and Obese with Chronic Hepatitis C: A Target for Intervention

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    Obesity in chronic hepatitis C (CHC) is associated with adverse hepatic and metabolic outcomes. This prospective study evaluates the agreement between self-perceived body weight (BW) status and measured body mass index (BMI) category and factors associated with its underestimation in CHC. Body size perception was measured with the Contour Drawing Rating Scale. Two hundred and seventy-three patients with CHC (overweight 45%, obese 18%) participated in this study. Although both overweight and obese demonstrated good body size perception, agreement between perceived BW and measured BMI categories was poor (Îș = 0.315, 95% CI 0.231–0.399); 33% of overweight/obese respondents considered themselves normal or underweight. Male gender (OR 2.84) and overweight (OR 2.42) or obese BMI (OR 14.19) were associated with underestimation of BW category. Targeted interventions are needed to improve body weight perception, thereby enhancing the uptake of health advice on management of excess body weight in CHC

    Early Psychosis Intervention-Spreading Evidence-based Treatment (EPI-SET) : Protocol for an effectiveness-implementation study of a structured model of care for psychosis in youth and emerging adults

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    Introduction While early psychosis intervention (EPI) has proliferated in recent years amid evidence of its effectiveness, programmes often struggle to deliver consistent, recovery-based care. NAVIGATE is a manualised model of EPI with demonstrated effectiveness consisting of four components: individualised medication management, individual resiliency training, supported employment and education and family education. We aim to implement NAVIGATE in geographically diverse EPI programmes in Ontario, Canada, evaluating implementation and its effect on fidelity to the EPI model, as well as individual-level outcomes (patient/family member-reported and interviewer-rated), system-level outcomes (captured in provincial administrative databases) and engagement of participants with lived experience. Methods and analysis This is a multisite, non-randomised pragmatic hybrid effectiveness-implementation type III mixed methods study coordinated at the Centre for Addiction and Mental Health (CAMH) in Toronto. Implementation is supported by the Provincial System Support Program, a CAMH-based programme with provincial offices across Ontario, and Extension of Community Healthcare Outcomes Ontario Mental Health at CAMH and the University of Toronto. The primary outcome is fidelity to the EPI model as measured using the First Episode Psychosis Services-Fidelity Scale. Four hundred participants in the EPI programmes will be recruited and followed using both individual-level assessments and health administrative data for 2 years following NAVIGATE initiation. People with lived experience will be engaged in all aspects of the project, including through youth and family advisory committees. Ethics and dissemination Research ethics board approval has been obtained from CAMH and institutions overseeing the local EPI programmes. Study findings will be reported in scientific journal articles and shared with key stakeholders including youth, family members, programme staff and policymakers. Trial registration number NCT03919760; Pre-results

    Metabolomic signatures associated with weight gain and psychosis spectrum diagnoses: A pilot study

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    Psychosis spectrum disorders (PSDs), as well as other severe mental illnesses where psychotic features may be present, like bipolar disorder, are associated with intrinsic metabolic abnormalities. Antipsychotics (APs), the cornerstone of treatment for PSDs, incur additional metabolic adversities including weight gain. Currently, major gaps exist in understanding psychosis illness biomarkers, as well as risk factors and mechanisms for AP-induced weight gain. Metabolomic profiles may identify biomarkers and provide insight into the mechanistic underpinnings of PSDs and antipsychotic-induced weight gain. In this 12-week prospective naturalistic study, we compared serum metabolomic profiles of 25 cases within approximately 1 week of starting an AP to 6 healthy controls at baseline to examine biomarkers of intrinsic metabolic dysfunction in PSDs. In 17 of the case participants with baseline and week 12 samples, we then examined changes in metabolomic profiles over 12 weeks of AP treatment to identify metabolites that may associate with AP-induced weight gain. In the cohort with pre-post data (n = 17), we also compared baseline metabolomes of participants who gained ≄5% baseline body weight to those who gained <5% to identify potential biomarkers of antipsychotic-induced weight gain. Minimally AP-exposed cases were distinguished from controls by six fatty acids when compared at baseline, namely reduced levels of palmitoleic acid, lauric acid, and heneicosylic acid, as well as elevated levels of behenic acid, arachidonic acid, and myristoleic acid (FDR < 0.05). Baseline levels of the fatty acid adrenic acid was increased in 11 individuals who experienced a clinically significant body weight gain (≄5%) following 12 weeks of AP exposure as compared to those who did not (FDR = 0.0408). Fatty acids may represent illness biomarkers of PSDs and early predictors of AP-induced weight gain. The findings may hold important clinical implications for early identification of individuals who could benefit from prevention strategies to reduce future cardiometabolic risk, and may lead to novel, targeted treatments to counteract metabolic dysfunction in PSDs

    The Relationship between Academic Motivation and Lifelong Learning in Psychiatry Residents

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    Lifelong learning (LLL) is a core training competency across the learner continuum and motivation to learn is one factor influencing the development of lifelong learners. The purpose of this study was to elucidate the relationship between LLL and academic motivation during postgraduate training, specifically in psychiatry residency training. We also studied trainee factors that may influence LLL during residency training. One hundred and five (105) of 173 psychiatry residents from the University of Toronto participated in this cross-sectional study examining orientation to LLL and academic motivation, specifically intrinsic motivation (IM), extrinsic motivation (EM) and amotivation. Residents completed a questionnaire characterizing self-directed learning practices, LLL and academic motivation. Participants’ orientation to LLL was significantly correlated with academic motivation total scores and with IM scores. There was no significant correlation between LLL and either EM or amotivation sub-scales. There was no significant difference in LLL or academic motivation scores based on respondents’ training year, gender, or age; however, residents participating in the research training stream had significantly higher orientations to LLL than non-research stream residents. Therefore, our results reinforce the association between IM and LLL during residency training. The incorporation of teaching and curricula to support autonomous motivation in postgraduate medical education may be beneficial to the development of LLL skills for practice

    Advances and Future Directions in the Clinical Utility of Food Addiction

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    The body of research examining the validity of food addiction and eating addiction far exceeds the research examining their clinical utility [...

    Advances and Future Directions in the Clinical Utility of Food Addiction

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    The body of research examining the validity of food addiction and eating addiction far exceeds the research examining their clinical utility [...

    Reading of the Week: A continuing professional development program for psychiatrists and residents that Osler would have liked

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    Introduction: William Osler started the first journal club more than a century ago. As in Osler’s, continuing professional development (CPD) is challenging to deliver in our day. This paper discusses the CPD outcomes of Reading of the Week (ROTW), an innovative online education resource aimed at Canadian psychiatrists and psychiatry residents.Methods: ROTW consists of a weekly email sent to these physicians through formal partnerships, including 13 residency training programs, and summarizes the latest literature in psychiatric care. An online survey using Moore’s continued medical education evaluation framework was conducted to determine the outcomes of ROTW and how to improve it.Results: One-third of ROTW subscribers (n = 332) responded to the survey. Respondents reported a very high rate of satisfaction (97%). The most significant findings: ROTW improved participants’ understanding of psychiatry (93%) and informed their practice (83%).Conclusions: ROTW is a program that addresses challenges related to remaining “up-to-date” amidst the vast amount of resources available. Survey data suggests that ROTW has a high satisfaction rate and achieves practice change, perhaps because it provides a boundless learning option for trainees and providers. Further research is needed better to understand the reasons for the success of this program.Introduction : Le premier club de lecture a Ă©tĂ© crĂ©Ă© par William Osler il y a plus d’un siĂšcle. Aujourd’hui comme hier, le dĂ©veloppement professionnel continu (DPC) est un dĂ©fi Ă  relever. Cet article traite des rĂ©sultats sur le plan du DPC des Lectures hebdomadaires (Reading of the Week - ROTW), une ressource Ă©ducative Ă©lectronique novatrice destinĂ©e aux psychiatres et aux rĂ©sidents en psychiatrie canadiens.MĂ©thodes : Il s’agit de l’envoi hebdomadaire d’un courriel aux mĂ©decins, par le biais de partenariats officiels, dont 13 programmes de formation en rĂ©sidence, rĂ©sumant les publications rĂ©centes en matiĂšre de soins psychiatriques. Un sondage en ligne fondĂ© sur le cadre d’évaluation de l’éducation mĂ©dicale continue de Moore a Ă©tĂ© menĂ© pour examiner les rĂ©sultats du programme et les moyens de l’amĂ©liorer.RĂ©sultats : Un tiers des abonnĂ©s aux Lectures hebdomadaires (n = 332) ont rĂ©pondu au sondage. Ils ont signalĂ© un taux de satisfaction trĂšs Ă©levĂ© (97 %). Les rĂ©sultats les plus significatifs : les Lectures amĂ©liorent la comprĂ©hension de la psychiatrie pour les participants (93 %), qui notent leur utilitĂ© dans la pratique (83 %).Conclusions : Le programme de Lectures hebdomadaires permet de relever le dĂ©fi de se tenir « à jour » dans un contexte de surabondance de ressources. D’aprĂšs les donnĂ©es du sondage, le taux de satisfaction Ă©levĂ© et l’impact sur la pratique des participants qu’a entraĂźnĂ©s le programme pourraient s’expliquer par le fait qu’il offre une possibilitĂ© d’apprentissage illimitĂ© aux stagiaires et aux fournisseurs de soins. Il conviendrait de poursuivre les recherches pour mieux comprendre les raisons du succĂšs de ce programme

    Psychiatric treatment considerations with direct acting antivirals in hepatitis C

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    Abstract Background Despite recent advances in hepatitis C (HCV) treatment, specifically the addition of direct acting antivirals (DAAs), pegylated interferon-alpha remains the backbone of HCV therapy. Therefore, the impact of DAAs on the management of co-morbid psychiatric illness and neuropsychiatric sequalae remains an ongoing concern during HCV therapy. This paper provides a review of the neuropsychiatric adverse effects of DAAs and drug-drug interactions (DDIs) between DAAs and psychiatric medications. Methods We conducted a Pubmed search using relevant search terms and hand searched reference lists of related review articles. In addition, we searched abstracts for major hepatology conferences and contacted respective pharmaceutical companies for additional studies. Results Limited data is available on the neuropsychiatric adverse effects of DAAs; however, data from major clinical trials suggest that DAAs have minimal neuropsychiatric risk. DAAs can potentially interact with a variety of psychotropic agents via cytochrome P450 and p-glycoprotein interactions. Triazolam, oral midazolam, St. John’s Wort, carbamazepine and pimozide, are contraindicated with DAAs. DDIs between DAAs and antidepressants, anxiolytics, hypnotics, mood stabilizers, antipsychotics and treatments for opioid dependence are summarized. Conclusions Although DAAs do not add significant neuropsychiatric risk, the potential for DDIs is high. Consideration of DDIs is paramount to improving medication adherence and mitigating adverse effects during HCV therapy

    Lecture de la semaine : un programme de dĂ©veloppement professionnel continu Ă  l’intention des psychiatres et des rĂ©sidents qui aurait gagnĂ© l’admiration d’Osler

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    Introduction: William Osler started the first journal club more than a century ago. As in Osler’s, continuing professional development (CPD) is challenging to deliver in our day. This paper discusses the CPD outcomes of Reading of the Week (ROTW), an innovative online education resource aimed at Canadian psychiatrists and psychiatry residents. Methods: ROTW consists of a weekly email sent to these physicians through formal partnerships, including 13 residency training programs, and summarizes the latest literature in psychiatric care. An online survey using Moore’s continued medical education evaluation framework was conducted to determine the outcomes of ROTW and how to improve it. Results: One-third of ROTW subscribers (n = 332) responded to the survey. Respondents reported a very high rate of satisfaction (97%). The most significant findings: ROTW improved participants’ understanding of psychiatry (93%) and informed their practice (83%). Conclusions: ROTW is a program that addresses challenges related to remaining “up-to-date” amidst the vast amount of resources available. Survey data suggests that ROTW has a high satisfaction rate and achieves practice change, perhaps because it provides a boundless learning option for trainees and providers. Further research is needed better to understand the reasons for the success of this program.Introduction : Le premier club de lecture a Ă©tĂ© crĂ©Ă© par William Osler il y a plus d’un siĂšcle. Aujourd’hui comme hier, le dĂ©veloppement professionnel continu (DPC) est un dĂ©fi Ă  relever. Cet article traite des rĂ©sultats sur le plan du DPC des Lectures hebdomadaires (Reading of the Week - ROTW), une ressource Ă©ducative Ă©lectronique novatrice destinĂ©e aux psychiatres et aux rĂ©sidents en psychiatrie canadiens. MĂ©thodes : Il s’agit de l’envoi hebdomadaire d’un courriel aux mĂ©decins, par le biais de partenariats officiels, dont 13 programmes de formation en rĂ©sidence, rĂ©sumant les publications rĂ©centes en matiĂšre de soins psychiatriques. Un sondage en ligne fondĂ© sur le cadre d’évaluation de l’éducation mĂ©dicale continue de Moore a Ă©tĂ© menĂ© pour examiner les rĂ©sultats du programme et les moyens de l’amĂ©liorer. RĂ©sultats : Un tiers des abonnĂ©s aux Lectures hebdomadaires (n = 332) ont rĂ©pondu au sondage. Ils ont signalĂ© un taux de satisfaction trĂšs Ă©levĂ© (97 %). Les rĂ©sultats les plus significatifs : les Lectures amĂ©liorent la comprĂ©hension de la psychiatrie pour les participants (93 %), qui notent leur utilitĂ© dans la pratique (83 %). Conclusions : Le programme de Lectures hebdomadaires permet de relever le dĂ©fi de se tenir « à jour » dans un contexte de surabondance de ressources. D’aprĂšs les donnĂ©es du sondage, le taux de satisfaction Ă©levĂ© et l’impact sur la pratique des participants qu’a entraĂźnĂ©s le programme pourraient s’expliquer par le fait qu’il offre une possibilitĂ© d’apprentissage illimitĂ© aux stagiaires et aux fournisseurs de soins. Il conviendrait de poursuivre les recherches pour mieux comprendre les raisons du succĂšs de ce programme
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