Vers une éducation médicale axée sur les compétences dans le domaine de la psychiatrie des toxicomanies: une revue systématique

Background: Current curriculum guidelines for addiction training in psychiatry need to be adapted to the competency by design framework to integrate clinical skills in addiction. Objective: We conducted a systematic review to identify curricular and educational interventions to build competency among psychiatry residents and fellows in addiction psychiatry. Methods: We followed the PRISMA guidelines, searching five databases from inception to August 2020 for relevant evaluation-type studies exploring addiction psychiatry competency among psychiatry residents and fellows. We appraised study quality using the Joanna Briggs Institute's risk of bias tool for observational designs. Results: From 1600 records, 17 studies met inclusion criteria. Addiction psychiatry competencies spanned themes involving core knowledge development; attitudinal, communication and leadership skills; screening, assessment, diagnosis; management; and special populations. Examples of effective educational interventions to enhance addiction competency include specific modules for substance use disorders and integrated clinical rotations that simultaneously combine multiple types of skills. Lived experience improved trainee attitudes towards addiction psychiatry. Conclusions: While there is current evidence supporting strategies for developing competency in addiction psychiatry, the lack of studies measuring sustained competence over a longer-term follow-up period and the absence of randomized controlled trials limit the overall strength of evidence in this review. Current psychiatry entrustable professional activities (EPAs) involving addiction only partly overlap with curriculum training guidelines and studies identified in this review. These EPAs need to be better identified for training programs, competence in those EPAs better delineated for residents and preceptors, and evaluations should be done to ensure that adequate competence in addictions is attained and sustained.Contexte : Les directives actuelles du programme d’études pour la formation sur les toxicomanies en psychiatrie doivent être adaptées au cadre de la CPC pour intégrer les compétences cliniques en toxicomanie. Objectif : Nous avons effectué une revue systématique de la littérature afin de repérer les interventions éducatives visant à renforcer les compétences des résidents et des stagiaires post-doctoraux (fellows) en psychiatrie des toxicomanies. Méthodes : Suivant les lignes directrices PRISMA, nous avons effectué une recherche dans cinq bases de données couvrant la période allant de leur création jusqu’à août 2020 pour recenser les études de type évaluation portant sur le développement de compétences en matière de toxicomanie par les résidents et les stagiaires postdoctoraux (fellows) en psychiatrie. Nous avons évalué la qualité des études à l’aide de l’outil d’évaluation du risque de biais de l’Institut Joanna Briggs pour les études observationnelles. Résultats : Dix-sept des 1600 études répertoriées répondaient à nos critères d’inclusion. Les compétences en matière de psychiatrie des toxicomanies couvrent les thèmes de développement des connaissances de base; l’attitude, la communication et les habiletés de leadership; le dépistage, l’évaluation et le diagnostic; la prise en charge; et les populations particulières. Parmi les exemples d’interventions éducatives efficaces visant à améliorer les compétences en matière de toxicomanie figurent les modules portant sur les troubles liés à l’abus de substances et les stages cliniques intégrées qui combinent simultanément plusieurs types d’habiletés. L’expérience concrète vécue semble améliorer l’attitude des apprenants à l’égard de la pratique de la psychiatrie des toxicomanies. Conclusions :  Bien qu’il existe actuellement des preuves à l’appui de stratégies visant à développer les compétences en psychiatrie des toxicomanies, le manque d’étude mesurant le maintien des compétences sur une période de suivi plus longue et l’absence d’essais cliniques randomisés limite la force des preuves de la présente revue.  Les APC qui abordent actuellement la dépendance ne recoupent que partiellement les lignes directrices pour les cursus de formation et le contenu des études recensées dans notre revue. Ces APC doivent être mieux définies pour les programmes d’études et les compétences qu’elles visent doivent être mieux circonscrites pour les résidents et les superviseurs. De surcroît, des évaluations doivent être effectuées pour garantir l’atteinte et le maintien d’une compétence adéquate en matière de toxicomanie

The critical role of peer reviewers: challenges and future steps

The critical role of peer reviewers in the publishing process is examined. Examples of typical challenges are provided including the relative lack of rewards for this important task. Particular attention is paid to the need to consider diversity of the peer reviewers recruited along with impediments to the selection beyond Areas of Competence, often due to the small available pool. Recommendations for improvement are suggested

Session 2-1-A: A Longitudinal Study of Alberta Electronic Machine Gamblers

Outline of the LLLP What is the LLLP? Launched in 2006 the LLLP is a five age cohort, four data collection wave longitudinal study that examines the incidence and determinants of gambling and problem gambling. The study was guided by four broad research questions: 1.What are the normal patterns of continuity and discontinuity in gambling and problem gambling behavior? 2.What bio-psychological variables and behavior patterns are most predictive of current and future responsible and problem gambling? 3.Are there distinct sub-groupings of gamblers and problem gamblers with different trajectories and predictors? 4.What etiological model of problem gambling is best supported by the longitudinal findings

Session 1-3-F: The Alberta Cohorts of Gambling Behaviors An Update

Objectives 1.Experience with recruitment & retention of five cohorts 2.Patterns of continuity & discontinuity in gambling behaviors as well as patterns of recovery from problems? 3. Biopsychosocial variables (risks & resilience) predicting the spectrum of gambling behaviors from responsible to problematic

Compulsive features in behavioural addictions: the case of pathological gambling

Aims To describe, in the context of DSM-V, how a focus on addiction and compulsion is emerging in the consideration of pathological gambling (PG). Methods A systematic literature review of evidence for the proposed re-classification of PG as an addiction. Results Findings include: (i) phenomenological models of addiction highlighting a motivational shift from impulsivity to compulsivity associated with a protracted withdrawal syndrome and blurring of the ego-syntonic/ego-dystonic dichotomy; (ii) common neurotransmitter (dopamine, serotonin) contributions to PG and substance use disorders (SUDs); (iii) neuroimaging support for shared neurocircuitries between behavioural and substance addictions and differences between obsessivecompulsive disorder (OCD), impulse control disorders (ICDs) and SUDs; (iv) genetic findings more closely related to endophenotypic constructs such as compulsivity and impulsivity than to psychiatric disorders; (v) psychological measures such as harm avoidance identifying a closer association between SUDs and PG than with OCD; (vi) community and pharmacotherapeutic trials data supporting a closer association between SUDs and PG than with OCD. Adapted behavioural therapies, such as exposure therapy, appear applicable to OCD, PG or SUDs, suggesting some commonalities across disorders. Conclusions PG shares more similarities with SUDs than with OCD. Similar to the investigation of impulsivity, studies of compulsivity hold promising insights concerning the course, differential diagnosis and treatment of PG, SUDs, and OCD.LundbeckLundbeckServierServierCristaliaCristaliaRocheRocheSandozSandozMohegan Sun CasinoMohegan Sun CasinoNational Center for Responsible GamingNational Center for Responsible GamingAlberta Gaming Research InstituteAlberta Gaming Research InstituteNIH [R01 DA019039, R01 DA020908, RL1 AA017539, RC1 DA028279, P20 DA027844]NI

Comorbid Depression Among Untreated Illicit Opiate Users : Results From a Multisite Canadian Study

This study aimed to describe patterns of major depression (MDD) in a cohort of untreated illicit opiate users recruited from 5 Canadian urban centres, identify sociodemographic characteristics of opiate users that predict MDD, and determine whether opiate users suffering from depression exhibit different drug use patterns than do participants without depression. Baseline data were collected from 679 untreated opiate users in Vancouver, Edmonton, Toronto, Montreal, and Quebec City. Using the Composite International Diagnostic Interview Short Form for Major Depression, we assessed sociodemographics, drug use, health status, health service use, and depression. We examined depression rates across study sites; logistic regression analyses predicted MDD from demographic information and city. Chi-square analyses were used to compare injection drug use and cocaine or crack use among participants with and without depression. Almost one-half (49.3%) of the sample met the cut-off score for MDD. Being female, white, and living outside Vancouver independently predicted MDD. Opiate users suffering from depression were more likely than users without depression to share injection equipment and paraphernalia and were also more likely to use cocaine (Ps < 0.05). Comorbid depression is common among untreated opiate users across Canada; targeted interventions are needed for this population

Designing a Longitudinal Cohort Study of Gambling in Alberta: Rationale, Methods, and Challenges

Sherpa Romeo green journal. Permission to archive accepted author manuscript.Longitudinal research on the determinants of gambling behavior is sparse. This article briefly reviews the previous seventeen longitudinally designed studies, focusing on the methodology for each study. This is followed by a description of our ongoing longitudinal study entitled the Leisure, Lifestyle, & Lifecycle Project (LLLP). Participants for the LLLP were recruited from four locations in Alberta, Canada, including both rural and urban populations. In the LLLP most participants were recruited using random digit dialing (RDD), with 1808 participants from 5 age cohorts at baseline: 13-15, 18-20, 23-25, 43-45, and 63-65. Individuals completed telephone, computer, and face-to-face surveys at baseline, with the data collection occurring between February and October, 2006. At baseline, a wide variety of constructs were measured, including gambling behavior, substance use, psychopathology, intelligence, family environment, and internalizing and externalizing problems. Finally, the conclusions that can be drawn thus far are discussed as well as the plans for three future data collections.Ye

Gambling and problem gambling in Canada in 2018: prevalence and changes since 2002

Permission to archive accepted author manuscript. Reuse is restricted to non-commercial and no derivative uses.Objective The purpose of this study was to provide an updated profile of gambling and problem gambling in Canada and to examine how the rates and pattern of participation compare to 2002. Method An assessment of gambling and problem gambling was included in the 2018 Canadian Community Health Survey and administered to 24,982 individuals aged 15 and older. The present analyses selected for adults (18+). Results A total of 66.2% of people reported engaging in some type of gambling in 2018, primarily lottery and/or raffle tickets, the only type in which the majority of Canadians participate. There are some significant inter-provincial differences, with perhaps the most important one being the higher rate of electronic gambling machine (EGM) participation in Manitoba and Saskatchewan The overall pattern of gambling in 2018 is very similar to 2002, although participation is generally much lower in 2018, particularly for EGMs and bingo. Only 0.6% of the population were identified as problem gamblers in 2018, with an additional 2.7% being at-risk gamblers. There is no significant inter-provincial variation in problem gambling rates. The inter-provincial pattern of problem gambling in 2018 is also very similar to what was found in 2002 with the main difference being a 45% decrease in the overall prevalence of problem gambling. Conclusions Gambling and problem gambling have both decreased in Canada from 2002 to 2018, although the provincial patterns are quite similar between the two time periods. Several mechanisms have likely collectively contributed to these declines. Decreases have also been reported in several other western countries in recent years and have occurred despite the expansion of legal gambling opportunities, suggesting a degree of inoculation or adaptation in the population.Ye

Relationship between craving and personality in treatment-seeking women with substance-related disorders

BACKGROUND: Individual differences may impact susceptibility to addiction. The impact of personality features on drug craving, however, has not been studied, particularly in women. METHODS: Ninety-five treatment-seeking women with substance dependence, abstinent for at least 5 and no more than 21 days, were investigated regarding the correlation between personality factors and craving. Personality was assessed using the Temperament and Character Inventory (TCI), the NEO Personality Inventory Revised (NEO-PI-R), and the Barratt Impulsiveness Scale version 11 (BIS-11). Cravings were assessed through the Pennsylvania Craving Scale (PCS), and the Craving Questionnaire (CQ). Anxiety and depressive symptomatology were also recorded. RESULTS: Craving scores were positively correlated with depression and negatively correlated with number of days abstinent from substance use. Also, craving scores were positively associated with the novelty-seeking factor from the TCI and the total score on the BIS-11, and negatively associated with the conscientiousness and agreeableness facets of the NEO-PI-R. CONCLUSION: Findings suggest that personality features, particularly impulsiveness, can be important predictors of craving in women, which has important implications for treatment planning