Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie最新文献

{"title":"Canadian Studies on the Effectiveness of Community Treatment Orders: An Updated Systematic Review of Quantitative Data: Études canadiennes sur l'efficacité des ordonnances de traitement en milieu communautaire : mise à jour d'un examen systématique des données quantitatives.","authors":"Steve Kisely, Mike Trott, Ravi Iyer","doi":"10.1177/07067437251339215","DOIUrl":"10.1177/07067437251339215","url":null,"abstract":"<p><p>ObjectivesCommunity treatment orders (CTOs) for people with severe mental illnesses are used across most of Canada. Our previous systematic review of 10 years ago found that the evidence-base was limited to small studies, with only one including controls. This review updates the evidence using studies conducted in Canada over the last decade.MethodsA systematic search of PubMed/Medline, Embase, CINAHL, and PsycINFO for any Canadian study of outcomes following CTO placement from March 2015 to January 2025.ResultsWe identified four articles from three studies. Adding these studies to the previous search gave a total of nine articles from seven studies. None could be included in a meta-analysis. There were reductions in readmission rates and bed-days following CTO placement, while psychiatric symptom, outpatient attendance, treatment adherence participation in psychiatric services and housing all improved. In one study, perceived coercion was no greater in the CTO cases than the controls and being on an order preferable to being in hospital. However, many of the studies were small and only two included controls, of which solely one adjusted for potential confounders using either matching or adjusted analyses. The certainty of evidence was therefore rated as very low.ConclusionsThe evidence-base for the use of CTOs in Canada remains limited. This research gap contrasts with other countries that have conducted large studies using randomized or matched controls and adjusted analyses. There is a need for larger studies with more standardized reporting methods to allow for the pooling of results.Protocol Registration NumberProspectively registered with PROSPERO registration number CRD42024615480.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"661-666"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Temporal Trends of Mental Disorders in Persons with Opioid Use Disorder and Concurrent Mental Disorders in British Columbia, Canada, Using Population-Level Administrative Data, 2013 to 2021: Prévalence et tendances temporelles des troubles mentaux chez les personnes souffrant d'un trouble lié à la consommation d'opioïdes et de troubles mentaux concomitants en Colombie-Britannique, au Canada, à partir de données administratives au niveau de la population, entre 2013 et 2021.","authors":"Angela Russolillo, Fahmida Homayra, Bohdan Nosyk","doi":"10.1177/07067437251347150","DOIUrl":"10.1177/07067437251347150","url":null,"abstract":"<p><p>ObjectiveOpioid use is a major public health issue and associated with a broad range of comorbid mental disorders. Globally, there is considerable variability in reported rates of mental disorders among individuals with opioid use disorder (OUD), limiting timely intervention and evidence-based treatment among this population. We estimate the prevalence of specific mental disorders among individuals with a concurrent OUD using population-level administrative data in British Columbia, Canada.MethodA population-based retrospective observational study using individual-level linked health administrative data in British Columbia, Canada. Individuals with an OUD and concurrent mental disorder between January 1, 2013, and August 31, 2021, were included and followed from their first indication of OUD until censoring (death, administrative loss to follow-up, or August 31, 2021). We reported annual period (2013-2021) prevalence rates and age-standardized prevalence rates per 100,000 population (stratified by sex).ResultsThe population included 73,855 individuals (female 40.6%, median age, 36 [27-48]) with an OUD and concurrent mental disorder. During the observation period anxiety disorders were the most prevalent (91.7%) mental disorders followed by depression (73.6%), bipolar disorder (35.3%), schizophrenia spectrum disorders (20.4%), and personality disorders (19.5%). Among the population, the annual period prevalence of any mental disorder increased from 35,603 in 2013 to 60,940 in 2021, with an average annual percent difference of 7.0%, driven by increases in schizophrenia spectrum disorders and attention deficit/hyperactivity disorder. Overall, the annual age-standardized prevalence of any mental disorder was higher among males.ConclusionsOur findings demonstrate a steadily growing prevalence of people with OUD and a concurrent mental disorder and emphasize the need for access to mental disorder treatment among this population. Estimating specific mental disorder prevalence is a pragmatic step toward informing clinical guidelines, service needs, and health system planning.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"667-680"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Reported Dignity among People Admitted to Psychiatric Wards and Its Association with Suicidal Behaviour: Perte de dignité auto-évaluée chez les personnes admises dans des services psychiatriques et son association avec les comportements suicidaires.","authors":"Matthew Buchok, Harvey M Chochinov, Sarah Kowall, Shay-Lee Bolton, Renée El-Gabalawy, Jennifer M Hensel, James M Bolton","doi":"10.1177/07067437251355644","DOIUrl":"10.1177/07067437251355644","url":null,"abstract":"<p><p>ObjectiveDignity is an important construct in vulnerable persons; however, there is limited research examining dignity in patients with mental illness. Our study aims to examine self-reported dignity-related distress among psychiatric inpatients using the patient dignity inventory (PDI) and investigate the relationship between this distress and demographic and clinical variables, including suicidality.MethodsBetween June 2021 and July 2022, 97 participants were recruited from two hospitals in Winnipeg, Canada. Participants were patients admitted to acute psychiatric wards, 18 years or older, and provided informed consent. Participants completed a series of standardized self-report measures including the PDI and validated measures of depression, alcohol use, and suicidal behaviour. Demographic and clinical information was also obtained from patient charts. General linear models were used to investigate the relationship between dignity-related distress and demographic and clinical variables.ResultsThe majority of the study sample had moderate to high depression symptomatology (57.7%), previous psychiatric hospitalizations (67.4%), and previous suicide attempts (52.6%). Dignity-related distress was not associated with gender, sexual orientation, age, marital status, or education. Higher levels of dignity-related distress were associated with mental disorder comorbidities (<i>P</i> < 0.01), greater depressive symptoms (<i>P</i> < 0.001), and higher risk alcohol use behaviours (<i>P</i> < 0.001). Increasing levels of dignity-related distress were associated with greater intensity of suicidal ideation (<i>P</i> < 0.001) having at least one previous suicide attempt (<i>P</i> < 0.001), and having a high desire to die during that attempt (<i>P</i> < 0.001).ConclusionAmong psychiatric inpatients, impairment in their sense of dignity was associated with greater clinical severity including both a history of suicide attempt and current suicidal ideation. Further investigation may lead to targeted interventions to mitigate dignity-related distress and improve patient outcomes.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"681-689"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concordance Between Urine Drug Screening and Self-Reported Use in the Context of a Pragmatic Randomized-Controlled Trial in People with <i>Prescription-Type</i> Opioid Use Disorder: Concordance entre le dépistage de drogues dans l'urine et l'usage autodéclaré dans le contexte d'un essai pragmatique contrôlé à répartition aléatoire chez des personnes présentant un trouble lié à l'usage d'opioïdes vendus sur ordonnance.","authors":"Gabriel Bastien, Anita Abboud, Christina McAnulty, Amani Mahroug, Bernard Le Foll, M Eugenia Socias, Louis-Christophe Juteau, Simon Dubreucq, Didier Jutras-Aswad","doi":"10.1177/07067437251367180","DOIUrl":"https://doi.org/10.1177/07067437251367180","url":null,"abstract":"<p><strong>Objective: </strong>In this study, we evaluated the concordance between urine drug screening (UDS) and self-reported use in a pragmatic randomized clinical trial.</p><p><strong>Methods: </strong>Our data was drawn from OPTIMA, a 24-week pragmatic multicentric open-label randomized-controlled trial comparing flexible take-home dosing of buprenorphine/naloxone to the methadone standard model of care for treating prescription-type opioid use disorder. A total of 272 participants were randomized (1:1 ratio) to methadone or buprenorphine/naloxone. Following treatment initiation, participants were followed-up every 2 weeks for 24 weeks. During each visit, participants provided urine samples for UDS and self-reported their substance use over the past 2 weeks. Self-reported use was dichotomized to align with UDS detection windows. Tetrachoric correlations and 2 × 2 contingency tables were used to estimate the sensitivity, specificity, positive predictive value and negative predictive value of self-reported use. A generalized linear mixed model assessed how substance type, time in the study, treatment assignment, study site, unstable housing, and sex impacted self-report accuracy.</p><p><strong>Results: </strong>Significant differences were found between substance types (<i>p</i> < 0.001) and study sites (<i>p</i> < 0.001). Fentanyl, cannabis, and amphetamines consistently showed the greatest concordance between measurement methods. Hydromorphone, oxycodone, heroin, and benzodiazepines had low sensitivity and low positive predictive value. Participants from Québec showed higher concordance between UDS and self-reported use compared to those from British Columbia, Alberta, and Ontario. There was no moderating effect of treatment assignment (<i>p</i> = 0.174), time in the study (<i>p</i> = 0.221), unstable housing (<i>p</i> = 0.733), or sex (<i>p</i> = 0.321) on the concordance between UDS and self-reported use.</p><p><strong>Conclusions: </strong>Our results indicate that concordance between UDS and self-reported use is impacted by several factors. Combining UDS and self-reported use could help provide a more accurate assessment of substance use.</p><p><strong>Clinical trial registration: </strong>This study was registered in ClinicalTrials.gov (NCT03033732).</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437251367180"},"PeriodicalIF":3.8,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electroconvulsive Therapy Variability Across Ontario 2007-2023: A Population Level Study: Variabilité de la thérapie électroconvulsive en Ontario de 2007 à 2023 : une étude au sein de la population.","authors":"Tyler S Kaster, Michael A Campitelli, Amreen Babujee, Anjie Huang, Karim Ladha, Daniel M Blumberger, Paul Kurdyak","doi":"10.1177/07067437251371977","DOIUrl":"https://doi.org/10.1177/07067437251371977","url":null,"abstract":"<p><strong>Objective: </strong>Electroconvulsive therapy (ECT) is an important but underused treatment for severe psychiatric illnesses. We sought to examine the variability of ECT utilization at a population level and between several subgroups. We also sought to quantify the impact of the COVID-19 pandemic on ECT utilization.</p><p><strong>Methods: </strong>We used population level data from Ontario to examine all ECT procedures administered from 1 January 2007 to 31 December 2023. Our primary measure of variability was the rate of ECT procedures per 1,000 population. We included three subgroups at time of ECT procedure: age (18-39, 40-64, and 65+), biologic sex (male/female), and Ontario Health (OH) region of residence (West, Central, Toronto, East, North West, North East). To quantify the impact of the COVID-19 pandemic we calculated the change in ECT rate from 2019 to 2020 (acute effect) and 2019 to 2023 (persistent effect).</p><p><strong>Results: </strong>There were 450,381 ECT procedures delivered during the observation period. The yearly rate of ECT increased from 1.69 per 1,000 in 2007 to a peak of 3.08 per 1,000 in 2019. In 2023 the greatest per capita rates of ECT use were in the 65+ age group, female sex, and North East geographic region. In 2023, the rates of ECT use in different geographic regions ranged from 1.28 (North West) to 4.19 per 1,000 (North East). The COVID-19 pandemic resulted in an immediate 26.73%, followed by a 17.47% persistent drop in the rate of ECT with notable regional heterogeneity.</p><p><strong>Conclusions: </strong>While ECT use increased over time, there were differences in this increase between age groups, biological sex, and geographic regions. The COVID-19 pandemic had significant immediate and persistent impacts on the rates of ECT use highlighting the need for ongoing population level monitoring of this important treatment.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437251371977"},"PeriodicalIF":3.8,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Criminal Justice System Contacts among Suicide Decedents in Toronto, 1998-2020: An Observational Study: Démêlés avec le système de justice pénale parmi les personnes décédées par suicide à Toronto, entre 1998 et 2020 : Une étude d'observation.","authors":"Daniel Sanchez-Morales, Samantha Mason, Prudence Po Ming Chan, Rohan Borschmann, Alexander Simpson, Lauren M Weinstock, Jennifer M Dmetrichuk, Ayal Schaffer, Rachel H B Mitchell, Rosalie Steinberg, Mark Sinyor","doi":"10.1177/07067437251342276","DOIUrl":"10.1177/07067437251342276","url":null,"abstract":"<p><p>ObjectiveThis exploratory correlational study explored the demographic, clinical, and offence-type characteristics of people with documented past-year contact with the criminal justice system (CJS) in Toronto, Canada who died by suicide. We aimed to compare demographic and clinical factors among individuals with CJS contact who died by suicide to those without recorded CJS contact who died by suicide.MethodsCoroners' final death reports from all recorded suicide deaths in Toronto between 1 January 1998 and 31 December 2020 were retrieved by research staff and coded at the Office of the Chief Coroner (OCC) of Ontario. A series of bivariate analyses and binary logistic regression analyses were performed to compare demographic and clinically relevant characteristics between these groups. Descriptive statistics relating to demographic, clinical, and offence-type characteristics were reported.ResultsA total of 5,288 people died by suicide, of whom 251 (4.7% of all suicides) had recorded CJS contact prior to death. Assault, physical assault, impaired driving, serious/death threats, and sexual assault were the most common criminal charges among those in the CJS contact group. When compared with the no recorded CJS contact group, the CJS contact group was slightly younger (<i>M</i> = 40.0, SD = ±13.4 vs. <i>M</i> = 47.5, SD = ±18.1, <i>p</i> <i><</i> <i>0</i><i>.001</i>), had a higher proportion of males (85.6% vs. 69.9%, <i>p</i> <i><</i> <i>0</i><i>.001</i>), more commonly experienced interpersonal (36.3% vs. 14.5%, <i>p</i> <i><</i> <i>0</i><i>.001</i>) and/or relationship break-up/breakdown stressors (16.7% vs. 7.5%, <i>p</i> <i><</i> <i>0</i><i>.001</i>), and substance misuse or substance use disorders (37.5% vs. 18%, <i>p</i> <i><</i> <i>0</i><i>.001</i>).ConclusionsOur findings highlight that younger men with interpersonal stressors and/or substance misuse characterize suicide decedents with recorded CJS contact in Toronto, Canada. Suicide prevention efforts and strategies should consider the profile differences among those navigating the CJS.Plain Language Summary TitleCriminal Justice System Contacts among Suicide Decedents in Toronto.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"639-648"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023: Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes.","authors":"","doi":"10.1177/07067437251349087","DOIUrl":"10.1177/07067437251349087","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"652"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Static and Dynamic Variables Associated with Inpatient Aggression: A Two-Year Retrospective Study: Variables statiques et dynamiques associées au comportement agressif des patients hospitalisés : étude rétrospective de deux ans.","authors":"Roland M Jones, Lavanya Vangala, Farhat Farrokhi, Mario Moscovici, Stephanie Penney, Alexander I F Simpson, Paul Kurdyak","doi":"10.1177/07067437251343293","DOIUrl":"10.1177/07067437251343293","url":null,"abstract":"<p><p>BackgroundAggressive behaviour is common in mental health inpatient units, and can cause physical and psychological harm, low work satisfaction among staff and be disruptive to the clinical care of patients. Identification of static and dynamic variables associated with inpatient aggression may help identify opportunities for intervention to reduce such incidents.MethodWe carried out a two-year retrospective study of consecutive admissions to the Centre for Addiction and Mental Health, the largest mental health facility in Canada. We created a multivariable model of risk factors associated with aggression, which included static and dynamic variables, as well as the Dynamic Appraisal of Situational Aggression (DASA), which was measured daily.ResultsWe included 4419 consecutive admissions comprising 88,124 patient-days. We found that High and Medium DASA scores were strongly associated with subsequent aggression (HR = 9.64, 95% CI = 7.75-11.99, and HR = 3.51, 95% CI = 2.82-4.37, respectively) after controlling for other variables. Other variables associated with aggression included the Aggressive Behaviour Scale of the Resident Assessment Instrument-Mental Health (RAI-ABS), male gender, younger age, ethnicity, PRN (as needed medication) administration, unit type, involuntary admission, medication refusal and self-harm. However, these variables were more weakly associated with subsequent aggression as compared to the DASA score categories.ConclusionsHigher DASA scores are strongly associated with aggression after controlling for a range of other patient variables. Frequent structured measurement of dynamic variables using the DASA may help identify patients most at risk of aggression and assist clinical staff in directing interventions to where they are most needed to reduce aggression on inpatient units.Plain Language Summary TitleWhat Factors Are Linked to Aggression in Mental Health Hospitals? A Two-Year Study.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"620-628"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Integrated Treatment Programs for Severe Concurrent Substance Use and Mental Disorders: Insights on Overdose from the ROAR CANADA Project: Améliorer les programmes de traitement intégré pour les troubles mentaux et les troubles liés à l'usage de substances psychoactives graves et concomitants : aperçu de la problématique des surdoses dans le cadre du projet ROAR CANADA.","authors":"Christian G Schütz, Tonia Nicholls, Laura Schmid, Sydney Penner, Myra Massey, Karina A Thiessen, Stefanie Todesco, Reza Rafizadeh, Kiefer Cowie, Sabrina K Syan, James MacKillop","doi":"10.1177/07067437251315516","DOIUrl":"10.1177/07067437251315516","url":null,"abstract":"<p><p>ObjectiveThis paper summarizes methods and initial overdose-related results from the Reducing Overdose and Relapse: Concurrent Attention to Neuropsychiatric Ailments and Drug Addiction (ROAR CANADA) project. ROAR CANADA is a longitudinal observational study of individuals with severe concurrent substance use and mental disorders (also called dual disorders or dual diagnosis). The study sampled patients treated at two tertiary treatment centres in British Columbia, Red Fish Healing Centre and Heartwood Centre, along with a concurrent treatment unit at St. Joseph's in Ontario. These facilities have implemented evidence-based integrated treatment programs. Our first analysis explores selected baseline characteristics as potential risk factors for drug overdose in this population.MethodSociodemographic factors, trauma history, and impulsivity were part of a more comprehensive longitudinal assessment. In this first investigation, we use bivariate analysis and logistic and linear regression modelling to examine these variables in relation to overdose history.ResultsOverall, 291 of 450 participants (64.7%) reported a history of ≥1 overdose. Across the three centres, patients had a lifetime average of 7.6 (<i>SD</i> = 12.9) overdoses. The prevalence and mean number of overdoses were somewhat higher among Red Fish patients (74.5% and 8.5, respectively). Adverse childhood events, lifetime trauma history, and impulsivity were all high, but only lifetime trauma history emerged as significantly associated with overdose across all treatment centres. Impulsivity indicators were selectively associated with overdose by site, but not consistently within the overall sample.ConclusionsThese results highlight the importance of prioritizing trauma-informed care in the treatment of individuals with severe concurrent substance use and mental disorders, who are at high risk of overdose. The integration of trauma treatment into existing programs may enhance patient outcomes and contribute to the ongoing evolution of effective care strategies for this complex population. These findings are particularly relevant in light of the overdose crisis.Plain Language Summary TitleEnhancing Integrated Treatment Programs for Severe Concurrent Substance Use and Mental Disorders: Insights on Overdose from the ROAR CANADA Project.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"600-610"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Matching-Adjusted Indirect Comparison (MAIC) of Centanafadine versus Methylphenidate Hydrochloride in Adults with Attention-Deficit/Hyperactivity Disorder (ADHD): Short-Term Safety and Efficacy Outcomes: Comparaison indirecte ajustée par appariement (MAIC) entre centanafadine et le chlorhydrate de méthylphénidate chez les adultes atteints d'un trouble déficitaire de l'attention avec ou sans hyperactivité (TDAH) : Résultats en matière d'innocuité et d'efficacité à court terme.","authors":"Jeff Schein, Maryaline Catillon, Chunyi Xu, Alice Qu, Anaïs Lemyre, Marjolaine Gauthier-Loiselle, Martin Cloutier, Ann Childress","doi":"10.1177/07067437251342279","DOIUrl":"10.1177/07067437251342279","url":null,"abstract":"<p><p>ObjectivesTo compare the short-term safety and efficacy of centanafadine, an investigational treatment, versus long-acting controlled-release methylphenidate hydrochloride (methylphenidate, Foquest^®) among adult patients with attention-deficit/hyperactivity disorder (ADHD), using matching-adjusted indirect comparison (MAIC).MethodsThis anchored MAIC used pooled individual patient data (IPD) from two centanafadine trials (NCT03605680, NCT03605836) and published aggregate data from one methylphenidate trial (NCT02139124). Using propensity scores, IPD from the centanafadine trials were reweighted to match the aggregate baseline characteristics of the methylphenidate trial. Safety and efficacy outcomes were compared at Week 4. Safety outcomes were the rates of adverse events reported by ≥5% of patients in any treatment group in either trial with an incidence twice that of the placebo. The efficacy outcome was the mean change from baseline in Adult ADHD Investigator Symptom Rating Scale (AISRS)/ADHD Rating Scale-5 (ADHD-RS-5) score at Week 4.ResultsAfter matching, no significant differences in baseline characteristics were observed across trials. Relative to methylphenidate, centanafadine exhibited a better safety profile, with a significantly lower risk of insomnia (risk difference in percentage points: -9.46 points) and initial insomnia (-4.68 points). There was no significant difference in efficacy across treatments as measured by the mean change from baseline in AISRS/ADHD-RS-5 score.ConclusionsIn this MAIC, centanafadine was associated with a lower risk of insomnia and comparable (i.e., nondifferent) efficacy compared to methylphenidate at Week 4. Information on the comparative safety and efficacy of ADHD treatments in the adult population will help inform personalized treatment decisions given the range of treatment options with varying attributes.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"629-638"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}