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

{"title":"Metformin, but Not Aripiprazole, Was Associated With Attenuation of Weight Gain in Clozapine-Treated Inpatients With Concurrent Disorders: A Repeated Measures Cohort Analysis: La metformine, mais non l'aripiprazole, a été associée à une atténuation du gain de poids chez les patients hospitalisés traités par la clozapine et présentant des troubles concomitants : une analyse de cohorte à mesures répétées.","authors":"Reza Rafizadeh, Laura Frankow, Vijaykumar Seethapathy, Lukas Hestvik, Manal Tanyous, Nickie Mathew, Christian G Schütz, Chad A Bousman","doi":"10.1177/07067437261486956","DOIUrl":"10.1177/07067437261486956","url":null,"abstract":"<p><p>BackgroundIndividuals with schizophrenia and concurrent substance use disorders (SUDs) face a high risk of rapid weight gain during residential treatment, driven by inpatient environmental factors, baseline metabolic vulnerability, and metabolically active psychotropic medications. Clozapine, commonly indicated for treatment-resistant psychosis, is frequently associated with early and substantial weight gain. This study examined whether adjunctive metformin or aripiprazole attenuated weight gain in individuals taking clozapine in a naturalistic residential setting.MethodsThis retrospective cohort study included adults prescribed clozapine during admission to a 105-bed provincial concurrent disorders facility in British Columbia, Canada (2021-2024). Adults with ≥90-day admissions and available therapeutic drug monitoring were included. Monthly weights were extracted from electronic records and linked to serum concentrations and medication exposure. Linear mixed-effects models with random intercepts and slopes assessed predictors of weight trajectories, with fixed effects including age, sex, baseline weight, norclozapine concentration, opioid agonist therapy (OAT), augmenting antipsychotic defined daily dose, and adjunctive metformin and aripiprazole. Interaction terms between time and adjunctive agents evaluated effects on weight trajectories.ResultsEighty individuals contributed 306 matched serum concentration-weight observations. The cohort was predominantly male with schizophrenia and comorbid SUDs. Higher baseline weight and greater time between admission and blood draw were associated with increased weight. In adjusted models, norclozapine concentration and OAT were associated with higher weight. Metformin was associated with attenuation of weight gain over time (time × metformin: B = -2.63, 95% CI -4.49 to -0.76), whereas aripiprazole was not (B = -0.38, 95% CI -2.58 to 1.82).ConclusionMetformin was associated with attenuation of weight gain trajectory in this population, whereas aripiprazole showed no clear effect. These findings highlight substantial metabolic vulnerability in inpatient concurrent disorders settings and support early preventive metabolic interventions during clozapine treatment.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261486956"},"PeriodicalIF":4.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972351","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":"From Promise to Practice: Artificial Intelligence in Psychiatry and the Path to Clinical Impact.","authors":"John-Jose Nunez, David Gratzer","doi":"10.1177/07067437261483431","DOIUrl":"10.1177/07067437261483431","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261483431"},"PeriodicalIF":4.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972353","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":"Pharmacological Management of Opioid Use Disorder: A Systematic Review and Network Meta-Analysis: Prise en charge pharmacologique du trouble de l'usage des opiacés : revue systématique et méta-analyse en réseau.","authors":"Myanca Rodrigues, Brittany B Dennis, Behnam Sadeghirad, Anna Oprea, Mikail Malik, Leen N Naji, Alannah McEvoy, Devon Malhotra, Sameer Parpia, Lehana Thabane, Zainab Samaan","doi":"10.1177/07067437261479071","DOIUrl":"10.1177/07067437261479071","url":null,"abstract":"<p><p>ObjectiveTo assess the comparative benefits and harms of opioid substitution and antagonist therapies (OSATs) for opioid use disorder (OUD) using a network meta-analysis (NMA) of randomized controlled trials (RCTs).Data SourcesMedline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, and the National Institutes of Health Clinical Trials Registry were searched through 10 August 2025, for trials assessing the effectiveness or safety of any OSAT for people with OUD.Data Extraction and SynthesisPairs of reviewers independently screened studies, extracted data, and assessed risk of bias. Frequentist random-effects NMAs were conducted, and certainty of evidence for treatment effects was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.Main Outcomes and MeasuresTreatment retention (people remaining in follow-up at study end), opioid abstinence (during follow-up), criminal activity, all-cause mortality, and overdose-related death.ResultsWe included 103 RCTs assessing 13 interventions across 26,624 people with OUD. Compared with placebo, moderate-certainty evidence demonstrated that heroin was most effective for treatment retention (Odds Ratio [OR] = 31.47; 95% confidence interval [CI] = 12.29,80.58). Heroin + methadone (OR = 8.00; 95% CI = 3.21,19.93) and high-dose methadone (HMET) (OR = 6.94; 95% CI = 3.76, 12.82) also ranked highly (moderate certainty). High- and low-dose buprenorphine (moderate certainty) and HMET (low certainty), improved abstinence as measured by urine drug screens. No intervention reduced criminal activity (moderate certainty), all-cause mortality (low certainty), or overdose-related death.Conclusions and RelevanceHeroin-assisted therapy, alone or with methadone, and HMET were most effective for treatment retention. Buprenorphine and HMET improved abstinence, although certainty was lower. Evidence for mortality, overdose, and other patient-important outcomes remains limited. Heroin-assisted therapy exclusively enrolled people with heroin dependence and should not be initiated in those without prior use. Larger trials directly comparing methadone, buprenorphine, and heroin-assisted therapy, and enrolling patients with fentanyl use, are needed in the evolving toxic drug supply.PROSPERO RegistrationCRD42013006507.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261479071"},"PeriodicalIF":4.4,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956707","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":"Cannabis Use Interacts With Psychosis Vulnerability in Borderline Personality Disorder: La consommation de cannabis interagit avec la vulnérabilité à la psychose dans le trouble de la personnalité limite.","authors":"James Mirabelli, James MacKillop, David Streiner, Michele Korostil","doi":"10.1177/07067437261486962","DOIUrl":"10.1177/07067437261486962","url":null,"abstract":"<p><p>BackgroundIndividuals with borderline personality disorder (BPD) frequently use cannabis, often for self-medication. However, cannabis use has also been linked to BPD symptom severity, suggesting heterogeneity in its effects. Individuals with BPD frequently experience psychotic-like symptoms and may demonstrate elevated psychosis vulnerability, which is associated with greater symptom severity and poorer clinical outcomes. Cannabis use may exacerbate psychotic symptoms. The relationship between psychosis vulnerability and BPD symptoms may therefore be influenced by cannabis use. This study examined whether cannabis use interacts with psychotic-like experiences (PLEs) in relation to BPD symptom severity in a clinical sample.MethodSeventy-nine outpatients with BPD completed questionnaires assessing BPD symptom severity, cannabis use, and PLEs. Moderation analyses tested whether cannabis use influenced the association between PLEs and BPD symptoms.ResultsCannabis use significantly moderated the relationship between PLEs and BPD symptom severity (ΔR² = 0.069, <i>P</i> = 0.006), such that the association between PLEs and BPD symptoms strengthened as cannabis use increased. A crossover interaction was observed: the lowest BPD symptom scores occurred in individuals with low PLEs and high cannabis use, whereas the highest BPD symptom scores occurred in those with high PLEs and high cannabis use. In addition, PLEs moderated the relationship between cannabis use and BPD symptoms, such that cannabis use was negatively associated with BPD symptoms among individuals with low PLEs (<i>β</i> = -0.358, <i>P</i> = 0.018).ConclusionsPLEs appear to be an important factor in understanding heterogeneous associations between cannabis use and BPD symptom severity. Individuals with BPD who endorse elevated PLEs may benefit from targeted psychoeducation regarding cannabis-related risks and consideration of treatment for cannabis use disorder when clinically indicated. Conversely, the observed negative association between cannabis use and BPD symptoms in individuals with lower PLEs warrants further study of clinically meaningful heterogeneity and individualized treatment approaches.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261486962"},"PeriodicalIF":4.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946092","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":"Adherence and Acceptability of Smartphone- and Wearable-Based Digital Phenotyping in Patients With First-Episode Psychosis: Observance et acceptabilité du phénotypage numérique fondé sur les téléphones intelligents et les objets personnels connectés chez les patients présentant un premier épisode de psychose.","authors":"Lu Yang, Kate Ross, Mackenzie Palmer, Qiang Ye, David Olson, Sabina Abidi, Jason Morrison, Philip G Tibbo, Jianli Wang","doi":"10.1177/07067437261486958","DOIUrl":"10.1177/07067437261486958","url":null,"abstract":"<p><p>ObjectiveTo examine adherence to smartphone- and wearable-based digital phenotyping in patients with first-episode psychosis (FEP) and explore stakeholder perspectives on its potential application for outcome prediction.MethodWe conducted a six-day mixed-methods digital phenotyping assessment involving ecological momentary assessment (EMA) via smartphone and passive monitoring using wearable devices. Patients with FEP (aged 12-35) were recruited from the Early Psychosis Intervention Nova Scotia program (<i>N</i> = 40). The present analysis focuses on adherence, acceptability, and stakeholder perspectives. Active and passive adherence were defined as the proportion of completed EMA surveys and available wearable data, respectively. Exploratory mixed-effects regression analyses were conducted to examine temporal trends and factors associated with adherence. Semi-structured interviews were conducted with 19 patients, six caregivers, and six clinicians, and analyzed thematically.ResultsMean active adherence was 71.32% (SD = 28.77). Mean passive adherence was 85.45% (SD = 25.80) for heart rate and accelerometry, and 82.90% (SD = 26.65) for sleep data, respectively. The odds of EMA survey completion declined beginning on Day 3, and passive adherence rate declined beginning on Day 2; however, neither trend remained significant after adjusting for prior adherence. In exploratory analyses, no consistent associations were observed between most demographic or clinical variables and adherence. Higher Social and Occupational Functioning Assessment Scale score was associated with lower odds of EMA survey completion (OR = 0.91, 95% CI: 0.84, 0.98), a finding that should be interpreted cautiously given the small sample. Barriers to adherence were identified by stakeholders, including EMA survey burden, psychological risks, usability and technical challenges, and inaccessibility to digital tools due to school or work restrictions.ConclusionDigital phenotyping appears generally feasible and acceptable in clinically stable FEP patients, but implementation should incorporate safeguards to minimize EMA burden, psychological distress, usability barriers, and ethical risks related to future predictive feedback.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261486958"},"PeriodicalIF":4.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946057","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":"School Cellphone Restrictions: Preliminary Data Examining the Policy Implications for Child and Youth Mental Health.","authors":"Kimberley C Tsujimoto, Eric Tu, Catherine S Birken, Katherine Cost, Danielle Baribeau, Alice Charach, Elizabeth Kelley, Julia Frei, Elisabetta Trinari, Nicole Lee, Konstantin Osokin, Christie L Burton, Jennifer Crosbie, Daphne J Korczak","doi":"10.1177/07067437261483882","DOIUrl":"10.1177/07067437261483882","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261483882"},"PeriodicalIF":4.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921873","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 Multivariate Approach to Communication Impoverishment and Cognitive Performance in Treatment-Resistant Schizophrenia: Analyse à plusieurs variables portant sur l'appauvrissement de la communication et la performance cognitive dans les cas de schizophrénie résistante au traitement.","authors":"Rafal M Skiba, Todd S Woodward, Ivan Caramanna, William G Honer, Randall F White, Mahesh Menon, Ivan J Torres","doi":"10.1177/07067437261484787","DOIUrl":"10.1177/07067437261484787","url":null,"abstract":"<p><p>ObjectiveLanguage and communication disturbances are enduring features of schizophrenia, often manifesting as impoverishment of speech. This exploratory study aims to examine how communicative deficits overlap with a cognitive profile of treatment-resistant chronic schizophrenia inpatients.MethodsWe employed Iterative Constrained Principal Component Analysis in a sample of inpatients (<i>n</i> = 138) to identify the optimized, multidimensional overlap between 17 neuropsychological measures and 26 symptom items from the Positive and Negative Syndrome Scale. Cognition was assessed via neuropsychological tests of verbal comprehension, semantic memory/verbal fluency, cognitive flexibility, verbal and visuospatial learning, processing speed, and working memory.ResultsThe analysis identified a distinct symptom-cognition cluster. Communication Impoverishment (specifically the Lack of Spontaneity and Flow of Conversation) was the primary predictor of a cognitive component characterized by Verbal Fluency and Executive Functioning. This component was defined by performance on tasks measuring category-based word generation, the ability to switch between semantic rules, and the depth of word knowledge and general factual information. This association was independent of antipsychotic dosage and correlated with real-world social and occupational functioning.ConclusionsThe results indicate that communication impoverishment in persistent psychosis reflects dysfunction within the verbal-semantic system, likely involving both the fluid executive ability to navigate categories and the integrity of the semantic store itself.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261484787"},"PeriodicalIF":4.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907995","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":"Trends in Canadian Suicide Mortality by Age and Sex From 2000 to 2024: Tendances en matière de mortalité attribuable au suicide au Canada selon l'âge et le sexe, de 2000 à 2024.","authors":"Sara Zulyniak, Gina Dimitropoulos, Eric C Chan, Scott B Patten","doi":"10.1177/07067437261480922","DOIUrl":"10.1177/07067437261480922","url":null,"abstract":"<p><p>ObjectivePrior research in Canada had only assessed suicide mortality rates through 2018, meaning that suicide trends during and beyond the COVID-19 pandemic are unknown. Thus, this study aimed to extend previous literature by characterizing trends of age- and sex-specific suicide mortality from 2000 to 2024.MethodsYearly rates of suicide in Canada were generated from 2000 to 2024 in overall, age- (by five-year age categorizations) and sex-stratified groups. Joinpoint regression analysis was then employed to determine annual percent change (APC) of defined trendlines, and nodes at which the direction or slope of the trendline changed (joinpoints).ResultsOverall rates of suicide in Canada have significantly declined from 2018 to 2024 by an APC of -4.85 (95% CI: -6.26, -3.68; <i>p</i> = 0.002). Most male age groups under 40 years of age saw significantly declining trends from 2018 to 2024. For example, males aged 15-19 years had an annual percent decline of 8.37 percentage points from 2018 to 2024 (95% CI: -17.86, -3.52; <i>p</i> = 0.01). However, females aged 10 to 14 years saw a significant increase of 2.40 percentage points per year (95%CI: 0.72, 4.39; <i>p</i> = 0.007) from 2000 to 2024, while 25-29-year-old females had an annual increase of 1.85 percentage points (95%CI: 1.00, 2.85; <i>p</i> < 0.001) during this same time. No other age/sex groups had significantly increasing trends through 2024.ConclusionsOverall trends and many Canadian age and sex groups have seen declining rates of suicide mortality beginning in 2018, though some young female groups have continued to have increasing rates of suicide from 2000 to 2024. Future literature should look to determine whether these changing suicide trends relate to changing patterns of mental disorder, particularly in young females, or whether other characteristics may better explain the different trends in suicide observed across distinct age and sex groups.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261480922"},"PeriodicalIF":4.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889470","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":"Serotonergic Antidepressants in Concurrent Disorders: A Call for Accelerated Research and Interdisciplinary Collaboration.","authors":"Matthew E Sloan, Anees Bahji, David N Crockford, Marlon Danilewitz, Didier Jutras-Aswad, Victor M Tang","doi":"10.1177/07067437261483871","DOIUrl":"10.1177/07067437261483871","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261483871"},"PeriodicalIF":4.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882539","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":"Response Letter to the Editor.","authors":"Valerie Taylor","doi":"10.1177/07067437261464734","DOIUrl":"10.1177/07067437261464734","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"736"},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438938","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}