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

{"title":"Magnetic Seizure Therapy in Refractory Psychiatric Disorders: A Systematic Review and Meta-Analysis: La thérapie par convulsions magnétiques pour la prise en charge des troubles psychiatriques réfractaires : revue systématique et méta-analyse.","authors":"Jake Prillo, Lorina Zapf, Caroline W Espinola, Zafiris J Daskalakis, Daniel M Blumberger","doi":"10.1177/07067437241301005","DOIUrl":"10.1177/07067437241301005","url":null,"abstract":"<p><p>ObjectiveTo qualitatively and quantitatively synthesize the literature on the efficacy and safety of magnetic seizure therapy (MST) in psychiatric disorders.MethodsA literature search was conducted of the OVID Medline, OVID EMBASE, PsychINFO, CINAHL, Web of Science and Cochrane databases from inception to 14 January 2024, using subject headings and key words for \"magnetic seizure therapy.\" Randomized controlled trials (RCTs), post-hoc analyses of RCTs, open-label trials, or case series investigating MST in adults with a verified psychiatric diagnosis and reporting on two possible primary outcomes (1) psychiatric symptom reduction (as measured by validated rating scale) or (2) neurocognitive outcomes (as measured by standardized testing), were included. Abstracts, individual case reports, reviews and editorials were excluded. Extracted data included: (1) basic study details; (2) study design; (3) sample size; (4) baseline demographics; (5) outcome data (including secondary outcomes of suicidal ideation and adverse events); and (6) stimulation parameters. Cochrane's risk of bias tool was applied. A quantitative analysis was conducted for the depression studies, using Hedge's g effect sizes.ResultsA total of 24 studies (n = 377) were eligible for inclusion. Seventeen studies in depression (including three RCTs), four studies in schizophrenia (including one RCT), one study in bipolar disorder, one study in obsessive-compulsive disorder and one study in borderline personality disorder were summarized. We found no significant difference in depressive symptom reduction between MST and electroconvulsive therapy (ECT) in randomized, controlled trials (g = 0.207 towards ECT, 95% confidence interval (CI) -0.132 to 0.545, <i>P</i> = 0.232). We found a significant reduction in depressive symptoms overall with MST in the pooled RCT and open-label analysis (g = 1.749, CI 1.219 to 2.279, <i>P</i> < 0.005). It is suggested that MST has modest cognitive side effects.ConclusionsLarge-scale RCTs are necessary to confirm early signals of MST as an effective intervention in psychiatric disorders with a cognitive profile that is potentially more favourable than ECT.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437241301005"},"PeriodicalIF":3.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803502","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":"Physical Activity as a Predictor of Internet Gaming Disorder in a Swiss Male Cohort (C-SURF): L'activité physique comme prédicteur des troubles liés aux jeux vidéo en ligne dans une cohorte de jeunes hommes suisses (C-SURF).","authors":"Adam Nowotarski, Stephane Rothen, Filip Kasina, Daniele Zullino, Gabriel Thorens","doi":"10.1177/07067437241293979","DOIUrl":"10.1177/07067437241293979","url":null,"abstract":"<p><strong>History and objectives: </strong>This study addresses the increasing global concerns surrounding Internet gaming disorder (IGD) by exploring their connection to physical activity (PA) as a potential preventive and early intervention measure. The research aims to examine the relationship between PA and the progression of IGD.</p><p><strong>Methods: </strong>Longitudinal data from the Cohort research on Substance Use Risk Factors involving young Swiss men undergoing army conscription was employed. PA levels were assessed using the International PA Questionnaire (IPAQ), while the Game Addiction Scale (GAS) and Compulsive Internet Use Scale determined IGD presence. Analysis involved zero-inflated negative binomial regression models.</p><p><strong>Results: </strong>Higher PA levels were associated with lower IGD risk. Notably, individuals engaging in high physical exercise exhibited a lower IGD prevalence compared to those with moderate or low activity levels.</p><p><strong>Discussion: </strong>The study suggests that intensive physical exercise might serve as a preventive strategy against developing IGD. This protective effect could stem from various mechanisms. However, the study's limitations, such as a male-only sample and a small low-activity group, should be considered when interpreting results.</p><p><strong>Conclusion: </strong>The longitudinal study demonstrates the positive influence of intense physical exercise on mitigating gaming-related issues. These findings underscore the potential of PA interventions in addressing the growing problem of IGDs and their impact on health. Further research is necessary to uncover underlying mechanisms behind the PA-IGD relationship and validate these findings across diverse demographics.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"855-860"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607529","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":"Graph Convolutional Network for AD and MCI Diagnosis Utilizing Peripheral DNA Methylation: Réseau de neurones en graphes pour le diagnostic de la MA et du TCL à l'aide de la méthylation de l'ADN périphérique.","authors":"Yuqin Qian, Xinlu Tang, Ruinan Shen, Yong Lu, Jianqing Ding, Xiaohua Qian, Chencheng Zhang","doi":"10.1177/07067437241300947","DOIUrl":"10.1177/07067437241300947","url":null,"abstract":"<p><strong>Objective: </strong>Blood DNA methylation (DNAm) alterations have been widely reported in the onset and progression of mild cognitive impairment (MCI) and Alzheimer's disease (AD); however, DNAm is underutilized as a diagnostic biomarker for these diseases. We aimed to evaluate the diagnostic performance of DNAm for MCI and AD, both individually and in combination with well-established AD biosignatures.</p><p><strong>Methods: </strong>A total of 1,891 blood samples from Alzheimer's Disease Neuroimaging Initiative (ADNI) studies were used to identify potential candidate DNAm biomarkers. Multimodal clinical data from 635 samples (normal control (NC), <i>n</i> = 193; MCI, <i>n</i> = 352; AD, <i>n</i> = 90) in the TADPOLE dataset were utilized to construct eight different classification models using a graph convolutional network, a machine learning framework.</p><p><strong>Results: </strong>After feature selection, 17 DNAm sites were selected for subsequent analysis. Remarkable differences in DNAm levels were observed at the screened DNAm loci in all three cohorts. Adopting DNAm features into multimodal models significantly improved the classification performance for three dichotomous subtasks (NC vs. non-NC, MCI vs. non-MCI, and AD vs. non-AD), especially when combined with cerebrospinal fluid (CSF) features for NC (area under the curve (AUC): 0.8534) and MCI classification (AUC: 0.7675). A weak correlation between DNAm and both magnetic resonance imaging and CSF features in the NC and MCI cohorts suggests good complementarity between modalities (correlation coefficient ≤0.2).</p><p><strong>Conclusions: </strong>Our study offers new insights into peripheral DNAm in MCI and AD and suggests promising diagnostic performance of models integrating epigenomics, imaging, or CSF biomarkers.</p><p><strong>Plain language summary title: </strong>Using Machine Learning and Blood-Based Genetic Markers to Help Diagnose Mild Cognitive Impairment and Alzheimer's Disease.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"869-879"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711882","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":"The Psychological Health of Iranian Citizens Protesting the Actions of Their Country's Morality Police: La santé psychologique des citoyens iraniens qui manifestent contre les actions de la police des mœurs de leur pays.","authors":"Sophia Marchetti, Anthony Feinstein","doi":"10.1177/07067437241295638","DOIUrl":"10.1177/07067437241295638","url":null,"abstract":"<p><strong>Objective: </strong>To determine the mental health of Iranian citizens protesting the actions of their country's Morality Police. Street protests across Iran were met with violent suppression that included security forces reportedly targeting protestors' eyes.</p><p><strong>Method: </strong>A group of 63 Iranian protestors (58.7% female; mean age 32.0 [SD = 9.43] years, from all socio-economic classes) who had been part of street protests against the regime's morality police, was recruited by convenience sampling between May and August 2023 by journalists working underground in Iran. The study was conducted in Farsi by telephone (<i>n</i> = 60) and in-person (<i>n</i> = 3). Demographic and psychometric data were collected, the latter including symptoms of posttraumatic stress disorder (PTSD; Impact of Events Scale-Revised) and depression (Beck Depression Inventory-Revised), in Farsi-validated scales. Between-group comparisons were undertaken with one-way ANOVA and post-hoc Tukey comparisons. Significance was set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>The protestors comprised three groups: not wounded (<i>n</i> = 27: 59.26% female, mean age 34.44 [SD = 12.11] years), non-eye wound (<i>n</i> = 23; 60.87% female, mean age 32.61 [SD = 5.89] years) and eye-wound (<i>n</i> = 13; 53.85% female, mean age 27.54 [SD = 6.58] years). The eye wound group (blinded in one or both eyes) had less severe intrusion symptoms of PTSD (<i>P</i> = 0.048) and depression (<i>P</i> = 0.0001) than the non-eye wound group. The not wounded group had less severe symptoms of depression than the non-eye wound group (<i>P</i> = 0.003). Every protestor who had lost sight regarded their actions, notwithstanding their physical consequences, in a positive psychological light.</p><p><strong>Conclusions: </strong>Contrary to our a-prior hypothesis, Iranian protestors blinded in one or both eyes were faring better psychologically than protestors with non-eye wounds. Possible reasons for this included higher rates of psychological treatment and social support in the eye-wound group compared to the other two groups post-injury and the nascent development of posttraumatic growth.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"861-868"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633265","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":"Stratified Care in Cognitive Behavioural Therapy: A Comparative Evaluation of Predictive Modelling Approaches for Individualized Treatment: La stratification des soins pour l'orientation vers une thérapie cognitivo-comportementale: une évaluation comparative des approches de modélisation prédictive pour un traitement individualisé.","authors":"Margaret Jamieson, Andrew Putman, Marsha Bryan, Bojay Hansen, Phillip E Klassen, Nicholas Li, Bethany McQuaid, David Rudoler","doi":"10.1177/07067437241295635","DOIUrl":"10.1177/07067437241295635","url":null,"abstract":"<p><strong>Objective: </strong>In response to high demand and prolonged wait times for cognitive behavioural therapy (CBT) in Ontario, Canada, we developed predictive models to stratify patients into high- or low-intensity treatment, aiming to optimize limited healthcare resources.</p><p><strong>Method: </strong>Using client records (<i>n</i> = 953) from Ontario Shores Centre for Mental Health Sciences (January 2017-2021), we estimated four binary outcome models to assign patients into complex and standard cases based on the probability of reliable improvement in Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. We evaluated two choices of cut-offs for patient complexity assignment: models at an ROC (receiver operating characteristic)-derived cut-off and a 0.5 probability cut-off. Final model effectiveness was assessed by assigning treatment intensity (high-intensity or low-intensity CBT) based on the combined performance of both GAD-7 and PHQ-9 models. We compared the treatment assignment recommendations provided by the models to those assigned by clinical assessors.</p><p><strong>Results: </strong>The predictive models demonstrated higher accuracy in selecting treatment modality compared to provider-assigned treatment selection. The ROC cut-off achieved the highest prediction accuracy of case complexity (0.749). The predictive models exhibited large sensitivity and specificity trade-offs (which influence the rates of patient assignment to high-intensity CBT) despite having similar accuracy statistics (ROC cut-off = 0.749, 0.5 cut-off = 0.690), emphasizing the impact of cut-off choices when implementing predictive models.</p><p><strong>Conclusions: </strong>Overall, our findings suggest that the predictive model has the potential to improve the allocation of CBT services by shifting incoming clients with milder symptoms of depression to low-intensity CBT, with those at highest risk of not improving beginning in high-intensity CBT. We have demonstrated that models can have significant sensitivity and specificity trade-offs depending on the chosen acceptable threshold for the model to make positive predictions of case complexity. Further research could assess the use of the predictive model in real-world clinical settings.</p><p><strong>Plain language summary title: </strong>Stratified Care in Cognitive Behavioural Therapy: A Comparative Evaluation of Predictive Modeling Approaches for Individualized Treatment.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"880-887"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633264","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":"Impacts and Implications of Cannabis Legalization on Key Outcomes Among Adolescents in Canada.","authors":"Tessa Robinson, Didier Jutras-Aswad, Benedikt Fischer","doi":"10.1177/07067437241293098","DOIUrl":"10.1177/07067437241293098","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"852-854"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513376","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":"Short-Term Psychodynamic Psychotherapy is the First-Line Option for Depression and Treatment Resistant Depression According to Available Evidence.","authors":"Allan Abbass, Patrick Luyten, Falk Leichsenring","doi":"10.1177/07067437241299487","DOIUrl":"10.1177/07067437241299487","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"888-889"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669878","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":"Access to University Mental Health Services: Understanding the Student Experience: L'accès aux services universitaires de santé mentale : comprendre l'expérience des étudiants.","authors":"Nathan King, William Pickett, Kurtis Pankow, Gina Dimitropoulos, Emma Cullen, Stephen McNevin, Scott B Patten, Anne Duffy","doi":"10.1177/07067437241295640","DOIUrl":"10.1177/07067437241295640","url":null,"abstract":"<p><strong>Objective: </strong>To describe student access to university mental health services and barriers and gaps in support.</p><p><strong>Methods: </strong>This multiple cohort study used self-report data from 4,138 undergraduate students who completed the U-Flourish Well-Being Survey at the start and completion of first year from 2018 to 2023. The survey incorporated validated measures of mental health symptoms, barriers to care, and open-text questions about the mental health care experience and perceived gaps. Quantitative analyses summarized utilization patterns and barriers. An interpretive qualitative analysis identified common themes about support services and opportunities for improvement from the student perspective.</p><p><strong>Results: </strong>At university entry, 43% of students screened positive for anxiety and/or depression, 30% reported a lifetime mental disorder and 23% a lifetime history of self-harm. Over first year, 15% of students surveyed accessed university mental health services. Access was more likely in students identifying as older, gender diverse, female, having a prior mental disorder and those who screened positive for anxiety or depression. Common attitudinal and practical barriers reported included <i>thinking problems would resolve</i> (74%), <i>being uncomfortable sharing</i> (73%), and <i>not knowing how to get help</i> (50%). Common stigma barriers included <i>concerns about what family or friends might think</i>. Students expressed that both campus-based well-being and mental health care offered during flexible hours and accessible through online booking were important.</p><p><strong>Conclusions: </strong>Student-tailored mental health literacy may be a sustainable approach to address the attitudinal and practical barriers identified. If such barriers are reduced, an increased service demand would be expected and improved efficiencies needed. A clear Statement of Services, an online singular point of access with embedded triage to signpost students to indicated levels of care, and clearly worked-out care pathways including to community-based services would better align with a stepped care model, improve efficiency and access, and foster realistic expectations around university mental health support.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"841-851"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577159","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":"Long-Term Impact of the Bloor Viaduct Suicide Barrier on Suicides in Toronto: A Time-Series Analysis: Effet à long terme de la barrière anti-suicide du viaduc Bloor sur les suicides à Toronto : une analyse chronologique.","authors":"Mark Sinyor, Vera Yu Men, Prudence Po Ming Chan, Daniel Sanchez Morales, Anthony J Levitt, Ayal Schaffer","doi":"10.1177/07067437241293978","DOIUrl":"10.1177/07067437241293978","url":null,"abstract":"<p><strong>Background: </strong>A suicide prevention barrier was installed at Toronto's Bloor Viaduct bridge in 2003. It was associated with short-term location substitution, possibly mediated by media effects that did not persist over 1 decade. The long-term impact of the barrier is unknown.</p><p><strong>Methods: </strong>We examined rates of suicides by jumping from the Bloor Viaduct, other bridges and by other methods using coroner's records in Toronto (1998-2020). We used interrupted time-series Poisson regression analyses to model changes in quarterly bridge-related suicides after barrier installation. A secondary analysis explored the potential substitution effects of suicide by other methods.</p><p><strong>Results: </strong>Of 5219 suicides from 1998 to 2020, 303 were by jumping from bridges. After controlling for covariates, installation of the Bloor Viaduct suicide barrier was associated with a 49% step decrease in bridge-related suicide in the next quarter in Toronto (incidence rate ratio [IRR] = 0.51, 95% CI, 0.30 to 0.86) with no rebound increase in bridge-related suicide during the subsequent 17 years after the original drop (IRR = 0.99, 95% CI, 0.96 to 1.03). There was also no associated change in suicides by other methods after the barrier (IRR = 1.04, 95% CI, 0.90 to 1.20).</p><p><strong>Conclusions: </strong>Contrary to initial findings, these results indicate an enduring suicide prevention effect of the Bloor Viaduct suicide barrier. They support the long-term utility of structural interventions at high-frequency sites for suicide.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437241293978"},"PeriodicalIF":3.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584954","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":"Efficacy and Safety of Modafinil for Treatment of Amphetamine-Type Stimulant Use Disorder: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials: Efficacité et innocuité du modafinil pour le traitement des troubles liés à l'usage de stimulants de type amphétamine : revue systématique et méta-analyse d'essais randomisés contrôlés par placebo.","authors":"Laurent Elkrief, Heidar Sharafi, Hamzah Bakouni, Christina McAnulty, Gabriel Bastien, Simon Dubreucq, Nicolas Garel, Annie Trépanier, Daniela Ziegler, Didier Jutras-Aswad","doi":"10.1177/07067437241262967","DOIUrl":"10.1177/07067437241262967","url":null,"abstract":"<p><strong>Introduction: </strong>Amphetamine-type stimulants (ATSs) are related to significant harm worldwide, with limited effective pharmacological treatments for ATS use disorder (ATSUD). Modafinil has been explored as a potential treatment for ATSUD. This systematic review and meta-analysis (PROSPERO ID: CRD42023388487) aimed to evaluate the efficacy and safety of modafinil for the treatment of ATSUD.</p><p><strong>Methods: </strong>A comprehensive search of major indexing sources and trial registries, from inception to search date, was conducted on February 15, 2023, and updated on October 31, 2023. Eligible studies were randomized placebo-controlled trials (RCTs) of modafinil in individuals meeting the criteria for the Diagnostic and Statistical Manual of Mental Disorders, fourth and fifth editions, diagnoses of ATSUD. Eligible studies were assessed for risk of bias, using the Cochrane Risk of Bias tool. The primary outcome included the effect of modafinil on ATS use. Secondary outcomes included retention in treatment, ATS craving, treatment discontinuation due to adverse events (AEs), and serious AEs. Subgroup analysis by modafinil dose was conducted where appropriate. Risk ratio (RR) or Peto's odds ratio (OR) was calculated for the meta-analysis of dichotomous variables and standardized mean difference (SMD) was calculated for the random-effect meta-analysis of continuous variables.</p><p><strong>Results: </strong>Five RCTs (<i>N</i> = 451 participants) were included. Modafinil did not significantly impact ATS use (RR = 0.99; 95% CI, 0.97 to 1.02; <i>p</i> = 0.655), retention in treatment (RR = 1.02; 95% CI, 0.91 to 1.14; <i>p</i> = 0.799), ATS craving (SMD = -0.36; 95% CI, -1.19 to 0.47; <i>p</i> = 0.398), or treatment discontinuation due to AEs (Peto's OR = 0.48; 95% CI, 0.20 to 1.14; <i>p</i> = 0.100). These results were consistent across subgroup analyses. More episodes of serious AEs were reported in the modafinil group than in the placebo group, at higher doses (Peto's OR = 4.80; 95% CI, 1.18 to 19.56, <i>p</i> = 0.029).</p><p><strong>Conclusion: </strong>There is currently no evidence suggesting that modafinil has a statistically significant effect on efficacy outcomes in populations with ATSUD. Continued research into effective treatments and harm reduction strategies for ATSUD is essential.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"793-805"},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735727","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}