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

{"title":"Non-Linear Relationships of Loneliness with Age in People Living with Schizophrenia and Non-Psychiatric Comparison Participants: Relations non linéaires entre la solitude et l'âge chez les personnes atteintes de schizophrénie et les personnes n'ayant aucun antécédent de maladie psychiatrique.","authors":"Andrea M Coppola, Jerry McDonald, Amy M Jimenez, Jin Cao, Lucy Shao, Yijia Xue, Bowei Zhang, Luke C Valmadrid, Lisa Eyler, Xin M Tu, Ellen E Lee","doi":"10.1177/07067437251355636","DOIUrl":"10.1177/07067437251355636","url":null,"abstract":"<p><strong>Objective: </strong>Loneliness - distress that arises from discrepancies between perceived and desired relationships - is increasingly prevalent and recognized as a major public health concern due to the association with negative health outcomes. People living with schizophrenia (PLWS) experience higher rates of loneliness than the general population and may be particularly vulnerable to these adverse outcomes. In the general population, loneliness fluctuates throughout the lifespan, but the relationship between loneliness and age in PLWS is not well understood.</p><p><strong>Method: </strong>271 adults, 141 adults with a diagnosis of schizophrenia or schizoaffective disorder (PLWS)and 130 adults with no history of major psychiatric illness (NCs) aged 27-69 completed clinical interviews and self-report measures assessing loneliness, perceived social support, and mental and physical health. Participants also completed blood draws for biomarkers of inflammation and hyperglycaemia. Locally Weighted Scatterplot Smoothing (LOWESS) regression modelling was used to examine potential non-linear relationships between loneliness and age for both groups and to select the polynomial that best fit the observed relationship.</p><p><strong>Results: </strong>We observed an age by diagnostic group interaction (log estimate = -0.005, SE = 0.003) such that PLWS reported higher loneliness scores compared to NCs of similar age. Patterns of loneliness differed with age between diagnostic groups such that loneliness remained relatively stable and high for PLWS while for NCs loneliness increased from age 40 to age 60. In both groups, loneliness was associated with worse self-reported physical health, depression, and, among PLWS, positive symptoms.</p><p><strong>Conclusion: </strong>Results suggest different patterns of loneliness across adulthood for PLWS and NC, reflecting the different social milestones for NCs during this age period that are not as commonly experienced by PLWS, such as marriage, empty nesting and retirement. Loneliness is linked with poor physical and mental health outcomes among PLWS and may be an important target for improving morbidity and mortality for PLWS.Plain Language Summary TitleLoneliness and Aging in Schizophrenia.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"552-562"},"PeriodicalIF":4.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735496","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":"Clinician's Corner: Chatbots for Psychotherapy.","authors":"David Gratzer, John Torous, Andrew Lustig, Emma Gratzer","doi":"10.1177/07067437261461955","DOIUrl":"10.1177/07067437261461955","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261461955"},"PeriodicalIF":4.4,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13309344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340900","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":"Understanding Illicit Prescription Painkiller Use: A Multivariable Exploration of Mental Health and Other Predictors Among Canadian University Students: Comprendre la consommation illicite d'analgésiques sur ordonnance : une analyse multivariée de la santé mentale et d'autres facteurs prédictifs chez les étudiants universitaires canadiens.","authors":"Sanewal Singh, Viktor Prifti, Samantha Meyer","doi":"10.1177/07067437261462695","DOIUrl":"10.1177/07067437261462695","url":null,"abstract":"<p><p>Background and ObjectivesIllicit prescription painkiller use among university students is a growing concern, influenced by a range of demographic, mental and physical health, academic, and co-substance use factors contributing to the elevated risk. However, Canadian evidence specific to university students remains limited. This study examined correlates of self-reported illicit prescription painkiller use among Canadian university students.MethodA secondary analysis of data from the American College Health Association National College Health Assessment II Canadian university edition was conducted. The dependent variable was past-year illicit prescription painkiller use, defined as a yes or no response to self-reported use of prescription painkillers without a prescription from a healthcare provider in the past 12 months. Descriptive statistics and binary logistic regression were used to examine associated demographic, academic, physical health, mental health, and co-substance use factors.ResultsAmong the analytical sample of 44,508, 5.8% (<i>n</i> = 2,585) reported illicit prescription painkiller use in the past 12 months. Significant predictors included race, sex, sexual identity, international student status, mental health factors, chronic illness, academic factors, and co-substance use. Higher odds of use were observed among West Asian and Black students, international students, students with chronic illness, students reporting hopelessness, feeling overwhelmed, depression with functional impairment, or suicidal ideation, and students reporting tobacco, alcohol, e-cigarette, or cocaine use.ConclusionsIllicit prescription painkiller use among Canadian university students was associated with demographic, mental health, physical health, academic, and co-substance use factors. Findings support campus-based prevention and support strategies that integrate substance use education, mental health services, and equitable access to care.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261462695"},"PeriodicalIF":4.4,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13303263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320826","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":"Sexsomnia: A Clinical Entity Psychiatrists Should Know About.","authors":"Colin M Shapiro, Julian A Gojer, Chris Y Kim","doi":"10.1177/07067437261458523","DOIUrl":"10.1177/07067437261458523","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261458523"},"PeriodicalIF":4.4,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260617","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 Chatbot for the Management of Bipolar Disorder: Using Retrieval-Augmented Generation With an Open-Weight Large Language Model to Answer Clinical Questions Based on the CANMAT and ISBD 2018 Guidelines for Bipolar Disorder: Un dialogueur pour la prise en charge du trouble bipolaire : utiliser la génération augmentée par récupération avec un grand modèle de langage (GML) à poids ouverts pour répondre aux questions cliniques fondées sur les lignes directrices de 2018 de CANMAT et de l'ISBD relatives au trouble bipolaire.","authors":"Yash Mali, Zejiao Zeng, Kayoung Heo, Grace Zhang, Antarip Kashyap, Jincheng Chen, Kamyar Keramatian, Gayatri Saraf, Marco Solmi, Edwin Tam, Sagar V Parikh, Ayal Schaffer, Serge Beaulieu, Raymond Ng, Lakshmi N Yatham, John-Jose Nunez","doi":"10.1177/07067437261457232","DOIUrl":"https://doi.org/10.1177/07067437261457232","url":null,"abstract":"<p><p>ObjectiveClinical practice guidelines support evidence-based care but are often underused due to complexity, time constraints, and navigation challenges. We investigated whether a conversational agent (chatbot) using an open-weight large language model (LLM) with retrieval-augmented generation (RAG) could provide guideline-consistent answers for bipolar disorder management based on the full 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and ISBD guidelines, comparing against a system using only the base LLM.MethodWe developed a multi-step RAG-based chatbot that retrieves relevant guideline sections and generates responses using Llama 3.3 70B. Twenty-one clinical vignettes spanning all guideline sections were created. Six expert psychiatrists generated queries and were presented with paired responses without labels from 2 systems: one using the base Llama 3.3 70B model, the other RAG-enhanced. Responses were rated for guideline consistency on a 3-point scale, and were analyzed using mixed-effects ordinal logistic regression.ResultsExperts evaluated 126 responses, of which 110 (87.3%) were rated as correct as or more correct than the baseline system. The RAG system produced 80 answers (63.5%) rated fully consistent with the guidelines versus 24 (19.0%) for baseline, and only 10 answers with major deviation (7.9%) versus 48 (38.1%) for baseline. Ordinal regression showed RAG responses were significantly more likely to be more correct (OR = 9.1, 95% CI [5.3-16.3], <i>P</i> < 0.001), which was consistent across all raters. Preference ratings favoured RAG answers in 78.7% of cases. Performance varied by vignette, with some errors in both retrieval and reasoning.ConclusionThe use of RAG with an open-weight model helped produce answers consistent with the CANMAT guidelines across vignettes that required adapting or combining guideline text, suggesting a proof-of-concept of a bipolar guideline chatbot. We identified areas to improve results and evaluation. Future work should explore additional retrieval strategies and LLMs, and test in more naturalistic settings.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261457232"},"PeriodicalIF":3.8,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SSTICS, SACCS, and SASCCS: Clarifying Nomenclature and Robustness in Meta-Analytic Research.","authors":"Emmanuel Stip, Naomi White, Stéphane Potvin","doi":"10.1177/07067437261458550","DOIUrl":"https://doi.org/10.1177/07067437261458550","url":null,"abstract":"<p><p>Plain language summaryWhy similar scale names can create confusion in schizophrenia researchThis letter responds to comments about our recent meta-analysis on subjective cognitive complaints in schizophrenia using the SSTICS scale. One study included in the analysis used a Norwegian scale with a similar acronym (SACCS), highlighting a broader problem in the field: several cognitive complaint scales have very similar names despite being different instruments. We repeated the analyses after excluding this study, and the results remained almost unchanged. This suggests that the overall conclusions of the meta-analysis are robust. The discussion also highlights the importance of clearer scale nomenclature and transparent reporting in future systematic reviews and cross-cultural research.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261458550"},"PeriodicalIF":3.8,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol consumption and substance use among French medical students: A nationwide cross-sectional study: Consommation d'alcool et de substances chez les étudiants en médecine de France : une étude transversale nationale.","authors":"Mathieu Gillet, Nicolas Doudeau, François Vilain, Kahina Sadat, Yannick Morvan, Ariel Frajerman","doi":"10.1177/07067437261457220","DOIUrl":"10.1177/07067437261457220","url":null,"abstract":"<p><p>ObjectivesMedical students are known to face significant psychological distress, making them vulnerable to substance use. There are few data on alcohol and drug consumption among medical students. The aim was to assess the prevalence of substance use, especially alcohol, in French medical students.MethodsThis cross-sectional nationwide study was conducted online from 10 June to 28 July 2024. A survey link was sent to French medical students and residents via official administrative emails. We assessed substance use (alcohol, tobacco, cannabis, cocaine, amphetamine, LSD, psilocybin, heroine, poppers, nitrous oxide and other). For alcohol consumption, we used the Alcohol Use Disorders Identification Test (AUDIT). Data analysis was performed, including recoding missing responses as zeros. Univariate and multivariate binary logistic regressions were performed with AUDIT as the dependent variable, categorized as binary (cutoff ≥8).ResultsWe included 8,312 students: 11% met criteria for hazardous drinking, and 5.5% for probable dependence according to the AUDIT; 23.3% respondents reported tobacco use, while cannabis use was reported by 13.4% with 1% using it more than 2 or 3 times a week. Among other substances, poppers (23.5%) and nitrous oxide (11.2%) were the most commonly reported. Multivariate analysis identified several factors associated with problematic alcohol use, such as male sex, younger age, financial difficulties, exposure to humiliation, harassment or sexual assault.ConclusionsAlcohol and psychoactive substance use remain prevalent among French medical students, at levels broadly comparable to those reported internationally. These findings underscore the need for targeted preventive and supportive actions within medical schools.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261457220"},"PeriodicalIF":4.4,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207073","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":"Transcranial Magnetic Stimulation for Bipolar Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Stimulation magnétique transcrânienne dans les cas de dépression bipolaire : une revue systématique et une méta-analyse d'essais contrôlés à répartition aléatoire.","authors":"Carl Zhou, Nicholas Fabiano, Stanley Wong, Mikkel Højlund, Risa Shorr, Michel Sabé, Mattia Campana, Joshua Hyde, Valerie Brandt, Samuele Cortese, Sara Tremblay, Ram Brender, Gayatri Saraf, Lakshmi N Yatham, Marco Solmi","doi":"10.1177/07067437261457224","DOIUrl":"10.1177/07067437261457224","url":null,"abstract":"<p><p>IntroductionBipolar depression is disabling and often inadequately responsive to medication alone. The current efficacy evidence of transcranial magnetic stimulation (TMS) for bipolar depression is conflicting. Therefore, we synthesized randomized controlled trials (RCTs) that tested the efficacy, safety, and tolerability of TMS for bipolar depression.MethodsWe searched MEDLINE/EMBASE/Cochrane/PsycINFO/gray literature (01/10/2025) for RCTs comparing any TMS protocol with sham. Co-primary outcomes were depressive symptoms, all-cause discontinuation; secondary outcomes were response, remission. Risk of bias (RoB) was assessed with RoB-2. Random-effects models estimated standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (95%CI), alongside sensitivity, subgroup, and meta-regression analyses.ResultsNineteen comparisons from 17 RCTs (N = 563; TMS = 293, sham = 270; mean N TMS = 15.4, sham = 15.9; mean duration = 2.40 weeks; RoB \"low\" = 35%, \"some concerns\" = 65%) were included. Among trials reporting subtypes (k = 13), 41.8% of participants had bipolar I disorder, and 58.2% had bipolar II disorder. The left dorsolateral prefrontal cortex was the most common target (k = 12). TMS reduced depressive symptoms versus sham (SMD = -0.34; 95%CI = -0.58 to -0.11), with no difference in all-cause discontinuation. TMS was favoured for response (RR = 1.41; 95%CI = 1.10 to 1.80) and remission (RR = 1.54; 95%CI = 1.06 to 2.23). However, these effects were not consistently confirmed in sensitivity or subgroup analyses by RoB, TMS type, stimulation site, or treatment resistance. Overall, 15 comparisons (88.2%) did not show superiority of TMS over sham for depressive symptoms at the individual trial level. No seizures or serious adverse events occurred; adverse events did not differ from sham. Meta-regression suggested a greater number of total pulses was associated with greater depressive symptom reduction (β = -0.018; <i>p</i> = .00017).ConclusionsTMS shows a small meta-analytic antidepressant effect and acceptable tolerability in bipolar depression despite most individual trials being negative. However, subgroups and sensitivity findings did not support TMS as an efficacious treatment at current doses. Further testing via larger RCTs with higher-dose protocols is warranted.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261457224"},"PeriodicalIF":4.4,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165620","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":"Revisiting the Management of Treatment-Resistant Depression.","authors":"Jonathan Jie Lee, Daniel M Blumberger","doi":"10.1177/07067437261456022","DOIUrl":"10.1177/07067437261456022","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261456022"},"PeriodicalIF":4.4,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152073","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":"Interpreting CBT Dose-Response Estimates: Implications of Case Mix, Response Definitions, and Modality Classification.","authors":"Nate Roy, Jacques Bruno Debruille","doi":"10.1177/07067437261457247","DOIUrl":"10.1177/07067437261457247","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":" ","pages":"7067437261457247"},"PeriodicalIF":4.4,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13229903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145597","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}