BACKGROUND:Despite evidence in scientific literature indicating the effectiveness of both cognitive behavioral therapy (CBT) and physical exercise in the management of major depressive disorder (MDD), few studies have directly compared them. OBJECTIVE:This study aims to evaluate and compare the effectiveness of group CBT, physical exercise, and only wait-listing to receive treatment-as-usual (TAU) in the management of MDD. The investigators hypothesize that participants with MDD assigned to the group CBT or exercise arms of the study will achieve superior outcomes compared with participants wait-listed to receive TAU only. METHODS:This prospective rater-blinded randomized controlled trial assesses the benefits of group CBT and exercise for participants with MDD. A total of 120 patients with MDD referred to addiction and mental health clinics in Edmonton, Canada, will be randomly assigned to one of the three equal-sized arms of the study to receive either weekly sessions of group CBT plus TAU, group exercise three times a week plus TAU, or only TAU for 14 weeks. Participants will be assessed at enrollment, 3 and 6 months post enrollment, midtreatment, and upon treatment completion for primary (functional and symptom variables) and secondary outcomes (service variables and health care utilization). In addition, participants in the intervention groups would be evaluated weekly with one functional measure. The data will be analyzed using repeated measures and effect size analyses, and correlational analyses will be completed between measures at each time point. RESULTS:The study will be conducted in accordance with the Declaration of Helsinki (Hong Kong amendment) and Good Clinical Practice (Canadian guidelines). Written informed consent will be obtained from each subject. The study received ethical clearance from the Health Ethics Research Board of the University of Alberta on September 7, 2018 (Pro 00080975) and operational approval from the provincial health authority (Alberta Health Services 43638). As of October 13, 2019, we have enrolled 32 participants. The results will be disseminated at several levels, including patients, practitioners, academics, researchers, and health care organizations. CONCLUSIONS:The results of the pilot trial may inform the implementation of a multicenter clinical trial and provide useful information for administrators and clinicians who are interested in incorporating group CBT and group exercise interventions into existing care. TRIAL REGISTRATION:ClinicalTrials.gov NCT03731728; https://clinicaltrials.gov/ct2/show/NCT03731728. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):PRR1-10.2196/14309.

On May 3, 2016, mandatory evacuation order was declared for Fort McMurray region as wildfire threatened. Over 90,000 residents were evacuated and firefighters from Canada and abroad worked constantly to protect the municipality. Overall, fire consumed about 2400 homes and over 200,000 ha of forest, reaching into Saskatchewan. The evacuation order was lifted with residents returning to the Municipality in phases from June 1, 2016. The aim of this study is to assess likely prevalence of PTSD in residents of Fort McMurray 6 months after a wildfire and to determine the predictors of likely PTSD in the respondents. A quantitative cross-sectional survey was used to collect data through self-administered paper-based questionnaires to determine likely PTSD. The PTSD Checklist for DSM 5 Part 3 was used to assess the presence or absence of likely PTSD in respondents randomly selected from a variety of natural settings in Fort McMurray. Data were analyzed with SPSS version 20 using univariate analysis with the chi-squared test and binary logistic regression analysis. One-month prevalence rate among adult residents for likely PTSD 6 months after the disaster was 12.8% (14.9% for females and 8.7% for males). While controlling for other factors in the logistic regression model, corresponding odds ratios included 9.51 and 4.88 for those who received no or only limited support respectively from friends/family, 8.00 for those who had history of an anxiety disorder before the wildfire, and 4.01 for those who received counseling after the wildfire. Respondents who presented with likely PTSD were significantly more likely to self-report increased drug abuse, but not increased alcohol use, after the fire. Our study has established that while support from family/friends following wildfires may be protective against likely PTSD, a prior diagnosis of an anxiety disorder significantly increased risk for developing PTSD. Further studies are needed to explore whether receiving counseling after a wild fire alters the likelihood of individuals presenting with PTSD.

Aims: To characterize the sex-specific differences in the demographic and clinical profile as well as psychiatric antecedents, and follow-up referral for new outpatient psychiatric patients in Fort McMurray. Methods: Information on a new patient data assessment tool was compiled as part of a clinical audit process between 1st January 2014 and 31st December 2014. Results: Overall, 677 patients were assessed over the 12 month period, comprising 261 (38.6%) males. The mean age for all the patients was 35.67 (SD=13.02). There were statistically significant differences between male and female patients in respect of all the demographic and social characteristics as well as psychiatric antecedents. 249 (36.8%) patients had primary Depressive disorders. With odds ratios ranging between 4.02 and 7.11, outpatients diagnosed with substance related disorders, personality disorders and trauma/stressor related disorders were about 4.5, 5.5, and 7 times respectively less likely to be offered follow-up appointments after their initial assessments compared to patients who had a primary depressive disorder controlling for other variables in a logistic regression model. Conclusion: By better understanding the outpatient profile and their clinical background, we are able to better understand the potential antecedents associated with greater need for quality psychiatric services.

OBJECTIVES:This retrospective clinical audit compared changes in community mental health service utilization before and during an economic recession in an oil sands region in Canada which was characterized by a doubling of unemployment rates and poor economic outlook.METHODS:Sociodemographic descriptors, psychiatric antecedents, clinical characteristics and follow-up care were compared before and during the recession for newly assessed patients in community mental health clinics located across a Northern Alberta oil mining region. Data were collected retrospectively as part of a clinical audit process and then analysed with descriptive statistics, cross-tabular univariate analyses with chi-square tests using SPSS version 20.RESULTS:A total of 1,465 patients were included. Sociodemographic factors disproportionately elevated during the recession included male sex, Caucasian ethnicity, own home ownership, higher levels of education and unemployment. More patients seeking mental health care were already taking psychotropic medications (e.g. antipsychotics, benzodiazepines and stimulants). At the same time, disproportionately fewer patients engaged in substance abuse or had a prior formal history of mental health problems. The referral reasons during recession were less likely to be associated with substance abuse or mood concerns and more likely for 'other' reasons. The patients seeking psychiatric help during a recession were disproportionately likely to be diagnosed with personality disorders and 'other' less common diagnostic categories and less likely to suffer from mood or trauma-related diagnoses. Referrals for counselling and social services were also disproportionately more common during the recession.CONCLUSION:This study provides a comprehensive description of longitudinal patterns of mental health service utilization before and during a recession. The findings provide important evidence for policy and planning decisions to encourage resource allocation to help promote accessibility of the most needed community mental health resources.

Background: Neurocognitive impairments are frequently observed in schizophrenia and major depressive disorder (MDD). However, it remains unclear whether reported neurocognitive abnormalities could objectively identify an individual as having schizophrenia or MDD. Methods: The current study included 220 first-episode patients with schizophrenia, 110 patients with MDD and 240 demographically matched healthy controls (HC). All participants performed the short version of the Wechsler Adult Intelligence Scale-Revised in China; the immediate and delayed logical memory of the Wechsler Memory Scale-Revised in China; and seven tests from the computerized Cambridge Neurocognitive Test Automated Battery to evaluate neurocognitive performance. The three-class AdaBoost tree-based ensemble algorithm was employed to identify neurocognitive endophenotypes that may distinguish between subjects in the categories of schizophrenia, depression and HC. Hierarchical cluster analysis was applied to further explore the neurocognitive patterns in each group. Results: The AdaBoost algorithm identified individual's diagnostic class with an average accuracy of 77.73% (80.81% for schizophrenia, 53.49% for depression and 86.21% for HC). The average area under ROC curve was 0.92 (0.96 in schizophrenia, 0.86 in depression and 0.92 in HC). Hierarchical duster analysis revealed for MDD and schizophrenia, convergent altered neurocognition patterns related to shifting, sustained attention, planning, working memory and visual memory. Divergent neurocognition patterns for MDD and schizophrenia related to motor speed, general intelligence, perceptual sensitivity and reversal learning were identified. Conclusions: Neurocognitive abnormalities could predict whether the individual has schizophrenia, depression or neither with relatively high accuracy. Additionally, the neurocognitive features showed promise as endophenotypes for discriminating between schizophrenia and depression. (C) 2017 Elsevier B.V. All rights reserved.

AIMS:To evaluate the effectiveness of an addiction-related supportive text messaging mobile intervention to improve treatment outcomes for patients with alcohol use disorder (AUD).METHODS:A single-rater-blinded randomized trial was conducted involving 59 AUD patients who completed a residential addiction treatment program. Patients in the intervention group (n = 29) received supportive text messages for three months following discharge. Patients in the control group (n = 30) received a text message thanking them for participating in the study. The primary outcome of this study was the three months Cumulative Abstinence Duration (CAD); secondary outcomes (units of alcohol per drinking day, numbers of days to first drink) and exploratory outcomes (health utilization) were evaluated. Subgroup analyses were also done. The enrollment rate in the study was 84%, and of those who enrolled, 73% were retained.RESULTS:When primary and secondary outcome measures were examined via effect size analysis, the number of days to first drink was longer in the intervention than control group (large effect size, although not statistically significant). The intervention group's mean first day to drink was over twice the length of the control group (e.g., approximately 60 vs. 26 days, respectively, with a mean difference of 34.97 and 95% CI of -5.87-75.81). Small to moderate effects were found for CAD and units of alcohol per drinking day. Small to negligible effects were found for health utilization. On subgroup analyses, the participants who received text messages, among those who did not attend follow-up outpatient counselling, showed a longer CAD.CONCLUSIONS:The results suggest text messaging is a feasible and effective opportunity for follow-up care in patients discharged from residential AUD treatment.

The Fort McMurray wildfire was the costliest disaster in Canadian history, with far-reaching impacts. The purpose of this paper is to examine the prevalence and risk factors of elevated generalized anxiety disorder (GAD) symptomatology in residents of Fort McMurray 6 months after the wildfire. Data were collected via random selection procedures from486 participants. Generalized anxiety disorder symptoms were measured via the GAD-7. The 1-month prevalence rate for GAD symptomatology 6 months after the disaster was 19.8% overall, regression analyses revealed six variables with significant unique contributions to prediction of GAD symptomatology. Significant predictors were: pre-existing anxiety disorder, witnessing of homes being destroyed by the wildfire, living in a different home after the wildfire, receiving limited governmental support or limited family support, and receiving counseling after the wildfire. Participants with these risk factors were between two to nearly seven times more likely to present with GAD symptomatology. In addition, participants who presented with elevated symptomatology were more likely to increase use or problematically use substances post-disaster. This study extends the literature on mental health conditions and risk factors following disasters, specifically in the area of generalized anxiety. Findings and implications are discussed.

This study assesses the prevalence rates for a major depressive disorder (MDD) in residents of Fort McMurray 6 months after a wildfire and to determine the demographic, clinical, and other predictors of likely MDD in the respondents. One thousand five hundred adult residents of Fort McMurray who could read and provide written informed consent were enrolled on this cross-sectional survey. The PHQ-9 was used to assess the presence or absence of probable MDD. Overall, 486 respondents with an age range of 18 to 88 and about a two thirds being females completed in full all of the key psychometric questionnaires and were included in the analysis. The 1-month prevalence rate for likely MDD 6 months after the disaster was 14.8% overall. Corresponding odds ratios for likely MDD included 2.77 (95% CI of 1.03–7.46) and 12.75 (95% CI of 2.22–73.21) for those who received limited or no support respectively from friends or family, 5.31 (95% CI of 1.3–20.1) for those who had history of an anxiety disorder before the wildfire and 2.57 (CI of 1.1–6.2) for those who have received counseling after the wildfire, while controlling for other factors in the model. While a prior diagnosis of an anxiety disorder significantly increased risk for developing MDD following wildfires, high level support from family and friends may be protective. Further studies are needed to explore the association between receiving counseling after a wildfire and presenting with likely MDD.

PURPOSE:Evaluate brain iron accumulation in alcohol use disorder (AUD) patients compared to controls using quantitative susceptibility mapping (QSM).METHODS:QSM was performed retrospectively by using phase images from resting state functional magnetic resonance imaging (fMRI). 20 male AUD patients and 15 matched healthy controls were examined. Susceptibility values were manually traced in deep grey matter regions including caudate nucleus, combined putamen and globus pallidus, combined substantia nigra and red nucleus, dentate nucleus, and a reference white matter region in the internal capsule. Average susceptibility values from each region were compared between the patients and controls. The relationship between age and susceptibility was also explored.RESULTS:The AUD group exhibited increased susceptibility in caudate nucleus (+8.5%, p=0.034), combined putamen and globus pallidus (+10.8%, p=0.006), and dentate nucleus (+14.9%, p=0.022). Susceptibility increased with age in two of the four measured regions - combined putamen and globus pallidus (p=0.013) and combined substantia nigra and red nucleus (p=0.041). AUD did not significantly modulate the rate of susceptibility increase with age in our data.CONCLUSION:Retrospective QSM computed from standard fMRI datasets provides new opportunities for brain iron studies in psychiatry. Substantially elevated brain iron was found in AUD subjects in the basal ganglia and dentate nucleus. This was the first human AUD brain iron study and the first retrospective clinical fMRI QSM study.

Depression is projected to be the primary cause of disability worldwide by 2030. In a recent survey, the most commonly cited unmet need among 42.4% of depressed Albertans was the lack of sufficient, accessible, and affordable counselling. Our aim was to test the efficacy of a supportive text messaging mobile health intervention in improving treatment outcomes in depressed patients.

The prevalence rate for child sexual abuse among new psychiatric outpatients in Fort McMurray was 20.7%. With an odds ratio for sex of 3.30, female patients are about 3 times more likely to report a history of child sexual abuse compared with male patients when controlling for other factors. Similarly, patients with at most high school education and those with previous contact with psychiatric services were about 2 times more likely to report a history of child sexual abuse compared to the patients with college or university education or no previous contact with psychiatric services, respectively. Similarly, patients with histories of substance abuse and patients with family histories of mental illness had higher likelihoods of reporting histories of child sexual abuse compared to patients without histories of substance abuse or family histories of mental illness, respectively. Our findings suggest that victims of child sexual abuse are an at-risk population in need of ongoing mental health and educational support.

BackgroundThere is only a limited body of literature which has examined the factors which can predict the presence of substance use disorders (SUD) in psychiatric patients seeking emergency room (ER) treatment.ObjectiveTo examine the factors that can predict the likelihood that a patient presenting to the emergency room and referred to the liaison psychiatric team will suffer from a SUD.MethodsNineteen independent demographic and clinical factors from data assessment tools for 477 patients assessed by the liaison psychiatric team in the ER over 12 months were compiled and analysed using univariate analyses and logistic regression in SPSS (version 20).ResultsThe 12-month prevalence rate of all SUDs in our clinical sample was 24.7%. Patients who presented to the ER with a chief alcohol and/or drug related complaint (withdrawal or intoxication) were 142 times more likely to fulfill the diagnostic criteria for SUD compared to those who presented with non-SUD related complaints. Male patients or patients with forensic history were both three times more likely to suffer from SUD than female patients or patients with no forensic history, respectively.ConclusionThere is a high prevalence of SUDs among psychiatric patients assessed in the ER. In addition to targeting patients who present to the ER with an alcohol or drug withdrawal/intoxication for brief psycho-educational interventions and referrals to addiction treatment services, patients with forensic history and male patients should be targeted for SUD screening.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background: There is only a limited body of literature which has examined the factors which can predict the presence of Substance Use Disorders (SUD) in psychiatric patients seeking Emergency Room (ER) treatment. Objective: To determine the prevalence rates for SUD and to examine the factors that can predict the likelihood that a patient presenting to the Emergency Room and referred to the liaison psychiatric team will suffer from a SUD. Methods: Nineteen independent demographic and clinical factors from data assessment tools for 477 patients assessed by the liaison psychiatric team in the ER over 12 months were compiled and analysed using univariate analyses and logistic regression in SPSS Version 20. Results: The 12 month prevalence rate of all SUDs in our clinical sample was 24.7%. Patients who presented to the ER with a chief alcohol and/or drug related complaint (withdrawal or intoxication) were 142 times more likely to fulfill the diagnostic criteria for SUD compared to those who presented with non-SUD related complaints. Male patients or patients with forensic history were both three times more likely to suffer from SUD than female patients or patients with no forensic history, respectively. Patients with a history of non-adherence, those living in camps and homeless patients were also more likely to have a SUD. Conclusion: There is a high prevalence of SUDs among psychiatric patients assessed in the ER. Our study adds to the literature by using Canadian ER data to confirm previous international research which suggests associations between SUD and male gender, criminal conviction, history of non-adherence to medication, living in camps and homelessness.

aimTo conduct a three-arm partial randomised controlled trail to evaluate the effectiveness of expedited regular supportive psychotherapy and assertive case management for patients presenting with suicidal ideation or self-harm to the emergency department (ED).Hypothesiswe expect expedited regular supportive psychotherapy plus assertive case management will reduce the suicidality and/or suicidal behaviour in patients by at least 20% at 4 weeks compared to patients receiving only assertive case management or routine care and these differences will be sustained at 6 months.MethodsThis will be a longitudinal, prospective, three-arm controlled single-rater-blinded partial randomized clinical trial with a recruitment period of 12 months and an observation period of 6 months for each participant. Patients in the intervention group will receive regular face-to-face or over the phone brief supportive psychotherapy during weekdays following presentation to the ED with suicidal ideation or self-harm until patients are actively enrolled in regular community mental health services with active case management by the therapist. Patients in the control and the assertive outreach arms will each receive the usual follow-up services offered routinely to regular patients and assertive outreach patients respectively who present to the ED with suicidal ideation or self-harm.ResultsRecruitment will commence in February 2016 and we expect the results of the study to be available by September 2017.ConclusionIf our hypothesis is proved correct, our intervention will be a new model for caring for patients with self-harm and suicidal ideation and is expected to reduce suicide rates.Disclosure of interestThe authors have not supplied their declaration of competing interest.

AimObsessive-compulsive disorder (OCD) is associated with deficits in response inhibition and planning, which are governed by the central executive network. The objective of this study was to investigate both intra- and inter-regional resting-state connectivity within the central executive network in OCD.MethodsThirty OCD patients and 30 matched healthy controls were scanned using resting-state functional magnetic resonance imaging. The independent component analysis was used on a separate sample of healthy controls to generate the central executive network mask for the subsequent OCD analyses. Regional homogeneity (ReHo) and seed-based functional connectivity analyses were used to explore the differences between intra- and inter-regional synchronized activity within the central executive network in OCD patients at rest.ResultsIncreased ReHo and functional connectivity in the key regions of the central executive network, such as the orbitofrontal cortex, dorsolateral prefrontal cortex, and the angular gyrus, were found in OCD patients. Furthermore, changes in both the ReHo within the orbitofrontal cortex and the functional connectivity between the orbitofrontal cortex and angular gyrus were negatively correlated with OCD duration.ConclusionThe increased resting-state functional organization within the central executive network may be related to OCD patients' deficits in cognitive control and symptom progression.

Objective: To describe the characteristics of liaison psychiatric patients in the emergency department (ED) of a medium sized hospital in the oil sands region of Northern Alberta.Methods: ED psychiatry services users were evaluated using a data assessment tool designed to capture all relevant demographic and clinical characteristics.Results: Overall, 477 patients (48.2% male) were assessed by the psychiatric team over the 12 month period. There was a fairly balanced distribution by age, ethnicity and relationship status between both sexes. The majority of patients with a history of self-harm or childhood sexual abuse were female while male patients were significantly more likely to report medication non-compliance. A higher proportion of female patients had depressive disorders and personality disorders while a higher proportion of male patients had anxiety disorders, bipolar and related disorders, schizophrenia spectrum disorders and substance-related disorders. Nearly one in five patients was admitted for inpatient treatment with a significantly higher proportion of males being admitted involuntarily.Conclusions: There were sex-specific differences in many of the demographic and clinical measures in our ED psychiatric sample. These differences indicate a potential need for targeted education and service initiatives to promote better access to psychiatric services and treatment outcomes.

The data provided here related to our research article (Chen et al., 2016) [1]. We provide whole-brain intrinsic functional connectivity patterns in obsessive-compulsive disorder at resting-state [1]. This article also provides supplementary information to our research article, i.e., between - group comparisons of the effect of selective serotonin reuptake inhibitors (SSRIs) and combined depression symptoms on resting-state neural activities in obsessive-compulsive disorder. The data presented here provide novel insights into the effect of SSRIs and combined depression symptoms on the neural activities at rest.

Altered brain activities in the cortico-striato-thalamocortical (CSTC) circuitry are implicated in the pathophysiology of obsessive-compulsive disorder (OCD). However, whether the underlying changes occur only within this circuitry or in large-scale networks is still not thoroughly understood. This study performed voxel-based functional connectivity analysis on resting-state functional magnetic resonance imaging (fMRI) data from thirty OCD patients and thirty healthy controls to investigate whole-brain intrinsic functional connectivity patterns in OCD. Relative to the healthy controls, OCD patients showed decreased functional connectivity within the CSTC circuitry but increased functional connectivity in other brain regions. Furthermore, decreased left caudate nucleus-thalamus connectivity within the CSTC circuitry was positively correlated with the illness duration of OCD. This study provides additional evidence that CSTC circuitry may play an essential role and alteration of large-scale brain networks may be involved in the pathophysiology of OCD.

Background To complement the oversubscribed counselling services in Alberta, the Text4Mood program which delivers daily supportive text messages to subscribers was launched on the 18th of January, 2016. This report presents an evaluation of self-reports of the impact of the program on the mental wellbeing of subscribers. Methods An online link to a survey questionnaire was created by an expert group and delivered via text messages to mobile phones of all 4111 active subscribers of the Text4Mood program as of April 11, 2016. Results Overall, 894 subscribers answered the survey (overall response rate 21.7 %). The response rate for individual questions varied and is reported alongside the results. Most respondents were female (83 %, n = 668), Caucasian (83 %, n = 679), and diagnosed with a psychiatric disorder (38 %, n = 307), including Depression (25.4 %, n = 227) and Anxiety (20 %, n = 177). Overall, 52 % ( n = 461) signed up for Text4Mood to help elevate their mood and 24.5 % ( n = 219) signed up to help them worry less. Most respondents felt the text messages made them more hopeful about managing issues in their lives (81.7 %, n = 588), feel in charge of managing depression and anxiety (76.7 %, n = 552), and feel connected to a support system (75.2 %, n = 542). The majority of respondents felt Text4Mood improved their overall mental well-being (83.1 %, n = 598). Conclusion Supportive text messages are a feasible and acceptable way of delivering adjunctive psychological interventions to the general public with mental health problems. Given that text messages are affordable, readily available, and can be delivered to thousands of people simultaneously, they present an opportunity to help close the psychological treatment gap for mental health patients in Alberta and elsewhere.