INTRODUCTION: Individuals with severe and persistent mental illnesses (SPMI) have high rates of tobacco smoking compared to the general population, increasing their risk of thoracic malignancies. There is little literature focused on thoracic surgical outcomes in this vulnerable patient population. METHODS: A retrospective cohort study of patients with SPMI and lung cancer was conducted with propensity-matching to non-SPMI patients. The Nova Scotia Cancer Registry was crosslinked with the Mental Health Encounter Database to identify patients with a diagnosis of lung cancer between 2013 and 2018 and a SPMI diagnosis. Administrative databases were used to extract demographics, procedure, adverse events, length of stay (LOS), discharge to higher level of care, pathologic stage, and survival. SPMI patients were propensity-matched to non-SPMI patients using age, sex, oncologic stage, and procedure type (open versus video assisted thoracic surgery (VATS)). Postoperative and oncologic outcomes were compared between the SPMI and non-SMPI groups. RESULTS: Eight SPMI patients were paired with 80 non-SPMI patients who underwent lung cancer resection. There were no statistically significant differences in LOS, readmissions or one-year survival. However, patients with SPMI had statistically significant lower 2-year survival and a trend towards a higher incidence of major postoperative adverse events. CONCLUSIONS: Curative intent lung resection can be tolerated in SPMI patients, however they may have a higher incidence of major postoperative adverse events. Patients with SPMI have similar one-year survival as non-SPMI patients undergoing lung cancer resection, but 2-year survival is worse. Studies including larger multi-center cohorts of patients are needed to further understand risks and outcomes of lung resection in SPMI patients.

Background: In experimental studies using the cue reactivity paradigm (CRP), classically conditioned substance craving is well-documented among individuals who use substances with trauma histories. However, the magnitude of this effect has not yet been quantified, nor have moderators of this relationship been identified [DeGrace, S., Romero-Sanchiz, P., Standage, C., & Stewart, S. H. (2022). A scoping review of the literature on trauma cue-induced drug craving in substance users with trauma histories or PTSD. IntechOpen. https://doi.org/10.5772/intechopen.103816].Objective: While the mechanism driving these trauma cue-induced craving effects has been suggested to involve trauma cue-induced negative affect [Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychological Review, 111(1), 33-51. https://doi.org/10.1037/0033-295X.111.1.33], this remains largely untested.Method: We conducted a meta-analysis to quantify the trauma cue-induced craving effect size, as well as possible moderators of these effects. Moreover, we utilized two-step meta-analytic structural equation modelling (TS-MA-SEM) to test the indirect effect of trauma (vs. neutral) cue exposure on substance craving through negative affect as the mediator. Our literature search returned n = 32 studies involving a total of k = 21 unique datasets that were included in our analyses.Results: Results supported our hypothesis that trauma cues would induce greater substance craving relative to other cue types/controls (neutral cues, substance cues, pre-cue baseline), with small to medium effect sizes (d = 0.259 - 0.526). We found a few theoretically relevant moderators (CRP method, study quality, and % of sample with PTSD) that varied by comparator condition. Additionally, results supported our proposed mediational model with negative affect indirectly explaining the relationship between trauma cue exposure and substance craving.Conclusions: Results suggest that trauma cue-elicited substance craving is a robust phenomenon that may be explained through trauma cue-induced negative affect driving increased craving.

IntroductionApproximately one-third of individuals with schizophrenia will meet the criteria for treatment-resistant schizophrenia (TRS), the majority of whom demonstrate poor pharmacological response early in their course of illness. Clozapine response is higher when used early in the illness trajectory; thus, there is a need to characterize the neurobiological underpinnings of TRS to support early stratification to clozapine. We hypothesized that elevated glutamate in the anterior cingulate cortex (ACC), measured using in vivo magnetic resonance spectroscopy (MRS), would be associated with clozapine eligibility in an early-phase psychosis (EPP) cohort.MethodsCriteria-defined clozapine-eligible (CE) individuals and treatment responders (TR) with non-affective EPP were recruited from the Nova Scotia Early Psychosis Program (within the first 5 years of illness onset). Clinical assessments were completed as well as 3T 1H-MRS to measure glutamate in the bilateral dorsal ACC. 1H-MRS acquisitions were performed using Point RESolved Spectroscopy (TE = 40 ms, TR = 2,000 ms; 128 averages).ResultsForty-six EPP individuals completed the study, with 24 meeting the criteria for clozapine eligibility (mean age = 24) and 22 as treatment responders (mean age = 22). Twenty-six individuals (56.5%) in the total sample were receiving treatment with a long-acting injectable antipsychotic (LAI) medication. The TR group (16 men, 6 women) did not differ from the CE group (19 men, 5 women) in age, years of education, family history of psychosis, or regular nicotine and cannabis use. The CE group had higher PANSS scores, a longer duration of untreated psychosis, and worse social functioning and were taking a higher burden of antipsychotic treatment [chlorpromazine (cpz) equivalencies]. Clinical variables that were significantly different between groups were added to the linear model, and nested model comparisons were used to select the final model for analysis of each metabolite. Glutamate was compared between the groups using a one-way ANOVA, and glutamine was compared using ANCOVA. While ACC glutamate was not found to be significantly different between the groups, glutamine, a precursor for glutamate, was higher in the CE group (M = 4.43, SD = 0.73) relative to the TR group (M = 4.02, SD = 0.64) [F (1, 40) = 5.44, p = 0.02].DiscussionWhile elevated ACC glutamate has been associated with poor response to antipsychotic medications in early psychosis samples, this is the first study to explore the association with clozapine eligibility. Contrary to our hypothesis, ACC glutamate was not higher in the CE group. However, glutamine, a precursor to glutamate, was higher in the CE group, in line with previous studies that have found elevated glutamatergic metabolites to be associated with poor treatment response to antipsychotic medication. Our results support future studies to further characterize the neurobiology of clozapine eligibility in early-phase psychosis to assist in the timely initiation of clozapine to maximize outcomes.

BACKGROUND:Poor engagement with Early Intervention Services (EIS) for first-episode psychosis threatens program effectiveness, yet research often reduces engagement to a binary measure (engaged/disengaged), limiting understanding of those who disengage and re-engage. This study examined demographics, clinical characteristics, and health service utilisation patterns among engaged, intermittently engaged, and disengaged patients of the Nova Scotia Early Psychosis Program (NSEPP). METHODS:A retrospective cohort comprised of 331 individuals enrolled in NSEPP between July 22, 2005, and October 9, 2015, was constructed by linking clinical and administrative datasets. Engagement types (engaged, intermittently engaged, disengaged) were characterised in terms of baseline demographics and clinical factors, along with patterns of health service utilisation before, during, and after program enrollment. Crude and adjusted associations between program engagement and post-program health service utilisation (emergency department (ED) use and mental health-related hospital admissions) were assessed using negative binomial regression models. RESULTS:During program enrollment, the intermittently engaged group had the greatest illness severity (35% spent 30+ days in hospital), and the highest proportion of individuals with at least one ED visit (85%) and one hospital admission (55%). These during-program health service use factors were the strongest predictors of post-program health service use outcomes. CONCLUSIONS:The three engagement types show distinct health service utilisation patterns, which may reflect differences in need, access, or program effectiveness. These results provide evidence that dichotomisation of engagement may mask important heterogeneity. Further characterisation of the engagement continuum to include intermittent engagement may provide insights to reducing barriers and improving access to and uptake of EIS.

OBJECTIVE:To prepare evidence-based guidelines on psychosis prevention. METHODS:We reviewed evidence on risk factors for/age at onset of psychosis, tools to assess clinical high-risk of psychosis (CHR-P), transition rates, risk calculation/ethical considerations around risk communication, CHR-P biological/clinical correlates, efficacy/cost-effectiveness of interventions/psychosis prevention services. The World Federation of Societies of Biological Psychiatry framework was used to grade evidence regarding interventions/services, elaborating guidelines with evidence-/consensus-based clinical recommendations to prevent psychosis in CHR-P subjects. RESULTS:At the service organisation level, (i) psychosis indicated prevention services might be implemented in close collaboration with early intervention services for psychosis to minimise duration of untreated illness, (ii) intake age criteria should be between 14 to 35, (iii) services should allow access to persons with cannabis use disorder. At the assessment and risk communication level, in clinical settings: (iv) staff in mental health services should be trained in administering/rating CHR-P assessment tools, (v) administer them, (vi) be trained in using/interpreting risk calculators, and (vii) in communicating risk, (viii) only use validated risk calculators, keeping a human-to-human interaction. Also, (ix) prevention services should assess comorbid mental disorders. At the intervention level: (x) staff should offer treatment for abstinence from cannabis, (xi) offer evidence-based treatment for comorbid mental disorders, and (xii) offer treatment for CHR-P based on patient preference, following the 'first do no harm' principle. CONCLUSIONS:Prevention services should be implemented, including interventions for cannabis use, reducing the duration of untreated psychosis, and treating comorbid mental disorders.

BACKGROUND AND AIMS:Cannabis use is highly prevalent among young adults with first-episode psychosis (FEP) and is associated with poorer clinical and functional outcomes. Mobile health interventions may help address structural barriers to delivering cannabis-focused psychosocial interventions within early intervention services (EIS), yet little is known about how such tools are experienced and integrated into routine care. This study explored young adults with FEP and clinician experiences of two cannabis-focused mobile interventions, iCanChange (iCC) and Cannabis Harm-reducing App to Manage Practices Safely (CHAMPS), with a particular focus on implementation within EIS. DESIGN:Qualitative exploratory study using semi-structured individual interviews. Data were analysed using a reflexive thematic approach informed by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. SETTING:Six EIS programs in Canada (five in Quebec and one in Nova Scotia). PARTICIPANTS:Twenty-eight young adults aged 18-35 years with FEP who participated in the intervention arms of the iCC or CHAMPS pilot randomized controlled trials, and 17 EIS clinicians from multiple professional backgrounds. MEASUREMENTS:Semi-structured interviews explored experiences of app use, perceived benefits and challenges, contextual influences, clinician involvement and factors affecting engagement and integration within EIS. Themes were mapped to the i-PARIHS domains of innovation, recipients, context and facilitation. FINDINGS:Participants generally perceived both mobile interventions as acceptable, relevant and well aligned with the daily realities of young adults with FEP. The apps' accessibility, flexibility and non-judgmental approach supported self-reflection, autonomy and increased awareness of cannabis use. However, engagement was shaped by individual motivation, psychosis-related symptoms, competing life and treatment priorities and, for some, app-related challenges, including content-related concerns and technical issues that interfered with use. Clinician involvement was widely viewed as beneficial for sustaining engagement and supporting reflection, yet was inconsistently implemented due to time constraints, limited familiarity with app content and uncertainty regarding clinicians' roles. CONCLUSIONS:Cannabis-focused mobile interventions appear to be acceptable and relevant complements to standard early intervention service care for psychosis. Their successful implementation depends not only on usability, but also on active facilitation, clear clinician role definitions and adaptive integration strategies that align with real-world constraints within early intervention services.

BACKGROUND:Adverse events and substance misuse are rarely examined together among people in early phase psychosis, although both are frequently examined in isolation given their high prevalence in this population. As a result, the frequency of the three-way overlap is unclear. Moreover, adverse events are often limited to childhood abuse and rarely include illness-related events (e.g., threatening hallucinations). This study aims to explore the overlap between these variables and provide a more detailed understanding of adversity in this population and their desire to disclose experiences. METHODS:We surveyed 110 individuals aged 16-35 years with early phase psychosis about substance misuse, lifetime adverse events, disclosure of adverse events, and PTSD symptoms. RESULTS:Nearly all participants (97.2%) had experienced at least 1 adverse event, recalling an average of 8 adverse events over lifetime (SD = 3.8). Over 22% met the cutoff for a probable PTSD diagnosis on a validated measure. Substance misuse was present in 67% of participants, often involving multiple substances (M = 2.7 substances, SD = 1.5), most commonly alcohol, cannabis, and tobacco. There was an overlap between early phase psychosis, substance misuse, and a history of at least 1 adverse event in 66.4% of the sample. Most participants (78.7%) had disclosed their adverse events to someone, and 72.7% expressed interest in speaking to a mental health professional about their experiences. CONCLUSION:Adverse events and substance misuse commonly co-occur in early phase psychosis, and these results have important clinical ramifications for assessment and treatment in an early phase psychosis population.

BACKGROUND:Recently, there has been a significant rise in potency (% tetrahydrocannabinol (THC)) of cannabis products globally. As such, there is a need for a better understanding of the relationship between cannabis potency and mental health outcomes, especially in a developmentally vulnerable population such as adolescents and young adults. AIMS:The objective of this scoping review was to summarise existing literature investigating the potency of cannabis products as it relates to mental health outcomes in adolescents and young adults aged 14-25. METHOD:Systematic searches of MEDLINE, Embase, CINAHL and PsycINFO were conducted for relevant manuscripts up to October 2025. Following PRISMA-ScR guidelines, retrieved studies were then screened and data extracted by two independent reviewers. RESULTS:Out of 11 225 studies identified by our searches, 71 were included in the review after screening. Compared with low-potency cannabis, our findings suggest that high-potency cannabis is more strongly associated with severe mental health issues, such as cannabis dependence, psychosis and cognitive deficits. CONCLUSIONS:Overall, it was found that high-potency cannabis use (>15% THC) was associated with a great number and magnitude of adverse mental health outcomes. As such, the potency of cannabis products should be measured in future cannabis research that investigates short- and long-term outcomes. Additionally, the potency of cannabis products should be a consideration in any future cannabis regulatory policy discussions.

BACKGROUND:Substance use has rapidly increased in North America. While acute harms (eg, overdoses) are well documented, less is known about potential other harms, including psychotic disorders that are associated with substance use. This study aimed to examine changes by birth cohort in first-episode psychosis incidence and substance use involvement in first-episode psychosis. METHODS:In this population-based study using health administrative data from Ontario, Canada, we included all individuals aged 14-50 years, without a history of psychosis, between Jan 1, 2006, and Dec 31, 2023. We identified: first, all new diagnoses of cases of first-episode psychosis (including substance-induced psychosis, schizophrenia spectrum disorders, or psychosis not otherwise specified); and second, substance-induced psychosis. The primary outcomes were incidence rates and cumulative incidence of first-episode psychosis. Secondary outcomes were the proportion of first-episode psychosis diagnoses in which individuals had hospital-based care for substance use in the preceding 3 years, and the proportion of first-episode psychosis cases coded as substance-induced. We compared outcomes by birth cohorts in 5-year increments between 1970 and 2004 using Poisson models. People with related lived experience were not involved in the research and ethnicity data were not available. FINDINGS:We included 7 451 463 individuals (mean age 28·8 years [SD 9·7]; 50·2% male and 49·8% female), of whom 114 423 (1·5%) were diagnosed with first-episode psychosis. Diagnoses of first-episode psychosis and substance-induced psychosis increased over time and by birth cohort. In individuals aged 20-24 years, incidence of first-episode psychosis increased by 24·9% (from 138·0 to 172·3 per 100 000 individuals) and of for substance-induced psychosis by 114·1% (from 17·0 to 36·4 per 100 000 individuals) between 2006 and 2023. Compared with those born in 1980-84, by age 30 years, individuals born in 1990-94 had approximately double (adjusted rate ratio [aRR] 2·54 [95% CI 2·46-2·61]) the cumulative incidence of first-episode psychosis (1·85% vs 0·73%) and quadruple (aRR 4·85 [95% CI 4·45-5·28]) the cumulative incidence of substance-induced psychosis (0·36% vs 0·08%). Substance involvement in first-episode psychosis rose by birth cohort. For example, in individuals aged 25-29 years with first-episode psychosis, the proportion with previous substance use care increased from 26·4% to 47·1% (aRR 1·76 [95% CI 1·65-1·87]) and the proportion of first-episode psychosis coded as substance-induced increased from 8·7% to 20·0% (aRR 2·24 [95% CI 1·98-2·54]) for those born in 1995-99 relative to 1980-84. Increases in cannabis involvement in first-episode psychosis were greater than increases associated with other substances over the study period. INTERPRETATION:The findings suggest that rising substance use could be associated with a higher prevalence and earlier age of onset of psychotic disorders in more recent birth cohorts. Upstream prevention strategies to reduce substance use, and improved clinical capacity for psychosis care, are indicated. FUNDING:Charite Universitätsmedizin Berlin.

BACKGROUND:30% of individuals with schizophrenia do not respond to first line dopamine-blocking antipsychotic medications and meet criteria for treatment resistant schizophrenia (TRS). Elevated glutamate levels in the anterior cingulate cortex (ACC) have been found to be associated with poor response to dopamine-blocking antipsychotics in early phase psychosis (EPP). Clozapine is the gold standard treatment for TRS with some evidence suggesting that clozapine may work in part through altering glutamate neurotransmission. However, the exact mechanisms through which clozapine is effective for TRS remain largely unclear and require further investigation. OBJECTIVE:To our knowledge, this is the first study to investigate glutamatergic changes after 6 months of clozapine treatment in patients with EPP. We hypothesized that there would be a decrease in glutamate concentration after 6-months of clozapine treatment. METHOD:Treatment resistant EPP patients were recruited for a larger neuroimaging study; 7 individuals who met criteria for TRS underwent measurement of ACC glutamate prior to starting clozapine, and following clozapine treatment for 6 months. 1H-MRS acquisitions were performed using Point Resolved Spectroscopy in the bilateral dorsal ACC. RESULTS:One case was excluded from imaging analyses due to poor MRS quality (Signal to noise ratio within LCmodel < 12). Paired sample t-test found a non-significant decrease in average glutamate concentration in the ACC 6 months after starting clozapine, (6) = 0.49, p = .647, 95% CI [- 2.72, 4.00]; however, a small effect size was detected (d = 0.34, 95% CI [-0.81, 1.47]). CONCLUSIONS:While there was not a significant change in glutamate in the ACC 6 months after starting clozapine, declining glutamate with a low-moderate effect size is aligned with the hypotheses and may inform future studies. This work suggests that future studies are warranted using a larger sample size. CLINICAL TRIAL NUMBER:Not applicable.

Background The association between cannabis use and suicidality has been established, but details on impacts of legalisation, as well as long-term service use, have had limited attention. Aims To examine if changes are present in suicide presentations with access to legal cannabis. Method This study employed administrative database and medical record reviews to identify two cohorts of patients presenting with suicidal ideation/attempts and cannabis use to emergency departments, for two periods: 17 October 2018 to 30 April 2019, and 17 October 2020 to 30 April 2021. Demographic and clinical outcome data were obtained, and emergency department healthcare usage for 2 years before and 2 years after index encounter were compared, to further understand emergency department presentations for the same complaint. Results Number of emergency department encounters following the index visit and number of emergency department encounters specifically relating to suicidality following the index visit were significantly different between cohorts (t = 2.05, P = 0.042; t = 2.23, P = 0.027, respectively), with the immediate post-cannabis legalisation period demonstrating greater numbers of subsequent emergency department visits for suicidality. Additional associations were found between personality disorders and repeat emergency department visits related to cannabis use. Conclusions There appears to be stability in the patient profile of those presenting to the emergency department with a complaint relating to suicide while reporting cannabis use from the period directly following legalisation in Canada, to a similar time frame 2 years later despite reported increased use of cannabis in the general population over this period. Despite the rising potency and access to legal cannabis, suicide risk remains stable, although concerning.

Cannabis use is widespread and associated with worsened prognosis for young adults with first-episode psychosis (FEP). Few cannabis harm reduction interventions have been evaluated for this population, despite potential to improve outcomes in those not ready for cannabis abstinence/reduction-focused interventions. This study aimed to determine a) the acceptability of a digital harm reduction intervention, the Cannabis Harm-reducing App to Manage Practices Safely (CHAMPS) and b) the feasibility of conducting a trial comparing FEP-specialized early intervention services (EIS)+CHAMPS versus EIS-only with this population. We conducted a multi-site pilot randomized controlled trial comparing both arms in 101 young adults (18 - 35 years old) with FEP using cannabis and attending EIS. Primary outcomes were trial retention rate (i.e., proportion of randomized participants retained at week 6; trial feasibility assessment) and CHAMPS completion rate (i.e., proportion of intervention participants completing four of six modules; CHAMPS acceptability assessment). Trial retention rate above 60 % indicated feasibility and completion rate above 50 % indicated acceptability. Additional outcomes included harm reduction strategy use, motivation to change cannabis behaviors, cannabis-related problems, cannabis use, psychotic symptoms and dependence severity, assessed at baseline, weeks 6, 12 and 18. Trial retention was 82.2 % and completion rate was 58.8 %, suggesting trial feasibility and CHAMPS acceptability. Signals of possible improvement in the intervention group were observed regarding harm reduction strategy use, motivation to change behaviors, cannabis-related problems and cannabis use frequency. This study supports conducting an efficacy trial assessing the potential of CHAMPS in improving outcomes for young adults with psychosis using cannabis.

BACKGROUND:A history of trauma increases risk for excessive and problematic cannabis use, and this relationship may involve conditioned cannabis craving to trauma cues arising through classical and operant conditioning. Alterations in functional connectivity (FC) after trauma reminders within or between brain regions associated with reward processing may potentiate this link; however, the underlying neural mechanisms remain unstudied. METHODS:We recruited cannabis users with trauma histories from February 2021 to August 2022. Participants completed a semi-structured interview about a personally relevant traumatic experience, a typical cannabis use situation unrelated to trauma or stress, and an emotionally neutral situation, with responses informing development of 3-minute audiovisual cues. Using a randomized cross-over design, we presented personalized audio recordings and images of the neutral, cannabis-related, and trauma-related situations to participants in counterbalanced order using a cue reactivity paradigm adapted for the magnetic resonance imaging (MRI) environment. Participants self-reported on subjective cannabis craving and positive and negative affect after each cue presentation. We measured FC between striatal, cortical, and limbic regions via functional MRI during each cue. RESULTS:We included 27 cannabis users with trauma histories (74.1% female, average age 32.2 years, standard deviation 10.5 years). Trauma cues increased cannabis craving and negative affect and decreased positive affect relative to other cues. Cannabis cues increased craving relative to neutral and baseline cues. Trauma cues increased FC within the striatum and between striatal-cortical regions relative to neutral cues and increased striatocortical FC relative to cannabis cues. Cannabis cues increased cortical and corticolimbic FC relative to trauma cues and increased striatocortical FC relative to neutral cues. LIMITATIONS:The sample was small in size and not formed exclusively of participants with diagnoses of posttraumatic stress disorder or cannabis use disorder. CONCLUSION:Findings suggested potential neural mechanisms underlying the link between trauma and cannabis use. Trauma- and cannabis-related cues may potentiate cannabis craving through altered reward circuit FC.

Substance misuse significantly impacts recovery during early phase psychosis (EPP). However, effective psychotherapeutic interventions for substance misuse in EPP patients are limited. Cognitive remediation offers a novel approach by targeting mechanisms underlying substance use, including cognitive control and emotional regulation. This pilot study aimed to explore the feasibility of using a modified Cognitive Enhancement Therapy (CET) intervention in young adults with EPP, examining its effects on problematic alcohol use. This intervention, which focuses on remediation of neurocognitive and social cognitive deficits, was adapted with a reduced timeframe (6 months) and delivered via a virtual platform with the intent to improve retention. Participants who received CET saw improvements in verbal learning and memory, along with reductions in negative psychotic symptoms. Although the small sample size precluded statistical analyses, a notable reduction (50 %) in alcohol use, or cessation, was seen in 6 out of 7 participants with 3 individuals notably reaching abstinence by the trial end. Overall alcohol use was reduced by 35 %. Additionally, 3 participants with co-occurring cannabis use had significant reduction in cannabis risk scores (60 %) over the course of the trial. Feedback from the participants suggests CET's focus on emotional regulation, social confidence, and functional recovery contributed to their reduction in alcohol dependence. These promising outcomes highlight the need for further research to explore the potential benefits of cognitive remediation treatments for addressing substance misuse in EPP. This study was registered at clinicaltrials.gov under #NCT05365347.

ObjectiveTo examine the patterns in the supply and use of psychiatric services in 3 Canadian provinces: British Columbia, Manitoba, and Ontario.MethodsWe conducted a repeated cross-sectional analysis spanning fiscal years 2012/13 to 2021/22, using patient- and psychiatrist-level data aggregated into administrative health regions. Descriptive statistics and linear regression were used to assess patterns and relationships between the per capita number of psychiatrists ("supply") and measures of use of psychiatric services ("utilization"), including any psychiatrist contact, psychiatric consultation (1-2 visits with the same psychiatrist), and ongoing psychiatric care (3 or more visits with the same psychiatrist).ResultsThe number of psychiatrists per capita remained stable within the 3 provinces during the study period. In 2021/22, Vancouver had the highest number in British Columbia (45 psychiatrists per 100,000 individuals), compared to 14 per 100,000 in lower-supply regions. Toronto had the highest number in Ontario (38 per 100,000), compared to 9 in lower supply regions. Winnipeg had the highest number in Manitoba (25 per 100,000), compared to 7 in the lower supply regions. In 2021/22, the per capita number of psychiatrists was moderately correlated with any psychiatrist contact (R2 = 0.290) and ongoing psychiatric care (R2 = 0.411), but weakly correlated with psychiatric consultation (R2 = 0.005). The relationship between supply and utilization diminishes with higher levels of regional supply.ConclusionsPsychiatrists were unevenly distributed within and across provinces. While more psychiatrists are needed, the moderate and diminishing relationships between their numbers and utilization suggest that increasing this number alone is unlikely to fully address unmet needs for mental healthcare. Strategies to improve access will need to directly target uneven distributions. Further research is needed to understand the factors influencing psychiatrists' practice choices and ways to better support them in increasing their access to care.

Background:Patients treated in early intervention for psychosis programs have better treatment outcomes and higher rates of long-acting injection (LAI) antipsychotic medication utilization (20%-50%) versus treatment as usual. These programs usually serve patients for 2-3 years, then most patients are discharged to other mental health services and studies of patients with longer-standing schizophrenia suggest switching to oral medications may be common. However, following patients post-discharge is complicated by the challenges of migrated patient records across clinical services and providers. Objectives:To examine whether LAI use continues after discharge from an early intervention service for psychosis. Design:This study was a retrospective cohort study examining the effects of continuation or discontinuation of LAI therapy in individuals who have completed treatment in an early intervention service (EIS) for psychosis. Methods:A retrospective cohort was created from a group of individuals discharged from EIS for psychosis over a 3-year period from January 1, 2016 to December 31, 2018 and followed for mental health outcomes and antipsychotic medications prescribed for a subsequent 2-year period at discharge, 6, 12, 18, and 24 months post-discharge. Results:Of 85 subjects discharged from three sites in three different provinces in Canada for whom full follow-up could be recorded, 60 subjects remained on LAI medications after 24 months (71%). The average age of the cohort was 22 years (SD 4.7) at admission to an EIS. At discharge, the most commonly used LAI was aripiprazole, and most subjects were maintained on the same formulation at 24 months, if still on LAI. Reasons for discontinuation were predominantly patient preference. Significant differences in clinical outcomes, measured through reduced rehospitalization were seen for those who remained on LAI as compared to those who did not. Conclusion:LAI adherence is still strong 24 months after discharge from an EIS for psychosis.

Objective: Increasingly, cannabis is being prescribed/used to help manage posttraumatic stress symptoms (PTSS) or chronic pain, as cannabis has been argued to be beneficial for both types of symptoms. However, the evidence on efficacy is conflicting with evidence of risks mounting, leading some to caution against the use of cannabis for the management of PTSS and/or chronic pain. We examined the main and interactive effects of PTSS and chronic pain interference on adverse cannabis outcomes (a composite of cannabis use levels and cannabis use disorder, CUD, symptoms). We hypothesized that chronic pain interference and PTSS would each significantly predict adverse cannabis outcomes, and that chronic pain interference effects on adverse cannabis outcomes would be strongest among those with greater PTSS. Method: Forty-seven current cannabis users with trauma histories and chronic pain (34% male; mean age = 32.45 years) were assessed for current PTSS, daily chronic pain interference, past month cannabis use levels (grams), and CUD symptom count. Results: Moderator regression analyses demonstrated chronic pain interference significantly predicted the adverse cannabis outcomes composite, but only at high levels of PTSS. Conclusions: Cannabis users with trauma histories may be at greatest risk for heavier/more problematic cannabis use if they are experiencing both chronic pain interference and PTSS.

Background:Cariprazine, a potent dopamine D3-preferring D3/D2 receptor partial agonist, has demonstrated benefits on negative symptoms among patients with schizophrenia. Secondary endpoint and post-hoc analyses have also suggested a benefit of cariprazine on quality of life (QoL) and attention. Methods:Data for this post-hoc analysis were pooled from two 6-week, placebo-controlled phase 3 trials evaluating cariprazine among patients with acute exacerbations of schizophrenia. One study included an aripiprazole active-control arm for assay sensitivity.Two populations were analyzed: pooled intention-to-treat (ITT) population (N = 1043), and the pooled subgroup with predominant negative symptoms (PNS, n = 215), as defined by the Positive and Negative Syndrome Scale (PANSS) subscale and item cut-off criteria at baseline. Analyses of interest were: Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) total score; Cognitive Drug Research (CDR) power of attention (PoA), and continuity of attention (CoA). Results:Among study completers, cariprazine and aripiprazole were associated with significant SQLS-R4 improvements in the ITT and PNS populations. Differences in CDR-PoA scores were significant for cariprazine vs. placebo in the ITT and PNS populations, but not for aripiprazole in the ITT or PNS analyses. Differences in CDR-CoA scores were significant for cariprazine vs. placebo in the ITT and PNS analyses; and was significant for aripiprazole vs. placebo in the PNS analysis, but not in the ITT analysis. Conclusions:This post-hoc analysis suggests that cariprazine may be associated with beneficial effects on measures of attention and QoL among patients with schizophrenia, and these effects could be more pronounced among individuals with PNS.

Background: Cannabis use and related problems are prevalent among Canadian emerging adults. Investigating risk factors for cannabis use and related problems, such as personality traits, is important for earlier risk mitigation in this vulnerable population. Anxiety sensitivity (AS) is associated with adverse cannabis outcomes in emerging adults, though the mechanisms driving this effect remain unclear. Theory linking AS to cannabis use and related problems through emotional (i.e., anxiety and/or depression) symptoms and negative reinforcement motivations for use (i.e., coping and conformity) required testing. Methods: N = 481 undergraduates completed online self-report measures. A chained indirect effects path analysis model was run with AS specified as the independent variable, cannabis-related problems and cannabis use frequency as correlated dependent variables, and emotional psychopathology and cannabis use motives as intermediate variables; bias-corrected bootstrapped 95% confidence intervals tested the presence/magnitude of indirect effects. Results: Consistent with hypotheses, AS was indirectly associated with both cannabis use frequency and cannabis-related problems through emotional psychopathology and, in turn, coping motives for cannabis use, with no evidence of a remaining direct pathway. Contrary to hypotheses, no indirect effects through conformity motives were observed. Conclusions: Results suggest that emerging adults higher in AS are at increased risk for more frequent and problematic cannabis use due to their increased propensity to use cannabis to cope with anxiety and/or depression, implicating both emotional symptoms and coping motives as potential targets for personality-matched cannabis use risk mitigation efforts.

Background: Individuals with serious mental illness (SMI) have higher rates of comorbid physical health conditions, poorer associated health outcomes, and die on average 10-20 years earlier than the general population. This qualitative study aimed to explore the perspectives and experiences of adults living with SMI and family members with accessing physical healthcare within primary and mental health settings in Canada. Methods: We conducted a qualitative descriptive study using semi-structured interviews with 20 adults living with SMI and five focus groups with 18 family members between July 2023 and April 2024. After coding by two authors, thematic analysis was completed with the support of a data analysis team to identify overarching themes capturing participant experiences with accessing physical healthcare, care needs and preferences. Results: Four main themes emerged from participant narratives: (1) The centrality of mental health problems in the lives of people with SMI; (2) Challenges in accessing physical healthcare; (3) The role of families in supporting access to care; (4) Perceived health priorities and preferences. There was a high degree of congruence between the perspectives of individuals living with SMI and family members. Both participant groups described challenges accessing primary care settings, fragmented health services, and a desire for person-centred, whole-person health within mental health settings, with family member support where available. Conclusions: Findings from this study highlight the need for advancing the integration of physical healthcare within mental health settings for adults living with SMI, who are less likely to engage with community-based primary care services. Enhanced access to physical healthcare could leverage multidisciplinary resources in these settings and partnerships with families. These findings can inform efforts to provide whole-person healthcare for individuals experiencing SMI. Patient or Public Contribution: The study team collaborated closely with community organizations and individuals with lived experience at every stage of this research. This included contributions to the funding proposal, the study protocol, participant recruitment, study materials, data analysis and preparing the manuscript. Individuals with lived experience and family members actively participated in management and project meetings for the duration of the study.