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Improvingearly care,understanding biology,identifying newtreatment modes.
Across the Lifespan into Adulthood -
Optimizing psychosis treatment
A new treatment algorithm for early psychosis symptoms may run counter to conventional prescribing patterns. Second-generation antipsychotic medications http://bit.ly/2gknK2l initial treatment. If a patient responds well, the algorithm recommends considering a long-acting injectable version, as it helps prevent relapse. If a patient doesn’t respond, then clozapine, a less commonly used medication might be effective. The algorithm is based on years of clinical research at CAMH, says Dr. Ofer Agid.
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The immune system and schizophrenia
Biological evidence from two CAMH studies is calling into question the posited link between the immune system, and psychosis and schizophrenia. A brain imaging study has shown that immune cells, called microglia, are no more active in people with first-episode psychosis than in those with no illness. A comprehensive genetics study revealed that genes involved in autoimmune disease are not major contributors to the risk for developing schizophrenia.
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As many asnine in 10 peoplewith alcohol problemsdon’t seekprofessional care.
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Help is online
For people with alcohol problems, online tools offer another option for help. The brief web intervention, Check Your Drinking, has been shown to reduce the amount people drink. In his latest study, Dr. John Cunningham compared Check Your Drinking with the Alcohol Help Center, which encompasses a more intensive set of online tools. Over a two-year period, users of both showed similar drops in alcohol consumption, affirming that people are willing to seek help online and a brief intervention can help.
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Briefer treatments
Briefer versions of successful treatments could enable more people to receive care. But are they as effective? Two major randomized controlled trials are exploring this question. The first will compare a modified version of cognitive adaptation training (CAT)—an intensive treatment to address symptoms of schizophrenia such as memory and difficulties engaging in daily activities—with a treatment combining CAT and another group-based intervention. The second study is investigating whether six months of dialectical behaviour therapy (DBT) is as effective as one year of treatment for people with borderline personality disorder.
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Brain stimulation for suicidal thinking
A type of brain stimulation treatment called magnetic seizure therapy (MST) shows promise in reducing suicidal thinking among people with depression who have not responded to other treatments. This initial study also suggests that brain cell activity, which was measured before treatment, could be used to predict who will respond to MST.
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Aboutnine per centof cannabisusers developdependence.
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Cannabis dependence and the brain
Science is still at the early days of uncovering how cannabis use—both recreational and medicinal—affects certain brain systems. A new CAMH-developed radiotracer, a chemical dye that shows brain chemistry, is helping. For the first time, a study using this radiotracer showed that a brain enzyme known as fatty acid amide hydrolase (FAAH) decreases significantly during early withdrawal in chronic cannabis users. Developing a fuller understanding of FAAH activity could provide new insights to treat cannabis dependence, for which no medications currently exist.
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Predicting risks
Before a forensic patient moves into the community, experts systematically assess risks to both patient and community. A study by Dr. Stephanie Penney reinforces the importance of ongoing assessment of the patient, as certain risks may change over time. These “dynamic” risk factors include medication adherence, symptoms and insight into illness. The study assessed risk in almost 90 patients at three time points. A year later, levels of victimization, violence and re-hospitalization were linked back to changes in these risk factors, showing the approach was reliable and clinically meaningful.
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Cultural influences on care
Culture can influence when and how people seek care for mental health problems. People with Chinese and South Asian backgrounds arrive in hospital with more severe symptoms of mental illness than other groups, suggesting delays in seeking help. Another study exploring suicide among Chinese-Canadian women showed they did go to their doctors but with symptoms such as insomnia, exhaustion or body pain. These were, in fact, signs of extreme distress, related to later suicidal thinking or attempts. Addressing cultural factors can improve strategies for outreach, treatment and suicide prevention.
Across the Lifespan into Late Life