6th Annual Integrative Psychiatry Conference | July 12th, 2023
Graduate Student Association of Psychiatry at McGill University
Published online: July 12th, 2023Support for Violent Radicalization: The role of relative deprivation, perceived discrimination, and immigration generation
2Department of Psychopedagogy and Andragogy, Université de Montréal, Montréal, QC, Canada
Corresponding Author: Mohammed Akhtar, email: syed.akhtar@mail.mcgill.ca
Abstract
Background: The rampant inequality perpetuated by globalization is amplified by the COVID-19 pandemic, leading to a rapid increase in violent radicalization (VR) throughout the world. In developing countries it is shown that material conditions may influence VR, the same cannot be said for developed countries. Previous research examining the relationship between socioeconomic status and support for VR depicts inconsistent results in North America and Europe. In the Canadian context, psychosocial processes such as experienced discrimination and upward social comparisons (relative deprivation) in terms of material assets may provide better explanations for the trends observed in VR. The objectives of the current study are three-fold. Firstly, we will examine the association between relative deprivation, perceived discrimination, and VR. Secondly, this study will investigate the moderating role of immigration generation in the association between relative deprivation, perceived discrimination, and VR. Finally, we will explore the mediating role of depressive symptoms on the association between relative deprivation, perceived discrimination, and VR. Methods: A total of 5,007 participants between the ages of 18-45 completed a web survey in Québec, Ontario, and Alberta. Relative deprivation will be derived by utilizing the Yitzhaki index for midpoint household incomes. Structural equation models will be utilized to assess the associations between relative deprivation, perceived discrimination, and sympathy for VR, while, determining the mediating role of depression and the moderating role of immigration generation. Discussion: The current research is of importance in addressing the impact of relative deprivation and perceived discrimination on VR. Individuals that perceive limited opportunities in comparison to their peers may develop social grievances that need to be expressed by non-violent means. A public health approach can be applied in developing preventative policies addressing SVR targeted at the collective/societal level by promoting inclusion via employment, job security, access to mental health services and positive inter-group relationships, while increasing community involvement and solidarity.
Understanding stigma from the perspectives of East Asian patients with first episode psychosis (FEP) and their family members: a qualitative study
2First Episode Psychosis Program, Jewish General Hospital, Montreal, QC, Canada
Corresponding Author: Ting Wang, email: ting.wang4@mail.mcgill.ca
Abstract
First episode psychosis (FEP) is a mental health illness in which a person experiences psychotic symptoms for the first time. People with severe mental illnesses, like FEP, experience relatively more stigma compared to people with other health problems. Stigma is known to impede access to mental health services, lower recovery outcomes and increase family burden. Evidence suggests that East Asian people experience higher rates of stigmatization for severe mental illnesses and self-report poorer mental health than White people. The term East Asian refers to individuals from China, Japan, Mongolia, North Korea, South Korea and Taiwan. East Asian Canadians also have fewer treatment options due to the shortage of culturally appropriate mental health resources and services. This study seeks to understand better the subjective experience of FEP and stigma for East Asian Canadians and uncover strategies to reduce stigma. This study will take place in three Montreal-based FEP clinics and consist of in-depth interviews with East Asian patients and their families. An ethnographic framework will (1) give voice to East Asian patients and their family members and (2) foster an emic perspective to gain insight into cultural nuances that influence their subjective experience. After administering the McGill Illness Narrative Interview (MINI) and the Semi-structured Interview Measure of Stigma (SIMS), NVivo will be used to interpret cultural themes in the transcripts of interviews. This study aims to add to the literature on the ramifications of stigma and uncover strategies to reduce stigma for East Asian populations. It will also provide suggestions for culturally adapting standard psychosocial interventions for ethnocultural minorities. The underrepresentation of East Asian Canadians in psychiatric research has contributed to ignorance about their mental health care needs. Researchers must develop strategies to encourage discussion about mental health and illness in East Asian cultures, to facilitate a healing environment.
Longitudinal Inference of a Multiscale Model of Functioning in Psychosis
2Douglas Research Centre, Montreal, QC, Canada
3Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
4Department of Biological and Biomedical Engineering, McGill University, Montreal, QC, Canada
5Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
6Department of Psychiatry & Neuropsychology, School for Mental Health and NeuroScience, Maastricht University, Maastricht, The Netherlands
7Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
Corresponding Author: Katie M. Lavigne , email: katie.lavigne@mcgill.ca
Abstract
Background and Objectives: In multiscale neuroscience, psychiatric disorders originate from aberrant interactions within and across multiple biopsychosocial scales, spanning genetics, neural connectivity, and functioning. We leverage this framework to propose a novel disease progression model of psychosis, elucidating how aberrant structural connectivity, cognition and symptoms might lead to poor functioning. More precisely, we propose that deteriorations in hippocampal-cortical connectivity lead to impaired episodic memory and social cognition, resulting in heightened negative symptoms and poor functional outcome. Given the heterogeneous clinical image of psychosis, we further predict to identify this disease progression in a subtype of the patient sample, with a second patient subtype showing normal-range connectivity, (social) cognition, functioning and low negative symptoms. Methods: To address this disease progression model in clusters of the sample, we applied Subtype and Stage Inference (SuStaIn), a recently developed machine-learning algorithm which uniquely combines these two methodologies. We sampled data from 163 patients and 117 non-clinical controls from two cross-sectional datasets on first-episode and multi-episode psychosis. SuStaIn was applied to the patient data of bilateral hippocampal-cortical connectivity, episodic memory, social cognition, negative symptoms and functional outcome. Results Through 10-fold cross-validation, SuStaIn identified three patient subtypes. Subtype 0 showed normal-range performance on all six variables. In comparison, Subtype 1 was characterized by significantly lower episodic memory, social cognition, higher negative symptoms, and poorer functional outcome than Subtype 0 and deteriorated from episodic memory to social cognition, negative symptoms, functional outcome and hippocampal-cortical connectivity. Subtype 2 showed significantly lower hippocampal-cortical connectivity than Subtype 0 and progressed from deteriorated hippocampal-cortical connectivity to episodic memory and social cognition, functional outcome and negative symptoms. Discussion: We identified distinct disease trajectories which may drive the heterogeneous psychopathological manifestations of psychosis. With this approach, we are the first to our knowledge to implement SuStaIn in a multiscale model of psychiatry.
Investigating the Relationship between Cannabis Use, Anxiety, and Endocannabinoid Activity
2Douglas Mental Health University Institute, Verdun, Quebec, Canada
3Department of Psychiatry, McGill University, Montreal, QC, Canada
Corresponding Author: Rachel Rabin, email: rachel.rabin@mcgill.ca
Abstract
Background and Objectives: Many people report using cannabis to cope with affective symptoms, such as anxiety. Paradoxically, chronic cannabis use has been associated with elevated rates of anxiety and anxiety disorders, though this evidence is equivocal. A dysregulated endocannabinoid (eCB) system may underlie anxiety symptoms. Tetrahydrocannabinol (THC), the active ingredient in cannabis, has been shown to reduce levels of the eCBs anandamide and 2-arachidonoylglycerol (2-AG). Thus, cannabis use may promote anxiety by dysregulating the eCB system. Yet, no study has investigated this relationship. I will use a well validated cannabis abstinence paradigm to explore the effects of 28-days of cannabis abstinence on anxiety and eCB levels in individuals with chronic cannabis use (CB+) relative to controls (CB-). Methods: I will measure anxiety and plasma-derived anandamide and 2-AG levels in CB+ before and following 28-days of cannabis abstinence. This timeframe coincides with the complete urinary elimination of THC from the body. Discussion: I predict that anxiety will decrease and eCBs will increase following 28-days of abstinence in CB+ compared to CB-. Findings from this study will help characterize the effects of cannabis use on anxiety and elucidate the molecular mechanisms facilitating this association. EDI: Historically, rates of cannabis use have been higher in men than women. However, in recent years, cannabis use escalated at a faster rate in women than in men, narrowing the gender gap in cannabis use prevalence. Additionally, women progress faster towards problematic cannabis use and experience anxiety at higher rates. Despite this, women remain underrepresented in cannabis research. Black Peoples, Indigenous Peoples, and People of Color are also underrepresented in cannabis research, which prevents the generalizability of results to racialized persons. My research takes equitable, diverse, and inclusive perspectives by actively seeking the recruitment of women and racialized persons to better understand the consequences of cannabis use.
Effects of Anticholinergic Burden on Verbal Memory Performance in First-Episode Psychosis
2Montreal Neurological Institute-Hospital, McGill University, Montreal, Quebec, Canada
3Department of Radiology, University of California San Diego, La Jolla, California, United States
Corresponding Author: Agnes Belkacem, email: agnes.belkacem@mail.mcgill.ca
Abstract
Background and objectives: Antipsychotics are widely used to treat first-episode psychosis but may have an anticholinergic burden, i.e., a cumulative effect of medications that block the cholinergic system. Studies suggest that a high anticholinergic burden negatively affects memory in psychosis, where cognitive deficits, particularly those in verbal memory, are a core feature of the disease. The present study sought to replicate this in a large cohort of well-characterized first-episode psychosis patients. We expected that patients in the highest anticholinergic burden group would exhibit the poorest verbal memory compared to those with low anticholinergic burden and healthy controls at baseline (3 months following admission). We further hypothesized that over time, at month 12, patients' verbal memory performance would improve but would remain inferior to controls. Methods: Patients (n=311; low anticholinergic burden [n=241] and high anticholinergic burden [n=70], defined by a Drug Burden Index cut-off of 1) and controls (n=128) completed a clinical and neurocognitive battery including parts of the Wechsler Memory Scale at month 3 and 12. Results: Cross-sectionally, using an ANOVA, patients in the highest anticholinergic burden group had the poorest performance in verbal memory when compared to the other groups at month 3 (F(2,430)=52.33, P<0.001). Longitudinally, using a Generalized Estimating Equation model, the verbal memory performance of all groups improved over time. However, patients' performance overall remained poorer than the controls. Discussion: These findings highlight the importance of considering the anticholinergic burden when prescribing medications in the early stages of the disease.
Association between video gaming and psychotic experiences in young adults
2McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, QC, Canada
3Department of Psychology, University of Quebec in Montreal, Montreal, QC, Canada
4The Royal’s Institute of Mental Health Research and Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
5Department of Neuroscience, Carleton University, Ottawa, ON, Canada
6Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, QC, Canada
7School of Criminology, University of Montreal, Montreal, QC, Canada
8Research Center of the Montreal Mental Health University Institute, Montreal, QC, Canada
9Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
Corresponding Author: Vincent Paquin, email: vincent.paquin2@mail.mcgill.ca
Abstract
Background and Objectives: There is emerging evidence of an association between video gaming and psychotic experiences. However, the direction of association remains unclear. We aimed to examine the longitudinal associations between video gaming and psychotic experiences in youth. Methods: We recruited adults aged 18-25 years from the general population. Participants completed questionnaires on three occasions between June 2021 and January 2022, including time spent on video games, psychotic experiences, and potential confounding factors related to sociodemographic characteristics, lifestyle, and mental health. To explore conditional associations between all measures, we generated a Gaussian graphical network model of the baseline data. Then, we examined between- and within-person associations of video gaming and psychotic experiences over follow-up using a random-intercept cross-lagged panel model (RI-CLPM). Results: We recruited 425 participants (82.5% female). In the network model, psychotic experiences were directly connected with video gaming, as well as with depression and anxiety, but not with other measures. RI-CLPM analysis supported an association between video gaming and psychotic experiences at the between-person level: individuals with a tendency for higher amount of video gaming also had a tendency for more frequent psychotic experiences: r=0.23 (95% CI: 0.07, 0.38). However, at the within-person level, a person’s fluctuation in video gaming at one time point was not associated with fluctuations in psychotic experiences at the next point: β=0.11 (95% CI: -0.06, 0.27). Results were similar after adjusting for potential confounders. Discussion: These findings show that youth from the community who spend more time playing video games endorse more psychotic experiences. However, individuals’ increase or decrease in video gaming over time does not seem to predict variations in their subsequent levels of psychosis expression. Other factors such as social adversity and creativity could explain the shared propensity for video gaming and psychotic experiences.
The Impact of Cannabis Legalization on Frequency of Acute Care Use among Youth from Addiction Treatment Centers in Quebec
2Douglas Research Center, Montreal, QC, Canada
Corresponding Author: Tiffany Chen, email: tiffany.chen2@mail.mcgill.ca
Abstract
Background/Objectives: In 2018, Canada legalized recreational cannabis. From 2018-2019, cannabis use increased from 14.9 to 16.8% in Canadians. Excessive cannabis use can lead to adverse events such as poisonings and cannabis-related-disorders(CRD), which may require emergency department use(EDU). Given how EDU are among the costliest forms of healthcare and indicator of public health burden, it's essential to monitor EDU pre/post legalization. This paper aims to measure the impact of cannabis legalization on EDU among youth with CRD. Methodology: Data will come from 32,047 patients with substance-related-disorders registered in Quebec addiction treatment centers from 2012-13. The impacts of cannabis legalization will be measured by observing fluctuations in EDU 3.5 years before and after legalization. Data will be extracted from FIPA, RAMQ, I-CLSC, BDCU and SIC-SRD. A mixed-effects negative binomial regression model will be used to measure frequency of EDU and a mixed-effects logistic regression model for hospitalization. The final model will be selected using Akaike and Bayesian Information Criterion. Results: The study will the first cohort-based research, incorporating the analysis of longitudinal data. The growing number of cannabis-related cases of acute care among US youth is a significant public health concern, but little data have been published on the acute care impact of the cannabis legalization in Canada. Current acute care use is likely to increase as more countries pursue legalization. Clinicians in areas with impending legalization measures should have broader understanding of CRD impacts and related interventions to prevent acute care and respond more to the needs of youth. Therefore, my study findings will assist decision-makers on strategies to better support vulnerable populations in the context of cannabis legalization. Discussion: The findings will help to establish the variations in the demand for care before/after CRD legalization for practitioner care, psychosocial interventions, and outpatient specialized care from psychiatrists and addiction treatment centers.
Identifying More Effective Ways to Engage Patients in Health Research and Disseminate Research Results to Patients
2Department of Psychiatry, McGill University, Montreal, QC, Canada
3Department of Psychology, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
4Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
5Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
6Department of Medicine, McGill University, Montreal, QC, Canada
7Department of Psychology, McGill University, Montreal, Quebec, Canada
8Biomedical Ethics Unit, McGill University, Montreal, QC, Canada
Corresponding Author: Claire Adams, email: claire.adams@mail.mcgill.ca
Abstract
Background and objectives: Patient engagement refers to active, meaningful collaboration between patients and researchers across the research process and can improve the quality and translation of research. There is limited evidence, however, on how best to engage patients and disseminate research results to patients. The objectives are to (1) conduct a scoping review and identify advantages and disadvantages of different strategies for engaging patients in health research; (2) conduct a series of trials comparing strategies for disseminating research results to patients; (3) Develop and implement a framework for effective and meaningful patient engagement and knowledge translation in the Scleroderma Patient-centered Intervention Network (SPIN), which can be applied to other diseases and settings. Methods: We will (1) conduct a scoping review to synthesize evidence on strategies for engaging patients and advantages and disadvantages of different strategies. We will search health and medical databases using a systematic search strategy to identify relevant studies. DistillerSR will be used for study selection and data charting. The PRISMA-ScR checklist will be followed when reporting the study; (2) conduct a series of RCTs to determine which tools are most effective for disseminating research results and facilitating understanding for patients. Each RCT will compare one or more tools (e.g., infographics, podcasts) to a plain-language summary comparator; (3) partner with patients, researchers, and clinicians, to develop an evidence-based framework for patient engagement in SPIN. Discussion: This project will provide evidence on strategies to meaningfully engage patients in health research and dissemination. Evidence will inform researcher-patient collaborations across areas of health research. Consideration of EDI principles: We will explicitly consider sex and gender in designing engagement and dissemination plans. The Patient Engagement Advisory Team includes cismen and ciswomen with scleroderma across age groups and we are seeking a trans, non-binary, Two-Spirit, or other non-cisgender identified individual to increase representation.
The responsiveness and adherence of suicidal adolescents to treatment and its associations with decrease in suicidal levels and increases in well-being: a pragmatic longitudinal study
2Child Centre for Development and Mental Health, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.
3The Psychotherapy center for children and families, of the David Yellin Collage, Jerusalem, Israel.
4Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805 Mali.
5Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada.
6The Mental Health Emergency Department, Montreal Children’s Hospital, Montreal, QC, Canada.
Corresponding Author: Tamar Axelrad Levy, email: tamar.axelradlevy@mail.mcgill.ca
Abstract
Context: Suicidality among adolescents is currently considered as the second leading cause of death 1. In an earlier study2, we compared adolescents who received a Rapidly Responsive Outpatient Treatment (RROP) and Treatment as Usual (TAU) and found that while the two groups achieved similar increases in functioning and decrease in levels of suicidality, the adolescents in RROP had a lower hospitalization rate. The current study goes beyond treatment arm analysis to examine specific treatment received over the 4 years of follow up to examine the associations between treatments and adolescents’ suicidality levels. Specifically, we ask whether treatment’s intensity and modality reduced suicidal-levels and increases well-being at 6-month and four-years after recruitment. Methods: The sample consisted of 286 adolescents who presented with suicidality in the emergency-room and were randomized to RROP (N=158) or TAU (N=128). Patients in the RROP group received an outpatient intervention from an experimental Emergency Follow-Up team immediately after their discharge from the hospital, while patients in the TAU group received the usual treatments available in their community. The randomization insured all subjects received equal opportunities, irrespective of their sex, age, cultural or ethnicity background. Data were collected at baseline, 2 and 6-months, and four years follow-up, and included clinical diagnostic, suicidal levels, ER visits, treatments received, sociodemographic and psychological traits. To estimate the effectiveness of therapy on suicidality, individual-patient data analysis will be performed. To detect small effects on therapy, analysis will be performed with subgroups (e.g. therapeutic intensity, day hospital and residential/inpatient). Results: The first findings for the effectiveness of therapies will be presented. 1Prevention CFDCa. Web-based Injury Statistics Query and Reporting System (WISQARS). Accessed October 12, 2020. www.cdc.gov/injury/wisqars 2Greenfield, B., Larson, C., Hechtman, L., Rousseau, C., & Platt, R. (2002). A rapid-response outpatient model for reducing hospitalization rates among suicidal adolescents. Psychiatric Services, 53(12), 1574-1579.
Improving Social Anxiety in First-Episode Psychosis by Reducing Internalized Stigma: The Effect of Group-Based Interventions
2Douglas Research Centre, Montreal, QC, Canada
Corresponding Author: Libby Lassman, email: libby.lassman@mail.mcgill.ca
Abstract
Background: Social anxiety is highly prevalent in first-episode psychosis (FEP) and has been associated with poor prognosis and significant social disability. A known contributor to social anxiety in FEP is internalized stigma, which is when individuals endorse and identify with negative stereotypes and attitudes about psychotic disorders. Previous psychosocial interventions such as Cognitive-Behavioral Therapy (CBT) have successfully targeted and improved internalized stigma, but research has not yet investigated whether this improvement underlies social anxiety after treatment and over time in FEP patients. Group therapy has various demonstrated benefits for people with FEP, including normalizing daily psychosis-related experiences. Objective: The aim of this study is to compare the benefits of group-based CBT and Cognitive Remediation Therapy (CRT) on reducing internalized stigma to improve social anxiety in FEP after treatment and at a three month-follow-up. Methods: Ninety-six FEP patients with social anxiety were recruited from five sites in Montreal and randomized to either a 13-week group-CBT for social anxiety or group-CRT. Assessments were conducted for social anxiety and internalized stigma at baseline, post-intervention and three-months post-intervention. Results: Linear regressions revealed that pre- to post-intervention change in internalized stigma significantly predicted improved social anxiety in both groups (1) immediately post-intervention, controlling for baseline social anxiety, and (2) at the three-month follow-up, controlling for baseline and post-intervention social anxiety. There was no significant interaction between treatment group (CBT or CRT) and change in internalized stigma. Discussion: The results revealed that reduced internalized stigma predicted improvements in social anxiety in FEP, which was not specific to CBT or CRT. This suggests the therapeutic effects of treatment on internalized stigma is due to nonspecific factors, specifically the group format of CBT and CRT. Findings highlight that group therapy can normalize and validate patient’s psychosis-related difficulties, therefore lessening internalized stigma, which in turn could alleviate social anxiety.
Toward patient-tailored care for treatment-resistant depression: A pilot patient-preference clinical trial of psilocybin-assisted psychotherapy
2Laboratory for Brain, Music and Sound Research, McGill University, Montreal, QC, Canada
3Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
4Department of Psychiatry, McGill University, Montreal, QC, Canada
5Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
Corresponding Author: Sara G. Gloeckler, email: sara.gloeckler@mail.mcgill.ca
Abstract
Background/Objectives: Depression is the leading cause of disability globally, and ~30% of patients will fail to meaningfully improve with existing treatments, leading to Treatment-Resistant Depression (TRD). As such, new treatments are sorely needed. One of psychiatry’s most promising new interventions is Psilocybin-Assisted Psychotherapy (PAP), which pairs 1-2 doses of psilocybin, a serotonergic psychedelic, with intensive psychotherapy. Clinical trials have demonstrated that PAP may safely and rapidly yield long-lasting antidepressant effects. However, much remains unknown about how the psychotherapeutic approach of this novel intervention may be optimized, particularly in diverse real-world populations. Methods: This pilot study will utilize a Patient Preference Clinical Trial (PPCT) design in which treatment preferences are elicited after enrollment, and patients are randomized to either have their choice of interventions or be assigned randomly to a treatment group. 20 patients with TRD will receive a 10-week intervention with two PAP sessions using either a music-centered or mindfulness-centered therapeutic approach. This study will also include a cross-over phase where all patients will eventually receive both trial interventions. This crossover-PPCT design will allow each patient’s experiences of both PAP variations to be explored by mixed-methods, as well as the effects of treatment preferences and choices. The Cultural Formulation Interview will explore individual treatment illness from a broad, biopsychosocial lens. Impact/Discussion: The results of this pilot study will provide preliminary guidance for clinicians and researchers aiming to maximize the effectiveness, safety, and inclusivity of PAP for TRD while generating hypotheses for future confirmatory research. EDI: Historically, psychedelic therapy has been cemented in western paradigms of treatment, which focus on psychocentric perspectives of healing and disregard complexities of the psychological, social, and spiritual aspects of healing. EDI is fundamental to our research paradigm, as we intend to dismantle systemic barriers and lack of treatment access by developing culturally appropriate, patient-tailored treatments.
The Entanglement of Policing and Mental Health in Ontario’s Mobile Crisis Intervention Teams
Corresponding Author: Sarah Wishloff, email: sarah.wishloff@mail.mcgill.ca
Abstract
Background and Objectives: In Canada, the majority of fatal police shootings involve persons with mental health concerns (Marcoux and Nicholson 2018). Heightened critical attention to violent police encounters has led to the creation of Mobile Crisis Intervention Teams (MCITs)—first-responder units that pair mental health clinicians with crisis-trained police officers. MCITs aim to avert the escalation of force in mental health calls and connect persons in crisis (PICs) to community care. Methods: To understand the circumstances that bring PICs into contact with the police and the growth of MCITs in Ontario, I analyze the Ontario Mental Health Act and the shifting policy frameworks from the late 20th century to the present day that shape the province’s mental health service system. This historical review is part of a larger ethnographic project consisting of ride-alongs and interviews with two MCITs in Southern Ontario. Results: Research studies on MCITs often attribute the ‘revolving door’ of frequent police encounters with the mentally ill to processes of deinstitutionalization and a corresponding lack of community resources to fill this gap in mental health care (Semple et al. 2021). However, this formulation masks the complex ways in which mental health has always been a matter of ‘police property’ framed in terms of order maintenance and social control. This entanglement of mental health and police systems has been reinforced in each iteration of mental health policy reform and is made explicit in the collaboration between mental health professionals and police officers in MCITS. Discussion: MCITs emerge in a context of hyper-visible instances of police violence and take up the issue of how best to respond to individuals experiencing mental health crises. In connecting PICs to community services, they create alternative spaces of care while simultaneously reinforcing the paradigm of policing mental health.
Beyond Expectations: The Neglected Potential of Patient Choice in Psychedelic-Assisted Psychotherapy
2Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
Corresponding Author: Sara de la Salle, email: sara.delasalle@mail.mcgill.ca
Abstract
Background: Robust research on conventional psychotherapies has demonstrated that incorporating patient choice can improve treatment tolerability, therapeutic alliances, and potential outcomes. However, patient choice has not been formally evaluated in psychedelic-assisted psychotherapy (PAP) trials. Given that psychedelic substances are well-known to amplify the subjective influences of “sets and settings” (internal and external treatment environments), there is a strong rationale for individually adapting treatment approaches and contexts. Objective: To review the conceptualization and implementation of patient choice in mental health interventions, including its comparison to treatment expectancy and potential therapeutic effects, and to suggest their incorporation within modern PAP. Methods: A narrative review of patient choice and treatment tailoring in conventional psychotherapies was conducted. The value of these methodologies for PAP trials is also discussed. Discussion: The partially-overlapping conceptualizations of treatment preferences and treatment expectations are distinct in their definitions, operationalizations, and consequences. The real-world effectiveness of a given treatment depends on its efficacy, as well as an individual’s preferences – and potentially the therapeutic value of choice itself. Receiving a preferred psychiatric intervention can improve outcomes, enhance therapeutic alliances, and reduce drop-outs. Patient Preference Clinical Trials (PPCTs) are a pragmatic variation of typical randomized controlled trials that can be employed to examine the effects of intervention preferences. However, few PPCTs are conducted in psychiatric research and are generally lacking in one or more methodological components. PPCTs are recommended for the study of interventions where preferences are likely to be clinically important, where outcomes are subjective, and when blinding is difficult or impossible – the latter being one of the most important methodological challenges in PAP. Incorporating culturally-adapted interview tools for assessing treatment preferences is also an important consideration for improving outcomes. Impact: Patient choice and treatment preference-informed PAP trials represent a promising opportunity to move towards patient-centered, tailored psychiatric interventions.
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