Centre For Addiction And Mental Health Research Articles

Behavioral skills training for teaching safety skills to mental health service providers compared to training-as-usual: a pragmatic randomized control trial.

Violence in the healthcare workplace has been a global concern for over two decades, with a high prevalence of violence towards healthcare workers reported. Workplace violence has become a healthcare quality indicator and embedded in quality improvement initiatives of many healthcare organizations. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, provides all clinical staff with mandated staff safety training for self-protection and team-control skills. These skills are to be used as a last resort when a patient is at imminent risk of harm to self or others. The purpose of this study is to compare the effectiveness of two training methods of this mandated staff safety training for workplace violence in a large psychiatric hospital setting. Using a pragmatic randomized control trial design, this study compares two approaches to teaching safety skills CAMH's training-as-usual (TAU) using the 3D approach (description, demonstration and doing) and behavioural skills training (BST), from the field of applied behaviour analysis, using instruction, modeling, practice and feedback loop. Staff were assessed on three outcome measures (competency, mastery and confidence), across three time points: before training (baseline), immediately after training (post-training) and one month later (follow-up). This study was registered with the ISRCTN registry on 06/09/2023 (ISRCTN18133140). With a sample size of 99 new staff, results indicate that BST was significantly better than TAU in improving observed performance of self-protection and team-control skills. Both methods were associated with improved skills and confidence. However, there was a decrease in skill performance levels at the one-month follow-up for both methods, with BST remaining higher than TAU scores across all three time points. The impact of training improved staff confidence in both training methods and remained high across all three time points. The study findings suggest that BST is more effective than TAU in improving safety skills among healthcare workers. However, the retention of skills over time remains a concern, and therefore a single training session without on-the-job-feedback or booster sessions based on objective assessments of skill may not be sufficient. Further research is needed to confirm and expand upon these findings in different settings.

Work-related and non-work-related mild traumatic brain injury: Associations with mental health and substance use challenges in a Canadian population-level survey.

Mild traumatic brain injury (mTBI) can profoundly impact overall health, employment, and family life. Incidence of mTBI in the workplace represents an important subgroup with poorer outcomes. Mental health (MH) and substance use (SU) challenges are a primary correlate of TBI, but are rarely assessed among individuals with a work-related (wr)-mTBI, particularly at a population-level. This study aimed to assess the association between lifetime wr-mTBI and non-wr-mTBI and the experience of MH and SU challenges. The 2019 Centre for Addiction and Mental Health (CAMH) Monitor is a cross-sectional telephone survey of adults aged≥18 years in Ontario, Canada, employing a stratified (six regions) two-stage (telephone number, respondent) list-assisted random digit dialing probability selection procedure (N = 1792). Adjusting for sociodemographic variables, binary logistic regression was conducted to assess the association between lifetime wr-mTBI and non-wr-mTBI (relative to no TBI) and four outcomes: hazardous use of alcohol and of cannabis, psychological distress, and fair/poor mental health. Adjusting for sociodemographic variables, non-wr-mTBI demonstrated increased odds of hazardous alcohol (AOR = 2.12, 95% CI = 1.41, 3.19) and cannabis use (AOR = 1.61, 95% CI = 1.05, 2.45), psychological distress (AOR = 1.68, 95% CI = 1.14, 2.49), and fair/poor mental health (AOR = 1.70, 95% CI = 1.11, 2.59). Lifetime wr-mTBI demonstrated increased odds of reporting psychological distress (AOR = 3.40, 95% CI = 1.93, 5.97) and fair/poor mental health (AOR = 2.16, 95% CI = 1.12, 4.19) only. Non-wr-mTBI was associated with both MH and SU, whereas wr-mTBI was associated with MH only. MH outcomes were more strongly associated with wr-mTBI than non-wr-mTBI. Physicians, employers, and insurers need to consider the potential association between wr-mTBI and MH, and provide care accordingly.

South Asian and East Asian Immigrant Pregnant women in Canada, United Kingdom, United States of America, Australia, and New Zealand: Prevalence of common mental health conditions and women’s lived experience with them

The goal of this review is to investigate the prevalence rates of common mental health conditions among pregnant East and South Asian immigrant women, as well as to understand their lived experiences with these conditions in 5 English-speaking countries: Canada, United Kingdom, United States of America, Australia, New Zealand. Pregnancy is a critical time in a woman's life marked by intricate physical, emotional, and psychological transitions. The mental health of pregnant women emerges as a paramount concern given its associations with poor pregnancy outcomes. This is crucial within the context of South Asian and East Asian immigrant women, who navigate unique cultural, social, and economic challenges in their host countries that may influence their emotional wellbeing. This review will investigate the prevalence rates of common mental health conditions. This review will also explore their encounters with mental health care services and interactions with perinatal mental health care providers and services. Quantitative and Qualitative studies in English language that examine East and/or South Asian immigrant women in the perinatal period will be considered for this review. Published abstracts and mixed methods studies will also be included. All languages and publication dates will be included. However, only studies with an English language translation will be considered. This review will exclude books/book chapters, editorials, commentaries, and reviews. CINAHL (EBSCO), MEDLINE ALL will be searched. Furthermore, a grey literature search will be included in the search using CINAHL and PsycINFO as well as websites such as Society of Obstetricians and Gynecologists of Canada (SOGC), Canadian Perinatal Surveillance System (CPSS), Canadian Perinatal Mental Health Collaborative (CPMHC), Centre for Addiction and Mental Health (CAMH) and the Canadian Pediatric Society. Screening, conflict resolution data extraction and aggregation will be done by two independent reviewers.

In Sickness and in Wealth: Mental Health, Income Levels, and COVID-19

Globally, COVID-19 has brought upon many challenges to mental health. Social distancing and isolation have led people to experience greater anxiety and negative affect, and financial distress has increased due to economic changes. Demographic features may differentiate the severity of distress individuals face. Using data from The Centre for Addiction and Mental Health (CAMH), the present study examined measures of psychological distress across a Canadian sample, identifying differences in age, sex, and income levels. Trends over time were observed. Lower-income Canadians reported higher distress. Women may be at greater risk than men, as well as younger compared to older Canadians. Psychological distress has remained relatively stable throughout the pandemic, although COVID-19 financial worry has lessened as people are not as worried about their finances. The findings of this study are informative of socioeconomic, sex, and age differences in mental health throughout the pandemic in a Canadian sample.

Culturally adapted psychoeducation for bipolar disorder in a low-resource setting: protocol for a multicentre randomized controlled trial

IntroductionBipolar disorder (BD) is a source of marked disability, morbidity, and premature death. There is a paucity of research on personalized psychosocial interventions for BD, especially in lowresource settings. A previously published pilot randomized controlled trial (RCT) of a Culturally adapted PsychoEducation (CaPE) intervention for BD in Pakistan reported higher patient satisfaction, enhanced medication adherence, knowledge and attitudes towards BD, and improvement in mood symptom scores and health-related quality of life measures compared to treatment-as-usual (TAU).ObjectivesThis protocol describes a larger multicentre RCT to confirm the clinical and cost-effectiveness of CaPE in Pakistan.MethodsA multicentre individual, parallel arm, RCT of CaPE in 300Pakistani adults with BD. Participants over the age of 18, with adiagnosis of bipolar I and II and who are currently euthymic, will berecruited from seven sites including Karachi, Lahore, Multan, Rawalpindi,Peshawar, Hyderabad and Quetta. Time to recurrence will be the primaryoutcome assessed using Longitudinal Interval Follow-up Evaluation(LIFE). Secondary measures will include mood symptomatology, qualityof life and functioning, adherence to psychotropic medications, andknowledge and attitudes towards BD.ResultsFull ethics approval has been received from National Bioethics Committee (NBC) of Pakistan and Centre for Addiction and Mental Health (CAMH), Toronto, Canada. The study has completed sixty-five screening across the seven centres, of which forty-eight participants have been randomised.ConclusionsA successful trial will lead to rapid implementation of CaPE in clinical practice, not only in Pakistan, but also in other low-resource settings including those in high-income countries, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority patients with BD.Disclosure of InterestNone Declared

The quick pivot: Capturing real world modifications for the re-implementation of an early psychosis program transitioning to virtual delivery.

Team-based Early Psychosis Intervention (EPI) services is standard of care for youth with psychosis. The COVID-19 pandemic required most EPI services to mount an unplanned, rapid pivot to virtual delivery, with limited guidance on how to deliver virtual clinical services or whether quality of re-implementation and treatment outcomes would be impacted. We used a structured approach to identify essential modifications for the delivery of core components and explored facilitators and barriers for re-implementation and fidelity of a virtually delivered EPI intervention. NAVIGATE is a structured approach to team-based EPI. It provides detailed modules to guide delivery of core components including medication management, psychoeducation and psychotherapies, supported employment/education, and family education. Having initially implemented NAVIGATE at the Centre for Addiction and Mental Health (CAMH) in 2017, the EPI service transitioned to virtual delivery amid the COVID pandemic. Using a practice profile developed to support implementation, we detailed how core components of NAVIGATE were rapidly modified for virtual delivery as reported in structured group meetings with clinicians. The Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions (FRAME) was used to describe modifications. Fidelity to the EPI standards of care was assessed by the First Episode Psychosis Fidelity Scale (FEPS-FS). Re-implementation barriers and facilitators and subsequent mitigation strategies were explored using structured clinician interviews guided by the Consolidated Framework for Implementation Research (CFIR). Identified modifications related to the intervention process, context, and training. We identified contextual factors affecting the re-implementation of virtually delivered NAVIGATE and then documented mitigating strategies that addressed these barriers. Findings can inform the implementation of virtual EPI services elsewhere, including guidance on processes, training and technology, and approaches to providing care virtually. This study identified modifications, impacts and mitigations to barriers emerging from rapid, unplanned virtual delivery of EPI services. These findings can support delivery of high-quality virtual services to youth with psychosis when virtual care is indicated.

Cannabis legalization and cannabis use, daily cannabis use and cannabis-related problems among adults in Ontario, Canada (2001–2019)

BackgroundIn the context of cannabis legalization in Canada, we examined the effects on cannabis patterns of consumption, including cannabis use, daily cannabis use and cannabis-related problems. In addition, we examined differential effects of cannabis legalization by age and sex. MethodsA pre-post design was operationalized by combining 19 iterations of the Centre for Addiction and Mental Health (CAMH) Monitor Surveys (N = 52,260; 2001–2019): repeated, population-based, cross-sectional surveys of adults in Ontario. Participants provided self-reports of cannabis use (past 12 months), daily cannabis use (past 12 months) and cannabis-related problems though telephone interviews. The effects of cannabis legalization on cannabis patterns of consumption were examined using logistic regression analyses, with testing of two-way interactions to determine differential effects by age and sex. ResultsCannabis use prevalence increased from 11 % to 26 % (p < 0.0001), daily cannabis use prevalence increased from 1 % to 6 % (p < 0.0001) and cannabis-related problems prevalence increased from 6 % to 14 % (p < 0.0001) between 2001 and 2019. Cannabis legalization was associated with an increased likelihood of cannabis use (OR, 95 % CI: 1.62, 1.40–1.86), daily cannabis use (1.59, 1.21–2.07) and cannabis-related problems (1.53, 1.20–1.95). For cannabis-related problems, a significant two-way interaction was observed between cannabis legalization and age (p = 0.0001), suggesting differential effects among adults ≥55 years. ConclusionsCannabis legalization was associated with an increased likelihood of cannabis use, daily cannabis use and cannabis-related problems. Given increases in these cannabis patterns of consumption, broader dissemination and uptake of targeted prevention tools is indicated.

Behavioral Skills Training for Teaching Safety Skills to Mental Health Clinicians: Protocol for a Pragmatic Randomized Control Trial

Workplace violence is an increasingly significant topic, particularly for staff working in mental health settings. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, considers workplace safety a high priority and consequently has mandated staff safety training. For clinical staff, key components of this training are self-protection and team-control skills, which are a last resort when an individual is at an imminent risk of harm to self or others and other interventions are ineffective (eg, verbal de-escalation). For the past 20 years, CAMH's training-as-usual (TAU) has been based on a 3D approach (description, demonstration, and doing), but without any competency-based assessment. Recent staff reports indicate that the acquisition and retention of these skills may be problematic and that staff are not always confident in their ability to effectively address workplace violence. The current literature lacks studies that evaluate how staff are trained to acquire these physical skills and consequently provides no recommendations or best practice guidelines. To address these gaps described by the staff and in the literature, we have used an evidence-based approach from the field of applied behavior analysis known as behavioral skills training (BST), which requires trainees to actively execute targeted skills through instruction, modeling, practice, and feedback loop. As part of this method, competency checklists of skills are used with direct observation to determine successful mastery. Our objectives are to evaluate the effectiveness of BST versus TAU in terms of staff confidence; their competence in self-protection and team-control physical skills; their level of mastery (predefined as 80% competence) in these skills; and their confidence, competency, and mastery at 1 month posttraining. We are using a pragmatic randomized controlled trial design. New staff registering for their mandatory safety training are randomly assigned to sessions which are, in turn, randomly assigned to either the BST or TAU conditions. Attendees are informed and consented into the study at the beginning of training. Differences between those consenting and those not consenting in terms of role and department are tracked to flag potential biases. This study was internally funded and commenced in January 2021 after receiving ethics approval. As of May 2022, data collection is complete; half of the baseline, posttraining, and 1-month videotapes have been rated, and three-fourths of the interrater reliability checks have been completed. The analysis is expected to begin in late summer 2022 with results submitted for publication by fall 2022. The findings from this study are expected to contribute to both the medical education literature as well as to the field of applied behavioral analysis where randomized controlled trial designs are rare. More practically, the results are also expected to inform the continuing development of our institutional staff safety training program. DERR1-10.2196/39672.

2.64 COVID-19–Related Anxiety and Mental Health Among Youth Throughout Changing Public Health Measures in Ontario

Throughout the pandemic, public health restrictions have been altered rapidly to reduce the spread of COVID-19. The effects of these restrictions on youth mental health have been of concern since the onset of the pandemic. Recently, the Centre for Addiction and Mental Health (CAMH) released data showing that 39% of Ontario students felt that the pandemic had worsened their mental health, and 47% experienced moderate to moderate-severe levels of psychological distress in spring 2021. Therefore, we: 1) examined the impact of stringent public health measures on youth mental health and COVID-19–related anxiety; and 2) determined if the impact remained with the restrictions removed.

Video Game to Attenuate Pandemic-Related Stress From an Equity Lens: Development and Usability Study.

BackgroundThe emergence of the novel coronavirus (COVID-19) has introduced additional pressures on an already fragile mental health care system due to a significant rise in depression, anxiety, and stress among Canadians. Although cognitive behavioral therapy (CBT) is known to be an efficacious treatment to reduce such mental health issues, few people have access to CBT in an engaging and sustainable manner. To address this gap, a collaboration between the Centre for Addiction and Mental Health (CAMH) and the National Research Council of Canada (NRC) developed CBT-based self-led, online, clinician-tested modules in the form of a video game, named Legend of Evelys, and evaluated its usability in the attenuation of a COVID-19–related increase in stress.ObjectiveWe here present the conceptualization and design of new self-care modules in the form of a video game, its implementation in a technological infrastructure, and inclusivity and privacy considerations that informed the development. A usability study of the modules was performed to assess the video game’s usability, user engagement, and user perceptions.MethodsThe development of the video game involved establishment of a technology infrastructure for secure implementation of the software for the modules and a clinician-led assessment of the clinical utility of these modules through two “whiteboard” sessions. The usability study was informed by a mixed methods sequential explanatory design to evaluate the intervention of the mobile app through two distinct phases: quantitative data collection using in-app analytics data and two surveys, followed by qualitative data collection by semistructured interviews.ResultsA total of 32 participants trialed the app for 2 weeks. They used the video game an average of six times and rated the game as “good” based on the Systems Usability Scale score. In terms of stress reduction, the study demonstrated a significant difference in the participants’ Perceived Stress Scale score at baseline (mean 22.14, SD 6.187) compared with that at the 2-week follow-up (mean 18.04, SD 6.083; t27=3.628, P=.001). Qualitative interviews helped participants identify numerous functionality issues and provided specific recommendations, most of which were successfully integrated into the video game for future release.ConclusionsThrough this collaboration, we have established that it is possible to incorporate CBT exercises into a video game and have these exercises adopted to address stress. While video games are a promising strategy to help people with their stress and anxiety, there is a further need to examine the real-world effectiveness of the Legend of Evelys in reducing anxiety.

The Substance Abuse Program for African-Canadian and Caribbean Youth (SAPACCY): An Innovative Program Serving the Mental Health Needs of African, Caribbean, and Black Youth

Black youth experience disproportionately poor health outcomes throughout Ontario's healthcare system, including the mental health and addictions system. The Substance Abuse Program for African Canadian and Caribbean Youth (SAPACCY) at the Centre for Addiction and Mental Health (CAMH) seeks to address this disparity by providing clinical services to youth who identify as Black and/or as having African and/or Caribbean heritage, and their families, who are struggling with problematic substance use and/or mental health concerns. The clinical team works from an Afrocentric, culturally responsive lens to promote recovery and support Black youth in working through their mental health and addiction concerns. The program offers mental health and addictions counselling and psychotherapy, psychiatric consultation, psychoeducation, resource navigation, advocacy, and case management services to assist youth and their families/caregivers in reducing harm, moving toward recovery, and making healthy choices for themselves and their family. This paper will discuss SAPACCY’s approach to helping clients build resilience and resistance to anti-Black racism.

In Case You Haven't Heard…

You have heard all the stories about cannabis and psychosis — mostly in the “which came first” category. Now a study has linked them in a perfect loop, finding that a genetic predisposition to schizophrenia may increase the risk of psychosis from cannabis use. The study, published in Translational Psychiatry by researchers from the Centre for Addiction and Mental Health (CAMH) and King's College London, found that while cannabis users had higher rates of psychotic experiences than non‐users, the difference was pronounced among those with a genetic predisposition to schizophrenia. “These results are significant because they're the first evidence we've seen that people genetically prone to psychosis might be disproportionately affected by cannabis,” said lead author Dr. Michael Wainberg, a scientist at the Krembil Centre for Neuroinformatics at CAMH. “And because genetic risk scoring is still in its early days, the true influence of genetics on the cannabis‐psychosis relationship may be even greater than what we found here.” Overall, people who had used cannabis were 50% more likely to report psychotic experiences than people who had not. However, among the fifth of participants with the highest genetic risk scores for schizophrenia, it was 60%, and among the fifth with the lowest scores, it was only 40%.

Static and Treatment-Responsive Brain Biomarkers of Depression Relapse Vulnerability Following Prophylactic Psychotherapy

Background: Neural reactivity to dysphoric mood induction indexes the tendency for distress to promote cognitive reactivity and sensory avoidance. Linking these responses to illness prognosis following recovery from Major Depressive Disorder informs our understanding of depression vulnerability and provides engagement targets for prophylactic interventions. Objective: A prospective fMRI neuroimaging design investigated the relationship between dysphoric reactivity and relapse following prophylactic intervention. Remitted depressed outpatients (N=85) were randomized to 8 weeks of either Cognitive Therapy or Mindfulness Based Cognitive Therapy and followed for 2 years to assess future relapse status. Findings: Dysphoric mood challenge evoked prefrontal activation and sensory inhibition. Controlling for number of past episodes and concurrent symptoms, somatosensory inhibition was significantly associated with depression recurrence in a static pattern that was unaffected by prophylactic treatment (HR ·05, 95% CI 0·02–0·17; p<·001). Treatment-related prophylaxis was, however, linked to reduced activation of the left lateral prefrontal cortex (LPFC; HR 3·35, CI 1·28–8·71; p =·013). Contralaterally, the right LPFC showed dysphoria-evoked inhibitory connectivity with the right somatosensory biomarker. Clinical Trial Registration Details: Registered at clinicaltrials.gov (NCT01178424). Interpretation: These findings support a two-factor model of depression relapse vulnerability, in which: i) enduring patterns of dysphoria-evoked sensory inhibition contribute to episode return, and ii) vulnerability may be mitigated by targeting prefrontal regions where reactivity is responsive to clinical intervention. Emotion regulation during illness remission may be optimized by reducing prefrontal cognitive processes in favor of sensory representation and integration. Funding Information: Canadian Institute of Health Research (Grant# 243812). Declaration of Interests: Dr. Segal reports personal fees from Guilford Press, personal fees from Centre for Mindfulness Studies, personal fees from Mindful Noggin Inc., outside the submitted work; all other authors have nothing to disclose. Ethics Approval Statement: The study protocol was approved by the institutional review board at the Centre for Addiction and Mental Health (CAMH). Participants were required to provide informed consent.

Ethnicity, Immigration Status, And Driving Under The Influence Of Alcohol

Background Understanding risk factors for driving under the influence of alcohol (DUIA) informs development of effective interventions. This study examined the association between ethnicity, immigration status, and DUIA, exploring psychological distress and hazardous drinking as additional contributors. Method Data were derived from the 2003-2011 cycles of the Centre for Addiction and Mental Health (CAMH) Monitor of 16,101 adults from Ontario, Canada. Hierarchical binary logistic regression analysis assessed self-identified ethnicity and immigration status as predictors of DUIA, adjusting for sociodemographics and driving exposure (Model 1), psychological distress (Model 2), and hazardous drinking (Model 3). Results In Model 1, respondents born outside of Canada had reduced odds of engaging in DUIA compared to those born in Canada (AOR = 0.72, 95%CI = 0.56 - 0.92). Relative to those identifying as Canadian, the odds of DUIA were significantly reduced for those identifying as East Asian (AOR = 0.28, 95%CI = 0.13 - 0.61) and South Asian (AOR = 0.52, 95%CI = 0.27 - 0.98). In Model 3, individuals who reported psychological distress (AOR = 1.69, 95%CI = 1.33 - 2.16) and those who reported hazardous drinking (AOR = 6.28, 95%CI= 5.13 - 7.69) were more likely to DUIA. Those identifying as East Asian continued to have reduced odds of DUIA compared to those identifying as Canadian (AOR = 0.38, 95%CI = 0.17 - 0.85). Conclusion Individuals born outside of Canada were less likely to engage in DUIA than individuals born in Canada. Drivers who self-identified as East Asian were less likely to DUIA than those who self-identified as Canadian. Understanding ethnic differences underlying divergent risks for DUIA will improve prevention initiatives and remedial measures programming.

ED to EPI: protocol for a pragmatic randomised controlled trial of an SMS (text) messaging intervention to improve the transition from the emergency department to early psychosis intervention for young people with psychosis

IntroductionWhile nearly half of all new psychotic disorders are diagnosed in the emergency department (ED), most young people who present to the ED with psychosis do not receive timely follow-up...

Early Psychosis Intervention-Spreading Evidence-based Treatment (EPI-SET): protocol for an effectiveness-implementation study of a structured model of care for psychosis in youth and emerging adults

IntroductionWhile early psychosis intervention (EPI) has proliferated in recent years amid evidence of its effectiveness, programmes often struggle to deliver consistent, recovery-based care. NAVIGATE is a manualised model of EPI...

Genome-wide association study of aggression and violence in schizophrenia

Schizophrenia patients are at higher risk of engaging in violent behavior than the general population. Schizophrenia is also regarded as a highly heritable disorder. This study aimed to analyze genome-wide the effect of SNPs on violence in schizophrenia. We recruited 205 subjects between the age of 18–75 from the Centre for Addiction and Mental Health (CAMH), who had a diagnosis of schizophrenia or schizoaffective disorder. We recorded physical, verbal and lifetime violence scores indicating any violent actions to inflict pain, bodily harm, or death on another individual from the standardized scale, Modified Overt Aggression Scale (MOAS). We genotyped each participant's DNA using the Illumina Omni 2.5, and the SNPs were analyzed using the whole genome analysis tool-set, PLINK. We probed for single nucleotide polymorphisms (SNPs) correlated with violence in schizophrenia patients. We found one SNP (rs2188177) on chromosome 7 which showed a trend for association with physical violence (p = 7.80E-06). This study is the first of its kind to investigate genome-wide, the polymorphisms associated with violence in schizophrenia. The findings of this study may promote collaborative efforts to understand the genetic basis of violent behavior in psychosis.

Assessing the impact of the 2015 introduction of increased penalties and enhanced public awareness and enforcement activities on texting while driving among adults in Ontario, Canada

Objective: Texting while driving (TWD) is considered a particularly hazardous form of distracted driving. It is highly prevalent among young drivers, but fewer studies of TWD among adult drivers exist and these prevalence rates may approach those of younger drivers. The effectiveness of measures to prevent distracted driving, and TWD specifically, is unclear. On September 1, 2015, Ontario introduced increased penalties for distracted driving accompanied by public education programs to increase public awareness of the new regulations. Provincial police also introduced enhanced enforcement efforts. The current study examined self-reported TWD in a representative sample of Ontario adults before and after introduction of the new legislation and the enhanced public education and enforcement efforts.Methods: Data were based on telephone interviews with 1,846 respondents who reported having driven in the past year. Data were derived from the 2015–2016 cycles of the Centre for Addiction and Mental Health (CAMH) Monitor, an ongoing cross-sectional telephone survey of adults aged 18+ years in Ontario, Canada. A binary logistic regression analysis of TWD in the previous 30 days was conducted, adjusting for demographic characteristics (sex, age), driving exposure, and introduction of the legislation (before versus after).Results: The proportion of the sample reporting TWD declined significantly from 37.6% before the law was introduced to 24.2% after the law was introduced. The impact appeared to be most pronounced among drivers who reported TWD more frequently. Adjusted odds of TWD declined 42% following introduction of the legislation and associated enhanced public education and enforcement.Conclusions: These results identify a decrease in TWD following the introduction of enhanced penalties with corresponding public education and enforcement efforts, adding to the existing evaluative evidence base to inform transportation safety policy. These results also support the need to examine TWD and its determinants among all age groups.

Factors Associated with Successful Antipsychotic Dose Reduction in Schizophrenia: A Systematic Review of Prospective Clinical Trials and Meta-Analysis of Randomized Controlled Trials

Background: The authors conducted a systematic review and meta-analysis to identify predictors associated with successful antipsychotic dose reduction in schizophrenia. Methods: We searched MEDLINE and Embase on Mar 31, 2019 for prospective clinical trials and randomized controlled trials (RCTs) examining antipsychotic dose reduction in schizophrenia. Findings: A total of 37 trials were identified. Only eight studies focused on second-generation antipsychotics (SGAs); no studies investigated long-acting injectable SGAs. Among 24 studies that evaluated relapse or symptom changes, 20 studies (83·3%) met the criteria for successful dose reduction. Study duration of 40 years of age, duration of illness of >10 years, and post-reduction chlorpromazine equivalent (CPZE) dose of >200 mg/day were associated with successful dose reduction. Clinical deterioration was mostly re-stabilized by increasing the dose back to the baseline (N=7/8, 87·5%). A meta-analysis of 18 RCTs demonstrated that relapse rate was significantly higher in the reduction than the maintenance group (risk ratio [RR] 1·96 [95% CI 1·23-3·12]) whereas neurocognition significantly improved (standardized mean difference [SMD] 0·69 [0·25-1·12]). Subgroup analysis indicated that only post-reduction CPZE dose of ≤200 mg/day was associated with an increased risk of relapse (RR 2·79 [1·29-6·03]). Interpretation: Clinicians should consider the risk of relapse in the long run among younger patients with a relatively short illness duration when reducing the doses of antipsychotics, and the final doses may be kept higher than CPZE 200 mg/day. Further studies, especially with SGAs, are warranted to elucidate optimal strategies for successful antipsychotic dose reduction in schizophrenia. Funding Statement: The authors state: There was no funding source for this study. Declaration of Interests: HT has received a grant from Eli Lilly; manuscript or speaker’s fees from Dainippon Sumitomo Pharma, Otsuka Pharmaceutical, Wiley Japan and Yoshitomi Yakuhin. ST has no competing interests to disclose. HU has received grants from Eisai, Otsuka Pharmaceutical, Dainippon-Sumitomo Pharma, and Meiji-Seika Pharmaceutical; speaker’s honoraria from Otsuka Pharmaceutical, Eli Lilly, Pfizer, Yoshitomi Yakuhin, DainipponSumitomo Pharma, Meiji-Seika Pharma, and MSD; and advisory panel payments from Dainippon-Sumitomo Pharma. TS has received manuscript or speaker’s fees from Astellas, Dainippon Sumitomo Pharma, Eli Lilly, Elsevier Japan, Janssen Pharmaceuticals, Kyowa Yakuhin, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Novartis, Otsuka Pharmaceutical, Shionogi, Tsumura, Wiley Japan, and Yoshitomi Yakuhin, and research grants from Eisai, Mochida Pharmaceutical, and Meiji Seika Pharma. MM has received has received speaker’s honoraria from Daiichi Sankyo, Dainippon-Sumitomo Pharma, Eisai, Eli Lilly, Fuji Film RI Pharma, Janssen Pharmaceutical, Mochida Pharmaceutical, MSD, Nippon Chemipher, Novartis Pharma, Ono Yakuhin, Otsuka Pharmaceutical, Pfizer, Takeda Yakuhin, Tsumura, and Yoshitomi Yakuhin; and grants from Daiichi Sankyo, Eisai, Pfizer, Shionogi, Takeda, Tanabe Mitsubishi, and Tsumura. HTak has received fellowship grants from Astellas Foundation for Research on Metabolic Disorders, the Canadian Institutes of Health Research (CIHR), Centre for Addiction and Mental Health (CAMH) Foundation, and the Japanese Society of Clinical Neuropsychopharmacology, speaker’s honoraria from Meiji Seika Pharma, Mochida, Otsuka, Sumitomo Dainippon Pharma, and Yoshitomiyakuhin, and manuscript fees from Sumitomo Dainippon Pharma. We declare no financial relationships to disclose related to this study. Ethics Approval Statement: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement.

SU90 - GENOME-WIDE ASSOCIATION STUDY (GWAS) AND ANALYSIS OF VIOLENCE IN SCHIZOPHRENIA

Background Schizophrenia patients are at higher risk of engaging in violent behaviours than the general population. Schizophrenia is also regarded as a highly heritable disorder, and in 2014, a large genetic study by the Schizophrenia Working Group (SWG) of the Psychiatric Genomics Consortium (PGC) identified 108 risk loci for SCZ. The relationship between violence and these risk loci has not been studied, neither has there been any GWAS where Single-Nucleotide Polymorphisms (SNPs) were correlated with violence. This study aims to analyze the specific effect of genome-wide significant schizophrenia SNPs on violence in schizophrenia. Methods We recruited 87 subjects between the age of 18 to 75 from the Centre for Addiction and Mental Health (CAMH), who had a diagnosis of schizophrenia or schizoaffective disorder. We recorded physical violence scores indicating any violent actions to inflict pain, bodily harm, or death on another individual from the standardized scale, Modified Overt Aggression Scale (MOAS). We genotyped 2.5 million SNPs for each participant, and the DNA was analyzed using the whole genome analysis tool-set, PLINK. Results We found 13 SNPs which were associated with violence, and the highest correlation was with the SNP kgp11155273 on chromosome 10 (p=2.051E-7). Discussion This study found an association between violence and the kgp11155273 SNP on chromosome 10. Further studies using larger subject pools are required to probe further into the nature of this association, and determine the genetic basis of violence in schizophrenia.