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Using Multivariate Statistics

Definition: To what extent does the study allow us to draw conclusions about a causal effect between two or more constructs? Issues: Selection, maturation, history, mortality, testing, regression towrd the mean, selection by maturation, treatment by mortality, treatment by testing, measured treatment variables Increase: Eliminate the threats, above all do experimental manipulations, random assignment, and counterbalancing.

Reliability and validity

The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first-line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first-line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second-line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not-recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long-acting injection, and adjunctive ziprasidone continue to be first-line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third-line options.

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Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013.

This article suggests that while mental health problems affect 10—20% of children and adolescents worldwide, the mental health needs of children and adolescents are neglected, especially in low-income and middle-income countries. The authors review the evidence and the gaps in the published work in terms of prevalence, risk and protective factors, and interventions to prevent and treat childhood and adolescent mental health problems.

Child and adolescent mental health worldwide: evidence for action

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

OBJECTIVE Though previous research has identified the high burden of mental health and addiction (MHA) concerns among precariously housed youth, earlier studies have not examined differences in MHA concerns among housing insecure Canadian youth across sectors. This study examines this issue using the Global Appraisal of Individual Needs Short Screener (GAIN-SS) in a cross-sectoral sample of Canadian youth. METHOD A total of 2605 youth ages 12 to 24 seeking services across sectors completed the GAIN-SS and a sociodemographic form. The analyses described demographic variables and sector of presentation, then evaluated internalizing, externalizing, substance use, and crime/violence concerns based on housing status. RESULTS While many precariously housed youth presented through the housing/outreach/support sector, 33.6% presented to other sectors. Housing groups endorsed comparably high levels of internalizing and externalizing problems. However, precariously housed youth reported higher rates of problematic substance use (OR = 1.54; 95% CI 1.25, 1.88; p < 0.01) and crime/violence issues (OR = 1.95; 95% CI 1.54, 2.46; p < 0.01). Precariously housed youth were 48% more likely to endorse concurrent disorders (OR = 1.48; 95% CI 1.21, 1.82; p < 0.01), which was largely driven by the high rate of concurrent disorders among precariously housed females. CONCLUSIONS Since precariously housed youth with multiple clinical needs presented across sectors, attention must be given to screening for both housing stability and MHA and building stronger cross-sectoral partnerships. The findings should encourage systematic screening, MHA training and capacity building within housing sectors as well as integrated services across all youth-serving organizations.

Housing Instability and Concurrent Substance use and Mental Health Concerns: An Examination of Canadian Youth.

Legalization of cannabis use in Canada: Impacts on the cannabis use profiles of youth seeking services for substance use.

KEY POINTS
In Canada, some 20% of youth experience mental health and addiction disorders,[1][1] yet rapid access to developmentally sensitive, evidence-based care is limited. Youth and caregivers consider Ontario’s system of care for mental health and addiction disorders in youth to be fragmented

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Youth engagement in the YouthCan IMPACT trial.

Categorization of brief temporal intervals : An auditory processing context may impair visual performances

Background: Schema theory, developed for chronic, treatment-resistant patients, has been largely applied to personality disorders. However, many patients with other psychiatric disorders, including mood and anxiety disorders, also demonstrate elevated early maladaptive schemas mas (EMSs). Based on schema theory and clinical observations, individuals with greater case complexity would be expected to demonstrate higher EMS activation. Aim: This study examines EMSs as a function of case complexity in individuals with mood and anxiety disorders. Method: 69 patients consulting for mood or anxiety disorders completed the YSQ-S3 and a thorough intake assessment. The relationship between EMSs and case complexity is explored.Results: Although some EMSs are more strongly activated as a function of comorbidities and degree of functional impairment, the greatest difference is a function of multiaxial case complexity. Conclusion: Complex clinical presentations are associated with EMS activation. Case complexity should be considered when applying schema theory to mood and anxiety disorders. Schema therapy may be a useful treatment alternative particularly for the more complex plex cases.Keywords: early maladaptive schemas; cognitive schemas; mood disorders; anxiety disorders; comorbiditySchema theory is an integrative theory developed to explain treatment-resistant psychological problems with a characterological underpinning (Young, 1990; Young, Klosko, & Weishaar, 2003). Consistent with Beckian cognitive theory, schema theory proposes that early experiences shape individuals' beliefs about themselves, the world and others, and that their impacts go on to influence behavior in adulthood. However, schema theory adds a broader conception of the developmental origins of the biases seen among people with severe psychopathology. It also expands the notion of schemas.At the heart of schema theory are "early maladaptive schemas" (EMSs), considered stable character traits that develop in reaction to toxic childhood experiences. The EMSs extend beyond cognition to incorporate emotions, memories, and bodily sensations. Young et al. (2003) have identified 18 different EMSs to date, each with its own proposed origin and long-term impact. The 18 EMSs are described in Table 1. A broad range of studies have demonstrated that EMSs are highly activated in a wide range of clinical populations (e.g., Halvorsen et al., 2009; Hawke & Provencher, 2012b; Renner, Lobbestael, Peeters, Arntz, & Huibers, 2012). Multiple studies have also confirmed that EMSs mediate the relationship between parenting style and the symptoms of depression and anxiety in adulthood, supporting the developmental aspect of the theory (e.g., Harris & Curtin, 2002; McGinn, Cukor, & Sanderson, 2005; Wright, Crawford, & Del Castillo, 2009).Schema theory has been widely associated with personality disorders, whereas EMSs have been clearly demonstrated to be elevated in this category of disorders (e.g., Jovev & Jackson, 2004). However, the theory also extends to mood and anxiety disorders (Hawke & Provencher, 2011). In fact, Young et al. (2003) propose that EMSs underlie chronic symptoms of depression and anxiety. Lending support to this notion, various studies have found that heightened EMS activation is associated with the general symptoms of depression and anxiety, as well as fully diagnosable depressive and anxiety disorders (Hawke & Provencher, 2011). Yet, schema activation is not limited to purely psychiatric disorders. Higher EMS scores have also been found among respondents who have physical health problems with a psychological component, such as chronic pain and obesity (Anderson, Rieger, & Caterson,2006; Saariaho, Saariaho, Karila, & Joukamaa, 2009). Furthermore, one preliminary investigation suggested an association between EMSs and global functional level (Hawke & Provencher, 2010).Given that schema theory was developed specifically for patients who are resistant to traditional cognitive behavioral therapy and who have considerable characterological issues underlying their diagnosed disorder, it would appear likely that EMSs would apply more strongly to complex, comorbid cases. …

Lisa D. Hawke

Papers

Housing Instability and Concurrent Substance use and Mental Health Concerns: An Examination of Canadian Youth.

Legalization of cannabis use in Canada: Impacts on the cannabis use profiles of youth seeking services for substance use.

Youth engagement in the YouthCan IMPACT trial.

Categorization of brief temporal intervals : An auditory processing context may impair visual performances

Early Maladaptive Schemas: Relationship With Case Complexity in Mood and Anxiety Disorders.