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Linking Opioid Use Disorder & High Levels of Out-patient Care Prior to Diagnosis

Research Paper Title

The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada.

Background

The ‘cascade of care’ framework, measuring attrition at various stages of care engagement, has been proposed to guide the public health response to the opioid overdose public health emergency in British Columbia, Canada.

The researchers estimated the cascade of care for opioid use disorder and identified factors associated with care engagement for people with opioid use disorder (PWOUD) provincially.

Methods

Retrospective study using a provincial-level linkage of four health administrative databases.

All PWOUD in BC from 01 January 1996 to 30 November 2017.

The eight-stage cascade of care included diagnosed PWOUD, ever on opioid agonist treatment (OAT), recently on OAT, currently on OAT and retained on OAT: ≥ 1, ≥ 3, ≥ 12 and ≥ 24 months).

Health-care use, homelessness and other demographics were obtained from physician billing records, hospitalisations, and drug dispensation records. Receipt of income assistance was indicated by enrolment in Pharmacare Plan C.

Results

A total of 55 470 diagnosed PWOUD were alive at end of follow-up. As of 2017, a majority of the population (n = 39 456; 71%) received OAT during follow-up; however, only 33% (n = 18 519) were currently engaged in treatment and 16% (n = 8960) had been retained for at least 1 year.

Compared with those never on OAT, those currently engaged in OAT were more likely to be aged under 45 years [adjusted odds ratio (aOR) = 1.75, 95% confidence interval (CI) = 1.64, 1.89], male (aOR = 1.72, 95% CI = 1.64, 1.82), with concurrent substance use disorders (aOR = 2.56, 95% CI = 2.44, 2.70), hepatitis C virus (HCV) (aOR = 1.22, 95% CI = 1.14, 1.33) and either homeless or receiving income-assistance (aOR = 4.35, 95% CI = 4.17, 4.55).

Regular contact with the health-care system-either in out-patient or acute care settings-was common among PWOUD not engaged in OAT, regardless of time since diagnosis or treatment discontinuation.

Conclusions

People with opioid use disorder in British Columbia, Canada show high levels of out-patient care prior to diagnosis.

Younger age, male sex, urban residence, lower income level and homelessness appear to be independently associated with increased opioid agonist treatment engagement.

Reference

Piske, M., Zhou, H., Min, J.E., Hongdilokkul, N., Pearce, L.A., Homayra, F., Socias, M.E., McGowan, G. & Nosyk, B. (2020) The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada. Addiction (Abingdon, England). doi: 10.1111/add.14947. [Epub ahead of print].

Completed my Level 2 Certificate in Information, Advice or Guidance

Introduction

The Level 2 Information, Advice or Guidance (IAG) qualification has been developed for learners working in this field to share good practice and build confidence in their ability to effectively fulfil their role as providers of advice and guidance.

What is the Level 2 Certificate in Information Advice or Guidance?

UK employers are often interested in candidates who can demonstrate an understanding of the importance of interacting appropriately with customers, clients and colleagues.

By studying the level 2 Information, Advice or Guidance (IAG) course, individuals will gain an in-depth understanding of the key areas associated with providing effective IAG, including signposting, referrals, record keeping, confidentiality and communication/listening techniques.

Curriculum

The IAG qualification will help learners to develop an understanding of the requirements of the IAG practice and aid them in guiding those that they are supporting to make informed choices.

  • Unit 1: IAG in Practice:
    • In this unit, individuals will learn about the various differences between IAG and the requirements of different clients and how these are best met.
    • It will also help individuals to gain in-depth knowledge of the boundaries and responsibilities present when offering IAG, including signposting, referrals and record keeping.
  • Unit 2: Developing Interaction Skills for IAG:
    • Within this unit, individuals will discover how to interact with clients, executing appropriate and effective questioning techniques, listening skills and non-verbal communication.
    • They will also gain knowledge of the impact of values, beliefs and attitudes on any interactions individuals may encounter, as well as the importance of confidentiality and impartiality.
  • Unit 3: Signposting and Referral in IAG:
    • In this unit, individuals will gain an understanding of the difference between signposting and referrals – when it is appropriate to refer or signpost an individual organisation’s procedures.
    • Employees will also gain knowledge of good practice when signposting and referring, including recording, monitoring and evaluating.
  • Unit 4: IAG in Context:
    • Within this unit, individuals will gain an understanding of IAG in the context of their own practice and a specific group of clients – exploring different ways of assisting clients to explore and make choices.
    • Knowledge on discriminatory practices and behaviours affecting specific client groups, as well as potential barriers and how to overcome them, are explored within this unit.
  • Unit 5: Skills for Advice Providers:
    • This unit provides individuals with an understanding of the purpose and process of an advice interview, examining the relationship between client and advisor, the advisor’s role, stages of the advice interview and how to ensure client confidentiality.
    • A key part of this section is gaining knowledge of social policy in advice work, negotiating effectively on a client’s behalf and support and action planning.

Learning Methods

This course will take approximately twenty (20) weeks to complete and consists of five (5) written assessments.

Each individual is required to give written responses to an assessment booklet. This can be either handwritten in the booklet itself or completed using an electronic template of the booklet.

Individuals will be required to submit five (5) assessments each taking approximately four (4) weeks to complete.

What is the Potential Utility of EEG as a Treatment Planning Tool for Escitalopram Therapy?

Research Paper Title

Use of Machine Learning for Predicting Escitalopram Treatment Outcome From Electroencephalography Recordings in Adult Patients With Depression.

Background

Social and economic costs of depression are exacerbated by prolonged periods spent identifying treatments that would be effective for a particular patient. Thus, a tool that reliably predicts an individual patient’s response to treatment could significantly reduce the burden of depression.

To estimate how accurately an outcome of escitalopram treatment can be predicted from electroencephalographic (EEG) data on patients with depression.

Methods

This prognostic study used a support vector machine classifier to predict treatment outcome using data from the first Canadian Biomarker Integration Network in Depression (CAN-BIND-1) study.

The CAN-BIND-1 study comprised 180 patients (aged 18-60 years) diagnosed with major depressive disorder who had completed 8 weeks of treatment. Of this group, 122 patients had EEG data recorded before the treatment; 115 also had EEG data recorded after the first 2 weeks of treatment.

All participants completed 8 weeks of open-label escitalopram (10-20 mg) treatment.

The ability of EEG data to predict treatment outcome, measured as accuracy, specificity, and sensitivity of the classifier at baseline and after the first 2 weeks of treatment.

The treatment outcome was defined in terms of change in symptom severity, measured by the Montgomery-Åsberg Depression Rating Scale, before and after 8 weeks of treatment.

A patient was designated as a responder if the Montgomery-Åsberg Depression Rating Scale score decreased by at least 50% during the 8 weeks and as a nonresponder if the score decrease was less than 50%.

Results

Of the 122 participants who completed a baseline EEG recording (mean [SD] age, 36.3 [12.7] years; 76 [62.3%] female), the classifier was able to identify responders with an estimated accuracy of 79.2% (sensitivity, 67.3%; specificity, 91.0%) when using only the baseline EEG data.

For a subset of 115 participants who had additional EEG data recorded after the first 2 weeks of treatment, use of these data increased the accuracy to 82.4% (sensitivity, 79.2%; specificity, 85.5%).

Conclusions

These findings demonstrate the potential utility of EEG as a treatment planning tool for escitalopram therapy.

Further development of the classification tools presented in this study holds the promise of expediting the search for optimal treatment for each patient.

Reference

Zhdanov, A., Atluri, S., Wong, W., Vaghei, Y., Daskalakis, Z.J., Blumberger, D.M., Frey, B.N., Giacobbe, P., Lam, R.W., Milev, R., Mueller, D.J., Turecki, G., Parikh, S.V., Rotzinger, S., Soares, C.N., Brenner, C.A., Vila-Rodriguez, F., McAndrews, M.P., Kleffner, K., Alonso-Prieto, E., Arnott, S.R., Foster, J.A., Strother, S.C., Uher, R., Kennedy, S.H. & Farzan, F. (2020) Use of Machine Learning for Predicting Escitalopram Treatment Outcome From Electroencephalography Recordings in Adult Patients With Depression. JAMA Network Open. 3(1):e1918377. doi: 10.1001/jamanetworkopen.2019.18377.

Dosed (2019)

Introduction

An award-winning documentary film about treating anxiety, depression and addiction with psychedelic medicine.

Outline

After years of prescription medications failed her a suicidal woman, Adrianne, turns to underground healers to try and overcome her depression, anxiety, and opioid addiction with illegal psychedelic medicine like magic mushrooms and iboga.

Production & Filming Details

  • Director(s): Tyler Chandler.
  • Producer(s): Robert J. Barnhart, Tyler Chandler, Jason Hodges, Kelley Hodges, Chris Mayerson, Nicholas Meyers, and Nick Soares.
  • Writer(s): Tyler Chandler, Nicholas Meyers, and Jessie Deeter (Story consultant).
  • Music: Jayme McDonald.
  • Cinematography: Nicholas Meyers.
  • Editor(s): Tyler Chandler and Nicholas Meyers.
  • Production: Golden Teacher Films.
  • Release Date: 20 March 2019 (US).
  • Running Time: 82 minutes.

A New Understanding: The Science of Psilocybin (2015)

Introduction

A New Understanding explores the treatment of end-of-life anxiety in terminally ill cancer patients using psilocybin, a psychoactive compound found in some mushrooms, to facilitate deeply spiritual experiences.

Outline

The documentary explores the confluence of science and spirituality in the first psychedelic research studies since the 1970’s with terminally ill patients.

As a society we devote a great deal of attention to treating cancer, but very little to treating the human being who is dying of cancer. The recent resurgence of psychedelic research is once again revealing the power of compounds like psilocybin to profoundly alter our understanding of both life and death. Through the eyes of patients, their loved ones, therapists, and researchers, A New Understanding examines the use of psilocybin in a controlled setting to reduce psychospiritual anxiety, depression, and physical pain.

The treatment aims to help the patient understand that a ‘good’ death is possible, and to help the patient’s family deal well with the dying process. A New Understanding shows patients and their families coming to terms with dying through the skillful treatment of the whole human being. If we can learn to work more skillfully with dying, we will also learn to take better care of life.

Production & Filming Details

  • Director(s): Roslyn Dauber.
  • Producer(s): Robert J Barnhart, Roslyn Dauber, Brady Dial, Matt Humble, Steve McDonald, Jeff Porter, and Mitch Schultz.
  • Music: Brian Satterwhite.
  • Editor(s): Jason Uson.
  • Studio: Red Phoenix Productions.
  • Production: Golden Teacher Films.
  • Release Date: March 2015 (US).
  • Running Time: 55 minutes.
  • Country: US.
  • Langauge: English.

What Haunts Us (2018)

Introduction

The 1979 class of Porter Gaud School in Charleston, South Carolina graduated 49 boys. Within the last 35 years, six of them have died by suicide.

Outline

When Paige Goldberg Tolmach gets word that another former student from her beloved high school has killed himself, she decides to take a deep dive into her past in order to uncover the surprising truth and finally release the ghosts that haunt her hometown to this day.

Production & Filming Details

  • Director(s): Paige Tolmach.
  • Producer(s): Sarah Gibson, James Huntsman, Andreas Olavarria, and Told Slater.
  • Music: Nathan Halpern.
  • Cinematography: Adam Dubrowa.
  • Editor(s): Derek Doneen and Allan Duso.
  • Production: Diamond Docs, Matt Tolmach Productions, and The Kennedy/Marshall Company.
  • Distributor(s): Blue Fox Entertainment.
  • Release Date: 24 February 2018 (Boulder International Film Festival) and 11 May 2018 (US, general release).
  • Running Time: 72 minutes.

Should we use tRNS (with the Current Stimulation Parameters) as a Therapeutic Intervention for the Treatment of Depression?

Research Paper Title

Transcranial random noise stimulation for the acute treatment of depression: a randomised controlled trial.

Background

Transcranial electrical stimulation has broad potential as a treatment for depression.

Transcranial random noise stimulation (tRNS), which delivers randomly fluctuating current intensities, may have greater cortical excitatory effects compared to other forms of transcranial electrical stimulation.

The researchers therefore aimed to investigate the antidepressant efficacy of tRNS.

Methods

Depressed participants were randomly assigned by computer number generator to receive 20 sessions of either active or sham tRNS over four weeks in a double-blinded, parallel group randomised-controlled trial.

tRNS was delivered for 30mins with a direct current offset of 2mA and a random noise range of 2mA. Primary analyses assessed changes in depression severity using the Montgomery-Asperg Depression Rating Scale (MADRS).

Neuroplasticity, neuropsychological, and safety outcomes were analysed as secondary measures.

Results

69 participants were randomised, of which three discontinued treatment early leaving 66 (sham n = 34, active n = 32) for per-protocol analysis.

Depression severity scores reduced in both groups (MADRS reduction in sham = 7.0 [95%CI 5.0-8.9]; and active = 5.2 [95%CI 3.2-7.3]).

However, there were no differences between active and sham groups in the reduction of depressive symptoms, or the number of participants meeting response (sham = 14.7%; active = 3.1%) and remission criteria (sham = 5.9%; active = 0%).

Erythema, paraesthesia, fatigue, and dizziness/light-headedness occurred more frequently in the active tRNS group.

Neuroplasticity, neuropsychological and acute cognitive effects were comparable between groups.

Conclusions

The researchers suggest the results do not support the use of tRNS with the current stimulation parameters as a therapeutic intervention for the treatment of depression.

Reference

Nikolin, S., Alonzo, A., Martin, D., Gálvez, V., Buten, S., Taylor, R., Goldstein, J., Oxley, C., Hadzi-Pavlovic, D. & Loo, C.K. (2020) Transcranial random noise stimulation for the acute treatment of depression: a randomized controlled trial. The International Journal of Neuropsychopharmacology. pii: pyz072. doi: 10.1093/ijnp/pyz072. [Epub ahead of print].

Reviewing Discontinuation Rates of Antidepressant Use by Dutch Soldiers

Research Paper Title

Discontinuation Rates of Antidepressant Use by Dutch Soldiers.

Background

Soldiers have a higher risk for developing psychiatric disorders that require treatment; often with antidepressants.

However, antidepressants as well as the psychiatric disorder, may influence military readiness in several ways.

In the general population, early discontinuation of antidepressant treatment is often seen. It is yet unknown whether this occurs to a similar extent in soldiers.

The objective of this study was to evaluate discontinuation of antidepressant use by Dutch soldiers in the first 12 months after start and determinants thereof.

Methods

Data were obtained from the military pharmacy. All Dutch soldiers who started using an antidepressant between 2000 and 2014 were included.

Kaplan-Meier curves were constructed to estimate the discontinuation rate over time and the influence of each determinant on discontinuation rate was estimated using Cox regression.

Results

About 25.9% of de 2479 starters had discontinued their antidepressant use after 1 month; after 3 and 6 months this number increased to 52.7% and 70.3%, respectively.

Early discontinuation was higher in soldiers who received their first prescription from a neurologist or rehabilitation specialist (HR 1.85, 95% CI 1.55-2.21, HR 2.66 95% CI 1.97-3.58) compared to soldiers with a first prescription from a general practitioner.

In addition, early discontinuation was lower in soldiers who were prescribed serotonin reuptake inhibitors and other antidepressants (HR 0.57, 95% CI 0.51-0.60, HR 0.63, 95% CI 0.55-0.73) and in soldiers between 40 and 50 years of age (HR 0.79, 95% CI 0.70-0.89).

Conclusions

More than half of the soldiers discontinued their prescribed antidepressant within 3 months and after 6 months, only 30% were still on antidepressants.

Reference

Janssen, D.G.A., Vermetten, E., Egberts, T.C.G. & Heerdink, E.R. (2019) Discontinuation Rates of Antidepressant Use by Dutch Soldiers. Military Medicine. 184(11-12), pp.868-874. doi: 10.1093/milmed/usz060.

What is the Association with Several Physical, Mental, & Cognitive Health Outcomes with Gait Speed in Older Adults?

Research Paper Title

Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes.

Background

Although clinical gait speed may indicate health and wellbeing in older adults, there is a lack of studies comparing clinical tests with ambulatory gait speed with regard to several health outcomes.

The objective of this study was to examine the associations of clinical gait speed, measured by the 2.44 meter walk test and the ambulatory gait speed with several physical, mental, and cognitive health outcomes in older adults.

A cross-sectional design was used.

Methods

The study population comprised 432 high-functioning community-dwelling older adults (287 women) aged between 65 and 92.

Clinical and ambulatory gait speeds were measured using the 2.44 m walk test and a portable gait analysis device, respectively.

Multiple linear regressions were used to examine the association of clinical and ambulatory gait speeds with several health outcomes (BMI, waist circumference, systolic and diastolic blood pressure, chronic conditions, self-rated health, exhaustion, upper and lower body strength, physical and mental health status, cognitive status and self-rated cognitive status).

Results

The results showed that the average gait speed for clinical and ambulatory measures cannot be directly compared.

Clinical gait speed was associated with 7 health outcomes, while the ambulatory gait speed was associated with 6 health outcomes.

The significant associations between measures of gait speed and the health outcomes converged in 5 of the 13 health outcomes studied, however, the strength of associations were singly different between measures.

The short monitoring time, the inability to distinguish between the ambulatory gait speed inside the home and outdoor gait speed, and the under-representative sample are limitations of the study.

Conclusions

The results indicated differences in the number and strength of associations between clinical and ambulatory gait speed.

Both measures have construct validity because they have been associated with physical and health outcomes, however, they may have different predictive validity.

Further research should be done to compare their predictive validity in longitudinal designs.

Reference

De la Cámara, M.Á., Higueras-Fresnillo, S., Sadarangani, K.P., Esteban-Cornejo, I., Martinez-Gomez, D. & Veiga, Ó.L. (2020) Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes. Physical Therapy. pii: pzz186. doi: 10.1093/ptj/pzz186. [Epub ahead of print].

Trying to Understand the Link between Socioeconomic Deprivation, Blood Lipids, Pyschosis, & Cardiovascular Risk

Research Paper Title

Socioeconomic deprivation and blood lipids in first-episode psychosis patients with minimal antipsychotic exposure: Implications for cardiovascular risk.

Background

The influence of socioeconomic deprivation on the cardiovascular health of patients with psychosis-spectrum disorders (PSD) has not been investigated despite the growing recognition of social factors as determinants of health, and the disproportionate rates of cardiovascular mortality observed in PSD.

Discordant results have been documented when studying dyslipidemia -a core cardiovascular risk factor- in first-episode psychosis (FEP), before chronic exposure to antipsychotic medications.

The objective of the present study is to determine the extent to which socioeconomic deprivation affects blood lipids in patients with FEP, and examine its implications for cardiovascular risk in PSD.

Methods

Linear regression models, controlling for age, sex, exposure to pharmacotherapy, and physical anergia, were used to test the association between area-based measures of material and social deprivation and blood lipid levels in a sample of FEP patients (n = 208).

Results

Social, but not material deprivation, was associated with lower levels of total and HDL cholesterol.

This effect was statistically significant in patients with affective psychoses, but not in schizophrenia-spectrum disorders.

Conclusions

Contrary to other reports from the literature, the relationship between socioeconomic disadvantage and blood lipid levels was contingent on the social rather than the material aspects of deprivation.

Furthermore, this association also depended on the main diagnostic category of psychosis, suggesting a complex interaction between the environment, psychopathology, and physical health.

Future studies exploring health issues in psychosis might benefit from taking these associations into consideration.

A better understanding of the biology of blood lipids in this context is necessary.

Reference

Veru-Lesmes, F., Rho, A., Joober, R., Iyer, S. & Malla, A. (2020) Socioeconomic deprivation and blood lipids in first-episode psychosis patients with minimal antipsychotic exposure: Implications for cardiovascular risk. Schizophrenia Research. pii: S0920-9964(19)30589-4. doi: 10.1016/j.schres.2019.12.019. [Epub ahead of print].