Mental and Social Health Commons^™

Disordered Eating Behaviours In Adolescents With And Without A Formal Ed Diagnosis: Comparing Individual And Contextual Factors, Eve G. Chapnik

Electronic Thesis and Dissertation Repository

This study explored various psychosocial factors associated with disordered eating in adolescents accessing mental health services across Ontario, Canada. Data were collected using the interRAI Child and Youth Mental Health (ChYMH) assessment tool and participants were categorized into three groups: individuals with diagnosed eating disorders (ED, n=207), disordered eating without a formal ED diagnosis (sub-ED, n=888), and other treatment-seeking youth (non-ED, n=3285). The ED and sub-ED groups did not differ in many ways, presenting with a similarly greater prevalence of mental health issues, and dysfunctional family and peer relationships, in comparison to non-ED youth. However, the ED …

Antidepressants Versus Placebo For Generalized Anxiety Disorder: A Systematic Review And Meta-Analysis, Katarina Kopcalic

Electronic Thesis and Dissertation Repository

Objectives: To assess the efficacy and acceptability of antidepressants compared to placebo among adults with a primary diagnosis of generalized anxiety disorder (GAD). Methods: Five electronic databases and 2 trial registries were searched to identify studies for inclusion. The risk of bias version 1 tool was used to assess the risk of bias. A random-effects meta-analysis was conducted using RevMan web. Results were presented using forest plots. Results: 38 studies (12,570 participants) were included. Very low-quality evidence showed a benefit for antidepressants over placebo in the rate of treatment response (RR, 1.39: 95% CI: 1.27, 1.52) and no differences in …

Regulatory Implications Of Inadequately Designed Pimavanserin Drug Trials Published With Risk Of Bias On Expedited Regulatory Approval Processes, Benson Law

Electronic Thesis and Dissertation Repository

The objective of this retrospective critical appraisal study was to determine if the trials submitted to the Food and Drug Administration for the expedited approval of pimavanserin was of sufficient methodological quality to ascertain its safety and efficacy. After the general metrics of the trials were assessed, the Risk of Bias 2 tool and the PRagmatic Explanatory Continuum Indicator Summary tool were employed to evaluate the risk of bias and the design suitability of the trials. This study suggests that the decision to approve pimavanserin for the treatment of Parkinson’s Disease Psychosis failed to meet the threshold of evidence normally …

How We Debrief: An Interpretive Description Of Social Service Community Workers' Experiences, Andrea C. Krywucky

Electronic Thesis and Dissertation Repository

The aim of this research was to understand current practices of debriefing being used or not used in community social service organizations and the presumed frameworks or evidence justifying these practices in London, Ontario. The geographical area under concern has seen an increasing poverty gap, lack of affordable housing, toxic drug crisis, with mental health issues being exasperated by the pandemic. Social service agencies are overwhelmed with caseloads, creating an increase in need of care for frontline workers, as they are the first point of contact for many. This research utilized an interpretive description methodology to explore workers’ experiences and …

Data-Driven Neuroanatomical Subtypes In Various Stages Of Schizophrenia: Linking Cortical Thickness, Glutamate, And Language Functioning, Liangbing Liang

Electronic Thesis and Dissertation Repository

The considerable variation in the spatial distribution of cortical thickness changes has been used to parse heterogeneity in schizophrenia. We aimed to recover a ‘cortical impoverishment’ subgroup with widespread cortical thinning. We applied hierarchical cluster analysis to cortical thickness data of three datasets in different stages of psychosis and studied the cognitive, functional, neurochemical, language and symptom profiles of the observed subgroups. Our consensus-based clustering procedure consistently produced a subgroup characterized by significantly lower cortical thickness. This ‘cortical impoverishment’ subgroup was associated with a higher symptom burden in a clinically stable sample and higher glutamate levels with language impairments in …

Predictors And Outcomes Of Patient Stigma Perception Appraisal: Developing And Testing Of A Dynamic Stigma Model Of Mental Illness, Sebastian Kwadwo Gyamfi

Electronic Thesis and Dissertation Repository

Background

The psychosocial perspectives of stigma have been explored over the years. However, research that encompasses the study of stigma as a socio-cultural, religious, and moral phenomenon is lacking. This study aimed to develop and test a Dynamic Stigma Model of Mental illness (DYSMO) among a cohort of Outpatients receiving care in Ghana.

Methods

The study examined hypothesized relationships within a newly developed stigma model using structural equation modeling techniques. A non-probabilistic convenience sampling technique was used to recruit 330 participants at the Out-Patient Department of two psychiatric hospitals in Southern Ghana.

Results

Confirmatory factor analysis produced a final model …

Role Of The Default-Mode Network During Narrative Integration In Major Depressive Disorder, Darren Ri-Sheng Liang

Electronic Thesis and Dissertation Repository

How brain activity is synchronized across individuals during narrative comprehension has previously been characterized by functional magnetic resonance imaging (fMRI) in healthy and patient populations. To our knowledge, there has been limited investigation as to how it is affected by major depressive disorder (MDD). We addressed this issue with fMRI through examination of inter-subject synchronization in the default mode network (DMN), brain structures which have previously been implicated in MDD pathology. Twenty-two patients with MDD and 20 matched control participants listened to Intact versus Scrambled versions of an auditory narrative; these experimental conditions differed in the degree of temporal integration …

Sex Differences In The Clinical Presentation Of Early Psychosis In A Primary Care Setting, Brooke Carter

Electronic Thesis and Dissertation Repository

Psychotic disorders can be variable in clinical presentation, and there may be differences by sex. The objective of this thesis was to explore sex differences in the clinical presentation of early psychosis in the context of primary care. Our systematic review and meta-analysis found that men experienced more negative symptoms and had a higher prevalence of substance use issues, whereas women experienced more depressive symptoms and had higher functioning. Our electronic medical record analysis from primary care found that positive symptoms and substance use were less prevalent in the medical records of women. We also found that visits by women …

Evaluating The Impact Of A Safe Exercise Training Workshop On Knowledge And Self-Efficacy To Manage Dysfunctional Exercise Among Eating Disorders Clinicians At Alsana Eating Disorders Center, Danika A. Quesnel

Electronic Thesis and Dissertation Repository

Engaging in dysfunctional exercise (DEX) is detrimental to eating disorders (EDs) prognosis, although common amongst clients. Though nutritionally supported exercise can improve ED treatment outcomes, without negatively impacting weight restoration, clinicians remain hesitant to address DEX, perhaps due to a lack of information and training. The current study examined the effects of a Safe Exercise at Every Stage (SEES) training on clinician knowledge and self-efficacy in managing DEX in ED treatment. Eating disorders clinicians completed measures before (n = 96) and after (n = 44) SEES training to assess their knowledge and self-efficacy around treating DEX, with a …

Emerging Adult Perspectives On Marijuana Usage And Social Isolation During Covid-19, Avery Kiana Wong

Electronic Thesis and Dissertation Repository

Individuals struggling with emotional distress are twice as likely to use marijuana routinely. Young adults, ages 18 to 24, continue to be at increased risk for accidents, injuries, and poor cognitive functioning when using cannabis regularly, compared to those 24 and older. In addition, studies have shown that increased social isolation further increases the risk of marijuana use in young adults. Previous literature also demonstrated that marijuana is currently being used as a method of treatment for emotional distress. Much of the research conducted to date has focused on the collection of checklist data that has looked at the presence …

The Functional And Structural Consequences Of Aberrant Microglial Activity In Major Depressive Disorder, Jasmine D. Cakmak

Electronic Thesis and Dissertation Repository

Major depressive disorder (MDD) is a highly debilitating neuropsychiatric illness which has been linked with increases in both peripheral and central inflammation, as well as with changes in connectivity. Although countless studies have investigated these two topics, the relationship between neuroinflammation and functional/structural connectivity has not been explored. Using [¹⁸F]FEPPA PET imaging, we measured translocator protein-related (TSPO) microglial activity in the subgenual anterior cingulate cortex (sgACC) and insula and confirmed significantly increased [¹⁸F]FEPPA uptake in depressed patients (N=12) compared to healthy controls (N=23). Using a seed-based ROI analysis of fMRI data, we found that patients show …

The Problem Of Operational Stress Injuries In An Ontario Fire & Rescue Organization, Megan Edgelow

The Dissertation in Practice at Western University

The purpose of this Organizational Improvement Plan (OIP) is to assist public safety leaders in understanding the human and financial costs of operational stress injuries (OSIs) and possible solutions to this issue. OSIs, including posttraumatic stress disorder (PTSD), are a growing problem for public safety organizations, requiring new and innovative solutions. This OIP is applied to a fire and rescue organization in a small urban centre in Ontario that faces similar OSI challenges to many other public safety organizations. The Problem of Practice (PoP) is a lack of implementation of effective practices to mitigate the impact of OSIs. The foundation …

Incidence Of Cancer And Stage At Diagnosis Among People With Recent-Onset Psychotic Disorders, Jared C. Wootten

Electronic Thesis and Dissertation Repository

Evidence on cancer incidence in people with psychotic disorders, compared to the general population, is equivocal, although those with psychotic disorders so have more advanced stage of cancer at the time of diagnosis. The objective of this thesis was to compare cancer incidence and stage at diagnosis for people with psychotic disorders, relative to the general population. Our systematic review did not observe a significant difference in overall cancer incidence among people diagnosed with psychotic disorders (RR = 1.08, 95% CI: 1.00 to 1.16), however people with psychotic disorders were more likely to be present with advanced stage cancer at …

Childhood-Onset Epilepsy And Long-Term Child And Maternal Well-Being, Klajdi Puka

Electronic Thesis and Dissertation Repository

The long-term prognosis of pediatric epilepsy is favorable with respect to seizures, whereby 66% to 80% of children attain seizure control. However, psychiatric and psychosocial problems among children with epilepsy (CWE) and their parents are common, and little is known about their long-term outcomes. The objectives of this dissertation were to: 1) validate a parent-reported measure of young adult’s health-related quality of life (HRQOL), to allow for a consistent informant to report on CWE’s HRQOL from childhood into young adulthood; 2) delineate the long-term course of CWE’s HRQOL and identify the clinical, parent, and family characteristics associated with the trajectory …

Long-Term Patterns Of Acute Mental Health Service Use After A First Episode Of Psychosis: Examining Ongoing Psychiatric Care Beyond The Critical Period, Eugene Law

Electronic Thesis and Dissertation Repository

The long-term patterns of acute mental health service use after treatment in an early psychosis intervention (EPI) program are not well known. The objective of this thesis was to investigate the long-term patterns of acute mental health service use. We used health administrative data to examine the patterns and risk factors associated with acute mental health service use over the of 5- to 10-year period post-EPI admission. Between years 5 to 10 post-EPI admission, approximately one quarter of people contacted acute mental health services. Factors associated with acute mental health service use during this period included younger age at admission, …

The Experiences Of Iraqi Refugees In Canada: A Life History Study Of War And Resilience In The Aftermath Of Migration, Nada Nessan

Electronic Thesis and Dissertation Repository

This thesis reports on a life history narrative on the experiences of Iraqi refugees who resettled in Canada after living through war. The aim of this study is to help change the narrow perspectives on the mental health of war affected populations to a broader perception shaped by cultural and social aspects and to inform the development of meaningful and cultural relevant programs and policies with a particular attention to the concept of resilience.

The first part of the study presents the chronological narratives, or profiles. of eight participants. The second part of the study is a thematic discussion of …

Trends And Factors Associated With Suicide Deaths In Older Adults, Eada Novilla-Surette

Electronic Thesis and Dissertation Repository

Suicide in older adults is a significant overlooked problem worldwide; particularly in Canada where a national suicide prevention strategy has not yet been established. This population-level study utilized and analyzed linked administrative health care databases (from 2011-2015) that were available at ICES (provincial health care administrative data steward), to build a better understanding of suicide (rate; trends; risks/preventive factors) in older adults living in Ontario, Canada. The findings suggest that suicide remains a persistent cause of death in older adults (with an average annual suicide rate of 0.1 per 1000 people over 5 years; the risks include being male, living …

Mood And Anxiety Disorders, Measurement, And Migrant Groups In Ontario, Jordan Edwards

Electronic Thesis and Dissertation Repository

Our objectives were to: (1) evaluate the current literature on the epidemiology of mood or anxiety disorders among migrant groups; (2) assess how current tools for measuring mood or anxiety disorders at the population level influence our understanding of the epidemiology by a) analyzing the concordance between two commonly used population measures, and b) using a Bayesian analysis to create a combined estimate using both measures; (3) estimate the prevalence and effects of potential risk factors on the prevalence of mood or anxiety disorders among first-generation migrant groups compared to the general population in Ontario. We conducted a systematic review …

The Experiences Of Female Adolescents Who Have Sustained A Concussion Through Sport Participation: A Consideration Of An Occupational Perspective During Recovery, Annalise Michelle Tichenoff

Electronic Thesis and Dissertation Repository

Adolescence is a time of rapid and tumultuous development in the physical, cognitive and psychosocial domains. Sustaining a concussion during this time period may complicate this development, particularly when symptoms are prolonged. Of particular importance is the study of adolescent females, as this population has been under-evaluated within the literature. This is especially troubling due to the number of concussions that occur among adolescent females, as concussions within this population reportedly occur at twice the frequency of adolescent males. This dissertation presents a qualitative case study investigation that explores the recovery experiences of adolescent female athletes who have sustained a …

Reducing Behavioural And Psychological Symptoms Of Dementia In Older Adult Long Term Care Home Residents With Virtual Reality Therapy, Munira Sultana

Electronic Thesis and Dissertation Repository

Individuals with dementia often exhibit Behavioural and Psychological Symptoms of Dementia (BPSD). BPSD worsens as dementia progresses and intensifies caregiver distress. The Registered Nurses’ Association of Ontario recommends non-pharmacologic methods such as group activities, music therapy, cognitive behavioral therapy, and cognitive stimulation therapy (CST) to manage BPSD. I wanted to explore the potential of virtual reality (VR) as a possible CST for Ontario long-term care home (LTC) residents with moderate to severe dementia. I analyzed data of a single site case series (n=24), piloted to explore the feasibility of VR therapy, residents’ tolerance for the therapy, facilitators and barriers to …

Social Connectedness And Self-Perceived Mental Health In Canadian Transitional Aged Youth, Romaisa Pervez

Electronic Thesis and Dissertation Repository

Introduction:Transitional aged youth (TAY; ages 15-24) is a vulnerable age group that face several life changes which contribute to many forms of distress in their lives.

Objective:To assess the impact social connectedness has on self-perceived mental health in Canadian TAY.

Methods:The dataset provided by the Canadian Community Health Survey 2016 cycle was used. Listwise deletion was used to handle missing data. The final sample size for the study was 5,378 youth between the ages of 15-24. Linear and ordinal logistic regressions were conducted for the statistical analysis of the dataset.

Results:With every point decrease in social …

The Neural Circuitry Of Sensory Processing In Post-Traumatic Stress Disorder, Sherain Harricharan

Electronic Thesis and Dissertation Repository

Background: Traumatic experiences can have severe emotional and psychological consequences, which may affect the capacity to process both internal and external sensory information. Such aberrations may have cascading effects in individuals with post-traumatic stress disorder (PTSD), where alterations in sensory processing may hinder the capacity for higher-order executive functions, including emotion regulation. Delineating the neural circuitry of subcortical and cortical structures thought to be central to sensory processing is therefore critical to the study of PTSD and may help to develop an understanding of the neurobiological mechanisms underlying this often debilitating disorder.

Methods: Various neuroimaging approaches were employed to investigate …

In Search Of Psychiatric Kinds: Natural Kinds And Natural Classification In Psychiatry, Nicholas Slothouber

Electronic Thesis and Dissertation Repository

In recent years both philosophers and scientists have asked whether or not our current kinds of mental disorder—e.g., schizophrenia, depression, bipolar disorder—are natural kinds; and, moreover, whether or not the search for natural kinds of mental disorder is a realistic desideratum for psychiatry. In this dissertation I clarify the sense in which a kind can be said to be “natural” or “real” and argue that, despite a few notable exceptions, kinds of mental disorder cannot be considered natural kinds. Furthermore, I contend that psychopathological phenomena do not cluster together into kinds in the way that paradigmatic natural kinds (e.g., chemical …

Early Treatment Response In First Episode Psychosis: A 7-Tesla Magnetic Resonance Spectroscopic Study Of Glutathione And Glutamate, Kara Dempster

Electronic Thesis and Dissertation Repository

Approximately one third of patients with schizophrenia fail to respond to dopamine-blocking antipsychotic medications. While treatment resistant schizophrenia (TRS) is generally thought to be present from the onset of first episode psychosis (FEP), prospective identification of these patients remains clinically challenging. We investigated the association of glutamate, and glutathione with time to response in the anterior cingulate cortex (ACC) of minimally-treated patients with FEP (n=26) and healthy controls (n= 27) using an ultra-high field 7T MRI protocol. Higher ACC glutathione at baseline was associated with decreased time to achieve 50% symptom improvement. There were no significant differences between patients and …

White Matter Inflammation And Executive Dysfunction: Implications For Alzheimer Disease And Vascular Cognitive Impairment, Alexander Levit

Electronic Thesis and Dissertation Repository

White matter integrity is crucial to healthy executive function, the cognitive domain that enables functional independence. However, in the ageing brain, white matter is highly vulnerable. White matter inflammation increases with age and Alzheimer disease (AD), which disrupts the normal function of white matter. This may contribute to executive dysfunction, but the relationship between white matter inflammation and executive function has not been directly evaluated in ageing nor AD. White matter is also particularly vulnerable to cerebrovascular disease, corresponding with the common presentation of executive dysfunction in vascular cognitive impairment (VCI). Thus, white matter may be an important substrate by …

Examining The Relationship Between Body Mass Index And Health-Related Quality Of Life Perception Among People With Mental Illness, Fatima Bukair

Electronic Thesis and Dissertation Repository

People suffering from mental illness are three times more likely to die prematurely from ‘natural’ causes than those without mental disorders as a result of their physical condition. Their life expectancy is reduced by 12-19 years. Obesity is commonly associated with mental illness and accounts for increased risk of cardiovascular disease, diabetes mellitus, stroke, heart disease, some cancers and osteoarthritis. This paper examined the relationship between body mass index (BMI) and health-related quality of life perception using the Short-Form Health Survey 36 among people living with mental illness. A Multivariate Multiple Regression model was employed to estimate the variables that …

Altered Brain Networks In Patients With Psychogenic Non-Epileptic Seizures (Pnes) Using Ultra High Field Mri, Brittney Castrilli

Electronic Thesis and Dissertation Repository

Background: Psychogenic Non-epileptic Seizures (PNES) are attacks that appear similar to epileptic attacks. However, they lack abnormal electrical discharges in the brain and have psychological underpinnings and causes. The gold standard of diagnosis is video-EEG which is not widely accessible, creating a poor prognosis for patients. Resting state functional magnetic resonance imaging can aid in the diagnosis and treatment of PNES by helping better understand brain networks in patients with PNES. This study examines brain networks in patients with PNES with a focus on the default mode network and salience network.

Methods: Twelve patients with PNES between the ages of …

Use Of Psychotropic Medications Among Pregnant Women With Bipolar Disorder: Patterns, Determinants, And Impact On Perinatal Outcomes, Misbah Salim

Electronic Thesis and Dissertation Repository

Navigating psychotropic treatment use for bipolar disorder (BD) in pregnancy is challenging as it is, but it is even more difficult with use of multiple medications across various drug classes for treatment, given the absence of evidence of their safe use. This retrospective cohort study assessed prescription patterns, patient characteristics associated with these patterns, risk of adverse outcomes, and rates of readmission in women with BD who were prescribed antipsychotic, antidepressant, or combination treatment during pregnancy, relative to untreated women. An estimated 25% of women were prescribed psychotropic drugs during pregnancy. Women with past suicide attempts and those with recurrence(s) …

Role Of The Dorsal Striatum In Learning And Decision Making, Nole M. Hiebert

Electronic Thesis and Dissertation Repository

The striatum, the input region of the basal ganglia, has been shown to mediate many cognitive functions. The striatum itself can be functionally segregated into dorsal (DS) and ventral striatum (VS). For more than 60 years, DS has been reported to mediate stimulus-response learning, though evidence has been accruing pointing to a role in decision making. These literatures have been growing independently and an aim of this thesis was to bridge these two bodies of knowledge. We directly investigated the role of DS in stimulus-response learning versus decision making using functional magnetic resonance imaging (fMRI) in patients with Parkinson’s disease …

Neuronal Correlates For Neuroendocrine Habituation To Repeated Stress, Sara Matovic

Electronic Thesis and Dissertation Repository

One way that the body actively responds to an impending stressor is by increasing systemic glucocorticoids through the activation of the hypothalamic-pituitary-adrenal (HPA) axis. While it is essential for short-term adaptation to stress, the sustained activation of the HPA axis during chronic stress can be detrimental and is linked to stress-related psychiatric conditions such as anxiety and depression. Therefore, it is important that the HPA axis adapts, or habituates, during chronic stress to minimize the negative consequences. Corticotropin releasing hormone (CRH) neurons in the paraventricular nucleus of the hypothalamus (PVN) function to assimilate incoming information from the stress circuitry and …