Jasmine Turna

There is an app for that! The current state of mobile applications (apps) for DSM-5 obsessive-compulsive disorder, posttraumatic stress disorder, anxiety and mood disorders

Mental health apps are viewed as a promising modality to extend the reach of mental health care beyond the clinic. They do so by providing a means of assessment, tracking, and treatment through a smartphone. Given that nearly 2/3 of the American population owns a smartphone, mental health apps offer the possibility of overcoming treatment barriers such as geographic location or financial barriers. Unfortunately, the excitement surrounding mental health apps may be premature as the current supporting literature regarding their efficacy is limited. The app marketplace is littered with apps claiming to treat or assess symptoms, but even those created by reputable organizations or those incorporating components of evidence‐based treatments have not yet been validated in terms of their efficacy. This review aims to provide a comprehensive review of the current state of the mental health app literature by examining published reports of apps designed for DSM‐5 anxiety and mood disorders, OCD, and PTSD. The breadth of apps reviewed includes those oriented around assessment, symptom tracking, and treatment as well as “multipurpose” apps, which incorporate several of these components. This review will also present some of the most popular mental health apps which may have clinical utility and could be prescribed to clients. While we discuss many potential benefits of mental health apps, we focus on a number of issues that the current state of the app literature presents. Overall there is a significant disconnect between app developers, the scientific community and health care, leaving the utility of existing apps questionable.

Is cannabis treatment for anxiety, mood, and related disorders ready for prime time?

Anxiety and related disorders are the most common mental conditions affecting the North American population. Despite their established efficacy, first‐line antidepressant treatments are associated with significant side effects, leading many afflicted individuals to seek alternative treatments. Cannabis is commonly viewed as a natural alternative for a variety of medical and mental health conditions. Currently, anxiety ranks among the top five medical symptoms for which North Americans report using medical marijuana. However, upon careful review of the extant treatment literature, the anxiolytic effects of cannabis in clinical populations are surprisingly not well‐documented. The effects of cannabis on anxiety and mood symptoms have been examined in healthy populations and in several small studies of synthetic cannabinoid agents but there are currently no studies which have examined the effects of the cannabis plant on anxiety and related disorders. In light of the rapidly shifting landscape regarding the legalization of cannabis for medical and recreational purposes, it is important to highlight the significant disconnect between the scientific literature, public opinion, and related policies. The aim of this article is to provide a comprehensive review of the current cannabis treatment literature, and to identify the potential for cannabis to be used as a therapeutic intervention for anxiety, mood, and related disorders. Searches of five electronic databases were conducted (PubMed, MEDLINE, Web of Science, PsychINFO, and Google Scholar), with the most recent in February 2017. The effects of cannabis on healthy populations and clinical psychiatric samples will be discussed, focusing primarily on anxiety and mood disorders.

“WHAT'S BUGGING THE GUT IN OCD?” A REVIEW OF THE GUT MICROBIOME IN OBSESSIVE–COMPULSIVE DISORDER

The gut microbiome has become a topic of major interest as of late, with a new focus specifically on psychiatric disorders. Recent studies have revealed that variations in the composition of the gut microbiota may influence anxiety and mood and vice versa. Keeping the concept of this bidirectional “microbiota‐gut‐brain” axis in mind, this review aims to shed light on how these findings may also be implicated in obsessive–compulsive disorder (OCD); potentially outlining a novel etiological pathway of interest for future research in the field.

An Update on the Relationship Between the Gut Microbiome and Obsessive-Compulsive Disorder

The gut microbiome, the collection of microbes and their genetic material in the human gastrointestinal tract, has recently become a topic of interest in psychiatry. To date, animal studies have repeatedly shown behavior to be affected by alterations in the gut microbiota. Furthermore, studies in clinical psychiatric populations have also illustrated that microbial dysbiosis may play a role in these conditions, but results have been inconsistent. Given the existing animal and human literature providing evidence for a role of the microbiome in anxiety and depressive disorders, this review explores and develops similar lines of evidence in obsessive-compulsive disorder. Theoretical treatment options targeting the gut microbiome are also discussed. [Psychiatr Ann. 2017;47(11):542-551.] Obsessive-compulsive disorder (OCD) is a psychiatric condition marked by recurrent intrusive thoughts and ritualistic behaviors aimed at reducing the associated distress. The etiology of OCD is complex and involves multiple pathways, with imbalances in central serotonin, glutamate, and dopamine systems thought to play a causative role. This etiological basis remains largely theoretical and has received mixed scientific support. The current theories are premised on the observed benefit of pharmacological interventions such as serotonin reuptake inhibitors (SRIs). Given that 40% to 60% of patients with OCD do not respond to first-line treatments such as SRIs or cognitive-behavioral therapy (CBT),1 it is important that Jasmine Turna, BSc, PhD(C), is a Research Assistant, MacAnxiety Research Centre, McMaster University; and a Graduate Student, MiNDS Neuroscience Graduate Program, McMaster University. Beth Patterson, BScN, MSc, is a Research Nurse, Department of Psychiatry and Behavioural Neurosciences, McMaster University; and a Research Research Manager, MacAnxiety Research Centre, McMaster University. Michael Van Ameringen, MD, FRCPC, is a Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University; the Director, MacAnxiety Research Centre, McMaster University; and a Psychiatrist, Hamilton Health Sciences. Address correspondence to Jasmine Turna, BSc, PhD(C), MacAnxiety Research Centre, McMaster University, 1057 Main Street W, L02, Hamilton, ON, L8S 1B7; email: turnaj@mcmaster.ca. Grant: M. V. A. has received grants from the Hamilton Academic Health Sciences Organization and the Canadian Foundation for Innovation. Disclosure: Beth Patterson reports that her spouse is on the speakers bureau for Lundbeck, Purdue, and Allergen; her spouse is a consultant for Purdue and Allergen; and her spouse has performed contracted research for Shire, Janssen-Ortho, and Pfizer. Michael Van Ameringen is on the speakers bureau for Lundbeck, Purdue, and Allergen; is a consultant for Purdue and Allergen; and has performed contracted research for Shire, Janssen-Ortho, and Pfizer. The remaining author reports no relevant financial relationships. doi: 10.3928/00485713-20171013-01

The Treatment of Refractory Generalized Anxiety Disorder

PurposePurpose Generalized anxiety disorder (GAD) is one of the most common anxiety disorders, afflicting approximately 6% of the general population in their lifetime. It has a chronic and episodic course, requiring a long-term treatment approach. A variety of pharmacological agents and psychological treatments have been shown to be efficacious as GAD treatments; however, remission effect sizes for first-line treatments are small. This review aims to examine the existing evidence for next-step pharmacological and psychological treatments for individuals who remain symptomatic after first-line treatment.Recent FindingsRecent Findings Relatively few studies have examined next-step treatments for treatment-resistant GAD (TR-GAD). The bulk of the available treatment-resistant literature has investigated augmentation with atypical antipsychotics or pregabalin.SummarySummary Unfortunately, there is little information to guide clinicians in this area. The strongest evidence supports augmentation with pregabalin, however, this is based primarily upon one study. Approaches to consider when treating patients with TR-GAD are discussed.

INTERNET ADDICTION OR PSYCHOPATHOLOGY IN DISGUISE? RESULTS FROM A SURVEY OF COLLEGE-AGED INTERNET USERS

Purpose Internet addiction, is a term describing pathological, compulsive internet use and has an estimated prevalence of 6% among the general population and higher in students[1]. Extreme internet use may have significant public health importance as it has been attributed to several cardio-pulmonary deaths and at least one murder. While the pathological use of alcohol or drugs has been historically accepted as an addiction, questions remain concerning whether extreme internet use should be conceptualized as an addiction. The Internet Addiction Test (IAT) was developed in 1998, prior to the wide-spread use of Smartphone and other mobile devices, to detect internet addiction [2]. It is unclear whether this instrument is capable of capturing problematic modern internet use. The purpose of this study was to examine the construct of “internet addiction” in a sample of college aged internet users. Method A survey was administered to first year undergraduate students at McMaster University and posted to our centre website www.macanxiety.com . Following acknowledgment of a disclosure statement, participants completed several self-report scales detailing internet usage, symptoms of depression and anxiety, impulsiveness and executive functioning. Measures included: a short demographics questionnaire as well as a survey containing the IAT, sections from the Mini International Neuropsychiatric Interview for OCD, GAD, SAD, the Barkley Adult ADHD Rating Scale, the Barratt Impulsiveness Scale, the Depression, Anxiety and Stress Scale (DASS-21), the Barkley Deficits in Executive Functioning Scale (BDEFS) and the Sheehan Disability Scale (SDS). Individuals were also asked to complete the Dimensions of Problematic Internet Use (DPIU); a scale based on DSM-5 addiction criteria. Once the survey was complete, respondents were informed of their score and interpretation on the IAT. Results Two hundred and fifty-four participants completed all assessments. They had a mean age of 18.5±1.6 years and 74.5% were female. In total 12.5% (n = 33) met screening criteria for internet addition according to the IAT, while 107 (42%) met addiction criteria according to the DPIU. The most frequently reported dimensions of internet use where respondents had difficulty controlling their use were: video streaming services (55.8%), social networking (47.9%) and instant messaging tools (28.5%). Those screening positive on the IAT and on the DPIU had significantly higher levels of functional impairment (p  Conclusion A high proportion of the sample met criteria for internet addiction. Participants meeting criteria for internet addiction had greater levels of psychopathology and functional impairment. With the exception of instant messaging tools, none of the dimensions of internet use differed between individuals who did and did not meet internet addiction criteria on the IAT. This study highlights that problematic internet use may be more widespread than once thought. Further studies are needed to understand the relationship between problematic internet use and psychopathology.

Hoarding in users of online classified advertisements

Background Hoarding disorder (HD) is a mental disorder that has been newly included in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. It is estimated that 2-6% of adults in the general population suffer from clinically significant hoarding symptoms, with 80 to 90% engaging in excessive acquisition [1]. Little research has examined the excessive acquisition component of hoarding disorder(HD), although preliminary evidence suggests that buying and obtaining free things are markers of HD severity. [2] Classified ad networks on the web provide a way to list items for sale, often for free. Many individuals who suffer from HD have limited insight into their condition and are reluctant to seek help, making prevalence estimates difficult to obtain. We elected to examine the prevalence of hoarding behaviours among users of online classified advertisements. Methods A link to an online survey was posted on the following classified ad sites: Kijiji, Craigslist, Locanto, Reddit and postad.ca. The ads were posted in communities across Canada from June 26, 2015 to February 26, 2016. Following acknowledgment of a disclosure statement, participants were asked to complete a short demographics questionnaire and general questions regarding their use of online classified advertisements; no personal identifiers were collected. The Hoarding Rating Scale (HRS) was then completed; individuals with clinically significant hoarding (based on HRS) also completed the Saving Inventory-Revised(SI-R) and the Clutter Image Rating. Participants were provided with feedback on their hoarding behaviours. Results Seven hundred twenty-four individuals completed the survey; 69% of respondents came from Kijiji advertisements. The sample was 66% female, with a mean age of 39.9 ± 13.8 years; 55% were married, 29% were single, 9% were separated or divorced and 1% were widowed. Clinically significant hoarding behavior was identified in 11% (n=80) using the HRS (x 26.1 ± 5.2 versus x 9.9 ± 7.0 in those without significant hoarding, p Discussion This sample of individuals visiting online classified ad sites had high rates of clinically significant hoarding behaviours - double that found in the general population. The amount of time spent on online classified sites did not appear to be associated with hoarding. Online classified ad sites may represent a unique medium to study individuals with hoarding behaviours.

Internet screening for anxiety disorders: Treatment-seeking outcomes in a three-month follow-up study

Although many people use the internet to diagnose mental health problems, little is known about the relationship between internet self-diagnosis and treatment-seeking. The MACSCREEN (a validated, self-report screening tool for anxiety and depression) was posted on our clinic homepage and respondents were invited to take an anxiety test. Three months after completing the MACSREEN and a variety of symptom severity scales, respondents were emailed a follow up questionnaire asking about treatment-seeking behaviours. Of the 770 MACSCREEN respondents, 103 completed the follow-up questionnaire. Of these, 100% met criteria for at least one anxiety or mood disorder diagnosis and 51% sought treatment after completing the MACSCREEN. In the 49% who did not seek treatment, fear of medication (57%), discomfort talking to their doctor about anxiety (28%) and the belief that symptoms were not severe enough (28%) were cited as barriers. Compared to non-seekers, treatment-seekers were significantly more likely to meet screening criteria for Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Posttraumatic Stress Disorder and Depression. Higher Sheehan Disability Scale scores and being married (versus single) significantly increased the odds of treatment-seeking, suggesting that functional impairment and disease burden on the family may be stronger predictors of treatment seeking than overall severity of symptoms.

Pharmacotherapy for Adolescent Social Phobia

Social anxiety disorder (SAD) is an anxiety disorder characterized by excessive fear of exposure to situations that involve potential scrutiny by others. This disorder is one of the most common psychiatric conditions in children and adolescents and often presents with comorbid anxiety and mood disorders. Although the onset of SAD is typically in late childhood or early adolescence, most afflicted individuals go undiagnosed for years, not seeking treatment until adulthood. Evidence-based first-line treatment of SAD in adults includes the use of both pharmacotherapy and cognitive–behavioral therapy. There is emerging data in adolescents with SAD which supports the use of similar treatments in this population. This chapter will review the epidemiology, clinical characteristics, diagnosis and comorbid disorders including selective mutism and avoidant personality disorder, as well as the pharmacological treatment of SAD in youth. Randomized controlled trials examining selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, as well as other antidepressants in youth with SAD will be reviewed. Issues related to safety and tolerability of these agents and risk of suicide will be discussed. Response and long-term efficacy of pharmacotherapy as well as practical guidelines for clinicians who treat children and adolescents are also presented.