Mario McKenna

Pilot Study and Evaluation of Postgraduate Course on “The Interface Between Spirituality, Religion and Psychiatry”

ObjectivesUnderstanding the role of religion and spirituality is significant for psychiatric practice. Implementation of formal education and training on religious and spiritual issues, however, is lacking. Few psychiatric residencies offer mandatory courses or evaluation of course utility. The authors present findings from a pilot study of a course on the interface between spirituality, religion, and psychiatry. Course objectives were to increase both residents’ understanding of clinically relevant spiritual/religious issues and their comfort in addressing these issues in their clinical work.MethodsA 6-hour mandatory course was implemented for third- and fourth-year psychiatry residents at the University of British Columbia. Teaching sessions consisted of didactic and case-based modules delivered by multidisciplinary faculty. The Course Impact Questionnaire, a 20-item Likert scale, was used to assess six areas: personal spiritual attitudes, professional practice attitudes, transpersonal psychiatry, competency, attitude change toward religion and spirituality, and change in practice patterns. A pre/post study design was used with the questionnaire being administered at week 0, week 6, and 6 months follow-up to two groups of residents (N=30). Qualitative feedback was elicited through written comments.ResultsThe results from this pilot study showed that there was increased knowledge and skill base for residents who participated in the sessions. Paired t test analysis indicated a statistically significant difference between the pre- and postsession scale for competency. No other statistically significant differences were found for the other components.ConclusionThe findings suggest improvement in the competency scores for residents and overall usefulness of this course; however, limited conclusions can be made due to a small sample size and lack of adequate comparison groups. Establishing educational significance will require gathering larger usable control data as well as validation of the Course Impact Questionnaire tool to distinguish between different skill levels.

Perception of mental illness: preliminary exploratory research at a cross-cultural outpatient psychiatric clinic.

This descriptive study presented an overview of culturally sensitive mental health services and potential barriers for immigrant Canadians. A semi-structured questionnaire was developed and administered to 173 patients who attended a large cross-cultural psychiatry outpatient clinic in Vancouver, British Columbia, Canada. Results indicated that only 21% of patients were able to state their diagnosis or were able to describe the symptoms of their diagnosis that met the DSM-IV criteria given by a psychiatrist. Examination of patient ethnicity showed that more South Asian (25%) or Southeast Asian (24%) patients had more diagnoses of anxiety disorder in comparison to other ethnic groups. Refugees characterized mental illness in terms of stress or stress-related factors (30%) in comparison to non-refugees (13%). There was a greater preference in women, when compared to men, to prefer the term ‘client’ versus ‘patient’. These results elucidate the importance of cultural and systemic barriers for immigrant Canadians. The need for appropriate service delivery is discussed.

Pilot study of the prevalence of alcohol, substance use and mental disorders in a cohort of Iraqi, Afghani, and Iranian refugees in Vancouver

This study investigated the prevalence rate of current alcohol, substance use, post‐traumatic stress disorder (PTSD) and depression in a cohort of Middle‐Eastern government‐assisted refugees (GAR) to British Columbia.Introduction This study investigated the prevalence rate of current alcohol, substance use, post-traumatic stress disorder (PTSD) and depression in a cohort of Middle-Eastern government-assisted refugees (GAR) to British Columbia. Methods A group of GARs (32 men and 36 women) were interviewed and assessed using four clinical assessments (AUDIT, DUDIT, IES-R, PHQ-9) at an intake facility in Metro Vancouver. Results Men had a higher prevalence of alcohol use compared to women (15.6% versus 0%, P < .05). Substance use was low for both men and women (3.1% and 2.8%) and consisted of Tylenol 3 use. Approximately the same proportion of male and female GARs had PTSD as a clinical concern (21.8% and 22.2%). GARs that were Iraqi, Muslim, had attended university, or had children had higher IES-R scores compared to other GARs. Depression as a clinical concern was found in female and male GARs (16.7% and 21.9%). Total PHQ-9 scores were higher for GARs who were unmarried. Discussion It would be beneficial for mental health care providers who treat Middle-Eastern GARs to review screening methods for PTSD, depression, and substance use. This may also include additional training in the screening of GARs for appropriate mental health services. Mental health services must be linguistically and culturally matched to the recipient for optimal therapeutic benefit.

Overview of psychiatric scales used in Nepal: their reliability, validity and cultural appropriateness.

A review of the Western mental health scales that have been utilized in Nepal was conducted. Academic search engines (PubMed, MEDLINE, PsychLIT, Social Sciences Citation Index, and Anthropology Plus) were searched using relevant terms for the years 1990–2011. Search results indicated a limited number of mental health scales had been used and/or developed in Nepal with mixed emphasis on reliability and validity, as well as cultural considerations. These scales, methods and limitations are discussed within the cultural and social background of Nepal.

Risperidone long-acting injection in the treatment of schizophrenia spectrum illnesses: A retrospective chart review of 19 patients in the Vancouver Community Mental Health Organization (Vancouver, Canada)

BACKGROUND Schizophrenia is a chronic debilitating disease that affects ~110,000 Canadians (0.55% lifetime prevalence). Risperidone long-acting injection (RLAI) is the first injectable, long-acting, atypical antipsychotic drug marketed in Canada. OBJECTIVE The aim of this study was to assess the clinical effectiveness and hospitalization rates of patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder treated with RLAI in a community mental health care setting. METHODS Data were collected between August 1, 2006 and September 30, 2006 via a retrospective chart review of outpatients diagnosed with schizophrenia, schizoaffective disorder, or schizophreniform disorder who received treatment from 1 of the 8 mental health teams within the Vancouver Community Mental Health Organization (VCMHO) in Vancouver, British Columbia, Canada. Collected data included: frequency and duration of institutional care, discharge and relapse rates, demographic variables, diagnosis history, RLAI medication history, and history of other medications. The overall severity of symptoms before and after RLAI treatment and the improvement in symptoms during treatment were evaluated using the Clinical Global Impression Scales for severity (CGI-S)(1 = not ill to 7 = extremely ill) and improvement (CGI-I)(1 = very much improved to 7 = very much worse). RESULTS Forty-four patients were identified as having received RLAI. The charts of 19 patients (10 men, 9 women; mean [SD] age at time of chart audit, 36.7 [11.7] years; mean [SD] age at primary diagnosis, 23.6 [7.4] years; race: white, 10 [52.6%]; Asian, 6 [31.6%]; American Indian, 1 [5.3%]; black, 1 [5.3%]; other, 1 [5.3%]) were included in the analysis. The majority of patients (78%) had been treated with another antipsychotic drug prior to treatment with RLAI: risperidone (77%), quetiapine (47%), zuclopenthixol (43%), olanzapine (43%), and loxapine (17%). Mean (SD) CGI-S Scale score declined significantly from 5.29 (1.3) before treatment initiation to 3.05 (1.0) posttreatment (P < 0.001). Mean (SD) CGI-I Scale score was 2.58 (0.71) (P < 0.001); 94% of patients had a CGI-I score ≤3. Mean (SD) duration of hospitalization decreased significantly from 15.7 (19.7) days before treatment to 2.4 (6.0) days after treatment (P < 0.05). Mean (SD) number of hospializations also decreased significantly from 2.0 (1.8) before treatment to 0.5 (1.3) after treatment (P < 0.01). CONCLUSIONS The results of this pilot study suggest that use of the atypical-antipsychotic medication RLAI significantly decreased duration and rates of hospitalization, compared with baseline, in these VCMHO patients with schizophrenia spectrum illnesses.

A case–control study regarding relative factors for behavioural and psychological symptoms of dementia at a Canadian regional long-term extended care facility: a preliminary report

Behavioural and psychological symptoms of dementia (BPSD) are prevalent and have an impact on the care of persons with dementia. Previous studies regarding predisposing factors have included pharmacotherapy, but other factors may not have been sufficiently studied. We hypothesized that psychotropic medications, past history, comorbid psychiatric disorders and other factors may be relevant factors related to BPSD.

Administration of PRN medications: a descriptive study of concurrent disorder patients

Background: There is a paucity of research on the use of pro re nata (PRN) medications in psychiatry, and even more so, their use in patients diagnosed with concurrent disorder (CD). Aim: To provide an initial review and description of this population with respect to the administration of PRN medications. Method: A retrospective review of 135 charts was conducted on patients admitted to the University of British Columbia Concurrent Disorder Unit from 1 June 2008 to 31 December 2008. Results: A total of 133 (98.5%) of the 135 patients had at least one PRN order in their charts. The most frequently ordered medications for use as a PRN were Lorazepam (103 orders), Quetiapine (91 orders), and Loxapine (68 orders). The mean dosages delivered for all medications were in the low, sedative range. The most common reasons for prescribing across medications were for: sleep, agitation, anxiety, and withdrawal symptoms. With respect to the proportion of PRN orders to actual PRN medications administered, Quetiapine (83...