Robbie Campbell

The Role of Nutrient-Based Epigenetic Changes in Buffering Against Stress, Aging, and Alzheimer’s Disease

Converging evidence identifies stress-related disorders as putative risk factors for Alzheimer Disease (AD). This article reviews evidence on the complex interplay of stress, aging, and genes-epigenetics interactions. The recent classification of AD into preclinical, mild cognitive impairment, and AD offers a window for intervention to prevent, delay, or modify the course of AD. Evidence in support of the cognitive effects of epigenetics-diet, and nutraceuticals is reviewed. A proactive epigenetics diet and nutraceuticals program holds promise as potential buffer against the negative impact of aging and stress responses on cognition, and can optimize vascular, metabolic, and brain health in the community.

Mental Health Engagement Network: Innovating Community-Based Mental Healthcare

Background: Canadian mental health care reform calls for new service delivery models that capitalize on health promotion, support and early intervention as patients and services are transitioning from institutions to communities. The Mental Health Engagement Network (MHEN) intervention is a smart technology enabled service delivery model that electronically links individuals to their health care professionals, promoting information sharing between individuals and their health care professionals, and promoting access to mental health care services. This project, funded by Canada Health Infoway, began in September 2011 and will complete in March 2013. Methods: The MHEN project is a longitudinal, mixed qualitative and quantitative research study which has recruited 400 (245 men and 155 women) research participants diagnosed with a mood or a psychotic disorder who are currently working with community based mental health care professionals (54 mental health care professionals across 4 agencies in the London and surrounding area). Each participant has been randomly assigned into Group 1 (early intervention) or Group 2 (later intervention). Group 1 participants received an iPhone 4S, a TELUS health space™ account, and version 1.0 of the Lawson SMART record (a web-based application that provides individuals with a personal health record and tools to help them manage their health) in July, 2012. Participants in Group 2 initially acted as a control group, and received the version 2 intervention in March, 2013. Results: Participants felt the Lawson SMART record was quite (33.1%) or extremely (29.2%) helpful, and gave participants quite a bit more (26.8%) and an extreme amount more (21%) independence. Web analytics demonstrated that participants visited the Lawson SMART record mobile and desktop home page a total of 16, 928 times. Conclusion: This new service delivery model has the potential to provide quality care to those living in the community with mental illness, enhance health status and quality of life, and reduce the burden of mental illness on the healthcare system by decreasing more costly service uses.

Suicide in hospitalized early psychosis patients at the time of discharge from hospital: An exploratory study of attempters and nonattempters

Background: Early intervention programs for psychosis are gateways for suicide prevention. These programs offer an excellent opportunity for prevention due to easy access, early identification, and provisions for continuity of care. These programs have been found effective in reducing rates of suicide after discharge to communities. The objective of this study was to examine suicide risk level among early psychosis patients admitted with and without previous suicide attempts. We hypothesized that all patients admitted with early psychosis would be at high risk of suicide, regardless of a previous suicide attempt. Methodology: Suicide risk was compared between patients admitted with a suicide attempt (n = 30) and patients admitted without a suicide attempt (n = 30). The primary outcome measure of interest was suicide risk which was measured with the Scale for Impact of Suicidality–Management, Assessment and Planning of Care clinical interview. All patients met DSM-IV TR criteria for schizophrenia. Psychopathology was assessed using the Brief Psychiatric Rating Scale and level of depression was assessed using the Hamilton Depression Rating Scale. The data were statistically analyzed. Results: Patients admitted with a previous attempt (mean = 29.5, standard deviation [SD] =12.0) did not differ significantly in suicide risk from those admitted without a previous attempt (mean = 27.5, SD = 12.5), (t[58] =0.63, P = 0.53). Patients admitted without a suicide attempt scored higher in depressive symptoms (t[58] =10.62, P < 0.001) than that of admitted with a suicide attempt. There were no significant differences between patients admitted with and without suicide attempts on any comorbidity, other than a trend toward a higher prevalence of personality disorder in patients with no suicide attempt. Attempters and nonattempters did not differ on any demographic variables either. Conclusions: Of those admitted without a previous suicide attempt, our findings suggest that it is critical that all patients discharged from an acute psychiatric unit must receive comprehensive community care. The identification of risk, and subsequent intervention for suicidal and self-harm behaviors, should be a central part of treatment for all mental disorders.

Cognitive remediation for inpatients with schizophrenia or schizoaffective disorder using smart technology in a simulated apartment: a feasibility and exploratory study

This study aimed to examine the feasibility of using and evaluating SMART (Supported Mental Assessment, Rehabilitation and Treatment) electronic technology as part of providing cognitive remediation for tertiary mental health care in-patients diagnosed with schizophrenia-related cognitive impairments that are considered a barrier to their independent living. This was an uncontrolled intervention feasibility and exploratory study. The study involved eight participants in total. Both qualitative and quantitative research strategies were used. Results to date are promising. Participating patients expressed satisfaction with the simulated apartment and the smart technology and patients were able to learn and use skills relevant to independent living.

Serum cholesterol and Suicide in first episode psychosis: A preliminary study

Background: Low levels of cholesterol have been described in suicide behavior including among those individuals who have an increased tendency for impulsivity. Violent suicide attempters show significantly lower cholesterol levels than nonviolent suicide attempters. The suicide rate is particularly high in the prodromal and early phase of schizophrenia. It is unclear if there is a psychopathological relationship between early psychosis, suicide, and cholesterol levels. The present study examines levels of cholesterol and suicide behavior in a cohort of early psychosis. Methodology: Sixty admitted patients with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of nonaffective schizophrenia spectrum disorder (early psychosis) were assessed in a naturalistic cross-sectional, cohort study. Psychopathology was assessed with the Positive and Negative Symptom Scale for Schizophrenia (PANSS), Hamilton Depression Rating Scale, and Scale for Impact of Suicidality–Management, Assessment and Planning of Care (SIS-MAP). Serum levels of cholesterol were estimated in the cohort as well. The findings were analyzed for a clinical correlation of cholesterol levels, suicidal attempters, and psychopathology. Results: Out of 60 patients, 13 patients had a suicide attempt in the recent past. No serum cholesterol abnormality (3.7 ± 1.2 mmol/L) was observed in patients as a group and those with low suicidality (SIS-MAP <17, serum cholesterol: 4.1 ± 1.3 mmol/L). However, low levels of cholesterol were observed in a subgroup with severe suicidality (SIS-MAP >33; serum cholesterol: 3.5 ± 1.4 mmol/L). Females with moderate suicidality showed statistically significant lower cholesterol levels than males (P = 0.047). Conclusions: The study suggests lower levels of cholesterol in patients of psychosis with severe suicidal thoughts and depression in early psychosis. More research is required in this field to determine the neurochemistry of suicide behavior in psychosis and its significance in the prediction of suicidal behavior.

RISK ASSESSMENT OF SUICIDE IN CLINICAL PRACTICE

Suicide is a global public health problem. Its management in clinical practice is complex and challenging .Studies show about 26% suicide in mental health system. Out of these, 14% commit suicide during hospital stay; about 50 90% have at least one psychiatric diagnosis. 60 70% of patients are hospitalized due to an attempt or potential crisis, about 15 20% attempt suicide prior to admission. Suicide is also common in post-discharge period. Every psychiatrist on an average loses atleast on client due to suicide in an average span of 20 years of practice. In about 70% of cases, suicide behavior is there as on for hospitalization in acute settings. Continuous training and skill development are two of the most important measures in clinical practice for dealing with suicide behavior. High suicide rates are reported in prodromal stage, acute illness, post-hospitalization and soon after discharge in the community. A clinician faces challenging situations while determining the level of care and referral for a patient with a high suicide potential. There is continued struggle amongst clinicians for decision-making in regards to the need for hospitalization, level of monitoring, voluntary status, and time of discharge. It is generally agreed that suicide is difficult to predict and prevent; however, in order to develop clinical excellence and offer a standard of care, continued education and knowledge translation for bringing research into practice is the least that can be done. Inspite of this need, continued education for mental health professionals and psychiatrists in-training remains limited. *Corresponding author: Amresh Shrivastava, Parkwood Institute, Mental health, 550 Wellington Road, London, ON N6C 0A7, Tel: (519) 646-6100; E-mail: dr.amresh@gmail.com Received Date: October 30, 2015 Accepted Date: November 29, 2016 Published Date: December 03, 2016