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Background: The dual diagnosis of cannabis use disorder (CUD) and severe mental disorder (SMD) results in clinically complex individuals. Cannabis use is known to have negative consequences on psychiatric symptoms, medication compliance, and disease prognosis. Moreover, the effectiveness of currently available psychotherapeutic treatments is limited in this population. In this context, our research team developed avatar intervention, an approach using virtual reality as a therapeutic tool to treat CUD in individuals with SMD., Objective: This pilot clinical trial aimed to evaluate, until the 1-year follow-up, the efficacy of avatar intervention for CUD among 32 participants with a dual diagnosis of SMD and CUD., Methods: Over the course of the 8 intervention sessions, participants were given the opportunity to enter a dialogue in virtual reality with an avatar representing a person with a significant role in their consumption, who was animated in real time by a therapist. The primary outcomes were the quantity of cannabis consumed and the frequency of use. Secondary outcomes included severity of problematic cannabis use, motivation for change, protective strategies for cannabis use, consequences of cannabis use, psychiatric symptoms, and quality of life. Changes in reported outcomes during the assessment periods before the intervention; postintervention; and 3, 6, and 12 months after the end of the intervention were assessed using a linear mixed-effects model., Results: Significant reductions were observed in the quantity of cannabis consumed, and these were maintained until the 12-month follow-up visit (d=0.804; P<.001; confirmed by urine quantification). Frequency of cannabis use showed a small significant reduction at the 3-month follow-up (d=0.384; P=.03). Moreover, improvements were observed in the severity of CUD, cannabis-related negative consequences, the motivation to change cannabis use, and the strategies used to mitigate harms related to cannabis use. Finally, moderate benefits were observed for quality of life and psychiatric symptoms., Conclusions: Overall, this unique intervention shows promising results that seem to be maintained up to 12 months after the end of the intervention. With the aim of overcoming the methodological limitations of a pilot study, a single-blind randomized controlled trial is currently underway to compare the avatar intervention for CUD with a conventional addiction intervention., (© Sabrina Giguere, Mélissa Beaudoin, Laura Dellazizzo, Kingsada Phraxayavong, Stéphane Potvin, Alexandre Dumais. Originally published in JMIR Mental Health (https://mental.jmir.org).)

Background: An increasing body of literature highlights the integration of machine learning with genomic data in psychiatry, particularly for complex mental health disorders such as schizophrenia. These advanced techniques offer promising potential for uncovering various facets of these disorders. A comprehensive review of the current applications of machine learning in conjunction with genomic data within this context can significantly enhance our understanding of the current state of research and its future directions., Objective: This study aims to conduct a systematic scoping review of the use of machine learning algorithms with genomic data in the field of schizophrenia., Methods: To conduct a systematic scoping review, a search was performed in the electronic databases MEDLINE, Web of Science, PsycNet (PsycINFO), and Google Scholar from 2013 to 2024. Studies at the intersection of schizophrenia, genomic data, and machine learning were evaluated., Results: The literature search identified 2437 eligible articles after removing duplicates. Following abstract screening, 143 full-text articles were assessed, and 121 were subsequently excluded. Therefore, 21 studies were thoroughly assessed. Various machine learning algorithms were used in the identified studies, with support vector machines being the most common. The studies notably used genomic data to predict schizophrenia, identify schizophrenia features, discover drugs, classify schizophrenia amongst other mental health disorders, and predict the quality of life of patients., Conclusions: Several high-quality studies were identified. Yet, the application of machine learning with genomic data in the context of schizophrenia remains limited. Future research is essential to further evaluate the portability of these models and to explore their potential clinical applications., (©Alexandre Hudon, Mélissa Beaudoin, Kingsada Phraxayavong, Stéphane Potvin, Alexandre Dumais. Originally published in JMIR Bioinformatics and Biotechnology (https://bioinform.jmir.org), 15.11.2024.)

Immunoglobuin E (IgE)-mediated food allergies greatly impact patients and their families, causing financial and emotional stress, and placing them at risk for lifethreatening reactions. Until recently, food allergies have been treated with allergen avoidance and emergency treatment of allergic reactions. Omalizumab was recently approved in adults and children greater than one year who are allergic to one or more foods for the prevention of serious allergic reactions in the setting of accidental exposure. Omalizumab also shows promise when combined with oral immunotherapy for possible allergen ingestion. Other classes of biologics and small molecule inhibitors have also demonstrated potential for use in preventing and treating food allergy., Competing Interests: Disclosure K.K. Brar has served as an advisor and received research support from Incyte Pharmaceuticals. She is an investigator for Sanofi, and Siolta Therapeutics., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Coronary artery disease (CAD) is more prevalent in men than in women, with endothelial dysfunction, prodromal to CAD, developing a decade earlier in middle-aged men. We investigated the molecular basis of this dimorphism ex vivo in arterial segments discarded during surgery of CAD patients. The results reveal a lower endothelial relaxant sensitivity in men, and a senescence-associated inflammaging transcriptomic signature in endothelial cells. In women, cellular metabolism and endothelial maintenance pathways are conserved. This suggests that senolytic therapies to reduce risk of cardiovascular events in women with CAD may not be as effective as in men., Competing Interests: This work was supported by the Canadian Institutes of Health Research grant (PJT-162446 to Dr Thorin), and the Foundation of the Montreal Heart Institute (Dr Thorin). Drs Mury and Lambert have been supported by the postdoctoral program of the Fonds de la recherche du Québec. Dr Cagnone has received support from the Vision Health Research Network. Dr Dagher has received support from the Canadian Institutes of Health Research (grant FBD-183276). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Context: To tackle the systemic injustices experienced by people in vulnerable situations, occupational therapists' agency, i.e. their power to act, is necessary. However, occupational therapists feel ill-equipped to exercise this power, and would like to develop their skills. The general aim of this research was therefore to document occupational therapists' perception of their skills before and after agency training., Methods: We used a mixed sequential explanatory design, comprising a quantitative component consisting of a pre- and post-training self-administered questionnaire and a descriptive qualitative component with group interviews., Results: A total of 103 occupational therapists completed the training between January 19 and October 19, 2019. Their sense of competence improved, especially for those with no prior training in agency. The skills perceived as having developed the most corresponded to the skills deemed a priority for development, namely effective communication, intentional collaboration, and observation and analysis. On the other hand, occupational therapists emphasized that they had not mastered the exercise of these skills in a real-life context., Conclusion: Although continuing education is one way of improving the skills needed to exercise agency, questions remain as to the optimal modalities for ensuring their full and lasting development., Competing Interests: Aucun conflit à rapporter., (© 2024 Carrier, Éthier, Beaudoin, Hudon, Bédard, Jasmin, Lavoie-Trudeau, Verville; licence Synergies Partners.)

Avatar therapy (AT) is a novel virtual reality-based psychotherapy that has been developed to treat auditory verbal hallucinations (AVH) in treatment-resistant schizophrenia. Various psychotherapeutic components, such as emotions and sense of presence, could contribute to clinical outcomes. However, the interplay between sense of presence, emotions, and clinical response has seldom been investigated. This study aimed to explore the relations between sense of presence, emotions, and clinical outcomes in AT. To conduct this investigation, data from previous and ongoing AT trials were used. Sense of presence and emotions were assessed using standardized questionnaires. AVH were evaluated using the Psychotic Symptom Rating Scales. While sense of presence was positively associated with positive emotions such as control and serenity, no significant associations were found for negative emotions. Moreover, a higher level of sense of presence was associated with a bigger decrease in AVH. Overall, positive emotions seem to be associated with sense of presence in AT. Sense of presence also seems to be involved in the therapeutic outcome, thereby suggesting that this could be an important component related to clinical response. More studies are needed to confirm these trends, which could be generalized to other virtual reality-based psychotherapies.

The interest in new 5-HT₆ agents stems from their ability to modulate cognition processing, food motivation and anxiety-like behaviors. While these findings come primarily from rodent studies, no studies on primates have been published. Furthermore, our understanding of where and how they act in the brain remains limited. Although the striatum is involved in all of these processes and expresses the highest levels of 5-HT₆ receptors, few studies have focused on it. We thus hypothesized that 5-HT 6 receptor blockade would influence food motivation and modulate behavioral expression in non-human primates through striatal 5-HT 6 receptors. This study thus aimed to determine the effects of acute administration of the SB-258585 selective 5-HT 6 receptor antagonist on the feeding motivation and behaviors of six male macaques. Additionally, we investigated potential 5-HT 6 targets using PET imaging to measure 5-HT 6 receptor occupancy throughout the brain and striatal subregions. We used a food-choice task paired with spontaneous behavioral observations, checking 5-HT 6 receptor occupancy with the specific PET imaging [ 18 F]2FNQ1P radioligand. We demonstrated, for the first time in non-human primates, that modulation of 5-HT 6 transmission, most likely through the striatum (the putamen and caudate nucleus), significantly reduces food motivation while exhibiting variable, weaker effects on behavior. While these results are consistent with the literature showing a decrease in food intake in rodents and proposing that 5-HT 6 receptor antagonists can be used in obesity treatment, they question the antagonists' anxiolytic potential., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: To review current and future treatment options for IgE-mediated food allergy., Recent Findings: Recent years have seen major developments in both allergen-specific and allergen-non-specific treatment options, with the first FDA-approved peanut oral immunotherapy (OIT) product becoming available in 2020. In addition to OIT, other immunotherapy modalities, biologics, adjunct therapies, and novel therapeutics are under investigation. Food allergy is a potentially life-threatening condition associated with a significant psychosocial impact. Numerous products and protocols are under investigation, with most studies focusing on OIT. A high rate of adverse events, need for frequent office visits, and cost remain challenges with OIT. Further work is needed to unify outcome measures, develop treatment protocols that minimize adverse events, establish demographic and clinical factors that influence candidate selection, and identify patient priorities., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Among older adults with disabilities, maintaining active aging can often be compromised. However, the literature highlights a positive link between mental health and autonomy on one hand, and self-determined motivation on the other. Therefore, self-determined motivation may be improved by promoting mental health and, in the end, older adults autonomy. In this context, the « pôle bien-être autonomie », a mental health promotion program, has been set up to offer activities adapted to the disabilities and needs of the elderly, hence fostering active aging. The purpose of this longitudinal study is to test the hypothesis that promoting the mental health of disabled older adults would preserve their autonomy through the development of self-determined motivation. The theoretical model was tested using structural equation modelling on data of 170 participants. A RCT was conducted between 2019 and 2021 with the same cohort. Results of the structural equation modelling support the importance of promoting mental health in maintaining active aging. Evaluation of the promotion program indicates a decrease in levels of depression, an increase in the frequency of self-determined activities and in the autonomy of beneficiaries after three months of operation. The discussion focuses on the relevance of a processual analysis of the promotion program and on new directions to maintain autonomy for seniors with disabilities.

Background: Pain management and early mobilization strategies are recommended in clinical practice guidelines for the prevention of delirium in older adults. However, available data on the implementation of these strategies in trauma are limited., Aims: To describe the use of pain management and early mobilization strategies in older adults at a level I trauma center, as well as the facilitators and barriers to their implementation., Methods: A convergent mixed methods study was used. Quantitative data were collected from sixty medical records. Qualitative data was collected through a focus group with healthcare providers to explore their perspectives regarding the use of the target practices and on barriers and facilitators to their implementation. Descriptive statistics were calculated, and a thematic analysis using an inductive and deductive interpretative descriptive approach was undertaken., Results: A question on the presence/absence of pain was the most frequently documented pain assessment method. Pain assessment was poorly documented. Frequencies of non-opioid and opioid administrations were similar, but non-pharmacological strategies were not widely used. The first mobilization was performed quickly and was most commonly to a chair. The focus group discussion confirmed many of the data collected in the medical records. Barriers to implementing the targeted strategies were primarily related to organizational context and facilitation processes., Conclusions: Areas for improvement were identified including pain assessment, the use of non-pharmacological pain management strategies and ambulation as a mobilization strategy. Our findings will serve as a starting point for optimizing and adapting practices for geriatric trauma patients and evaluating their impact., Competing Interests: Declaration of competing interest The authors declare that they have no known competing personal relationships that could have appeared to influence the work reported in this paper. The authors declare that they have no known competing financial interests that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Recent longitudinal studies point toward the existence of a positive relationship between cannabis use and violence in people with severe mental disorders (SMD). However, the existence of a dose-response relationship between the frequency/severity of cannabis use and violence has seldom been investigated. Therefore, this study aims to determine if such a relationship exists in a psychiatric population. Methods: To do so, a total of 98 outpatients (81 males and 17 females, all over 18 years of age) with SMD were recruited at the Institut universitaire de santé mentale de Montréal (Montréal, Canada) and included in the analyses. Clinical evaluations were conducted every 3 months for a year. Substance use, violent behaviors, and potential covariables were assessed through self-reported assessments, urinary testing, as well as clinical, criminal, and police records. Using generalized estimating equations, the association between cannabis use frequency (nonusers, occasional, regular, and frequent users) and violence was investigated, as well as the association between the severity of cannabis use and violent behaviors. Results: It was found that cannabis use frequency and severity were significant predictors of violent behaviors. After adjustment for time, age, sex, ethnicity, diagnoses, impulsivity, and use of alcohol and stimulants, odds ratios were of 1.91 ( p <0.001) between each frequency profile and 1.040 ( p <0.001) for each increase of one point of the severity of cannabis use score (ranging from 0 to 79). Conclusions: Despite the high attrition rate, these findings may have important implications for clinicians as cannabis use may have serious consequences in psychiatric populations. Nevertheless, the mechanisms underlying this association remain unclear.

Background: In many neurological disorders, including Alzheimer disease, early olfactory dysfunction is observed., Objective: In order to determine if deficits in olfactory memory are present in the elderly and if olfactory dysfunction correlates with cognitive impairment in the aging population, olfactory testing has been done on seniors from the NuAge cohort accepting to participate in the Olfactory Response Cognition and Aging (ORCA) secondary sub-study. The t-Mini Mental Statement Examination and the Telephone Interview for Cognitive Status tests were done to assess cognition levels., Results: Overall, 94% of the ORCA cohort displayed olfactory dysfunction. Deficits in olfactory memory were also present. A correlation was observed between olfactory function and cognitive test scores. Moreover, in women who smoked, there was an association between olfactory memory and cognitive scores., Conclusion: Our results suggest that olfactory dysfunction may predict impending cognitive decline and highlights the need for olfactory training in seniors to improve olfaction and overall well-being.