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Abstract Our laboratory previously developed a method for assessing experimentally induced pain perception through a 2-min constant heat pain stimulation. However, the traditional analysis relying on group means struggles to interpret the considerable inter-individual variability due to the dynamic nature of the response. Recently, trajectory analysis techniques based on extended mixed models have emerged, providing insights into distinct response profiles. Notably, these methods have never been applied to pain paradigms before. Furthermore, various socio-demographic and neurobiological factors, including endocannabinoids, may account for these inter-individual differences. This study aims to apply the novel analysis to dynamic pain responses and investigate variations in response profiles concerning socio-demographic, psychological, and blood endocannabinoid concentrations. 346 pain-free participants were enrolled in a psychophysical test involving a continuous painful heat stimulation lasting for 2 min at a moderate intensity. Pain perception was continuously recorded using a computerized visual scale. Dynamic pain response analyses were conducted using the innovative extended mixed model approach. In contrast to the traditional group-mean analysis, the extended mixed model revealed three pain response trajectories. Trajectory 1 is characterized by a delay peak pain. Trajectory 2 is equivalent to the classic approach (peak pain follow by a constant and moderate increase of pain perception). Trajectory 3 is characterized by extreme responses (steep peak pain, decrease, and increase of pain perception), Furthermore, age and blood anandamide levels exhibited significant variations among these three trajectories. Using an innovative statistical approach, we found that a large proportion of our sample had a response significantly different from the average expected response. Endocannabinoid system seems to play a role in pain response profile.

Abstract Background Our societies are facing mental health challenges, which have been compounded by the Covid-19. This event led people to isolate themselves and to stop seeking the help they needed. In response to this situation, the Health and Recovery Learning Center, applying the Recovery College (RC) model, modified its training program to a shorter online format. This study examines the effectiveness of a single RC training course delivered in a shortened online format to a diverse population at risk of mental health deterioration in the context of Covid-19. Methods This quasi-experimental study used a one-group pretest-posttest design with repeated measures. Three hundred and fifteen (n = 315) learners agreed to take part in the study and completed questionnaires on wellbeing, anxiety, resilience, self-management, empowerment and stigmatizing attitudes and behaviors. Results Analyses of variance using a linear mixed models revealed that attending a RC training course had, over time, a statistically significant effect on wellbeing (p = 0.004), anxiety (p

Background: Fibromyalgia (FM) and major depression disorder (MDD) frequently co-occur. Both disorders may share common serotonergic alterations, although there is less evidence of such alterations in FM. It is also unclear as to whether these alterations are persistent over time or transient. The objectives of this study were to (i) examine the changes in mRNA expression of serotonin transporter (SERT) on the surface of peripheral blood mononuclear cells (PBMCs) in FM, MDD, and the FM + MDD subjects compared to healthy controls, and to (ii) evaluate the effect of drug treatment on SERT expression. Methods: PBMCs were isolated from FM, MDD, FM + MDD, and control subjects. SERT expression was analyzed at the mRNA level via quantitative real-time polymerase chain reaction. Statistical analyses were performed using analyses of variance and linear mixed-effects models. Results: SERT mRNA expression was significantly reduced in MDD subjects compared to controls (p < 0.001), but not in FM nor in FM + MDD subjects. Although the drug treatments improved symptoms in FM, MDD, and FM + MDD subjects, they had no significant effect on SERT mRNA expression. Conclusions: These results corroborate the role of the SERT in the pathophysiology of MDD, but not in FM, and show that the decreased mRNA expression of SERT is a persistent, rather than transient, phenomenon.

BackgroundStudies report a growing tendency for students to experience state anxiety in schools. However, the combination of individual susceptibilities likely to trigger students’ anxious states remains unclear.AimsThis study examined whether distinct profiles of students emerge regarding their susceptibility to anxiety sensitivity and/or test anxiety and evaluated whether students’ profile predicted anxious states. We also verified whether susceptibility profiles varied across gender, school level, and school type.Sample and methodsIn total, 1,404 Canadian students in Grades 5 and 10 (589 boys; Mage = 15.2, SD = 2.1) from 13 public and private schools completed self-reported measures of state/trait anxiety, anxiety sensitivity, and test anxiety.ResultsLatent profile analyses identified four susceptibility profiles: (1) Double-susceptibility: highest anxiety sensitivity and test anxiety scores; (2) Unique-susceptibility to test anxiety: high test anxiety score and low anxiety sensitivity score; (3) Unique-susceptibility to anxiety sensitivity: high anxiety sensitivity score and low test anxiety score; and (4) No-susceptibility: lowest anxiety sensitivity and test anxiety scores. The profiles comprised 12, 9, 6, and 73% of the sample, respectively, and their membership varied across gender and school type, but not across school levels. A linear mixed-effect model showed that state anxiety varied significantly between profiles, where the Double-susceptibility profile predicted the highest state anxiety scores, followed by the two Unique-susceptibility profiles (indifferently), and the No-susceptibility profile.ConclusionBeyond their theoretical contribution to the state–trait anxiety literature, these findings suggest that selective interventions designed more specifically for students with the Double-susceptibility profile may be worthwhile. Results also highlight the high proportion of students with the No-susceptibility profile and shed light on the reassuring portrait regarding students’ anxiety.

BackgroundThe offset of a painful and unpleasant sensation can elicit pleasure. This phenomenon, namely pleasant pain relief (PPR), is attracting growing interest in research. While the cold pressor test (CPT) has been frequently used to study the inhibition of pain by the administration of another painful stimulation (inhibitory conditioned pain modulation; ICPM), a preliminary study from our research team has shown that CPT can also elicit a robust and long-lasting PPR. However, its effects on pain relief and inhibition vary greatly between subjects. Although substantial research has been carried out on inter-individual variability in the case of ICPM, the same cannot be said of PPR. Therefore, the current study sought to identify clusters of healthy volunteers with similar dynamic pain responses during the CPT, using a data-driven approach, and to investigate the inter-subject variability for PPR and ICPM.MethodsOne hundred and twenty-two healthy volunteers were recruited. A sequential ICPM paradigm was carried out with CPT (water at 10°C) and a Peltier Thermode to evaluate pain intensity and unpleasantness. Moreover, PPR was measured for four minutes at CPT offset. Statistical analyses were performed using group-based trajectory modelling.ResultsFour trajectories (groups) were identified for CPT pain intensity and unpleasantness ratings with varying levels of tonic pain and pain sensitization (e.g., temporal summation). PPR scores were correlated with both pain ratings trajectories (p

ObjectivesTo systematically review and meta-analyze the psychological effects and mortality rate in inmates having been exposed to solitary confinement in correctional settings.MethodsPubMed, PsycINFO, Web of Science, and Google Scholar were searched using keywords describing solitary confinement in combination with keywords for psychological or mortality outcomes. Eligible case-control studies for the systematic review met an operational definition for solitary confinement and evaluated outcomes after exposure to such confinement. Studies presenting statistical data which allowed to compute standardized mean differences for symptom scales or odds ratio for mortality were further meta-analyzed using random-effects models.ResultsSystematic review identified 13 studies for inclusion, with a total sample of 382,440 inmates (23% having been exposed to solitary confinement). Higher quality evidence showed solitary confinement was associated with an increase in adverse psychological effects, self-harm, and mortality, especially by suicide. Meta-analysis of five studies (n = 4,517) showed a standardized mean difference of 0.45 for general psychological symptomatology, which increased to 0.51 upon outlier exclusion. Small to moderate significant effects were observed for mood, psychotic, and hostility symptoms specifically. In addition, meta-analysis of two mortality studies (n = 243,050) showed a trend for a moderate effect for mortality by any or unnatural causes (i.e., suicide, homicide, overdose, and accidents).ConclusionsAnalyses showed that solitary confinement is associated with the psychological deterioration of inmates. This effect appears to be beyond that of general incarceration or presence of prior mental illness. Thus, solitary confinement may pose significant harm for inmates. Still, further studies are required to show that exposure to SC can increase risk of post-release death. Finally, add-on treatments and alternatives to solitary confinement that could alleviate the associated psychological harm are discussed.

BackgroundThe endogenous cannabinoid system mediates the psychoactive effects of cannabis in the brain. It has been argued that this system may play a key role in the pathophysiology of schizophrenia. While some studies have consistently shown that the levels of anandamide, an endogenous cannabinoid ligand, are increased in the cerebrospinal fluid of schizophrenia patients, inconsistent results have been observed in studies measuring anandamide levels in the periphery. Here, we sought to determine if the assessment of peripheral anandamide levels in patients evaluated in a psychiatric emergency setting would show robust increases.MethodsOne hundred seven patients with a schizophrenia-spectrum disorder from the psychiatric emergency settings of the Institut Universitaire en Santé Mentale de Montréal and 36 healthy volunteers were included in the study. A subsample of thirty patients were assessed at two time points: at the emergency and at their discharge from the hospital. Anxious and depressive symptoms, sleep and substance use were assessed using self-report questionnaires. In addition to anandamide, the levels of oleoylethanolamide (OEA), an anorexigenic fatty-acid ethanolamide, were also measured, since the prevalence of the metabolic syndrome is increased in schizophrenia. Plasma levels of anandamide and OEA were measured using liquid chromatography and mass spectrometry.ResultsPlasma anandamide and OEA levels were significantly increased in schizophrenia patients, relative to controls (Cohen’s d=1.0 and 0.5, respectively). Between-group differences remained significant after controlling for metabolic measures. No differences were observed between schizophrenia patients with and without a comorbid substance use disorder at baseline. Importantly, the levels of both endocannabinoids significantly decreased after discharge from the emergency setting.ConclusionThe current results add to the growing body of evidence of endocannabinoid alterations in schizophrenia. The strong elevation of plasma anandamide levels in schizophrenia patients assessed in the psychiatric emergency setting suggests that anandamide and OEA area potential biomarkers of the psychological turmoil associated with this context.

BackgroundViolence is a major concern and is prevalent across several mental disorders. The use of substances has been associated with an exacerbation of psychiatric symptoms as well as with violence. Compared to other substances such as alcohol and cocaine, existing literature on the cannabis–violence relationship has been more limited, with most studies being conducted in the general population, and has shown controversial results. Evidence has suggested a stronger relationship when examining the effects of the persistency of cannabis use on future violent behaviors. Though, while cannabis use is highly prevalent amid psychiatric patients, far less literature on the subject has been conducted in this population. Hence, the present prospective study aims to investigate the persistency of cannabis use in psychiatric patients.MethodThe sample comprised of 1,136 recently discharged psychiatric patients provided by the MacArthur Risk Assessment Study. A multi-wave (five-assessment) follow-up design was employed to allow temporal sequencing between substance use and violent behaviors. Generalized estimating equations (GEE) were used to examine the effect of persistency of cannabis use on violence, while controlling for potential confounding factors. Potential bidirectional association was also investigated using the same statistical approach.ResultsOur results suggest a unidirectional association between cannabis use and violence. GEE model revealed that the continuity of cannabis use across more than one time wave was associated with increased risks of future violent behavior. Patients who reported having used cannabis at each follow-up periods were 2.44 times more likely to display violent behaviors (OR = 2.44, 95% CI: 1.06–5.63, p

Background: Hair has become an increasingly valuable medium to investigate the association between chronic stress, stable differences in systemic cortisol secretion and later health. Assessing cortisol in hair has many advantages, notably its non-invasive and retrospective nature, the need for a single biospecimen and convenient storage until analysis. However, few studies offered empirical evidence documenting the long-term temporal stability of hair cortisol concentration (HCC) prior to analysis, especially in humans. Yet, knowing how long hair samples can be stored without compromising the accuracy of cortisol measurement is of crucial importance when planning data collection and analysis. This study examined the stability of HCC in hair samples assayed twice, five years apart. Methods: We randomly selected from a larger distribution of HCC measured in 17-year-old participants 39 hair samples to be reanalyzed five years later, under the same general conditions. Samples were assayed in duplicate using a luminescence immunoassay and compared with the original HCC using the Lin's concordance correlation coefficient (CCC), Bland-Altman plot analysis and Wilcoxon rank test. Results: Findings indicated a good concordance and temporal stability between the two samples assayed five years apart (CCC [95% confidence interval] = 0.84 [0.72–0.91]), although a small decrease in HCC was noted 5 years later (8.4% reduction, p = 0.001). Conclusion: Our study confirms that hair samples, when stored at room temperature and away from sunlight, can be assayed for at least five years without risking a loss of precision in HCC measurement.

Beyond sex as a binary or biological variable, within-sex variations related to sociocultural gender variables are of increasing interest in psychiatric research to better understand individual differences. Using a data-driven approach, we developed a composite gender score based on sociodemographic and psychosocial variables showing sex differences in a sample of psychiatric emergency patients upon admission (N = 1708; 39.4% birth-assigned females; mean age = 40 years; age standard deviation = 14). This gender score was extracted from a confirmatory factor analysis (CFI = 0.966; RMSEA = 0.044, SRMR = 0.030) and could predict a person's birth-assigned sex with 67% accuracy. This score allowed the further identification of differences on impulsivity measures that were absent when looking solely at birth-assigned sex. Female birth-assigned sex was also associated with higher rates of mood and personality disorder diagnoses, while higher feminine gender scores were related to higher proportions of anxiety and mood disorder diagnoses. By contrast, male birth-assigned sex and higher masculine gender scores were associated with higher proportions of psychotic and substance use disorder diagnoses. Patients with undifferentiated gender scores (i.e., scoring between masculine and feminine threshold defined by terciles) were more represented in the psychotic disorder group. Considering both sex and gender in psychiatric research is essential and can be achieved even when using secondary data to index gender comprised of demographic and psychosocial variables.

Abstract Background Cognitive biases are recognized as important treatment targets for reducing symptoms associated with severe mental disorders. Although cognitive biases have been linked to symptoms in most studies, few studies have looked at such biases transdiagnostically. The Cognitive Bias Questionnaire for psychosis (CBQp) is a self-reported questionnaire that assesses cognitive biases amongst individuals with a psychotic disorder, as well as individuals with other severe mental disorders. The current study aims to validate a French version of the CBQp and to explore transdiagnostic cognitive biases in individuals with psychotic disorders, individuals with depression, and in healthy controls. Methods The CBQp was translated into French following a protocol based on international standards. Discriminant validity and internal consistency were determined for total score and each subscale score. Confirmatory factor analyses were performed to test construct validity. Finally, cluster analyses were conducted to investigate cognitive biases across diagnostic groups. Results Our results were similar to those of the original authors, with the one-factor solution (assessment of a general thinking bias) being the strongest, but the two-factor solution (assessing biases within two themes relating to psychosis) and the five-factor solution (assessment of multiple distinct biases) being clinically more interesting. A six-cluster solution emerged, suggesting that individuals with similar diagnoses score differently on all cognitive biases, and that individuals with different diagnoses might have similar cognitive biases. Conclusions The current findings support the validity of the French translation of the CBQp. Our cluster analyses overall support the transdiagnostic presence of cognitive biases.

Abstract While research focus remains mainly on psychotic symptoms, it is questionable whether we are placing enough emphasis on improving the quality of life (QoL) of schizophrenia patients. To date, the predictive power of QoL remained limited. Therefore, this study aimed to accurately predict the QoL within schizophrenia using supervised learning methods. The authors report findings from participants of a large randomized, double-blind clinical trial for schizophrenia treatment. Potential predictors of QoL included all available and non-redundant variables from the dataset. By optimizing parameters, three linear LASSO regressions were calculated (N = 697, 692, and 786), including 44, 47, and 41 variables, with adjusted R-squares ranging from 0.31 to 0.36. Best predictors included social and emotion-related symptoms, neurocognition (processing speed), education, female gender, treatment attitudes, and mental, emotional, and physical health. These results demonstrate that machine learning is an excellent predictive tool to process clinical data. It appears that the patient’s perception of their treatment has an important impact on patients’ QoL and that interventions should consider this aspect. Trial registration: ClinicalTrials.gov Identifier: NCT00014001.

ObjectiveAcross the globe more than 35,000 children a year are adopted by non-relatives, and some studies suggest that adopted individuals may be more vulnerable to developing mental disorders. To map the differences in suicide risk factors in adopted and non-adopted individuals, this study will compare the development of mental disorders as well as life events occurring before the age of 18 for both adopted and non-adopted individuals deceased by suicide.MethodsThis study included 13 adopted and 26 non-adopted individuals deceased by suicide as well as 26 non-adopted living control individuals. Cases were taken from a data bank created over the last decade by researchers of [our institution] comprising a mixture of 700 suicide cases and living control individuals aged from 14 to 84. Adopted and non-adopted individuals deceased by suicide; adopted individuals deceased by suicide and non-adopted living control individuals were each compared on Axis I and II disorders, early life events, and burdens of adversity.ResultsResults show significant differences, with a higher rate of Attention Deficit Hyperactivity Disorder, mental health comorbidity and Cluster C personality disorders among adopted individuals. Furthermore, adopted individuals have higher adversity scores prior to the age of 15.ConclusionThis study underlines the fact that adoptive families need to be supported throughout adoption. Health care professionals need specialized training on this matter, and the psychological challenges adopted individuals face need to be treated at the earliest juncture.

Surveys report that about three-quarters of visits to general practitioners in America are for stress-related complaints. Animal and human studies have consistently demonstrated that exposure to acute and/or chronic stress leads to the activation of the autonomic nervous system (ANS) and/or hypothalamic-pituitary-adrenal (HPA) axis, and to the production of catecholamines and glucocorticoids. Yet, many studies performed in humans do not report significant associations between subjective feelings of stress and increases in these stress biomarkers. Consequently, it is not clear whether the stress-related complaints of individuals are associated with significant increases in these stress biomarkers. In the present study, we measured whether individuals who self-identify as being ‘very stressed out’ or ‘zen’ present differences in psychological (depression and anxiety symptoms), biological (basal and reactive levels of glucocorticoids and alpha-amylase) and socioemotional (emotion regulation, mind wandering, personality, resilience and positive mental health) factors associated with stress. Salivary levels of cortisol and alpha-amylase were obtained in the home environment and in reaction to the Trier Social Stress Test in 123 adults aged between 19 and 55 years. All participants completed questionnaires assessing the psychological and socioemotional factors described above. The results showed that groups significantly differed on almost all psychological and socioemotional factors, although we found no significant group differences on biological markers of stress (cortisol or alpha-amylase). These results suggest that when people complain of being ‘very stressed out’, what they may really be alluding to is an experience of psychological distress that is related to poor emotion regulation capacities. It is thus possible that the construct of stress used by people to discuss their internal state of 'stress' is quite different than the construct of stress measured in animal and human laboratories using biomarkers of 'stress'.

Abstract Background Suicide is the third leading cause of death worldwide among youth aged 10- to 19, and mental disorders are often associated in the etiology of suicidal behavior. Mental disorders are often under-diagnosed and under-treated in young people, a situation likely to increase the severity of the disorder and suicide risk. Presence of school difficulties may, in some cases, be a consequence of mental disorder, and theses difficulties are observable. Therefore, early detection and early intervention of school difficulties may alleviate the development of mental disorders and suicide vulnerability. The aim of this study is to understand the link between school difficulties and suicide risk. Methods We used the data bank gathered by the McGill Group on Suicide Studies over the past two decades through interviews with the relatives of individuals who died by suicide and with individuals from the community as a control group. We included data on common sociodemographic characteristics, life events and mental health characteristics identified before age 18, among individuals who died before the age of 35 or were interviewed before the age of 35. We identified 200 individuals who died by suicide and 97 living controls. We compared groups according to gender and characteristics. Results Within the total sample, 74% were male, 13% had met with academic failure, 18% had engaged in inappropriate behavior at school, and 18% presented combined school difficulties. Combined school difficulties (academic failure and inappropriate behavior) for both sexes and academic failure alone for males were associated with higher suicide risk before the age of 35. School difficulties generally began in early childhood and were linked to mental disorders/difficulties and substance abuse before age 18. Conclusions This study underlines the importance for parents, teachers, and educators to identify children with school difficulties—academic failure and behavioral difficulties at school—as early as possible in order to be able to propose adapted interventions. Early identification and proper diagnosis may prevent chronicity of some disorders, accumulation of adverse events, and even suicide.

Objectives To determine whether studying aetiological pathways of depression, in particular the well-established determinant of childhood trauma, only in a specialised mental healthcare setting can yield biased estimates of the aetiological association, given that the majority of individuals are treated in primary care settings.Design and setting Two databanks were used in this study. The Canadian Community Health Survey (CCHS) on Mental Health and Well-Being 2012 is a national survey about mental health of adult Canadians. It measured common mental disorders and utilisation of services. The Signature mental health biobank includes adults from the Island of Montreal recruited at the emergency department of a major university mental health centre. After consent, participants filled standardised psychosocial questionnaires, gave blood samples, and their clinical diagnosis was recorded. We compared the cohort of depressed individuals from CCHS and Signature in contact with specialised services with those in contact with primary care or not in treatment.Participants There were 860 participants with depression in the CCHS and 207 participants with depression in the Signature Bank.Primary and secondary outcomes The Childhood Experiences of Violence Questionnaire was used to measure childhood trauma in both settings. Childhood trauma is associated with depression as with other common mental and physical disorders.Results Individuals with depression in the CCHS who reported having been hospitalised for psychiatric treatment or having seen a psychiatrist or those from Signature were found to be more strongly associated with childhood abuse than individuals with depression who were treated in primary care settings or did not seek mental healthcare in the preceding year.Conclusions Berkson’s bias limits the generalisability of aetiological associations observed in such university-hospital-based biobanks, but the problem can be remedied by broadening recruitment to primary care settings and the general population.

Background: Individuals with severe mental illnesses are at greater risk of offenses and violence, though the relationship remains unclear due to the interplay of static and dynamic risk factors. Static factors have generally been emphasized, leaving little room for temporal changes in risk. Hence, this longitudinal study aims to identify subgroups of psychiatric populations at risk of violence and criminality by taking into account the dynamic changes of symptomatology and substance use.Method: A total of 825 patients from the MacArthur Violence Risk Assessment Study having completed five postdischarge follow-ups were analyzed. Individuals were classified into outcome trajectories (violence and criminality). Trajectories were computed for each substance (cannabis, alcohol, and cocaine, alone or combined) and for symptomatology and inputted as dynamic factors, along with other demographic and psychiatric static factors, into binary logistic regressions for predicting violence and criminality. Best predictors were then identified using backward elimination, and receiver operator characteristic (ROC) curves were calculated for both models.Results: Two trajectories were found for violence (low versus high violence). Best predictors for belonging in the high-violence group were low verbal intelligence (baseline), higher psychopathy (baseline) and anger (mean) scores, persistent cannabis use (alone), and persistent moderate affective symptoms. The model’s area under the curve (AUC) was 0.773. Two trajectories were also chosen as being optimal for criminality. The final model to predict high criminality yielded an AUC of 0.788, retaining as predictors male sex, lower educational level, higher score of psychopathy (baseline), persistent polysubstance use (cannabis, cocaine, and alcohol), and persistent cannabis use (alone). Both models were moderately predictive of outcomes.Conclusion: Static factors identified as predictors are consistent with previously published literature. Concerning dynamic factors, unexpectedly, cannabis alone was an independent co-occurring variable, as well as affective symptoms, in the violence model. For criminality, our results are novel, as there are very few studies on criminal behaviors in nonforensic psychiatric populations. In conclusion, these results emphasize the need to further study the predictors of crime, separately from violence and the impact of longitudinal patterns of specific substance use and high affective symptoms.

Objective: Impulsivity is a multidimensional construct that has an important role for the understanding of diverse psychopathologies and problematic behaviors. The UPPS-P impulsive behavior scale, measuring five distinct facets of impulsivity, has been subject to several studies. No study has investigated the clinical utility of this questionnaire amongst an unstable psychiatric population. The aim of the current study is to examine the psychometric properties of the short version of this scale in a psychiatric emergency unit.Method: The S-UPPS-P was administered to 1,097 psychiatric patients in an emergency setting, where a subgroup of 148 participants completed a follow-up. The internal consistency, the construct validity, the test-retest reliability, and correlations with a substance misuse measure were examined.Results: Confirmatory factor analyses supported a five-factor solution. Results indicated good psychometric properties across psychiatric diagnoses and gender. The S-UPPS-P was partially invariant across sexes. The authors have found differences on the loading of one item and on the thresholds of two items from lack of premeditation and positive urgency subscales.Conclusion: This validation study showed that the UPPS-P conserved good psychometric properties in an unstable psychiatric sample, indicating that the instrument can be utilized in such settings.