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Borderline personality disorder (BPD) has high rates of comorbidity with mood disorders, including treatment-resistant depression (TRD). Comorbidity of BPD with depression is associated with poorer response to antidepressants. Intravenous ketamine is a novel treatment for TRD that has not been specifically evaluated in patients with comorbid BPD. In this retrospective analysis of data collected from participants who received care at the Canadian Rapid Treatment Centre of Excellence (CRTCE; Braxia Health; ClinicalTrials.gov: NCT04209296), we evaluated the effectiveness of intravenous ketamine in a TRD population with comorbid BPD (N=100; n=50 BPD-positive compared with n=50 BPD-negative). Participants were administered four doses of intravenous ketamine (0.5-0.75mg/kg over 40 minutes) over two weeks. The primary outcome measures were changes in depressive symptom severity (as measured by Quick Inventory of Depressive Symptomatology-Self Report 16-item (QIDS-SR 16 )) and borderline symptom severity (as measured by Borderline Symptom List 23-item (BSL-23)). Both BPD-positive and BPD-negative groups improved significantly on the QIDS-SR 16 , QIDS-SR 16 suicide ideation item, anxiety, and functionality scales with large effect sizes. There was no significant difference between groups. The BPD-positive group exhibited significant reduction of 0.64 on BSL-23 scores and a significant reduction of 5.95 on QIDS-SR 16 scores. Patients with TRD and comorbid BPD receiving ketamine exhibited a significant reduction in symptoms of depression, borderline personality, suicidality, and anxiety., Competing Interests: Declaration of Competing Interest Dr. Joshua D Rosenblat has received research grant support from the Canadian Institute of Health Research (CIHR), Physician Services Inc (PSI) Foundation, Labatt Brain Health Network, Brain and Cognition Discovery Foundation (BCDF), Canadian Cancer Society, Canadian Psychiatric Association, Academic Scholars Award, American Psychiatric Association, American Society of Psychopharmacology, University of Toronto, University Health Network Centre for Mental Health, Joseph M. West Family Memorial Fund and Timeposters Fellowship and industry funding for speaker/consultation/research fees from iGan, Boehringer Ingelheim, Janssen, Allergan, Lundbeck, Sunovion and COMPASS. He is the Chief Medical and Scientific Officer of Braxia Scientific and the medical director of the Canadian Rapid Treatment Centre of Excellence (Braxia Health). Kevin Kratiuk is the Vice President of Operations at Braxia Health and is a shareholder of Braxia Scientific Corp. Dr. Roger McIntyre has received research grant support from Global Alliance for Chronic Diseases/Canadian Institutes of Health Research (CIHR)/National Natural Science Foundation of China's Mental Health Team Grant; speaker/consultation fees from Lundbeck, Janssen, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Sunovion, Bausch Health, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge Pharmaceuticals, Abbvie. Dr. Roger McIntyre is a CEO of Braxia Scientific Corp. Kayla M. Teopiz has received personal fees from Braxia Scientific Corp. All other authors have no conflicts of interest to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction Borderline personality disorder (BPD) is associated with many unhealthy behaviors. Psychoactive substance (alcohol and drugs) use is present in 78% of adults with BPD. Moreover, a poor sleep seems linked to the clinical profile of adults with BPD. Finally, some physical comorbid disorders like obesity, cardiovascular diseases, and diabetes are linked to physical inactivity and sedentary behaviors. However, to this day no study analyzed these behaviors in French-speaking individuals with BPD. Objectives This study's goal is to document health behaviors in adults with BPD in Canada and in France. Method This cross-sectional study consists of an online survey on the LimeSurvey platform including validated questionnaires distributed in France and Canada. To measure physical activity, we used the "Global Physical Activity Questionnaire." Insomnia was measured with the "Insomnia Severity Index." Substance use was measured with the "Alcohol, Smoking and Substance Involvement Test." Descriptive statistics (N,% and mean) are used to describe previously mentioned health behaviors. Five regression models have been realized to find the main associated variables (age, perceived social status, education level, household income, body mass index, emotional regulation difficulties, BPD symptoms, depression level, previous suicide attempts and psychotropic medication use) to health behaviors. Results A total of 167 participants (92 Canadians, 75 French; 146 women, 21 men) filled out the online survey. In this sample, 38% of Canadians and 28% of French reported doing less than 150 minutes of physical activity weekly. Insomnia affected 42% of Canadians and 49% of French. Tobacco use disorder affected 50% of Canadians and 60% of French. Alcohol use disorder affected 36% of Canadians and 53% of French. Cannabis use disorder affected 36% of Canadians and 38% of French. All tested variables were linked to physical activity (R² = 0.09). Insomnia was only linked with BPD symptoms (R² = 0.24). Tobacco use disorder was linked to social status and alcohol use disorder (R² = 0.13). Alcohol use disorder was linked to social status, body mass index, tobacco use disorder, and depression (R² = 0.16). Finally, cannabis use disorder was linked to age, body mass index, tobacco use disorder, depression, and past suicide attempts (R² = 0.26). Conclusion These results are essential to design health prevention interventions in French-speaking adults with BPD in Canada and in France. They help identify the main factors associated with these health behaviors.

Objectives: Borderline personality disorder (BPD) is a disorder associated with emotion dysregulation and is common in clinical samples of adolescents. The identification and delineation of BPD from other disorders is important, yet methods for effectively screening for BPD are lacking. Here, we examine whether irritability can be used as a screening item for BPD in adolescents at risk for the disorder., Methods: We assessed Diagnostic Interview for Borderline-Revised and Development of Well-Being Assessment scores in a clinical sample of female adolescents ages 12-17 (n = 78) to identify BPD and group cases into 'irritable' and 'non-irritable' mood types, respectively. We then examined the prevalence of irritability and its predictive association with BPD., Results: The prevalence of BPD was 26% (n = 20). There was a significant association between irritable mood and BPD, specifically (χ 2 (1) = 17.740, p < 0.001). Irritability was endorsed in all (n = 20) BPD cases (sensitivity: 100%), while in non-BPD cases (n = 58), irritability was endorsed in 27 (specificity: 53%; positive predictive value: 0.33; and negative predictive value: 1.0)., Conclusion: Irritability is a highly sensitive screening item for BPD in adolescents. The absence of irritability in an adolescent may be an important clinical tool to rule out BPD. © 2020 John Wiley & Sons, Ltd., (© 2020 John Wiley & Sons, Ltd.)

The article highlights considerations within the debate of whether medical assistance in dying (MAiD) can be appropriate for mental illness such as borderline personality disorder (BPD) and guides the assessment of patients with BPD for eligibility should MAiD for mental illness become available in Canada. Topics include BPD among patients requesting MAiD, criteria for Canadian MAiD, and concerns regarding the provision of MAiD to those with BPD.

Borderline personality disorder (BPD) is a disorder characterized by emotion regulation (ER) difficulties. Although research indicates that patterns of ER differ across racial groups, few studies have examined the role of race in the ER-BPD association. This study sought to address this gap. Participants in this study identified as either East Asian, White, or Black, and were recruited from sites in Western Canada and the Southern United States. Two samples were included in this study: (a) 194 university students who self-reported BPD features and (b) 88 adults from the community who underwent diagnostic interviews and had a BPD diagnosis. All participants self-reported ER difficulties. Results revealed that race moderated the link between some aspects of ER difficulties and BPD. For instance, relations between (a) nonacceptance of emotions and BPD affect instability, (b) limited access to ER strategies and BPD identity disturbance, and (c) low emotional awareness and BPD diagnosis were stronger among White (vs. Black or East Asian) participants. Implications of these findings for the diagnosis and treatment of BPD across racial groups are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The individual and societal burden of psychopathy warrants an investigation into identifying its early precursors and developmental course. Accordingly, we examined the longitudinal pathways between primary and secondary psychopathic traits, anxiety, and borderline personality disorder (BPD) features across adolescence. Participants included 572 Canadian adolescents (253 girls; aged 13.96 [SD = 0.37] in Grade 8; 70.6% Caucasian) who were assessed annually on five occasions (Grades 8-12) using the Antisocial Process Screening Device (psychopathic traits), the Behavior Assessment System for Children-2 (symptoms of anxiety), and the Borderline Personality Features Scale for Children (features of BPD). Autoregressive latent trajectory models with structured residuals provided stringent tests of within-person cross-lagged associations, while controlling for sex, race/ethnicity, household income, and parental education. Results indicated that primary psychopathic traits were preceded by and predicted anxiety such that individuals who increased in primary psychopathic traits subsequently declined in anxiety, and vice versa. Results also indicated that BPD features were associated with secondary psychopathic traits and anxiety. Specifically, increases in BPD features were linked with increases in secondary psychopathic traits and anxiety. Our results suggest that even after accounting for between-person associations and other known correlates, the development of psychopathic traits is embedded within the development of emotional characteristics and personality features. This highlights areas for intervention in adolescence, particularly around the core, shared trait of impulsivity and anger. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Previous studies have demonstrated individual associations between borderline personality disorder (BPD), panic attacks (PAs), and panic disorder (PD) in relation to suicide attempts (SAs). This study examined the comorbid effects of these variables. Data from wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (N = 34,653) were used to examine using logistic regression the relationship between individuals with BPD (n = 562), PA (n = 253), PD (n = 255), comorbid BPD and PD (n = 146), and co-occurring BPD and PA (n = 119) who had attempted suicide. It was found that BPD, PD, and PA are associated with SAs. Comorbid PD and BPD, or PA and BPD, only slightly increased the association of BPD alone with SA. Associations were greatly decreased after controlling for affective dysregulation. These findings emphasize the importance of affective dysregulation in individuals with BPD in relation to suicide attempts.

Objective: People with borderline personality disorder (BPD) are at high risk for attempting suicide. There are some data to suggest that risk factors for suicide attempts change over time. We conducted a prospective cohort study to examine risk factors for suicide attempts in a treated sample of patients with BPD., Method: One hundred eighty participants with BPD were followed over a year-long course of dialectical behaviour therapy or general psychiatric management and then for 2 more years in naturalistic follow-up. Participants were assessed for suicidal and self-injurious behaviours at baseline, every 4 months over the 1-year treatment phase, and every 6 months over a 2-year follow-up period. Participants were classified as suicide or non-suicide attempters based on their behaviour at the end of the 1-year treatment phase and after the 2-year follow-up period. Groups were then compared on baseline clinical and demographic variables., Results: Nearly 26% of participants made a suicide attempt during the 1-year treatment phase, while 16.7% reported a suicide attempt over the 2-year follow-up period. Baseline number of suicide attempts during the 4 months prior to study and severity of childhood sexual abuse predicted suicide attempts during the treatment year. Similarly, baseline suicide attempts, severity of childhood sexual abuse, and number of hospitalizations in the 4 months prior to study entry predicted suicide attempts during the 2-year follow-up., Conclusions: Risk factors for suicide attempts in this treated sample of patients with BPD were fairly stable, largely non-modifiable, and unrelated to psychopathology or psychosocial functioning at baseline.

This study aimed to determine if the diagnosis of borderline personality disorder (BPD) is associated with specific narrative descriptions of interpersonal functioning. Narratives of relationship episodes were scored using the Core Conflictual Relationship Theme (CCRT) standard categories. The scores of 68 participants with BPD were compared to those of 139 participants with other personality disorders. Results on the CCRT standard categories showed that patients with BPD had more wishes to be distant and to be like others, and more wishes to be hurt and to hurt others; others were seen as controlling and bad; and patients with BPD were less open, helpful and self-confident than those without BPD. These findings are discussed in reference to previous studies on the interpersonal functioning of patients with BPD. How these findings may inform research on the effectiveness of treatment for BPD remains to be considered.

Objective: To describe the development and implementation of General Psychiatric Management (GPM), a dynamically informed psychotherapeutic and case management approach along with symptom-targeted pharmacological interventions for the treatment of borderline personality disorder (BPD), derived from the American Psychiatric Association's (APA) guidelines for treating BPD., Method: Clinician adherence to GPM was assessed using the General Psychiatric Management Adherence Scale (GPMAS), which measured the amount of emphasis accorded to therapeutic tools and strategies during individual therapy sessions. GPMAS surveys were completed by 9 different therapists every 6 weeks during 1 year for 50 patients., Results: GPMAS displayed excellent internal consistency and good-to-excellent test-retest reliability. The convergence between patient- and therapist-rated sessions was excellent. Mean levels of emphasis were significantly greater for GPM interventions than prohibited ones across all time points. The mean number of prescribed psychotropic medications was 2.3, and the most frequently prescribed class of medication was antidepressants, followed by neuroleptics., Conclusions: From these results, we conclude that the clinicians were adherent to the outlined protocol and that the GPMAS is a valuable measure for demonstrating adherence to therapies based on the APA guidelines.

In a group of intact families, we examined the rates and parameters of verbal, physical, and sexual abuse in 35 women with borderline personality disorder (BPD), 34 women with anorexia nervosa (AN), and 33 women without a clinical history (NC); their experience of multiple abuse and its correlation with their SCL-90-R scores; and their reports of abuse of their siblings. Corroboration of abuse was obtained from some parents in each group. Women with BPD suffered more intrafamilial verbal and physical abuse. Whereas AN and NC women experienced relatively rare single events of extrafamilial sexual abuse at an older age, those with BPD suffered repeated intrafamilial sexual abuse at a younger age and also suffered more multiple abuse. All multiply abused women had more psychopathology. Siblings were reported abused in the same proportions as subjects; many parents of BPDs corroborated their daughters' reports of all three forms of abuse.

The article focuses on a research on the identification of mental disorder from the faces of women with borderline personality disorder. Topics discussed include getting cues from face for helping diagnose physical illness and visual manifestations of mental disorder; important role played by configuration of facial cues in judgments for mental disorder; and correlation of depression ratings with targets' actual depressive symptoms.

Dialectical behaviour therapy (DBT) is a therapy model incorporating elements of Eastern philosophies and cognitive behavioural principles. Originally designed for people struggling with chronic suicidality and borderline personality disorder (BPD), it has been adapted to treat complex, multi-diagnostic presentations, such as those in forensic mental health settings. To date, there has been little evaluation when the primary diagnosis is of psychosis. To explore the effectiveness of DBT, with patients, with multiple comorbidities, including psychosis, in a forensic psychiatric inpatient setting. A descriptive outcome study with a cohort of offender-patients in one specialist forensic mental health unit. Before and after treatment change scores were compared on anger, aggression, hopefulness, coping abilities, emotional intelligence, insight and subjective symptom severity scales, as well as staff-rated risk, and length of stay. Nine men and five women residents in one Canadian secure hospital completed a standard DBT programme, and self-ratings, over about 1 year. Scale scores indicated significantly increased insight and acknowledgment of problems. Apparently increased anger and vengeance scores were clinically associated. Independent staff ratings indicated reductions in risk and most patients achieved early release. This study provides support for extension of the use of DBT to offender-patients with psychosis among the complex mix in their presentation. It suggests that a randomised controlled trial with cost-benefit analysis is warranted, as well as further work, to promote understanding of mechanisms of effectiveness., (© 2020 John Wiley & Sons Ltd.)

A deficit in emotion regulation is thought to be a trans-diagnostic factor of several mental disorders and is mostly assessed by using self-report measures. Comparing values and results cross-nationally presupposes that these scores are based on the invariance of psychometric properties. The present study aims to compare the psychometric properties and the factorial invariance of the Emotional-Dysregulation-Scale (ED-Scale) cross-nationally. Analyses were based on data of treatment-seeking Canadian and German clinical samples ( n = 144; n = 115). They were diagnosed using structured clinical interviews and completed self-report measures. We calculated reliability and validity indices. In order to determine the factorial invariance (configural, metric, scalar, and residual invariance), we conducted several multi-group confirmatory factor analyses. For both samples, Cronbach’s α s proved to be excellent. Convergent, divergent and discriminant validity were supported. Comparing increasingly stringent models, tests of measurement invariance indicated at least partial measurement invariance . These findings suggest that the ED-Scale operates in a similar fashion among English and German-speaking clinical samples. Therefore, we conclude that the psychometric properties of the ED-Scale are appropriate and that results can be compared cross-nationally. Future research should examine the measurement invariance in different cultures and ethnic minority groups. [ABSTRACT FROM AUTHOR]

Background: Despite links between early relational experiences and psychopathology, data regarding childhood emotional neglect among Canadian mental health services users are scarce. Aims: To explore the absence of emotional support experiences reported by Canadian psychiatric outpatients, and to examine the relationship between childhood emotional support and borderline personality disorder (BPD) features. Methods: A survey regarding childhood emotional support was completed by consecutively admitted adult outpatients, along with self-report assessments of symptom distress and BPD features. Results: A substantial proportion of outpatients reported absent emotional support experiences. After controlling for the effects of age and symptom distress, childhood emotional support was found to be significantly negatively associated with BPD features. Conclusion: The findings add further support to the need for clinical attention to the early relational experiences of mental health service users. [ABSTRACT FROM AUTHOR]

It is known that assertive community treatment (ACT) is being used to treat people with borderline personality disorder (BPD), a puzzling trend given the lack of empirical support for this practice and the consensus that reserving ACT for a carefully selected population is critical to the sustainability of this costly intervention. Little is known about the contributors to this phenomenon and the ways in which ACT programs have adapted to the influx of patients with BPD. Many ACT programs in the United States and Canada have integrated dialectical behavioral therapy into the regular ACT programming, a practice that also lacks rigorous evidence of effectiveness. We provide a framework for policy-makers to decide on the optimal role of ACT in the continuum of care for people with BPD, and offer policy recommendations to address this phenomenon. There is an urgent need to generate the missing evidence and to improve and expand the services available to people with BPD, particularly those who are now being treated in ACT programs. [ABSTRACT FROM AUTHOR]

Childhood abuse has been consistently linked with borderline personality disorder (BPD) and recent studies suggest that some forms of childhood abuse might be uniquely related to both BPD and BPD features. In addition, difficulties with emotion regulation have been found to be associated with childhood abuse, BPD, as well as BPD features. The present study examined (1) whether frequency of childhood emotional abuse is uniquely associated with BPD feature severity when controlling for other forms of childhood abuse and (2) whether difficulties with emotion regulation accounts for the relationship between childhood emotional abuse and BPD feature severity. A sample of undergraduates (n=243) completed the Childhood Trauma Questionnaire - Short Form, Difficulties in Emotion Regulation Scale, and Borderline Symptom List-23. Multiple regression analyses and Structural Equation Modeling were conducted. Results indicated that frequency of childhood emotional abuse (and not sexual or physical abuse) was uniquely associated with BPD feature severity. In addition, while there was no direct path between childhood emotional abuse, childhood physical abuse, or childhood sexual abuse and BPD features, there was an indirect relationship between childhood emotional abuse and BPD features through difficulties with emotion regulation. These findings suggest that, of the different forms of childhood abuse, emotional abuse specifically, may have a developmental role in BPD pathology. Prevention and treatment of BPD pathology might benefit from the provision of emotion regulation strategies., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

This article examines a large cohort of previously suicidal adolescents, identifying those that surpassed threshold criteria for borderline personality disorder (BPD), according to the Abbreviated Diagnostic Interview of Borderlines (Ab-DIB), and determining the stability, correlates and predictors of BPD from early-to-late adolescence. Two hundred and eighty-six youth (mean baseline age 14.6 years; SD 1.5), presenting consecutively to a metropolitan pediatric hospital emergency department for evaluation of suicidality, were assessed at initial consultation for Axis I and II disorders and demographic and clinical variables. Two hundred and twenty-nine (80 %) were re-assessed for those variables 4 years later and 204 (70.3 %) had complete data sets at recruitment and follow-up. Previously suicidal youths who met BPD threshold on the Ab-DIB at recruitment were distinguishable at baseline from those who did not in conduct disorder symptoms ( p < 0.003), lower levels of functioning ( p < 0.001), drug use ( p < 0.001), stressful life events ( p < 0.003) and family relations ( p < 0.001). The BPD diagnosis was consistent, according to this measure, at baseline and follow-up for 76 % of participants. Four groups with respect to borderline pathology (persisting, remitting, emerging and never) were identified (ICC = 0.603, 95 % CI = 0.40-0.78). Persistent BPD status was predictable by older age at presentation ( p < 0.01) and level of functioning ( p < 0.05). Eight percent were also suicidal at the 4-year follow-up. Using a self-report measure of BPD, we suggest that suicidal youth can indeed be diagnosed with the disorder at 14 years old, supporting the shift from DSM-IV to DSM-5, given what appears to be its temporal stability, differentiation of those suffering with considerable symptomatology or not, and predictors of its status in late adolescence. The low suicidality rate at follow-up indicates a good short-term prognosis. [ABSTRACT FROM AUTHOR]

The working alliance between therapist and patient is an important component of effective interventions for borderline personality disorder (BPD). The current study examines whether client personality affects the development of the working alliance during the treatment of BPD, and whether this influences treatment effectiveness. Data was based on 87 patients with BPD who were participants in a randomized controlled trial comparing Dialectical Behavior Therapy (DBT) and general psychiatric management. Higher levels of trait Agreeableness were associated with steeper increases in working alliance throughout treatment, but only in the DBT condition. Increases in working alliance were in turn associated with better clinical outcomes. Mediation models revealed a significant indirect path from Agreeableness to better clinical outcomes, mediated through larger improvements in working alliance over time. These results highlight the role that patient personality can play during the therapeutic process, with a specific focus on the importance of Agreeableness for alliance development. [ABSTRACT FROM AUTHOR]

Research focusing on the role of adverse childhood experience (ACE) of individuals involved in sexual homicide (SH) is scarce. Theoretical models of SH have postulated a connection between these adverse experiences and the development of internal risk factors. However, such assumptions have never been empirically tested. Therefore, the current research aims to identify how ACEs affect the development of personality disorders and problematic behaviors during adolescence, which constitute internal risk factors for the commission of SH. The sample comes from a database including 613 individuals involved in sexual crimes in Canada among which 60 committed a SH. Bivariate and multiple regression analyses were conducted to identify personality disorders and problematic behaviors during adolescence associated with the presence of ACEs. Next, path analysis was used to identify the direct and indirect relationships between ACEs, internal risk factors, and the commission of SH. Results showed that individuals who experienced ACEs were more likely to develop internal risk factors involved in the commission of SH. Moreover, findings suggest that the impact of these adverse experiences will differ, depending on whether the child has been victim of violence or if he/she has witnessed it. [ABSTRACT FROM AUTHOR]

No longitudinal study has examined risk factors for future suicide attempts in major depressive disorder in a nationally representative sample. The objective of this study was to investigate baseline sociodemographic characteristics, comorbid mental disorders, specific depressive symptoms, and previous suicidal behavior as potential risk factors for suicide attempts at 3 years follow-up. Data came from the national epidemiologic survey on alcohol and related conditions (NESARC), a large nationally representative longitudinal survey of mental illness in adults [Wave 1 (2001-2002); Wave 2 (2004-2005) n=34,653]. Logistic regression examined associations between risk factors present at Wave 1 and suicide attempts at Wave 2 (n=169) among individuals with major depressive disorder at baseline assessment (n=6004). Risk factors for incident suicide attempts at Wave 2 (n=63) were identified among those with major depressive disorder at Wave 1 and no lifetime history of suicide attempts (n=5170). Results revealed specific comorbid anxiety, personality, and substance use disorders to be associated with incident suicide attempts at Wave 2. Comorbid borderline personality disorder was strongly associated with suicide attempts in all models. Several comorbid disorders were strongly associated with suicide attempts at Wave 2 even after adjusting for previous suicidal behavior, notably posttraumatic stress disorder (adjusted odds ratio (AOR)=2.20; 95% confidence interval (95% CI) 1.27-3.83) and dependent personality disorder (AOR=4.43; 95% CI 1.93-10.18). These findings suggest that mental illness comorbidity confers an increased risk of future suicide attempts in major depressive disorder that is not solely accounted for by past suicidal behavior.

Objective: To provide a conceptual basis for psychopharmacology., Method: This review compares contemporary psychopharmacology practice with the Hippocratic tradition of medicine by examining the original Hippocratic corpus and modern interpretations (by William Osler and Oliver Wendell Holmes)., Results: The Hippocratic philosophy is that only some, not all, diseases should be treated and, even then, treatments should enhance the natural healing process, not serve as artificial cures. Hippocratic ethics follow from this philosophy of disease and treatment. Two rules for Hippocratic medicine are derived from the teachings of Osler (treat diseases, not symptoms) and Holmes (medications are guilty until proven innocent). The concept of a diagnostic hierarchy is also stated explicitly: Not all diseases are created equal. This idea helps to avoid mistaking symptoms for diseases and to avoid excessive diagnosis of comorbidities. Current psychopharmacology is aggressive and non-Hippocratic: symptom-based, rather than disease oriented; underemphasizing drug risks; and prone to turning symptoms into diagnoses. These views are applied to bipolar disorder., Conclusions: Contemporary psychopharmacology is non-Hippocratic. A proposal for moving in the direction of a Hippocratic psychopharmacology is provided.

Emerging evidence suggests that transgender individuals are more likely than cisgender peers to receive a diagnosis with a primary mental disorder. Attributions of madness, though, may serve the social function of dismissing and discrediting transgender individual's self-perceptions. The narratives of individuals who stop or reverse an initial gender transition who also identify as living with mental health conditions can sometimes amplify these socio-political discourses about transgender people. Through a critical mental health lens, this article presents a qualitative analysis of 16 individuals who stopped or reversed a gender transition and who also reported a primary mental health condition. Semi-structured, virtual interviews were conducted with people living in Canada. Applying constructivist grounded theory methodology, and following an iterative, inductive approach to analysis, we used the constant comparative method to analyse these 16 in-depth interviews. Results show rich complexity such that participants narrated madness in nuanced and complex ways while disrupting biased attitudes that madness discredited their thoughts and feelings, including prior gender dysphoria. Instead, participants incorporated madness into expanding self-awareness and narrated their thoughts and feelings as valid and worthy. Future research must consider provider's perspectives, though, in treating mad individuals who detransitioned, since alternate gender-affirming care models may better support the identification and wellness of care-seeking individuals who may be identified (in the past, present, or future) as mad. [ABSTRACT FROM AUTHOR]

Non-suicidal self-injury (NSSI) is highly prevalent and associated with tissue damage, emotional distress, and psychiatric disorders. While often discussed in the context of Borderline Personality Disorder and suicide, research demonstrates that NSSI is distinct from these constructs and should be viewed as an independent diagnostic category. Recently, Non-Suicidal Self-Injury Disorder (NSSID) was included in the revised Diagnostic and Statistical Manual of Mental Disorders as a condition for further study. In this article, we describe the properties of a self-report measure designed to assess proposed criteria for NSSID. Undergraduate students at 2 large, public universities completed the NSSID Scale (NSSIDS) along with other measures of NSSI characteristics and psychopathology. Among participants with a history of NSSI, approximately half (54.55%) met diagnostic criteria for NSSID. Participants were most frequently excluded from an NSSID diagnosis on the basis of criterion A (frequency of NSSI) and criterion E (distress or impairment related to NSSI), while participants were least likely to be excluded from diagnosis on the basis of criterion D (NSSI method exclusions) and criterion F (diagnostic “rule-outs”). Consistent with previous literature, the most commonly reported precipitants to NSSI were negative feelings or thoughts (criterion C2). Participants who met criteria for NSSID reported more severe depression, anxiety, and NSSI than participants who engaged in NSSI but did not meet criteria for NSSID. These results support the use of the NSSIDS as a reliable and valid self-report measure of NSSID symptoms. [ABSTRACT FROM PUBLISHER]

The article reviews clinical studies on personality disorders. A study on using general psychiatric management for borderline personality disorder (BPD) compared to dialectical behavioral therapy was conducted in a randomized controlled trial in Canada. Another study showed the ineffectiveness of selective serotonin-reuptake inhibitors (SSRIs) in treating the symptoms of comorbid depression among those with BPD showing the role of pharmacotherapy in BPD treatment.

Reports issues related to psychiatry in Canada. Development of short-term psychotherapies in the treatment of depression; Promotion of shared mental health care; Etiology of borderline personality disorder.

The Correctional Service of Canada (CSC) has received international praise for its new policies with female prisoners serving federal sentences of two or more years. Regarded as progressive, even radical, other countries have looked toward Canada for inspiration in the design of their own policies [Carlen, (2002)Criminal Justice2(2)]. CSC’s “women-centered” mental health agenda, however, while rhetorically progressive, remains consistent with disciplinary processes which prioritize self-regulation and aim to correct or normalize those considered failed citizens [Kemshall, (2002),The Howard Journal41(1), 41-58]. Using Nicolas Rose’s concept of governance through self-regulation [Rose 1991, b Rose (1996). Inventing Ourselves: Psychology, Power and Personhood. Cambridge: Cambridge University Press; Rose (2000).British Journal of Criminology40, 321-339] as a theoretical framework, we argue that correctional mental health practices privileges a psychological discourse which serves to regulate women prisoners as opposed to empowering or supporting them. We examine the over use of psychiatric labelling of women, such as that of Boderline Personality Disorder, and the resulting treatment regime, Dialectical Behavior Therapy, to illustrate that the CSC has constructed women prisoners as disorderly and disordered and thus in need oftaming.This discussion is followed by recommendations for new directions in feminist mental health treatment for women in prison that more adequately confront the inherent tensions and contradictions of prison therapeutic services and that incorporate multi-faceted understandings of the mental health needs of women offenders. We conclude with some policy and research implications of adopting a feminist informed mental health correctional strategy. [ABSTRACT FROM AUTHOR]

Suicide is known to vary according to season, with peaks in the spring and troughs in the winter. The presence of psychopathology is a significant predictor of suicidality, and it is possible that the seasonal variation of suicide completion may be related to seasonality in the manifestation of psychiatric disorders common to suicide completers. In the current study, we evaluated 115 French-Canadian male suicide completers from the Greater Montreal Area for DSM-IV psychiatric disorders using proxy-based diagnostic interviews. Subjects were assessed for seasonal differences in the prevalence of DSM-IV psychiatric diagnoses just before their deaths. Diagnoses of major depressive disorder (MDD) without comorbid cluster B personality disorders, and schizophrenia were differently distributed between seasons. Most (63.4%) subjects with MDD committed suicide in the spring/summer (P =.038). However, closer examination revealed that depressed suicides with comorbid cluster B personality disorders did not show seasonality, while 83.3% of depressed suicides without comorbid cluster B personality disorders committed suicide in the spring/summer (P =.019). 87.5% of those suicides with schizophrenia committed suicide in the fall/winter (P =.026), and the only suicide with schizophrenia who died in the spring/summer was also the only one without positive symptomology. Our study is limited to male suicide completers, and results should not be generalized to women. We conclude that seasonal variation in suicide manifests itself differently in patients with different psychopathology. These findings indicate that assessment of suicide risk may need to include consideration of possible seasonal effects, depending on psychopathology.

Objective: To measure the predictive power of the Suicide Probability Scale (SPS) in a male inmate population (federal penitentiary) with the added contribution of actuarial data., Method: SPS scores and data from the files of 518 inmates were analyzed in relation to their suicidal behaviors over the following 10 years., Results: During this period, 12 inmates committed suicide (2.32%), 43 engaged in non-lethal self-harm (8.3%) and 15 expressed serious suicidal intention (2.9%), for a total of 70 (13.51%) who manifested at least one form of suicidal behavior. The records of the 518 inmates allowed identifying seven actuarial variables (out of 24 documented) that distinguished the group that acted out. These variables were tested in combination with the SPS score to determine the best predictive models of suicidal behavior. Depending on type of suicidal behavior and on observation period, the following seven variables could prove useful in improving the predictive capacity of the SPS: age, prior suicidal behavior, borderline personality disorder, length of sentence, number of sentences, prior incarceration in a provincial prison, and juvenile priors. However, analyses did not allow developing a better predictive model for the specific subgroup of suicide completers., Conclusions: SPS is improved when adding actuarial data., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Although, a large population-based literature exists on the relationship between childhood adversity and Axis I mental disorders, research on the link between childhood adversity and Axis II personality disorders (PDs) relies mainly on clinical samples. The purpose of the current study was to examine the relationship between a range of childhood adversities and PDs in a nationally representative sample while adjusting for Axis I mental disorders., Methods: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n=34,653; data collection 2004-2005); a nationally representative sample of the United States population aged 20 years and older., Results: The results indicated that many types of childhood adversity were highly prevalent among individuals with PDs in the general population and childhood adversity was most consistently associated with schizotypal, antisocial, borderline, and narcissistic PDs. The most robust childhood adversity findings were for child abuse and neglect with cluster A and cluster B PDs after adjusting for all other types of childhood adversity, mood disorders, anxiety disorders, substance use disorders, other PD clusters, and sociodemographic variables (Odd Ratios ranging from 1.22 to 1.63). In these models, mood disorders, anxiety disorders, and substance use disorders also remained significantly associated with PD clusters (Odds Ratios ranging from 1.26 to 2.38)., Conclusions: Further research is necessary to understand whether such exposure has a causal role in the association with PDs. In addition to preventing child maltreatment, it is important to determine ways to prevent impairment among those exposed to adversity, as this may reduce the development of PDs., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

While population-based research confirms that women with disabilities abused by their intimate partners experience significant mental health issues, few studies compare this in intimate partner violence (IPV)-specific samples of women with or without disabilities and none analyze possible impacts based on disability type. This secondary mixed methods analysis examined 660 Canadian women (50.6% Indigenous, 43.1% White, and 6.1% visible minority) with respect to whether they reported having a disability that impacted their employability or daily living (291 or 44% yes; 369 or 56% said no). In the 291 women with disabilities, about one-third (30.7%) had a physical disability-only, one-quarter had a mental health disability-only, and 44.1% reported both physical and mental health disabilities. Women with mental health and both physical and mental health disabilities reported significantly more Severe Combined IPV on the Composite Abuse Scale, depression (CES-D-10; Center for Epidemiological Studies-Depression), psychological distress (Symptom Checklist Shortform-10; SCL-10; in the clinical range), PTSD symptoms (PTSD Checklist), and lower quality of life (Quality of Life Questionnaire or QoL-9) than women without disabilities. Education about disabilities is needed for IPV advocates and disability practitioners need education about IPV. Developing services specific to survivors of IPV with disabilities is recommended. [ABSTRACT FROM AUTHOR]

Introduction: Individuals experiencing housing instability face significant health inequities. Addressing housing instability requires an understanding of the factors that contribute to these inequities—a responsibility that has been assumed by community-based organizations. Interviewing individuals from 3 Canadian provinces, the present study aimed to examine the perspectives of individuals from front-line services of the social determinants of health (SDoH) needs of individuals experiencing housing instability. Methods: As part of a larger knowledge translation study, we conducted 8 semi-structured interviews with individuals from front-line services (eg, shelter workers and shelter mental health nurses) in Canada (Nova Scotia, Saskatchewan, and Alberta) and used thematic analysis to identify predominant unmet SDoH needs. Results: Individuals from front-line services discussed the roles of many SDoH that may perpetuate housing instability in their clients. These included: (1) limited social supports; (2) poor access to health services; (3) poor opportunities for income and employment; (4) lack of transportation; (5) gender-based discrimination; (6) race-based discrimination; and (7) limited access to education and limited literacy skills. Conclusion: This study reveals how front-line service providers observe SDoH factors contributing to housing instability and create barriers to accessing support services. They advocate for a multi-system approach to addressing intersecting SDoH factors to validate clients' experiences and help them achieve stable housing. Additionally, more research and consultation with front-line providers are necessary to understand and overcome systemic barriers to stable housing. [ABSTRACT FROM AUTHOR]

Despite the well-documented link between child maltreatment (CM) and mental health, evidence suggests substantial variability in the post-traumatic sequelae of CM across cultures. The perceived acceptability of CM in one's community might moderate the association between CM and mental health, but little research has been conducted on it so far. This study examined how the perceived acceptability of CM may influence the relationship between CM experiences and post-traumatic symptoms in individuals from four different continents and if the pattern of associations is the same across countries. We recruited a sample of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122). We administered online questionnaires and performed multiple group moderation analyses for total CM, neglect, physical abuse, emotional maltreatment, sexual abuse, and exposure to domestic violence (DV). A significant positive main effect of CM on post-traumatic symptoms was found in the overall sample and in Cameroon; in Germany, only neglect and emotional maltreatment were positively associated to post-traumatic symptoms. Moderation effects were identified; the perceived acceptability of neglect in Cameroon and Germany and of exposure to DV in Cameroon had a dampening effect on the relationship between CM experiences and post-traumatic symptoms. Our findings confirm that CM experiences entail long-term post-traumatic sequelae that can vary across cultures and CM subtypes and further our understanding of this issue by showing that the perceived acceptability of CM may be an understudied moderator. [ABSTRACT FROM AUTHOR]

Background: The recovery process is characterized by the interaction of a set of individual, environmental and organizational conditions common to different people suffering with a mental health problem. The fact that most of the studies have been working with schizophrenic patients we cannot extend what has been learned about the process of recovery to other types of mental problem. In the meantime, the prevalence of anxiety, affective and borderline personality disorders continues to increase, imposing a significant socioeconomic burden on the Canadian healthcare system and on the patients, their family and significant other [1]. The aim of this study is to put forward a theoretical model of the recovery process for people with mental health problem schizophrenic, affective, anxiety and borderline personality disorders, family members and a significant care provider. Method and design: To operationalize the study, a qualitative, inductive design was chosen. Qualitative research open the way to learning -- the inside -- about different perspectives and issues people face in their process of recovery. The study proposal is involving a multisite study that will be conducted in three different cities of the Province of Québec in Canada: Montréal, Québec and Trois-Rivières. The plan is to select 108 participants, divided into four comparison groups representing four types of mental health problem. Each comparison group (n = 27) will be made up of 9 units. Each unit will comprise one person with a mental health problem (schizophrenia, affective anxiety, and borderline personality disorders. Data will be collected through semi-structured open-ended interview. The in-depth qualitative analysis inspired from the grounded theory approach will permit the illustration of the recovery process. Discussion: The transformation of our Health Care System and the importance being put on the people well-being and autonomy development of the person who are suffering with mental problem This study protocol follows-up on earlier theory-building process that begun with the work of Noiseux [2]. The contribution of the present study is to increase the comprehension of the concept of recovery and to enhance the body of knowledge in that domain. Very few studies have examined recovery and the one that did used a descriptive approach which did not take into account the perspective of the family members and the caregivers of the recovery process. [ABSTRACT FROM AUTHOR]

Background: Alcohol-induced injury is one of the leading causes of preventable morbidity and mortality. We investigated the relationship between impulsive personality and physical injury (e.g. falls, sports), and whether peak drinking quantity specifically, and/or risky behaviour more generally, mediates the relationship between impulsivity and injury in undergraduates. Method: We used data from the winter 2021 UniVenture survey with 1316 first- and second-year undergraduate students aged 18–25 years (79.5% female) from five Canadian Universities. Students completed an online survey regarding their demographics, personality, alcohol use, risky behaviours, and injury experiences. Impulsivity was measured with the substance use risk profile scale, past 30-day peak alcohol use with the quantity-frequency-peak Alcohol Use Index, general risky behaviour with the risky behaviour questionnaire, and past 6-month injury experience with the World Health Organization's (2017) injury measurement questionnaire. Results: Of 1316 total participants, 12.9% (n = 170) reported having sustained a physical injury in the past 6 months. Mean impulsivity, peak drinking quantity, and risky behaviour scores were significantly higher among those who reported vs. did not report injury. Impulsivity and peak drinking quantity, but not general risky behaviour, predicted injury in a multi-level generalized mixed model. Mediation analyses supported impulsivity as both a direct predictor of physical injury and an indirect predictor through increased peak drinking (both p <.05), but not through general risky behaviour. Conclusion: Results imply emerging adults with impulsive tendencies should be identified for selective injury prevention programs and suggest targeting their heavy drinking to decrease their risk for physical injury. [ABSTRACT FROM AUTHOR]

Background: Naturopathic medicine uses natural and evidence-based treatments to promote health. The objective of this study was to characterize and evaluate the effectiveness of naturopathic medicine in reducing symptoms of anxiety and depression in patients seeking care from the Mental Health Shift at a Canadian naturopathic teaching clinic. Methods: Charts of 192 consecutive patients who attended appointments between 1 January 2019 and 6 March 2020 were reviewed. Subjects were included if they screened positive on the General Anxiety Disorder 7 (GAD7) or the Patient Health Questionnaire 9 (PHQ9) and attended follow up at least 4 weeks after initial treatment. Results: Of the 22 included subjects, a clinically significant decrease of at least 5 points occurred in 76% of individuals with elevated baseline PHQ9 scores and 59% of individuals with elevated GAD7 scores. Mean PHQ9 and GAD7 scores decreased 7.5 (p<0.0001) and 4.6 (p<0.008) points, respectively. Mild adverse events were reported in 9 charts (41%). No serious adverse events were reported. Most subjects were also in the care of a medical doctor and counsellor. Conclusion: Naturopathic medicine as performed on the Mental Health Shift may be effective in reducing depression and anxiety symptoms as an adjunctive treatment. Further research incorporating comparison groups is warranted. [ABSTRACT FROM AUTHOR]

Patients in community mental health settings frequently endorse suicidal thoughts. While a variety of factors may be involved, the role of impaired quality of object relations– structuralized representations of self-other relationships – may significantly contribute to the likelihood of experiencing suicidal ideation. The present study examined the association between current suicidal thoughts and quality of object relations impairment in a sample of 101 patients presenting for community mental health services. Logistic regression analysis indicated that overall impairment of quality of object relations was significantly associated with current suicidal thoughts after controlling for past suicide attempts and severity of psychiatric symptoms. Individuals with highly impaired quality of object relations had a nearly two-and-a-half times greater likelihood of reporting current suicidal thoughts. [ABSTRACT FROM AUTHOR]

Background: In Canada, ensuring public safety, and the safety and well-being of accused individuals under the jurisdiction of the provincial review board are very important. While previous studies have reported a significant risk of self-harming behaviors (non-suicidal self-injury and suicide attempt) in forensic psychiatric settings, no large population study has assessed any relationship between forensic system-related factors and self-harming behaviors. A better understanding of these factors can help clinicians implement protective measures to mitigate self-harming behaviors or actions. Methods: Using the Ontario Review Board (ORB) database covering 2014–2015 period (n = 1211, mean age = 42.5 ± 13.37 years, males = 86.1%), we analyzed the prevalence and factors associated with self-harming behaviors, emphasizing the characterization of the forensic system-related factors (ORB status, legal status, type of offense, previous criminal history, and victim relationship). The relationships between the forensic system-related factors and self-harming behaviors were explored using five separate logistic regression models, controlling for clinical and sociodemographic characteristics. Results: Approximately 4% of the individuals in the forensic system over the study period engaged in self-harming behaviors Among the studied patients, individuals determined to be unfit to stand trial and inpatients were significantly more likely to have self-harming behaviors. There was no significant relationship between the type of offence, victim relationship, and previous criminal history with self-harming behavior. Conclusion: Forensic psychiatry inpatients should have close observation, screening, monitoring, and individual tailored management strategies for self-harming behaviors. The findings of this study indicate that forensic system-related factors, especially those that pertain to the status of individuals in the forensic system (i.e., unfit to stand trial and being an inpatient) are more responsible for self-harming behaviors among forensic patients in Ontario. [ABSTRACT FROM AUTHOR]

Background: Those who detransition have received increased public and scholarly attention and their narratives are often presented as evidence of limitations with contemporary gender-affirming care practices. However, there are scant empirical studies about how this population experienced their own process of gaining access to gender-affirming medical/surgical interventions, or their recommendations for care practice. Aims: To qualitatively explore the care experiences and perspectives of individuals who discontinued or reversed their gender transitions (referred to as detransition). Methods: Between October 2021-January 2022, Canadian residents aged 18 and older with experience of stopping, shifting, or reversing a gender transition were invited to participate in semi-structured, one-on-one, virtual interviews. A purposive sample of 28 was recruited by circulating study adverts over social media, to clinicians in six urban centres, and within participants' social networks. Interviews ranged between 50–90 minutes, were audio-recorded, and transcribed verbatim. Following constructivist grounded theory methodology, interview data were analyzed inductively and thematically following a two-phase coding process to interpret participants' experiences of, and recommendations for, gender care. Results: Participants were between the ages of 20–53 (71% were between 20–29). All participants identified along the LGBTQ2S+ spectrum. Twenty-seven out of 28 of the participants received medical/surgical interventions (60% were ages 24 and younger). A majority (57%) reported three or more past gender identities, with 60% shifting from a binary transgender identity at the time of initiating transition to a nonbinary identity later in their transition journey. To access medical/surgical interventions, most participants were assessed via the gender-affirming care model pathway and also engaged in talk therapy with a mental healthcare provider such as a psychologist or psychiatrist. Some participants experienced their care as lacking the opportunity to clarify their individual treatment needs prior to undergoing medical/surgical transition. Decisional regret emerged as a theme alongside dissatisfaction with providers' "informed consent" procedures, such that participants felt they would have benefitted from a more robust discussion of risks/benefits of interventions prior to treatment decision-making. Overall, participants recommended an individualized approach to care that is inclusive of mental healthcare supports. Conclusions: To optimize the experiences of people seeking and receiving gender care, a thorough informed consent process inclusive of individualized care options is recommended, as outlined by the World Professional Association of Transgender Health, standards of care, version 8. [ABSTRACT FROM AUTHOR]

Topic: Globally, the COVID‐19 pandemic had impacted the health care delivery including inpatient psychiatric facilities. Within psychiatric settings, life of inpatients was profoundly altered. Purpose: This paper aimed to understand if pandemic‐related changes within an inpatient Eating Disorder Unit in a specialized psychiatric hospital in Ontario, Canada impacted incidence of aggression and use of coercive methods among adolescents. Source Used: An exploratory study design was used to examine incidence of aggression, self‐harm, code whites, staff assist, restraints and seclusion, and nasogastric feeding (NGF) among adolescents with eating disorders before and after the modified service delivery within the inpatient unit. Descriptive analyses were conducted. Results: Analyses revealed a complete reduction in episodes of self‐harm, aggression, staff assists, use of restraint and seclusion as well as an 80.14% reduction on average use of NGF. Conclusion: Authors speculate that the change in environment and program delivery method, peer influence, and shift in power relations between patient and staff may have resulted in improved experiences. This report provides insights to adopt a recovery‐oriented service delivery for adolescents with eating disorders in inpatient settings. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to provide a preliminary evaluation of treatment outcomes, retention and client satisfaction following a 12-week combined cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) group treatment for cannabis use disorder (CUD) delivered in an outpatient setting. Implementation of the program is also described. Methods: A retrospective observational cohort study was conducted using data collected from medical records and self-report assessments. Participants were treatment-seeking cannabis users at the Centre for Addiction and Mental Health, Toronto. Cannabis use, cannabis-related problems, craving, withdrawal symptoms, self-efficacy for remaining abstinent, depression and anxiety were assessed pre- and post-treatment. Treatment retention was calculated by inspecting clinic attendance records, and client satisfaction was evaluated using an anonymous feedback survey. Potential predictors of treatment outcomes and retention were investigated in exploratory analyses. Results: Cannabis use was lower and days of abstinence higher post-treatment (vs pre-treatment). Post-treatment improvements in cannabis-related problems, craving, withdrawal symptoms, self-efficacy and mood were also observed. Completion of group treatment (⩾75% of sessions attended) was 57% and moderate levels of treatment satisfaction were reported. Conclusions: This study provides preliminary evidence that a 12-week combined CBT and MET treatment for cannabis use disorder delivered in a novel group setting improves cannabis use outcomes. Potential predictors of reduced cannabis use and retention were identified. Future controlled studies are warranted, and strategies for increasing retention should be explored. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) is a commonly occurring, yet historically poorly understood, mental health concern among post-secondary students. The present study sought to identify the current knowledge needs of university stakeholders to inform training efforts around effective NSSI response and student support on university campuses. Participants were 1,762 university students, staff, and student-staff (77% female) from seven universities in Canada, the USA, New Zealand, and Australia. Participants completed an online survey about their attitudes and knowledge of both general mental health and NSSI. University stakeholders reported significantly greater stigma toward NSSI than mental illness in general. Student-staff reported greater perceived knowledge and comfort, and demonstrated greater knowledge of NSSI, than students and staff. Findings underscore the need for additional training and resources to reduce stigma and increase knowledge about NSSI on university campuses internationally. [ABSTRACT FROM AUTHOR]

Animals are often prohibited in public areas, which limit opportunities for people to experience improvements in well-being from their presence. Visual representations of animals, such as videos, may serve as an alternative intervention to the physical presence of live animals. University students, in particular, may benefit from virtual animal-assisted interventions, given that they report high rates of stress, and opportunities to interact with live animals at tertiary institutions are generally limited. This study recruited 200 participants from introductory psychology courses through a research participant pool at Toronto Metropolitan University in Canada. Following exposure to a mental arithmetic stressor that was 3 minutes in length, participants were randomly assigned to watch a 3-minute video that featured either a dog, puppy, nature, or blank screen. In light of previous research that found that infantile facial features elicit greater attention and positive affect among viewers compared with mature facial features, this study hypothesized that the video of the puppy would be the most effective at enhancing wellbeing. Data were collected through the Depression Anxiety Stress Scales (DASS-21), Social Phobia Inventory (SPIN), Positive and Negative Affect Schedule (PANAS), Visual Analog Scale (VAS), and the Subjective Appraisal of Video Affects (SAVA). The results revealed that the puppy video produced significantly higher scores of happiness relative to the nature and control videos (F(8.54,557.94) = 3.29, p < 0.001, ηp2= 0.05). Additionally, participants reported that the puppy video was significantly more effective at inducing relaxation compared with the control video (F(3,199) = 7.58, p < 0.001, ηp2 = 0.10). These results suggest that watching a video of a puppy can be useful to improve wellbeing among university students. This study offers novel contributions to the limited literature examining the impact of visual representations of infant animals on stress. [ABSTRACT FROM AUTHOR]