Mapping the future of interventional psychiatry for the obsessive-compulsive related disorders: A scoping review.

Body dysmorphic disorder (BDD), hoarding disorder (HD), skin-picking disorder (SPD), and hair-pulling disorder (HPD) are characterized by compulsive behaviours leading to distress and impairment. Current treatments attain only partial or non-response. Interventional psychiatric approaches may target specific regions of the brain for treatment. This scoping review maps the current literature and synthesizes key findings. Databases were searched up to June 27, 2022 for studies examining interventional psychiatric treatments for BDD, HD, SPD, and HPD, producing 910 results. Twenty were included; 16 were case reports, two were case series, and two were randomized controlled trials. Studies reported on electroconvulsive therapy (ECT) (n=7), deep brain stimulation (DBS) (n=1), and intermittent theta-burst stimulation repetitive transcranial magnetic stimulation (rTMS) (n=1) for BDD; rTMS (n=1) and transcranial direct current stimulation (n=1) for HD; gamma knife capsulotomy (n=1) and rTMS (n=1) for SPD; and rTMS (n=2) and ECT (n=1) for HPD. Four studies reported on DBS for other indications complicated by SPD or HPD. The current literature consists mainly of case reports. Future studies should be randomized, controlled, adequately powered and blinded, examining rTMS localized to the anatomical targets for each disorder. Presently, the mainstay of treatment remains disorder-specific psychotherapy with limited evidence for medications.

Psychotherapies and digital interventions for OCD in adults: What do we know, what do we need still to explore?

BACKGROUND: Despite significant advances in the understanding and treatment of obsessive compulsive disorder (OCD), current treatment options are limited in terms of efficacy for symptom remission. Thus, assessing the potential role of iterative or alternate psychotherapies is important. Also, the potential role of digital technologies to enhance the accessibility of these therapies, should not be underestimated. We also need to embrace the idea of a more personalized treatment choice, being cognisant of clinical, genetic and neuroimaging predictors of treatment response. PROCEDURES: Non-systematic review of current literature on emerging psychological and digital therapies for OCD, as well as of potential biomarkers of treatment response. FINDINGS: A number of 'third wave' therapies (e.g., Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy) have an emerging and encouraging evidence base in OCD. Other approaches entail employment of elements of other psychotherapies such as Dialectical Behaviour Therapy; or trauma-focussed therapies such as Eye Movement Desensitisation and Reprocessing, and Imagery Rescripting and Narrative Therapy. Further strategies include Danger Ideation Reduction Therapy and Habit Reversal. For these latter approaches, large-scale randomised controlled trials are largely lacking, and the precise role of these therapies in treating people with OCD, remains to be clarified. A concentrated 4-day program (the Bergen program) has shown promising short- and long-term results. Exercise, music, and art therapy have not been adequately tested in people with OCD, but may have an adjunctive role. Digital technologies are being actively investigated for enhancing reach and efficacy of psychological therapies for OCD. Biomarkers, including genetic and neuroimaging, are starting to point to a future with more 'personalised medicine informed' treatment strategizing for OCD. CONCLUSIONS: There are a number of potential psychological options for the treatment of people with OCD who do not respond adequately to exposure/response prevention or cognitive behaviour therapy. Adjunctive exercise, music, and art therapy might be useful, albeit the evidence base for these is very small. Consideration should be given to different ways of delivering such interventions, including group-based, concentrated, inpatient, or with outreach, where appropriate. Digital technologies are an emerging field with a number of potential applications for aiding the treatment of OCD. Biomarkers for treatment response determination have much potential capacity and deserve further empirical testing.

Characterizing the content, messaging, and tone of trichotillomania on YouTube: A content analysis.

BACKGROUND: Trichotillomania is associated with secrecy and reluctance to seek help due to shame and lack of knowledge. Social media can connect people with similar lived experience. However, there is no literature regarding online communities related to trichotillomania. This study is a content analysis of depictions of trichotillomania on YouTube to identify the potential role of social media in this disorder. METHODS: We used a cross-sectional observational study to examine the 100 most-viewed YouTube videos for trichotillomania content until June 2018. Up to 96 variables were abstracted from each video including demographics, characteristics of the videos, and depictions of trichotillomania. RESULTS: View counts ranged from 9,186 to 15,597,149. Uploaders had a mean age of 20.1 years, were mostly female (85%) and appearing Caucasian (63%). Nearly half of the videos were self-filmed stories (48%). Most had a neutral message (44%), provided strategies to stop hair-pulling (31%), or focused on stimulating discussion (17%). Approximately half had a factual tone (51%) and many were hopeful (44%). Videos accurately described hair-pulling and associated characteristics. LIMITATIONS: This study was limited to an analysis of video content. Future research should examine the comments on the videos as well as other social media platforms. It may also be important to assess the socioeconomic status of video uploaders and ensure the broader accessibility of positive messages on trichotillomania. CONCLUSIONS: People with trichotillomania may find positive messages, information, and helpful recommendations on YouTube. This may represent an under-leveraged venue to improve clinical outcomes for people with trichotillomania.

A Population-Based Susceptible, Infected, Recovered Simulation Model of the Spread of Influenza-Like-Illness in the Homeless versus Non-Homeless Population.

PURPOSE: To examine the prevalence and characteristics of influenza-like illness (ILI) related presentations among people experiencing homelessness compared to the general population as well as to use the Susceptible, Infected, Recovered (SIR) simulation model parameters ß and γ to model infectious interactivity, recovery rate, and population-level basic reproduction number (R0). METHODS: Using administrative health data from emergency department (ED) visits in the province of Ontario, Canada from 2010 to 2017, an SIR model was used to calculate the R0 for ILI in both the general population and the population of homeless individuals. RESULTS: From 2010 to 2017, a total of 17,056 homeless and 85,553 non-homeless individuals presented with an ILI to an ED in Ontario. The estimated infectious interactivity (ß) was lower while the recovery rate (γ) was longer for infected people experiencing homelessness. CONCLUSIONS: Our results suggest that infections of ILI will result in more secondary cases in the homeless population compared to the homed population. This evaluation of the dynamics of ILI spread in the homeless population provides insight into how illnesses such as COVID-19 may be much more infectious in this population compared to the homed population.

Hard-to-Reach Populations and Administrative Health Data: A Serial Cross-sectional Study and Application of Data to Improve Interventions for People Experiencing Homelessness.

BACKGROUND: Intervention studies with vulnerable groups in the emergency department (ED) suffer from lower quality and an absence of administrative health data. We used administrative health data to identify and describe people experiencing homelessness who access EDs, characterize patterns of ED use relative to the general population, and apply findings to inform the design of a peer support program. METHODS: We conducted a serial cross-sectional study using administrative health data to examine ED use by people experiencing homelessness and nonhomeless individuals in the Niagara region of Ontario, Canada from April 1, 2010 to March 31, 2018. Outcomes included number of visits; unique patients; group proportions of Canadian Triage and Acuity Scale (CTAS) scores; time spent in emergency; and time to see an MD. Descriptive statistics were generated with t tests for point estimates and a Mann-Whitney U test for distributional measures. RESULTS: We included 1,486,699 ED visits. The number of unique people experiencing homelessness ranged from 91 in 2010 to 344 in 2017, trending higher over the study period compared with nonhomeless patients. Rate of visits increased from 1.7 to 2.8 per person. People experiencing homelessness presented later with higher overall acuity compared with the general population. Time in the ED and time to see an MD were greater among people experiencing homelessness. CONCLUSIONS: People experiencing homelessness demonstrate increasing visits, worse health, and longer time in the ED when compared with the general population, which may be a burden on both patients and the health care system.

Characterizing people experiencing homelessness and trends in homelessness using population-level emergency department visit data in Ontario, Canada.

BACKGROUND: Data on people experiencing homelessness often come from time- and labour-intensive cross-sectional counts and surveys from selected samples. This study uses comprehensive administrative health data from emergency department (ED) visits to enumerate people experiencing homelessness and characterize demographic and geographic trends in the province of Ontario, Canada, from 2010 to 2017. DATA AND METHODS: People experiencing homelessness were identified by their postal code, designated as "XX." Outcomes included the number of people experiencing homelessness stratified by year and week, gender and age plotted annually, the location of each ED visit, and composition changes in demographics and geographic distribution. RESULTS: Over seven years, 39,408 individuals were identified as experiencing homelessness. The number of ED visits increased over the study period in all of Ontario. The average peak in the number of visits occurred annually in September, with the fewest visits in January. Rises in overall homelessness were secondary to increases in working-age homelessness. ED presentations were concentrated in urban centres. The total proportion of patients experiencing homelessness became less concentrated in Toronto, decreasing from 60% to 40% over the study period, with a shift toward EDs outside the city. DISCUSSION: This study shows that administrative health data can provide comprehensive information on demographics and other characteristics analyzed over time. Surveillance can be conducted cost-effectively, and changes can be tracked in real time to allow for services to be coordinated and implemented in a time-sensitive manner.

Health Care While Homeless: Barriers, Facilitators, and the Lived Experiences of Homeless Individuals Accessing Health Care in a Canadian Regional Municipality.

Persons struggling with housing remain significantly disadvantaged when considering access to health care. Effective advocacy for their needs will require understanding the factors which impact their health care, and which of those most concern patients themselves. A qualitative descriptive study through the lens of a transformative framework was used to identify barriers and facilitators to accessing health care as perceived by people experiencing homelessness in the regional municipality of Niagara, Canada. In-person, semi-structured interviews with 16 participants were completed, and inductive thematic analysis identified nine barriers and eight facilitators. Barriers included affordability, challenges finding primary care, inadequacy of the psychiatric model, inappropriate management, lack of trust in health care providers, poor therapeutic relationships, systemic issues, and transportation and accessibility. Facilitators included accessibility of services, community health care outreach, positive relationships, and shelters coordinating health care. Knowledge of the direct experiences of marginalized individuals can help create new health policies and enhance the provision of clinical care.

How research-based theatre is a solution for community engagement and advocacy at regional medical campuses: The Health and Equity through Advocacy, Research, and Theatre (HEART) program.

BACKGROUND: Regional medical campuses are often located in geographic regions that have different populations than the main campus, and are well-positioned to advocate for the health needs of their local community to promote social accountability within the medical school. METHODS: At the Niagara Regional Campus of McMaster University, medical students developed a framework which combined research, advocacy, and theatre to advocate for the needs of the local population of the regional campus to which they were assigned. This involved a qualitative study using semi-structured interviews with homeless individuals to explore their experience accessing the healthcare system and using a transformative framework to identify barriers to receiving quality healthcare services. Findings from the qualitative study informed a play script that presented the experiences of homeless individuals in the local health system, which was presented to health sciences learners and practicing health professionals. Participants completed two instruments to examine the utility of this framework. RESULTS: Research-based theatre was a useful intervention to educate current and future health professionals about the challenges faced by homeless individuals in the region. Participants from both shows felt the framework of research-based theatre was an effective strategy to promote change and advocate for marginalized populations. CONCLUSION: Research-based theatre is an innovative approach which can be utilized to promote social accountability at regional medical campuses, advocating for the health needs of the communities in which they are located, with the added bonus of educating current and future health professionals.