Department of Psychiatry
Permanent URI for this collectionhttps://hdl.handle.net/1807/16986
Housing 682 active faculty members each within one of the departments 14 academic divisions or programs, the Department of Psychiatry at the University of Toronto is now considered one of the largest worldwide. Ever since founded in 1908, the department, as it had always been, is dedicated in carrying out research and the education and training of students of the Medical School. The department is also extremely supportive of Continuing Education as it is the most active provider of Continuing Mental Health Education (CMHE) as well as providing leadership to the Ontario Psychiatric Outreach Program (OPOP).
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Item Mediating wife assault: Battered women and the "new family."(University of British Columbia Allard School of Law, 1991) Hilton, N. ZoeAs the battered women's movement was fighting to politicize wife assault, a movement towards mediation services in and around tie court system was also growing. Today, cases of wife assault and other disputes involving battered women and their partners may be channelled into mediation, where assumptions of equality in the family offer little or no protection to the battered woman. This paper presents the growth of mediation and the effects of mediation philosophy as examples of the failure of reform based on a concept of the public and private as distinct spheres. The public/ private dichotomy is now of limited use to feminist arguments, for mediation, although it has limited public accountability, is interdependent with the more formal court process. This study of the ramifications of mediation offers evidence that the theme of the new, egalitarian family is seeping into the family court system, where it conflicts with the more traditional view of the dependent wife, to the disadvantage of battered women. Fighting for formal legal intervention alone fails to address other legal processes and ideologies faced by battered women. Awareness of both formal and administrative justice, and recognition of the ways in which they interact are essential for addressing the legal response to wife assault. Toward this end, a revised conceptualization of the public and private distinction is encouraged.Item Religiosity is associated with less prediction of the typical: An event-related brain potential study(Elsevier, 2020-03-29) Kiang, Michael; Cupid, Justice; Ahmed, Sarah; Lepock, Jennifer R; Girard, Todd AWhy are some people more religious than others? According to one hypothesis, people who strongly seek definitive explanations for situations with incomplete information are more likely to be religious. According to a different hypothesis, individuals with smaller "prediction error" responses to unexpected stimuli are more likely to discount evidence contradicting religious beliefs, predisposing them to maintain such beliefs. We sought neurophysiological evidence for these hypotheses using the N400 event-related potential (ERP), which is smaller to more contextually expected stimuli, reflecting prediction of probable completions for meaningful situations. We recorded ERPs from participants viewing category definitions followed by high-typicality category exemplar (HTE), low-typicality exemplar (LTE), or non-exemplar (NE) words. As expected, N400s were largest for NEs, intermediate for LTEs, and smallest for HTEs. Religiosity correlated with smaller N400 amplitude differences between HTEs and both LTEs and NEs. Less strong prediction of probable stimuli based on prior information may predispose to religiosity.Item Attachment security and existential distress among patients with advanced cancer(Elsevier, 2018-11-27) Vehling, S; Tian, Y; Malfitano, C; Shnall, J; Watt, S; Mehnert, A; Rydall, A; Zimmermann, C; Hales, S; Lo, C; Rodin, GFelt security in close relationships may affect individual adaptation responses to existential threat in severe illness. We examined the contribution of attachment security to demoralization, a state of existential distress involving perceived pointlessness and meaninglessness in advanced cancer.Item The Assessment of Mentalization: Measures for the Patient, the Therapist and the Interaction(Springer, 2019-04-08) Shaw, Chloe; Lo, Chris; Lanceley, Anne; Hales, Sarah; Rodin, GaryPurpose: Mentalization has been clearly defined in the literature as a relational concept and yet in surveys and transcript-based measures it is almost universally treated as an individual capacity. That approach has value but may not capture the emergent nature of mentalization, as it is jointly constructed within a relational context. Methods: We report here on a critical evaluation of measurement approaches commonly used to conceptualize and assess mentalization and argue for the value of conversation analysis (CA) as an alternative approach. Results: A variety of approaches have been shown to have utility in assessing mentalization as an individual capacity. We illustrate how conversation analysis allows for an in-depth-analysis of mentalization as it is co-created across different contexts in real-life therapy sessions. This method of analysis shifts the focus from content to process. Conclusion: Conversation analysis is a potentially valuable tool to support training, to assess treatment integrity, and to improve outcomes with mentalization-based interventions.Item Mentalization in CALM psychotherapy sessions: Helping patients engage with alternative perspectives at the end of life(Elsevier, 2018-10-03) Shaw, Chloe; Chrysikou, Vasiliki; Lanceley, Anne; Lo, Chris; Hales, Sarah; Rodin, GaryObjective: To identify how therapists invite patients with advanced cancer to engage with alternative perspectives about their illness trajectory and their end of life. Methods: Sequences of talk in which a therapist introduced a patient to alternative perspectives, were transcribed and analysed using the method of conversation analysis. Results: The analysis identifies one subtle way a patient is invited to consider an alternative perspective relating to their disease progression. Meaning expansion enquiries invite the patient to expand on the meaning of an utterance and in doing so, implicitly problematize the singularity of the patient’s assumptions, without directly challenging them. The questions work as preliminary moves, providing the patient with the opportunity to expand on their assumptions. This enables the therapist to subsequently present an alternative perspective in a way that incorporates the patient’s expanded perspective. Conclusion: The analysis reveals a skillful way in which therapists can cautiously and collaboratively introduce a patient to alternative perspectives concerning end-of-life, without invalidating the patient’s perspective in this particularly delicate context. Practice Implications: Whilst mentalization is considered an important therapeutic process, the present study reveals precisely how this phenomenon can be enacted in therapy and within the particularly challenging context of end-of-life.Item Pain in patients with newly diagnosed or relapsed acute leukemia(Springer, 2018-12-18) Shaulov, Adir; Rodin, Gary; Popovic, Gordana; Caraiscos, Valerie B; Le, Lisa W; Rydall, Anne; Schimmer, Aaron D; Zimmermann, CamillaBackground: Acute leukemia (AL) is associated with substantial morbidity and mortality. We assessed the prevalence and correlates of pain in patients with newly-diagnosed or relapsed AL. Methods: Patients with newly-diagnosed or relapsed AL admitted to a comprehensive cancer center completed the Memorial Symptom Assessment Scale (MSAS), which assesses prevalence, severity and distress associated with pain and other symptoms. Factors associated with severe pain were assessed using logistic regression. Two raters completed chart reviews in duplicate for patients with severe pain (MSAS severity ≥3/4) to determine the site of pain. Results: In total, 318 patients completed questionnaires; 245 (77.0%) had acute myeloid or acute promyelocytic leukemia (AML/APL) and 73 (23.0%) had acute lymphoblastic leukemia (ALL); 289 (90.91%) were newly-diagnosed and 29 (9.1%) had relapsed disease. Pain was reported in 156/318 (49.2%), and 55/318 (17.3%) reported severe pain (≥3/4). Pain was associated with all psychological symptoms (all p<0.005) and some physical symptoms. Severe pain was associated with younger age (p=0.02), worse performance status (p=0.04), ALL diagnosis (p=0.04) and time from onset of chemotherapy (p=0.03), with pain peaking at 4 weeks after chemotherapy initiation. The most common sites of severe pain were oropharynx (22; 40%), head (12; 21.8%) and abdomen (11; 20%). Only 3 patients (0.9%) were referred to the symptom control/palliative care team during the month prior to or following assessment. Conclusions: Pain is frequent, distressing and predictable in patients undergoing induction chemotherapy for AL. Further research is needed to assess the efficacy of early supportive care in this population.Item Managing Cancer and Living Meaningfully (CALM): A Randomized Controlled Trial of a Psychological Intervention for Patients With Advanced Cancer(American Society of Clinical Oncology, 2018-08-10) Rodin, Gary; Lo, Christopher; Rydall, Anne; Shnall, Joanna; Malfitano, Carmine; Chiu, Aubrey; Panday, Tania; Watt, Sarah; An, Ekaterina; Nissim, Rinat; Li, Madeline; Zimmermann, Camilla; Hales, SarahPurpose: Individuals with advanced cancer experience substantial distress in response to disease burden and impending mortality. Managing Cancer And Living Meaningfully (CALM) is a novel, brief, manualized psychotherapeutic intervention intended to treat and prevent depression and end-of-life distress in patients with advanced cancer. We conducted a randomized controlled trial to compare CALM with usual care (UC) in this population. Methods: Patients with advanced cancer were recruited from outpatient oncology clinics at a comprehensive cancer center into an unblinded randomized controlled trial. Permuted block randomization stratified by Patient Health Questionnaire-9 depression score allocated participants to CALM plus UC or to UC alone. Assessments of depressive symptoms (primary outcome), death-related distress, and other secondary outcomes were conducted at baseline, 3 months (primary end point), and 6 months (trial end point). Analyses were by intention to treat. Analysis of covariance was used to test for outcome differences between groups at follow-up, controlling for baseline. Mixed-model results are reported. Results: Participants (n = 305) were recruited between February 3, 2012, and March 4, 2016, and randomly assigned to CALM (n = 151) or UC (n = 154). CALM participants reported less-severe depressive symptoms than UC participants at 3 months (Δ = 1.09; P = .04; Cohen's d = 0.23; 95% CI, 0.04 to 2.13) and at 6 months (Δ = 1.29; P = .02; d = 0.29; 95% CI, 0.24 to 2.35). Significant findings for greater end-of-life preparation at 6 months also favored CALM versus UC. No adverse effects were identified. Conclusion: Findings suggest that CALM is an effective intervention that provides a systematic approach to alleviating depressive symptoms in patients with advanced cancer and addresses the predictable challenges these patients face.Item Emotion And Symptom-focused Engagement (EASE): a randomized phase II trial of an integrated psychological and palliative care intervention for patients with acute leukemia(Springer, 2019-04-17) Rodin, Gary; Malfitano, Carmine; Rydall, Anne; Schimmer, Aaron; Marmar, Charles M; Mah, Kenneth; Lo, Christopher; Nissim, Rinat; Zimmermann, CamillaPURPOSE: We designed a novel, manualized intervention called Emotion And Symptom-focused Engagement (EASE) for acute leukemia (AL) and report here on a phase II randomized controlled trial (RCT) to assess its feasibility and preliminary efficacy. METHODS: Patients were recruited within 1 month of hospital admission and randomized to EASE plus usual care (UC) or UC alone. EASE includes: 1) EASE-psy, a tailored psychotherapy delivered over 8 weeks; and 2) EASE-phys, weekly physical symptom screening over 8 weeks to trigger early palliative care. The primary outcome was traumatic stress symptoms; secondary outcomes included physical symptom burden and quality of life. Assessments were conducted at baseline, 4, 8 and 12 weeks. Between-group differences were evaluated using multilevel modeling. RESULTS: Forty-two patients were randomized to EASE (n=22) or UC (n=20), with 76% retention at 12 weeks. Predefined feasibility outcomes were met: 86% (19/22) of EASE participants completed ≥50% of EASE-psy sessions (goal ≥64%); 100% received Edmonton Symptom Assessment System (ESAS, modified for AL) screenings, 64% (14/22) of whom completed ≥50% of planned screenings (goal ≥50%); and 100% with scores ≥4/10 on any physical ESAS-AL item had ≥1 meeting with the EASE-phys team (goal 100%). Significant treatment-group differences favouring EASE were observed in traumatic stress symptoms at 4 and 12 weeks, and pain intensity and interference at 12 weeks (all p<.05). CONCLUSIONS: EASE is feasible in patients newly-diagnosed with AL and shows promise of effectiveness. These results warrant a larger RCT to provide evidence for its more routine use as a standard of care.Item The experience of medical communication in adults with acute leukemia: Impact of age and attachment security(Wiley, 2019-01-16) Fraser, Brooke; Korenblum, Chana; Mah, Kenneth; Watt, Sarah; Malfitano, Carmine; Rydall, Anne; Schimmer, Aaron; Zimmermann, Camilla; Rodin, GaryHealth care providers' (HCPs) communication with cancer patients provides both information and support. Younger patient age and greater difficulty accepting support (attachment security) have been linked to poorer communication experiences with HCPs. The present secondary data analysis examined the impact of age group and attachment security on perceived communication problems with HCPs in adults with acute leukemia (AL).Item Demoralization and death anxiety in advanced cancer(Wiley, 2018-11-05) An, Ekaterina; Lo, Christopher; Hales, Sarah; Zimmermann, Camilla; Rodin, GaryThe circumstances of advanced cancer can cause considerable psychological distress, including death anxiety and demoralization. Although these states of existential distress have a negative impact on the quality of life of patients with advanced cancer, they are rarely evaluated as outcomes or targets of interventions in this population. In an effort to improve understanding of existential distress, a structural model of relationships among death anxiety, demoralization, symptom burden, and social relatedness was tested in patients with advanced cancer.Item Impact of medical assistance in dying (MAiD) on family caregivers(BMJ Journals, 2019-03-01) Goldberg, Rachel; Nissim, Rinat; An, Ekaterina; Hales, SarahMedical assistance in dying (MAiD) is a globally polarising topic which often sparks debate surrounding the ethical and moral dilemmas that arise with a life-ending intervention. To gain a better understanding of this intervention, it is important to explore the experience of those most intimately affected by MAiD. Family caregivers of those with a terminal illness are the backbone of the healthcare and support team, often providing a substantial amount of informal care while at the same time coping with their own distress and anticipatory grief. However, we know the least about how MAiD impacts the psychosocial well-being of these same individuals. The aim of this article is to explore the experience of MAiD from the family caregiver perspective, namely their beliefs and opinions about the intervention, how the process of MAiD impacts them, how the intervention shapes their view of their loved one's quality of death, and the psychosocial outcomes after the passing of their loved one. Beyond the literature, challenges within both the clinical and research realms will be discussed and future directions will be offered. While MAiD is currently legal in only a small number of countries, a better understanding of the impact of MAiD will help inform policy and legislation as they are developed in other jurisdictions. Further, this article aims to inform future research and clinical interventions in order to better understand and support those seeking MAiD and their families.Item Assessment of Risk for Seclusion Among Forensic Inpatients: Validation and Modification of the Risk of Administrative Segregation Tool (RAST)(Sage Publishing, 2019-02-01) Hilton, N. Zoe; Ham, Elke; Seto, Michael C.Seclusion is used in psychiatric care to protect patients and staff or to manage aggression but may have adverse effects. The ability to identify at-risk patients could help reduce seclusion. This study tested the Risk of Administrative Segregation Tool’s (RAST) ability to predict any seclusions among 229 male forensic inpatients followed for up to 1 year of hospitalization, and days spent secluded, controlling for length of stay. RAST scores were lower than in correctional samples. The RAST did not predict seclusions in Year 1, but modification of three items to fit the forensic population (RAST-F) offered a small improvement. Among 62 patients hospitalized for more than 1 year, the RAST significantly predicted seclusions in Year 2, and the modifications improved prediction. The present modest findings support the RAST’s potential to help identify patients most in need of clinical efforts to avert seclusion. Replication in larger samples, including female patients, is needed.Item Contesting Mad versus Bad: The Evolution of Forensic Mental Health Services and Law at Toronto(2014) Court, John PM; Simpson, Alexander IF (Sandy); Webster, Christopher DWe analyze relevant aspects in the history of forensic mental health services in the Toronto area, which offers a well-documented historical record for contextualizing current public debates and controversies. Spanning the late 18th century to the present, we trace the development of common and statute law, and service responses in the forensic and criminal justice systems, through the evolution of asylums to latter-day psychiatric facilities and services. Addressing themes of evolving interfaces between the practices of law and mental health care reveals that the balance, as enacted in law and interpreted by the courts, has generally favoured legal interpretations of mental illness, despite psychiatry’s steadily increasing claim to superior insights and evidence on what constitutes mental illness in juridical contexts. The experience of forensic psychiatry over this 200-year period points to relevant implications for continued refinement of legal, court and clinical provisions for this service, and directions for future research.Item The Stricklands: Living and Working at Queen Street a Century Ago(2008) Court, John PMItem An Erosion of Imagination: Unfulfilled Plans for a University Botanical Gardens and Taddle Creek, 1850 to 1884.(Ontario Historical Society, 2003) Court, John PMItem Book Review: _Academic Freedom in Canada: A History_, by Michiel Horn (University of Toronto Press, 1999, ISBN 0-8020-0726-0).(Association of Canadian Archivists (ACA), 1999) Court, John PMItem Historical Synopsis – The Department of Psychiatry at the University of Toronto(Department of Psychiatry, Faculty of Medicine, University of Toronto, 2011) Court, John PMThe initial version of this brief account of the Department of Psychiatry’s origins and founding (web-published, 2004) ranged from 1845 to 1925. This updated synopsis extends the account, as a convenient chronological marker, to the Department’s centenary year, 2007-08. A more substantial focus remains on the pre-history and early history, since those eras were lived before the life experiences of most of us, and have not been documented to the same extent as the more recent events in the life of our Department.Item Recruiting a Scientific Enigma: Ramsay Wright at the University of Toronto and its Reconstituted Medical School, 1874–1912(2010) Court, John PMRamsay Wright was appointed in 1874 to the University of Toronto’s Chair in Natural History through an advertised competition designed to replace patronage with adjudicating candidates on merit. An absence of transparency and inconsistencies in the outcome, however, provoke doubts that the process was pursued fairly to acquire the most qualified candidate. Premier Mowat passed over eminently-qualified Canadians for this inexperienced Edinburgh lab tutor. The Darwinian orientation of his education together with training in the German scientific research methods, although sub rosa criteria because of their political contentiousness, appear to have been decisive for Wright’s selection. From archival evidence, this study contrasts the recently-enacted protocol for fair, objective faculty recruitment with the shadowy process through which Wright was chosen. Once installed, with sparkling lecturing skills and the benefit of mentoring, Wright sidestepped his modest research output to progress in administration. Passed over for Toronto’s presidency, he diverged to embrace a later-discredited aspect of evolution, advocating publicly for human eugenics. Wright retired to Oxford in 1912, after which the more engaging aspects of his persona were periodically burnished for the university’s commemorative contexts.Item Introducing Darwinism to Toronto's post-1887 Reconstituted Medical School(2011) Court, John PMCharles Darwin's scientific paradigm was largely welcomed in Canadian academic biology and medicine, while reaction among other faculty and lay-people ranged from interest to outrage. In 1874, Ramsay Wright, a Darwinian-era biologist from Edinburgh, was appointed to the University of Toronto's Chair of Natural History. Over his 38-year career Wright integrated the evolutionary perspective into medical and biology teaching without accentuating its controversial source. He also applied the emerging German experimental research model and laboratory technology. This study identifies five categories of scientific and personal influences upon Wright through archival research on biographical sources and his writings.