Implementation and evaluation of a curriculum on the assessment and treatment of disruptive behaviour disorders.

Disruptive behaviour disorders (DBDs)-which can include or be comorbid with disorders such as attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder and disruptive mood dysregulation disorder-are commonly seen in paediatric practice. Given increases in the prescribing of atypical antipsychotics for children and youth, it is imperative that paediatric trainees in Canada receive adequate education on the optimal treatment of DBDs. We describe the development, dissemination, and evaluation of a novel paediatric resident curriculum for the assessment and treatment of DBDs in children and adolescents. Pre-post-evaluation of the curriculum showed improved knowledge in participants.

Psilocybin for alcohol use disorder: Rationale and design considerations for a randomized controlled trial.

Several lines of evidence suggest that classic psychedelics (5-HT2A receptor agonists or partial agonists) such as psilocybin might facilitate behavior change in individuals with substance use disorders. We conducted a multi-site, double-blind, randomized controlled trial (RCT) to assess the effects of psilocybin-assisted psychotherapy in alcohol-dependent volunteers. In addition to a structured 12-week psychotherapy platform, participants (n = 96) were randomly assigned (1:1) to receive either oral psilocybin or an active placebo (oral diphenhydramine) in each of two dosing sessions (at weeks 4 and 8). Initial doses were 25 mg/70 kg psilocybin or 50 mg diphenhydramine, which could be increased in the second session depending on initial response. The psychotherapy platform combined evidence-based, manualized therapy for alcohol dependence with a supportive context for the dosing sessions. All participants were followed in the RCT through week 36. At the end of the RCT, participants who still met safety criteria were offered an open-label psilocybin session. Data collected at screening, baseline and throughout the study included: demographics, measures of alcohol use, subjective response to psilocybin and diphenhydramine, and safety measures. The primary outcome was the proportion of heavy drinking days during the 32 weeks after the first dosing session (i.e., between week 4 and week 36). Secondary outcomes included safety, additional measures of drinking (e.g., abstinence, drinking days, etc.), craving, self-efficacy, and acute effects. We will also explore moderators and mediators of the primary outcome. The primary outcomes will be published elsewhere. In this paper, we describe the protocol and rationale for our design decisions.

Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial.

Importance: Although classic psychedelic medications have shown promise in the treatment of alcohol use disorder (AUD), the efficacy of psilocybin remains unknown. Objective: To evaluate whether 2 administrations of high-dose psilocybin improve the percentage of heavy drinking days in patients with AUD undergoing psychotherapy relative to outcomes observed with active placebo medication and psychotherapy. Design, Setting, and Participants: In this double-blind randomized clinical trial, participants were offered 12 weeks of manualized psychotherapy and were randomly assigned to receive psilocybin vs diphenhydramine during 2 day-long medication sessions at weeks 4 and 8. Outcomes were assessed over the 32-week double-blind period following the first dose of study medication. The study was conducted at 2 academic centers in the US. Participants were recruited from the community between March 12, 2014, and March 19, 2020. Adults aged 25 to 65 years with a DSM-IV diagnosis of alcohol dependence and at least 4 heavy drinking days during the 30 days prior to screening were included. Exclusion criteria included major psychiatric and drug use disorders, hallucinogen use, medical conditions that contraindicated the study medications, use of exclusionary medications, and current treatment for AUD. Interventions: Study medications were psilocybin, 25 mg/70 kg, vs diphenhydramine, 50 mg (first session), and psilocybin, 25-40 mg/70 kg, vs diphenhydramine, 50-100 mg (second session). Psychotherapy included motivational enhancement therapy and cognitive behavioral therapy. Main Outcomes and Measures: The primary outcome was percentage of heavy drinking days, assessed using a timeline followback interview, contrasted between groups over the 32-week period following the first administration of study medication using multivariate repeated-measures analysis of variance. Results: A total of 95 participants (mean [SD] age, 46 [12] years; 42 [44.2%] female) were randomized (49 to psilocybin and 46 to diphenhydramine). One participant (1.1%) was American Indian/Alaska Native, 3 (3.2%) were Asian, 4 (4.2%) were Black, 14 (14.7%) were Hispanic, and 75 (78.9%) were non-Hispanic White. Of the 95 randomized participants, 93 received at least 1 dose of study medication and were included in the primary outcome analysis. Percentage of heavy drinking days during the 32-week double-blind period was 9.7% for the psilocybin group and 23.6% for the diphenhydramine group, a mean difference of 13.9%; (95% CI, 3.0-24.7; F1,86 = 6.43; P = .01). Mean daily alcohol consumption (number of standard drinks per day) was also lower in the psilocybin group. There were no serious adverse events among participants who received psilocybin. Conclusions and Relevance: Psilocybin administered in combination with psychotherapy produced robust decreases in percentage of heavy drinking days over and above those produced by active placebo and psychotherapy. These results provide support for further study of psilocybin-assisted treatment for AUD. Trial Registration: ClinicalTrials.gov Identifier: NCT02061293.

The Best of Both Worlds: Resident Experiences of Urban and Regional Contexts in a Hybrid Pediatrics Residency Program.

BACKGROUND: The context for specialty residency training in pediatrics has broadened in recent decades to include distributed community sites as well as academic health science centers. Rather than creating parallel, community-only programs, most programs have expanded to include both community and large urban tertiary health center experiences. Despite these changes, there has been relatively little research looking at residents' experiences in these distributed graduate medical education programs. OBJECTIVE: A longitudinal case study was undertaken to explore the experiences of residents in a Canadian pediatrics residency program that involved a combination of clinical placements in a large urban tertiary health center and in regional hospitals. METHODS: The study drew on 2 streams of primary data: 1-on-1 interviews with residents at the end of each block rotation and annual focus groups with residents. RESULTS: A thematic analysis (using grounded theory techniques) of transcripts of the interviews and focus groups identified 6 high-level themes: access to training, quality of learning, patient mix, continuity of care, learner roles, and residents as teachers. CONCLUSIONS: Rather than finding that certain training contexts were "better" than others when comparing residents' experiences of the various training contexts in this pediatrics residency, what emerged was an understanding that the different settings complemented each other. Residents were adamant that this was not a matter of superiority of one context over any other; their experiences in different contexts each made a valuable contribution to the quality of their training.

Experience with image-guided gastrostomy and gastrojejunostomy tubes in children and adolescents with primary psychiatric illness.

OBJECTIVE: To investigate the clinical experience with G/GJ tubes in child and adolescent psychiatry patients with disordered eating. METHOD: Health Records and Image-Guided Therapy databases (1995-2005) identified patients with primary psychiatric illness who received radiologically placed G/GJ tubes for refeeding. Patient charts were reviewed for relevant data. RESULTS: Nine patients who were 11-17 years old had G/GJ tubes inserted for refeeding as a result of their psychopathology. Prior to G/GJ tube insertion, adolescent inpatients were fed by NG/NJ tube for 0.5-7.3 months (mean 3.1 months) and subsequently fed by G/GJ tube for 5-60 months (mean 29 months) on an outpatient basis. No major complications or episodes of intentional tube manipulation/removal occurred. G/GJ tube feeding was effective in restoring and/or maintaining weight. CONCLUSION: Image-guided enterostomy tubes are a safe and well-tolerated method for feeding pediatric patients with psychiatric disorders and food refusal, and allow outpatient management of underlying psychopathology.