A week long "pep" talk - initial and 2-3-year longitudinal data on the Ottawa Psychiatry Enrichment Program (OPEP).

BACKGROUND: Recruitment to psychiatry as a career has been challenging in Canada and abroad despite the known shortage and increasing burden of psychiatric issues globally. Deterrents to choosing psychiatry as a career include its negative stigma and paucity of knowledge about the field. The study goal was to evaluate the Ottawa Psychiatry Enrichment Program (OPEP), a one-week extracurricular program about psychiatry as a career for 1st and 2nd year medical students. We hypothesized OPEP would improve students' attitudes towards psychiatry, and positive changes would be sustained 2-3 years later following their residency match. We hypothesized there would be a high recruitment of OPEP attendees to psychiatry programs. METHODS: 1st and 2nd year medical students from Canada applied to OPEP. Attendees completed the Attitudes Towards Psychiatry Questionnaire (ATP-30) at three times: before OPEP (PreOPEP), after OPEP (PostOPEP) and after their Canadian Residency Matching Service (CaRMs) match 2-3 years later. OPEP ATP-30 scores were compared to third-year student ATP-30 scores before and after their psychiatry rotation. Data were analysed using Friedman non-parametric ANOVA and post hoc testing by either Wilcoxon rank sum test, Wilcoxon matched pairs signed rank test, or parametric Welch independent t-test as appropriate. Effect sizes of group mean differences were calculated using Cohen's "d". RESULTS: Between 2017-2018, 29/53 Canadian applicants were selected for OPEP. 100%, 93.1% and 75.8% of OPEP students completed the PreOPEP, PostOPEP, and CaRMs ATP-30 surveys respectively. 43% of OPEP attendees matched to psychiatry. PostOPEP ATP-30 scores (mean = 133, median = 137, SD = 10.6) were significantly higher than PreOPEP ATP-30 (mean score = 121, median = 122, SD = 9.3, p < 0.001) and CaRMS ATP-30 (mean = 126, median = 127, SD = 12.3, p < 0.02) scores. OPEP effect size on ATP-30 scores was large (d = 1.2) but decreased 2-3 years later (p = 0.078, d = 0.44). 97/202 students completed the ATP-30 before and after their psychiatry rotation (clerkship). Clerkship effect size on improvement in ATP-30 was moderate (d = 0.39). There was a non-significant difference between OPEP CaRMS ATP-30 and post clerkship ATP-30 scores (median 127 vs 121, p = 0.056). CONCLUSIONS: OPEP ameliorated attitudes toward Psychiatry, but improvement deteriorated longitudinally. Strategies for program design, and innovations to boost/retain improvements during clerkship years are discussed.

Geriatric Psychiatry Teaching in Canadian Medical Schools: a Cross-Sectional Study.

OBJECTIVE: With a growing geriatric population and limited geriatric psychiatrists in Canada, it is crucial to provide sufficient training in geriatric psychiatry during medical school. The authors examined how geriatric psychiatry education is delivered in Canadian medical schools during clerkship. Factors that could be associated with increased geriatric psychiatry teaching in medical schools were examined. The authors were also interested in comparing Canadian to US findings. METHODS: A cross-sectional survey was distributed to the psychiatry medical education representatives attending the Canadian Organization of Undergraduate Psychiatry Educators (COUPE) semi-annual meeting in September 2017. RESULTS: All 17 (100%) medical schools completed the survey. Fifteen of the 17 schools (88%) have geriatric psychiatry-specific learning objectives. Five schools (29%) offer a clinical component in geriatric psychiatry. One school has an award for clerks (6%), and no awards exist for faculty. The number of lecture hours in geriatric psychiatry is moderately correlated with the presence of a geriatric component to psychiatry clerkship (Spearman's rho = 0.67, p = 0.003) and the length of the geriatric portion of clerkship (Spearman's rho = 0.64, p value = 0.006). Lecture hours are also moderately correlated with the presence of a geriatric fellowship (Spearman's rho = 0.68, p value = 0.003). CONCLUSIONS: Geriatric psychiatry clerkship education is inconsistent in Canada. There is virtually no recognition of excellence in teaching or undergraduate performance in this area in clerkship. Geriatric psychiatry may receive more frequent attention in Canadian medical schools than in US medical schools.

Effect of atypical antipsychotics on body weight in geriatric psychiatric inpatients.

BACKGROUND: Studies suggest that antipsychotic-induced weight gain is not a great concern in the elderly population. This study investigated the weight change in elderly patients with various treatment duration and antipsychotics. Part 1 of the study was to determine whether atypical antipsychotics induced weight change in elderly patients. Part 2 was to determine whether certain atypical antipsychotics induced more weight change in elderly patients. METHODS: In Part 1, a retrospective chart review was done on 115 geriatric inpatients. After exclusion, patients were divided into four groups: control (n = 17), new treatment (n = 18), long-term treatment (n = 13), and medication switch groups (n = 8). In Part 2, a retrospective medication review was performed on 169 geriatric inpatients. After exclusion, patients were divided into three groups: aripiprazole (n = 18), olanzapine (n = 49), and risperidone (n = 57). Body weights were obtained at two different time points. RESULTS: No significant difference in weight change was observed among the control (1.5 kg), new treatment (0.8 kg), long-term treatment (-0.3 kg), and medication switch (1.9 kg) groups. No significant difference in weight change was observed between patients with and without dementia (0.8 and 1.1 kg, respectively). The weight change in the aripiprazole group (-2.0 kg; -2.30% from baseline) was significantly different from the weight change in the olanzapine group (0.7 kg; 1.87% from baseline; p < 0.05), but not from the risperidone group (-0.4 kg; -0.45% from baseline). Clinically significant weight gain (>7% increase in body weight) occurred in 14.3% of the olanzapine patients, a percentage significantly higher than the 3.5% in the risperidone group. CONCLUSION: Although atypical antipsychotics were generally weight neutral in the geriatric population, aripiprazole and olanzapine were associated with significant weight loss and weight gain, respectively.

Localization of Nogo-A and Nogo-66 receptor proteins at sites of axon-myelin and synaptic contact.

Axon regeneration in the adult CNS is limited by the presence of inhibitory proteins. An interaction of Nogo on the oligodendrocyte surface with Nogo-66 Receptor (NgR) on axons has been suggested to play an important role in limiting axonal growth. Here, we compare the localization of these two proteins immunohistochemically as a test of this hypothesis. Throughout much of the adult CNS, Nogo-A is detected on oligodendrocyte processes surrounding myelinated axons, including areas of axon-oligodendrocyte contact. The NgR protein is detected selectively in neurons and is present throughout axons, indicating that Nogo-A and its receptor are juxtaposed along the course of myelinated fibers. NgR protein expression is restricted to postnatal neurons and their axons. In contrast, Nogo-A is observed in myelinating oligodendrocytes, embryonic muscle, and neurons, suggesting that Nogo-A has additional physiologic roles unrelated to NgR binding. After spinal cord injury, Nogo-A is upregulated to a moderate degree, whereas NgR levels are maintained at constant levels. Taken together, these data confirm the apposition of Nogo ligand and NgR receptor in situations of limited axonal regeneration and support the hypothesis that this system regulates CNS axonal plasticity and recovery from injury.