Ohio Department of Mental Health and Addiction Services

Workforce shortages pose a significant barrier to meeting the mental health needs of Australians. This study sought to explore the factors contributing to the recruitment and retention of public (salaried) psychologists and psychologists working as private practitioners within a public mental health service in metropolitan Melbourne. The project involved an online survey of staff and semi-structured interviews. The study found that both private and salaried psychologists identified a number of reasons as to why they were attracted to working in this setting compared with the higher salaries available in full-fee paying private practice. Issues included working with a specific cohort of clients, support of intake and administration teams, flexible working hours, teamwork, the location of the service, the profile of the organisation, and not having to pay room rent or advertise. Salaried staff highlighted the team culture and access to other clinicians for informal discussions as important factors, while private practitioners within the public mental health service most commonly identified financial concerns, including remuneration and failure to attend/cancellations as the biggest challenges. Lack of income was the most commonly cited reason for clinicians’ decisions to leave public mental health. Private practitioners within this setting identified the absence of supervision and professional development, feelings of isolation and lack of team culture as significant deterrents. In sum, numerous issues influence the decisions of psychologists to work in public mental health services rather than, or as well as holding private roles. Public health services need to recognise these and ameliorate identified challenges if they are to attract and retain an adequate psychological workforce.

Coordinated specialty care (CSC) is considered the gold-standard treatment for individuals experiencing first episode psychosis (FEP). However, CSC teams are resource-intensive, motivating the development of a hybrid delivery approach where community mental health centers (CMHCs) collaborate with an academic medical center to deliver a mix of in-person and virtual services. To inform the development of this hybrid approach, a needs assessment was conducted, evaluating the existing capacity of Ohio CMHCs to treat FEP and identifying barriers to expanded use of telemental health. CMHC administrators throughout Ohio whose agencies primarily provide mental health services were surveyed using a novel instrument. A concurrent mixed methods approach combined multivariable analysis of cross-sectional survey data with thematic coding of responses to open-ended questions. The 56 responding CMHCs on average offered 10.96 of 17 services associated with CSC for FEP. Agency size was positively associated with number of service offerings, but rurality was not. Most agencies perceived gaps in their care for patients with FEP, particularly rural CMHCs. 75% believed that telemental health service expansion would benefit patients. Thematic analysis revealed three success factors for expanded telemental health usage: adapting care to virtual assessment, ensuring patient access, and adjusting workflows for virtual delivery. Responding CMHCs generally agreed that care for individuals with FEP could be improved and saw potential in expanded use of virtual services. Hybrid models may represent a valuable opportunity to overcome conventional barriers to CSC availability, but their development must account for current CMHC resource infrastructure and workflows.

Orthopaedic outpatient surgery in the form of Ambulatory Surgical Centers (ASCs) continues to rise over the past several decades with enhancements for the patient and organization that includes ease of convenience, efficiency, and cost-effectiveness when examining the comparison to a traditional hospital with outpatient departments (Wang, K. Y., Puvanesarajah, V., Marrache, M., Ficke, J. R., Levy, J. F., & Jain, A. (2022). Ambulatory surgery centers versus hospital outpatient departments for orthopaedic surgeries. Journal of the American Academy of Orthopaedic Surgeons, 30 (5), 207–214). Furthermore, the rise of ASCs also includes various ownership models such as a sole physician, ASC management company, or a health system, which also commonly results in a blend of all three elements based on the strategy of the group. The purpose of this brief is to examine the unique delivery role that durable medical equipment (DME) plays in the care for patients following an orthopaedic surgery at an ASC when providing DME by Certified Athletic Trainers. Optimizing Certified Athletic Trainers in the ASC space creates opportunities for improving patient satisfaction and surgical staff burden while adding revenue to the ASC.

Xylazine, traditionally used as a veterinary sedative, has recently emerged as a new psychoactive substance, being typically ingested in combination with fentanyl derivatives and hence raising significant public health concerns. Despite its increasing prevalence, little is known about its molecular interactions with human neuroreceptors, specifically the serotonin 7 (5‐HT 7 R) and kappa‐opioid (KOR) receptors, which play critical roles in mood regulation, consciousness and nociception. Hence, the binding affinity and molecular interactions of xylazine with both 5‐HT 7 R and KOR through docking simulations and molecular dynamics calculations were investigated. These computational approaches revealed critical insights into receptor binding motifs and highlighted structural modifications that could enhance receptor affinity. The isosteric replacements within the xylazine structure to improve its binding efficacy were assessed, demonstrating that minimal structural modifications can potentiate its interaction with 5‐HT 7 R and KOR. These findings may well advance our understanding of xylazine's mechanism of action, possibly contributing to identifying suitable treatment/management approaches in treating xylazine‐related overdoses.

Adolescence is a vulnerable period for the onset of mental disorders and risk behaviours. Whole‐school interventions hold vast potential in improving mental health and preventing risk behaviours in this developmentally‐sensitive cohort. Modelled on the World Health Organisation's Health‐Promoting Schools Framework, whole‐school interventions aspire for change across eight domains: (i) school curriculum, (ii) school social‐emotional environment, (iii) school physical environment, (iv) school governance and leadership, (v) school policies and resources, (vi) school and community partnerships, (vii) school health services and (viii) government policies and resources. Through embodying a systems‐based approach and involving the key stakeholders in an adolescent's life, including their peers, parents and teachers, whole‐school interventions are theoretically more likely than other forms of school‐based approaches to improve adolescent mental health and prevent risk behaviours. However, vague operationalisation of what is to be implemented, how and by whom presents challenges for stakeholders in identifying concrete actions for the eight domains and thus in realising the potential of the Framework. Mapping how whole‐school interventions operationalise the eight domains enables appraisal of current practice against the recommendations of the Health‐Promoting Schools Framework. This facilitates identification of critical evidence gaps in need of research, with the aim of fostering optimal translation of the Framework into practice to promote mental health and prevent risk behaviours in adolescence. Our EGM's objective was to map how randomised controlled trials of whole‐school interventions promoting mental health and preventing risk behaviours in adolescence addressed the eight domains of a whole‐school approach. Our EGM was conducted in accordance with a pre‐registered protocol (PROSPERO ID: CRD42023491619). Eight scientific databases were searched: Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Ovid Emcare, CINAHL, ERIC, CENTRAL and Scopus. Expert‐recommended sources of the grey literature were also searched, including the Blueprints for Healthy Youth Development registry of evidence‐based positive youth development programmes and the SAMHSA Evidence‐Based Practice Resource Centre. To be included in our EGM, studies had to involve randomised controlled trials or cluster randomised controlled trials comprising students aged 12 to 18. Interventions had to demonstrate a whole‐school approach promoting mental health and/or preventing risk behaviours, including at least one program component addressing each of the curriculum‐, ethos and environment‐, and community‐levels of a whole‐school approach. Studies had to include an active or inactive comparator. Studies had to report on at least one of the mental health and/or risk behaviour outcomes detailed in the WHO‐UNICEF Helping Adolescents Thrive Initiative, which includes positive mental health, mental disorders, mental health literacy, substance use, bullying and aggression. Two independent reviewers screened search results, with disagreements resolved by a third reviewer on the research team. Risk‐of‐bias assessments were completed by two independent reviewers for each included study using the Cochrane risk‐of‐bias tool, with disagreements resolved by a third reviewer on the research team. Data extraction for each included study was completed independently by two reviewers, in accordance with a prespecified template. Data extraction included study characteristics and intervention components, the latter of which was mapped against the eight domains of a whole‐school approach. 12, 897 records were identified from the searches. A total of 28 studies reported in 58 publications fulfilled the inclusion criteria. The majority of interventions implemented by studies classified as either substance use prevention (10 of 28 studies) or multiple risk behaviour interventions (8 of 28 studies). The majority of studies involved students in lower secondary school grade levels, with only 5 of 28 studies targeting students in grades 10 to 12. The majority of studies were set in high‐income countries, with minimal representation of low‐ and middle‐income countries (5 of 28 studies). The interventions implemented by studies ranged from 9 weeks to 3 years in duration. Though 100% of studies involved students in the evaluation stage and 61% in the implementation of intervention strategies, only 39% involved students in the planning and 29% in the design of whole‐school interventions. Significant variability existed in how frequently whole‐school interventions addressed each of the eight domains, ranging from 7% to 100%. This included 100% of interventions implemented by studies addressing the school curriculum domain, 64% the school social‐emotional environment domain, 46% the school physical environment domain, 50% the school governance and leadership domain, 61% the school policies and resources domain, 93% the school and community partnerships domain, 29% the school health services domain and 7% the government policies and resources domain. Despite different intervention foci, there was a clear overlap in whole‐school intervention strategies within each domain. Our EGM identifies several critical foci for future research. These include the need to investigate (i) whether certain domains of a whole‐school approach are critical to intervention success; (ii) whether addressing more domains translates to greater impact; and (iii) the relative effectiveness of common intervention strategies within each domain to enable the most effective to be prioritised. Our EGM identifies the need for greater investment in older adolescent populations and those from low‐ and middle‐income countries. Finally, we encourage stakeholders including researchers, schools, public health and policy makers to consider four crucial factors in the design and planning of whole‐school interventions and to investigate their potential impact on intervention success. These include: (i) the provision of training and support mechanisms for those implementing interventions; (ii) the decision between single‐issue versus multiple‐issue prevention programs; (iii) the optimal intervention duration; and (iv) the involvement of adolescents in the design and planning of whole‐school interventions to ensure that interventions reflect their real‐world needs, preferences and interests.

Opioid use disorder is a major cause of drug-related harm and mortality. These can be reduced by expanded access to evidence-based and highly effective opioid agonist maintenance treatment or therapy (OMT). There is a lack of consensus on how to assess opioid use disorder treatment outcomes, and key health outcomes are often omitted. We report the results of a Delphi study to produce service user- and public health–centred international consensus guidance for OMT outcomes monitoring. An international group of 110 substance use specialists in 32 countries, including service providers, researchers and people with lived experience of OMT, produced draft guidance over multiple meetings. The guidance includes a service user-reported OMT outcomes questionnaire, based on 26 core questions, plus optional questions, in six domains (treatment, physical health, mental health, social functioning, substance use, quality of life). A Delphi panel of 757 OMT professionals and service users (46%) from 29 countries, of which 40% were female, reviewed the questionnaire over two survey rounds, supporting and improving it (round 2 mean agreement score on a 1-6 Likert scale: 5.2; 95%CI 5.1–5.3). By focusing on service user–reported and public health–centred outcomes of OMT, the OPTIMUS consensus guidance aims to facilitate the communication between service providers and service users and improve the quality of care and the survival, health and quality of life of OMT service users.

Introduction Although anxiety, depression and insomnia in people with HIV (PWH) are prevalent and have a major impact on clinical outcomes and quality of life, physicians fail to evaluate them routinely. The CONECTAR Project [Neuropsychiatric Comorbidity (NPC): Key to Antiretroviral Treatment] aimed to improve NPC clinical care in PWH in Spain by upskilling healthcare professionals (HCPs). Methods A group of HCPs developed a training programme, supported by national and international guidelines, to improve expertise on detecting and managing NPCs in PWH. The programme was conducted through workshops for physicians and nurses in various Spanish regions from April to November 2023; survey questionnaires were administered to physicians before the commencement of training and 15 days after. Later, a workshop was held for nurses who manage NPCs in PWH. Results The programme was completed by 64 physicians (22 had completed both questionnaires) and 11 nurses (no feedback obtained). Feedback from physicians reflected that the programme boosted awareness and self‐perception of being more qualified, knowledgeable and able to use management tools and resources. Physicians also reported improved perception of time available for visits and more frequent enquiries about patients' NPC symptoms. Despite their satisfaction with the workshops, half of the physicians recognized the need for more training. Conclusion The CONECTAR Project was a successful training programme that was well received and valued by HCPs who routinely manage NPCs in PWH. Institutions involved in HCP training to manage anxiety, depression and insomnia more effectively in PWH should consider similar proposals to reinforce clinical practices.

Adolescence is a vulnerable period for the onset of mental disorders and risk behaviours. Based on the Health-Promoting Schools Framework, whole-school interventions offer a promising strategy in this developmentally-sensitive cohort, through championing a systems-based approach to promotion and prevention that involves the key stakeholders in an adolescent’s life. The evidence-base surrounding the effectiveness of whole-school interventions, however, remains inconclusive, partly due to the insufficient number of studies in previous meta-analyses. An updated systematic review and meta-analysis was thus conducted on the effectiveness of whole-school interventions promoting mental health and preventing risk behaviours in adolescence. From 12,897 search results, 28 studies reported in 58 publications were included. Study characteristics and implementation assessments were synthesized across studies, and quality appraisals and meta-analyses performed. Analyses identified a significant reduction in the odds of cyber-bullying by 25%, regular smoking by 31% and cyber-aggression by 37% in intervention participants compared to the control. Whole-school interventions thus offer substantial population health benefits through the reduction of these highly-prevalent issues affecting adolescents. The non-significant findings pertaining to the remaining eleven outcomes, including alcohol use, recreational drug use, anxiety, depression and positive mental health, are likely attributable to suboptimal translation of the Health-Promoting Schools Framework into practice and inadequate sensitivity to adolescents’ local developmental needs. Given the ongoing challenges faced in the implementation and evaluation of these complex interventions, this study recommends that future evaluations assess the implementation of health-promoting activities in both intervention and control conditions and actively use this implementation data in the interpretation of evaluation findings. Preregistration: A pre-registered PROSPERO protocol (ID: CRD42023491619) informed this study.

Bipolar disorder is a leading contributor to the global burden of disease¹. Despite high heritability (60–80%), the majority of the underlying genetic determinants remain unknown². We analysed data from participants of European, East Asian, African American and Latino ancestries (n = 158,036 cases with bipolar disorder, 2.8 million controls), combining clinical, community and self-reported samples. We identified 298 genome-wide significant loci in the multi-ancestry meta-analysis, a fourfold increase over previous findings³, and identified an ancestry-specific association in the East Asian cohort. Integrating results from fine-mapping and other variant-to-gene mapping approaches identified 36 credible genes in the aetiology of bipolar disorder. Genes prioritized through fine-mapping were enriched for ultra-rare damaging missense and protein-truncating variations in cases with bipolar disorder⁴, highlighting convergence of common and rare variant signals. We report differences in the genetic architecture of bipolar disorder depending on the source of patient ascertainment and on bipolar disorder subtype (type I or type II). Several analyses implicate specific cell types in the pathophysiology of bipolar disorder, including GABAergic interneurons and medium spiny neurons. Together, these analyses provide additional insights into the genetic architecture and biological underpinnings of bipolar disorder.

The Clubhouse Model of Psychosocial Rehabilitation provides non-clinical social support for adults living with a diagnosed mental illness or self-reported mental ill-health (referred to as ‘members’). The Stepping Stone Clubhouse in Brisbane, Australia was evaluated between August 2022 and August 2023 using a participatory action research approach. Data was sourced from member surveys, member interviews, and an existing Clubhouse Member Database. Outcomes included members’ self-reported psychosocial recovery, social connectedness, quality of life, frequency of hospitalizations, and their attainment of employment and/or education aspirations. In this cross-sectional evaluation, it was hypothesized that existing members (membership: 11 months – 28 years) would report better outcomes than new members (membership: 0–14 days). In total, 161 existing members and 76 new members completed a survey. Twenty-three members also participated in a semi-structured interview. Participants were aged on average 47.1 years (± 13.5), 62% were male and 31% had a primary diagnosis of schizophrenia/schizoaffective disorder. Existing members reported better scores than new members for: three of the four psychosocial recovery domains (Functional Recovery: 78.0% vs. 74.0%, p = 0.01; Symptom Management Recovery 69.5% vs. 65.2%, p = 0.03; Social Recovery 74.3% vs. 70.0%, p = 0.01); social connection with other members (38.1 vs. 32.2, p = 0.03) and staff (44.5 vs. 38.1, p = 0.02); quality-of-life summary scores (4.6 vs. 4.1, p = 0.01), and rates of mental health-related hospitalization (16% vs. 41%, p < 0.01). Existing members were also more likely to be in some form of employment, compared to new members (p = 0.01). There were no significant differences between existing and new members for their educational goals, with 58% of each group wanting further formal education. Stepping Stone members have better outcomes than members who have recently joined the Clubhouse. This evaluation was successful because it intentionally built evaluative capacity and empowered member-centric processes.

Objectives To establish whether the risk of psychotic disorders in cannabis users changes with time following cannabis cessation using data from the European Network of National Networks studying Gene–Environment Interactions in Schizophrenia (EU-GEI) case–control study. Methods The EU-GEI case–control study collected data from first episode psychosis patients and population controls across sites in Europe and Brazil between May 2010 and April 2015. Adjusted logistic regressions were applied to examine whether the odd of psychosis case status changed: (1) with time following cannabis cessation and (2) across different cannabis use groups. Results Psychosis risk declined following cessation of cannabis use (β = −0.002; 95% CI −0.004 to 0.000; P = 0.067). When accounting for duration of use, this effect remained (β = −0.003; 95% CI −0.005 to −0.001; P = 0.013). However, in models adjusting for frequency and potency of use the result was not significant. Analysis of different cannabis use groups indicated that ex-users who stopped 1 to 4 weeks previously had the highest risk for psychotic disorder compared to never users (OR = 6.89; 95% CI 3.91–12.14; P < 0.001); risk declined for those who stopped 5 to 12 weeks previously (OR = 2.70; 95% CI 1.73–4.21; P < 0.001) and 13 to 36 weeks previously (OR = 1.53; 95% CI 1.00–2.33; P = 0.050). Ex-users who stopped 37 to 96 weeks (OR = 1.01; 95% CI 0.66–1.57; P = 0.949), 97 to 180 weeks (OR = 0.73; 95% CI 0.45–1.19; P = 0.204), and 181 weeks previously or more (OR = 1.18; 95% CI 0.76–1.83; P = 0.456) had similar psychosis risk to those who had never-used cannabis. Conclusion Risk of psychotic disorder appears to decline with time following cannabis cessation, receding to that of those who have never used cannabis after 37 weeks or more of abstinence. Although, preliminary results suggest that frequent users of high potency types of cannabis might maintain an elevated risk compared to never users even when abstaining for longer than 181 weeks.

Physical Restraint (PR) is a coercive procedure used in emergency psychiatric care to ensure safety in life-threatening situations. Because of its traumatic nature, studies emphasize the importance of considering the patient’s subjective experience. We pursued this aim by overcoming classic qualitative approaches and innovatively applying a multilayered semiautomated language analysis to a corpus of narratives about PR collected from 99 individuals across seven mental health services in Italy. Compared to a reference corpus, PR narratives were characterized by reduced fluency and lexical density, yet a greater use of emotional and cognitive terms, verbs, and first-person singular pronouns. Sadness was the most represented emotion, followed by anger and fear. One-third of the PR narratives contained at least one metaphor, with Animals and War/Prison as the most distinctive source domains. The quality and length of the PR experience impacted both the structure and the sentiment of the narratives. Findings confirm the distressful nature of PR but also point to the use of various linguistic mechanisms which might serve as an early adaptive response toward healing from the traumatic experience. Overall, the study highlights the importance of Natural Language Processing as an unobtrusive window into subjective experience, offering insights for therapeutic choices. Supplementary Information The online version contains supplementary material available at 10.1038/s41598-024-83999-9.

The Youth Risk of Cognitive Impairment Toolkit (Youth ROCIT) is a free, online written guide designed to help health and mental health workforces screen for risk of cognitive difficulties in young people aged 12–25. The Behaviour Change Wheel (BCW) provides a structured approach to behaviour change initiatives for workforces and can be utilised to support the implementation of tools like the Youth ROCIT. Using a modified BCW method, this project aimed to develop and pilot a tailored behaviour change approach to improve screening for cognitive impairment risk using the Youth ROCIT in an Australian youth (12–18 years) drug and alcohol service. The BCW method was applied to understand and address behavioural drivers of cognitive screening within a multidisciplinary team, and design strategies to support the implementation of the Youth ROCIT in routine clinical practice. Data on context, practices, barriers, enablers, and perspectives on the Youth ROCIT were collected through surveys, interviews, and interactive workshops. Routine service data from the patient management system was used to understand behaviour change. Multiple strategies were identified to support the implementation of the Youth ROCIT and the methodology was seen as acceptable and feasible by implementation facilitators and workshop participants. The service team rated the Youth ROCIT as acceptable, appropriate, and feasible, and reported high intentions to use the tool with young people. Service data showed changes in practice following the initiative. The BCW provided an acceptable and feasible framework for developing strategies to support the implementation of the Youth ROCIT in a youth health service setting.

Insomnia is a common and challenging complaint in older adults (> 65 years) because of age-related alterations in sleep physiology. Cognitive behavioral therapy for insomnia is the gold standard for treatment of insomnia in young as well as older patients. Both clinicians and patients often prefer the simplicity of medication, but risks associated with some hypnotics increase with age. Pharmacologic options for older adults include low-dose doxepin, melatonin, ramelteon, and the dual orexin receptor antagonists. A well-informed clinician can help patients navigate the risks and benefits of both pharmacologic and behavioral options.

Introduction: Intravenous drug use has a significant impact on oral and maxillofacial health, often resulting in complications like tooth loss and osteomyelitis. This study investigates the differences in oral health between drug users enrolled in replacement therapy and those not yet participating, with the goal of assessing the impact of structured treatment programs. Aim: To evaluate and compare the prevalence of oral and maxillofacial complications among drug users involved in replacement therapy and those newly registering for treatment. Methods: This cross-sectional study was conducted in Tbilisi, Georgia, at the Center for Mental Health and Prevention of Addiction. Participants were divided into two groups: 135 individuals registering for replacement therapy for the first time and 115 participants who had been enrolled for over a year. Data collection involved questionnaires and intraoral examinations, focusing on inflammatory signs, functional impairments, and complications like retained roots and signs of toxic osteomyelitis. Statistical analysis was performed using IBM SPSS Statistics version 23. Results: The findings revealed that individuals without prior replacement therapy had significantly more severe inflammatory symptoms, including draining fistulas (12.6% vs. 3.5%, χ²(2) = 8.61, p = 0.013), exposed bone (12.6% vs. 0.9%, χ²(1) = 13.74, p = 0.000), and visualized sequestra (8.9% vs. 1.7%, χ²(1) =6.01, p =0.014). Functional impairments, such as difficulties in mouth opening (31.1% vs. 12.2%, χ²(1) = 12.81, p = 0.000) and tooth loosening (51.1% vs. 35.7%, χ²(1) =6.02, p =0.014), were also more prevalent in this group. Retained dental roots were notably higher in the posterior lower jaw among untreated individuals (72.6% vs. 53.9%, χ²(1) = 9.41, p = 0.002). Conclusion: The findings suggest that drug replacement therapy plays a significant role in reducing severe oral and maxillofacial complications. Integrating dental care into addiction programs is essential for addressing untreated oral health issues and preventing severe outcomes such as osteomyelitis. Longitudinal studies are recommended to further evaluate the long-term benefits of replacement therapy and refine intervention strategies.

Background Determining whether the incidence of suicidal behavior during the COVID-19 pandemic changed for those with severe mental disorders is essential to ensure the provision of suicide preventive initiatives in the case of future health crises. Methods Using population-based registers, quarterly cohorts from the first quarter of 2018 (2018Q1) to 2021Q4 were formed including all Swedish-residents >10 years old. Interrupted time series and generalized estimating equations analyses were used to evaluate changes in Incidence Rates (IR) of specialised healthcare use for suicide attempt and death by suicide per 10 000 person-years for individuals with or without specific severe mental disorders (SMDs) during, compared to before the pandemic. Results The IR (95% Confidence interval, CI) of suicide in individuals with SMDs decreased from 16.0 (15.0–17.1) in 2018Q1 to 11.6 (10.8–12.5) in 2020Q1 (i.e. the quarter before the start of the pandemic), after which it dropped further to 6.7 (6.3–7.2) in 2021Q2. In contrast, IRs of suicide attempt in SMDs showed more stable trends, as did the trends regarding suicide and suicide attempt for individuals without SMD. These discrepancies were most evident for individuals with substance use disorder and ASD/ADHD. Changes in IRs of suicide v. suicide attempt for one quarter during the pandemic for substance misuse were 11.2% v. 3.6% respectively. These changes for ASD/ADHD were 10.7% v. 3.6%. Conclusions The study shows pronounced decreases in suicide rates in individuals with SMDs during the pandemic. Further studies aiming to understand mechanisms behind these trends are warranted to consult future suicide prevention strategies.

Background Despite the increasing substance use in Canada, our understanding of how substance use varies based on the intersections of gender, ethnicity/race, and income sources among preclinical populations remains limited. Thus, this study aimed to investigate, among clients of mental health and addiction (MHA) intake in Nova Scotia: 1) the prevalence of substance use by gender, ethnicity, and income source; 2) the routes of substance administration; 3) factors associated with substance use. Understanding how gender, ethnicity, and income sources intersect to influence substance use patterns is essential for designing prevention and treatment strategies tailored to an individual’s unique needs. Additionally, exploring the various routes of substance administration can provide insight into potential health risks, helping to inform harm reduction strategies. Methods This cross-sectional study included 22,500 adults who contacted MHA central intake in Nova Scotia in 2020 and 2021. Clients were assessed for substance use, substance use frequency, route of substance administration, and mental and physical health problems. The prevalence of substance use was examined as a function of gender, ethnicity, and income source. Multinomial logistic regression was used to investigate factors associated with substance use. Results Among the included MHA Intake clients, 36.1% reported daily substance use. The highest prevalence of daily substance use was identified among homeless (69.7%) and non-White men on social assistance/disability (60.9%). Also, non-White individuals on social assistance/disability were more likely to engage in frequent (aOR = 2.66, 95% =1.64, 4.30) and daily (aOR = 2.82, 95% CI: 2.08, 3.82) substance use compared to White individuals. Being young (aged 19-29), lack of access to private insurance, current/past mental illness, moderate/high suicide risk, and presence of two or more psychosocial stressors, were associated with occasional, frequent, and daily substance use alike. Conclusions The high prevalence of daily substance use among MHA Intake service users in Nova Scotia highlights the need for prevention and treatment strategies to address individual and structural level factors contributing to daily substance use.

Background Multiple genetic and environmental risk factors play a role in the development of both schizophrenia-spectrum disorders and affective psychoses. How they act in combination is yet to be clarified. Methods We analyzed 573 first episode psychosis cases and 1005 controls, of European ancestry. Firstly, we tested whether the association of polygenic risk scores for schizophrenia, bipolar disorder, and depression (PRS-SZ, PRS-BD, and PRS-D) with schizophrenia-spectrum disorder and affective psychosis differed when participants were stratified by exposure to specific environmental factors. Secondly, regression models including each PRS and polyenvironmental measures, including migration, paternal age, childhood adversity and frequent cannabis use, were run to test potential polygenic by polyenvironment interactions. Results In schizophrenia-spectrum disorder vs controls comparison, PRS-SZ was the strongest genetic predictor, having a nominally larger effect in nonexposed to strong environmental factors such as frequent cannabis use (unexposed vs exposed OR 2.43 and 1.35, respectively) and childhood adversity (3.04 vs 1.74). In affective psychosis vs controls, the relative contribution of PRS-D appeared to be stronger in those exposed to environmental risk. No evidence of interaction was found between any PRS with polyenvironmental score. Conclusions Our study supports an independent role of genetic liability and polyenvironmental risk for psychosis, consistent with the liability threshold model. Whereas schizophrenia-spectrum disorders seem to be mostly associated with polygenic risk for schizophrenia, having an additive effect with well-replicated environmental factors, affective psychosis seems to be a product of cumulative environmental insults alongside a higher genetic liability for affective disorders.

Bipolar disorder is a debilitating psychiatric condition characterized by recurrent episodes of mania and depression, affecting millions worldwide. While pharmacotherapy remains the cornerstone of treatment, a significant proportion of patients exhibit inadequate response or intolerable side effects to conventional medications. In recent years, neuromodulation techniques have emerged as promising adjunctive or alternative treatments for bipolar disorder. We performed a narrative review, according to the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines, to provide a comprehensive overview of the current literature on neuromodulation interventions in bipolar disorder across the course of lifespan. Specifically, it examines the efficacy, safety, and mechanisms of action of various neuromodulation strategies, including, among others, transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and it describes the therapeutic experiences across the different ages of illness. Additionally, this review discusses the clinical implications, challenges, and future directions of the integration, in clinical practice, of neuromodulation into the management of bipolar disorder. By synthesizing evidence from different studies, this review aims to inform clinicians, researchers, and stakeholders about the evolving landscape of neuromodulation treatments and their potential role in improving outcomes for individuals with bipolar disorder.