Research: CAMH Annual Report 2003

CAMH Annual Report

CAMH conducts research into three areas: clinical, neuroscience and social, prevention and health policy. We translate research into best practices and share that knowledge with health professionals across Ontario and beyond.

A genetic subtype of schizophrenia

Dr. Anne Bassett and her team in the Clinical Research Program have begun a large-scale study into a genetic condition that is now considered to be a subtype of schizophrenia. The condition, called 22q11.2 Deletion Syndrome (also known as velo-cardio-facial syndrome), has a known genetic abnormality. It is the first identifiable genetic subtype of schizophrenia.

Learning more about this subtype is helping us improve the day-to-day care of people who have it. Our research, which includes screening clients of the Schizophrenia Program, promises to lead to discoveries about the genetics and expression of schizophrenia.

New tool for treating depression

Dr. Zindel Segal, with colleagues in the United States and the United Kingdom, recently found that Mindfulness Based Cognitive Therapy (MBCT) can help prevent relapses of major depression. Using a mix of breathing exercises, yoga stretches and educational tools, MBCT helps people with depression understand the links between thinking and feeling, and how they can best look after themselves when depression threatens to overwhelm them. In clinical trials, Segal and his colleagues found the relapse rate of those who participated in MBCT was 50 per cent lower than those who did not.

Psychotherapy and pharmacotherapy acting together

While psychotherapy has often been considered "talk therapy," there is evidence that it has an impact on the brain, changing brain circuits and brain connections. A new scientific framework has been proposed in which pharmacotherapy (drug therapy) and psychotherapy can act together -- pharmacotherapy providing the neurochemical ground and psychotherapy building on this ground. Our research is looking to find the most effective combination of these two types of therapy in the early stages of schizophrenia. We hope that this line of research could lead to preserving normalcy and preventing some of the effects of the illness.

Neighbour @ Work Initiative

For years we have known that the relationship between stress and satisfaction at work influences the mental health of employees. The breakthrough finding this year is how perceptions of fairness also play a role in this relationship.

When employees feel that they are being treated unfairly in the workplace, they have higher rates of mental distress, principally anxiety and depression. This finding has led to the Neighbour @ Work Initiative. This experimental initiative uses a four-question survey, called the Stress Satisfaction Offset Score, to identify workplace conditions that produce problems such as anxiety, depression, immune system disorders and cardiovascular disease.

Epigenetics Research Laboratory first of its kind

While all cells in a person's body have identical genes, cells from different parts of the body look and function differently. This difference results because of the way that genes are regulated: genes that are active in one type of cell are "switched off" in others. The science of how genes are regulated is called epigenetics.

Our Krembil Family Epigenetics Research Laboratory is the first in the world dedicated to understanding the role of epigenetics in mental illness. Epigenetic research, unlike genetic research, promises to explain various unclear issues in major psychosis, such as why genetically identical twins may have epigenetic differences. Such study promises to lead to major research breakthroughs. In 2002, Dr. Arturas Petronis received a prestigious Ontario Mental Health Foundation Special Initiatives Grant to pursue epigenetic factors in psychiatric illness.

PET Centre

CAMH has acquired the most advanced brain positron emission tomography (PET) scanner in the world. Our new high-resolution, high-sensitivity camera allows researchers to create images of brain regions eight times smaller than possible with our old scanner. We are using the new technology in our two well-established PET research programs, Schizophrenia and Mood and Anxiety (Mood Neurochemistry), as well as in emerging programs in Addiction and Geriatrics.

Our researchers are recognized as international leaders in brain PET research. This recognition is the result of breakthroughs such as Dr. Shitij Kapur's study of the benefits of low-dose antipsychotic therapy in first episode schizophrenia and our development of a PET imaging agent that allows us to investigate the serotonin transporter that is the brain target of most antidepressants. Our researchers were involved with the manufacturer in designing the sophisticated new PET scanner.

Gambling and mental illness

CAMH undertook a study of people who have gambling problems, people who gamble socially and people who have recovered from a gambling problem. We looked at the prevalence of mental illness among the groups and how the mental illness affected their gambling behaviour.

The study showed that mood and anxiety disorders were the most commonly reported disorders for all three groups. The rate of mood and anxiety problems was higher among pathological gamblers compared to the general population. Participants who reported a mental illness also had significantly higher rates of current emotional distress as well as greater substance use and substance use problems, compared to gamblers without a psychiatric diagnosis. Otherwise, we found few group differences, suggesting that people who gamble have similar behaviour patterns, regardless of whether or not they have a psychiatric disorder.

The design and delivery of methadone maintenance treatment programs

In November 2002, Health Canada released two publications, a best practices document and a comprehensive literature review on methadone maintenance treatment, which were developed largely through the efforts of Drs. Bruna Brands and David Marsh.

Best Practices in the Design and Delivery of Methadone Maintenance Treatment Programs is intended to make current programs more effective and encourage service providers to start new programs. Ideally, this document will increase awareness among practitioners and service providers, engage and retain clients and patients, and improve treatment outcomes.

Best practices for concurrent disorders

A CAMH research project on concurrent disorders, funded by Health Canada, synthesized research literature, expert opinion and input from client focus groups. From this information, we created a report that contains recommendations for assessment and treatment services. The report, which focuses on the need for an integrated approach, was released by Health Canada as a best practices guide.

The guide has been well received nationally and internationally and has been highlighted in our provincial concurrent disorders plan. We hosted a videoconference, with more than 260 participants in 19 locations, to introduce the best practices guide and discuss its implications, both for treatment and for systems planning. We then followed up with a provincial forum of 40 representatives of government, agencies and health providers to get broad input on a plan of action on concurrent disorders. Recommendations include creating a provincial working group, better systems planning, improved services, policy development, networking, training and a focused approach by government.