DEPARTMENT OF

PSYCHIATRY
Research Conference

June 16,2021

Program and Abstracts

 TABLE OF CONTENTS
Program of Events ......................................................................................................... 3

Accreditation Information ........................................................................................... 3

Keynote Speaker – Dr. Kate Harkness ....................... ……………………………………4

Oral Presentations ......................................................................................................... 5

Poster Presentations ................................................................................................... 6-8

Oral Abstracts ........................................................................................................... 9-16

Poster Abstracts...................................................................................................... 17-34

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 PROGRAM OF EVENTS

8:00 – 8:05 Welcome and Opening Remarks – Dr. Claudio Soares

8:05 - 9:45 Oral Presentations

9:45 – 10:00 Break

10:00 – 11:00 Keynote Speaker – Dr. Kate Harkness

11:00 – 12:15 Oral Presentations

12:15 – 12:45 Break

12:45 – 1:30 Poster Presentations

Accreditation

Credits for Royal College Specialists:

This event is an Accredited Group Learning Activity (Section 1) as defined by the
Maintenance of Certification Program of The Royal College of Physicians and
Surgeons of Canada, and approved by Queen's University Office of CPD. You
may claim a maximum of 4.5 hours (credits are automatically calculated).

Credits for Health Professionals:

This is an accredited learning activity which provided up to 4.5 hours of
Continuing Education.

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 KEYNOTE SPEAKER
Dr. Kate Harkness
“How Childhood Maltreatment Shapes Exposure and
Response to Future Stress”
Learning Objectives:
At the conclusion of this activity, participants will be able to:
1. Explain the relation of childhood maltreatment to the heightened generation of,
and response to, future stress
2. Identify key neurobiological sequelae of childhood maltreatment
3. Determine whether patients with depression will be likely to respond to
pharmacological versus cognitive-behavioural treatment based on their history
of childhood maltreatment and proximal stress

Background:
Dr. Kate Harkness is a Full Professor in the Departments of Psychology and Psychiatry at
Queen’s University, where she also serves as Director of the Mood Research Laboratory
and Assessment Service. Dr. Harkness completed an Honours BSc at the University of
Toronto, followed by a PhD from the University of Oregon with Dr. Scott Monroe. Dr.
Harkness joined Queen’s in 2000 after completing her residency and post-doctoral
fellowship with Drs. Ellen Frank and Michael Thase at Western Psychiatric Institute and
Clinic in Pittsburgh, Pennsylvania.

Dr. Harkness’ research programme is focused on understanding how stress, both in

childhood and later in adulthood, causes and maintains depression. Her recent work is
particularly concerned with the ways in which adversity in childhood leads to critical
changes in biological and psychological processes that enhance sensitivity to the
stressful life events that trigger depression. Dr. Harkness is an international leader in the
use of rigorous, interview measures of stress, and she is currently heading the psychosocial
component of the Canadian Biomarker Integration Network for Depression (CAN-BIND),
a pan-Canadian research initiative to develop personalized treatments for depression.

Dr. Harkness is the author of a series of high-impact theoretical papers on the nature of
stress in depression, as well as the publication this year of the definitive Oxford Handbook
of Stress and Mental Health. Her work has held peer-reviewed funding from CIHR, SSHRC,
OMHF, the Sick Kids Foundation, and the Templeton Foundation.

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 ORAL PRESENTATIONS
Abstracts for oral presentations begin on page 9

8:05 – 8:30 Efficacy of a Six-Week-Long Therapist-Guided Online Therapy Versus Self-

help Internet-Based Therapy for COVID-19-Induced Anxiety and
Depression: Open-label, Pragmatic, Randomized Controlled Trial
Mohammed Al-Alawi, Roopa K McCall, Alya Sultan, Naser Al Balushi,
Tamadhir Al-Mahrouqi , Abdullah Al Ghailani , Hilal Al Sabti , Abdullah
Al-Maniri , Sathiya M Panchatcharam, and Hamed Al Sinawi

8:30 – 8:55 Ethics in the Psychiatric Evaluation of Terrorists

Elyse Platt and Philip J. Candilis

8:55 – 9:20 Comparative Efficacy and Tolerability of Antipsychotics for Youth with
Schizophrenia Spectrum Disorders: Systematic review and Network
Meta-Analysis
Caitlin Yee, Anees Bahji, Maria Lolich, Ross Baldessarini, and
Gustavo Vazquez

9:20 – 9:45 Calibration Of Visually Internalised Distance (Two-Metre-Test)

Oyedeji Ayonrinde, Olusola Adeyemi, Naseem Alhujaili, Bola Ola, Nomusa
Mngoma, Terry Landry, Ben Gooch, and Karin Carmichael

11:00 – 11:25 The Hypothesis of the Metabolic Jet Lag in Bipolar Disorder: A Pilot Feasibility
Study Exploring the Association between Eating Rhythms Disruption and
Illness Trajectories
Elena Koning, Fabiano A. Gomes, Alexander Bambokian, Rafael Freire,
Rodrigo B. Mansur, Jennifer Fabe, Roumen Milev, and Elisa Brietzke

11:25 – 11:50 Medically Supervised Ketogenic Therapy in the Treatment of Adult

Attention-Deficit/Hyperactivity Disorder: A Pilot Feasibility Study
Vitor Breda, Arun Chinnameyyappan, Alina Marin, Roumen Milev,
Christopher Bowie, Jennifer Fabe, Claudio N Soares, Fabiano A Gomes, and
Elisa Brietzke

11:50 – 12:15 Masked Obstructive Sleep Apnea in Treatment-Resistant Depression:

Exploring Gender Differences
Emily Kasurak, Emily Hawken, Dusan Kolar, and Ruzica Jokic

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 POSTER PRESENTATIONS
Breakout Room 1
Abstracts for poster presentations begin on page 17

12:45 – 12:50 Using online delivered therapy and brain imaging to better understand
OCD: A pilot study
Callum Stephenson, Niloufar Malakouti, Tim Salomons, Roumen Milev,
& Nazanin Alavi

12:50 – 12:55 Combining Ketamine with online Cognitive-Behavioural Therapy for the
Treatment of PTSD
Aaron Philipp-Muller, Taras Reshetukha, Roumen Milev, Gustavo Vazquez,
& Nazanin Alavi

12:55 – 1:00 Women as Caregivers to the Elderly

Ahila Vithiananthan, Shabbir Amanullah, Natasha Snelgrove,
Suhaila Ghuloum, & K. S. Shivakumar

1:00 – 1:05 Cognitive ability and depressive symptom severity have differential
relationships with productive activities vs social relationships in Major
Depressive Disorder
Isabelle Hau, Chelsea Wood-Ross, Stephanie Woolridge &
Christopher Bowie

1:05 – 1:10 A Review of Neurologic Music Therapy in Stroke

Arian Sattari, Lola Cuddy, Kate Gee, Ariel Albin, & Elvina Chu

1:10 – 1:15 Terrorism Typologies and Implications for Clinical Practice in Psychiatry
Robert JE Reid, Tariq Hassan, Reinhard Dolp, & Najat Khalifa

1:15 – 1:20 Psychiatric assessment of terror subjects and those at risk of engaging in
acts of terrorism
Reinhard Dolp, Tariq Hassan, Robert Reid, & Najat Khalifa

1:20 – 1:25 The Psychiatric Aspects of Terrorism: Prevention and Rehabilitation

Andrew Shaw, Najat Khalifa, & Dr. Tariq Hassan

1:25 – 1:30 Cortisol Reactivity and Hippocampal Volume as Mediators of the

Relationship Between Childhood Maltreatment and Depression
Jessica Rowe, Jordan Poppenk, Roumen Milev, Katherine E. Wynne-
Edwards, Sidney H. Kennedy, & Kate L. Harkness

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 POSTER PRESENTATIONS
Breakout Room 2
Abstracts for poster presentations begin on page 26

12:45 – 12:50 Barriers to the Implementation of Action-Based Cognitive Remediation in

Early Psychosis Clinics
Maya McGregor, Chelsea Wood-Ross, Stephanie Woolridge, Melissa
Milanovic, & Christopher Bowie

12:50 – 12:55 Increasing treatment efficiency and personalization for patients with
depression through a stepped care e-CBT model
Jasleen Jagayat Anastasia Shao, Amirhossein Shirazi, Mohsen Omrani,
Anne O’Riordan, Gunnar Blohm, & Nazanin Alavi

12:55 – 1:00 Omnibus Inventory of Trait Rumination Questionnaires Has a Multi-Factorial

Structure Representing Deliberate Analysis, Positive Thinking, and
Distressing Rumination
Scott D. Squires, Roumen V. Milev, Kate L. Harkness, & Jordan Poppenk

1:00 – 1:05 The Impact of Non-Infection Pandemic-Related Stress on Depression and

Anxiety Severity: Investigating Mediation by Intrusive and
Deliberate Rumination
Scott D. Squires, Mianzhi Hu, Roumen V. Milev, & Jordan Poppenk

1:05 – 1:10 Initiating and Maintaining Medically Supervised Ketogenic Diet in the
Treatment of Brain-Based Diseases in Different Clinical Populations
and Settings
Jennifer Fabe, Charlene Tan-Smith, Carol Shaw, Nadine Nevland, Andrew
Smith, Fabiano A. Gomes, & Elisa Brietzke

1:10 – 1:15 Is provider adherence to the CANMAT guideline related to better discharge
and post-discharge outcomes for patients with acute mania?
Julia Fagen, Fabiano A. Gomes, Taylor Magee, Tatiana Valverde-da-
Conceicao, Linda Wang, Roumen Milev, & Elisa Brietzke

1:15 – 1:20 Determinants of serum concentrations of vitamin D and its association with
depressive symptoms: a cross-sectional and longitudinal analysis of the
Epifloripa Idoso
Gilciane Ceolin, Fabiano A. Gomes, Débora Kurrle Rieger Venske, Júlia
Dubois Moreira, & Elisa Brietzke.

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1:20 – 1:25 The Effects of the Ketogenic Diet on Premature Aging in Major
Depressive Disorder
Alexander Bambokian, Gabriel Fries, Calvin Sjaarda, Rodrigo B. Mansur,
Roger S. McIntyre, Fabiano A. Gomes, Jennifer Fabe, Roumen Milev,
Claudio N Soares, & Elisa Brietzke.

1:25 – 1:30 Temporal Dynamics and Evolution of SARS-CoV-2 in Ontario During First Two
Waves of Pandemic
Calvin Sjaarda, Robert Colautti, & Prameet Sheth

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 ABSTRACTS
Oral Presentations
Efficacy of a Six-Week-Long Therapist-Guided Online Therapy Versus Self-help
Internet-Based Therapy for COVID-19-Induced Anxiety and Depression: Open-label,
Pragmatic, Randomized Controlled Trial
Mohammed Al-Alawi, Roopa K McCall, Alya Sultan, Naser Al Balushi, Tamadhir Al Mahrouqi ,
Abdullah Al Ghailani , Hilal Al Sabti , Abdullah Al-Maniri , Sathiya M Panchatcharam, and Hamed
Al Sinawi

Objectives: This study aimed to comparatively assess the efficacy of therapist-guided online
therapy with that of self-help, internet-based therapy focusing on COVID-19-induced symptoms
of anxiety and depression among individuals living in Oman during the COVID-19 pandemic.

Material and Methods: This was a 6-week-long pragmatic randomized controlled trial
involving 60 participants who were recruited from a study sample surveyed for symptoms of
anxiety or depression among the Omani public amid the COVID-19 pandemic. Participants in the
intervention group were allocated to receive 1 online session per week for 6 weeks from certified
psychotherapists in Oman; these sessions were conducted in Arabic or English. The
psychotherapists utilized cognitive behavioral therapy and acceptance and commitment therapy
interventions. Participants in the control group received an automatic weekly newsletter via email
containing self-help information and tips to cope with distress associated with COVID-19. The
information mainly consisted of behavioral tips revolving around the principles of cognitive
behavioral therapy and acceptance and commitment therapy. The primary outcome was
measured by comparing the change in the mean scores of Patient Health Questionnaire-9 (PHQ-
9) and General Anxiety Disorder-7 (GAD-7) scale from the baseline to the end of the study (ie,
after 6 sessions) between the two groups. The secondary outcome was to compare the
proportions of participants with depression and anxiety between the two groups.

Results: Data from 46 participants were analyzed (intervention group n=22, control group
n=24). There was no statistical difference in the baseline characteristics between both groups.
Analysis of covariance indicated a significant reduction in the GAD-7 scores (F1,43=7.307; P=.01)
between the two groups after adjusting for baseline scores. GAD-7 scores of participants in the
intervention group were considerably more reduced than those of participants in the control
group (β=-3.27; P=.01). Moreover, a greater reduction in mean PHQ-9 scores was observed
among participants in the intervention group (F1,43=8.298; P=.006) than those in the control
group (β=-4.311; P=.006). Although the levels of anxiety and depression reduced in both study
groups, the reduction was higher in the intervention group (P=.049) than in the control group
(P=.02).

Conclusions: This study provides preliminary evidence to support the efficacy of online therapy
for improving the symptoms of anxiety and depression during the COVID-19 crisis in Oman.
Therapist-guided online therapy was found to be superior to self-help, internet-based therapy;
however, both therapies could be considered as viable options.

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Learning Objectives:
1. Assess the efficacy of e-mental health in improving COVID-19 invoked psychological
distress in vulnerable, non-western society.
2. Evaluate the efficacy of therapist guided vs self-help psychotherapy on COVID-19
induced symptoms of anxiety and depression.
3. Understand the caveats and limitations of telehealth during of COVID-19 pandemic

Keywords: Depression; Anxiety; COVID-19; E-Mental Health; Online Therapy

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Ethics in the Psychiatric Evaluation of Terrorists
Elyse Platt and Philip J. Candilis

Background: Psychiatry and psychology are increasingly called upon to offer evaluations and
explanations for terrorism. In the context of established mental health expertise in threat and risk
assessment this follows a comfortable and established logic. However, because of a range of
definitions and cultural perspectives, identifying terrorists and defining terrorism remain open
questions in international law and academia. While these limitations do not diminish the urgency of
assessing radicalization, mitigation, risk and protective factors, they do create two substantive ethical
problems. The first is that by asking mental health professionals to evaluate and treat people who
commit acts of terrorist violence, the professions run the risk of medicalizing political thought.
Terrorism laws have famously been used to silence “dangerous” speech by non-dominant groups.
Secondly, if psychiatrists and other medical professionals stand apart from the political and historical
implications of terrorism, they may be working outside their ethics. Medical ethics has come to
recognize cross-cultural narratives, the evidence of implicit bias, and the differential treatment of
non-dominant groups. To counter these potential pitfalls, it may be possible to draw from narrative
ethics in order to conduct these fraught psychiatric evaluations while still taking into account the full
range of explanatory social, political, and historical factors.

Learning Objectives:
1. Investigate ethical issues in the psychiatric assessment of terrorists.
2. Explore how narrative ethics can account for political, historical, social and cultural factors at
play in the psychiatric assessment of terrorists.

Keywords: Ethics, Terrorism, Forensic Psychiatry

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Comparative Efficacy and Tolerability of Antipsychotics for Youth with Schizophrenia
Spectrum Disorders: Systematic review and Network Meta-Analysis
Caitlin Yee, Anees Bahji, Maria Lolich, Ross Baldessarini, and Gustavo Vazquez

Objectives: Comparative performance of antipsychotics used in early onset schizophrenia (EOS) is

unclear due to few head-to-head trials. We aimed to compare the efficacy and safety of
antipsychotics used in this population.

Material and Methods: Systematic literature search following the PRISMA guidelines was
conducted for randomized trials comparing antipsychotics used in control conditions, from January
to May 2021. The Cochrane risk of bias tool for evaluating the study-level risk of bias was applied.
Primary outcomes were PANSS scores, and dichotomized retention in treatment. Secondary
outcomes were treatment discontinuation and dropouts due to adverse events.

Results: 15 acute (<6 months, 2,208 participants, 39.2% female, median age 15.3 years) and 10
maintenance RCTs (>6 months, 1,366 participants, 35.0% female, median age 15.6 years) were
included. Apparent therapeutic benefit, based on reduction of total PANSS scores, ranked clozapine
(d = –1.35 [–1.97 to –0.73]), molindone (d = –1.22 [–1.68 to –0.75]), olanzapine (d = – 1.12 [–
1.44 to –0.81]), and risperidone (d = –0.93 [–1.22 to –0.63]) as most efficacious. Only lurasidone
demonstrated efficacy as a maintenance strategy. Clozapine (RR=12.76) and haloperidol (RR=5.15)
was associated with more dropouts due to adverse events, while risperidone was associated with
lower overall rate of discontinuation.

Conclusions: Most of the antipsychotics tested in youth are reasonably well-tolerated and
demonstrated efficacy in the acute treatment phase. There is limited evidence to recommend
maintenance therapies for EOS, as only a single agent, lurasidone, appeared to demonstrate efficacy
over placebo.

Learning Objectives:
1. To determine the comparable efficacies of various monotherapy antipsychotic agents used
in the treatment of early onset schizophrenia
2. To explore the tolerability and side effect profiles of these agents, used in the treatment of
early onset schizophrenia
3. To demonstrate the paucity of research regarding the pharmacological management of
schizophrenia in the child and adolescent population

Keywords: Early Onset Schizophrenia, Efficacy, Antipsychotic

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Calibration Of Visually Internalised Distance (Two-Metre-Test)
Oyedeji Ayonrinde, Olusola Adeyemi, Naseem Alhujaili, Bola Ola, Nomusa Mngoma, Terry Landry,
Ben Gooch, and Karin Carmichael

Background: The WHO recommends a number of preventive COVID interventions to reduce the
risk of infection of which social (physical) distancing is one of the primary pillars. In many, countries
a physical distance of 2 meters has been described as optimal. This guidance assumes a universal
understanding and ability to implement this distance, however, we hypothesize that it is difficult to
accurately judge distance, and innovative public health strategies are required to mitigate this.

Objective: To determine the accuracy of estimating “two metres” in an internationally diverse

population across high, medium and low-income countries – Canada, Saudi Arabia, South Africa and
Nigeria.

Materials and Method: Participants were requested to estimate “two-metres” with a place marker,
from a vertical reference point. Distance accuracy was determined with a tape measure and
immediate feedback given, thereby providing knowledge translation.

Results: Estimation of two-metres was inconsistent across rural and urban areas in wealthy and
poor populations internationally. There was no significant difference across groups in these
countries.

Conclusion: WHO directives targeting different countries such as the need for “social” or physical
distancing, require national and local interpretation and translation to allow universal consistency of
application.

Learning Objectives:
1. To illustrate the cognitive difficulty associated with estimating short distances in international
populations.
2. To highlight the need for knowledge translation in public policy directives.

Keywords: COVID, Global Health, Social-Distance

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The Hypothesis of the Metabolic Jet Lag in Bipolar Disorder: A Pilot Feasibility Study
Exploring the Association between Eating Rhythms Disruption and Illness
Trajectories
Elena Koning, Fabiano A. Gomes, Alexander Bambokian, Rafael Freire, Rodrigo B. Mansur,
Jennifer Fabe, Roumen Milev, and Elisa Brietzke

Objectives: The main objective of this study is to determine the feasibility of an investigation to
evaluate the association between metabolic jet leg evaluated through disruption in eating rhythms
and markers of severity of illness trajectory in individuals with Bipolar Disorder (BD).

Material and Methods: Ten male and female individuals with DSM-5 defined BD type 1 will be
enrolled on this feasibility study. Severity of illness trajectory parameters will be age of onset,
duration of illness, number of manic, hypomanic and depressive episodes, number of admissions,
history and number of suicide attempts, and functional status. Anthropometric variables to be
evaluated are weight, body mass index and waist/hip ratio. A personalized “feedogram” will be
elaborated using the app “InnerAnalytics” which uses Artificial Intelligence to create a history of
all the foods and liquids ingested by the individual based on pictures that the research subjects
will be asked to take from their meals for a period of 14 days. Clinical evaluation of eating rhythms
disruptions will be conducted using the Biological Rhythm Interview for Assessment in
Neuropsychiatry (BRIAN).

Results: This study will be the first to integrate the field of chrononutrition in the study of BD
and the first to use the concept of metabolic jet lag in psychiatry.

Conclusions: This study will expand our knowledge on the circadian dysfunction in mood
disorders and will contribute with the development of innovative, affordable, and safe nutritional
approaches in psychiatry, such as time-restricted feeding (e.g. intermitted fasting).

Learning Objectives:
1. Understand the role of biological rhythms disfunction in BD.
2. Explore different ways to evaluate eating rhythms disruption in BD.
3. Understand the applications of chrononutrition in Psychiatry.

Keywords: Bipolar Disorder; Biological Rhythms, Chronobiology, Chrononutrition

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Medically Supervised Ketogenic Therapy in the Treatment of Adult Attention-
Deficit/Hyperactivity Disorder: A Pilot Feasibility Study
Vitor Breda, Arun Chinnameyyappan, Alina Marin, Roumen Milev, Christopher Bowie,
Jennifer Fabe, Claudio N Soares, Fabiano A Gomes, and Elisa Brietzke

Objectives: The main objective of this project is to preliminarily assess the potential benefits of
a Medically Supervised Ketogenic Therapy (MSKT) in the treatment of Attention-Deficit/
Hyperactivity Disorder (ADHD) in adults through a 16-week open-label pilot clinical trial.

Material and Methods: This is an open-label single arm clinical trial of a dietary intervention to
reduce severity of ADHD symptoms. The efficacy and tolerability of the MSKT will be evaluated
in a 4-week induction phase followed by a 12-week maintenance phase trial in 20 adult patients
with DSM-5 defined ADHD. ADHD symptoms severity will be assessed through the Swanson,
Nolan and Pelham Rating Scale-Version IV (SNAP-IV) adapted for adults and the level of
impairment will be assessed through the Clinical Global Impression (CGI) at weeks 0, 4, 8, 12,
and 16. MSKT will be implemented gradually, with calculated progressive reduction of
carbohydrates and increase in fat content in the diet, with a Registered Dietician (RD) supervision.
Monitoring of diet will be used with the support of the KetoSuite application software. After the
completion of the trial, a regular healthy diet will be reintroduced with the support of an RD.

Results: The primary outcome is the severity of ADHD symptoms. Secondary outcomes are
cognitive performance, treatment emergent adverse effects, and experience of the patient.

Conclusions: MSKT has been extensively evaluated for children with treatment resistant epilepsy
and has benefits that go beyond seizures control, such as cognitive and behavioral improvements.
Our study is the first to explore this in Adult ADHD population.

Learning Objectives:
1. Evaluate the therapeutic effect of a MSKT in a short-term open trial on the symptoms
severity of ADHD in adults;
2. Evaluate the specific effect of a MSKT in the severity of anxiety and depressive symptoms;
3. Evaluate the safety and side effects profile of the ketogenic diet in adults with ADHD

Keywords: Adult ADHD; Ketogenic Diet; Clinical Trial.

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Masked Obstructive Sleep Apnea in Treatment-Resistant Depression: Exploring
Gender Differences
Emily Kasurak, Emily Hawken, Dusan Kolar, and Ruzica Jokic

Background: Major depressive disorder (MDD) and Obstructive sleep apnea (OSA) are common
disorders. The association between these conditions has been addressed in the literature but
remains unclear. Untreated OSA complicates the management of MDD and contributes to
functional impairment. To date, few studies have investigated OSA in individuals with treatment
resistant depression (TRD).

Objectives: Given the high societal burden and impact of both conditions on function and quality
of life, we aimed to probe the comorbidity of OSA and TRD in order to elucidate potential gender
differences in presentation, hypothesizing that there would be a high prevalence of previously
undiagnosed OSA in both men and women with TRD, and significant differences in the clinical
presentation of OSA in TRD between genders.

Material and Methods: Cross-sectional retrospective design in 94 patients recruited from a

subspecialist mood disorders outpatient service who had no previous sleep assessment;
participants completed overnight polysomnography and a battery of rating scales assessing mood,
sleep, and daytime functioning.

Results: There was a surprisingly high prevalence of previously undiagnosed OSA in TRD. TRD
closed the gap in OSA prevalence between men and women in MDD. We demonstrated typical
symptoms in TRD overshadow key symptoms of undetected OSA, specifically in women. Our
results confirm increased OSA severity in women after menopause. Only in women daytime
fatigue masked a potentially significant underlying sleep disorder.

Conclusions: We propose comprehensive assessment and screening for OSA in patients with
TRD and emphasize the importance of investigating severity of fatigue in this population.

Learning Objectives:
1. To investigate prevalence of Obstructive Sleep Apnea in Treatment Resistant depression
2. To investigate gender differences in presentation of OSA in TRD
3. To emphasize the importance of investigating fatigue in this population

Keywords: Treatment-resistant depression, obstructive sleep apnea,

gender differences

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 ABSTRACTS
Poster Presentations – Breakout Room 1
Using online delivered therapy and brain imaging to better understand OCD: A
pilot study
Callum Stephenson, Niloufar Malakouti, Tim Salomons, Roumen Milev, & Nazanin Alavi

Background: Obsessive-compulsive disorder (OCD) is a debilitating disorder with an unknown

cause. The basal ganglia and frontal cortex have been hypothesized to contribute to the
development, however, more research is needed to uncover the truth. By observing the effects
of proven treatments on brain activation levels, the causation of OCD can be better understood.
The gold standard treatment is cognitive behavioural therapy (CBT) with exposure and response
prevention (ERP). However, CBT is often inaccessible. Fortunately, CBT can be effectively
delivered through the internet (e-CBT) while addressing many accessibility barriers.

Objective: This pilot study will provide an e-CBT program for OCD and observe its effects on
brain activation levels. It is hypothesized that activation levels in the basal ganglia and frontal
cortex will decrease following treatment.

Material and Methods: Individuals with OCD will be offered a 16-week e-CBT program
mirroring in-person CBT content that will be administered through a secure online platform.
Efficacy of treatment will be evaluated using symptomology questionnaires at baseline, week 8,
and post-treatment (week 16). Using functional magnetic resonance imaging (fMRI) at baseline
and post-treatment, brain activation levels will be assessed at resting state, and while exposed
to anxiety-inducing images (i.e., dirty dishes if cleanliness is an obsession).

Results: The effects of treatment on neural anxiety processing and the correlation between
symptom severity and activation levels will be analyzed.

Conclusions: Findings from this pilot study and a future randomized controlled trial can further
our understanding of OCD causation, helping to develop more targeted and effective treatments.

Learning Objectives:
1. Understand the hypothesized causations of OCD and how observing neural anxiety
processing can help us uncover the truth.
2. Understand the efficacy and feasibility of implementing e-CBT as a treatment for OCD.

Keywords: Obsessive Compulsive Disorder, Brain Imaging, Psychotherapy

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Combining Ketamine with online Cognitive-Behavioural Therapy for the Treat- ment
of PTSD
Aaron Philipp-Muller, Taras Reshetukha, Roumen Milev, Gustavo Vazquez, & Nazanin Alavi

Objectives: Over a third of patients with Post-Traumatic Stress Disorder (PTSD) do not respond
to current pharmacological and psychotherapeutic interventions. Ketamine is one potential
treatment avenue, however its therapeutic effects for PTSD last only 7 days and weekly doses
may have adverse side-effects. Administering ketamine in con- junction with psychotherapy is
one potential means of prolonging its effects, and on- line Cognitive-Behavioural Therapy (e-CBT)
is a highly compatible candidate. This study will investigate a novel approach to treating refractory
PTSD by combining ket- amine with e-CBT.

Material and Methods: 20 patients will be assigned either to a waitlist or they will receive a
combi- nation of 6 IV ketamine infusions and 14 weeks of online Trauma-Focused Cognitive-
Behavioural Therapy (TF-eCBT). Patients in both conditions will be assessed for symp- toms of
PTSD before, during, and after treatment.

Results: In this proposed study, we expect patients in the treat- ment condition to have a
significantly greater reduction in PTSD symptoms than those in the control condition.

Conclusions: This study will demonstrate the combined effects of ketamine and e- CBT,
providing opportunities to increase PTSD treatment response. This study will also shed light on
the institutional barriers to care and will provide insight into the patho- physiology of PTSD, as
well as the involvement of glutamate in fear, memory, and neu- roplasticity.

Learning Objectives:
1. To gain a better understanding of certain challenges associated with effective treatment
of PTSD, particularly in the time of COVID.
2. To learn about contemporary applications of psychedelic medication as well as new uses
of online psychotherapy for treating PTSD.
3. To learn about the interplay between pharmacological and psychotherapeutic techniques.

Keywords: Ketamine, eCBT (online Cognitive-Behavioural Therapy), PTSD (PostTraumatic

Stress Disorder)

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Women as Caregivers to the Elderly
Ahila Vithiananthan, Shabbir Amanullah, Natasha Snelgrove, Suhaila Ghuloum, &
K. S. Shivakumar

Background: The value of the caregiver to the elderly with a rapidly ageing population is
unequivocal. Caregivers are able to reduce the cost of health care for this ageing generation and
provide ‘personalised care’. It is important to identify caregiver needs that addresses both their
positive and negative psychosocial outcomes including personal neglect and both perceived and
actual stress. Women are often juggling multiple roles and this chapter addresses how caregiving,
although rewarding, can significantly affect a female caregiver’s own health and finances. This
chapter explores the experiences of immigrants and indigenous peoples and reviews present
interventions for coping with caregiver burnout.

Objectives: The objective of this paper is to assess caregiver needs in order to address
significant psychosocial outcomes.

Material and Methods: Literature review.

Results: The purpose of this paper is to understand the growing needs of caregivers and address
the social and legislative discourse to reflect individual caregiving needs in an informal setting.
We must provide supports that are in a person’s cultural context and are culturally appropriate.

Conclusions: Caregiving will pose challenges to the healthcare system and social services.
Recognizing the role which women play helps reduce the burden on the healthcare system.

Learning Objectives:
1. To better understand the psychosocial outcomes of caregivers.
2. Highlight the perspectives of both immigrants and the indigenous community.
3. Look at possible interventions that would be beneficial in assisting caregivers.

Keywords: Caregiver, Stress, Burnout

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Cognitive ability and depressive symptom severity have differential relationships with
productive activities vs social relationships in Major Depressive Disorder
Isabelle Hau, Chelsea Wood-Ross, Stephanie Woolridge & Christopher Bowie

Background:
Major depressive disorder (MDD) is a pervasive mood disorder that is often characterized by
persistent cognitive deficits that are present even during episodes of remission. Research has
demonstrated bivariate relationships between poorer cognitive functioning and a variety of real-
world functioning issues, including in social and everyday activities. However, little is known about
the direct and mediating effects of cognitive problems on everyday functioning outcomes in MDD.
Thus, the current study sought to explore how cognition is related to everyday functioning
outcomes to improve social and productive functioning for those affected by MDD. Individuals 18-
65 years of age from two cognitive remediation studies for depression (N = 111) were assessed
on several domains, including neurocognition, social cognition, depressive symptom severity,
functional competence (performance-based assessment of what one can do), and real-world
everyday activities (in two domains: Productive Activities and Social Relationships). In assessing
predictors of productive activities, hierarchical multiple regression analyses indicated that
neurocognition significantly accounts for 15% of the variance, and adding depression symptom
severity significantly accounted for an additional 11% of the variance. In exploring predictors of
social functioning, neurocognition alone significantly accounted for 6% of the variance and
depression symptom severity contributed an extra 31% of variance. The findings highlight unique
pathways for neurocognition and depressive symptom severity significantly depending on the
type of functioning outcome. Treatment priorities based on functional deficits or functional goals
might allocate techniques aligned with the area most strongly associated with that domain of
functioning.

Learning Objectives:
1. Identify the direct and mediating effects of cognitive problems on everyday functioning
outcomes in major depressive disorder.
2. Highlight how different functioning outcomes are associated with unique pathways for
neurocognition and depressive symptom severity.
3. Analyze and apply findings to improve the social and productive functioning of individuals
with major depressive disorder.

Keywords: Major Depressive Disorder, Functional Competence, Cognition

Research Conference 2021 P a g e | 20

A Review of Neurologic Music Therapy in Stroke
Arian Sattari, Lola Cuddy, Kate Gee, Ariel Albin, & Elvina Chu

Objectives: Stroke is the third leading cause of death in Canada with an annually increasing
numbers of stroke survivors also at greatly increased risk of neuropsychiatric co-morbidity. The
objective of this systematic literature review was to assess whether neurologic music therapy
(NMT) or any of the 20 NMT components were effective in stroke rehabilitation.

Material and Methods: Electronic journal database searching was performed on MEDLINE,
EMBASE, PsycINFO, CINAHL, Cochrane Library, Web of Science and the Nordic Journal of Music
Therapy. Search terms - music therapy, neurologic music therapy, stroke, cerebrovascular
accident, brain attack, cerebral vascular accident, apoplexy, brain vascular accident, brain
ischemia, brain accident, brain insult, cerebral insult, cerebral stroke, cerebrovascular. Inclusion
criteria were post-stroke patients undergoing NMT rehabilitation. Exclusion criteria were case
reports and review articles.

Results: Using COVIDENCE software, 3010 articles were identified as containing the search
terms in the title and/or abstract. After initial screening, a further 20 of 38 studies were omitted
mainly due to wrong study design. 18 articles were included for full text review.

Conclusions: Outcomes from systematic literature review indicated that NMT appears to be a
useful tool in stroke rehabilitation for recovery of speech and motor function. It is widely
acceptable to patients and well tolerated. Limitations included a lack of sizeable study populations
and an absence of studies specifically examining treatment effects of NMT for neuropsychiatric
co-morbidities in stroke.

Learning Objectives:
1. Recognizing that stroke is associated with a high burden of neuropsychiatric co-morbidity.
2. Understanding that NMT may have a useful clinical role in stroke rehabilitation.

Keywords: Neurologic Music Therapy, Stroke, Neuropsychiatry

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Terrorism Typologies and Implications for Clinical Practice in Psychiatry
Robert JE Reid, Tariq Hassan, Reinhard Dolp, & Najat Khalifa

Background: Typology development entails systematically clustering related attributes among

individuals or groups to examine trends that might explain complex human interactions and
behaviours. This approach has demonstrated its utility in behavioural sciences with important
implications for policy, aetiology, course, and treatment. This article aims to provide an overview
of terrorism typologies, examine their implications for clinical practice, and provide some direction
for future research in the field. We argue that the theoretical nature and heterogeneity of existing
terrorism typologies limit their clinical utility, highlighting the need to develop empirically driven
typologies.

Keywords: Terrorism, Radicalization, Psychiatry, Risk Assessment, Mental Health

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Psychiatric assessment of terror subjects and those at risk of engaging in acts of
terrorism
Reinhard Dolp, Tariq Hassan, Robert Reid, & Najat Khalifa

Background:
Terrorism is a multi-faceted phenomenon that entails the strategic and instrumental use of
violence to achieve ideological or political goals. Despite decades of research in the field, empirical
data to guide clinical practice is still lacking. This presentation aims to provide an overview of the
social, psychological and political-cultural risk factors for radicalization to terrorism; putative link
between mental illness and terrorism; and threat assessment and management tools. In the
absence evidence based clinical guidelines, a thorough understanding of these issues may help
inform psychiatric assessments of terrors subjects.

Learning Objectives:
1. Understanding the connection between psychiatric disorders and terrorism
2. Getting familiar with the psychiatric assessment of terror suspects
3. Understanding psychiatric and social-cultural risk factors for radicalization to terrorism

Keywords: Terrorism, Forensic Psychiatry

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The Psychiatric Aspects of Terrorism: Prevention and Rehabilitation
Andrew Shaw, Najat Khalifa, & Dr. Tariq Hassan

Background: Preventing terrorism has thus far been in the domain of national security and law
enforcement agencies. The expectation that psychiatry has a primary role to play in the
rehabilitation of terrorist subjects remains controversial, although the significance of certain
mental disorders has been highlighted among lone actor terrorists. This contribution aims to
provide an overview of the motivating factors for radicalization to terrorism at both community
and individual levels, as well as preventative and rehabilitative approaches to terrorism. We argue
that psychiatry might have a role to play in these approaches with the goal of preventing violence
in select cases.

Learning Objectives:
1. To understand the radicalization process that leads to terrorism.
2. To summarize the existing literature on preventing acts of terrorism and rehabilitating
terrorists.

Keywords: Terrorism, Prevention, Rehabilitation

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Cortisol Reactivity and Hippocampal Volume as Mediators of the Relationship
Between Childhood Maltreatment and Depression
Jessica Rowe, Jordan Poppenk, Roumen Milev, Katherine E. Wynne-Edwards, Sidney H. Kennedy,
& Kate L. Harkness

Background: Childhood maltreatment has been documented as one of the strongest risk factors
for the development of depression. It has been theorized that childhood maltreatment acts as a
chronic stressor, resulting in enduring changes to stress-related brain mechanisms that heighten
risk for depression. Specifically, dysregulation of the stress response and the subsequent atrophy
of the hippocampus, have long been shown to be independently associated with both histories of
maltreatment and depression. The overarching goal of the current research was to examine both
the association of these neurobiological correlates and whether they acted as mediators of the
relationship between childhood maltreatment and depressive disorders. Data was leveraged from
a larger study investigating the biomarkers of depression and participants included 144 adults,
90 of whom were currently experiencing or had a history of depression. Childhood maltreatment
and depression was assessed via comprehensive interviews where the cortisol stress response
was collected using the Trier Social Stress Tests, a social stress paradigm. Further, hippocampal
volumes were segmented from T1-weighted structural scans. It was found that hippocampal
volume and cortisol reactivity were associated, but only within the context of emotional
maltreatment. Cortisol reactivity significantly mediated the relationship between childhood
maltreatment and depression, however, reduced hippocampal volume was only associated with
maltreatment history. These results suggest that hippocampal differences found between
depressive and control groups in prior research may be better accounted for by childhood
maltreatment and provide an important foundation for identifying neurobiological consequences
of maltreatment that are specific to depression.

Learning Objectives:
1. Investigate the relation between cortisol reactivity and hippocampal volume.
2. Investigate cortisol reactivity and hippocampal volume as mediators between childhood
maltreatment and depression.

Keywords: HPA-Axis, Depression, Childhood Maltreatment

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 ABSTRACTS
Poster Presentations – Breakout Room 2
Barriers to the Implementation of Action-Based Cognitive Remediation in Early
Psychosis Clinics
Maya McGregor, Chelsea Wood-Ross, Stephanie Woolridge, Melissa Milanovic, & Christopher
Bowie

Background: Action-Based Cognitive Remediation (ABCR) is a behavioural treatment that

addresses neurocognitive impairments associated with psychosis, using computer exercises
paired with role-plays to improve real-world functioning. ABCR has been widely and internationally
disseminated to clinical sites, yet uptake of the manualized treatment has been limited at some
sites.

Objectives: We aimed to understand the barriers that clinics face in implementing ABCR.

Material and Methods: Trained ABCR therapists (e.g., psychiatrists, psychologists,

occupational therapists, nurses, social workers) completed a survey on their clinic’s experiences
with ABCR, including the greatest barriers they faced with implementation and whether the
therapist modified the ABCR protocol, either by reducing the number of sessions offered (<16
sessions) and/or the number of hours per session (<2 hours).

Results: Protecting staff time was reported as the greatest clinic-related barrier in administering
ABCR, followed by manager support, patient geographics, equipment, and space. Further,
therapists who reduced ABCR administration (n=29) reported facing significantly greater barriers
of manager support compared to those who administered regular ABCR dosage (n=22), t(1, 49)
= -3.13, p < .01. We did not find significant differences between groups in reported barriers of
staff time, geographic issues, equipment, or space. Lastly, a greater proportion of patients
completing their ABCR sessions was associated with fewer barriers to patient-therapist rapport (r
= -.68, p <.001).

Conclusions: Addressing these preliminary barriers may help increase the successful
implementation of ABCR and, in turn, improve treatment access across a wider array of clinical
settings.

Learning Objectives:
1. Identify barriers that clinics face in implementing Action-Based Cognitive Remediation
(ABCR)
2. Measure differences in barriers faced by therapists who reduced ABCR administration
compared to therapists who did not.
3. Analyze whether patient completion of ABCR sessions is associated with barriers to
patient-therapist rapport.

Keywords: Cognitive remediation, Psychosis, Neurocognition

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Increasing treatment efficiency and personalization for patients with depression
through a stepped care e-CBT model
Jasleen Jagayat Anastasia Shao, Amirhossein Shirazi, Mohsen Omrani, Anne O’Riordan, Gunnar
Blohm, & Nazanin Alavi

Background:
Depression is a leading cause of disability, annually affecting up to 300 million people worldwide,
yet less than one third of patients with depression receive care. With barriers regarding face-to-
face therapy, electronic cognitive behavioural therapy (e-CBT) has been increasingly implemented
as a reliable solution to increase care efficiency, accessibility and affordability. The online format
allows for easy integration of additional tools that can increase care outcomes and tailor care to
patients. This study aims to develop an efficient stepped-care model for depression-based e-CBT,
and explore if guiding interventions based on previous patients data is reliable and effective. In
this study, participants receive treatment tailored to their improvement of depressive symptoms
informed by their understanding of CBT concepts, engagement levels, changes in clinical
questionnaire scores, FitBit activity data, and primarily, the therapist’s discretion. Participants will
be randomized into either an e-CBT (control) group or an e-CBT with intervention (treatment)
group. If participants in the treatment group do not show signs of improvement, an intervention
will be added to their care until their symptoms improve. There are a total of five possible stepped
interventions: (1) Message from therapist, (2) Telephone call from therapist, (3) Enhanced
telephone call from therapist, (4) Video call from therapist, and (5) Video call from primary
psychiatrist. It is hypothesized that the stepped care approach will increase treatment efficiency
and provide a wholesome approach to care. The results from this study can help tailor e-CBT
programs for depression to patient needs and maximize treatment efficiency through stepped
care.

Learning Objectives:
1. Introduction on e-CBT and the advantages of e-CBT over traditional face-to-face therapy.
2. Understanding different factors that may predict the outcome of e-CBT therapy for
patients.
3. Explore additional interventions that can increase e-CBT efficiency.

Keywords: Major Depressive Disorder, Electronic Cognitive Behavioural Therapy

(e-CBT), Stepped Care Intervention

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Omnibus Inventory of Trait Rumination Questionnaires Has a Multi-Factorial
Structure Representing Deliberate Analysis, Positive Thinking, and Distressing
Rumination
Scott D. Squires, Roumen V. Milev, Kate L. Harkness, & Jordan Poppenk

Objectives: Ruminative thinking is a common experience, especially in people at risk for

psychopathology. Despite this, no universally agreed-upon definition of rumination exists, except
that it is internally focused, cognitively demanding, and involves repetitive and/or recurrent
thought that lasts many minutes, hours, or longer. Most theories are at odds over core
characteristics of rumination, such as its triggering contexts, content, emotional valence,
orientation in time, function, and adaptiveness. This has created an inconsistent literature, limiting
progress of research into this often-maladaptive cognitive process. To unify and understand the
structure of the latent variables underlying the diversity of constructs called rumination, we used
exploratory factor analysis to identify factors that parsimoniously described the covariance of
items within an omnibus trait rumination inventory representing most of the field’s questionnaires.

Material and Methods: Four hundred and forty-two items from 76 scales/subscales were split
into two item pools, with 756 participants completing either pool online, administered pseudo-
randomly. Exploratory factor analysis was conducted on the item responses to identify the factors
that parsimoniously account for the correlations among items.

Results: A hierarchical factor structure was revealed, consistent between item pools. It
distinguished Deliberate Analysis and Positive Thinking from six facets of distressing rumination:
general Uncontrollability, plus Post-Event/Counterfactual, Pessimistic/Self-Critical, Anger-
Related, Illness-Related, and Overwhelming/Anxious Rumination

Conclusions: Multiple kinds of rumination exist within a hierarchical structure, with only some
factors overlapping with previous theoretical definitions. Uncovering the factor structure
underlying trait rumination is critical for unifying the field’s understanding of the construct and
informing treatment of its maladaptive forms.

Learning Objectives:
1. To learn about the state of basic and clinical research about rumination.
2. To learn that rumination is a heterogeneous construct made up of many related kinds that
have different characteristics and outcomes.
3. To learn about factor analysis as a tool to uncover the latent factor structure underlying
a set of questionnaire items.

Keywords: Rumination, Reflection, Factor Analysis

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The Impact of Non-Infection Pandemic-Related Stress on Depression and Anxiety
Severity: Investigating Mediation by Intrusive and Deliberate Rumination
Scott D. Squires, Mianzhi Hu, Roumen V. Milev, & Jordan Poppenk

Objectives: The links between pandemic-related stress and the severity of depression and
anxiety are well-established. However, little work has examined rumination as an explanatory
factor in these associations and no studies have examined the effects on psychopathology of
different kinds of rumination in response to the COVID-19 pandemic. Post-traumatic stress
research has observed that psychological distress worsens after intrusive, but not deliberate
rumination about stressful events. We investigated if this pattern generalized to non-infection,
pandemic-related stress in the general population.

Material and Methods: With data from an online sample of 1090 participants, a parallel
mediation model with multiple dependent variables tested if the associations of non-infection,
pandemic-related stress (e.g., impacts on job, education, social life, childcare, supply/medication
shortages, etc.) with depression and anxiety severity were mediated by intrusive and/or
deliberate rumination about the pandemic.

Results: As hypothesized, pandemic-related stress was associated with greater depression,

anxiety, and intrusive and deliberate rumination. Additionally, intrusive, but not deliberate
rumination partially mediated the effects that stress had on psychopathology.

Conclusions: Non-infection, pandemic-related stress is related to higher levels of rumination

generally, but it is specifically rumination of an intrusive, unwanted, and uncontrollable nature
that translates this stress into psychopathology, not rumination that is deliberate, purposeful, and
controllable.

Learning Objectives:
1. To learn about the impact of pandemic-related stress on rumination, depression, and
anxiety.
2. To learn about rumination as a heterogeneous construct that has different impacts on
mental well-being across different kinds of rumination.
3. To learn about the Event-Related Rumination Inventory, a measure of intrusive and
deliberate rumination about a stressful experience.

Keywords: COVID-19 Stress, Rumination, Depression/Anxiety

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Initiating and Maintaining Medically Supervised Ketogenic Diet in the Treatment of
Brain-Based Diseases in Different Clinical Populations and Settings
Jennifer Fabe, Charlene Tan-Smith, Carol Shaw, Nadine Nevland, Andrew Smith, Fabiano A.
Gomes, & Elisa Brietzke

Objectives: Explore tolerance of medically supervised ketogenic therapy (MS-KT) and

sustainability tools in different populations and settings.

Material and Methods: MS-KT is a high fat, low carbohydrate diet therapy option for refractory
epilepsy population. It requires moderate to strict MS-KT prescriptions & registered dietitians (RD)
support. Traditionally initiated rapidly but often accompanied with metabolic fluctuations of
acidosis, hypoglycemia, and gut intolerance. Adapting an initiation of low ratio, slow outpatient
titration method improves initiation tolerability and supports gradual diet lifestyle change. We will
explore if this is amenable to those who clinically or psychosocially may not tolerate abrupt diet
lifestyle change like the major depressive disorder population. Maintenance of MS-KT requires the
diet to be flexible & adaptable per our Canadian survey of ketogenic RDs & New Zealand (NZ)
parent focus groups. In response, different tools were developed to support patient MS-KT
sustainability: a) Food Exchange-Meal Plans b) KetoSuiteTM: first ever Canada & NZ software
supporting MS-KT prescription meal balancing, food variety & recipe adaptation. Data to be
collected: indication for MS-KT, ketosis, acidosis, blood glucose, diet prescription, gut tolerance,
supportive tools utilized, length of therapy, reason for discontinuation or drop out.

Results: Preliminary data:

a) Low ratio, slow outpatient initiation is tolerable with minimal metabolic fluctuations and
adaptable to virtual practice in both Canada and NZ.
b) Sustainability is supported with tools that maintain diet prescription but offers flexible food &
menu options.

Conclusions: This study will expand our knowledge on how to support MS-KT therapy
sustainability.

Learning Objectives:
1. Explore tolerance of MS-KT in adults & major depressive disorder population.
2. Understand & evaluate variables that may affect sustainability of MS-KT.

Keywords: Ketogenic Diet, Major Depressive Disorder, Nutrition

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Is provider adherence to the CANMAT guideline related to better discharge and post-
discharge outcomes for patients with acute mania?
Julia Fagen, Fabiano A. Gomes, Taylor Magee, Tatiana Valverde-da-Conceicao, Linda Wang,
Roumen Milev, & Elisa Brietzke

Objectives: The objective of this study is to evaluate real-life implementation of the Canadian
Network for Mood and Anxiety Treatments (CANMAT) 2018 in the treatment of acute mania.

Material and Methods: In this study, we will evaluate the possible association between provider
adherence to the CANMAT 2018 guidelines in the treatment of acute mania and healthcare
relevant outcomes such as length of stay, 30-days visits to the emergency room, and 30-days
readmission rates. The study will also investigate possible predictors of guideline adherence. This
is a retrospective chart review of patients aged 12 to 60 years old, who spent at least 12 hours
at the Kingston General Hospital Inpatient Psychiatric Unit (Burr 4) due to an acute manic episode
since the publication of CANMAT in 2018. Socio-demographic variables, medications and dosing,
and assessment of outcomes will be extracted from the medical records. Provider adherence will
be assessed by a simple concordance analysis and by an adaptation of the provider adherence
index.

Results: Guidelines are designed to assist providers, but their implementation is inadequately
planned, reported, and measured. The results of this project have the potential to guide actions
to create consistency among the care provided, improve the education of residents and students,
provide high quality care to patients, and produce benefits to the healthcare system.

Conclusions: Although the CANMAT 2018 is an evidence-based guideline for clinical decisions,
its real impact in clinical practice remain to be established. Our study will contribute to generate
data on its implementation.

Learning Objectives:
1. Understand the role of evidence-based medicine in the treatment of BD.
2. Explore a proposal of assessment of adherence to CANMAT 2018 recommendations for
the treatment of acute mania.
3. Explore possible predictors of adherence and non-adherence to the CANMAT 2018
guidelines.

Keywords: Acute mania; Bipolar Disorder; Evidence-Based Psychiatry; Mood

Stabilizers; Guidelines; Implementation.

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Determinants of serum concentrations of vitamin D and its association with
depressive symptoms: a cross-sectional and longitudinal analysis of the
Epifloripa Idoso
Gilciane Ceolin, Fabiano A. Gomes, Débora Kurrle Rieger Venske, Júlia Dubois Moreira, &
Elisa Brietzke.

Objectives: To evaluate the longitudinal association between vitamin D serum concentration

and depressive symptoms in older adults from Epifloripa Idoso cohort study.

Material and Methods: This project is part of a PhD research project developed at the
Postgraduate Program in Nutrition of Universidade Federal de Santa Catarina, Brazil, in
collaboration with the NeuroMood Lab, Queen’s University. The database to perform analysis is a
cohort study that evaluates the health conditions of older adults (≥60 years old) living in
Florianopolis, Santa Catarina, Brazil. The study carried out the data collection since the baseline
in 2009/2010, with a second and third waves collected in 2013-2014 and 2017-2019, respectively.
Blood sampled were collected in the second wave (2013-2014) and Vitamin D levels will be
estimated by the assessment of 25-hydroxycholecalciferol serum concentration. The main
outcome is the severity of depressive symptoms which was collected at the baseline, wave 2 and
wave 3 by the 15 items version of Geriatric Depressive Scale (GDS-15). We will use machine
learning strategies to control multiple covariates.

Results: This study is currently under execution and the data analysis will be developed from
September 2021 to February 2022 at the Centre for Neuroscience Studies (CNS),
Queen’s University.

Conclusions: The results of this study will contribute to elucidate the role of Vitamin D levels in
geriatric depression using a strong methodology. Gilciane Ceolin recieved funidng from a
scholarship from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.

Learning Objectives:
1. Understand the role of Vitamin D in geriatric depression.
2. Present the Epifloripa Idoso Cohort.
3. Investigate the association between Vitamin D peripheral levels and depressive symptoms
severity.

Keywords: Vitamin D; Depression; Older Adults.

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The Effects of the Ketogenic Diet on Premature Aging in Major Depressive Disorder
Alexander Bambokian, Gabriel Fries, Calvin Sjaarda, Rodrigo B. Mansur, Roger S. McIntyre,
Fabiano A. Gomes, Jennifer Fabe, Roumen Milev, Claudio N Soares, & Elisa Brietzke.

Objectives: Major Depressive Disorder (MDD) is associated with premature aging. Caloric
restriction is associated with an increase in life span in humans, but the potential of the ketogenic
diet (KD) has yet to be investigated. This study aims to investigate the potential effect of a KD
on the biomarkers of premature aging in sixty individuals with MDD.

Material and Methods: Individuals currently enrolled in a randomized clinical trial, whereby a
KD is used as an adjuvant therapy for depression, will be included. We hypothesize that the
intervention will increase telomerase mRNA expression, increase telomere length, and reduce
epigenetic aging in individuals with MDD consuming the KD, as compared to the control group.
Bioanalysis includes the quantification of telomerase mRNA expression and telomere length.
Telomerase mRNA will be analyzed from peripheral blood mononuclear cells using qPCR to
quantify mRNA both prior to KD administration, and 12-weeks following KD initiation. Telomere
length will also be determined by qPCR. Rates of epigenetic aging will be defined through DNA
methylation quantification via EZ-DNA-MethylationTM Kit analysis in both groups.

Results: This study is currently under execution. The data analysis will be developed at the
Ongwanada Resource Centre and the Centre for Neuroscience Studies, Queen’s University.

Conclusions: This study will be the first to determine the effects of a KD on premature aging in
individuals with MDD. It can provide insight into the unknown mechanisms underlying MDD, and
facilitate the development of innovative, affordable, and safe nutritional approaches in psychiatry
for targeting mood disorders. Alexander Bambokian is supported by a CIHR scholarship.

Learning Objectives:
1. Understand the role of the KD on premature aging in MDD.
2. Investigate the unknown mechanisms of the KD as a potential alternative treatment for
MDD.
3. Understand the interactions between KD consumption and genome DNA methylation

Keywords: Major Depressive Disorder; Ketogenic Diet; Premature aging; Telomere;

Telomerase; Epigenetics

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Temporal Dynamics and Evolution of SARS-CoV-2 in Ontario During First Two Waves
of Pandemic
Calvin Sjaarda, Robert Colautti, & Prameet Sheth

Objectives: Genome-wide variation in SARS-CoV-2 reveals evolution and transmission dynamics

which are critical considerations for disease control and prevention decisions. Using existing next
generation sequencing equipment and bioinformatic tools at Queen’s Genomics Lab at
Ongwanada (Q-GLO), we generated and analyzed SARS-CoV-2 whole genome data to describe
local variants, detect newly emerging strains, and reconstruct chains of transmission.

Material and Methods: Nasopharyngeal swabs were obtained from thirty-two of the first
COVID-19 positive cases (March 18-30, 2020) in Kingston Ontario, and viral genomes (n=27)
were sequenced using Ion Torrent and MinION sequencing platforms. In addition, we analyzed
the temporal distribution of variants and lineages in 1,743 genomes published from Ontario prior
to November 24, 2020.

Results: We identified forty-six polymorphic sites including five variants in the spike protein
gene. A heterozygous variant was detected by both sequencing platforms but filtered by the
ARTIC network bioinformatic pipeline. Phylogenetic analysis identified multiple, international
introductions as well as community spread. The reported mutation rate (~10-6 nt-1 cycle-1) for
SARS-CoV-2 is typical of coronaviruses. Analysis of published SARS-CoV-2 genomes revealed that
the G614 spike protein mutation has dominated Ontario infections and that SARS-CoV-2 lineages
have not differed significantly in their rate of spread.

Conclusions: Whole genome sequencing may complement contact tracing and help reconstruct
transmission chains of emerging diseases. We demonstrate that heterozygous variants may be
underreported in the SARS-CoV-2 literature. The SARS-CoV-2 population circulating in Ontario did
not changed significantly over first two waves, but ongoing genome monitoring is essential for
detection of new variants and lineages.

Learning Objectives:
1. Describe how genomics can be used to reconstruct transmission chains of infectious
diseases.
2. Explain how reducing the number of hosts is an effective strategy for minimizing the
evolution of variants of concern.

Keywords: COVID-19, Genome, Variants

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 SPECIAL THANKS AND
ACKNOWLEDGEMENTS

Queen’s University Department of Psychiatry Research Committee Members:

Dr. Gustavo Vazquez Dr. Spencer Haze

Dr. Nazanin Alavi Tabari Dr. David Carlone
Dr. Muhammad Ayub Dr. Rebecca Douglas
Dr. Felicia Iftene Dr. Caroline Wallace
Dr. Claudio Soares

Brittany Foerster, Administrative Support

Our Panel of Judges

Special thanks to Queen’s Videoconferencing Unit for making today possible.

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