@article{pmid40037661,

title = {Elevated plasma B and betaine levels in women with anorexia nervosa: possible role in illness pathophysiology and epigenetic regulation},

author = {Howard Steiger and Kevin F Casey and Jessica Burdo and Valerie Marcil and Maegan Harvison and Juliana Meyerfreund and Édith Breton and Zsofia Nemoda and Lea Thaler and Annie St-Hilaire and Mimi Israel and Chloe Paquin-Hodge and Luis B Agellon and Véronique Bélanger and Linda Booij},

doi = {10.1503/jpn.240155},

issn = {1488-2434},

year  = {2025},

date = {2025-01-01},

journal = {J Psychiatry Neurosci},

volume = {50},

number = {2},

pages = {E85--E91},

abstract = {BACKGROUND: Phenomenology in anorexia nervosa (AN) appears to be subject to epigenetic regulation via DNA methylation. The micronutrients B and betaine contribute directly to DNA methylation and have been shown to be abnormally elevated in blood samples from people with AN.nnMETHODS: We measured plasma B and betaine levels, as well as leukocyte DNA methylation levels, among women with active AN (AN-active group), those in 1-year remission from AN (AN-remitted group), and those who had never experienced an eating disorder (NED group). We compared the groups on micronutrient levels and on the strength of association between micronutrients and methylation.nnRESULTS: We included 64 women in the AN-active group, 49 in the AN-remitted group, and 49 in the NED group. Relative to those with NED (B: mean 339.6 [standard deviation (SD) 224.3] μmol/L; betaine: mean 33.74 [SD 17.10] μmol/L), participants with active AN showed high B and betaine (B: mean 571.0 [SD 505.2] μmol/L; betaine: mean 43.73 [SD 22.50] μmol/L); AN-remitted participants had elevated B alone (B: mean 588.2 [SD 379.9] μmol/L; betaine: mean 33.50 [SD 19.20] μmol/L). There were also group-based differences in the strength of association between B and site-specific DNA methylation at genes regulating insulin function, glucose metabolism, cell regulation, and neurotransmitter function. These associations between B and methylation levels were generally stronger among those without an ED than among those with either active or remitted AN.nnLIMITATIONS: The extent to which plasma nutrient levels provide a meaningful proxy to cellular processes affecting DNA methylation is uncertain and the sample size limits the stability of results. We included only biological females in this investigation.nnCONCLUSION: Elevated B levels in AN resemble elevations reported among people with autoimmune, neoplastic, or other disorders. Such elevations imply that plasma B levels may misrepresent nutritional status among people with AN. Observed associations between levels of B and methylation at certain gene regions have ambiguous importance, but may indicate an influence of nutritional status on epigenetic mechanisms or may be the coincidence of separate processes that independently affect levels of micronutrients and DNA methylation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38997243,

title = {Outcomes of a Virtual Day Treatment Program for Adults With Eating Disorders-Comparison With In-Person Day Treatment},

author = {Lea Thaler and Linda Booij and Annie St-Hilaire and Chloé Paquin-Hodge and Nesrine Mesli and Hope Burko and Viveca Lee and Stephanie Oliverio and Mimi Israël and Howard Steiger},

doi = {10.1002/eat.24263},

issn = {1098-108X},

year  = {2024},

date = {2024-10-01},

journal = {Int J Eat Disord},

volume = {57},

number = {10},

pages = {2135--2140},

abstract = {OBJECTIVE: Previous studies have indicated that virtual treatments for eating disorders (EDs) are roughly as effective as are in-person treatments; the present nonrandomized study aimed to expand on the current body of evidence by comparing outcomes from a virtual day treatment program with those of an in-person program in an adult ED sample.nnMETHOD: Participants were 109 patients who completed at least 60% of day treatment sessions (n = 55 in-person and n = 54 virtual). Outcome measures included ED and comorbid symptoms, and motivation.nnRESULTS: Linear mixed models showed that global EDE-Q scores decreased during treatment (AIC = 376.396, F = 10.94, p = 0.002), irrespective of treatment modality (p = 0.186). BMI significantly increased over time (AIC = 389.029, F = 27.97, p < 0.001), with no effect of treatment modality (p = 0.779).nnDISCUSSION: Our findings suggest that the virtual delivery of day treatments produces comparable outcomes to those obtained using in-person formats, and that virtual formats may represent a pragmatic treatment option, especially in situations in which access to in-person care is limited.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37644511,

title = {Development of a transdiagnostic digital interactive application for eating disorders: psychometric properties, satisfaction, and perceptions on implementation in clinical practice},

author = {Linda Booij and Mimi Israël and Manuela Ferrari and Annie St-Hilaire and Chloé Paquin-Hodge and Melissa Allard and Amélie Blaquière and Julia Dornik and Shiri Freiwald and Shawna A Long and Marika Monarque and William D Pelletier and Lea Thaler and Miriam Yaffe and Howard Steiger},

doi = {10.1186/s40337-023-00871-3},

issn = {2050-2974},

year  = {2023},

date = {2023-08-01},

journal = {J Eat Disord},

volume = {11},

number = {1},

pages = {146},

abstract = {BACKGROUND: Given limited availability of informed treatments for people affected by eating disorders (EDs), there has been increasing interest in developing self-administered, technology-based ED interventions. However, many available interventions are limited to a specific ED diagnosis or assume that participants are ready to change. We developed a digital self-help application (called ASTrA) that was explicitly designed to be transdiagnostic and to help increase motivation for change. The aim of the present study was to describe the development and examine the psychometric properties, user satisfaction and rated potentials for practical use of our application.nnMETHODS: The content of our application was based on concepts derived from self-determination theory, the transtheoretical model of change, and cognitive theory. The application was developed by a multidisciplinary team of clinicians, researchers, staff members and individuals with lived ED experience, each being involved in all steps of the application's development. We tested validity, reliability, satisfaction and perceived feasibility for clinical implementation in an independent sample of 15 patients with an ED and 13 clinicians specialized in ED treatment. Psychometric properties were evaluated using descriptive statistics, correlations, content validity indices and intraclass coefficients. Differences in satisfaction ratings and perceived potential for clinical implementation of the application between clinicians and patients were examined using Mann-Whitney U tests.nnRESULTS: The digital application showed excellent validity (mean i-CVI: .93, range: .86-.96) and internal reliability (all Cronbach alpha's > .88). Patients and clinicians both considered the application acceptable, appropriate, and feasible for use in clinical practice.nnCONCLUSIONS: Findings suggest that our transdiagnostic interactive application has excellent psychometric properties. Furthermore, patients and clinicians alike were positive about the possible use of the application in clinical practice. The next step will be to investigate the application's effectiveness as an intervention to promote autonomous motivation and to facilitate remission in people on the waitlist for specialized ED treatment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36180648,

title = {Barriers and Facilitators to the Implementation of an Eating Disorders Knowledge Exchange Program for Non-specialist Professionals},

author = {Lea Thaler and Chloé Paquin-Hodge and Anne-Gaëlle Leloup and Aimée Wallace and Stephanie Oliverio and Shiri Freiwald and Mimi Israel and Howard Steiger},

doi = {10.1007/s11414-022-09822-3},

issn = {1556-3308},

year  = {2023},

date = {2023-07-01},

journal = {J Behav Health Serv Res},

volume = {50},

number = {3},

pages = {365--380},

abstract = {Despite availability of evidence-based treatments for eating disorders (EDs), individuals with EDs often do not receive informed treatment. Training of non-specialized clinicians by experienced professionals through knowledge exchange (KE) programs is an effective way to enhance accessibility to evidence-based treatments for EDs. The authors conducted a qualitative analysis of factors that facilitated or impeded the uptake of an ED-focused KE program. Semi-structured interviews were conducted with mental health professionals (n = 43) and managers (n = 11) at 13 community mental-health sites at which the KE program was offered. Data were analyzed using a qualitative content analysis. Key facilitators identified were management support for the program and building competence through ongoing supervision of clinicians. Main barriers were limited access to ED patients to treat and having insufficient time to apply ED interventions in front-line settings. The results provide insights into the practical imperatives involved in implementing a KE initiative for ED treatment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37419977,

title = {Amphetamine disrupts dopamine axon growth in adolescence by a sex-specific mechanism in mice},

author = {Lauren M Reynolds and Giovanni Hernandez and Del MacGowan and Christina Popescu and Dominique Nouel and Santiago Cuesta and Samuel Burke and Katherine E Savell and Janet Zhao and Jose Maria Restrepo-Lozano and Michel Giroux and Sonia Israel and Taylor Orsini and Susan He and Michael Wodzinski and Radu G Avramescu and Matthew Pokinko and Julia G Epelbaum and Zhipeng Niu and Andrea Harée Pantoja-Urbán and Louis-Éric Trudeau and Bryan Kolb and Jeremy J Day and Cecilia Flores},

doi = {10.1038/s41467-023-39665-1},

issn = {2041-1723},

year  = {2023},

date = {2023-07-01},

journal = {Nat Commun},

volume = {14},

number = {1},

pages = {4035},

abstract = {Initiating drug use during adolescence increases the risk of developing addiction or other psychopathologies later in life, with long-term outcomes varying according to sex and exact timing of use. The cellular and molecular underpinnings explaining this differential sensitivity to detrimental drug effects remain unexplained. The Netrin-1/DCC guidance cue system segregates cortical and limbic dopamine pathways in adolescence. Here we show that amphetamine, by dysregulating Netrin-1/DCC signaling, triggers ectopic growth of mesolimbic dopamine axons to the prefrontal cortex, only in early-adolescent male mice, underlying a male-specific vulnerability to enduring cognitive deficits. In adolescent females, compensatory changes in Netrin-1 protect against the deleterious consequences of amphetamine on dopamine connectivity and cognitive outcomes. Netrin-1/DCC signaling functions as a molecular switch which can be differentially regulated by the same drug experience as function of an individual's sex and adolescent age, and lead to divergent long-term outcomes associated with vulnerable or resilient phenotypes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35703085,

title = {DNA methylation in people with anorexia nervosa: Epigenome-wide patterns in actively ill, long-term remitted, and healthy-eater women},

author = {Howard Steiger and Linda Booij and Lea Thaler and Annie St-Hilaire and Mimi Israël and Kevin F Casey and Stephanie Oliverio and Olivia Crescenzi and Viveca Lee and Gustavo Turecki and Ridha Joober and Moshe Szyf and Édith Breton},

doi = {10.1080/15622975.2022.2089731},

issn = {1814-1412},

year  = {2023},

date = {2023-03-01},

journal = {World J Biol Psychiatry},

volume = {24},

number = {3},

pages = {254--259},

abstract = {OBJECTIVES: Recent studies have reported altered methylation levels at disorder-relevant DNA sites in people who are ill with Anorexia Nervosa (AN) compared to findings in people with no eating disorder (ED) or in whom AN has remitted. The preceding implies state-related influences upon gene expression in people with AN. This study further examined this notion.nnMETHODS: We measured genome-wide DNA methylation in 145 women with active AN, 49 showing stable one-year remission of AN, and 64 with no ED.nnRESULTS: Comparisons revealed 205 differentially methylated sites between active and no ED groups, and 162 differentially methylated sites between active and remitted groups ( < 0.01). Probes tended to map onto genes relevant to psychiatric, metabolic and immune functions. Notably, several of the genes identified here as being differentially methylated in people with AN (e.g. , , ) have figured in previous studies on AN. Effects also associated illness chronicity and lower BMI with more pronounced DNA methylation alterations, and remission of AN with normalisation of DNA methylation.nnCONCLUSIONS: Findings corroborate earlier results suggesting reversible DNA methylation alterations in AN, and point to particular genes at which epigenetic mechanisms may act to shape AN phenomenology.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35366169,

title = {Barriers and facilitators to providing autonomy supportive counselling to individuals seeking treatment for an eating disorder},

author = {Stephanie Oliverio and Howard Steiger and Annie St-Hilaire and Chloé Paquin-Hodge and Anne-Gaëlle Leloup and Mimi Israel and Lea Thaler},

doi = {10.1007/s40519-022-01395-6},

issn = {1590-1262},

year  = {2022},

date = {2022-10-01},

journal = {Eat Weight Disord},

volume = {27},

number = {7},

pages = {2919--2929},

abstract = {PURPOSE: Self-determination theory suggests that autonomous motivation for change (i.e., motivation that is internal and self-endorsed) can be enhanced in therapeutic contexts by clinicians acting in an autonomy supportive manner. While previous research has established a link between autonomy support (AS) and autonomous motivation in enhancing outcomes in eating disorder (ED) treatment, few studies have examined factors that support or hinder therapists' ability to be autonomy supportive in the context of an ED therapeutic encounter. The goal of the present study was to conduct a qualitative analysis of personal and contextual factors that facilitated or hindered therapists' ability to provide autonomy supportive interventions.nnMETHODS: Semi-structured interviews were conducted with 10 therapists conducting outpatient psychotherapy at a specialized eating disorders treatment program. Data were analyzed using thematic analysis.nnRESULTS: The most frequently noted facilitators were organizational support of AS interventions and patients' engagement and motivation for treatment. The most frequently noted barriers were patients' personality variables such as patients that exhibit passive and help-rejecting behaviours, as well as therapists feeling overwhelmed due to a high workload.nnCONCLUSION: Our results provide insight into the factors that facilitate and impede the utilization of an autonomy supportive approach in specialized ED treatment and can be used to inform future quantitative research on such factors.nnLEVEL OF EVIDENCE: Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34971014,

title = {Predictors of non-completion of a day treatment program for adults with eating disorders},

author = {Lea Thaler and Linda Booij and Nuala Burnham and Samantha Kenny and Stephanie Oliverio and Mimi Israel and Howard Steiger},

doi = {10.1002/erv.2879},

issn = {1099-0968},

year  = {2022},

date = {2022-03-01},

journal = {Eur Eat Disord Rev},

volume = {30},

number = {2},

pages = {146--155},

abstract = {Although treatment dropout is common among patients with eating disorders, very few studies have examined predictors of non-completion in day treatment. We investigated various potential predictors of dropout from adult day treatment. Participants were 295 adult patients with a diagnosis of Anorexia Nervosa (restricting or binge-eating/purging subtype), Bulimia Nervosa (BN), Other Specified Feeding or Eating Disorder, or Avoidant Restrictive Food Intake Disorder. Predictors included eating-disorder characteristics, motivation at the commencement of treatment, Body Mass Index (BMI), time spent in treatment and personality dimensions. Logistic regression analyses showed that for patients with a BMI of less than 20 at the start of treatment, low BMI was a significant predictor of staff-initiated termination due to not meeting weight gain goals. Furthermore, completing less than 6 weeks of treatment was associated with staff-initiated termination. For the whole sample, those with higher changes in weight over the course of treatment were less likely to terminate prematurely. None of the other predictor variables yielded significant results. Results of the current study highlight characteristics of patients who are more likely not to complete day treatment and can help identify patients who may be at risk for not succeeding in multi-diagnostic day treatment programs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34953204,

title = {Evaluating the perceived utility of an artificial intelligence-powered clinical decision support system for depression treatment using a simulation center},

author = {Myriam Tanguay-Sela and David Benrimoh and Christina Popescu and Tamara Perez and Colleen Rollins and Emily Snook and Eryn Lundrigan and Caitrin Armstrong and Kelly Perlman and Robert Fratila and Joseph Mehltretter and Sonia Israel and Monique Champagne and Jérôme Williams and Jade Simard and Sagar V Parikh and Jordan F Karp and Katherine Heller and Outi Linnaranta and Liliana Gomez Cardona and Gustavo Turecki and Howard C Margolese},

doi = {10.1016/j.psychres.2021.114336},

issn = {1872-7123},

year  = {2022},

date = {2022-02-01},

journal = {Psychiatry Res},

volume = {308},

pages = {114336},

abstract = {Aifred is a clinical decision support system (CDSS) that uses artificial intelligence to assist physicians in selecting treatments for major depressive disorder (MDD) by providing probabilities of remission for different treatment options based on patient characteristics. We evaluated the utility of the CDSS as perceived by physicians participating in simulated clinical interactions. Twenty physicians who were either staff or residents in psychiatry or family medicine completed a study in which they had three 10-minute clinical interactions with standardized patients portraying mild, moderate, and severe episodes of MDD. During these scenarios, physicians were given access to the CDSS, which they could use in their treatment decisions. The perceived utility of the CDSS was assessed through self-report questionnaires, scenario observations, and interviews. 60% of physicians perceived the CDSS to be a useful tool in their treatment-selection process, with family physicians perceiving the greatest utility. Moreover, 50% of physicians would use the tool for all patients with depression, with an additional 35% noting that they would reserve the tool for more severe or treatment-resistant patients. Furthermore, clinicians found the tool to be useful in discussing treatment options with patients. The efficacy of this CDSS and its potential to improve treatment outcomes must be further evaluated in clinical trials.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34904742,

title = {In-person versus virtual therapy in outpatient eating-disorder treatment: A COVID-19 inspired study},

author = {Howard Steiger and Linda Booij and Olivia Crescenzi and Stephanie Oliverio and Ilana Singer and Lea Thaler and Annie St-Hilaire and Mimi Israel},

doi = {10.1002/eat.23655},

issn = {1098-108X},

year  = {2022},

date = {2022-01-01},

journal = {Int J Eat Disord},

volume = {55},

number = {1},

pages = {145--150},

abstract = {OBJECTIVE: Findings show virtual therapy (conducted using internet-based videoconferencing techniques) to be a viable alternative to in-person therapy for a variety of mental-health problems. COVID-19 social-distancing imperatives required us to substitute virtual interventions for in-person sessions routinely offered in our outpatient eating disorder (ED) program-and afforded us an opportunity to compare the two treatment formats for clinical efficacy.nnMETHODS: Using self-report assessments, we compared outcomes in a historical sample of 49 adults with heterogeneous EDs (treated in-person over 10-14 weeks in individual and group therapies) to those of 76 patients receiving comparable virtual treatments, at distance, during the COVID-19 outbreak. Linear mixed models were used to study symptom changes over time and to test for differential effects of treatment modality.nnRESULTS: Participants in both groups showed similar improvements on eating symptoms, levels of weight gain (in individuals in whom gain was indicated), and satisfaction with services.nnDISCUSSION: Our results suggest that short-term clinical outcomes with virtual and in-person ED therapies are comparable, and point to potentials of virtual therapy for situations in which geographical distance or other barriers impede physical access to trained therapists or specialized treatments.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34694234,

title = {Evaluating the Clinical Feasibility of an Artificial Intelligence-Powered, Web-Based Clinical Decision Support System for the Treatment of Depression in Adults: Longitudinal Feasibility Study},

author = {Christina Popescu and Grace Golden and David Benrimoh and Myriam Tanguay-Sela and Dominique Slowey and Eryn Lundrigan and Jérôme Williams and Bennet Desormeau and Divyesh Kardani and Tamara Perez and Colleen Rollins and Sonia Israel and Kelly Perlman and Caitrin Armstrong and Jacob Baxter and Kate Whitmore and Marie-Jeanne Fradette and Kaelan Felcarek-Hope and Ghassen Soufi and Robert Fratila and Joseph Mehltretter and Karl Looper and Warren Steiner and Soham Rej and Jordan F Karp and Katherine Heller and Sagar V Parikh and Rebecca McGuire-Snieckus and Manuela Ferrari and Howard Margolese and Gustavo Turecki},

doi = {10.2196/31862},

issn = {2561-326X},

year  = {2021},

date = {2021-10-01},

journal = {JMIR Form Res},

volume = {5},

number = {10},

pages = {e31862},

abstract = {BACKGROUND: Approximately two-thirds of patients with major depressive disorder do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence-powered clinical decision support systems (CDSSs) to assist physicians in their treatment selection and management, improving the personalization and use of best practices such as measurement-based care. Previous literature shows that for digital mental health tools to be successful, the tool must be easy for patients and physicians to use and feasible within existing clinical workflows.nnOBJECTIVE: This study aims to examine the feasibility of an artificial intelligence-powered CDSS, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural network-based individualized treatment remission prediction.nnMETHODS: Owing to the COVID-19 pandemic, the study was adapted to be completed entirely remotely. A total of 7 physicians recruited outpatients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Patients completed a minimum of one visit without the CDSS (baseline) and 2 subsequent visits where the CDSS was used by the physician (visits 1 and 2). The primary outcome of interest was change in appointment length after the introduction of the CDSS as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semistructured interviews.nnRESULTS: Data were collected between January and November 2020. A total of 17 patients were enrolled in the study; of the 17 patients, 14 (82%) completed the study. There was no significant difference in appointment length between visits (introduction of the tool did not increase appointment length; F=0.805; mean squared error 58.08; P=.46). In total, 92% (12/13) of patients and 71% (5/7) of physicians felt that the tool was easy to use; 62% (8/13) of patients and 71% (5/7) of physicians rated that they trusted the CDSS. Of the 13 patients, 6 (46%) felt that the patient-clinician relationship significantly or somewhat improved, whereas 7 (54%) felt that it did not change.nnCONCLUSIONS: Our findings confirm that the integration of the tool does not significantly increase appointment length and suggest that the CDSS is easy to use and may have positive effects on the patient-physician relationship for some patients. The CDSS is feasible and ready for effectiveness studies.nnTRIAL REGISTRATION: ClinicalTrials.gov NCT04061642; http://clinicaltrials.gov/ct2/show/NCT04061642.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33403948,

title = {Using a simulation centre to evaluate preliminary acceptability and impact of an artificial intelligence-powered clinical decision support system for depression treatment on the physician-patient interaction},

author = {David Benrimoh and Myriam Tanguay-Sela and Kelly Perlman and Sonia Israel and Joseph Mehltretter and Caitrin Armstrong and Robert Fratila and Sagar V Parikh and Jordan F Karp and Katherine Heller and Ipsit V Vahia and Daniel M Blumberger and Sherif Karama and Simone N Vigod and Gail Myhr and Ruben Martins and Colleen Rollins and Christina Popescu and Eryn Lundrigan and Emily Snook and Marina Wakid and Jérôme Williams and Ghassen Soufi and Tamara Perez and Jingla-Fri Tunteng and Katherine Rosenfeld and Marc Miresco and Gustavo Turecki and Liliana Gomez Cardona and Outi Linnaranta and Howard C Margolese},

doi = {10.1192/bjo.2020.127},

issn = {2056-4724},

year  = {2021},

date = {2021-01-01},

journal = {BJPsych Open},

volume = {7},

number = {1},

pages = {e22},

abstract = {BACKGROUND: Recently, artificial intelligence-powered devices have been put forward as potentially powerful tools for the improvement of mental healthcare. An important question is how these devices impact the physician-patient interaction.nnAIMS: Aifred is an artificial intelligence-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore the use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician-patient interaction.nnMETHOD: Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-h study at a clinical interaction simulation centre with standardised patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-min clinical scenarios with standardised patients portraying mild, moderate and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews and standardised patient feedback.nnRESULTS: All 20 participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible for use during clinical encounters. Clinicians indicated a willingness to use the tool in real clinical practice, a significant degree of trust in the system's predictions to assist with treatment selection, and reported that the tool helped increase patient understanding of and trust in treatment. The simulation environment allowed for the evaluation of the tool's impact on the physician-patient interaction.nnCONCLUSIONS: The simulation centre allowed for direct observations of clinician use and impact of the tool on the clinician-patient interaction before clinical studies. It may therefore offer a useful and important environment in the early testing of new technological tools. The present results will inform further tool development and clinician training materials.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34250463,

title = {Identification of Suicidal Ideation in the  Using Deep Learning},

author = {Sneha Desai and Myriam Tanguay-Sela and David Benrimoh and Robert Fratila and Eleanor Brown and Kelly Perlman and Ann John and Marcos DelPozo-Banos and Nancy Low and Sonia Israel and Lisa Palladini and Gustavo Turecki},

doi = {10.3389/frai.2021.561528},

issn = {2624-8212},

year  = {2021},

date = {2021-01-01},

journal = {Front Artif Intell},

volume = {4},

pages = {561528},

abstract = { Suicidal ideation (SI) is prevalent in the general population, and is a risk factor for suicide. Predicting which patients are likely to have SI remains challenging. Deep Learning (DL) may be a useful tool in this context, as it can be used to find patterns in complex, heterogeneous, and incomplete datasets. An automated screening system for SI could help prompt clinicians to be more attentive to patients at risk for suicide.  Using the Canadian Community Health Survey-Mental Health Component, we trained a DL model based on 23,859 survey responses to classify patients with and without SI. Models were created to classify both lifetime SI and SI over the last 12 months. From 582 possible parameters we produced 96- and 21-feature versions of the models. Models were trained using an undersampling procedure that balanced the training set between SI and non-SI; validation was done on held-out data.  For lifetime SI, the 96 feature model had an Area under the receiver operating curve (AUC) of 0.79 and the 21 feature model had an AUC of 0.77. For SI in the last 12 months the 96 feature model had an AUC of 0.71 and the 21 feature model had an AUC of 0.68. In addition, sensitivity analyses demonstrated feature relationships in line with existing literature.  Although further study is required to ensure clinical relevance and sample generalizability, this study is an initial proof of concept for the use of DL to improve identification of SI. Sensitivity analyses can help improve the interpretability of DL models. This kind of model would help start conversations with patients which could lead to improved care and a reduction in suicidal behavior.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32954512,

title = {Pretreatment motivation and therapy outcomes in eating disorders: A systematic review and meta-analysis},

author = {Jeanne Sansfaçon and Linda Booij and Lise Gauvin and Émilie Fletcher and Farah Islam and Mimi Israël and Howard Steiger},

doi = {10.1002/eat.23376},

issn = {1098-108X},

year  = {2020},

date = {2020-12-01},

journal = {Int J Eat Disord},

volume = {53},

number = {12},

pages = {1879--1900},

abstract = {OBJECTIVE: Identifying modifiable predictors of outcomes following treatment for eating disorders may help to tailor interventions to patients' individual needs, improve treatment efficacy, and develop new interventions. The goal of this meta-analysis was to quantify the association between pretreatment motivation and posttreatment changes in eating disorder symptomology.nnMETHOD: We reviewed 196 longitudinal studies reporting on change on indices of overall eating-disorder symptomatology, weight gain, binge-eating, vomiting, anxiety/depression, and treatment adherence. Meta-analyses were performed using two complementary approaches: (a) combined probability analysis using the added Z's method; (b) effect size analyses. Using random-effect models, effect sizes were pooled when there were at least three studies with the same type of statistical design and reporting statistics on the same outcome. Heterogeneity in study outcome was evaluated using Q and I statistics. Studies were reviewed qualitatively when the number of studies or reported data were insufficient to perform a meta-analysis.nnRESULTS: Forty-two articles were included. Although samples and treatments differed substantially across studies, results across studies were remarkably consistent. Both combined-probability and effect-size analyses indicated positive effects of pretreatment motivation on improvement in general eating-disorder symptoms (Cohen's r = .17), and an absence of effects on anxiety/depression symptoms. Remaining outcome indices were subject to selective reporting and/or small sample size bias.nnDISCUSSION: Our findings underscore the importance of incorporating treatment engagement approaches in the treatment of eating disorders. Optimal reporting of study findings and improving study quality would improve future efforts to obtain an in-depth understanding of the relationship between motivation and eating disorder symptoms.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32427359,

title = {Plasma levels of one-carbon metabolism nutrients in women with anorexia nervosa},

author = {Jessica Burdo and Linda Booij and Esther Kahan and Lea Thaler and Mimi Israël and Luis B Agellon and Evan Nitschmann and Linda Wykes and Howard Steiger},

doi = {10.1002/eat.23292},

issn = {1098-108X},

year  = {2020},

date = {2020-09-01},

journal = {Int J Eat Disord},

volume = {53},

number = {9},

pages = {1534--1538},

abstract = {OBJECTIVE: People who are ill with anorexia nervosa (AN) show altered availability of key plasma nutrients. However, little is known about the patterning of alterations that occurs across diverse nutrients during active phases of illness or about the persistence of any such alterations following remission of illness.nnMETHOD: We compared plasma levels of one-carbon metabolism nutrients across women with active AN (AN-Active: n = 53), in remission from AN (AN-Remitted: n = 40), or who had no eating-disorder history (NED: n = 36). We also tested associations between body mass index (BMI) changes and changes in pre- to posttreatment nutrient levels, and explored the association between nutrient levels, on the one hand, and BMI and eating symptoms, on the other. Choline, betaine, and methionine were analyzed using mass spectrometry. Folate and B12 were analyzed using the AccuBind® ELISA kit. Eating-disorder symptoms were assessed by interview and self-report.nnRESULTS: Compared to NED individuals, AN-Active individuals exhibited significantly elevated B12 and (less-reliably) betaine. In AN-Active individuals, lower BMI was associated with higher B12.nnDISCUSSION: The observed alterations run contrary to the intuition that plasma nutrient levels should be directly responsive to nutritional status and suggest, instead, the existence of compensatory adaptations to malnutrition in individuals with active AN. Further study is required to clarify mechanisms that underlie such effects.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31192517,

title = {DCC-related developmental effects of abused- versus therapeutic-like amphetamine doses in adolescence},

author = {Santiago Cuesta and José Maria Restrepo-Lozano and Christina Popescu and Susan He and Lauren M Reynolds and Sonia Israel and Giovanni Hernandez and Rana Rais and Barbara S Slusher and Cecilia Flores},

doi = {10.1111/adb.12791},

issn = {1369-1600},

year  = {2020},

date = {2020-07-01},

journal = {Addict Biol},

volume = {25},

number = {4},

pages = {e12791},

abstract = {The guidance cue receptor DCC controls mesocortical dopamine development in adolescence. Repeated exposure to an amphetamine regimen of 4 mg/kg during early adolescence induces, in male mice, downregulation of DCC expression in dopamine neurons by recruiting the Dcc microRNA repressor, microRNA-218 (miR-218). This adolescent amphetamine regimen also disrupts mesocortical dopamine connectivity and behavioral control in adulthood. Whether low doses of amphetamine in adolescence induce similar molecular and developmental effects needs to be established. Here, we quantified plasma amphetamine concentrations in early adolescent mice following a 4 or 0.5 mg/kg dose and found peak levels corresponding to those seen in humans following recreational and therapeutic settings, respectively. In contrast to the high doses, the low amphetamine regimen does not alter Dcc mRNA or miR-218 expression; instead, it upregulates DCC protein levels. Furthermore, high, but not low, drug doses downregulate the expression of the DCC receptor ligand, Netrin-1, in the nucleus accumbens and prefrontal cortex. Exposure to the low-dose regimen did not alter the expanse of mesocortical dopamine axons or their number/density of presynaptic sites in adulthood. Strikingly, adolescent exposure to the low-dose drug regimen does not impair behavioral inhibition in adulthood; instead, it induces an overall increase in performance in a go/no-go task. These results show that developmental consequences of exposure to therapeutic- versus abused-like doses of amphetamine in adolescence have dissimilar molecular signatures and opposite behavioral effects. These findings have important clinical relevance since amphetamines are widely used for therapeutic purposes in youth.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31823473,

title = {Methylation of the OXTR gene in women with anorexia nervosa: Relationship to social behavior},

author = {Lea Thaler and Sarah Brassard and Linda Booij and Esther Kahan and Kevin McGregor and Aurelie Labbe and Mimi Israel and Howard Steiger},

doi = {10.1002/erv.2703},

issn = {1099-0968},

year  = {2020},

date = {2020-01-01},

journal = {Eur Eat Disord Rev},

volume = {28},

number = {1},

pages = {79--86},

abstract = {DNA methylation allows for the environmental regulation of gene expression and is believed to link environmental stressors to psychiatric disorder phenotypes, such as anorexia nervosa (AN). The oxytocin receptor (OXTR) gene is epigenetically regulated, and studies have shown associations between OXTR and social behaviours in various samples, including women with AN. The present study examined differential levels of methylation at various CG sites of the OXTR gene in 69 women with active AN (AN-Active), 21 in whom AN was in remission (AN-Rem) and 35 with no eating disorder (NED). Within each group, we explored the correlation between methylation and measures of social behaviour such as insecure attachment and social avoidance. Hypermethylation of a number of CG sites was seen in AN-Active participants as compared with AN-Rem and NED participants. In the AN-Rem sample, methylation at CG27501759 was significantly positively correlated with insecure attachment (r = .614, p = .003, permutation Q = 0.008) and social avoidance (r = .588, p = .005, permutation Q = 0.0184). Our results highlight differential methylation of the OXTR gene among women with AN, those in remission from AN, and those who never had AN and provide some evidence of associations between OXTR methylation and social behaviour in women remitted from AN.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31408212,

title = {A naturalistic comparison of two inpatient treatment protocols for adults with anorexia nervosa: Does reducing duration of treatment and external controls compromise outcome?},

author = {Chloé Paquin Hodge and Lise Gauvin and Annie St-Hilaire and Mimi Israel and Michelle Azzi and Esther Kahan and Lea Thaler and Eve Dansereau and Howard Steiger},

doi = {10.1002/eat.23150},

issn = {1098-108X},

year  = {2019},

date = {2019-09-01},

journal = {Int J Eat Disord},

volume = {52},

number = {9},

pages = {1015--1023},

abstract = {OBJECTIVE: Although hospitalization is sometimes necessary when treating individuals with anorexia nervosa, the available literature provides limited guidance to inform decisions surrounding optimal components or duration of inpatient treatments. We report observational data comparing outcomes of two inpatient treatments. The first was longer and more strictly structured around a Contingency Management Protocol (CMP) emphasizing external incentives for achieving weight-restoration goals; the second was a shorter Autonomy Support Protocol (ASP) that progressively increased patient autonomy around meal management without external incentives.nnMETHOD: We compared data from 41 patients who participated in the ASP to a historical sample of 41 patients treated using the CMP. At admission, discharge, and post-treatment follow-up, participants completed the Eating Disorder Examination Questionnaire and the Behavior and Symptom Identification Scale-32, and we measured height and weight to compute body mass index.nnRESULTS: Multilevel modeling analyses that controlled for time in treatment and time in follow-up indicated the two protocols yielded equivalent in-treatment gains and post-treatment loss of gains.nnDISCUSSION: Our results indicate that shorter inpatient stays emphasizing autonomous control over eating behavior may yield outcomes that are equivalent to those of lengthier, more stringent, and more costly approaches implicating external incentives and controls.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}