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Article: Problematic features of episode-based definitions of depression and a preliminary proposal for their replacement.

Patten, Scott B

2023 Volume 14, Page(s) 1121524

Abstract: Episodes of depression are constructed by imposing temporal and symptom-severity thresholds onto symptom levels that vary over time, resulting in a loss of information. Consequently, it is widely acknowledged that binary categorization of depressive ... ...

Abstract	Episodes of depression are constructed by imposing temporal and symptom-severity thresholds onto symptom levels that vary over time, resulting in a loss of information. Consequently, it is widely acknowledged that binary categorization of depressive episodes is problematic. Binary classification can make similar symptom levels appear different and different symptom levels appear similar. Furthermore, symptom severity is only one of several thresholds that are applied in the construction of depressive episodes in DSM-5 and ICD-11, others being: a minimum duration of symptoms, the application of a "no significant symptoms" threshold for remission, and time requirements (e.g., 2 months) for remission. Application of each of these thresholds leads to a loss of information. The joint occurrence of these four thresholds creates a complex set of circumstances in which similar patterns of symptoms may be categorized differently and different patterns may be categorized as similar. The ICD-11 definition can be expected to lead to better classification than the DSM-5 approach since it does not require two symptom-free months for remission, eliminating one of four problematic thresholds. A more radical change would be to adopt a truly dimensional perspective which would need to incorporate new elements to reflect time spent at various levels of depression. Such an approach, however, seems feasible both in clinical practice and research.
Language	English
Publishing date	2023-03-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2023.1121524
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Vaping and Mental Health.

Patten, Scott B

Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent

2021 Volume 30, Issue 1, Page(s) 3–5

Abstract: Vaping" refers to the inhalation of aerosols produced in devices that heat liquid solutions. The aerosols may contain various additives, flavours, nicotine and other drugs such as cannabis. Nicotine is the most common psychoactive substance in vaping ... ...

Abstract	"Vaping" refers to the inhalation of aerosols produced in devices that heat liquid solutions. The aerosols may contain various additives, flavours, nicotine and other drugs such as cannabis. Nicotine is the most common psychoactive substance in vaping devices (or e-cigarettes) in Canada. While vaping has been viewed primarily as a cessation method or harm reduction strategy for smokers of combustible tobacco cigarettes, a new pattern is becoming evident in adolescents and youth (age 15-24) in Canada. In this age group, vaping is reported in increasing frequencies among those who have never smoked. This suggests the possible emergence of a de novo pattern of substance use and suggests the emergence of an unmet treatment need, vaping cessation. The mental health implications of vaping are largely unknown but available data suggest that vaping is associated with mental health changes similar to those seen with combustible tobacco cigarettes. Understanding the mental health impact of "vaping" will be challenging and research is needed. An important message from the smoking literature is that data from randomized cessation trials may be especially valuable because of complex issues of temporality and confounding connected to observational data.
Language	English
Publishing date	2021-02-01
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2381637-5
ISSN	2293-6122 ; 1719-8429
ISSN (online)	2293-6122
ISSN	1719-8429
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Article ; Online: Cannabis and non-psychotic mental disorders.

Patten, Scott B

Current opinion in psychology

2020 Volume 38, Page(s) 61–66

Abstract: Non-psychotic mental disorders are burdensome conditions within the general population, and their course is often complicated by the use of psychoactive substances and comorbid substance use disorders. Decriminalization or legalization of cannabis has ... ...

Abstract	Non-psychotic mental disorders are burdensome conditions within the general population, and their course is often complicated by the use of psychoactive substances and comorbid substance use disorders. Decriminalization or legalization of cannabis has led to concern that increasing use of cannabis will contribute to an increased burden of these disorders. In keeping with this concern, a sizable literature has established the existence of cross-sectional associations between cannabis use and non-psychotic mental disorders. However, few longitudinal studies have been conducted, and those that have been published have reported heterogeneous results. The potential advantages of longitudinal data for causal inference have not yet been realized in this literature. Questions remain about the temporality of the reported associations and the extent to which they are confounded by other variables. Consequently, there is insufficient evidence to confirm a causal role for cannabis in the etiology of non-psychotic mental disorders. There is also a stark contrast between survey data exploring subjective motivations for 'medical' cannabis use and the empirical literature about its potential efficacy for the treatment of non-psychotic disorders. Despite these limitations, the association of cannabis use with non-psychotic disorders, which has been strongly established by cross-sectional studies, has important implications for clinical practice and for guiding health services administration and policy.
MeSH term(s)	Cannabis ; Cross-Sectional Studies ; Humans ; Mental Disorders/epidemiology ; Motivation ; Substance-Related Disorders
Language	English
Publishing date	2020-09-16
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2831565-0
ISSN	2352-2518 ; 2352-250X ; 2352-250X
ISSN (online)	2352-2518 ; 2352-250X
ISSN	2352-250X
DOI	10.1016/j.copsyc.2020.09.006
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Article ; Online: Current perspectives on co-morbid depression and multiple sclerosis.

Patten, Scott B

Expert review of neurotherapeutics

2020 Volume 20, Issue 8, Page(s) 867–874

Abstract: Introduction: Depression is a common comorbidity in multiple sclerosis. Depression in MS often requires treatment due to its negative impact on quality of life, functioning, and MS outcomes. However, there have been very few randomized controlled trials ...

Abstract	Introduction: Depression is a common comorbidity in multiple sclerosis. Depression in MS often requires treatment due to its negative impact on quality of life, functioning, and MS outcomes. However, there have been very few randomized controlled trials of treatment of depression in MS. Most reviews of this topic have consequently presented a predominantly negative assessment of antidepressant treatment, concluding, for example, that there is insufficient evidence to guide treatment or that evidence only exists for a few uncommon antidepressant medications or forms of treatment. Areas covered: This review will provide a summary of currently available literature on depression in MS, with an emphasis on the clinical utility of available information. This includes information from published therapeutic trials, but also how general aspects and principles of depression treatment can guide neurotherapeutics in this area. Expert opinion: Management of depression in MS should be guided primarily by available evidence on depression treatment and not exclusively by the small and inadequate literature of randomized controlled trials. Differential diagnosis is important since depression manifests across a broad spectrum of morbidity in MS, a reality that has real-world implications for treatment. Basic guiding principles can support management of depression in people with MS.
MeSH term(s)	Comorbidity ; Depressive Disorder/diagnosis ; Depressive Disorder/drug therapy ; Depressive Disorder/epidemiology ; Humans ; Multiple Sclerosis/epidemiology
Language	English
Publishing date	2020-08-15
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2112534-X
ISSN	1744-8360 ; 1473-7175
ISSN (online)	1744-8360
ISSN	1473-7175
DOI	10.1080/14737175.2020.1806062
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Article ; Online: Burden of Mental, Neurological, Substance Use Disorders and Self-Harm: Counting the Cards, or Shuffling the Deck?

Patten, Scott B

Canadian journal of psychiatry. Revue canadienne de psychiatrie

2019 Volume 65, Issue 2, Page(s) 104–106

MeSH term(s)	Canada ; Humans ; Mexico ; North America ; Self-Injurious Behavior ; Substance-Related Disorders ; United States
Language	English
Publishing date	2019-12-09
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	304227-3
ISSN	1497-0015 ; 0008-4824 ; 0706-7437
ISSN (online)	1497-0015
ISSN	0008-4824 ; 0706-7437
DOI	10.1177/0706743719892706
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Article: Psychopharmacology of multiple sclerosis.

Patten, Scott B

Handbook of clinical neurology

2019 Volume 165, Page(s) 309–315

Abstract: A variety of neuropsychiatric problems can occur in people with multiple sclerosis (MS) and these are often among the most important determinants of their quality of life. Taken together, a high prevalence of depression, anxiety, fatigue, and cognitive ... ...

Abstract	A variety of neuropsychiatric problems can occur in people with multiple sclerosis (MS) and these are often among the most important determinants of their quality of life. Taken together, a high prevalence of depression, anxiety, fatigue, and cognitive problems means that most people with MS end up struggling with one or more of these neuropsychiatric difficulties. Although these problems manifest across a broad range of severity, this is often a burdensome struggle. Pharmacologic treatments are an important domain of therapeutic intervention. Unfortunately, the use of these medications is supported by a very limited literature. Clinicians often must make clinical decisions about the use of psychopharmacologic treatments in the absence of guidance from high quality evidence. This requires synthesizing clinical information about MS with more general principles of psychiatric and psychopharmacologic care. This chapter provides such a synthesis of available evidence as it pertains to the most important neuropsychiatric syndromes in MS. The goal is to help facilitate effective psychopharmacologic treatment, which, in turn, can translate into better quality of life for people with MS.
MeSH term(s)	Anxiety/drug therapy ; Anxiety/epidemiology ; Anxiety/psychology ; Cognitive Dysfunction/drug therapy ; Cognitive Dysfunction/epidemiology ; Cognitive Dysfunction/psychology ; Depression/drug therapy ; Depression/epidemiology ; Depression/psychology ; Fatigue/drug therapy ; Fatigue/epidemiology ; Fatigue/psychology ; Humans ; Multiple Sclerosis/drug therapy ; Multiple Sclerosis/epidemiology ; Multiple Sclerosis/psychology ; Psychopharmacology ; Psychotropic Drugs/therapeutic use
Chemical Substances	Psychotropic Drugs
Language	English
Publishing date	2019-11-14
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	0072-9752
ISSN	0072-9752
DOI	10.1016/B978-0-444-64012-3.00018-6
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Article ; Online: The WHODAS-2 and Community Psychiatry.

Patten, Scott B / Williams, Jeanne Va

Canadian journal of psychiatry. Revue canadienne de psychiatrie

2021 Volume 66, Issue 12, Page(s) 1094–1095

MeSH term(s)	Community Psychiatry ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Psychiatric Status Rating Scales
Language	English
Publishing date	2021-05-19
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	304227-3
ISSN	1497-0015 ; 0008-4824 ; 0706-7437
ISSN (online)	1497-0015
ISSN	0008-4824 ; 0706-7437
DOI	10.1177/07067437211017868
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Article ; Online: Lifestyle Factors Associated With Frequent Recurrent Headaches in Children and Adolescents: A Canadian Population-Based Study.

Nilles, Christelle / Williams, Jeanne V / Patten, Scott B / Pringsheim, Tamara M / Orr, Serena L

Neurology

2024 Volume 102, Issue 6, Page(s) e209160

Abstract: Background and objectives: Lifestyle behaviors have been postulated to affect headache frequency in youth and are often the primary target of self-management recommendations. Our study aimed to assess the association between various lifestyle factors ... ...

Abstract	Background and objectives: Lifestyle behaviors have been postulated to affect headache frequency in youth and are often the primary target of self-management recommendations. Our study aimed to assess the association between various lifestyle factors and frequent recurrent headaches in children and youth. Methods: Children and adolescents aged 5-17 years were enrolled in a large cross-sectional Canadian population-based health survey, completed on January 31, 2019. Headache frequency was dichotomized into "approximately once/week or less" or ">once/week" (defined as frequent recurrent headaches). The association between frequent headaches and meal schedules, screen exposure, physical activity, chronotype, and frequent substance use/exposure (alcohol, cigarettes, electronic cigarettes, and cannabis) was assessed using both unadjusted logistic regression models and models adjusted for age/sex. Fully adjusted models examined the odds of frequent headaches according to all exposures. Survey design effects were accounted for using bootstrap replicate weighting. Results: There were an estimated n Discussion: Several lifestyle behaviors were associated with frequent headaches in children and youth, such as meal irregularity, late chronotype, prolonged screen exposure, and frequent substance use/exposure, suggesting that these are potential modifiable risk factors to target in this population.
MeSH term(s)	Child ; Humans ; Adolescent ; Female ; Male ; Electronic Nicotine Delivery Systems ; Cross-Sectional Studies ; Canada/epidemiology ; Headache/epidemiology ; Substance-Related Disorders ; Life Style
Language	English
Publishing date	2024-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000209160
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Article ; Online: P

Patten, Scott B / Streiner, David L

Canadian journal of psychiatry. Revue canadienne de psychiatrie

2020 Volume 66, Issue 4, Page(s) 421–422

MeSH term(s)	Confidence Intervals ; Humans ; Models, Statistical ; Psychotic Disorders ; Substance-Related Disorders
Language	English
Publishing date	2020-09-29
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	304227-3
ISSN	1497-0015 ; 0008-4824 ; 0706-7437
ISSN (online)	1497-0015
ISSN	0008-4824 ; 0706-7437
DOI	10.1177/0706743720962277
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Article ; Online: The "Clinician's illusion" and the epidemiology, diagnosis and treatment of depressive disorders.

Patten, Scott B

BMC psychiatry

2018 Volume 18, Issue 1, Page(s) 395

Abstract: Background: Depression often occurs in association with stressful events. However, people with depressive disorders may experience episodes in response to minor stressors or "out of the blue." Similar episodes can occur in people who do not have a ... ...

Abstract	Background: Depression often occurs in association with stressful events. However, people with depressive disorders may experience episodes in response to minor stressors or "out of the blue." Similar episodes can occur in people who do not have a disorder in response to severe events. This plurality of symptom patterns, occurring as it does in the absence of precise demarcation from normality has led to controversy over how depressive disorders should be defined, how common they are, and when treatment should be offered. Much of the controversy, however, may be illusory, arising from a tendency to view depressive disorders as defects or disease processes (the "clincian's illusion"). Avoiding the illusion involves understanding depression as a defense rather than a defect and requires consideration of aspects of signal detection theory and the associated "smoke detector" principle. This perspective may help to understand aspects of depressive disorders that are otherwise puzzling and controversial. Methods: In this paper, implications of signal detection theory and the "smoke detector principle" are explored: (1) conceptually, (2) using calculations performed in a spreadsheet and (3) using an agent-based model. Depressive episodes are conceptualized or represented as all-or-nothing phenomena activated in response to stressful life events. These events occur in an environment that also includes variable levels of baseline stress, creating a signal detection problem. The agent-based framework allows interaction with the environment as agents attempt to achieve an ideal level of adaptation. Results: The smoke detector principle, if valid, may explain otherwise puzzling and controversial features of the depressive disorders, such as their lack of precise demarcation from normality, the role of life events and stressors and their patterns of prevalence. Conclusions: Signal detection concepts help to avoid the "clinician's illusion" in which aspects of functioning of the body's defenses are mistaken for a disease entity or defect. These principles emphasize inevitable difficulties that are encountered in attempts to conceptualize depressive disorders without reference to the environment in which they occur, and without addressing possible stochastic (randomly varying) elements. Because of the "clinicians illusion", current research priorities, as well as diagnosis and treatment strategies, may be flawed.
MeSH term(s)	Depression/diagnosis ; Depression/etiology ; Depression/psychology ; Depression/therapy ; Depressive Disorder/diagnosis ; Depressive Disorder/epidemiology ; Depressive Disorder/psychology ; Depressive Disorder/therapy ; Humans ; Life Change Events ; Patient Care Management/methods ; Stress, Psychological/classification ; Stress, Psychological/complications ; Stress, Psychological/psychology
Language	English
Publishing date	2018-12-20
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2050438-X
ISSN	1471-244X ; 1471-244X
ISSN (online)	1471-244X
ISSN	1471-244X
DOI	10.1186/s12888-018-1969-3
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