Department of Psychiatry’s June 10th Research Day Event Featured a Total of 20 Presentations, Including Four by Psychiatry Residents

The Department of Psychiatry’s 19th annual Research Day event showcased the work of 16 Graduate Program students and four Psychiatry Residents on a broad range of topics.

6 July 2021

The Department of Psychiatry’s 19th annual Research Day event showcased the work of 16 Graduate Program students and four Psychiatry Residents on a broad range of topics.

The virtual, Zoom-enabled conference June 10th followed the traditional Research Day format, with each of the 20 presenters giving three-minute summary talks on their research, followed by a short question-and-answer session.

The 2021 Research Day theme was Indigenous Health, with guest speaker Dr. Caroline Tait – a Professor in the Department of Psychiatry at the University of Saskatchewan – delivering a keynote address titled: Building collective intelligence through work with Indigenous Elders and Knowledge Keepers.

Dr. Tait, a member of the Métis Nation-Saskatchewan, has conducted community-based research for the past 25 years in partnership with First Nations and Métis communities, organizations and federal and provincial governments.

Dr. Andrew Greenshaw, Professor and Associate Chair in the Department of Psychiatry, presented opening remarks to kick off Research Day.

Graduate Program Director Dr. Allen Chan announced the award winners at the conclusion of the day-long event. The best presentation awards for graduate students went to Master’s student Precious Amusan and PhD student Dr. Tarek Turk. Master’s student Huda Al-Shamali received an honourable mention.

Dr. Olivia Guerra, a PGY-4 Resident, won the best presentation award for Psychiatry Residents, for her study on the history and ethical ramifications of CTOs (Community Treatment Orders).

The winner of the photo contest was PhD student Zijia Yu, and Dr. Tarek Turk received an honourable mention.

A major highlight of this year’s Research Day event was the participation of not one but four Psychiatry Residents, including Dr. Olivia Guerra, Dr. Natalia Stavilla, Dr. Brittany Chubbs and Dr. Justine Greer.

“It was very inspiring to see the growth of scholarly work among our Residents and to see that four of our trainees were brave enough and passionate enough about their research to represent the Residency Program on Research Day,” says Dr. Maryana Kravtsenyuk, Assistant Clinical Professor in the Department of Psychiatry and Chair of the Resident Research Subcommittee.

“This was a very valuable contribution from our trainees and I hope it encourages others in the Residency Program to consider following in the footsteps of these determined and dedicated trainees in future.”

Since the Royal College of Physicians and Surgeons of Canada mandated in 2015 that Psychiatry Residents engage in scholarly activity along with their clinical training, dozens of Residents have completed research projects, although not all have presented on Research Day.

Some, like Dr. Rejish (Reji) Thomas, who is now an Assistant Clinical Professor at both the University of Calgary and the U of A, used their research to earn a Master’s degree in the Graduate Program before they finished Residency.

“The expectations around research engagement during Residency substantially increased in 2015 when the Royal College’s requirements for scholarly activity changed,” says Dr. Kravtsenyuk. “The important contributions of our Residents on Research Day this year really reflect that.”

Following is a recap of the presentations delivered by the four above-mentioned Residents at the June 10th Research Day event.

Dr. Chubbs is part of a research team that is conducting a study on the addictive potential / risks associated with ketamine when used as a treatment for Major Depressive Disorder (MDD).

The study – titled Drug likeability and cravings for ketamine in a sample of patients treated with ketamine for Treatment-Resistant Depression – is led by principal investigator Dr. Jennifer Swainson, an Assistant Clinical Professor in the Department of Psychiatry and a staff Psychiatrist at Misericordia Community Hospital.

Recent evidence indicates that IV (intravenous) ketamine at sub-anesthetic doses provides clinically significant antidepressant effects. Due to the inconvenience and costs associated with IV ketamine treatment, however, some patients self-administer ketamine at home via intranasal spray or in sublingual (pill) form.

This has raised concern about the potential for ketamine misuse or dependence, says Dr. Chubbs, prompting the need for the study. The research team’s findings will be based on the responses obtained from an online survey involving up to 60 participants. Thus far, between 30 and 40 subjects have agreed to participate, she says.

According to a study abstract presented by Dr. Chubbs, the researchers will “set out to determine the degree of ketamine likeability and craving; risk of ketamine use in doses greater than prescribed; risk of initiation of other drugs with abuse potential; and likelihood of meeting criteria for a Ketamine Use Disorder for patients currently or previously treated with intranasal or sublingual forms of ketamine for TRD (Treatment-Resistant Depression).”

Based on what the Psychiatrists involved in the study have thus far observed clinically, the abstract notes, “we hypothesize that few, if any, patients currently or previously treated with intranasal or sublingual ketamine will report such markers of dependence/misuse. Our hope is that this study will serve to better inform the safe prescribing of ketamine for TRD in the future.”

“When I entered Residency, I didn’t anticipate having such an interest in research, says Dr. Chubbs, who also holds a Master’s degree in Health Ethics. “Working at the Misericordia this past year and being exposed to Psychiatrists who are passionate about research, however, has really inspired me to take on a bigger role in this addictions-related project.”

Dr. Greer, a PGY-3 Psychiatry Resident, presented a study titled Mental Health and the Residency Training Experience: A Photovoice Project.

Dr. Melanie Marsh-Joyal, Assistant Clinical Professor, supervised Dr. Greer’s research, and Dr. Olivia Guerra, a PGY-4 Resident, was a co-researcher.

According to the abstract, the study set out to create a qualitative understanding of how Residency impacts Residents’ mental health, as well as the barriers faced in seeking mental health supports, in order to build awareness and identify solutions.

“Research examining the impacts of Residency training on mental health exists, yet there has been marginal success in improving Resident well-being. Our research aimed to explore whether missing aspects of the training experience are catalyzing changes to Residents' mental health,” the abstract explained.

Dr. Greer attempted to recruit Residents from all programs and postgraduate years at the U of A, to anonymously contribute photographs and short text submissions about their training and its impact on their mental health. Their goal was to employ the submissions in a poster campaign in Edmonton- area hospitals.

Between July 2020 to January of 2021, a total of 23 Residents accessed the online survey, with 14 Residents providing demographic information, including 12 females and two males, between 26 and 35 years of age. However, since only one text submission and two combined photo-and-text submissions were received, recruitment was deemed insufficient to complete the project.

Dr. Greer believes the unique stresses and demands placed on Residents during the pandemic played a role in limiting the number of people who took the time to participate in the survey. Nonetheless, given the diversity of Residents who accessed the survey, she believes there is interest in Resident mental health across a broad range of demographics, and further study is justified.

“I’m pretty close to my cohort of Residents. We sometimes meet together to talk about the stresses of Residency, and with the pandemic, not being able to meet in person and talk about that has certainly been difficult. I notice that my Resident colleagues who live alone or are a bit more isolated have had a harder time throughout the pandemic.”

Dr. Olivia Guerra also played a central role in the aforementioned study on the mental health of Residents. It was also presented at Adult Psychiatry Grand Rounds at Grey Nuns Community Hospital and University of Alberta Hospital, as well as the Alberta Psychiatric Association Conference in March.

Dr. Greer and Dr. Guerra both received Resident Research Awards for the latter presentation.

Dr. Guerra, a prolific researcher, is also currently completing a systematic review of the impact of economic recessions on mental health in developed countries, under the supervision of Dr. Vincent Agyapong, a Clinical Professor in the Department of Psychiatry, and with the support of Dr. Ejemai Eboreime, a Research Associate in the Faculty of Medicine and Dentistry at the U of A.

Dr. Guerra’s award-winning Research Day presentation – titled Community Treatment Orders and Considerations During the COVID-19 Pandemic – an overview – was an essay on the history and ethical considerations associated with CTOs (Community Treatment Orders), with a focus on the special considerations during the COVID-19 pandemic.

“CTOs tend to be used for people with psychotic disorders, or people with poor insight and difficulty in terms of compliance with medications. It typically reflects either a lack of insight or a lot of executive dysfunction, so these are people who have difficulty with problem solving, planning or organizing,” she says. “As a result, they end up repeatedly presenting or becoming unwell and are either dangerous to themselves or others.”

Her study was supervised by Dr. Nnamdi Nkire, Assistant Clinical Professor, Department of Psychiatry, and Site Lead for Psychiatry, Sturgeon Community Hospital. It has been submitted for publication to the American Journal of Psychiatry Residents' Journal.

The CTO is a tool used by Psychiatrists to assist patients with treatment compliance while living in the community. Dr. Guerra’s article reviewed the emergence of CTOs in Canada and around the world in the wake of the deinstitutionalization movement of the 1960s and 1970s.

“CTOs were developed to combat the emergent issues of trans-institutionalization, downward social drift, complex community health systems and decrease the cycle of involuntary hospitalizations, decompensation, and readmission,” the abstract for Dr. Guerra’s presentation explains.

“In the current conditions of the COVID-19 pandemic, further considerations exist, which highlight the ethical considerations and controversy around CTOs, the need for further research in this area in Canada and internationally, and heighten the importance of balancing procedural justice, individual rights, and the importance of maintaining clinical stability in unstable times.”

Dr. Natalia Stavila, a PGY-2 Resident, presented preliminary findings from a qualitative study she completed for her Master’s degree titled: Infant feeding in women with eating disorders – insights from healthcare professionals.

The study was done under the supervision of Dr. Lara Ostolosky, an Assistant Clinical Professor in the Department of Psychiatry and head of the Eating Disorders Program at University of Alberta Hospital; Dr. Tanya Park, Assistant Professor in the Faculty of Nursing at the U of A; and Dr. Esther Fujiwara, Professor in the Department of Psychiatry and former Director of the Graduate Program.

“Dr. Andy Greenshaw introduced me to Dr. Ostolosky when I was looking for research opportunities in the Department of Psychiatry. I knew I was going to apply for Residency and I wanted to improve my CV. Research was something I was lacking so he connected me with Dr. Ostolosky and Dr. Fujiwara, and that led to this project on eating disorders,” Dr. Stavila explains.

“We initially started it as a quantitative study but realized that in the charts the data we were looking for wasn’t reported, so we decided to go for a qualitative study instead. We had planned a two-phase study in which we’d interview the healthcare professionals first, and in the second phase, the moms themselves to see if they were potentially using breastfeeding as a source of weight loss. But Residency is very demanding so I had to stop at the end of the first phase and Dr. Fujiwara will try to find someone who may be interested in continuing with the second phase.”

According to the study abstract presented by Dr. Stavila, “Eating disorders (EDs) are severe mental health conditions with significant impact on physical health. EDs affect predominantly women, including during the reproductive phases of their lives. Although pregnancy and childbirth can have protective and restorative functions for some women with EDs, post-partum relapse is common.”

“Using interpretive description, we explored seven healthcare providers’ experiences with infant feeding choices of women with EDs. Interview transcripts were examined by three observers and extracted themes included women’s and healthcare providers’ personal beliefs around breastfeeding, specific ED symptoms affecting coping with pregnancy, postpartum, and infant care (i.e., body image and cognitive distortions, need for control, infant attachment, changes to the identity as a woman), denial of abusive breastfeeding practices, and support for breastfeeding,” the abstract explained.

“Our preliminary analysis suggests that women with EDs may benefit from tailored recommendations on infant feeding choices, including support for healthy extended breastfeeding. Healthcare providers may benefit from specific education on recognizing signs of excessive breastfeeding practices in women with (suspected) EDs, and on delivering ED-informed advice with a balanced approach to breastfeeding that is beneficial to the infant and not detrimental to mother’s health.”