A Survey of Mental Health Services at Post-Secondary Institutions in Alberta

Objectives:

The relatively high prevalence of mental health problems among students at post-secondary institutions in Canada is well documented; in contrast, less is known about the adequacy of mental health services available to Canadian post-secondary students on campuses. Our study sought to examine the current state of campus mental health initiatives and services in Alberta as well as the extent to which resources identified in mental health literature as being key in mental health problem prevention and promotion appear to be available.

Methods:

A 60-question, online survey was sent to staff (primarily front-line workers; n = 45) at Alberta’s 26 publicly funded post-secondary institutions. Responses were organized according to small (less than 2000 students), medium (2000 to 10 000 students), and large (10 000 or more students) institutions.

Results:

All of Alberta’s post-secondary institutions were represented in the responses. Mental health initiatives and services are available, to varying extent, at all of Alberta’s post-secondary institutions. However, many institutions do not have initiatives and (or) services aimed at identifying students with mental health problems or policies for monitoring their mental health services. Additionally, smaller institutions are less likely to offer certain services (for example, gatekeeper training and campus medical services), compared with larger ones. Finally, a systematic review or an evaluation of services appears to be infrequently conducted.

Conclusions:

These findings highlight the need for post-secondary institutions in Alberta, and by extension in Canada, to develop and institute a comprehensive strategy to evaluate and optimize the delivery of mental health initiatives and services.     

Impact of a clinical pathway on the postoperative care of children undergoing surgical closure of atrial septal defects

The purpose of this study was to impact of a clinical pathway on the postoperative management of children undergoing surgical closure of atrial septal defects (ASDs). Three groups of children were studied: group 1 (14 patients), before introduction of an intensive care team, minimally invasive surgery, and the clinical pathway; group 2 (17 patients), after the introduction of the intensive care team and minimally invasive surgical techniques but before the pathway; and group 3 (30 patients), after implementation of the clinical pathway. Average hospital length of stay fell from 118.52 +/- 19.83 hours (4.9 +/- 0.83 days) in group 1 to 95.92 +/- 66.48 hours (3.99 +/-2.77 days) in group 2 and declined further to 54.29 +/- 20.17 hours (2.26 +/- 0.84 days) in group 3 (p <.05). There were statistically significant decreases in laboratory resource utilization (p <.05). The addition of a dedicated intensive care team and utilization of minimally invasive surgical techniques reduced mean length of stay (by 20%) and resource utilization (by 50%). However, only the implementation of the pathway provided the consistency necessary for maximal quality management, cost saving, and reduction in length of stay (additional 44% reduction in mean length of stay and 40% reduction in resource utilization). These results show the incremental advantage of implementing a defined clinical pathway for postoperative management of children with atrial septal defects.     

Auditory P3 in antidepressant pharmacotherapy treatment responders,non-responders and controls

Event-related potentials (ERPs), derived from electroencephalographic (EEG) recordings, can index electrocortical activity related to cognitive operations. The fronto–central P3a ERP is involved in involuntary processing of novel auditory information, whereas the parietal P3b indexes controlled attention processing. The amplitude of the auditory P3b has been found to be decreased in major depressive disorder (MDD). However, few studies have examined the relations between the P3b, the related P3a, and antidepressant treatment response. We tested 53 unmedicated individuals (25 females) with MDD, as well as 43 non-depressed controls (23 females) on the novelty oddball task, wherein infrequent deviant (target) and frequent standard (non-target) tones were presented, along with infrequent novel (non-target/distractor) sounds. The P3a and P3b ERPs were assessed to novel and target sounds, respectively, as were their accompanying behavioral performance measures. Depression ratings and the antidepressant response status were assessed following 12 weeks of pharmacotherapy with three different regimens. Antidepressant treatment non-responders had smaller baseline P3a/b amplitudes than responders and healthy controls. Baseline P3b amplitude also weakly predicted the extent of depression rating changes by week 12. Females exhibited larger P3a/b amplitudes than males. With respect to task performance, controls had more target hits than treatment non-responders. ERP measures correlated with clinical changes in males and with behavioral measures in females. These results suggest that greater (or control-like) baseline P3a/b amplitudes are associated with a positive antidepressant response, and that gender differences characterize the P3 and, by extension, basic attentive processes.     

A feasibility study of working memory training for individuals with paediatric-onset multiple sclerosis

Objective: To investigate the feasibility and experiences of paediatric-onset multiple sclerosis (MS) patients completing a working memory training programme.

Methods: Nine paediatric-onset MS patients (mean age 19.3?±?4.1 years) identified as having attention and/or working memory difficulties underwent a five-week (five days/week) internet-based working memory training programme (Cogmed?); weekly coaching was provided. Measures of adherence and tolerance were used to establish the feasibility of implementing computerised cognitive training. Qualitative experiences reported by the patients were analysed and factors that may modulate the effects of training were explored.

Results: Six of the nine enrolled patients completed the programme within the recommended time, and all individuals, with the exception of one, were considered to tolerate the training well. Eight of the nine participants acknowledged that training was helpful in one or more ways. All but one participant reported improvements in working memory, although evidence for improvement on objective neuropsychological testing was limited. Lower normalised brain volume emerged as a potentially important variable in predicting extent of improvement on the training programme.

Conclusion: Selected paediatric-onset MS patients can tolerate and complete an intensive cognitive rehabilitation programme. Future investigation of moderators of training effects and the stability of the findings over time is needed.     

Co-existence of Phenylketonuria and Fabry disease on a 3 year-old boy: case report

Background  

The co-existence of two genetically distinct metabolic disorders in the same patient has rarely been reported. Phenylketonuria (PKU) is an inborn error of the metabolism resulting from a phenylalanine hydroxylase deficiency. Fabry disease (FD) is an X-linked lysosomal storage disorder due to a deficiency of the enzyme alpha-galactosidase A.