Report on Research Consultation on Early Life Events and First Episodes of Brain Disorders
Montreal, Quebec
February 9-10, 2004
Contents
Introduction
Common Mechanisms
Research Themes
1. Early Detection and Intervention
2. Genetic, Biological and Environmental Interactions in Brain Development and Plasticity
3. Intergenerational Transmission
Transmission and Intervention Framework
4. Risk and Protective Factors
5. Stigma and Discrimination
6. Valid Measures
Implementation
Current Strengths
Additional Requirements
Future Partnerships
Peer Review
Closing Remarks
Appendix #1: Key Terms
Appendix #2: Strategic Research Framework
Appendix #3: Determinants of Health
Appendix #4: Participants
Introduction
The CIHR Institute of Neurosciences, Mental Health and Addiction (INMHA) has a commitment to fostering collaborative, cross-disciplinary research on Early Life Events and First Episodes of Brain Disorders1. To this end, a consultation was held in February, 2004 to bring together researchers, clinicians and representatives from non-government organizations and industry.
The purpose of this initiative was to develop a cross-disciplinary, cross-disorder research agenda for Early Life Events and First Episodes of Brain Disorders.
Objectives of the consultation were:
- To review the current situation in Canada and internationally related to early life events and first episodes research.
- To address common mechanisms (e.g., genetic, environmental and psychosocial risk factors) that may apply to traditionally disparate areas of research such as epilepsy, bipolar disorder, depression, dementia, schizophrenia, Huntingtons disease, addictions, early life events and sensory disorders.
- To identify and agree on research themes fundamental to addressing health, health services and social issues associated with the onset of brain disorders.
- To stimulate interest in a CIHR INMHA Request for Applications (RFA) on early life events and first episodes.
- To explore and support the development of potential partnerships among those with an interest in this domain.
Dr. Richard Brière, Assistant Director, CIHR Institute of Neurosciences, Mental Health and Addictions (INMHA), welcomed participants to Montréal. He explained how this is the third initiative in INMHA's development of new strategic directions; the first were nicotine and tobacco abuse, and regenerative medicine. INMHA has already funded successful Requests for Application (RFA) in the tobacco area and is looking to develop additional RFA that will lead to new tools and funding mechanisms for large research teams working across the four CIHR themes. Dr. Brière encouraged participants to be creative, be innovative and have fun.
Dr. Stan Kutcher, Professor, Department of Psychiatry, Dalhousie University and INMHA Institute Advisory Board member, posed the question "Why are we here?" He noted that this initiative represented a new direction in Canada and that this consultation was part of a process to transform current thinking and practices through collaboration with the most creative minds in a variety of research disciplines. Dr. Kutcher emphasized the importance not only of interdisciplinary integration, but of integration through the lifecycle. He observed that of the top ten non-communicable diseases identified by the WHO, six were related to disorders of brain function.
In closing, Dr. Kutcher asked participants to listen, think, debate, and think again before providing advice to INMHA as consultants and potential RFA partners on a national strategic research agenda. He emphasized the need to identify new themes, new partnerships and new directions to transform Canadian research in this area.
Norms for Working Together
Participants used the following norms for working together to help guide their interactions during discussions at this consultation.
- Explore perspectives: focus on integrated approaches.
- Be clear and concise.
- Collaborate to reach agreement.
- Think strategic.
- Don't overlook the simple or the obvious.
Hopes
Following is a summary of participants' responses to the question "What is one hope you have related to this consultation?"
Participants hoped that this consultation would:
- provide an opportunity to explore common mechanisms and risk factors and then define what turns them into specific disorders
- yield information on what's happening in Canada in this area, as well as related areas such epidemiology, neuroimmune exposure, addictions
- generate insight on the mechanism of resilience - why some predisposed people manifest disorders while others do not identify partners who are willing to participate in interesting collaborative projects
- explore the development of a Canadian cohort of healthy volunteers to follow longitudinally
- help them to develop strategies to look at various issues, i.e.,
- what happens with very young children in their environments that leads to the kinds of illness we deal with in adults, e.g., disadvantaged populations
- understand and define risk factor mechanisms and how to study them in the population
- brain plasticity and its relationship to the development of disease, e.g., existence of critical periods
- identify potential sources of funding and information on how funding mechanisms work
- given limited resources, provide ideas about how to help the people who need it most
- look at how can early interventions be best focused and how priorities are determined
- clarify the role of industry as a partner
- provide a starting point for the development of meaningful practical applications, e.g., how parents can identify warning signs in their children
- explore the relationship between this initiative and other CIHR institutes, especially Institute of Population and Public Health and Institute of Human Development Child and Youth Health
- discuss issues related to a national strategic research agenda, e.g., do we concentrate on areas of strength in Canadian research or do we start in areas where we have limited expertise; or how we can work together to counter the effects of political/economic change on long-term research viability.
Challenge Address
Dr. Stan Kutcher defined the challenge for this consultation as working together to develop an integrated research agenda for early life events and first episodes of brain disorders that would fulfill the fundamental purpose of the research - to improve the lives of real people with real problems. He encouraged participants to move away from their individual "little boxes" and to take a broad strategic view, recognizing that everyone has to be a pioneer in change processes and that all disciplines need to work together with respect to this part of the lifecycle.
Through a lively interactive dialogue with participants, Dr. Kutcher used the metaphor of Janus, the Roman god who looks forward and backward at the same time to describe the first onset of a disorder, i.e., the disorder does not begin when the individual is diagnosed; there is a need to look both backwards and forwards to fully understand the individual's situation.
In closing, Dr. Kutcher outlined the three key points of the consultation challenge:
- the creation of research groups across traditional domains of study
- integrated approaches both horizontally and vertically, as well as across disciplines and CIHR research pillars
- transformation of individual disciplines through sharing of expertise and research strategies and results.
Presentations
The following presentations provided a context and specific examples for three different disease areas.
| Toxicomanies | Dre Louise Nadeau, professeure, Département de psychiatrie, Université de Montréal et vice présidente du conseil d'administration des IRSC |
| Dépression/trouble bipolaire/psychose | Dr Ashok Malla, professeur de psychiatrie et chef de la Division de la recherche clinique, Centre de recherche de l'Hôpital Douglas |
| Épilepsie | Dr Ante Padjen, professeur, Département de pharmacologie et de thérapeutique, Université McGill |
Discussion Points
- The concepts of critical periods in CNS development (i.e., at what point does development become irreversible) and loss of control (i.e., at what point does the drug take over) are crucial areas for research.
- There are no studies of early onset for addictions, e.g., addiction is a clinical barometer for underlying disorders; this is a good field for cross-fertilization.
- Animal studies can help establish thresholds; we also need to think about ongoing addiction services and what we can learn, e.g., physicians working on chronic diseases. What is it that makes a difference? How can we intervene through a real psycho-physical mechanism that we can identify? What treatment are a handicap, e.g., methadone?
- How do protective factors relate to a familial or genetic predisposition?
- There is a tendency to leap over child-parent interactions - we need to look at ways to explore these interactions in terms of the vulnerable individual emerging into adolescence.
- One of the factors for individuals who begin to exhibit psychotic symptoms seems to be self-esteem; is this driven by early environmental experience?
- Being perceived as a "pure brain disorder" may limit research possibilities.
- Toxicity of the psychotic experience, and possible related residual damage within the brain needs further exploration, e.g., the mechanisms of psychosis, sensitization of circuitry; varying evidence of brain damage as a result of seizures?
- There is evidence that subtle behavioural changes have all the appearance of epilepsy and perhaps should be treated as such. We need to consider a continuum approach to research on brain disorders, looking for linking themes, e.g., the biology of aggressive behaviour has many similarities to that of epilepsy.
- What do we really know? Kindling could cause or prevent injury if dosed in the proper way - we may need to coordinate this area, e.g., what is the situation, how do we define this situation, how do we get to these answers?
- We may need to rationalize techniques (e.g., induced seizures) that work on only some patients.
Common Mechanisms
For the purposes of this consultation, common mechanisms (e.g., genetic, environmental and psychosocial risk factors) enable integrated approaches to traditionally disparate areas of research such as epilepsy, bipolar disorder, depression, dementia, schizophrenia, Huntingtons disease, addictions, early life events and sensory disorders.
Following the identification of accomplishments and gaps in this research area, participants developed the following list (not in priority order) of common mechanisms that could provide opportunities for integrated approaches to research priorities.
- Developmental processes
- Longitudinal/prospective studies
- Mechanisms of sensitivity and tolerance
- Methodology for the interactive relationships among vulnerability, risk and protective factors
- Multidimensional outcomes and their relationships
- Pathological and non-pathological factors
- Plasticity/critical periods
- Sensitivity vs. specificity of risk factors and early interventions
- Stigma across all disorders.
Research Themes
For the purposes of the consultation, a research theme was defined as an area meeting the following criteria:
- is of population or public health significance (burden of disease)
- has the strongest potential for impact
- takes advantage of Canada's special strengths
- offers the opportunity to link and connect through an integrated approach
- is work that is unlikely to be done elsewhere
- encourages innovation.
Participants worked in small groups to develop potential research themes. They then discussed these themes in plenary and agreed on the following areas (listed below in alphabetical, not priority order).
- Early Detection and Intervention
- Genetic, Biological Interactions in Brain Development and Plasticity
- Intergenerational Transmission
- Risk and Protective Factors
- Stigma and Discrimination
- Valid Measures.
Participants then formed working groups to explore these themes and develop research questions for potential RFA.
1. Early Detection and Intervention
This theme area includes:
- Key features of disorders/behaviours across age groups and genders.
- Definition of case and sub-threshold case.
- Evaluation of different methods of case detection.
- Socioeconomic and cultural factors influencing early detection and intervention.
- Outcome measures.
- Evidence-based phase-specific models of intervention.
A. Research pillars most relevant to this theme/area
| Basic biomedical, e.g., genetic, molecular, cellular, tissue physiology | Applied clinical, e.g., drugs, devices, social intervention | Health systems, health services, e.g., epidemiology, health care quality, cost-effectiveness | Societal, cultural and environmental influences on health and the health of populations |
| x | x | x | x |
Comments
- Pillar #3 is key to this area, e.g., knowledge translation.
B. Determinants of health most closely linked to this theme/area
| Determinants | Check | Determinants | Check |
|---|---|---|---|
| Income and Social Status | Personal Health Practices and Coping Skills | ||
| Social Support Networks | Healthy Child Development | ||
| Education | Biology and Genetic Endowment | ||
| Employment/ Working Conditions | Health Services | ||
| Social Environments | Gender | ||
| Physical Environments | Culture |
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C. Potential Research Questions
Current research in this theme/area
Research is occurring related to early case identification in psychosis and phase appropriate intervention. There is some targeted research regarding high risk cases (e.g., anxiety, depression, bipolar disorder, autism, schizophrenia, addictions and suicide). There have also been early detection studies for glaucoma.
New Research Topics
| Topics | Intended Impact | |
|---|---|---|
| 1.1 | Evidence-based interventions in individuals in the early stages of psychiatric illnesses or addictions and treatment/evaluation of childhood neglect or abuse. | Improved outcomes |
| 1.2 | Cultural differences and their effect on early detection and intervention. | Improved access, detection and culturally appropriate treatment |
| 1.3 | Robust early indicators of specific disorders to achieve a high level of predictive value. | Improved detection and possible prevention |
| 1.4 | Define the processes involved in the conversion of sub-threshold/high risk mental states to full disorder and evaluation of least harmful/most effective intervention. | Improved prevention of full disorder and more cost effective intervention |
| 1.5 | Use of new technologies (e.g., telemedicine) in promoting early detection and knowledge translation/transfer. | Improved access and knowledge transfer in remote areas |
| 1.6 | Effective methods of promoting case detection for early intervention. | Early intervention and improved long term outcomes; e.g., decrease in the rate of suicide |
| 1.7 | Impact of community-based prevention programs on incidence of various disorders. | Primary prevention |
Discussion Points
- Evidence-based approaches must include sensitivity to cultural aspects of research subjects, e.g., demonstrate efficacy and effectiveness for a given culture.
- Issues related to cost and length of time required for effective research must be considered.
- It is premature to use the word "screening" because adequate screening instruments (including indicators) have not yet been refined in most areas (some screening is done for Down's Syndrome).
- Quality of life should be a prime consideration.
2. Genetic, Biological and Environmental Interactions in Brain Development and Plasticity
This theme area includes:
- Brain development:
- proliferation
- differentiation
- migration
- synaptogenesis/apoptosis
- myelination/glial
- re-organization
- research evaluation of brain volumes.
- Plasticity:
- physiologic (including stress, rehabilitation, stimulation, etc.) and biologic
- injury induced, e.g., external environment
- genetic
- age-dependent
- gender-dependent
- treatment-dependent.
- Mechanisms:
- receptor modification (including channelopathy)
- gene expression
- growth factors.
A. Research pillars most relevant to this theme/area
| Basic biomedical, e.g., genetic, molecular, cellular, tissue physiology | Applied clinical, e.g., drugs, devices, social intervention | Health systems, health services, e.g., epidemiology, health care quality, cost-effectiveness | Societal, cultural and environmental influences on health and the health of populations |
| (1) | (3) | (4) | (2) |
Comments
- Numbers in brackets indicate level of applicability.
B. Determinants of health most closely linked to this theme/area
| Determinants | Check (x) | Determinants | Check (x) |
|---|---|---|---|
| Income and Social Status | Personal Health Practices and Coping Skills | ||
| Social Support Networks | Healthy Child Development | x | |
| Education | x | Biology and Genetic Endowment | x |
| Employment/ Working Conditions | Health Services | ||
| Social Environments | x | Gender | x |
| Physical Environments | x | Culture |
Comments
- All determinants are linked; checkmarks indicate priorities.
C. Potential Research Questions
Current research in this theme/area
Research includes:
- apoptosis
- channelopathies
- migration disorders
- stem cell research
- neurogenesis
- social interaction (mother/child - maternal care)
- functional imaging (e.g., fMRI, SPECT, MSI)
- neurodegenerative and neurodevelopmental disorders
- functional recovery.
New Research Topics
| Topic | Intended Impact | |
|---|---|---|
| 2.1 | Gender differences: effect on plasticity and disease state. | More accurate diagnosis and treatment |
| 2.2 | Differential functional outcome following central nervous system insult. | Targeting therapy |
| 2.3 | Mechanism of plasticity during the silent period. | Prevention of second episodes and disease and early intervention |
| 2.4 | Molecules involved in normal and abnormal processes (reorganization). | New treatment targets |
| 2.5 | Consequences of drug therapies in the developing brain. | Rational therapy |
| 2.6 | Consequences of targeted therapies in the developing brain. | Rational therapy |
| 2.7 | Role of environmental factors in the developing brain. | Prevention and identification of unknown risk factors |
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3. Intergenerational Transmission
This theme area includes:
The intergenerational transmission of disorders (e.g., addictions, bipolar illness) and behaviours (e.g., suicide, school dropout) that are impacted by biological, psychological and social variables. The way in which (i.e., mechanisms) these variables effect change across generations may vary over time and with each generation. Models are needed that show how these variables impact and interact on the disorder/behaviour over time. Intervention studies are needed to show how changes in these variables can affect the trajectories of disorders/behaviours over time and generations.
A. Research pillars most relevant to this theme/area
- This theme can bring all pillars together in varying degrees of influence.
B. Determinants of health most closely linked to this theme/area
- All determinants of health are important - this is an overarching theme where all areas are related but may have different weightings.
- More research on determinants is needed.
- Determinants are additive, i.e., greater than the sum of their parts.
C. Potential Research Questions
Current research in this theme/area
Group members were not aware of any groups doing intergenerational research (with the possible exception of Richard Tremblay's work on early intervention). They were, however, aware of genetic studies, e.g., genetic vs. environmental effects and interaction of variables of risk and resiliency over time (Rutter at Cambridge). Wave Three (adult phase) of the Ontario Child Health Study is underway and has the potential to look at a number of variables, including transmission of psychiatric symptoms.
New Research Topics
Studies are proposed in two general areas: transmission and intervention. The intent is to leave open the factors that can produce positive or negative impacts rather than specify risk vs. protective factors or concepts of resilience.
The following questions frame the study areas, with researchers defining the variables to study for each question.
| Topic | Intended Impact | |
|---|---|---|
| 3.1 | Transmission: What proportion of the transmission across generations of variables of interest is explained by variable x, y, z (e.g., biological, social, familial, etc.)? |
Targeting interventions |
| 3.2 | Interventions: What proportion of the transmission across generations of variables of interest can be changed by interventions x, y, z, (e.g., biological, social, familial, etc.)? |
Reduction in disability |
The diagram on the following page provides a linear view of this framework.
[ top of page ]Transmission and Intervention Framework
4. Risk and Protective Factors
The objective for this theme area is to elucidate the interplay between risk and protective factors and their underlying mechanisms, with particular attention to the following areas:
- genetic
- biological: perinatal, in utero, , inflammation, traumatic, ischemic, toxic, drugs, stress, neuroendocrine, neurocognitive functions
- psychological: temperament2, coping, resourcefulness, psychopathology, attachment, cognitive style, self esteem
- sociological: e.g. life events, parenting, peers, cultural values, socioeconomic status.
There is a large gap in our knowledge as to how the underlying causal mechanisms influence onset, clinical course and outcomes of specific disorders. Development and testing of specific models will be encouraged as well as studies on how risk factors are sensitive to developmental stages.
A. Research pillars most relevant to this theme/area
| Basic biomedical, e.g., genetic, molecular, cellular, tissue physiology | Applied clinical, e.g., drugs, devices, social intervention | Health systems, health services, e.g., epidemiology, health care quality, cost-effectiveness | Societal, cultural and environmental influences on health and the health of populations |
| (1) | (3) | (4) | (2) |
Comments
- Numbers in brackets indicate level of applicability.
B. Determinants of health most closely linked to this theme/area
| Determinants | Check (x) | Determinants | Check (x) |
| Income and Social Status | (x8) | Personal Health Practices and Coping Skills | (x11) |
| Social Support Networks | (x10) | Healthy Child Development | (x6) |
| Education | (x7) | Biology and Genetic Endowment | (x1) |
| Employment/ Working Conditions | (x9) | Health Services | (x12) |
| Social Environments | (x2) | Gender | (x4) |
| Physical Environments | (x3) | Culture | (x5) |
C. Potential Research Questions
Current research in this theme/area
Research includes:
- Bipolar disorder risk study
- Panic disorders
- Eating disorders
- Abused children
- Anxiety
- Families with autism
- Post-traumatic stress disorder
- Intrauterine insult and schizophrenia, animal model
- Febrile seizures
- Maternal deprivation
- Kindling and GABA receptors
- Post-traumatic epilepsy
- Fetal alcohol spectrum disorder
- Maternal nutrition
- School effects on substance abuse and mental health
- Anxiety disorders and educational attainment.
New Research Topics
| Topic | Intended Impacts | |
|---|---|---|
| 4.1 | Mechanisms underlying disparate risk and protective factors. | Prevention and therapeutic intervention |
| 4.2 | Identifying and defining protective factors or factors causing resilience. | Prevention and therapeutic intervention |
| 4.3 | Relative weights and the nature of interactions of multiple risk factors. | Targeted intervention |
| 4.4 | Identification of common- versus syndrome- specific risk factors. | Screening and targeted intervention |
| 4.5 | Influence of developmental stages on specific risk/protective factors. | Education and targeted prevention |
Discussion Point
- Current research in this area is very specific, whereas the research topics show a movement toward the general. Is this a new direction?
Stigma and discrimination play important roles in the experience of health problems by patients, families, professionals, health and legal systems and society at large. They may influence how problems are detected and treated, as well as outcomes following intervention, help-seeking, course of disease, etc. This theme looks at the social influences on outcomes of individuals with early onset illness, including culture, stigma and social support. In addition, prediction and improvement of social/functional outcomes (such as educational attainment, employment and quality of life) are explored.
A. Research pillars most relevant to this theme/area
| Basic biomedical, e.g., genetic, molecular, cellular, tissue physiology | Applied clinical, e.g., drugs, devices, social intervention | Health systems, health services, e.g., epidemiology, health care quality, cost-effectiveness | Societal, cultural and environmental influences on health and the health of populations |
| (3) | (2) | (2) | (1) |
Comments
- Numbers indicate hierarchy of importance for this theme/area.
B. Determinants of health most closely linked to this theme/area
- All determinants of health are relevant, either directly or in interaction with others.
C. Potential Research Questions
Current research in this theme/area
There is research mostly on impact of stigma, less on effective interventions to reduce stigma and discrimination, as well as social support and outcomes on stigma. There is significant evidence that the level of social support predicts outcome (especially in the field of psychosis); cultural factors are also known to play a role.
New Research Topics
| Topics | Intended Impacts | |
|---|---|---|
| 5.1a | Most effective ways to reduce stigma and discrimination to enhance early detection, help-seeking and social support. | Better informed and sensitized public Lower social and economic burdens Earlier detection, better help-seeking Better informed decision making at the family level |
| 5.1b | The effect of reduced stigma and discrimination on outcomes (including social support) at all developmental/illness stages. | Improved and more targeted treatment Improved outcomes Better understanding of the mechanisms Better adapted/more suitable treatments for individuals and families |
| 5.2 | Identification of cultural differences in the stigmatization process. | Services/interventions adapted to Canada's population mosaic Culturally competent services Strengthened and maintained family support and stability More effective engagement in treatment |
| 5.3 | Impact of stigmatization and development of potential coping strategies in families of early episode individuals, e.g., how does one intervene with different members of the family and support systems? What are the most effective ways of intervening with different family members? | Better homecare, respite and family-based/community-based interventions |
| 5.4 | Evaluation of interventions/intervention models and their effect on employment, legal and educational outcomes. | Improved quality of life Lower social and economic burden |
| 5.5 | Major influences on quality of life for those affected by illness and their family members. | Greater understanding of the relationship between various outcomes and improved quality of life |
| 5.6 | Determination of the role of professionals in maintaining stigma and discrimination, including its effect on detection, treatment and outcomes. | Improved understanding of this area and opportunities for training and development |
| 5.7 | Development of models of stigmatization, which may be disease-specific or across diseases. | Tools for understanding and implementing behavioural change |
Discussion Points
- Gus Baker has done work on felt and inactive stigma; we need to think about it developmentally, e.g., how does it links to social inclusion/exclusion and participation.
- We need more information about stigma, e.g., common agreement and understanding on what constitutes stigma and its genesis, cross-disease comparisons, individual factors, methodologies and processes, etc.
- Health care professionals have a fundamental role in creating and maintaining stigma. This area requires further study.
Results are affected by the type and quality of instruments we use. Currently "invalid" results are common because:
- psychometric properties are lacking in many instruments
- there is a lack of validation for different target populations, e.g., gender, age, ethnic groups
- the purpose of the original instrument is not respected, e.g., screening measures used for diagnostic purposes; timelines that are not respected
- there is administrative fatigue related to repeated testing.
In addition,
- There is individual variability in test results that is not always accounted for in the final results.
- There may be inconsistency in results given the time and context when measures are administered.
- Measures developed to evaluate cognitive neuropsychological deficits must be used in the appropriate context.
- The relationships between and among results of various measures need to be better understood.
- There is a need to develop valid measures for animal models, as well as for replication of studies and triangulation of measures in research.
- There is a need for better definition of constructs, e.g., categorized vs. non-categorized.
- Computer administration of measures could be a means to ensure standardization of results; however, the suitability of using existing tests with new technology needs to be explored.
- Measures must take into account literacy problems or disabilities.
- Biologically valid measures and life events measures need to be developed.
A. Research pillars most relevant to this theme/area
| Basic biomedical, e.g., genetic, molecular, cellular, tissue physiology | Applied clinical, e.g., drugs, devices, social intervention | Health systems, health services, e.g., epidemiology, health care quality, cost-effectiveness | Societal, cultural and environmental influences on health and the health of populations |
| x | x | x | x |
Comments
- Self-reported questionnaires may be culture bound.
- There is a need to update validation methods.
B. Determinants of health most closely linked to this theme/area
| Determinants | Check (x) | Determinants | Check (x) |
|---|---|---|---|
| Income and Social Status | Personal Health Practices and Coping Skills | x | |
| Social Support Networks | x | Healthy Child Development | |
| Education | Biology and Genetic Endowment | ||
| Employment/ Working Conditions | x | Health Services | x |
| Social Environments | x | Gender | x |
| Physical Environments | x | Culture | x |
- It is essential to ensure the validity of instruments measuring complex and changing constructs that affect health.
C. Potential Research Questions
Current research in this theme/area
There is incomplete information regarding current research in this theme/area. Some success stories include: the validation in French of the Addiction Severity Index (ASI)/l'indice de gravité d'une toxicomanie (IGT) and the development of A-DEP-ADO and the use of the Composite International Diagnostic Interview (CIDI) by Statistics Canada. One significant concern is the use of a dated instrument (South Oaks Gambling Screen - SOGS) for community screens in gambling.
New Research Topics
| Topics | Intended Impact | |
|---|---|---|
| 6.1 | Evaluation of the measures in first episodes for instruments that are in the public domain. | Valid results from which social and treatment policies, etc., can be derived |
| 6.2 | Determination of the gold standard for the psychometric properties and instruments used in research. | Comparative, valid data |
| 6.3 | Development of a compendium of best practices for the validation of instruments that can be included in grant proposals. | Standardization and reliability of results in all studies |
| 6.4 | Development of an instrument to measure health determinants. | Clinicians have a rapid grasp of the coefficient of social difficulty the patient/client is experiencing |
Discussion Points
- Existing tools should be evaluated before new ones are created.
- The research theme needs to be initially reported in terms of first episodes, but should also be flagged by CIHR as a theme with general application.
- Consideration must be given to the cross cultural use of instruments.
- We need a strategy to deal with error-prone measurement strategies.
Implementation
Participants discussed implementation issues in terms of current strengths, additional requirements, future partnerships and recommendations for a peer review process more appropriate to this area of research.
Canada has a well-established health care system with well-developed social services that have the capacity to do effective work in the community and schools, e.g., the Shared Care initiative. In addition, the federal government has a strong interest in this area: chronic disease prevention has been identified as a priority; a policy statement to advance health research and children. There is strong collaboration among federal, provincial/territorial governments and NGOs on health research in Canada and internationally, e.g., Human Resources and Development Canada has developed a disability framework. The Romanow and Kirby reports on reorganization of health care in Canada offer a golden opportunity to capitalize on the current climate through promoting the cost effectiveness of early intervention and encouraging a first episodes research agenda.
CIHR is an active partner in health research, providing support through various mechanisms such as training grants, funding for New Emerging Teams (NET), pilot grants for high risk projects and policy grants for health systems research. CIHR could take an even more active role in making submissions to government related to the burden of illness and effective use of resources. If possible, CIHR could also foster international funding partnerships, e.g., where part of the research is conducted in another country but the principal investigator is based in Canada.
There are foundations, industry, NGOs, and governments (federal and provincial) that have established funding partnership models, e.g., Lilly providing money to the WHO to look at stigma. On the whole, the cost of clinical research is less in Canada because of lower overheads and a generally favourable rate of currency change.
Canada's universal health care system facilitates evidence-based research, which has the potential to inform changes in the health care system. There is strong epidemiological research in Canada, as well as good health registries (although linkages of data across registries and sectors/ministries/agencies creates difficulties related to data capture) and a strong standard of education across the board (e.g., elementary to university level). Centres of Excellence promote multi-disciplinary work and collaboration. The Canada Foundation for Innovation provides equipment and infrastructure support and has links with Industry Canada. There is a pool of researchers with international experience that has the potential for international partnerships, as well as a strong Canadian neurobiological research community. In addition, opportunities for clinical/biomedical research and promotion of clinician scientists programs (MD/PhD) are growing.
Existing educational and health databases could be utilized in many of the facets of an RFA in early episode disease processes. There are provincial medical databases (such as RAMQ and drug utilization/prescription databases in Quebec and the addictions database in Ontario), but accessibility of databases is generally non-systematic and complicated by ethical and institutional issues. Canada also has a variety of special populations for study, such as unique genetically homogeneous populations for genetic inquiries.
Studies such as the National Longitudinal Study of Children and Youth and the Ontario Child Health Study are also making a valuable contribution to the research area. Other assets include: the establishment of a new Alberta gambling cohort; statistics exist related to the burden of illness and depression and initiatives such as Youth Net Ottawa, and Youth Theatre Ottawa.
Internationally, Australia, Canada, Germany and Norway are strong in the area of early life events and first episodes of brain disorders. Royal College psychiatrists in England have also established a network on anti-sigma interventions.
[ top of page ]Overall, this research area could benefit from effective lobbying by key stakeholders such as CIHR, universities and funding organizations related to capacity development (e.g., more funding for operating grants and training), as well as better communication among stakeholders/researchers of different types, e.g., through an INMHA approved multidisciplinary symposium. This communication could be facilitated through improved multidisciplinary networking/networks supported (clinical and research) by CIHR. This support needs to include a public relations strategy to make existing and potential partners better known to each other, e.g., travel budgets, a linkage funding to establish common databases. Communication could also be enhanced through website/portal/lists to link potential partners/collaborators. Mechanisms to establish linkages with researchers (e.g., conferences, consensus meetings) in similar areas to explore potentials for research also need to be established.
Continuing engagement of NGOs is necessary to maintain input on direction of research and implementation of findings, e.g., make research applicable and understandable to the public. Bringing NGOs with commonalities together to explore opportunities to pool funds and research on areas of common interest and outcomes should be encouraged. NGOs could also collaborate with CIHR institutes and should be informed of any RFAs related to this consultation. A national funding agency for mental health research on the scale of the Heart and Stroke Foundation of Canada would be a significant step forward.
Involving Ministries of Education (e.g., liaising with educators, access to a non-clinical population, grass root initiative) is another option. The private sector could also be engaged, e.g., through the Business and Economic Roundtable on Addiction and Mental Health. Another option is to fund "knowledge missions" (similar to trade missions) to promote national and international collaborations, production and trade in knowledge, and take advantage of any financial spin-offs.
Provinces must increase funding to hospitals and health care institutions to ensure implementation - these are federally supported ideas but are dependent on provinces for endorsing and supporting them. Different provinces may have different acts and priorities; provincial budget cuts have put hospitals and universities under increasing pressure. The relationships between provincial and federal government and the pharmaceutical industry also need to be improved.
Statistics related to burden of illness should be leveraged to obtain more secure funding for psychiatric research nationally. Funding alternatives include providing tax structure incentives for donations to research associated charities and reinstituting provision of matching funding dollars.
Legislative issues include the need for legislation to enable collection of data across generations, as well as the impact of privacy issues and the use of provisions under the Charter of Rights for a study on stigma.
Research-specific improvements include:
- Encouragement for embedding of research in clinical settings that do not have a university affiliation, e.g., supporting researchers with career support grants
- Fostering national training programs and career building activities, including research training for young investigators to build their own teams
- Improvement of the ability to follow programs of research prior to publication in peer reviewed journals
- Access to work in progress (where possible) and studies with negative findings not publishable in most journals, i.e., to prevent duplication
- More investment in postdoctoral fellow training and other highly qualified people (HQP)
- Promotion of Alternative Funding Plans (AFP) across the country to free up clinicians' (and basic scientists') time for research.
Participants identified the following potential future partnerships (alphabetical order):
- CIHR Institutes, e.g., among the Institute of Aboriginal Peoples' Health, Institute of Human Development, Childhood and Youth, Institute of Gender and Health, Institute of Genetics, Institute of Circulatory and Respiratory Health, Institute of Population and Public Health, Institute of Health Services and Policy Research.
- Funders, e.g., the Canadian Health Services Research Foundation, Social Sciences and Humanities Research Council of Canada, FRSQ, Alberta Heritage Foundation for Medical Research, Natural Sciences and Engineering Research Council, Michael Smith Foundation (BC).
- Funding Issues, e.g., channel more gambling/tobacco/alcohol tax revenues into related research areas; increase funds to support additional day care (early intervention).
- Provincial/Territorial Agencies, e.g., Ministries of Education and Health in each province, Children's Secretariat in Ontario, corrections-related services.
- Federal government departments and agencies, e.g., Corrections Canada, Industry Canada.
- Industry, e.g., imaging and drug companies, Noralou and Leslie Roos from the Manitoba Centre for Health Policy.
- NGOs and Foundations (e.g., Ontario Mental Health Foundation, Epilepsy Canada, Autism Research Foundation, Canadian Association for Suicide Prevention).
- Consumer/community and stakeholder partnerships to facilitate access to populations and to support knowledge translation, e.g., community outreach programs, protection services, education agencies and school boards.
- Research-oriented partnerships, e.g., among child welfare researchers and clinical/biomedical researchers; related to expansion of population databases; links to clinical settings; promotion of partnering of researchers in childhood health, perinatal and adult-oriented researchers; toxicological institutes.
- International, e.g., Canadian International Development Agency, International Development Research Council, Fogarty Centre at the US National Institutes of Health. Encouage CIHR to lobby the federal government regarding both national and international knowledge missions to link researchers and academics nationally and internationally.
Participants provided the following recommendations for a fair, transparent review process that takes into account the unique features of research into early life events and first episodes of brain disorders.
- There should be good representation from all stakeholder disciplines, including researchers who have specific expertise and multi- and interdisciplinary research experience across the CIHR research pillars. To encourage transparency, disciplines represented on peer review committees should be identified.
- The peer review committees must to sensitive to the purpose of the RFA and should allow for some perceived riskier proposals.
- The use of international reviewers (e.g., from England, Australia, Norway) should be considered where appropriate.
- A good balance should be struck between political agendas and realistic scientific potential - the focus should be on scientific excellence.
- A two-tiered system of prescreening each appraisal could reduce the level of effort involved in grant writing and peer review.
- Priority should be given to collaborative, interdisciplinary, multi-factor applications, e.g.,
- promote teams that cover a greater breadth of determinants of health in their proposal
- provide additional points for bringing on new partners and for new collaborators (expanding existing teams
- new emerging teams.
- Priority should be given to new investigators (within 10 years) - this is about promoting partnerships early on in an individual's career.
- Methodological reviews need to be consistent with the methodology of the grant proposal.
Participants noted the challenges inherent in working in multidisciplinary teams related to the diversity of different areas and the differing use of language and methods across disciplines.
[ top of page ]Closing Remarks
In his closing remarks, Dr. Rémi Quirion, Scientific Director, CIHR INMHA, thanked participants for their constructive engagement on research issues throughout the consultation. He committed to acting on the new peer review process and reaffirmed his institute's commitment to an RFA for early life events and first episodes of brain disorders and asked participants to stay involved during the RFA process. Dr. Quirion also encouraged participants to contact INMHA staff if they have questions related to any of the many ongoing CIHR initiatives.
Appendix #1: Key Terms
Collaboration: is a process through which parties who see different aspects of a problem can constructively explore their differences and search for solutions that go beyond their own visions of what is possible. Collaboration involves joint problem solving and decision making among key stakeholders in a problem or issue.
Four features are critical to collaboration:
- the stakeholders are interdependent
- solutions emerge by dealing constructively with differences
- decisions are jointly owned
- stakeholders assume collective responsibility for the future direction of the domain.
In collaboration it is common to have:
- lack of clarity about who is a stakeholder
- disparity of power and/or resources among stakeholders
- complex problems that are not well defined
- scientific uncertainty
- differing perspectives that lead to adversarial relationships
- dissatisfaction with previous and existing approaches and processes.
Collaboration is a distinctly different process than coordination and cooperation.
| Coordination formalized, defined relationships among organizations |
Cooperation informal trade-offs and agreements established in the absence of formal rules |
Collaboration an emergent and evolving process of building substantive agreement |
Both coordination (formalized process) and cooperation (informal process) often occur as part of a collaborative process. Once initiated, collaboration creates a temporary forum within which participants can seek consensus about a problem, invent mutually agreeable solutions and develop collective actions for implementation.
Barbara Gray. Collaborating: Finding Common Ground for Multiparty Problems. Jossey-Bass Publishers, London, 1989, 5. Adapted.
Community
A community is a specific group of people who:
- share a common culture, beliefs, values and norms
- exhibit some awareness of their identity (personal/social/professional) as a group
- may live in a defined geographical area
- share common needs and a commitment to meeting them
- are arranged in a social or professional structure according to relationships which the community has developed over a period of time. (Adapted from the WHO definition)
Consensus
Substantial agreement. The degree of consensus that has been achieved is measured by asking participants to express one of the following positions:
- I agree with the proposal
- I can live with the proposal
- I disagree, or remain undecided.
Silence is not interpreted as consent.
Key questions to determine consensus are:
- Can you live with this?
- Will you support this decision or action within this group?
- Will you support this decision or action outside of this group?
If unable to answer "yes" to these questions, a participant is asked,
- What has to change in order for you to support this decision or action?
Innovation
The degree to which new approaches are used for solving problems and exploiting opportunities in research, and/or the degree to which the research will focus on new types of important or potentially important issues. (See also the Industry Canada Paper "Achieving Excellence" (new window) [ Help ].
Innovative Research
Research initiatives which produce something new that will have a significant impact in an area.
Knowledge Translation (KT)
Within a complex system of interactions, knowledge translation (KT) is the process that transfers research results from knowledge producers to knowledge users for the benefit of Canadians. Moving beyond the traditional domain of academic publication, it comprises three interlinked components: knowledge exchange, synthesis, and ethically sound application. The goal of KT is to improve health processes, services, and products as well as the health-care system itself. It employs broad-based and often interactive mechanisms of uptake, dissemination, and debate and entails a complex set of interactions among producers, users and contexts. (CIHR)
Network
Individuals, groups and organizations working collaboratively in support of mutually agreed-upon goals, principles and benefits.
Partnership
For the purpose of this workshop, a partnership is a relationship involving two or more parties who have agreed to work collaboratively toward the goal of addressing an issue or a set of issues. A partnership requires the sharing of power, work, support, resources and information with others. A partnership accrues benefits to each partner while fostering an achievement of ends which are mutually acceptable. Three common types/levels of partnership are: principal, collaborating and consulting.
Stakeholders
Stakeholders are organizations or individuals who have a strong interest in the success of the strategic research agenda.
[ top of page ]Appendix #2: Strategic Research Framework
A. Themes
For the purposes of this workshop, themes are research areas or applications that are central to collaborative, cross-disciplinary research on early life events and first episodes of brain disorders. Themes tend to cross disciplines, determinants of health and CIHR research themes. They may vary in scope but should be focused enough to enable the identification of appropriate approaches or methodologies.
CIHR Research Themes
- Which research themes are relevant to this theme area?
- Basic biomedical, e.g., genetic, molecular, cellular, tissue physiology
- Applied clinical, e.g., drugs, devices
- Health systems, health services, e.g., quality of care, cost-effectiveness
- Societal, cultural and environmental influences on health and the health of populations.
- Determinants of Health
- Which of the following determinants of health are closely linked to this theme area?
- Biology and genetic endowment
- Culture
- Education
- Employment and working conditions
- Gender
- Health behaviors and practices, coping skills
- Health child development
- Access to health services
- Income and social status
- Physical and social environments (e.g., home/family, workplace, recreation)
- Social support networks.
B. Potential Research Questions
These are examples of research questions that could fit into a theme area. They give an indication of the scope of the theme area and help define how the theme could contribute to the research agenda.
- What research questions are you aware of that are being investigated in this theme area?
- What new research questions could provide significant value in this theme area?
Potential Impact
- What impact (outcomes) could these research questions have in this theme area?
C. Implementation
- Current Strengths and Supports
- What capacities, competencies, experience or situations exist in Canada that would facilitate the implementation of this research agenda?
- Opportunities
- What initiatives and trends could we take advantage of to facilitate the implementation of this research agenda?
- Current Challenges
- What additional capacities, competencies, expertise or supports are required to ensure the success of this research agenda? Identify gaps or problems and propose solutions to address each one.
Appendix #3: Determinants of Health
| Key Determinants | Underlying Premises |
|---|---|
| Income and Social Status | Health status improves at each step up the income and social hierarchy. High income determines living conditions such as safe housing and ability to buy sufficient good food. The healthiest populations are those in societies which are prosperous and have an equitable distribution of wealth. |
| Social Support Networks | Support from families, friends and communities is associated with better health. The importance of effective responses to stress and having the support of family and friends provides a caring and supportive relationship that seems to act as a buffer against health problems. |
| Education | Health status improves with level of education. Education increases opportunities for income and job security, and equips people with a sense of control over life circumstances - key factors that influence health. |
| Employment/ Working Conditions | Unemployment, underemployment and stressful work are associated with poorer health. People who have more control over their work circumstances and fewer stress related demands of the job are healthier and often live longer than those in more stressful or riskier work and activities. |
| Social Environments | The array of values and norms of a society influence in varying ways the health and well-being of individuals and populations. In addition, social stability, recognition of diversity, safety, good working relationships, and cohesive communities provide a supportive society that reduces or avoids many potential risks to good health. Studies have shown that low availability of emotional support and low social participation have a negative impact on health and well-being. |
| Physical Environments | Physical factors in the natural environment (e.g., air, water quality) are key influences on health. Factors in the human-built environment such as housing, workplace safety, community and road design are also important influences. |
| Personal Health Practices and Coping Skills | Social environments that enable and support healthy choices and lifestyles, as well as people's knowledge, intentions, behaviours and coping skills for dealing with life in healthy ways, are key influences on health. Through research in areas such as heart disease and disadvantaged childhood, there is more evidence that powerful biochemical and physiological pathways link the individual socio-economic experience to vascular conditions and other adverse health events. |
| Healthy Child Development | The effect of prenatal and early childhood experiences on subsequent health, well-being, coping skills and competence is very powerful. Children born in low-income families are more likely than those born to high-income families to have low birth weights, to eat less nutritious food and to have more difficulty in school. |
| Biology and Genetic Endowment | The basic biology and organic make-up of the human body are a fundamental determinant of health. Genetic endowment provides an inherited predisposition to a wide range of individual responses that affect health status. Although socio-economic and environmental factors are important determinants of overall health, in some circumstances genetic endowment appears to predispose certain individuals to particular diseases or health problems. |
| Health Services | Health services, particularly those designed to maintain and promote health, to prevent disease, and to restore health and function, contribute to population health. |
| Gender | Gender refers to the array of society-determined roles, personality traits, attitudes, behaviours, values, relative power and influence that society ascribes to the two sexes on a differential basis. "Gendered" norms influence the health system's practices and priorities. Many health issues are a function of gender-based social status or roles. Women, for example, are more vulnerable to gender-based sexual or physical violence, low income, lone parenthood, gender-based causes of exposure to health risks and threats (e.g., accidents, STDs, suicide, smoking, substance abuse, prescription drugs, physical inactivity). Measures to address gender inequality and gender bias within and beyond the health system will improve population health. |
| Culture | Some persons or groups may face additional health risks due to a socio-economic environment, which is largely determined by dominant cultural values that contribute to the perpetuation of conditions such as marginalization, stigmatization, loss or devaluation of language and culture and lack of access to culturally appropriate health care and services. |
[ top of page ]
Appendix #4: Participants
Dr. Karen Benzies
Faculty of Nursing
University of Calgary
2500 University Drive NW
Calgary, AB T2N 1N4
Tel: 403-220-2294
Fax: 403-284-4803
E-mail: benzies@ucalgary.ca
Dr. Kathryn Bennet
Associate Professor
Department of Clinical Epidemiology and Biostatistics
McMaster University
1280 Main Street West
Hamilton, ON L8S 4L8
Tel: 905-525-9140 ext 22914
E-mail: kbennett@mcmaster.ca
Dr. Karine Bertrand
Psychologue Chercheure
Domremy Maurice/Centre du Quebec
440, rue des Forges
Trois Rivieres, QC G9A 2H5
Tel: 819-374-4744 ext. 129
Fax: 819-374-4502
E-mail: karine_bertrand@ssss.gouv.qc.ca
Dr. Susan Bradley
Psychiatrist
Department of Psychiatry
Hospital for Sick Children, University of Toronto
555 University Avenue
Toronto, ON M5G 1X8
Tel: 416-813-8050
Fax: 416-813-5326
E-mail: susan.bradley@sickkids.ca
Dr. Jacques Bradwejn
Chair of Psychiatry
University of Ottawa
Royal Ottawa Hospital
1145 Carling Avenue
Ottawa, ON K1Z 7K4
Tel: 613-722-6521 ext. 6546
Fax: 613-798-2473
E-mail: jbradwej@rohcg.on.ca
Dr. Richard Brière
Assistant Director
Douglas Hospital
6875 boulevard Lasalle
Verdun, QC H4H 1R3
Tel: 514-761-6131 ext 3930
Fax: 514-888-4060
E-mail: richard.briere@douglas.mcgill.ca
Dr. Thomas Brown
Director, Addiction Research Program
Douglas Hospital Research Centre
6875 Lasalle Blvd, H 1133
Verdun, QC H4H 1R3
Tel: 514-761-6131
Fax: 514-888-4064
E-mail: brotho@douglas.mcgill.ca
Dr. Peter Carlen
Senior Scientist/Professor
Toronto Western Research Institute
University of Toronto
Room 12-413 - TWRI
399 Bathurst Street
Toronto, ON M5T 2S8
Tel: 416-603-5044
Fax: 416-603-5745
E-mail: carlen@uhnres.utoronto.ca
Dr. Lionel Carmant
Hôpital Ste-Justine
Division of Neurology
17 Cote Ste-Catherine
Montréal, BC H3T 1C5
Tel: 514-345-4331 ext. 5394
Fax: 514-345-4787
E-mail: lionel.carmant@umontreal.ca
Dr. Normand Carrey
Department of Psychiatry
Dalhousie University
Halifax, NS
Tel: 902-470-8378
E-mail: normand.carrey@iwk.nshealth.ca
Dr. Florence Chanut
Fellow en psychiatrie des addictions
Hôpital Douglas
Programme de recherche sur les addictions
6855 boulevard LaSalle
Verdun, QC H3H 1R3
Tel: 514-761-6131 ext.4394
E-mail: florence.chanut@douglas.mcgill.ca
Dr. Patrick Cossette
CHUM-Hôpital Notre-Dame
1560 Sherbrook Street
Montréal, QC H2L 4M1
Tel: 514-890-8237
Fax: 514-412-7554
E-mail: patrick.cossette@mail.mcgill.ca
Dr. Anne Duffy
Associate Director, Bipolar Research
Insitute for Mental Health Research
Royal Ottawa Hospital
1145 Carling Avenue
Ottawa, NS K1Z 7K4
Tel: 613-722-6521 ext. 7025
Fax: 613-798-2993
E-mail: aduffy@rohcg.on.ca
Dr. Danielle Duhamel
Psychologue Clinicienne
Clinique Cormier-Lafontaine
110 rue Prince Arthur ouest
Montréal, QC H2X 1S7
Tel: 514-282-6060
Fax: 514-282-5030
E-mail: danielle.duhamel.ccl@ssss.gouv.qc.ca
Ms. Fiona Dunbar
Vice President Clinical Affairs
Janssen-Ortho Inc.
Dr. Nady el-Guebaly
Professor and Head, Adiction Psychiatry Division
Foothills Hospital Addiction Centre
1403-29 Street NW
Calgary, AB T2N 2T9
Tel: (403) 944-2025
Fax: (403) 944-2056
E-mail: nady.el-guebaly@calgaryhealthregion.ca
Dr. Martine Flament
Research Director
Institute of Mental Health Research
Royal Ottawa Hospital
1145 Carling Avenue
Ottawa, ON K1Z 7K4
Tel: 613-722-6521 ext. 6455
Fax: 613)-798-2973
E-mail: mflament@rohcg.on.ca
Dr. Yvon Gauthier
Hôpital Ste Justine, Dept. Psychiatrie
3175 Cote Ste Catherine
Montréal, QC H3T 1C5
Tel: 514-345-4635
E-mail: yvon.gauthier.1@umontreal.ca
Ms. Branka Gudelj
Board Member/Chapter Leader
Fragile X Research Foundation of Canada,
Ottawa Chapter
1979 Oakdean Cres.
Ottawa, ON K1J 6H6
Tel: 613-748-6009
E-mail: gudelj@rogers.com
Dr. Lorie Hamiwka
Pediatric Neurologist
1820 Richmond Rd. SW
Calgary, AB T2T 5C7
Tel: 403-943-7811
Fax: 403-943-7609
E-mail: lorie.hamiwka@calgaryhealthregion.ca
Dr. Grace Iarocci
Assistant Professor
Simon Fraser University
Department of Psychology
888 University Dr.
Burnaby, BC V5A 1S6
Tel: 604-268-6668
Fax: 604-291-4327
E-mail: giarocci@sfu.ca
Dr. Tammy Ivanco
Assistant Professor
University of Manitoba
P430 Duff Robin Bldg. Dept. of Psychology
Winnipeg, MB R3T 2N2
Tel: 204-474-7375
Fax: 204-474-7599
E-mail: ivancotl@ms.umanitoba.ca
Dr. Ridha Joober
Assistant Professor
Douglas Hospital Research Centre
Douglas Hospital
6875 Boulevard Lasalle
Verdun, QC H4H 1R3
Tel: 514-761-6131
Fax: 514-888-4064
E-mail: ridha.joober@mcgill.ca
Dr. Diana Koszycki
Research Director, Anxiety Research Unit
University of Ottawa, Institute of Mental Health
Royal Ottawa Hospital
1145 Carling Avenue
Ottawa, ON K1Z 7K4
Tel: 613-722-6521 ext. 6134
Fax: 613-722-9920
E-mail: dkoszyck@rohcg.on.ca
Dr. Stan Kutcher
Associate Dean
Dalhousie University
Department of Psychiatry
S909 Veterans Memorial Lane
9th Floor, ASLB
Halifax, NS B3H 2E2
Tel: 902-473-6214
Fax: 902-473-4887
E-mail: stan.kutcher@dal.ca
Dr. Lucyna Lach
Assistant Professor
McGill University
350 University Street
Montréal, QC H3A 2A7
Tel: 514-398-7050
Fax: 514-398-4760
E-mail: lucy.lach@mcgill.ca
Dr. Ron Leslie
Professor and Head of Department
Department of Anatomy & Neurobiology
Faculty of Medicine
Dalhousie University
5850 College Street
Halifax, NS B3H 1X5
Tel: 902-494-6850
Fax: 902-494-1212
E-mail: ron.leslie@dal.ca
Dr. Ashok Malla
Professor of Psychiatry
Head, Division of Clinical Research
Douglas Hospital Research Centre
6875 Boulevard LaSalle
Verdun, QC H4H 1R3
Tel: 514-761-6131 ext. 3390
Fax: 514-888-4064
E-mail: ashok.malla@douglas.mcgill.ca
Dr. Zul Merali
President/CEO
University of Ottawa Institute of Mental Health Research
1145 Carling Avenue
Lady Grey, Room 2054
Ottawa, ON K1Z 7K4
Tel: 613-722-6521 ext. 6551
Fax: 613-722-5871
E-mail: merali@uottawa.ca
Dr. Heather Milliken
Associate Professor
Dalhousie University
Department of Psychiatry
Abbie J. Lane Building, QE II HSC
5909 Veterans' Memorial Lane
Halifax, NS BH 2E2
Tel: 902-473-4883
Fax: 902-473-4545
E-mail: heather.milliken@dal.ca
Dr. Louise Nadeau
Professeur, département de Psychologie
Université de Montréal
C.P. 6128, succ. Centre-Ville
Pavillon Marie-Victorin,
1525 Boul Mont-Royal Oues
Porte D-329
Montréal, QC H3J 3C7
Tel: 514-343-6989
Fax: 514-343-2285
E-mail: louise.nadeau.2@umontreal.ca
Dr. Ross Norman
Professor
University of Western Ontario
Room 114A
WMCH Building CHSC,
392 South Street
London, ON N6A 4G5
Tel: 519-685-8300 ext 75493
Fax: 519-667-6623
E-mail: rnorman@uwo.ca
Dr. Ante Padjen
Department of Pharmacology and Therapeutics
McGill University
Montréal, QC
Tel: 514-398-3603
E-mail: ante.padjen@mcgill.ca
Dr. Roberta Palmour
Professor
McGill University
1033 Pine Avenue West # 326
Montréal, QC H3A 1A1
Tel: 514-398-7303
Fax: 514-398-4370
E-mail: roberta.palmour@mcgill.ca
Dr. Quentin Pittman
Professor/AHFMR Medical Scientist
Neuroscience Res. Group
Department of Physiology & Biophysics
Faculty of Medicine
University of Calgary
3330 Hospital Dr. NW
Calgary, AB T2N 4N1
Tel: 403-220-7383
Fax: 403-283-2700
E-mail: pittman@ucalgary.ca
Dr. Rémi Quirion
Scientific Director, Institute of Neurosciences, Mental Health and Addiction
Institute of Neurosciences, Mental Health and Addiction
Douglas Hospital Research Centre
6875 Blvd Lasalle
Verdun, QC H4H 1R3
Tel: 514-761-6131
E-mail: quirem@douglas.mcgill.ca
Dr. Johanne Renaud
Young Investigator CIHR
Child and Adolescent Psychiatrist
Associate Professor University of Montreal
Department of Psychiatry
CHU mère-enfant Sainte-Justine
3175 Cote Sainte-Catherine
Montréal, QC H3T 1C5
Tel: 514-345-4931 ext. 5734
Fax: 514 345-4635
E-mail: johanne_renaud@ssss.gouv.qc.ca
Dr. Paul Roy
Director, Ottawa First Episode Psychosis Program
Assistant Professor
University of Ottawa
4425-501 Symth Road
Ottawa, ON K1H 8L6
Tel: 613-737-8069
Fax: 613-737-8069
E-mail: paroy@ottawahospital.on.ca
Dr. Martin Steinbach
Director, Eye Research
Toronto Western Hospital
399 Bathurst St.
6MP-302
Toronto, ON M5T 2Z8
Tel: 416-603-6479
Fax: 416-603-5126
E-mail: mjs@yorku.ca
Dr. Allan Thornton
Assistant Professor
Dept. of Phychology
Simon Fraser University
8888 University Avenue
Burnaby, BC V5A 1S6
Tel: 604-291-5471
Fax: 604 -291-3427
E-mail: aethornt@sfu.ca
Dr. Phil Upshall
Chair, Canadian Alliance on Mental Illness and Mental Health
7 Coventry Drive
Guleph, ON N1G 2T9
Tel: 519-824-5565
Fax: 519-824-9569
E-mail: phil@mooddisorderscanada.ca
Dr. Gayle Vincent
Research Chair
Canadian Association for Suicide Prevention
Suicide Prevention Research Projects
#320-1202 Centre Street SE
Calgary, AB T2G 5A5
Tel: (403) 245-3900
Fax: (403) 245-0299
E-mail: gayle@suicideinfo.ca
Dr. Sharon Whiting
Head, Division of Neuology/Associate Professor
Children’s Hospital of Eastern Ontario
University of Ottawa
401 Smyth Rd.,
Ottawa, ON K1H 8L1
Tel: 613-737-7600 ext 2605
Fax: 613-738-4294
E-mail: whiting@cheo.on.ca
Dr. Arlene Young
Associate Professor
Simon Fraser University
Dept. of Psychology
88888 University Drive
Burnaby, BC V5A 1S6
Tel: 604-291-5329
Fax: 604-291-4327
E-mail: aryoung@sfu.ca
Ms. Leah Young
Communications Officer
Schizophrenia Society of Canada
50 Acadia Avenue
Suite 205
Markham, ON L3R 0B3
Tel: 905-415-2007 ext. 25
Fax: 905-415-2337
E-mail: youngl@schizophrenia.ca
Consultants:
Strachan•Tomlinson and Associates
31 Euclid Avenue
Ottawa, ON K1S 2W2
Tel: 613-730-1000
E-mail: stractom@cyberus.ca
Process Design and Facilitation: Dorothy Strachan
Project Management: Barbara Metcalfe
Consultation Report
1 For the purposes of this initiative, the starting point for the early development or first episode of a brain disorder was defined as clinical recognition of the disorder irrespective of age. Clinical recognition is closely associated with initial diagnosis and the initiation of treatment. Proceeding from clinical recognition, research can explore issues that occur prior to the point of clinical recognition (PRE) such as risk factors, precipitating factors, patho-physiological mechanisms, pathways to care, prevention, promotion and early intervention strategies. Post-recognition issues that occur later in time (POST) include interventions and outcomes.
2 Participants noted that temperament might also go under biological factors. Personality could also be considered under psychological factors.