Name: Jenna Boyd
Supervisors: Dr. Katherine Holshausen
Education Program and Level: Psychology Resident, St. Joseph’s Healthcare Hamilton
Jenna Boyd is a PhD Candidate in the research and clinical training stream of McMaster University’s Psychology graduate program and a Psychology Resident at St. Joseph’s Healthcare Hamilton (SJHH). She is passionate about understanding the phenomenology, maintaining factors, and treatments for individuals suffering from Post-traumatic Stress Disorder. Jenna is involved in research investigating factors that affect treatment outcomes for individuals with Borderline Personality Disorder (BPD) through her rotation at the Borderline Personality Disorder Service at SJHH. Her future career goals include working as a Psychologist in the area of trauma and trauma-related disorders and continuing her research on factors that affect functioning and treatment outcomes for these individuals.
Posttraumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD) are two psychiatric conditions that often co-occur, where as many as 50% of individuals with BPD also have PTSD. Individuals with both disorders experience greater disease severity, such as risk of attempting suicide, additional psychiatric conditions, and greater impairments in quality of life.
Dialectical Behaviour Therapy (DBT) targets key symptoms of BPD, including difficulties managing emotions, impulsive behaviour, and difficulties in social relationships. Given that individuals with both BPD and PTSD experience increased symptom severity, it has been suggested that PTSD symptoms may impact response to treatment with DBT. Previous research has been inconclusive as to whether this is the case.
The purpose of this study was to assess changes in PTSD and BPD symptoms over the course of treatment with DBT and investigate the impact of PTSD symptoms on treatment outcome over the first four months of treatment. Twenty-seven individuals with BPD and PTSD symptoms participated in four months of standard DBT (group and individual therapy and phone coaching). Participants completed questionnaires assessing BPD and PTSD symptoms and emotion regulation difficulties.
Statistical analyses revealed that higher PTSD symptoms were associated with higher levels of BPD symptoms and emotion regulation difficulties at the beginning of treatment. We also found that participation in DBT was associated with a significant improvement in BPD symptoms and emotion regulation difficulties, but not PTSD symptoms. However, PTSD symptom severity at the beginning of treatment did not have an influence on change in BPD symptoms or emotion regulation difficulties.
These results suggest that PTSD symptoms at the beginning of treatment do not negatively impact the ability of individuals with BPD to benefit from treatment with DBT. It also demonstrates that additional treatment is required to address symptoms of PTSD, as these symptoms did not improve with DBT alone. Future work should determine when and what treatments are most effective for the treatment of PTSD among individuals with BPD.
Name: Katrina Bouchard
Supervisor: Dr. Heather Moulden
Education Program and Level: Psychology Resident
Katrina Bouchard is a PhD Candidate in Clinical Psychology at Queen’s University and a Psychology Resident at St. Joseph’s Healthcare Hamilton. She currently works in the Forensic Psychiatry Program and the Community Psychiatry Clinic. Ms. Bouchard’s doctoral dissertation is aimed at examining sex research methodologies, including the ways in which sexual arousal is elicited and assessed in a lab environment. She will be joining Forensic Mental Health Services at Providence Care Hospital in Kingston, Ontario as a Psychologist after the completion of her residency at St. Joe’s. The data she presented at Research Day was collected by members of the Forensic Psychiatry Program, including Ms. Casey Myers, Ms. Katrina Messina, Ms. Michelle Fram-Kovar, and Ms. Silvia M
Problematic sexual behaviours range in intrusiveness and involve engagement with an atypical sexual activity (e.g., exhibitionism) or with an atypical sexual target (e.g., prepubertal children). Not all problematic sexual behaviours result in criminal sanctions. For individuals diagnosed with a psychotic disorder, problematic sexual behaviours may be motivated by delusions and hallucinations with sexual themes, termed sexual psychosis. The purpose of the study was twofold: (1) To characterize the prevalence of sexual psychosis and problematic sexual behaviours in a sample of psychiatric patients diagnosed with a psychotic disorder. (2) To examine whether individuals with symptoms of sexual psychosis exhibit higher rates of problematic sexual behaviours than patients with hallucinations and/or delusions devoid of sexual themes. A retrospective chart review was conducted for a random selection of 115 patients from the Forensic Psychiatry Program and the Schizophrenia Outpatient Clinic at St. Joseph’s Healthcare Hamilton. Files were coded for history of problematic sexual behaviours and sexual psychosis as well as demographic, medical, psychiatric, and criminal history. Nearly half of the total sample (48%) experienced some form of sexual psychosis, which could include sexually-themed delusions, hallucinations, or both. Almost one third of the total sample (29%) exhibited a history of engaging in at least one problematic sexual behaviour, with the majority of this subsample (64%) exhibiting multiple occurrences of problematic sexual behaviours. As expected, individuals with sexual psychosis were more likely to exhibit problematic sexual behaviours than individuals without sexual psychosis. Findings from this study suggest that sexual psychosis is related to problematic sexual behaviours in a sample of psychiatric patients. The outcome of this study points to the potential benefit of querying for sexual themes in the context of assessing psychotic symptoms. Further research is needed to examine the effect of paraphilic interests, personality disorders, and neurological impairment on problematic sexual behaviours in individuals diagnosed with a psychotic disorder.
Name: Avni Pardasani & Alyssa Wang
Supervisor: Dr. Roberto Sassi
Education Program and Level: Psychiatry Residency Program, PGY-4
About Avni & Alyssa:
Alyssa and Avni are currently in their fourth year of psychiatry residency at McMaster University. Alyssa hopes to pursue a psychiatric practice working with young adults and also has an interest in cultural psychiatry. Avni hopes to pursue a career in general outpatient psychiatry.
Avni & Alyssa’s Project:
The aim of our quality improvement project was to gather information to improve the patient and caregiver experience for children attending psychiatric consultations at the Ron Joyce Children’s Health Centre. Each child and their caregiver completes an intake questionnaire with clinical and research utility that adds an additional hour to their consultation. We wanted to explore if receiving the intake questionnaire at other times (at home, prior to the consultation appointment) would be preferable, and for whom. We collated preferences for three groups individually: children (patients), caregivers, and clinicians. Based on this, we piloted a change that would allow caregivers to complete the portion of their intake questionnaire at home, in advance of their appointment, in paper format. The results of this pilot change were received positively and indicated increased caregiver satisfaction with the process of completing the intake questionnaire. We hope that our results will inform the intake process at Ron Joyce Children’s Health Centre to improve the patient and caregiver experience overall.