Dames, Shannon
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Item Longitudinal experiences of Canadians receiving compassionate access to psilocybin‑assisted psychotherapy(Springer Nature, 2024-07-17) de la Salle, Sara; Kettner, Hannes; Lévesque, Julien Thibault; Garel, Nicolas; Dames, Shannon; Patchett-Marble, Ryan; Rej, Soham; Gloeckler, Sara; Erritzoe, David; Carhart-Harris, Robin; Greenway, Kyle T.Recent clinical trials have found that the serotonergic psychedelic psilocybin effectively alleviates anxiodepressive symptoms in patients with life-threatening illnesses when given in a supportive environment. These outcomes prompted Canada to establish legal pathways for therapeutic access to psilocybin, coupled with psychological support. Despite over one-hundred Canadians receiving compassionate access since 2020, there has been little examination of these ‘real-world’ patients. We conducted a prospective longitudinal survey which focused on Canadians who were granted Section 56 exemptions for legal psilocybin-assisted psychotherapy. Surveys assessing various symptom dimensions were conducted at baseline, two weeks following the session (endpoint), and optionally one day post-session. Participant characteristics were examined using descriptive statistics, and paired sample t-tests were used to quantify changes from baseline to the two-week post-treatment endpoint. Eight participants with Section 56 exemptions (four females, Mage = 52.3 years), all with cancer diagnoses, fully completed baseline and endpoint surveys. Significant improvements in anxiety and depression symptoms, pain, fear of COVID-19, quality of life, and spiritual well-being were observed. Attitudes towards death, medical assistance in dying, and desire for hastened death remained unchanged. While most participants found the psilocybin sessions highly meaningful, if challenging, one reported a substantial decrease in well-being due to the experience. These preliminary data are amongst the first to suggest that psilocybin-assisted psychotherapy can produce psychiatric benefits in real-world patients akin to those observed in clinical trials. Limited enrollment and individual reports of negative experiences indicate the need for formal real-world evaluation programs to surveil the ongoing expansion of legal access to psychedelics.Item The Montreal model: An integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression(Frontiers, 2023-09-19) Garel, Nicolas; Drury, Jessica; Lévesque, Julien Thibault; Goyette, Nathalie; Lehmann, Alexandre; Looper, Karl; Erritzoe, David; Dames, Shannon; Turecki, Gustavo; Rej, Soham; Richard-Devantoy, Stephane; Greenway, Kyle T.This article presents the Montreal model, a comprehensive biopsychosocial approach to ketamine for severe TRD refined over 6 years in public healthcare settings. To contextualize its development, we review the evidence for ketamine as a biomedical and as a psychedelic treatment of depression, emphasizing each perspectives’ strengths, weaknesses, and distinct methods of utilization. We then describe the key clinical experiences and research findings that shaped the model’s various components, which are presented in detail.Item Safety and tolerability of intramuscular and sublingual ketamine for psychiatric treatment in the Roots To Thrive ketamine-assisted therapy program: A retrospective chart review(Sage, 2023-05-25) Tsang, Vivian W.L.; Tao, Brendan; Dames, Shannon; Walsh, Zach; Kryskow, PamThis study reports on adverse effects of intramuscular and sublingual ketamine dosing in a community group psychotherapy setting among 128 participants across four cohorts.Item Changes in cognitive control following a novel resilience-focused nursing educational program: An exploratory study(Quality Advancement in Nursing Education - Avancées en formation infirmière, 2022) Dames, Shannon; Young, Wendy; Krigolson, Olave; Zhang, Kelly; Stoller, Lincoln; Bartle, RobynPatient care is currently challenged by various factors including stress and nurse fatigue that can negatively impact nurses' health and patient safety. Emotional exhaustion and burnout among nurses are at an all-time high. Canadian nurses are reporting clinical rates of depression, anxiety, and panic at disproportionately higher rates than other public safety personnel. Innovative educational programs are desperately needed to mitigate stress and relieve distress, which will ultimately promote a healthier and more productive workforce. Little is known about the effectiveness of research informed cognitive control education within a community of practice (COP) to help nurses and nursing students process difficult experiences in order to thrive in stressful work environments. The purpose of this exploratory mixed methods study is to determine if a novel nursing educational program that was embedded in a COP framework leads to changes in cognitive control in a combined group of 16 nurses and nursing students. It included the delivery of 20 hours of community interaction over a 5-week period. Changes in cognitive control were evaluated through electroencephalographic (EEG) measurements before and after completing the course. Participants' perceived values and priorities for improvement were captured through a focus group. Data demonstrated an increase in cognitive control before and after the COP intervention. The focus group identified nine themes that centered on promoting connection, self-efficacy, non-attachment, accountability, and trauma-informed support, and culture change. Addressing emotional pain through structured relational practice and resilience development provides a larger context for understanding workplace stress, overload, and degraded function. Connecting these disparate stressors clarifies the supporting relationships between cognitive control, personal value, social identity, and spiritual purpose. Resilience development education within a COP improved cognitive control, promoted an alignment with personal values, buffered participants from workplace stress, and empowered them to carry their learnings as change agents in healthcare. The study was limited by a small sample size and a relatively homogeneous population. Further research is needed to examine the impact of evidence-informed and resilience-focused COP on patient care, safety, and costs.Item A cohort-based case report: The impact of ketamine-assisted therapy embedded in a community of practice framework for healthcare providers with PTSD and depression(Frontiers, 2022-01-12) Dames, Shannon; Kryskow, Pamela; Watler, CrosbieAmid an international pandemic and a worsening mental health crisis, ketamine-assisted therapy is emerging as a promising solution for those deemed “treatment resistant.” Post-traumatic stress disorder (PTSD) and depression are on the rise, with accelerating direct (e.g., burden of suffering) and indirect (e.g., disability/role impairment and impact on family) costs. Psychedelic-assisted therapies show significant promise in the treatment of a number of clinically challenging conditions, including depression, anxiety, PTSD, addiction, and end-of-life distress. Ketamine is currently the only safe, effective and legal widely available psychedelic-like medicine. To address the echo pandemic of health care provider distress, a multi-disciplinary team was charged with developing a ketamine-assisted psychotherapy program, delivered in a community of practice (CoP) group model and evaluated in a quality improvement framework. Program evaluation occurred through mixed methods. Quantitative mental health assessments included the PHQ-9 for depression, the PCL-5 for PTSD, GAD-7 for generalized anxiety disorder (GAD), and B-IPF for work/life functionality. Participant narrative feedback was collected to evaluate outcomes and for quality improvement purposes. Mean mental health scores were collected across three cohorts, totaling 94 patients. The mean aggregate scores of participants meeting the mental health assessment cut-off criteria (screening positive) were analyzed to assess clinical significance. Mean aggregate results comparing baseline vs. outcome measures (measured within 1–2 weeks after completion of the 12-week program) were clinically significant, demonstrating significant improvements in depression, post-traumatic stress disorder, generalized anxiety disorder and work/life functionality. In summary, 91% saw improvements in generalized anxiety, 79% saw improvements in depression, 86% of those who screened positive for PTSD now screen negative, and 92% had significant life/work functionality improvements. Qualitative feedback was overwhelmingly positive, with several unsolicited self-reports of transformation. Participant and team feedback enables the program to continue improving with each iteration. Results speak to the effectiveness of ketamine for psychedelic-assisted therapy, supported by a CoP framework. Outcomes are relevant for mental health programming, education and healthcare policy.