Research Streams | Psychiatry | School of Medicine

The department has a wide range of research and clinical studies resources. Our research units have well-developed infrastructure to support our studies and well-trained staff that have many years of both clinical and research expertise. We strive to further the promotion and development of research activities and research excellence within the department.

We provide opportunities for research training and support to enable the development of research interests among faculty and residents.

Pen on the word research

Department of Psychiatry Research Streams

Anxiety Disorders and Obsessive Compulsive Disorders

Research Champion

Rafael Freire
Associate Professor
Email: rafael.freire@queensu.ca

This research stream focuses on neurobiology, biomarkers, neurostimulation, and psychopharmacology in anxiety disorders and obsessive-compulsive disorders.

Key researchers in this stream

Elisa Brietzke
Professor, Department of Psychiatry, Queen’s University
elisa.brietzke@queensu.ca

Claudio Soares
Professor, Department of Psychiatry, Queen’s University
c.soares@queensu.ca

Current research projects

Trigeminal nerve stimulation in treatment-resistant generalized anxiety disorder: a feasibility study
PI: Rafael Freire
Co-investigators: Elisa Brietzke and Claudio Soares

A Randomized, Double-Blind, Placebo-Controlled Trial of Adjunctive Troriluzole in Obsessive Compulsive Disorder
PI: Rafael Freire
Co-investigators: Elisa Brietzke and Claudio Soares

Adjunctive Treatment with L-methylfolate for Treatment-Resistant Generalized Anxiety Disorder: a Pilot Study
PI: Rafael Freire
Co-investigators: Elisa Brietzke and Claudio Soares

Publication list (last 5 years):

1. Al-Mahrouqi T, Al Alawi M, Freire RC. (2023) Dexmedetomidine in the Treatment of Depression: An Up-to-date Narrative Review. Clin Pract Epidemiol Ment Health.; 19:e174501792307240. doi: 10.2174/17450179-v19-230823-2023-4.

2. Freire RCR, Nardi AE. (2023) Is it possible to prevent relapse in panic disorder? Expert Rev Neurother.; 23(8):677-679. doi: 10.1080/14737175.2023.2229955. Epub 2023 Jun 26.

3. Brietzke E, Gomes FA, Gerchman F, Freire RCR. (2023) Should systematic reviews and meta-analysis include data from preprints? Trends Psychiatry Psychother.;45:1-2. doi: 10.47626/2237-6089-2021-0324. Epub 2021 Sep 8.

4. Faria CGF, de Matos UMA, Llado-Medina L, Pereira-Sanchez V, Freire R, Nardi AE. (2022) Understanding and addressing COVID-19 vaccine hesitancy in low and middle income countries and in people with severe mental illness: Overview and recommendations for Latin America and the Caribbean. Front Psychiatry.;13:910410. doi: 10.3389/fpsyt.2022.910410.

5. Garakani A, Freire RC, Buono FD, Thom RP, Larkin K, Funaro MC, Salehi M, Perez-Rodriguez MM. (2022) An umbrella review on the use of antipsychotics in anxiety disorders: A registered report protocol. PLoS One, Vol. 17(6):e0269772

6. Ferreira-Garcia R, Costa MA, Gonçalves FG, de Nonohay RG, Nardi AE, Freire RCDR, Manfro GG. (2021) Heart rate variability: A biomarker of selective response to mindfulness-based treatment versus fluoxetine in generalized anxiety disorder. J Affect Disord.;295:1087-1092. doi: 10.1016/j.jad.2021.08.121. Epub 2021 Sep 2.

7. Kyriakoulis P, Kyrios M, Nardi AE, Freire RC, Schier M. (2021) The Implications of the Diving Response in Reducing Panic Symptoms. Front Psychiatry.;12:784884. doi: 10.3389/fpsyt.2021.784884.

8. Garakani, A.; Freire, R. C.; Murrough, J. W. (2021). Pharmacotherapy of Anxiety Disorders: Promises and Pitfalls. Front Psychiatry, 12: 662963.

9. Freire, R. C. and V. A. Santos (2021). Features shared between fear of missing out on rewarding experiences (FOMO) and internet gaming disorder. Braz J Psychiatry, 43 (2): 129-130.

10. Zugliani, M.M., Fidry, M., Steffen, R., Lan, C., Brietzke, E., Milev, R., Nardi, A.E. and Freire, R.C. (2021). Clinical effectiveness of non-TMS neurostimulation in depression: Clinical trials from 2010 to 2020. Progress in Neuro-Psychopharmacology and Biological Psychiatry:110:110287. doi: 10.1016/j.pnpbp.2021.110287. Epub 2021 Feb 19.

11. Javelot, H., Weiner, L., Hingray, C., Freire, R. C., Nardi, A. E. (2020). COVID-19 and its psychological consequences: Beware of the respiratory subtype of panic disorder. Respir Physiol Neurobiol 282: 103530.

12. Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., Iosifescu, D. V. (2020). Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Front Psychiatry 11: 595584.

13. Faria, C. G. F., Fidry, M., do Cabo, M. C., Quagliato, L. A., Nardi, A. E., Zaman, R., Freire, R. (2020). A Brazilian Case of Treatment-Resistant Generalized Anxiety Disorder Successfully Treated with Monoamine Oxidase Inhibitor (MAOI). Psychiatr Danub 32(Suppl 1): 139-141.

14. Brietzke E, Magee T, Freire RCR, Gomes FA, Milev R. Three insights on psychoneuroimmunology of mood disorders to be taken from the covid-19 pandemic. Brain Behav Immun Health. 2020:100076.

15. Okuro RT, Freire RC, Zin WA, Quagliato LA, Nardi AE. Panic disorder respiratory subtype: psychopathology and challenge tests - an update. Braz J Psychiatry. 2020.

16. Freire RC, Ferreira-Garcia R, Cabo MC, Martins RM, Nardi AE. Panic attack provocation in panic disorder patients with a computer simulation. J Affect Disord. 2020;264:498-505.

17. Carta MG, Moro MF, Piras M, Ledda V, Prina E, Stocchino S, Orrù G, Romano F, Brasesco MV, Freire RC, Nardi AE, Tondo L (2020). Megacities, migration and an evolutionary approach to bipolar disorder: a study of Sardinian immigrants in Latin America. Braz J Psychiatry 42(1): 63-67.

18. Ferreira-Garcia, R., Faria, C. G. F., Nardi, A. E., Freire, R. C. D. (2019). Negative Affect Mediates Impulsivity in Generalized Anxiety Disorder. Psychopathology 52(6): 327-333.

19. Nardi AE, Freire RC, Kahn JP. The Master of Psychopharmacology: an inspiration for future generations - Donald F. Klein (1928-2019). Braz J Psychiat. 2019;41(6):465-6.

20. Fidry M, Zugliani MM, do Valle CR, Martins RM, do Cabo MC, Nardi AE, et al. Quality of life in panic disorder: the influence of clinical features and personality traits. Trends Psychiatr Psychother. 2019;41(4):387-93.

21. Santos VA, Hoirisch-Clapauch S, Nardi AE, Freire RC. Panic Disorder and Chronic Caffeine Use: A Case-control Study. Clin Pract Epidemiol Ment Health. 2019;15:120-5.

22. Balon R, Silberman EK, Starcevic V, Cosci F, Freire RC, Nardi AE, Rickels K, Shader R. Benzodiazepines, antidepressants and addiction: A plea for conceptual rigor and consistency. J Psychopharmacol. 2019 Nov;33(11):1467-1470. doi: 10.1177/0269881119878171.

23. Quagliato LA, Cosci F, Shader RI, Silberman EK, Starcevic V, Balon R, Dubovsky SL, Salzman C, Krystal JH, Weintraub SJ, Freire RC, Nardi AE; International Task Force on Benzodiazepines. Selective serotonin reuptake inhibitors and benzodiazepines in panic disorder: A meta-analysis of common side effects in acute treatment. J Psychopharmacol. 2019 Nov;33(11):1340-1351. doi: 10.1177/0269881119859372.

24. Quagliato LA, Freire RC, Nardi AE. Elevated peripheral kynurenine/tryptophan ratio predicts poor short-term auditory memory in panic disorder patients. J Psychiatr Res 113:159-164, 2019. doi: 10.1016/j.jpsychires.2019.03.027.

25. Zugliani MM, Cabo MC, Nardi AE, Perna G, Freire RC. Pharmacological and Neuromodulatory Treatments for Panic Disorder: Clinical Trials from 2010 to 2018. Psychiatry Investig 16(1):50-58, 2019. doi: 10.30773/pi.2018.12.21.1.

Research grants (internal and external)

Name of awarding organisation: Faculty of Health Sciences, Queen’s University
Amount in $CAN: 30,000
Duration of funding: 2 years

Name of awarding organisation: Biohaven Pharmaceuticals Inc.
Amount in $CAN: up to 243,000 (deliverable-based invoicing)
Duration of funding: open-ended

Name of awarding organisation: Department of Psychiatry, Queen’s University
Amount in $CAN: 10,000
Duration of funding: 1 year

Current students

Undergraduate: Hiroki Yasui – Queen’s University
MSc: Mariana Cabo – Federal University of Rio de Janeiro (co-supervision)
PhD: Morená Zugliani – Federal University of Rio de Janeiro (co-supervision)

Other information

Link to Queen's University Anxiety Research Lab (QAnxiety) - https://qanxiety.ca/

ResearchGate profile: https://www.researchgate.net/profile/Rafael_Freire

Web of Science profile: https://www.webofscience.com/wos/author/record/872338

Scopus: https://www.scopus.com/authid/detail.uri?authorId=34067584800

ORCID: https://orcid.org/0000-0003-3875-4601

Google Scholar: ‪Rafael C R Freire - ‪Google Scholar

Digital Mental Health

Online Psychotherapy Lab

Online Psychotherapy Lab aims to improve the lives of all those affected by mental health disorders through the advancement in mental health research. Primarily located at Queen's University, Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, ON.

In our online Psychotherapy Lab, we design, different online psychotherapy modules and courses for various mental illnesses including Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), Obsessive Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), Borderline Personality Disorder and substance use disorder.

Through online psychotherapy more service at lower cost could be delivered which could potentially double the performance of the healthcare system. This change in wait time and increased coverage could lead to significant financial and societal cost savings, given the debilitating impact of mental health disorders on individuals’ functioning while waiting for proper care. Diagnosis based care delivery through an online clinic provides a new approach to address the barriers of receiving therapy in the multi-cultural and geographically dispersed society.

Check out the QUOPL website for more information here.

The QUOPL is led by Dr. Nazanin Alavi, Psychiatrist and Assistant Professor.

Forensic Mental Health

Research Champion

Dr. Najat Khalifa, MD, MBChB, FRCPsych, FRCPC
Professor of Psychiatry

Key Researchers

Dr. Andrew Bickle, MBChB, BMedSc, DipMedSc(Dist), LLM(Dist), FRCPsych, FRCPC
Assistant Professor in Forensic Psychiatry
https://psychiatry.queensu.ca/directory/faculty-gft/andrew-bickle

Dr. Rebecca Douglas, Honours BA, PhD, C.Psych
Assistant Professor
https://psychiatry.queensu.ca/directory/faculty-adjunct-1/rebecca-douglas

Dr. Tariq Hassan, MBBS, FRCPsych, FRCPC Psychiatry, FRCPC Forensic
Associate Professor in Forensic Psychiatry
https://psychiatry.queensu.ca/directory/faculty-gft/tariq-hassan

Dr. Zoe Selhi, MD, MA, FRCPC
Assistant Professor
https://psychiatry.queensu.ca/directory/faculty-gft/zoe-selhi

Dr. Christine Rose
Assistant Professor

Recent Research Projects

Non-Invasive Brain Stimulation (NIBS)

The use of combined cognitive training and Anodal Transcranial Direct Current Stimulation (tDCS) to modulate risky decision-making: A double blind Randomized Controlled Trial (PI: Dr. Najat Khalifa with collaborators from Queen’s University).
The use of Anodal Transcranial Direct Current Stimulation (tDCS) to reduce impulsivity and aggression in people with mild intellectual developmental disabilities: A Randomized Controlled Trial (PI: Dr. Najat Khalifa with collaborators from Queen’s University).
The use of non-invasive brain stimulation techniques in people with intellectual developmental disabilities: a systematic review and meta-analysis (PI: Dr. Andrew Bickle with collaborators from Queen’s University).
The use of transcranial Direct Current Stimulation to reduce body weight and food cravings (Dr. Khalifa with collaborators from the University of Nottingham, UK).
The use of co-design in developing cognitive health-related interventions with community-dwelling older adults: a scoping review protocol (Dr. J. C. Rose)

Terrorism and Mental Health

Risk factors for terrorism: an examination of family, childhood and personality risk factors among Iraqi terrorists, murderers and (Dr. Khalifa with collaborators from the George Washington University, USA).
Pathways to terrorism: The role of childhood factors, personality, and ideology (Dr. Khalifa with collaborators from the George Washington University, USA).
Classifying terrorism: A latent class analysis of primary source socio-political and psychological data (Dr. Khalifa with collaborators from the George Washington University, USA).
Distinguishing lone from group actor terrorists: A comparison of attitudes, ideologies, motivations, and risk factors (Dr. Khalifa with collaborators from the George Washington University, USA).
The psychiatric aspects of terrorism: Prevention and rehabilitation (Dr. Hassan and Dr. Khalifa with collaborators from Queen’s University).
Terrorism Typologies and implications for clinical practice in psychiatry (Dr. Khalifa and Dr. Hassan with collaborators from Queen’s University).
Psychiatric assessment of terror subjects and those at risk of engaging in acts of terrorism (Dr. Khalifa and Dr. Hassan with collaborators from Queen’s University).

Forensic Mental Health

Patient characteristics, outcome measurement and predictors of treatment completion in a community justice and mental health (At-Risk) program in Kingston (PI: Dr. Tariq Hassan with collaborators from Queen’s University).
Traumatic Brain Injury in Criminal Justice Systems: A Systematic Literature Review (PI: Dr. Andrew Bickle with collaborators from Queen’s University).

Program Development/Evaluation

Grading Risk of Inpatient Threat (GRIT)
GRIT is an assessment, communication, and risk management system for the imminent (within 24 hours) risk of inpatient violence. It has been designed for use on the Forensic Services Inpatient Unit at Providence Care, based on current research on imminent risk for violence, practices at other forensic facilities, and current legislative requirements. GRIT will shortly be pilot tested on Forensic Services; an adapted version of the GRIT system will later be implemented on other inpatient units at Providence Care Mental Health Services. The GRIT system will be formally evaluated for effectiveness in reduction of inpatient violence. In addition, data from the project may be combined with data from similar implementations at other forensic sites, as part of a larger scale multi-site research project.

Project Lead/Primary Investigator: Dr. Rebecca Douglas
Collaborators: Kim Knight, RN; Dr. Tariq Hassan

SAFEWARDS implemented on forensic units to improve inpatient safety
The model of care in the Forensic Inpatient Service at Providence Care Hospital incorporates the key components of the Safewards Model, namely originating domains, flashpoints, conflict, and containment. Originating domains are those six broad aspects that affect a patient’s well-being: patient community, patient characteristics, the regulatory framework, the staff team, the physical environment, and external factors (e.g., visitors). The flashpoints are social situations, behaviours, or ways of thinking arising from those originating domains that can trigger a conflict. Conflict is defined as any action or behaviour that can threaten the safety of a patient and those around them. Containment entails actions that staff must take in order to eliminate or reduce conflict.

Sources of Research Funding

Department of Psychiatry

Recent Publications

Medical Education Scholarship and Research

This research stream focuses on research and scholarship in medical education.

Research Champion:

Dr. Maria Hussain, MD FRCPC (Psychiatry and Geriatric Psychiatry)
Associate Professor, Department of Psychiatry, Queen’s University
Contact: mh144@queensu.ca

Grants, Projects, and Publications:

1. Leveraging Simulation to Increase Competence in Assessment of Capacity in Psychiatry and Geriatric Psychiatry Training. PI: Hussain M; Co-Is: Andrew M, Kirkham, J, Nemiroff L, O'Brien S, St. Denis E, Braund H.
Funded by the SEAMO Endowed Scholarship and Education Fund

2. Operationalizing subspecialty training in the Competence by Design model: A case study of lived experiences PI: Hussain, M, Co-Is: Andrew M; Dejong P; Marcotte L; Delgarno N; Braund H.
Funded by the SEAMO Endowed Scholarship and Education Fund

3. A Realist, Multi-Site Comparison of Competence Committee Implementation Practices. Acai A, Hanmore T, Andrew M, Askari S, Hussain M, Sonnadara R, Trier J. A Realist, Multi-Site Comparison of Competence Committee Implementation Practices.

4. Early lessons in operationalizing Competence Committees: A conceptual framework for decision-making. PI: Trier, J; Co-Is: Hanmore T, Dare J, Andrew M, Askari S, Hussain, M.
Funded by the SEAMO Endowed Scholarship and Education Fund

5. Refining Entrustable Professional Activities in Geriatric Psychiatry Subspecialty Training. PI: Melissa Andrew; Co-Is: Hussain M, Egan R
Funded by the Department of Psychiatry

6. Developing an Entrustable Professional Activity for the Evaluation of a Geriatric Psychiatry Subspecialty Resident’s Ability to Perform a Capacity Assessment. PI: St. Denis E, Co-Is Andrew M, Hussain M

Resident Projects in Medical Education Research:

1. Exploring advantages and pitfalls of implementing CBME in geriatric psychiatry. Huynh, D. (geriatric psychiatry resident); supervisor Hussain M.

2. Teaching the skill of effective handover to Psychiatry residents during transitions in care for older adults. Nimrit Bath (geriatric psychiatry resident); supervisor Hussain M.
Funding from the Department of Psychiatry

3. Using simulation to teach assessments of capacity to psychiatry residents. Jonathan Pipitone (psychiatry resident); supervisor Hussain M.

4. Use of large language models in psychiatry residency education. Thusanth Jogarajah, (psychiatry resident); supervisor Hussain M.

Key Researchers:

Dr. Melissa Andrew

Mood Disorders

Research Champion

Professor Gustavo Vazquez
Email g.vazquez@queensu.ca

Most significant Research Projects in the last five years (2018-2023) *

Principal Investigator. Research Initiation Grant (Queen’s University RIG) – Treatment-resistant bipolar depression: A randomized controlled trial of electroconvulsive therapy (ECT) versus intermittent theta burst transcranial magnetic stimulation (iTBS). CAD 30,000.

Principal Investigator. PCH Research Innovation Grant (Providence Care Hospital) - Low dose Ketamine infusion for the treatment of refractory depression in patients with unipolar and bipolar disorders. CAD 23,000

Principal Investigator. Queen’s University, Department of Psychiatry, Internal Grant. Intranasal Esketamine versus Intravenous Ketamine: An observational pilot study assessing efficacy and tolerability of two novel 'standard of care' treatments for treatment resistant depression in naturalistic clinical practice. CAD 29,200

Principal Investigator. Kingston Health Sciences Center, Women Giving Circle Grant. Low dose IV ketamine treatment for the management of severe depression and suicidal ideation in adolescents, a randomized pilot study. CAD 37,000

Co- Principal Investigator. PCH Research Innovation Grant (Providence Care Hospital) – Delivering Electronic Cognitive Behavioural Therapy to Patients with Bipolar Disorder and Residual Depressive Symptoms. CAD 53,000

Co-Investigator in the study “The longitudinal course of Intracortical Myelination and Cognitive Function in Bipolar Disorder” initiated in the Canadian Institutes of Health Research (CIHR); Neuroscience, Mental Health and Addiction. CAD 1,200,000

Co-Investigator in the study “Biomarkers of Treatment Response in Bipolar Depression: A CANBIND Study” initiated in the Canadian Institutes of Health Research (CIHR); Neuroscience, Mental Health and Addiction. CAD 2,300,000

Co-Investigator in the study “Functional Improvement and Recurrence Risk after First Episode Depression: Independent and Interactive Roles of Premorbid Factors, Cognition, Reward and Stress” initiated in the Canadian Institutes of Health Research (CIHR); Neuroscience, Mental Health and Addiction. CAD 950,000

Co-Investigator in the study “Predicting Trajectories in Bipolar Disorder: A Multiscale Prospective Longitudinal Study” initiated in the Canadian Institutes of Health Research (CIHR); Neuroscience, Mental Health and Addiction. CAD 1,200,000

Co-Investigator in the study “Efficacy of Ketamine on Depression in Comparison to Electroconvulsive Shock Treatment” initiated in the Canadian Biomarker Integration Network in Depression (CAN-BIND) and Ontario Brain Institute (OBI). CAD 850,000

Co-Investigator in the study “Demographic and Clinical Profile of Patients Receiving Electroconvulsive therapy (ECT)” funded by and initiated in the Department of Psychiatry, Queen’s University. CAD 10,000

Co-Investigator in the study “Effect of sleep disorder treatment on sleep quality, cognitive function and quality of life in older patients with mood disorders” funded by and initiated in the Department of Psychiatry, Queen’s University. CAD 20,000

Co-Investigator in the study “Repetitive Transcranial Magnetic Stimulation: A ten-year retrospective study examining the effects of maintenance treatment for mood disorders” funded by and initiated in the Department of Psychiatry, Queen’s University. CAD 10,000

Co-Investigator in the study “Cannabidiol Adjunctive Therapy for Acute Bipolar Depression: A Randomized Double-Blind Placebo Controlled Trial” initiated in the Canadian Institutes of Health Research (CIHR); Neuroscience, Mental Health and Addiction. CAD 2,400,000

Co-Investigator in the study “Combined Low Dose Intravenous Ketamine and electronic Cognitive Behavioral Therapy (eCBT) Treatment for Post-Traumatic Stress Disorder (PTSD)” funded by and initiated in the Providence Care Hospital, Queen’s University. CAD 54,000

Principal Investigator. Queen’s University, Department of Psychiatry, Internal Grant. Cognitive performance changes and potential side effects associated with maintenance IV ketamine treatment in patients with MDD-TRD, an observational pilot study of naturalistic clinical practice. CAD 20,000

Co-Principal Investigator. Characterization of treatment-resistant depression and exploration of experimental ketamine treatment on clinical and behavioural outcomes. CAD 20,000
Sub-Investigator. CAN-BIND-17 Optimized Predictive Treatment In Medications for Unipolar Major Depression (OPTIMUM-D). CAD 1,495,575

* Pharmaceutical companies funded trials excluded

Current students (PhD Candidates)

Aleks Biorac, Dr. Carolina Hernandorena, Dr. Christian Avila, Dr. Micaela Dines

Research Champion

Roumen V Milev, MD PhD FRCPsych FRCPC DFCPA DFAPA

Professor of Psychiatry and Psychology, Queen's University, Providence Care, Kingston, On, Canada

roumen.milev@queensu.ca

Google scholar: https://scholar.google.ca/citations?hl=en&user=AJqiHW8AAAAJ&view_op=list_works&sortby=pubdate

Pubmed: https://www.ncbi.nlm.nih.gov/myncbi/1peNF5gyZ0pk5/bibliography/public/

Milev's Mood Disorder Research Team

Student Mental Health

Research Champion

Professor Anne Duffy, MSc, MD, FRCPC
Professor of Psychiatry, Director U-Flourish Collaborative Research Centre, Visiting Professor, University of Oxford, Department of Psychiatry

Key researchers and current projects in this stream:

https://www.queensu.ca/u-flourish/

Research grants (internal and external)

U-Flourish Research is funded by competitive grants from the Canadian Institutes of Health Research, Mach-Gaensslen Foundation, Rossy Family Foundation and the McCall MacBain Foundation. U-Flourish Research has been adapted and implemented at 5 UK universities with a competitive grant from the Medical Research Council MRC-UKRI under the banner of Nurture-U (https://www.nurtureuniversity.co.uk/ )

U-Flourish Publications