MonthNovember 2015

Reading of the Week: Can We Prevent Depression For Those At Risk?

Depression is the leading cause of disability worldwide and commonly begins in adolescence. Prevention is one viable strategy for reducing the population burden of depression because most depressed adolescents do not receive specialty mental health treatment and because untreated depression is associated with enduring deleterious effects on interpersonal relationships, educational attainment, and occupational status.

Single-site studies have demonstrated the efficacy of an adaptation of the Coping with Depression for Adolescents intervention in preventing the onset of depression relative to usual care in adolescents with subsyndromal depressive symptoms and in those with a parental history of depression. These results were replicated in our 4-site randomized clinical trial of 316 high-risk adolescents randomly assigned to either an adaptation of the Coping with Depression for Adolescents (cognitive-behavioral prevention [CBP]) plus usual care or usual care alone, which found a lower incidence of depressive episodes at 9 and 33 months after enrollment in those who received CBP.

So begins a new paper that seeks a lofty goal: using a psychological intervention to prevent depression before it starts.

This week’s Reading: “Effect of a Cognitive-Behavioral Prevention Program on Depression 6 Years After Implementation Among At-Risk Adolescents: A Randomized Clinical Trial” by Dr. David A. Brent et al., which was published in the November JAMA Psychiatry.

In this paper, Brent et al. attempt something we often dream about in psychiatry – but are so rarely able to achieve: prevention. That alone would make this paper worth considering. But there’s more: the study features an incredible follow up period (a full six years) and a consideration of the parent, not just the at-risk adolescent. Pulling it together: this is a big paper in a big journal with a big result.

Dr. David Brent

So, can we take an at risk population and, with therapy, prevent them from developing a major mental illness? This is what the study authors seek to find out. As they note early in the paper: “We hypothesized that those who received CBP would have a lower hazard of depression onsets and better developmental competence during emerging adulthood.” Continue reading

Reading of the Week: Mindless Psychiatry?

Recently, a psychiatric study on first episodes of psychosis made front-page news. People seemed quite surprised by the finding: that treatment programs that emphasized lower doses of psychotropic drugs, along with individual psychotherapy, family education and a focus on social adaptation, resulted in decreased symptoms and increased wellness.

So begins a thoughtful essay considering the state of psychiatry.

This week’s Reading: “Psychiatry’s Mind-Brian Problem” by Dr. George Makari, which was published recently in The New York Times.

You can find the article here:

http://www.nytimes.com/2015/11/11/opinion/psychiatrys-mind-brain-problem.html?src=me

In this short essay, Dr. Makari, a professor of psychiatry at Weill Cornell Medical College, opens by contemplating the new American Journal of Psychiatry paper by Dr. John M. Kane et al., which shows that first-episode psychosis patients treated with more than just medications – individual psychotherapy and family education and a focus on social adaptation in the study – did better than those treated with just meds.

The real surprise… was that this was considered so surprising.

Continue reading

Reading of the Week: Psychiatry’s Dirty Little Secret?

Stigma has repeatedly been identified as a major barrier to help seeking for mental health problems across various disorders and across the lifespan. Stigma is also an obstacle to community reintegration and rehabilitation in people suffering from severe mental illness. Moreover, people with psychiatric diagnoses suffer the effects of discrimination in health care settings. Not only do people with mental illness have diminished access to primary care, there is evidence to suggest that physicians perform fewer physical examinations and laboratory investigations, provide less preventive health care, and undertake fewer therapeutic interventions in this population. Researchers are increasingly framing the problem of stigma as a public health issue.

So begins a new paper that considers stigma and mental health.

This week’s Reading: “Explicit and Implicit Attitudes of Canadian Psychiatrists Toward People With Mental Illness” by Dr. Layla Dabby et al., which was just published in The Canadian Journal of Psychiatry.

This paper shows that members of the public demonstrated relatively negative explicit attitudes towards mental illness. In fact, Canadians reported a desire for greater social distance from the patient with schizophrenia as opposed to the patient with diabetes, even though the study describes the patient with schizophrenia as well-controlled by medication. Wow.

Except here’s the twist in the tale. The paper actually didn’t look at the public. The paper looked at psychiatrists and residents of psychiatry. In other words, the relatively negative explicit attitude wasn’t from the uninformed small businessman in Edmonton or the teacher in Halifax; it reflects the biases of people like… me.

Is this psychiatry’s dirty little secret? Continue reading

Reading of the Week: Ending Revolving Door Justice?

More than 10 million people are currently in prison worldwide, and substantially larger numbers of ex-prisoners are living in society. Despite reported decreases in violence in many countries, repeat offending remains high across many high-income and middle-income countries. In the USA and UK, more than a third of released prisoners are reconvicted for a new crime within 2 years, and more than half within 5 years. Furthermore, about 70% of those convicted in the USA are repeat offenders. In England and Wales, this figure is estimated at 90%, and the proportion of individuals convicted who have had 15 or more previous offences has been increasing since 2008.

So begins a new paper that considers Swedish prisoners and the likelihood of reoffending with a particular focus on those with mental disorders. This opening paragraph well describes our incredible success at crime reduction – historical lows across the west – and our incredible failure – those who do end up in jail often are convicted again (and again and again).

This week’s Reading: “Psychiatric disorders and violent reoffending: a national cohort study of convicted prisoners in Sweden” by Zheng Chang et al., which was just published in The Lancet Psychiatry.

Zheng Chang

This paper may not seem immediately relevant – it draws on European data and was published in a British journal. In fact, it is. First, Canada’s prison population has a high rate of mental illness (an International Journal of Law and Psychiatry study found that a third of people entering Canadian penitentiaries met criteria for mental illness.). Second, there is growing interest in prisoners and mental health, both in Ottawa and beyond. Chang et al. helps shed light on this important issue – and perhaps even points the way to more sensible public policy. Continue reading