MonthMarch 2018

Reading of the Week: Is Lithium Underrated? Preventing Rehospitalization with Bipolar – the New JAMA Psychiatry Paper

From the Editor

From the perspective of the treatment team, a rehospitalization is a failure – a patient returning to the system, unwell again. From the perspective of the patient and her or his family, a rehospitalization can be frightening and humiliating.

How best to keep people with bipolar affective disorder out of hospital? In a new JAMA Psychiatry paper, the University of Eastern Finland’s Markku Lähteenvuo and his co-authors attempt to answer this question – not by using a RCT, but instead by tapping Finnish national databases.

For the record, they find one medication works better than the others: lithium.

800px-central_hospital_of_central_finlandFinland’s Central Hospital: adequate architecture but good data

In this Reading, we consider the new paper by Lähteenvuo et al., and also consider their approach.

DG

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Reading of the Week: Early Psychosis Intervention – Lifesaver? The New Anderson Paper from the AJP; Also, Michael Weinstein’s Burnout

From the Editor

The argument is simple: intervene early and outcomes will ultimately be better.

For people with psychosis, early intervention programs have been tried for more than two decades. In our first selection, we look at a new American Journal of Psychiatry paper considering early psychosis intervention and outcomes. This paper is particularly interesting because it draws on the real-world experience – and 17 years worth of data. (Bonus: the data is Canadian.) The lead author, Western University’s Prof. Kelly K. Anderson, looks at several outcomes.

She and her co-authors conclude that patients had faster access to psychiatrists and used EDs less. More importantly: early intervention was a lifesaver, with the rate of death being four times lower than those who didn’t use the program.

caa58b79-155d-451f-6734f0c9af79d4c2Does Franklin’s comment about an ounce of prevention being worth a pound of cure apply to first episode psychosis?

And in our other selection, Dr. Michael Weinstein writes about his career as a trauma surgeon – and his depression. “I have learned that many of us suffer in silence, fearing the stigma associated with mental illness,” he observes in The New England Journal of Medicine.

Please note that there will be no Readings for the next two weeks.

DG

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Reading of the Week: Do Antidepressants Work? The New Cipriani Study

From the Editor

Last week, I spoke to a patient about antidepressants. “But do they really work?” she asked. While antidepressants are commonly prescribed, many patients wonder about them. That’s not surprising: in popular culture, these medications are often portrayed as risky and unhelpful. Just a few weeks ago, the most popular women’s fitness magazine in the world described fawningly how a woman quit her medications and felt better (“I felt more alive and in control of my emotions with each passing day”). A few years ago, a major study suggested that antidepressants basically match placebo in efficacy; 60 Minutes covered it.

And now there is the new Cipriani et al. paper. “We found that all antidepressants included in the meta-analysis were more efficacious than placebo in adults with major depressive disorder…”

Is this the biggest psychiatry paper of the year? Certainly, it may be one of the most impressive. It took six years of effort. Oxford University’s Andrea Cipriani and his co-authors drew from all available data – published and unpublished, and covering more than 500 trials.

The media coverage has been incredible. The Guardian summarized the paper with the first two words of its article: “Antidepressants work.”

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In this Reading, we look at the big study and mull the big implications.

DG

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