MonthMay 2018

Reading of the Week: Can Computerized CBT Help People with Substance Problems? The New AJP Paper. Also, How Many People Really Have Mental Illness?

From the Editor

More than ever, we are talking about substance use problems. But as with other mental health services, people struggle to get care, particularly evidence-based therapies.

In the first selection, we consider a new paper from The American Journal of Psychiatry, published last week. Yale University’s Brian Kiluk and his co-authors compare traditional CBT (done with a therapist and in-person) with a computer-based therapy program, CBT4CBT. They conclude: “This computerized version of CBT thus appears to be an engaging and attractive approach for persons with substance use disorders.”

typingTyping to Treat Substance Use?

In the second selection, we consider an essay by The Globe and Mail’s André Picard who asks a simple question: How many people actually suffer from mental illness? Picard cautions us on “pathologizing normal emotions.”

DG

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Reading of the Week: Involuntary Psychiatric Admissions – More Common, But Why? Also, the Failure of AI

From the Editor

Some patients are so ill that we take away their basic rights and freedoms, admitting them involuntarily to hospital. But how common is the practice?

In the first selection, we consider a new paper by Michael Lebenbaum et al. that looks at involuntary admissions from 2009 to 2013. They find the percentage is not only high (by international standards) but that it has soared in recent years – from 70.7% in 2009 to 77.1% in 2013.

Hand holding key (with key hole)

We consider a recent essay on AI in the second selection. Google has made international headlines with its program, Duplex, that can call and book appointments. In this piece, the authors note that AI has failed to live up to its potential. “Schedule hair salon appointments? The dream of artificial intelligence was supposed to be grander than this…”

DG

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Reading of the Week: Mukherjee on Why Checklists Save Lives – Except When They Don’t

From the Editor

“How could an idea that worked so effectively in so many situations fail to work in this one? The most likely answer is the simplest: Human behavior changed, but it didn’t change enough.”

Readings of the Week generally focus on psychiatric topics. But here’s a task for all of us in health care: improving the quality of care. This week, we look at a new essay written by oncologist Siddhartha Mukherjee, the Pulitzer Prize-winning writer. In it, he talks about the success of using checklists in reducing complications in some places – but not in others. The above quotation comes from this provocative essay.

checklist-850x476 Checklists: Shown to save lives, except when they don’t

Why do checklists work some of the time? In this Reading, we consider the essay, and the larger questions it raises.

DG

 

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Reading of the Week: MDMA for PTSD – the New Lancet Psychiatry Paper; Is the Club Drug Really a Breakthrough Drug?

From the Editor

“When it kicked in, it was like an epiphany. I could see all these things from combat I was afraid to look at before, and I had a totally new perspective. I relived the parts of me I had lost. I realized I had viewed myself as a monster, and I was able to start to have some compassion for myself. It was a turning point, and for the next year I continued to get better.”

In a recent article on MDMA (often called Molly or Ecstasy), The New York Times quotes U.S. Marine Nigel McCourry, who has PTSD, talking about his experience taking the drug. So – is there a role for MDMA in the treatment of PTSD? In a new paper published in The Lancet Psychiatry, researchers seem to find there is. In the study, therapy sessions were enhanced with MDMA; after the sessions, 68% of the patients no longer met the clinical criteria for PTSD.

The paper has gained international attention. The New York Times covered it (and quoted McCourry). So did Global News with an online article headlined: “‘Party drug’ MDMA touted as breakthrough therapy for PTSD patients.” The Independent’s story begins: “MDMA ‘cures’ sufferers’ post-traumatic stress disorder in a few weeks during study.”

mdma-pills-ecstasy-600x500MDMA: Colourful pills – helpful pills?

In this Reading, we consider the paper behind the headlines, and the Comment piece that accompanies it. We also consider what to tell patients if they ask about MDMA for PTSD.

DG

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Reading of the Week: Depression and Its Management — The American Journal of Psychiatry on Exercise and Long-term Use of Medication

From the Editor

It’s one of the most common and disabling illnesses. But how to treat depression in the long term?

In the first selection, we consider a paper just published by The American Journal of Psychiatry. In it, LaSalle University’s Felipe B. Schuch and his co-authors present a meta-analysis on exercise and depression. Drawing on 49 studies, they find that physical activity can protect against the development of depression, regardless of age and geographical region.

treat-alternative-exercise_an_alternative_adhd_treatment-article-3280a-man_running_sunset-ts_451886305-3Exercise: good for the heart, the lungs, and the prevention of depression?

In the second selection, Harvard University’s Roy H. Perlis writes a commentary for The American Journal of Psychiatry responding to a recent New York Times article that questioned the long-term use of antidepressants. He writes: “The informative analogy might be treatment of type 2 diabetes. While diet and exercise have a substantial impact on disease course (notably, results far more compelling than those in depression), it is hard to envision front-page articles in the New York Times about the dangers of long-term diabetes treatment.”

DG

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