MonthNovember 2018

Reading of the Week: Vulnerable Youth & ‘13 Reasons Why’ — the New Psych Services Paper; Also, Dr. Orford Considers his Brother’s Suicide in JAMA

From the Editor

It’s a hit show. Is it dangerous?

Since its launch, 13 Reasons Why has been highly controversial; the storyline of the Netflix series revolves around a teenager’s decision to suicide – which is graphically depicted over three minutes in one episode.

In this week’s Reading, we look at a new Psychiatric Services paper. University of Michigan’s Dr. Victor Hong and his co-authors consider the impact of the show on youth seeking psychiatric care for suicide-related risk. While other studies have analyzed the response in the larger community (including google searches), this study focuses on a vulnerable population. They find: “For certain youths, watching the series correlated with a perceived nonzero elevation in their suicide risk; identification with the main female character and strong affective reactions may be markers of increased risk associated with viewing the show.”

13-reasons-picBig buzz, big problem?

In the other selection, we look at a short essay recently published in JAMA. In “Grief After Suicide,” Dr. Orford discusses the suicide of his brother. The Deakin University intensivist notes that: “As a physician, I have cared for thousands of patients and families in the last hours and days of life. I have listened, watched, and learned.” The loss of his brother, however, continues to have a major effect on his life, three decades later.

DG

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Reading of the Week: Computers & Health Care – Dr. Gawande’s New Essay on “Why Doctors Hate Their Computers”

From the Editor

I’m running late – and I’m more than a bit concerned. I need to get to a meeting at the other campus, but first, I need to discharge a patient. That involves printing out a prescription and writing a short note. I’m in my fourteenth year of inpatient work, not counting residency, and I’m pretty good with prescriptions and notes. I believe I can do this. But does the EHR believe I can do this?

Many of us are frustrated with electronic health records (EHRs). In this week’s selection, we consider a new essay by Harvard University’s Atul Gawande, a surgeon, who considers EHRs and practice. Dr. Gawande talks about his own struggles with computers, and ties into the larger literature.

frustrateddocBig computer system, big problem?

We discuss his essay, and the potential and problems of EHRs. We touch on the Canadian experience and wonder about quality improvement. To that end, we look at “Getting Rid of Stuff,” just published in The New England Journal of Medicine.

DG

 

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Reading of the Week: Suicidal? Get a Postcard. The New JCP Paper on Suicide Prevention. Also, Ketamine & Inpatients

From the Editor

Can we do better at suicide prevention?

In recent years, several studies have tried brief contact interventions – that is, interventions aimed at maintaining a post-discharge connection – reporting success. These interventions have been relatively simple, such as handwritten postcards or phone calls for people post-attempt.

In this week’s selection, we look at a new paper from The Journal of Clinical Psychiatry. Involving 23 emergency departments and crisis centres in France, the authors pulled together different interventions, coming up with an algorithm offering patients care informed by the best evidence. So some patients received calls, but others were given crisis cards.

It’s an ambitious project. Did it work? The results weren’t statistically significant.

p1110389Postcards: colourful and pretty – and life-saving?

We consider this paper, the negative result, and ask: what does this say about suicide prevention? And then, looking at the evolving literature on suicide, we briefly consider a paper written by Sunnybook’s Mark Sinyor that uses IV ketamine for suicidal thoughts.

Please note: there will be no Reading next week.

DG
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Reading of the Week: Prevention Works – the New JAMA Psychiatry Paper on MIs & Mortality in Patients with Schizophrenia

From the Editor

Statistically, people with major mental illness have a life expectancy that is decades shorter than those without. Not only is that gap significant, but it may be growing. In a 2013 paper, drawing on Danish data, Nielsen et al. showed that the expansion of life expectancy seen in the general population over the past 30 years hasn’t been enjoyed by those with schizophrenia.

Why the gap? And what can be done? A major new paper in JAMA Psychiatry considers the treatment of myocardial infarction. Like Nielsen et al., Aalborg University’s Pirathiv Kugathasan and his co-authors use Danish national databases. They focus on the use (or lack of use) of cardioprotective medications, like statins, after MI. Interestingly, they find that when people with schizophrenia have cardioprotective medications, they can match the outcomes of those without mental illness.

Female doctor with the stethoscope holding heartIs heart health the way to address the gap?

In this week’s Reading, we consider the Kugathasan et al. paper, as well as the accompanying editorial. Then we consider the big question: what can be done?

DG

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