MonthDecember 2018

Reading of the Week: The Best of 2018

From the Editor

It’s an annual Reading of the Week tradition. At the end of each year, we pause, take stock, and consider the best selections of the past 12 months.

new-year-2018

2018 was an eventful year.

Start here: the federal government legalized the recreational use of cannabis.

We have heard so much about legalization over these past few years, that the event itself seemed almost anti-climactic. But remember: Canada is only the second country in the world to do this.

And 2018 has seen further evidence that stigma continues to fade: governments across the country have committed themselves to increased funding for mental health; more people spoke of their experiences with mental illness; more people talked about previously taboo topics, such as suicide.

And so with an eye on the future, let’s look back at the last year. In this final Reading of 2018, we look at a few memorable selections. Enjoy.

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

DG

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Reading of the Week: Smoking, Cognitive Performance, & Mental Illness: Quitting Matters – the New AJP Study

From the Editor

I don’t quite know when the shift occurred, but somewhere between the zeal of residency and the busyness of life as an attending physician, I stopped documenting nicotine use disorder. Indeed, working with severely ill patients, it was a given that they did smoke, and thus hardly worth mentioning. (Studies suggest that smoking is thrice as prevalent among those with schizophrenia compared to the general population.)

For many of our patients, tobacco use is a deadly problem – a major reason why people with severe, persistent mental illness have a life expectancy much shorter than ours.

This week, we consider a new paper from The American Journal of Psychiatry. The University of Academisch Medisch Centrum Universiteit van Amsterdam’s Dr. Jentien M. Vermeulen and her co-authors consider smoking in those with psychosis, their families and a control group, studying the impact on smoking on cognition – and also the impact of smoking cessation on cognition. Though work has been done in this area, the Vermenulen et al. paper is strong: they consider two comparison groups and follow people for six years. Spoiler alert: smoking cessation improved cognition in people with psychosis.

1304701062nosmokingButt out, think better?

In this Reading, we consider the paper, as well as the editorial by the University of Miami’s Philip D. Harvey, who raises some good points about what is – and isn’t – in the data.

We close the Reading with a couple of housekeeping items, including my new podcast (which may be of interest to Ontario doctors).

DG

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Reading of the Week: How to Improve Depression Treatment? Cuijpers in JAMA. Also, Kurdyak on Access & Goodman on Mental Health Screening for Docs

From the Editor

This week, we consider three provocative but thoughtful essays.

In the first selection, Vrije Universiteit Amsterdam’s Pim Cuijpers – a highly published researcher in depression – wonders what needs to be done to improve depression outcomes. In this JAMA paper, he notes the importance of the task: “One estimate suggests that approximately 30% of patients with depressive disorders have a chronic course with limited response to treatment.”

ketamine-a-miracle-drug-for-depression-or-not-rm-1440x810Is ketamine a possible breakthrough for depression? Cuijpers ask.

In the second selection, the University of Toronto’s Dr. Paul Kurdyak considers how to address the shortage of psychiatrists – and notes, in this healthydebate.ca essay, that the problem is more complicated than some would suggest; he argues that the supply of psychiatrists across Ontario has little impact on access because of practice styles.

Finally, in the third selection, Columbia University’s Matthew L. Goldman and his co-authors note that doctors are screened for TB. They ask: “Should physicians also be screened for mental health conditions such as depression or burnout?”

DG

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Reading of the Week: A 20th Century Medical Renaissance Man – the Life & Legacy of Dr. Roger Bland

From the Editor

Few individuals have contributed more to the evolution psychiatry, the promotion of mental health, or served as a more committed and effective advocate for the mentally ill than Dr. Roger C. Bland. He inspired us, he guided us, he mentored us and enriched us. He was a father figure to many – a voice of experience, compassion, reason and intelligence we could always count on.

Simply put, Dr. Bland was a great man.

Dr. Roger Bland had a storied career.

He was a practicing psychiatrist for decades. He also held many leadership and administrative positions over the years: Chair of the University of Alberta’s Department of Psychiatry, President of the Alberta Psychiatric Association, Vice-President International Federation of Psychiatric Epidemiology, Assistant Deputy Minister of Health for Alberta, and Deputy Editor of The Canadian Journal of Psychiatry. For his accomplishments, he was appointed to the Order of Canada. He also found time to be a father and grandfather. And he was an accomplished chef.

He passed at the end of July.

orderofcanadaDr. Roger Bland being invested in the Order of Canada

I had a few interactions with Dr. Bland. A couple of years ago, at the CPA Annual Conference, we started to talk about suicide prevention after a colleague’s presentation, and we ended up debating our interpretation of several papers. I remember breaking into a slight sweat as I realized that he had a near encyclopedic knowledge of the literature.

But if he could be tough in a discussion, he was an amazing collaborator. At the request of a younger colleague, I once asked Dr. Bland for input into a collaborative care project. He was generous of his time and very thoughtful. (Dr. Bland had been a founding member of the Canadian Collaborative Mental Health Initiative, which involved a dozen organizations; he testified before Parliament on the work of this Initiative.) Yet, he had no hesitation talking about how to structure a partnership with primary care and even how to think about our documentation – pro-tip: keep the notes short and focused; family doctors are busy.

In this Reading, we consider the life and contributions of Dr. Roger Bland.

I asked Dr. Scott Patten, the editor-in-chief of The Canadian Journal of Psychiatry, to write about him – his work and also what it was like to work with him. Dr. Patten also discusses some of Dr. Bland’s most important papers.

For those who wish to read more about Dr. Bland, I’ve included links to his Globe and Mail obituary. There is also a link to the University of Alberta Department of Psychiatry’s monthly newsletter where colleagues reflect on his life and legacy – the opening quotation is from Dr. Xin-Min Li, the Chair; and Dr. Bland gives an interview – his last – on his career (spoiler alert: his training included 10,000 home visits).

DG

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