AuthorDavid Gratzer

Reading of the Week: How to Change Docs? Send Them a Letter. The New JAMA Psychiatry Paper on Prescribing

From the Editor

How do we get doctors to practice better medicine?

Here’s a simple idea: what if we send them a sternly written letter? In this week’s Reading, we consider a paper by Columbia University’s Adam Sacarny and his co-authors who did just that. Targeting primary care physicians who were heavily prescribing quetiapine (or Seroquel), they looked at the effects of letters written by government officials, comparing prescribing habits of these physicians with their peers. The result? In the new JAMA Psychiatry paper, they find that prescriptions of quetiapine dropped markedly.

nudge

A little nudge, better care?

The core of the idea is that a nudge – that is, the behavioural economic idea of a positive reinforcement and/or an indirect suggestion – can change outcomes. In this Reading, we consider doctors and nudges (and behavioural economics). We also look at a recent study on opioid prescribing, also involving letters.

DG

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Reading of the Week: Physician Burnout and Depression – and Patient Safety. New Papers from the AJP and JAMA Internal Medicine

From the Editor

Not so many years ago, no one seemed to discuss physician burnout.

Today, we speak much more about physician health and wellness.

In this week’s Reading, we consider a new American Journal of Psychiatry paper written by Dr. Erick Messias and Victoria Flynn of the University of Arkansas for Medical Sciences. In this highly readable Clinical Case Conference, the authors discuss the case of a mid-career psychiatrist – and then weigh the larger problem of burnout, and its overlap with depression.

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Also, we consider the literature around burnout, and highlight a new JAMA Internal Medicine paper. “The pooled outcomes of the main analysis indicated that physician overall burnout is associated with twice the odds of involvement in patient safety incidents (OR, 1.96…).”

DG

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Reading of the Week: ECT & Dementia – the New Lancet Psychiatry Paper

From the Editor

It’s effective but is it really safe?

Electroconvulsive therapy (ECT) remains controversial 80 years after its first clinical use. At the heart of the controversy: its effects on cognition. Some wonder about the possibility that ECT could be linked to dementia.

Despite the strong concerns expressed over the years, relatively little research has been done on the possible connection between ECT and dementia. This week, we consider a new paper by the University of Copenhagen’s Merete Osler and her co-authors. In this Lancet Psychiatry study, they tap Danish national databases, finding no connection.

old-man-in-sorrow-vincent-van-goghvan Gogh’s Old Man in Sorrow – in need of ECT?

In this Reading, we look at the paper and consider some recent work on ECT.

DG

 

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Reading of the Week: Appointment Letters & Focused Therapies – Thinking Outside the Box

From the Editor

When we speak of improving the quality of mental health care, we often think about cutting-edge innovation – wearables, virtual reality, genetics, to name a few things.

This week, there are two selections. Both discuss innovations aimed at improving care – but neither could be considered particularly “cutting edge.”

In the first selection, researchers sought to improve outpatient appointment attendance with a decidedly low-tech idea: appointment letters reminding patients of the importance of follow up. Spoiler alert: it worked.

In the second selection, drawn from The New York Times, reporter Andrea Petersen discusses clinics that use a short, intense version of CBT.

Thinking outside the box

Together, these two selections illustrate some thinking outside the box.

DG

 
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Reading of the Week: Antidepressants after Acute Coronary Syndrome and Depression – A Lifesaver? The New JAMA Paper

From the Editor

State-of-the-art care for acute coronary syndrome includes oxygen and clot-busting drugs. Should it also include a depression screen and an antidepressant if necessary?

In this week’s Reading, we look at a new JAMA paper showing a response to escitalopram for patients post-ACS (Acute Coronary Syndrome) with depression. Though work has been done in this area before, this paper is an important contribution: it’s well designed, and offers a long follow-up period. Chonnam National University Medical School’s Jae-Min Kim and his co-authors conclude: “In this median 8.1-year follow-up of a randomized 24-week clinical trial of treatment for depression in patients with recent ACS, MACE [major adverse cardiac event] incidence was significantly lower in patients receiving escitalopram than those receiving placebo.”

We consider the paper and its implications.

norm_2xGood EKG, good antidepressant?

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

DG
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Reading of the Week: Mental Illness & Crime Victimization – the New JAMA Psychiatry Paper

From the Editor

After the mass shooting on Toronto’s Danforth, mental illness has been much in the news. The Canadian Psychiatric Association went so far as to warn against stigmatizing those with mental illness.

Despite stereotypes, studies show that people with mental disorders are more likely to be victims of violent crime rather than perpetrators. That said, the literature is light on how much crime patients experience, and the diagnoses of these patients.

This week, we look at a new paper just published by JAMA Psychiatry. Drawing on databases from Denmark, the University of New South Wales’ Kimberlie Dean and her co-authors consider crime (including violent crime) in a cohort study involving more than two million people. What do they find? Those with mental illness are much more likely to be victims than the general population.

gettyimages-126140612_superDenmark: old buildings and not-so-old data

In an accompanying editorial, Duke University School of Medicine’s Jeffrey W. Swanson and Charles M. Beldendiscuss the paper, and contrast it with American data. Their piece begins memorably: “The media-driven notion that mentally ill people pose a danger to others appears to be encrusted like a barnacle on the concept of mental illness submerged in the public mind.” They also weigh in on difference in rates of violence between Denmark and the United States.

DG

 

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Reading of the Week: Suicide Notes & Lessons Learned – the New CJP Paper; Also, Mukherjee on Case Reports

From the Editor

Many people didn’t write one. But some did. The notes were usually short, typically only 600 words or so, and were often handwritten. Some talked about their illness; others didn’t.

What lessons can we learn from these suicide notes?

In the first selection, University of Toronto psychiatry resident Dr. Zainab Furqan and her co-authors consider notes left by those who suicided in a paper just published in The Canadian Journal of Psychiatry. They argue that we can learn from them, and offer clinical suggestions.

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In the second selection, Columbia University’s Dr. Siddhartha Mukherjee argues that the obscure is relevant – he notes the decline and fall of the case report, and calls for its return.

DG

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Reading of the Week: Common Medications and the Link to Depression – the New JAMA Psychiatry Paper

From the Editor

“Many may be surprised to learn that their medications, despite having nothing to do with mood or anxiety or any other condition normally associated with depression, can increase their risk of experiencing depressive symptoms, and may lead to a depression diagnosis.”

JAMA Psychiatry papers rarely make international news. A new paper by the University of Illinois’ Dima Mazen Qato (who is quoted above) and her co-authors has, however. In looking at prescribed drugs like proton pump inhibitors, they find that many are linked to depressive symptoms. One online news report began with the headline: “37% of US Adults Are Using Common Meds They Don’t Realise Could Cause Depression: It’s even worse if you use several medications together.”

It’s a big study with a big result. For the record, a couple of patients have already brought up the findings with me.

statin_2819148bMany small pills, one big problem?

What to think and how should it affect patient care? In this week’s Reading, we consider the paper.

DG

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Reading of the Week: Higher Volume, Better Care? The Rasmussen Paper

From the Editor

How do we improve mental health services?

Past Readings have explored many topics from measurement-based care to better access. This week, we consider a new paper by Aalborg University’s Line Ryberg Rasmussen et al. The study authors look at volume and quality of mental health care, drawing on Danish inpatient admissions.

Their finding? “This nationwide, population-based cohort study demonstrated that patients with depression who were admitted to psychiatric hospitals with very-high-volume wards were more likely to receive care in accordance with clinical guidelines, compared with those admitted to low-volume wards.”

ptelemnursing01High volume, better care (if not better cafeteria food)?

This week, we look at the Rasmussen et al. paper and consider its implications.

DG

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Reading of the Week: Marijuana Policy After Legalization; Also, Remembering Charles Krauthammer

From the Editor

Last week, the Senate voted 52 to 29 in favour of Bill C-45, clearing the last hurdle for marijuana legalization. The federal government is aiming for implementation in the fall.

So, what now?

In the first selection, the University of Toronto’s Tony P. George et al. discuss a “framework” for cannabis policy post-legalization. This Canadian Journal of Psychiatry perspective paper is prescriptive, aiming to reduce the negative effects of the legal change. They make six recommendations, including a national strategy for education.


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Also, in this week’s Reading, we consider the life and psychiatric contributions of Charles Krauthammer, who died last week at age 68. Dr. Krauthammer is best known for his political commentary, but he had a career in psychiatry before becoming a prominent essayist, and penned a classic paper on “secondary mania.”

Please note that there will be no Reading next week.

DG

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