AuthorDavid Gratzer

Reading of the Week: Smoking Cessation & Incentives – the NEJM Paper

From the Editor

“So to put it simply, forcing people to choose is not always wise, and remaining neutral is not always possible.” University of Chicago economist Richard H. Thaler and Harvard Law School Professor Cass R. Sunstein write this comment in their widely-read book Nudge: Improving Decisions about Health, Wealth and Happiness. They argue that people could be nudged in a certain direction, improving outcomes. Among the book’s fans: former UK Prime Minister David Cameron and former US President Barack Obama.

Thaler and Sunstein write about shaping basic decisions, like encouraging people to choose among their company’s pension plans. Retirement planning can significantly help people with their finances in their twilight years. But what about substance use? The stakes seem higher: smoking cessation can prevent major health problems long before retirement.

This week, we look at a new paper by University of Pennsylvania Perelman School of Medicine’s Dr. Scott D. Halpern and his co-authors. Published in The New England Journal of Medicine, they consider smoking cessation and find “financial incentives added to free cessation aids resulted in a higher rate of sustained smoking abstinence than free cessation aids alone…”

file-20170804-6503-18ujgw6Nudging people to butt out?

In this week’s Reading, we consider the paper and its implications. (There is, however, no financial incentive offered here.)

DG

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Reading of the Week: On Spade, Suicide, and the New CDC Report

From the Editor

“I didn’t know Kate Spade, who hanged herself with a red scarf in her bedroom on Tuesday at the age of 55, other than through the prism of her insistently cheerful and whimsical accessories. But everything about Ms. Spade and her designs suggested a sunny temperament, from her candy-colored aesthetic to the perky image she projected. We have a hard time squaring a seemingly successful woman — one with a highflying career, a family and heaps of money — with a despondency so insinuating that it led her to end it all. All this helps explain why Fern Mallis, the former director of the Council of Fashion Designers of America and a friend of Ms. Spade’s, called her death ‘so out of character.’ In fact, it turned out that the bubbly girl from Kansas City ‘suffered from depression and anxiety for many years,’ as her husband, Andy, said.”

So writes novelist Daphne Merkin The New York Times. In the essay, Merkin writes about her depression and her own suicidal thoughts.

Kate Spade. Then Anthony Bourdain.

It’s been a remarkable few days.

bourdain-obama-429e2fd0-b412-4a22-804a-acb7a25d8d43Anthony Bourdain with President Barack Obama

In this Reading, we look at the new CDC report on suicide in the United States. Suicide rates south of the 49thparallel have risen nearly 30% since 1999. We consider the paper and its implications.

DG

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Reading of the Week: Alastair Campbell on his Brother, his Life and his Schizophrenia

From the Editor

“So, my schizophrenia story. Well, the story is mine, but the schizophrenia was Donald’s. He would happily have told you his story himself, for he was very proud of the life he led, given the seriousness of the condition. Sadly, he can’t, as he is dead. So I will tell his story instead.”

Alastair Campbell is many things. He is the author of more than a dozen books. He is a former press secretary and director of communications for UK Prime Minister Tony Blair. He is the father of three.

And he’s the brother of a person who had schizophrenia.

In this week’s Reading, we consider his speech for the Schizophrenia International Research Society, “The Shittiest of all the Shitty Illnesses.” He discusses his brother’s illness and its impact on his family – and he also talks about his brother.

stream_imgAlastair Campbell

In this Reading, we consider Campbell’s comments, and also the larger issue of reduced life expectancy for those with severe mental illness.

DG

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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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Reading of the Week: Suicide & the News – the New CPA Media Guidelines for Reporting on Suicide

From the Editor

“Hemingway Dead of Shotgun Wound; Wife Says He Was Cleaning Weapon.” So reads the headline from the front page of The New York Times reporting the death of author Ernest Hemingway. It quotes Frank Hewitt, the Blaine County Sheriff, who comments that the death “looks like an accident… There is no evidence of foul play.”

It is well known that writer Ernest Hemingway died by suicide – the sheriff didn’t want to say it. As we as a society discuss mental illness more and more, how do we discuss topics like suicide? For years, of course, we didn’t – or, if we did, reporting was often insensitive.

In last month’s Canadian Journal of Psychiatry, Sunnybrook Hospital’s Mark Sinyor and his co-authors, including other psychiatrists and journalists, suggest guidelines for the reporting of suicide. The effort provides an update of a past report, and includes recommendations for social media.

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In this Reading we look at the guidelines, and consider the opportunities and problems of the Twitter era.

DG

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Reading of the Week: Big Buzz, Big Impact? Considering Bell Let’s Talk and Other Awareness Campaigns

From the Editor

Bell Let’s Talk generates incredible attention. The annual effort raised almost $7 million this January, with tens of millions of social media interactions. It was praised by many, including the Prime Minister.

But do awareness campaigns like Bell’s actually result in people seeking care? And are awareness campaigns ultimately helpful? In this week’s Reading, we have two selections that consider these questions.

In the first selection, the study authors look at the Bell campaign, as well as outpatient visits for mental health, tapping Ontario databases. “The 2012 Bell Let’s Talk was temporarily associated with increases in the trends of outpatient mental health visits, especially within the adolescent female cohort.”

The second selection is an interview with Dr. Simon Wessely, one of the most prominent psychiatrists in the U.K., and the president of the Royal Society of Medicine. In a BMJ interview, he weighs in on integrating mental health and physical health services, his choice of psychiatry as a profession, and – yes – the role of awareness campaigns. “Every time we have a mental health awareness week my spirits sink. We don’t need people to be more aware. We can’t deal with the ones who already are aware.”

bell1Big campaign, big impact?

So are awareness campaigns worthwhile? You can read these selections and draw your own conclusions.

DG

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