AuthorDavid Gratzer

Reading of the Week: Depression, Pills & Adherence – the Sirey et al. Study on Improving Depression Treatment

From the Editor

The patient is depressed. The doctor has prescribed medications. But the patient doesn’t take them.

As a clinician, this scenario is too familiar with results that are too familiar – the patient doesn’t get better. What can we do to improve adherence?

In this week’s selection, we look at a new paper by Weil Cornell Medicine’s Jo Anne Sirey et al., considering this question. The authors do a randomized controlled trial with “a brief psychosocial intervention designed to improve adherence to pharmacotherapy for patients with depression.” So, is this intervention a game-changer? The authors find a five-fold increase in adherence during the first 6 weeks of care – but not much change in overall depressive symptoms.

153745515Pretty pill bottle: But how can we get patients to take the pills?

In this Reading, we review the paper.

DG

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Canadian Journal of Psychiatry: “Telepsychiatry 2.0”

‘Closed-circuit television has been introduced into the field of mental hygiene as a medium for the administration of therapy to a mass audience. The present evidence indicates that that the use of this type of television may promote the development of new and more effective methods for the treatment of the mentally ill.’ This hopeful statement appeared at the beginning of a 1957 peer-reviewed paper. Four years later, the potential of telepsychiatry ‘as a means of extending mental health services to areas that are remote from psychiatric centers’ was described. Six decades later, where are we?

So begins an editorial in the current issue of The Canadian Journal of Psychiatry.  I’ve co-authored the paper; Dr. David Goldbloom is the first author.

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Drawing on the Serhal et al. paper on telepsychiatry in Ontario, we consider the current state:

Consider: of the more than 48,000 people in need of psychiatric care (defined by the authors as psychiatric or primary care within a year after a psychiatric hospitalisation), fewer than 1% saw a psychiatrist through telepsychiatry—and 39% saw no psychiatrist. We note the marked contrast with the United States, where telepsychiatry has been rapidly growing.

And we consider how to move forward. We propose a four-point plan, including “a province-wide strategy that has defined clinical priorities, geographic rationales, and measured outcomes.”

You can find our editorial here:

http://journals.sagepub.com/doi/full/10.1177/0706743717714469

Note: open access.

Reading of the Week: “Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy?” JAMA on Psychotherapy

From the Editor

Is CBT overrated? The authors of a new JAMA paper raise this question in a cutting Viewpoint.

In this two-part Reading of the Week series, we look at two papers, both published in JAMA. These Viewpoint pieces make interesting, provocative arguments.

Last week, we looked at conversational agents.

This week, we ask: is CBT really the gold standard for psychotherapy?

University of Giessen’s Falk Leichsenring and Medical School Berlin’s Christiane Steinert consider CBT and the research that has been done in the area. “CBT is usually considered the gold standard for the psychotherapeutic treatment of many or even most mental disorders.” But should it be? Leichsenring and Steinert argue no.

beck_aaron_t-_112798Aaron Beck: Great bowtie, but is his CBT really so great?

In this Reading, we review their paper, and consider their argument.

DG

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Reading of the Week: “Talking to Machines About Personal Mental Health Problems.” JAMA on Therapy & AI

From the Editor

Will people seek therapy with computers one day, getting care from programs built with Artificial Intelligence?

The authors of a new JAMA paper consider this in a short, clever piece, titled “Talking to Machines About Personal Mental Health Problems.”

In this two-part Reading of the Week series, we look at two papers, both published in JAMA. These Viewpoint pieces make interesting, provocative arguments.

This week, we look at conversational agents.

Next week, we ask: is CBT really the gold standard for psychotherapy?

Stanford University’s Adam S. Miner and his co-authors consider conversational agents – that is software programs that “use conversational artificial intelligence to interact with users through voice or text.” Could there be therapeutic value in such a program? What are the ethical challenges?

Robot and human hands almost touching - 3D render. A modern take on the famous Michelangelo painting in the Sistine Chapel; titled, "The Creation of Adam".

In this Reading, we review the paper, and consider the potential of conversational agents, with an eye on what’s currently available.

DG

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Reading of the Week: “What do you wear on the first day back to work after a psychotic break?” – Zack Mcdermott on his Return to Work

From the Editor

“What do you wear the first day back to work after a 90-day leave of absence because of a psychotic break?”

Lawyer Zack Mcdermott asks this question at the beginning of a moving, honest, and raw essay that was published recently in The New York Times.

zack-and-cindy-1The writer and his mother

In this Reading, we look at his piece and his journey.

DG

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Reading of the Week: Stressed & Expensive – the Chiu et al. Study on the Health-Care Costs of Distress and Depression

From the Editor

He isn’t able to work. He often can’t get out of bed. His partner is beside herself. And his diabetic management is poor.

He’s the sort of patient who we see often – in specialist offices (like mine) and in family medicine clinics, and also in emergency departments and on hospital wards. His depression is affecting his life, his family, his workplace – and, yes, his health. Here’s a quick question: how much higher are his health-care costs than those who don’t struggle with depression?

In this week’s selection, we look at a new paper by Maria Chiu et al., considering the costs of depression and distress.

business-comment_01_temp-1382010303-525fcdbf-620x348Distress and depression: Painful to patients – and costly to the system?

In this Reading, we review the paper, and consider the larger context.

DG

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Public Coverage for Evidenced-based Therapies for Depression and Anxiety?

Should there be public coverage for evidenced-based psychotherapies for major depressive disorder and generalized anxiety disorder? The Ontario Health Technology Advisory Committee recommended yes in a new draft paper, and gave comment on ways of doing this.

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The Committee asked for public feedback. In my submission, I noted: “The recommendations of the Ontario Health Technology Advisory Committee are reasonable and thoughtful.”

You can find my full submission here:

gratzer-ohtac-submission

Reading of the Week: Mental Health Care – Doing Bad, Feeling Good? The Hayes et al. Study

From the Editor

Greetings from Ottawa. This morning, the Canadian Psychiatric Association’s 67th Annual Conference opens here. And the agenda looks great, and includes the release of the new Canadian guidelines for the treatment of schizophrenia.

It’s difficult not to feel upbeat, as people from coast to coast to coast gather to discuss new findings and new ideas on problems like refractory depression and chronic pain and, yes, schizophrenia. And this is a great time to be involved in mental health care – as stigma fades and societal recognition grows.

But how are we doing in terms of actual outcomes? This week, we look at a new British Journal of Psychiatry paper. Hayes et al. consider mortality for those with severe mental illness and the rest of us. Unfortunately, the authors find that the mortality gap has grown with time.

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Ottawa: Host city of this year’s CPA Annual Conference

In this Reading, we review the paper and an editorial, and consider the larger context.

DG

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Reading of the Week: “All Aboard the Bipolar Express” – Beth Beattie on Her Illness & Her Decision to Speak Out

From the Editor

“I was a victim of mental-health stigma – both societal and self-imposed.”

Lawyer Beth Beattie makes that observation in her essay about her experience with bipolar. Her piece – which was just published by The Globe and Mail – is moving and thoughtful.

Bipolar Express: Beattie writes about her journey

In this Reading, we highlight her essay, and comment further on the importance of people speaking out about their illness.

DG

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Reading of the Week: Can Lithium in Drinking Water Help Prevent Dementia? The Kessing et al. Paper from JAMA Psychiatry

From the Editor

Since the extraordinary work of John Cade some seven decades ago, lithium has been used as a medication to help people with bipolar. But the history of lithium use is longer – for many years, people have understood that it has medicinal value, and bottled water containing lithium was popular at the turn of the twentieth century (long before Dr. Cade started medical school).

We know that lithium affects the brain in many ways (for example, it slows apoptosis, or programmed cell death); we also that know that dementia can work on those same pathways, but in a negative way (it may sped up apoptosis). In this week’s selection, the authors wonder if lithium can prevent dementia. It’s a big question – and the authors tap a big national database. They find a non-linear correlation between lithium in drinking water and dementia.

Tap water: A potential prevention for dementia if it has lithium in it?

So – does this paper represent something of a breakthrough? We look at the paper and an editorial to answer that question.

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