AuthorDavid Gratzer

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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Reading of the Week: “The Name of the Dog” – Dr. Tafder’s Excellent NEJM Paper & More

From the Editor

There is something often dehumanizing about the health-care experience – the way patients can be reduced to medical-record numbers, the way lives can be summarized in disease names and a few demographic details (“a 30 year old woman with schizophrenia”).

This week, we consider two essays that are about people who happen to be patients – and the lessons that our colleagues have drawn from their stories.

In the first selection, we look at a paper written by Dr. Taimur Safder that was published in The New England Journal of Medicine. It’s about the name of a dog – and much more. During his training, Dr. Safder presents the case of a person who develops chest pain when walking his dog. When the supervisor asks the name of the dog, the physician isn’t sure. “Four years later, I’m not sure anything I’ve carried from residency has been more useful than that question.”

dy_wosjwsamveozNo, this Reading isn’t really about dogs

And, in the second selection, we consider a short essay by Dr. Lee Lu. The Texas doctor describes her experiences working with a patient with substance use problems – and wrestling with her own biases.

Finally, returning to the topic of cannabis legalization, we consider some responses to last week’s Reading, and a CMAJ editorial on the topic.

DG

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Reading of the Week: Cannabis Legalization – Clinical Implications & Major Papers

From the Editor

It’s legal.

After decades of debate, Canada has legalized recreational marijuana, joining an exclusive club of nations with just one other member: Uruguay.

In the coming weeks, many details will be sorted out – some small (the regulation of edibles), some not so small (driving and use). But starting this week, we clinicians work in a different world.

What are the clinical implications of legalization? Will we see more use? How will people present to our EDs and clinics? What should we ask on a history? And how do we treat cannabinoid hyperemesis syndrome? (Spoiler alert: ginger stat.)

In the first selection, I highlight comments by CAMH’s Dr. Jonathan Bertram made in an interview with me. We discuss what every clinician should know about legalization.

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And then with an eye on the journals, I pick a few essential articles on cannabis, drawing from The New England Journal, JAMA, and other major publications, considering topics from the adverse effects of marijuana to the implications for pain management.

DG

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Reading of the Week: Weight Loss for People with Schizophrenia? STEPWISE Didn’t Work. On the Big Paper, the Not-So-Big Result & Negative Results

From the Editor

Years ago, I worked with a patient who lost 70 pounds with an aggressive regiment of exercise. His determination was exceptional but his struggles with obesity weren’t. People with schizophrenia are twice as likely as the general population to deal with weight problems.

In the first selection, we consider a paper on weight loss for those with schizophrenia and related illnesses. STEPWISE offered these patients a thoughtful approach to weight management. The paper is remarkable for its finding: the intervention didn’t work. As the University of Southampton’s Dr. Richard I. G. Holt and his co-authors write: “the intervention was neither clinically nor cost-effective over the 12-month intervention period.”

In this Reading, we consider the paper, but also the larger issue of negative trials and their lack of presence in the literature.

bank-failure-lw-schwenk-locWe often read about bank failures; medical study failures, not so much

In the second selection, we draw on a New York Times essay by pediatrician Aaron E. Carroll who calls for the publication of more negative trials. “These actions might make for more boring news and more tempered enthusiasm. But they might also lead to more accurate science.”

DG

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Reading of the Week: Social Media & Paranoia — the new Acta Paper; Also, How Do We Change Docs? A Reader Responds

From the Editor

Politicians tweet about townhall meetings; celebrities put vacation pictures on Instagram; your cousin in Europe has her own YouTube channel.

Our world is very different than it was just a few short years ago. (Fun fact: Facebook – a decade and a half old – claims to have more than 2 billion active monthly users.)

But how has social media affected those with mental illness? While this is much discussed in the media, there is little in the literature. In this week’s Reading, we consider a new paper that looks at social media and mental illness, in particular psychosis. Tweet this: the University of Manchester’s Natalie Berry and her co-authors didn’t find a connection between use of social media and increased paranoia.

BELCHATOW POLAND - MAY 02 2013: Modern white keyboard with colored social network buttons.

In this week’s Reading, we consider this new paper from Acta Psychiatrica Scandinavica. We also wonder about the role of the Internet and social media for those with psychosis, drawing from a Psychiatric Services paper.

Also, the University of Toronto’s Dr. Ivan Silver writes a letter to the editor about a previous Reading.

DG

 
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Reading of the Week: Do Antidepressants Beat Placebo? Does Measurement-based Care Work? Four Papers and Some Thoughts on a Fourth Anniversary

From the Editor

This month, the Reading of the Week – in its present form – turns four.

Today, the Readings are emailed out from sea to sea to sea. It’s a big evolution from the first Readings, started more than six and a half years ago, with me handing out photocopies of papers on the inpatient ward where I worked.

To celebrate our silk anniversary, I’ve picked four major selections from the past four years. I’ve also included some papers that haven’t been discussed – but should have been.

p9180013Silk: good for a fourth wedding anniversary, but a fourth Reading anniversary?

Enjoy.

DG

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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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