AuthorDavid Gratzer

Reading of the Week: Cancer and Suicide – the New JAMA Psychiatry Paper

From the Editor

When I worked closely with cancer patients, we would often speak of that moment – the moment they were diagnosed, when they officially became cancer patients. Many recalled their first emotions: the disbelief, the shock, the anger. A few could even tell me sparkling details, like the way the doctor looked at them or what she was wearing. And, for all, that moment had been life altering.

That moment is followed by challenges, and for some, depression and even suicide.

What is the risk of suicide after the cancer diagnosis? In this week’s Reading, we look at a new JAMA Psychiatry paper. Drawing on English data, and involving 4.7 million people, Public Health England’s Katherine Henson and her co-authors look at cancer and suicide. They find: “Despite low absolute numbers, the elevated risk of suicide in patients with certain cancers is a concern, representing potentially preventable deaths.”

popepaintingBig diagnosis, big risk?

In this Reading, we consider the paper on this important topic, as well as an editorial.

DG

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Reading of the Week: VR for Phobias? The New JAMA Psychiatry Paper. Also: Lancet Psychiatry on the Potential & Pitfalls of Digital Health

From the Editor

At the end of medical school, I spent some time working with an attending psychiatrist who was keen on behavioural interventions. He asked me to see a patient with acrophobia, a fear of heights, and told me to take the patient for an elevator ride for a “real-world experience.” For the record, the patient declined. (Having had no background in behavioural interventions, I’m not sure who was more anxious about that possible elevator ride, the patient or me.)

For people with phobias, exposure can be helpful. And so, therapists have taken their patients on plane trips and to visit tall buildings, and encouraged them to sign up for public speaking classes. As technology advances, we can ask: could virtual reality, or VR, work?

In the first selection, we consider a new paper from JAMA Psychiatry. Vrije Universiteit Amsterdam’s Tara Donker and her co-authors use VR for acrophobia. They choose a very basic intervention – an app and cardboard google glasses. They find: “A low-cost fully self-guided app-based virtual reality cognitive behavioral therapy with rudimentary virtual reality goggles can produce large acrophobia symptom reductions.”

googlecardboard-580x358

The future of psychiatry? Maybe – and certainly recyclable

In the second selection, we look at a new editorial from The Lancet Psychiatry. While the authors are keen on digital psychiatry – the sort of work that Donker and her team do – they also warn about potential problems.

DG

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Reading of the Week: Should You Google Your Patients? Can Telemedicine Help with Medication Adherence?

From the Editor

A few years ago, a patient told me that he had won the lottery. When I expressed some surprise (and skepticism), he replied: google my name. I did, and he had won the lottery.

We google restaurant suggestions, people in the news, and our partner’s new bff.  But is googling your patients ethical? Is it advisable?

In the first selection, we look at a new paper from Psychiatric Services. Yale University’s Charles C. Dike and his co-authors consider these questions and more. They conclude: “Except in emergencies, it is advisable to obtain a patient’s informed consent before performing an Internet or social media search for information about the patient or the patient’s family and significant others.”

3888Does a good history include a good google of your patients?

For the second selection, we consider another paper from Psychiatric Services; the authors ask whether telemedicine can help with medication adherence. In this study, the University of Greifswald’s Lara N. Schulze and her co-authors use texting and phone calls. Spoiler alert: the intervention worked.

And a quick request: I’m looking for feedback on the Reading series. Please take a few minutes to complete the (anonymous) online survey: https://www.surveymonkey.com/r/GP5XXMB.

Note: there will be no Readings for the next two weeks.

DG

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Reading of the Week: How to Think about Practice Today – And Tomorrow? A New CJP Paper, a Podcast, and a Report

From the Editor

How do we practice today – and how will we practice in the future?

This week’s Reading includes three selections.

In the first selection, we consider how we practice today, with a new paper by University of Ontario Institute of Technology’s David Rudoler and his co-authors. Drawing on administrative data, they look for practice patterns, finding three distinct ones. Spoiler alert: practice patterns are very different, with 30% of psychiatrists seeing just two or fewer patients per month.

Then, we look ahead. In the second selection, we consider a new podcast discussing digital psychiatry. I talk with Dr. John Torous of the Harvard-affiliated Beth Israel Deaconess Medical Center. And, yes, he has tips on good apps for your patients.

Finally, in the third selection, we consider the recent Ontario government report on ending hallway medicine. The authors look to the future, and make several suggestions, including embracing the potential of digital health care.

messaging-appsApps – the future?

Enjoy.

DG

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Reading of the Week: Can Psychotherapy Help Inpatients? Why did Michael Wilson Speak Out? Are Patients Experts?

From the Editor

Almost two decades ago, I was invited to a conference. The keynote speaker was Michael Wilson, the former federal Minister of Finance, who died earlier this month. I remember two things about this presentation: first, the audience was perfectly still – as Wilson spoke about his son’s suicide, no one shuffled her papers or chatted with his neighbour; second, I remember thinking how unusual this presentation was: he spoke about suicide at a time when suicide wasn’t discussed.

This week, we look at three selections, including an interview in which Wilson discusses his decision to speak out.

We also consider two other pieces: a new study on psychotherapy for inpatients with depression and an essay considering whether patients are experts.

pjimage-11Michael Wilson

Enjoy.

And I hope you will take a few minutes to complete our survey, aimed at improving the Readings.

https://www.surveymonkey.com/r/GP5XXMB

DG

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Interview on TVO

Is the future of psychiatry digital? I was invited to discuss chatbots, apps, and data on TVO’s The Agenda recently.

gratzer-tvo

The full interview can be found here:

https://www.tvo.org/video/programs/the-agenda-with-steve-paikin/mental-health-theres-an-app-for-that

Reading of the Week: Do E-Cigarettes Help with Smoking Cessation? The New NEJM Paper

From the Editor

Last week, I spoke to a patient who wanted passes off the ward so that he could smoke. When I suggested that we could help him reduce his nicotine use – and maybe even help him quit – he responded: “I’ve been smoking for 40 years. I’ll never quit.”

As much as the comment is disappointing, it is all too familiar. Nicotine is highly addictive, and it’s very challenging for our patients to quit.

What then to make of e-cigarettes? While they have been marketed well for smoking cessation, the evidence to date has been lacking. Do they offer a pathway to ending nicotine use? Or are e-cigarettes another type of nicotine product – addictive and ultimately unhelpful?

This week, we look at a paper just published in The New England Journal of Medicine. Queen Mary University of London’s Peter Hajek and his co-authors report on a “pragmatic, multicenter, individually randomized, controlled trial” comparing e-cigarettes to nicotine replacement therapy (NRT). It’s the first adequately powered study on this topic. And this Very Big Paper comes with a Very Big Result: e-cigarettes offered a strong advantage over NRTs.

e-cigGreat ad, great product?

In this week’s Reading, we look at the Hayek et al. paper and consider e-cigarettes.

Have thoughts on the Readings of the Week? Please take this 15-question survey to make the Readings better: https://www.surveymonkey.com/r/GP5XXMB.

DG

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Reading of the Week: “It was scary and sad, but it was also a terrible sort of relief” – Dr. Danziger on Her Father’s Suicide

From the Editor

“By the time my father died, it wasn’t a surprise. It was scary and sad, but it was also a terrible sort of relief.”

So begins a short and honest essay by Dr. Phoebe Danziger. Our American colleague’s JAMA paper doesn’t require much of an introduction. She speaks about her father, his mental illness, and his death. She also touches on her own depression. And she speaks candidly of a childhood coloured by her father’s illness.

36yts2xd_400x400Phoebe Danziger

In this Reading, we consider Dr. Danziger’s essay.

DG

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Reading of the Week: How to Cope With a Patient’s Suicide? What to do When Nudges Don’t Work? Can Technology Bring Physicians Together?

From the Editor

“We talk about the toll suicide takes on families… We talk about the tragedy for the people who’ve died… What we don’t openly talk about is suicide’s toll on the doctors who have treated these patients.”

So writes Dr. Dinah Miller, a psychiatrist affiliated with Johns Hopkins Medicine. She discusses the death of a patient and the impact on her life.

Dr. Miller’s essay is one of three selections in this week’s Reading.

The papers are different and look at different issues. The one common thread: they were all published in The New England Journal of Medicine.

And they all ask important, thought-provoking questions:

How to cope with a patient’s suicide?

What to do when nudges don’t work?

Can technology bring physicians together?

p17Dr. Dinah Miller

Enjoy.

DG

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Reading of the Week: A Statin a Day Keeps the Doctor Away? The New Hayes et al. JAMA Psych Paper

From the Editor

Statins can help prevent MIs in people with high cholesterol. Can they also prevent psychiatric admissions for those with schizophrenia?

The question may seem odd, but there is evidence that statins can reduce symptoms in people with schizophrenia – though the evidence is light. That may not be as surprising as it seems: statins are anti-inflammatories, and a growing literature suggests neuro-inflammation is involved in major mental illness.

So should our patients receive medications like statins? The concept of repurposing common medications has gained attention.

This week, we look at a paper just published in JAMA Psychiatry. In their study, University College London’s Joseph F. Hayes and his co-authors consider the effect of statins, calcium channel blockers, and biguanides (such as metformin). Spoiler alert: they find that these medications reduce psychiatric hospital admissions and self-harm in people with serious mental illness.

statins-understandingthehypeStatins for schizophrenia?

In this Reading, we review the new paper about the not-so-new meds. We also take a quick look at another paper (on ketamine).

DG

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