AuthorDavid Gratzer

Reading of the Week: COVID & Suicide (JAMA Psych); also, Digital Mental Health (JMIR) and Solomon on COVID & Depression (NYT)

From the Editor

Will suicide rates rise with COVID? How will mental health care delivery change? Are we overlooking the most vulnerable?

This week’s Reading will focus on the latest in the literature on the COVID and mental health care, with three selections.

In the first, we consider a paper on COVID and suicide. In a JAMA Psychiatry paper, Mark A. Reger (of University of Washington) and his co-authors consider the impact of the global emergency on suicide. They are practical, and explain that there are clear opportunities for suicide prevention. In responding to COVID, they call for a “comprehensive approach that considers multiple US public health priorities, including suicide prevention.”

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What is the role of digital mental health during and after this pandemic? In the second selection, we consider a new JMIR Mental Health paper. Dr. John Torous (of Harvard University) and his co-authors note the greater use of telemental health, apps, and other forms of e-mental health care. They write: “The COVID-19 crisis and global pandemic may be the defining moment for digital mental health, but what that definition will be remains unknown.”

Finally, in the third selection, we look at an essay by Andrew Solomon. The Pulitzer Prize-finalist author discusses pandemic and mental health, worrying that those in need may be overlooked. “When everyone else is experiencing depression and anxiety, real, clinical mental illness can get erased.”

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Reading of the Week: COVID & Serious Mental Illness (JAMA Psych); also, Mental Health Care (Lancet Psych) and Hospital Care (Neurosci Bull)

From the Editor

In a heavy moment, a colleague of mine observed that spring is finally here, but none of us can enjoy it. This comment is one of many made over these past weeks about our new life. Our businesses are closed; our elderly are hiding; our colleagues are on the front lines and at risk. And, yes, the simple pleasure of enjoying a spring day – the warmth in the air, the song of the birds – has been lost, at least for now.

This week’s Reading has three selections, and each touches on the intersection between the pandemic and mental health care. Our new life means new challenges as we attempt to deliver mental health care services.

In the first selection, we consider a paper on COVID and serious mental illness. In a JAMA Psychiatry paper, Dr. Benjamin G. Druss (of Emory University) writes: “Disasters disproportionately affect poor and vulnerable populations, and patients with serious mental illness may be among the hardest hit.”

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What is the role of mental health care during this pandemic? In the second selection, we consider a new Lancet Psychiatry editorial. The editors write: “Although the mental health field’s interest in trauma has greatly expanded in recent decades, our scientific understanding of trauma has lagged far behind, including our understanding of its definition and aetiology, and, importantly, of how to effectively intervene.”

Finally, in the third selection, we look at a letter by Dr. Yuncheng Zhu (of Shanghai Jiao Tong University School of Medicine) and his co-authors. They discuss inpatient care and the risk and prevention of infection. “Panic is inevitable among patients and medical staff and timely mental health care for dealing with the novel coronavirus outbreak is urgently needed.”

DG

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Reading of the Week: Exposure to COVID & Mental Health (JAMA Netw Open); Also, the Psych Impact of Quarantine (Lancet) and Inspiring Docs (NYT)

From the Editor

We read often about the physical health effects of COVID. But how does this pandemic affect mental health?

This week’s Reading has three selections, with two focused on this question.

In the first selection, we consider the psychological effects of COVID on health care workers. In a new JAMA Network Open paper, Jianbo Lai (of Zhejiang University School of Medicine) and co-authors look at mental health outcomes and the factors associated with them in China. “Among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.”

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During this pandemic, many Canadians are self-isolating; in the coming weeks, many could be quarantined. In the second selection, we consider a new Lancet paper on quarantine and its psychological impact. Samantha K. Brooks (of King’s College London) and her co-authors write: “Given the developing situation with coronavirus, policy makers urgently need evidence synthesis to produce guidance for the public. In circumstances such as these, rapid reviews are recommended by WHO.”

Finally, in the third selection, we look at a NYT essay by Dr. Donald Berwick (of Harvard Medical School). He discusses the way health care providers have risen to the challenge of COVID. “We are witnessing professionalism in its highest form, skilled people putting the interests of those they serve above their own interests.”

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Reading of the Week: Innovation & Pandemics (NEJM); Also, Telemental Health & Practice (QuickTakes) and Scott on Isolation (NYT)

 

From the Editor

After a short break, the Readings are back. And the world has changed over these past weeks.

We are all dealing with the stress of the pandemic, both at home and at work. I spoke recently with a physician who is a young mother, and she talked about balancing her different obligations, and working to keep her patients and family safe.

These are challenging times.

I want to acknowledge the frustration that we all have, particularly the PGY5s, who are so close to completing their studies but have had their Royal College examination postponed. It’s a tough moment for our young colleagues. But I have a few grey hairs, and have seen tough moments come and go – and I believe that things will work out just fine.

This week’s Reading includes three selections.

In the first selection, we consider innovation in the age of pandemic, with a new NEJM paper by Drs. Judd E. Hollander (of Thomas Jefferson University) and Brendan G. Carr (of Sinai). They discuss telemedicine and COVID. “Disasters and pandemics pose unique challenges to health care delivery. Though telehealth will not solve them all, it’s well suited for scenarios in which infrastructure remains intact and clinicians are available to see patients.”

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Then, we take a practical turn. Many of us clinicians use telemental health; with COVID, many more are thinking about taking the virtual care plunge. In the second selection, we consider a new podcast discussing telemental health. I talk with Dr. Allison Crawford of the University of Toronto. And, yes, she has tips on how to up your virtual care game. And to those thinking about using telemental health, she offers simple advice: “Do it. Try it.”

Finally, in the third selection, we look at a NYT essay by an astronaut. Thinking about his time and isolation in space, Scott Kelly provides some clever advice. “I’ve found that most problems aren’t rocket science, but when they are rocket science, you should ask a rocket scientist.”

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Reading of the Week: ED Visits & Follow Ups – the New Psych Services Paper; Also, Antipsychotics and Brains (JAMA Psych) and Physician Biases (NEJM)

From the Editor

How accessible is urgent outpatient mental health care in Canada? Do antipsychotics affect the brain structure of people with psychotic depression? How can physician biases change cardiac care?

This week, we consider three very different selections, drawing from the latest in the literature.

Outpatient Sign over a Hospital Outpatient Services Entrance

In the first selection, Dr. Lucy C. Barker (University of Toronto) and her co-authors look at follow-ups after an ED visit. As the authors note: “Urgent outpatient mental health care is crucial for ongoing assessment and management and for preventing repeat visits to the ED and other negative outcomes.” Drawing on Ontario data, they find that “fewer than half had a physician follow-up visit within 14 days of the ED visit for outpatient mental health care.” Ouch.

In the second selection, we consider a new paper by Dr. Aristotle N. Voineskos (University of Toronto) et al. In an impressive study across multiple sites, they find a connection between cortical thinning and the use of antipsychotics: “olanzapine exposure was associated with a significant reduction compared with placebo exposure for cortical thickness.” Ouch.

Finally, it’s said about health care that “geography is destiny” – so much of the patient experience is tied to her or his place of care, with incredible variations in services between, say, rural and urban centres. In an unusual research letter for The New England Journal of Medicine, Andrew R. Olenski (Columbia University) and his co-authors consider heart surgery and patient age – that is, within two weeks of a patient’s 80th birthday. They argue that numbers are destiny, with heart surgery influenced by “the occurrence of left-digit bias in clinical decision-making…” Ouch.

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

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Reading of the Week: Social Media & Youth Mental Health – the New CMAJ Paper; Also, Antonetta and Her Illness (NYT)

From the Editor

Politicians tout their opinions on social media. Celebrities use it to tell us about their lives. And for everything from cute kid pics to debates over big issues, social media is part of our way of communicating with the world.

But what are the implications to the mental health of adolescents? Many have an opinion, but what can we glean from the literature? This week, we have a couple of selections. In the first and main selection, we look at a review paper from CMAJ. Dr. Elia Abi-Jaoude (University of Toronto) and his co-authors consider the literature on social media. Then, pulling the different studies together, they offer some clinical advice.

social_media_picSocial media: many options, many problems?

In the second selection, we look at an essay by author Susanne Antonetta. She discusses her psychosis and recovery. “There’s difference between psychosis and physical ailments: In the case of psychosis, no one is likely to stop by with a casserole.”

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Reading of the Week: Depression – What is the Economic Burden? The New CJP Paper; Also, Zimmerman on Scales (JAMA) and Bernard on her Illness (CMAJ)

From the Editor

For the patient sitting in front of you, depression is a weight around her shoulders, the reason she can’t enjoy her favourite activities or laugh at her partner’s jokes. Such is the patient experience.

This week, we have three selections, and all consider different aspects of this illness. In the first, we look at a paper from The Canadian Journal of Psychiatry. Julie-Anne Tanner (University of Toronto) and her co-authors draw on data to estimate the economic burden of depression in Manitoba. They conclude: “Depression contributes significantly to health burden and per patient costs in Manitoba, Canada. Extrapolation of the results to the entire Canadian health-care system projects an excess of $12 billion annually in health system spending.”

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Manitoba: big prairie & big burden of depression

In the second selection, we review a short JAMA paper by Dr. Mark Zimmerman (Brown University) considering depression management. He recommends the use of the PHQ-9 in screening. As for treatment, he writes: “the PHQ-9 should be administered at each visit to quantitatively measure a patient’s treatment response.”

And in the third selection, returning to the patient experience, Dr. Carrie Bernard (University of Toronto) writes in CMAJ about her journey. “I am a committed family physician, skilled researcher and respected leader at my university. And I suffer from depression. Why is that so difficult to write?”

DG

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Reading of the Week: COVID-19 & Mental Health (Lancet Psych); Also, Depression & Online Mindfulness (JAMA Psych) and Help for Youth (Globe)

From the Editor

Earlier this week, a patient mentioned that, until recent events, he hadn’t heard of Wuhan, China. Today, it would seem, we are all familiar with this city.

Much reporting and commentary have focused on infections and deaths. But what are the psychiatric implications of the outbreak? This week, we have three selections. In the first, we look at a short and thoughtful paper from The Lancet Psychiatry that tries to answer this question. Dr. Yu-Tao Xiang (University of Macao) and his colleagues note: “In any biological disaster, themes of fear, uncertainty, and stigmatisation are common and may act as barriers to appropriate medical and mental health interventions.”

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In the second selection, we review a new study that uses an online mindfulness-based cognitive therapy aimed at patients with residual depressive symptoms, involving 460 participants. Zindel V. Segal (University of Toronto) and his co-authors find that the intervention “resulted in significant improvement in depression and functional outcomes compared with [usual depression care] only.”

And in the third selection, Drs. Pier Bryden and Peter Szatmari, both of the University of Toronto, discuss their new book. They open their Globe essay with a simple question: “What can I do to help my child?”

DG

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Reading of the Week: Is CBD Useful for Mood Disorders? The New CJP Paper. Also, Peer Support and Online CBT (Psych Services) & the Art of Daniel Regan

From the Editor

This week, we have three selections.

With the legalization of cannabis, many big claims haven been made about the medicinal aspects of this drug – including by industry. Cannabidiol, or CBD, is often touted as being helpful yet non-addictive (in contrast to THC, the more famous cannabis molecule). In the first selection, UBC’s Jairo Vinícius Pinto and his co-authors consider cannabidiol in the treatment of mood disorders, reviewing the existing literature. Does CBD help? “The methodology varied in several aspects and the level of evidence is not enough to support its indication as a treatment for mood disorders.”

In the second selection, the University of Michigan’s Paul N. Pfeiffer and his co-authors try to improve depression treatment outcomes by combining a cutting-edge psychotherapy (CBT, delivered by computer) with a not-so-cutting edge approach (peer support). They conclude that the intervention “should be considered as an initial treatment enhancement to improve effectiveness of primary care treatment of depression.”

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And in the third selection, we look at the work of artist Daniel Regan, which is featured on the front cover of February issue of The Lancet Psychiatry. He notes: “I really think if I hadn’t gone on to study photography, I wouldn’t be here.” Featured above is “Abandoned,” part of a series of photos from Victorian-era asylums in the UK.

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Reading of the Week: Cuijpers on Depression Treatment (WP); Also, Suicide (NEJM), and Sinyor on DeRozan & Depression (Star)

From the Editor

How to treat depression? How do we approach suicide? Who is the greatest Raptor of all time?

This week, we consider three pieces.

In the first selection, Pim Cuijpers (Vrije Universiteit Amsterdam) and his co-authors do a network meta-analysis of depression treatment, weighing psychotherapy, pharmacotherapy, and the combination of the two. They find: “combined treatment is more effective than psychotherapy or pharmacotherapy alone in the short‐term treatment of moderate depression, and there are no significant differences between psychotherapy and pharmacotherapy.”

In a short New England Journal of Medicine paper, Drs. Seena Fazel (Oxford University) and Bo Runeson (Karolinska Institutet) review a topic of relevance to all clinicians: suicide. “Management of suicidality calls for a comprehensive approach to assessment and treatment.”

TORONTO, ON - SEPTEMBER, 25 DeMar DeRozen poses for photos. It was media day for the Toronto Raptors at their training facility, the BioSteel Centre. Coaches and players met with media, answered questions and had a variety of photographs taken. (Richard Lautens/Toronto Star via Getty Images)Yes, we talk about basketball this week

Finally, in the third selection, the University of Toronto’s Dr. Mark Sinyor writes about basketball and his favourite Raptor – and, yes, stigma.

DG

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