CategoryReading of the Week

Reading of the Week: Is Adult Mental Illness More Common? The New Acta Paper; Also, Hill on Cannabis & Neustadter’s Med School Experience

From the Editor

Family physician colleagues talk about how many patients now disclose mental health problems. Our EDs see more patients with mental illness than ever. Antidepressant use has doubled between 2000 and 2015 across OECD countries.

So is mental illness more common than before?

Just last week, a CBC reporter asked me this question. She noted that the rise of businesses offering mindfulness and the proliferation of mental health apps. But as stigma fades and people are more comfortable talking about mental illness, it’s also possible that more people are seeking care, but that there aren’t more people with illness.

depressionintcover0807Mental illness: more commonly discussed, more common?

In our first selection, we consider a new paper from Acta Psychiatrica Scandinavica. Dirk Richter (of Bern University of Applied Sciences) and his co-authors use a systematic review and meta-analysis to see if adult mental illness is increasing over time. “We conclude that the prevalence increase of adult mental illness is small and we assume that this increase is mainly related to demographic changes.”

In the second selection, we consider a new JAMA review of the evidence – or lack of evidence – for medical use of cannabis. Dr. Kevin P. Hill (of Harvard Medical School) writes: “Insufficient evidence exists for the use of medical cannabis for most conditions for which its use is advocated.”

In the third selection, Yale School of Medicine med student Eli Neustadter discusses a challenging patient and the connection they form. “MB and I also found time to meet weekly in a quiet room with nothing but two chairs, two guitars, and two picks.”

There will be no Readings for the next two weeks. The conversation will continue after Labour Day.

DG

 

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Reading of the Week: PTSD & Treatment – What’s Evidence Based? JAMA Psychiatry’s New Network Meta-analysis

From the Editor

Just over a century ago, Dr. Charles Myers wrote “A Contribution To The Study Of Shell Shock” in The Lancet, the first paper on shell shock. Today, our understanding of PTSD has greatly evolved.

But what’s the most effective treatment for people with PTSD?

This week, we consider the new paper by the University of Basel’s Jasmin Merz and her co-authors. They use a network meta-analysis to determine whether patients do better with medications, psychotherapy, or both; in other words, they attempt to analyze different studies in this area, but not necessarily those that do direct comparisons (that’s my Twitter-length biostatistical summary). They find: “The available evidence is sparse and appears not to support the use of pharmacological therapy as first-line treatment for posttraumatic stress disorder…”

ptsd

We also consider an editorial that runs with the study. Murray B. Stein and Sonya B. Norman, both of University of California San Diego, are critical, commenting that aspects of the study may be “hard to swallow.”

DG

 

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Reading of the Week: Mental Health & the Opinion Pages – Mental Health Reform (Star), ECT (Guardian), and Suicide and “13 Reasons Why” (LA Times)

From the Editor

“Mental health is out of the closet. Now that we’ve opened the door, time for a closer look at what’s been out of sight for so long.”

This week, we consider three selections. They appeared in newspapers in recent days, and discuss mental health topics. The opening quotation – which is from the first essay – applies to all of them; a closer look: calls for more debate about how mental health services are organized, the care that patients are offered, and the way mental illness is portrayed in our culture.

In our first selection, we consider an op ed from Toronto Star columnist Martin Regg Cohn. He wonders about improving access to mental health care. In a provocative essay, he mulls the mismatch between the supply and demand of services (particularly psychiatric services). He argues: “We might as well accept that our mental health spending will increase significantly over the years. All the more reason to start reallocating funds wisely now.”

newspapersThree Selections, Three Newspapers

In the second selection, we look at an essay by Dr. Mariam Alexander, an NHS psychiatrist, who discusses ECT. She opens simply: “It might come as quite a surprise to learn that, as a psychiatrist, if I ever had the misfortune to develop severe depression, my treatment of choice would be electroconvulsive therapy (ECT).”

And in our third selection, the University of Toronto’s Dr. Mark Sinyor considers the popular show “13 Reasons Why” and offers a cautionary note about the portrayal of suicide. The LA Times op ed notes that Netflix and others have “the potential to do good in the world when handling sensitive mental health issues.”

Enjoy.

DG

 

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Reading of the Week: Care – At the System Level, At the Individual Level

From the Editor

As stigma fades, there is increasing interest in mental health care. But how can we best help those who need help?

This week, we consider three selections. From an opinion piece written by a politician to a study in a leading journal, there is a common thread: how to improve care, whether at the individual level or at the system level.

In our first selection, we consider a new paper from The Canadian Journal of Psychiatry. Evgenia Gatov (a senior epidemiologist at ICES) and her co-authors consider trauma in the inpatient population, with a big finding. “In this population-based study of adult psychiatric inpatients in Ontario, Canada, almost one in three individuals reported prior experiences of interpersonal trauma.”

19609_mainInpatient Care: a need for trauma care?

In our second selection, Dr. Adam Philip Stern (of Harvard Medical School) discusses the challenges of being a patient and a psychiatrist. Dr. Stern – ill with cancer – is in psychotherapy. He discusses much, including the value of connectedness.

And, in our third selection, we look at an essay by Boris Johnson (the new Prime Minister of the United Kingdom) who discusses depression and work. He advocates for tax changes making it easier for companies to help mentally ill employees.

Enjoy.

DG

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Reading of the Week: Cutting-Edge Care – Esketamine for Depression (NEJM), Digital Psychiatry for Suicide Prevention (JAMA Psych), Asylums for All (AJP)

From the Editor

This time of year, many doctors take to social media to offer advice to young colleagues as they start their specialty training (#TipsForNewDocs). Generally, the tweets give solid suggestions on everything from the importance of mentorship to doing regular exercise. For those new grads beginning psychiatry training, I offer: read more, the field is evolving. Since I started my psychiatry residency 19 years ago this month, we have seen new antidepressants placed into the drug cabinets of our patients, mental-health apps populate their smart phones, and clinical guidelines enter our practices, helping us better manage their mental illness.

This week’s Reading focuses on cutting-edge care, and there is plenty to read.

In our first selection, we consider a new paper from The New England Journal of Medicine. Written by Dr. Jean Kim and four other FDA officials, the authors discuss esketamine for depression. “The drug represents an important addition to the treatment options for patients with treatment-resistant depression.”

nasal-spray-sEsketamine: from club drug to depression care

In our second selection, Dr. John Torous (of Harvard Medical School) and Rheeda Walker (of the University of Houston) consider digital psychiatry and suicide prevention, reviewing the field with cautious optimism. The paper opens with a single sentence that puts these efforts in perspective: “Because the rates of suicide attempts and deaths have recently increased to 50-year highs,new solutions are needed.”

And, in our third selection, we look at a not-so-new editorial from The American Journal of Insanity that calls for better treatment of the poor.

Enjoy.

DG

 

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Reading of the Week: ‘Sister First, Doctor Second’ – Dr. Sediqzadah’s NEJM Paper on Her Brother and His Illness

From the Editor

“‘I think your brother has schizophrenia,’ she said.

“I was entering my third year of medical school when I received a phone call from my brother’s friend.”

So begins a perspective paper published in today’s issue of The New England Journal of Medicine. The essay is deeply moving. Written by Dr. Saadia Sediqzadah, a fifth year psychiatry resident at the University of Toronto, the author discusses her brother’s schizophrenia and her family’s efforts to get him care – for Dr. Sediqzadah, dealing with mental illness is not just part of her training.

inclusion-programs-18Saadia Sediqzadah

This week, we consider Dr. Sediqzadah’s paper.

Note that for some of our younger colleagues who have just finished their medical training and begun their specialty training in psychiatry, this week will be your first Reading. Welcome to the conversation.

DG

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Reading of the Week: Can British Reforms Prevent Mental Illness? What Should Every Physician Know About Burnout? Also, Cardiac Surgery (and Us)

From the Editor

Governments in Canada and across the west have committed themselves to spending more on mental health care. But how should we spend this new money? Should we focus on people earlier in the illness experience? Should we fund evidence-based treatments like CBT? Should education campaigns aimed at reducing stigma be the priority?

UK Prime Minister Theresa May recently announced new mental health reforms. She explained: “It’s time to rethink how we tackle this issue, which is why I believe the next great revolution in mental health should be in prevention.” In this week’s first selection, we look at Prime Minister May’s announcement, and we ask: should Canadian policymakers look to 10 Downing Street for mental health ideas?

larry-cat-10-downing-street10 Downing Street

Also, this week, we consider an interview with Dr. Treena Wilkie, CAMH’s Deputy Physician-in-Chief for Medical Affairs and Practice, who talks about physician burnout. Dr. Wilkie closes with a few words of advice for our colleagues: “There’s help available.”

And, in our third selection, The New York Times investigates deaths in an American hospital. The article isn’t about psychiatry (it’s about health care). But could it be about the problems in your hospital?

This will be the last Reading of the academic year. To my young colleagues who have just graduated: I hope you enjoy your careers in psychiatry as much as I have.

There will be no Reading next week. Should you fall off the distribution list of these Readings, please don’t hesitate to pop me an email.

DG

 

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Reading of the Week: Your Patient’s Suicide – the New BJP Bulletin Paper; Also, Langford on Suicide and His Journey

From the Editor

It’s the phone call that we all dread – the call from the family or the coroner, explaining that your patient has died, likely by suicide.

At some point, we all receive that call.

Obviously, we think about the impact of suicide on families. But what impact does suicide have on us clinicians? In this week’s Reading, we consider the new BJP Bulletin paper on suicide and psychiatrists. Dr. Rachel Gibbons, an English psychiatrist, and her co-authors try to answer this question with a survey. Among their findings: a quarter of psychiatrist has considered a career change after a patient’s suicide.

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In this week’s other selection, in a Lancet Psychiatry paper, Dr. Alex Langford, also an English psychiatrist, talks about the impact that suicide has had on his life.

DG

 

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Reading of the Week: Who is at Risk for Daily Cannabis Use? What Should Every Physician Know About Global Psychiatry? And Hussein on Her Psychotic Break

From the Editor

It’s legal. It’s also addictive.

As clinician, we worry about who may be at risk of heavier use of cannabis. In a new paper published in The Canadian Journal of Psychiatry, the University of Montreal’s Erika Nicole Dugas and her co-authors draw on data to try to identify early risk factors for daily use, drawing on 23 potential risk factors. Their findings are plausible – could the list be used for early interventions?

school-tests

At risk?

Also, this week, we consider my podcast interview with Harvard University’s Vikram Patel, who talks about mental health services in low-income nations. Dr. Patel is fresh off his win of the John Dirks Canada Gairdner Global Health Award, called the Canadian Nobel by some. (I do ask him what he plans to do with the prize money.)

And, in our third selection, singer Ladan Hussein discusses her psychosis – “I returned home to Toronto in January 2018, broken, dishevelled and deranged” – and her recovery.

DG

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Reading of the Week: On D-Day, Three Papers on Shell Shock, One by Dr. Charles Myers

From the Editor

Today is the 75th anniversary of D-Day.

Ceremonies are planned across the country, and across Europe; Prime Minister Justin Trudeau is in France. During these anniversaries, people comment on the importance of the moment. US President Barack Obama noted: “much of the progress that would define the 20th century, on both sides of the Atlantic, came down to the battle for a slice of beach only six miles long and two miles wide.” And people speak of the loss of life. US President Ronald Reagan, on a past anniversary, talked about “the boys of Pointe du Hoc” who had tried to take “these cliffs” off the beaches, noting that the majority were killed.

But the damage of war is not only in the loss of life.

In this week’s Reading, we consider shell shock and PTSD starting with the first paper on the topic, written by Dr. Charles S. Myers for The Lancet, published just over a century ago. Dr. Myers writes about three cases of shell shock, noting the similarities in their presentations.

La pointe du Hoc en Normandie (Calvados, Basse-Normandie, France)

We also consider a recent paper, published in JAMA Internal Medicine, discussing a more modern presentation – but perhaps not a profoundly different presentation. Finally, we consider a summary of recent published guidelines.

DG

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