CategoryReading of the Week

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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Reading of the Week: Is Cannabis Helpful? Can We Prevent Depression? What’s It Like to be Depressed & in Medicine?

From the Editor

In most Readings of the Week, a paper or essay is selected and then discussed. This week, we return to an older format, and look at several selections, offering an overview of a few topics.

The selections ask thought-provoking questions:

Is cannabis helpful?

Can we prevent depression?

What’s it like to be depressed – and in medicine?

cbd-oil-cannabis-leaf-1296x728

Cannabis: Hype or Help?

Enjoy.

DG

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Reading of the Week: Measurement-based Care – Big Idea, Not-So-Big Reality

From the Editor

Imagine the excitement if a new antidepressant came to market that boasted that it could achieve the symptom reduction of other antidepressants in about half the time, yet had no significant new side effects.

There is no new antidepressant, but there is a study to mull: In 2015, The American Journal of Psychiatry published a paper on measurement-based care for people with depression, and the patients in the measurement group achieved remission in about half the time compared to people seeing a psychiatrist without the guidance of measurement. Though the paper has limitations, it also suggests the incredible potential of measurement-based care.

The measuring tape isolated on white backgroundThe measuring tape isolated on white background

In the first selection, we consider a new review paper published in JAMA Psychiatry. Kaiser Permanente Washington Health Research Institute’s Cara C. Lewis and her co-authors contemplate the potential of measurement-based care – and its reality (greatly underused). They make six points of observation and discussion before going on to propose an agenda.

In the second selection, we look at a paper by the University of Pennsylvania’s David W. Oslin and his co-authors who use survey data to consider the use of measurement-based care in a paper published by Psychiatric Services.

DG

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Reading of the Week: The Best of 2018

From the Editor

It’s an annual Reading of the Week tradition. At the end of each year, we pause, take stock, and consider the best selections of the past 12 months.

new-year-2018

2018 was an eventful year.

Start here: the federal government legalized the recreational use of cannabis.

We have heard so much about legalization over these past few years, that the event itself seemed almost anti-climactic. But remember: Canada is only the second country in the world to do this.

And 2018 has seen further evidence that stigma continues to fade: governments across the country have committed themselves to increased funding for mental health; more people spoke of their experiences with mental illness; more people talked about previously taboo topics, such as suicide.

And so with an eye on the future, let’s look back at the last year. In this final Reading of 2018, we look at a few memorable selections. Enjoy.

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

DG

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Reading of the Week: Smoking, Cognitive Performance, & Mental Illness: Quitting Matters – the New AJP Study

From the Editor

I don’t quite know when the shift occurred, but somewhere between the zeal of residency and the busyness of life as an attending physician, I stopped documenting nicotine use disorder. Indeed, working with severely ill patients, it was a given that they did smoke, and thus hardly worth mentioning. (Studies suggest that smoking is thrice as prevalent among those with schizophrenia compared to the general population.)

For many of our patients, tobacco use is a deadly problem – a major reason why people with severe, persistent mental illness have a life expectancy much shorter than ours.

This week, we consider a new paper from The American Journal of Psychiatry. The University of Academisch Medisch Centrum Universiteit van Amsterdam’s Dr. Jentien M. Vermeulen and her co-authors consider smoking in those with psychosis, their families and a control group, studying the impact on smoking on cognition – and also the impact of smoking cessation on cognition. Though work has been done in this area, the Vermenulen et al. paper is strong: they consider two comparison groups and follow people for six years. Spoiler alert: smoking cessation improved cognition in people with psychosis.

1304701062nosmokingButt out, think better?

In this Reading, we consider the paper, as well as the editorial by the University of Miami’s Philip D. Harvey, who raises some good points about what is – and isn’t – in the data.

We close the Reading with a couple of housekeeping items, including my new podcast (which may be of interest to Ontario doctors).

DG

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Reading of the Week: How to Improve Depression Treatment? Cuijpers in JAMA. Also, Kurdyak on Access & Goodman on Mental Health Screening for Docs

From the Editor

This week, we consider three provocative but thoughtful essays.

In the first selection, Vrije Universiteit Amsterdam’s Pim Cuijpers – a highly published researcher in depression – wonders what needs to be done to improve depression outcomes. In this JAMA paper, he notes the importance of the task: “One estimate suggests that approximately 30% of patients with depressive disorders have a chronic course with limited response to treatment.”

ketamine-a-miracle-drug-for-depression-or-not-rm-1440x810Is ketamine a possible breakthrough for depression? Cuijpers ask.

In the second selection, the University of Toronto’s Dr. Paul Kurdyak considers how to address the shortage of psychiatrists – and notes, in this healthydebate.ca essay, that the problem is more complicated than some would suggest; he argues that the supply of psychiatrists across Ontario has little impact on access because of practice styles.

Finally, in the third selection, Columbia University’s Matthew L. Goldman and his co-authors note that doctors are screened for TB. They ask: “Should physicians also be screened for mental health conditions such as depression or burnout?”

DG

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Reading of the Week: A 20th Century Medical Renaissance Man – the Life & Legacy of Dr. Roger Bland

From the Editor

Few individuals have contributed more to the evolution psychiatry, the promotion of mental health, or served as a more committed and effective advocate for the mentally ill than Dr. Roger C. Bland. He inspired us, he guided us, he mentored us and enriched us. He was a father figure to many – a voice of experience, compassion, reason and intelligence we could always count on.

Simply put, Dr. Bland was a great man.

Dr. Roger Bland had a storied career.

He was a practicing psychiatrist for decades. He also held many leadership and administrative positions over the years: Chair of the University of Alberta’s Department of Psychiatry, President of the Alberta Psychiatric Association, Vice-President International Federation of Psychiatric Epidemiology, Assistant Deputy Minister of Health for Alberta, and Deputy Editor of The Canadian Journal of Psychiatry. For his accomplishments, he was appointed to the Order of Canada. He also found time to be a father and grandfather. And he was an accomplished chef.

He passed at the end of July.

orderofcanadaDr. Roger Bland being invested in the Order of Canada

I had a few interactions with Dr. Bland. A couple of years ago, at the CPA Annual Conference, we started to talk about suicide prevention after a colleague’s presentation, and we ended up debating our interpretation of several papers. I remember breaking into a slight sweat as I realized that he had a near encyclopedic knowledge of the literature.

But if he could be tough in a discussion, he was an amazing collaborator. At the request of a younger colleague, I once asked Dr. Bland for input into a collaborative care project. He was generous of his time and very thoughtful. (Dr. Bland had been a founding member of the Canadian Collaborative Mental Health Initiative, which involved a dozen organizations; he testified before Parliament on the work of this Initiative.) Yet, he had no hesitation talking about how to structure a partnership with primary care and even how to think about our documentation – pro-tip: keep the notes short and focused; family doctors are busy.

In this Reading, we consider the life and contributions of Dr. Roger Bland.

I asked Dr. Scott Patten, the editor-in-chief of The Canadian Journal of Psychiatry, to write about him – his work and also what it was like to work with him. Dr. Patten also discusses some of Dr. Bland’s most important papers.

For those who wish to read more about Dr. Bland, I’ve included links to his Globe and Mail obituary. There is also a link to the University of Alberta Department of Psychiatry’s monthly newsletter where colleagues reflect on his life and legacy – the opening quotation is from Dr. Xin-Min Li, the Chair; and Dr. Bland gives an interview – his last – on his career (spoiler alert: his training included 10,000 home visits).

DG

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Reading of the Week: Vulnerable Youth & ‘13 Reasons Why’ — the New Psych Services Paper; Also, Dr. Orford Considers his Brother’s Suicide in JAMA

From the Editor

It’s a hit show. Is it dangerous?

Since its launch, 13 Reasons Why has been highly controversial; the storyline of the Netflix series revolves around a teenager’s decision to suicide – which is graphically depicted over three minutes in one episode.

In this week’s Reading, we look at a new Psychiatric Services paper. University of Michigan’s Dr. Victor Hong and his co-authors consider the impact of the show on youth seeking psychiatric care for suicide-related risk. While other studies have analyzed the response in the larger community (including google searches), this study focuses on a vulnerable population. They find: “For certain youths, watching the series correlated with a perceived nonzero elevation in their suicide risk; identification with the main female character and strong affective reactions may be markers of increased risk associated with viewing the show.”

13-reasons-picBig buzz, big problem?

In the other selection, we look at a short essay recently published in JAMA. In “Grief After Suicide,” Dr. Orford discusses the suicide of his brother. The Deakin University intensivist notes that: “As a physician, I have cared for thousands of patients and families in the last hours and days of life. I have listened, watched, and learned.” The loss of his brother, however, continues to have a major effect on his life, three decades later.

DG

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