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Reading of the Week: Coming to Canada – Immigration and Mental Illness

From the Editor

Last week, when in Halifax, I went to Pier 21, a museum that now stands where more than a million immigrants entered this country by ship. The exhibits describe the aspirations, the experiences, and the struggles of these people – our people. As a nation of immigrants, here’s an important question to ask: what impact does immigration have on mental health?

Different studies show different things of the immigrant experience. On the one hand, some studies find that immigrants (and refugees) have higher rates of psychosis (including a recent Canadian paper by Anderson et al.); on the other hand, other studies show a “healthy migrant effect” – that is, immigrants have lower rates of mental illness overall.

The August issue of The Canadian Journal of Psychiatry has a thoughtful paper that considers immigration and mental illness. The authors tread on familiar ground – there is a rich body of work in this area, but they offer a Canadian perspective by looking at people in Montreal, and they consider mental health utilization and service satisfaction.

Pier 21: A boat, a pier, and the beginning of the new beginning for hundreds of thousands – but are there implications for mental illness?

Spoiler alert: immigrants tended to have lower rates of depression and alcohol dependence than the general population.

DG

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Reading of the Week: “13 Reasons Why” – Is This TV Show Glamorizing Suicide?

From the Editor

Is a popular TV show glamorizing suicide?

13 Reasons Why is a Netflix series in which the main character suicides – depicted graphically in the show. We will leave it to critics to judge the value of the show as a cultural contribution. Here’s a relevant question for those of us in mental health: is this show promoting suicide?

San Diego State University John W. Ayers and his co-authors consider google searches after the show’s premiere aired, bringing data to this discussion.

13 Reason Why: Popular Show, Problematic Effect?

In this Reading, we consider their research letter and an editorial responding to it – and the larger debate about the series.

DG Continue reading

Reading of the Week: “Your Smartphone Will See You Now” – Torous on Digital Psychiatry; Also, the Costs of Homelessness

From the Editor

A few weeks ago, a patient’s daughter called. She was deeply concerned: the patient was acting differently, she explained. “He’s sick again.” She noted that he was starting to go on long walks at night, and to different neighbourhoods – something he does when he’s starting to get ill with his bipolar. She feared that, without a change in medications and careful follow up, he would end up in the hospital again. As a psychiatrist, that type of information can be invaluable – a clue that a patient is doing less well.

Could technology help us find clues for emerging illness, maybe even before family members or patients themselves?

This week, the first selection weighs this question. Harvard University’s Dr. John Torous considers big data and mental health. In his essay, “Your Smartphone Will See You Now,” he reviews current trends and writes: “I predict that this technology will have an enormous impact on psychiatry.”

mjkxndi1nwClever cover – promising future?

In the second selection, we consider a new paper that looks at the costs of homelessness in Canada. As part of the work of At Home/Chez Soi, the authors answer a basic and important question: what are the costs of homelessness?

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

DG

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Reading of the Week: ECT and Inpatients – An Underused Tool?

From the Editor

It’s a powerful tool that helps people with refractory depression and other illnesses.

It’s a treatment that carries a heavy stigma, and is used less today than even a decade ago.

Both statements describe electroconvulsive therapy (or ECT) – perhaps the most controversial intervention in psychiatry. And while it has been studied for decades, little work has been done considering the impact of ECT on inpatient readmissions. In this week’s Reading, we look at a new JAMA Psychiatry paper that studies ECT and readmissions.

Spoiler alert: the study authors found it decreased readmits.

Electroconvulsive therapy at Winwick Hospital in 1957: relevant then as now?

The paper begs a larger question: is an important tool in the treatment of those with mental illness being underutilized as newer (and less effective) treatments are chosen?

DG Continue reading

Reading of the Week: “Taking On the Scourge of Opioids” – Dr. Sally Satel’s New Essay

From the Editor

Today, the addicted are not inner-city minori­ties, though big cities are increasingly reporting problems. Instead, they are overwhelmingly white and rural, though middle- and upper-class individuals are also affected. The jarring visual of the crisis is not an urban ‘gang banger’ but an overdosed mom slumped in the front seat of her car in a Walmart parking lot, toddler in the back.

So writes Dr. Sally Satel, an addiction psychiatrist, about the opioid epidemic.

Dr. Satel is writing about the United States, but these problems are also seen north of the 49th parallel. Canadians remain the second highest per-capita consumers of opioids in the world; for the record, only our southern neighbours best us. And, like in the U.S., opioid use has soared in recent years – and so has misuse.

Opioids: little pills, big problems

How did we get here? And where do we go?

This week’s selection: a new essay by Dr. Satel. Drawing on the words of Nicholas Eberstadt, she describes “a new plague for a new century.” Dr. Satel writes about the roots of this drug problem and considers options moving forward.

DG

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Reading of the Week: “The Secret to My Success? Antidepressants”

From the Editor

With the end of the academic year and the start of the new one, I’ll spend the next few days updating the distribution lists for the Reading of the Week series. I’m using this opportunity to make a few technical changes, too. This is the Reading of the Week equivalent of a spring clean-up – though it’s July, and I’m not touching a dustpan.

Spring cleaning, at least before computers

In any clean-up, we can mistakenly throw away something valuable – it’s possible that some of you may stop receiving these emails (if you are getting our emails). If that happens and you would like to continue to get the Readings, simply pop me a message.

This week, I’ve picked an entertaining and yet moving essay from writer Julia Fierro talking about her illness and her recovery. Enjoy.

Oh, and congratulations to our colleagues who have finished their studies. I hope you enjoy your career in medicine as much as I have.

DG

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Reading of the Week: Do Suicide Barriers Work? Sinyor et al. on the Bloor Viaduct and Toronto Suicides

From the Editor

Do suicide barriers really work, or do they cost money that could have been better spent elsewhere?

This debate raged in Toronto about a decade and a half ago when some argued that a suicide barrier must be added to the Bloor Viaduct. That bridge, which connects downtown Toronto with its east end, was considered a “suicide magnet” – a place that proved popular for suicide attempts. In North America, only the Golden Gate Bridge in San Francisco had more suicides associated with it. Media coverage of the debate included an article in The New York Times; it ran with the dramatic headline: “A Veil of Deterrence for a Bridge With a Dark Side.”

And in 2003, the barrier went up.

So did the suicide rate go down?

This week, we look at a new paper just published by Sunnybrook’s Mark Sinyor et al. Drawing on years of data, they consider the utility of the Bloor Viaduct suicide barrier. They find that it has saved lives. The paper obviously has implications for other bridges and cities.

The Bloor Viaduct: big debate, big outcome?

The authors also looked at media reporting on suicide.

DG Continue reading

Reading of the Week: Is ‘New’ Overrated? Antipsychotics in the Real World

From the Editor

Is new better?

You may be reading this on an iPhone 7, having driven to work this morning in a 2017 Hybrid Prius. So should your patients be taking a medication that became available four-and-a-half decades ago – when people drove gus-gusling eight-cylinder Oldsmobiles and smartphones didn’t even exist in science fiction novels.

This week, we look at a just-published JAMA Psychiatry paper which promises to look at the “real-world” effectiveness of antipsychotics. The authors tapped Swedish databases to consider outcomes for nearly thirty thousand people with schizophrenia.

Sweden: elaborate welfare state, beautiful historic buildings, and – yes – rich databases

Spoiler alert: new wasn’t better. That is, newer antipsychotics tended to underperform clozapine and depot medications.

We also look at similar “real-world” work drawing from a Finnish database considering treatment of depression.

DG Continue reading

Reading of the Week: Dreams of My Uncle – Husock on His “Unmentionable” Uncle & His Mental Illness

From the Editor

“To say that I didn’t know my great-uncle, Wolfe Levine, would understate things. I didn’t even know of such an uncle, brother of my mother’s father (a grandfather with whom I was close). In retrospect, it’s clear that my great-uncle was simply unmentionable.”

So begins Howard Husock, Vice President of the Manhattan Institute for Public Policy, in a long essay that traces the illness and institutionalization of his great uncle.

The author’s great uncle

The piece asks a simple question: “Are we treating the mentally ill better today than we did a century ago?”

It’s a beautiful essay, that touches on history, psychiatry, and a family member who was “unmentionable.”

DG Continue reading

Award of Excellence in Mental Health

Individuals in need of Cognitive Behavioral Therapy (CBT) typically face challenges like long wait lists, a shortage of therapists, and lack of access to a therapist outside of regular business hours. Now, adult outpatient clients of Scarborough and Rouge Hospital’s Mental Health department can access treatment for anxiety and depression any time and place that is most convenient for them.

My Scarborough and Rouge Hospital team was awarded the 2017 Award of Excellence in Mental Health and Quality Improvement from the Canadian College of Health Leaders.

cchl-ccls_vertical-tagline_colour_250px

Our  team won this honour for our e-therapy work. The gala dinner was in Vancouver this Sunday.

Full details here: https://www.cchl-ccls.ca/site/awards_mentalhealth_quality

Nice.