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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?”

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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.

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Reading of the Week: Too Few Psychiatrists? Anderssen on the Gap in Access (Globe); Also, Cuijpers on Success in Depression Treatment (Expert Review)

From the Editor

After a break, the Readings are back. In the coming weeks, we will consider important papers on depression treatment, cannabis, help for the homeless, and more.

This week, there are two selections.

In the first selection, we consider the new Globe and Mail essay by reporter Erin Anderssen on the supply (or the lack of supply) of psychiatrists across Canada. This essay does a sparkling job of pulling together stories and reports, and includes an overview of the literature. It paints a familiar, if unsettling, picture of need unmatched by availability, and includes interviews and original data analysis.

She writes: “The modern psychiatrist can’t be everywhere. So they should be where Canadians need them most.”

We summarize the essay and some of the larger questions raised.

anderssenErin Anderssen

In the second selection, the Vrije Universiteit Amsterdam’s Pim Cuijpers writes about depression and treatment. Thinking about successful care, he asks a simple question: “When patients seek treatment, is a reduction of depressive symptoms really what they want, or do patients have other goals as well?”

DG

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Reading of the Week: The Best of 2019

From the Editor

It’s an annual Reading of the Week tradition. As one year draws to a close and we start the next, we pause, take stock, and consider the best selections of the past 12 months.

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We can also think about the Readings, mental health care policy, and what to expect in 2020.

So, let’s start with the not-so-big picture: the Reading of the Week has completed another year. For the first time, in the spring, I did a formal evaluation with the help of Faisal Islam (of CAMH Education). Among the survey results: the Readings enjoy a 97% satisfaction rate. Nice. And many readers had good suggestions, which I’m looking forward to using.

And in the big picture: 2019 was a year when further progress was made in the public discourse on mental illness. More people spoke about their personal experiences. Governments across Canada committed themselves to mental health reforms. But it wasn’t all great: moments also reminded us of the work that must be done, especially around stigma, even among prominent Canadians.

The 2019 selections of the Readings included some sparkling and important research. As I have commented before, I find psychiatric journals to be more interesting and more relevant with each passing year (and, at this point, I’ve seen a few passing years).

Does cannabis help with the treatment of mental illness? How does Ramadan affect the mental health of our Muslim patients? Does VR and other new technologies offer hope in the treatment of anxiety and other mental disorders?

These important questions were asked by researchers, and their papers help inform our work as clinicians.

And so with an eye on the future, let’s look back at the last year. Enjoy.

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

DG

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Reading of the Week: Lithium Prescribing – Rare, Too Rare (CJP)? Also, Social Media & Medical Research (Nat Med) and Chocolate Survival Time (BMJ)

From the Editor

Lithium is effective as a medication. How often is it prescribed?

This week, there are three selections, and we open with a small paper with a big finding.

In the first selection, Dr. Scott B. Patten and Jeanne V. A. Williams (both of the University of Calgary) draw on national survey data to consider lithium prescribing in Canada. “The frequency of lithium use is surprisingly low,” they find.

lithium-on-the-periodic-tableLithium: on the Periodic Table, but not in the drug cabinet

In the second selection, we look at a Nature Medicine article that contemplates social media and medical research. Writer Nicole Wetsman quotes Dr. Esther Choo, an emergency physician who is prominent on Twitter: “It’s incredible medical education.”

Finally, for the third selection, we tip our hats to the holiday season, and consider a not-so-new BMJ paper on holiday chocolates. Published as part of a past Christmas issue – the popular, annual tradition that takes a light-hearted approach to inquiry – Bedford Hospital’s Parag R. Gajendragadkar and his co-authors ask a not-so-weighty question: how long do holiday chocolates last on hospital wards?

Note that there will be no Reading next week. Happy Holidays.

DG

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Reading of the Week: A Century After Osler, Is He Relevant (NEJM)? Also, AI & Diagnosis (CMAJ) and Ketamine & Safety (JAD)

From the Editor

A century after his death, is Dr. Osler still relevant?

This week, there are three selections. First, we start with a look back with an essay on Dr. William Osler. We then look forward: with papers on AI and ketamine.

In the first selection, Drs. Charles S. Bryan (the University of South Carolina) and Scott H. Podolsky (Harvard University) write in The New England Journal of Medicine about Dr. Osler on the 100th anniversary of his death. Contemplating his life and views, they note that he “gave physicians what certain national historians gave their countries: warm feelings of togetherness, pride, and purpose.”

nlc012022-v6William Osler

In the second selection, we look at a CMAJ paper. Considering AI and health care, University of Strasbourg’s Dr. Thierry Pelaccia and his co-authors write about the reasoning of mind and machine. They see a bright future: “AI can assume its place as a routine tool in medical practice.”

Finally, for the third selection, we consider a new paper on ketamine and safety from the Journal of Affective Disorders. Drawing on several studies, NIMH’s Elia E. Acevedo-Diaz and her co-authors conclude: “The results indicate that a single intravenous subanesthetic-dose ketamine infusion was relatively safe for the treatment of [treatment-resistant depression].”

DG

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Reading of the Week: Better PTSD Symptom Control, Less Diabetes (JAMA Psych)? Also, Buckley on Cannabis (Quick Takes), and the Life of Kajander (Globe)

From the Editor

Better PTSD symptom control, less diabetes? How do we talk to our patients about cannabis (and cannabis use disorder)? Who was Dr. Ruth Kajander?

This week, there are three selections. The first two deal with timely and relevant topics: the intersection of physical and mental health and the use of cannabis post-legalization. The third reminds us of the youth of our field.

In the first selection, Saint Louis University School of Medicine’s Jeffrey F. Scherrer and his co-authors consider PTSD and diabetes, asking if improvement with the mental health disorder results in a lower risk of type 2 diabetes. Drawing on Veterans Health Affairs data involving nearly 1 600 people, they find that “clinically meaningful reductions in PTSD symptoms are associated with a lower risk of type 2 diabetes.”

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In the second selection, we draw on a podcast interview with the University of Toronto’s Dr. Leslie Buckley, the chief of addictions division at CAMH, on cannabis. What advice would she give clinicians about cannabis use? “Try to have that long conversation with [patients] about their use and make sure that they know the harms – because I feel like most people don’t.”

Finally, with an eye on yesterday and not today, we look at the recent Globe obituary for Dr. Ruth Kajander, a psychiatrist who served in many roles, and was a member of the Order of Canada.

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