Tagaccess

Reading of the Week: CBT for Depression – What Really Works? The New JAMA Psychiatry Paper

From the Editor

“It changed my life.”

A few years ago, a patient described to me how helpful cognitive behavioural therapy was for him. CBT wasn’t his only treatment – he had a couple of medication trials – but he found the psychotherapy to be very helpful.

Others have had a similar experience, but CBT isn’t widely available in Canada; Puyat et al. found in a Canadian Journal of Psychiatry paper that the vast majority of people with depression don’t receive any form of psychotherapy or counseling. How can we address this access gap? Could different forms of CBT work including those that are less resource intensive? What to make of self-help?

In this Reading, we consider a new paper by Vrije Universiteit Amsterdam’s Pim Cuijpers and his co-authors that seeks to answer these questions. They use a network meta-analysis to compare five treatment formats with each other and control conditions (waiting list, care as usual, and pill placebo). Their conclusion: “This study suggests that group, telephone, and guided self-help treatments are effective interventions that may be considered as alternatives to individual CBT.”

dr-aaron-beck-at-work-595048284-5af62b4dae9ab80036aca7faAaron Beck: How to deliver the CBT he has championed (and should we all wear a bow tie)?

In this Reading, we consider the big paper and its big result, and the accompanying editorial by the University of Pittsburgh’s Dr. Holly A. Swartz and Jay Fournier.

DG

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Reading of the Week: How to Think about Practice Today – And Tomorrow? A New CJP Paper, a Podcast, and a Report

From the Editor

How do we practice today – and how will we practice in the future?

This week’s Reading includes three selections.

In the first selection, we consider how we practice today, with a new paper by University of Ontario Institute of Technology’s David Rudoler and his co-authors. Drawing on administrative data, they look for practice patterns, finding three distinct ones. Spoiler alert: practice patterns are very different, with 30% of psychiatrists seeing just two or fewer patients per month.

Then, we look ahead. In the second selection, we consider a new podcast discussing digital psychiatry. I talk with Dr. John Torous of the Harvard-affiliated Beth Israel Deaconess Medical Center. And, yes, he has tips on good apps for your patients.

Finally, in the third selection, we consider the recent Ontario government report on ending hallway medicine. The authors look to the future, and make several suggestions, including embracing the potential of digital health care.

messaging-appsApps – the future?

Enjoy.

DG

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Reading of the Week: Remembering Dr. Elliot Goldner

From the Editor

I met him just once. Dr. Elliot Goldner was invited to give the Distinguished Member Lecture at the Canadian Psychiatric Association’s 2015 Annual Conference in Vancouver. Before a packed room, he gave a lucid speech on the state of the system – a speech peppered with insights and statistics, drawn from numerous papers; it was mesmerizing. After, he stayed to talk with people, and I joined the group that had gathered. Late for my own presentation, I received angry texts from my co-presenter. I couldn’t resist the opportunity to talk further about the access issues that he had so clearly discussed.

But if we met just once, over the years, I have read many of the papers that Dr. Goldner wrote and co-wrote. A Goldner paper – like a Goldner presentation – is impressive and memorable.

Dr. Goldner died in late November.

Dr. Elliot Goldner

In this Reading, we look at his life and career through the comments of some colleagues. We also consider his 2011 Canadian Journal of Psychiatry paper on access and psychiatry.

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Reading of the Week: First Episode Psychosis and Access – The Anderson-Kurdyak Paper, and More

From the Editor

“If your son or daughter had cancer or diabetes, do you think it would be reasonable for them to wait? I don’t think it’s any different for mental illness.”

Access. It’s one of the biggest problems with mental health services.

How big is the access problem? What can be done about it?

This week, we consider a new paper looking at access and first episode psychosis. Dr. Paul Kurdyak, a CAMH psychiatrist and a program lead with the Institute for Clinical Evaluative Sciences, made the above comment to the CBC when discussing this new paper. In it, Kelly Anderson and Dr. Kurdyak find that 40% of patients didn’t receive physician follow-up in the month after diagnosis. Imagine – tying back to Dr. Kurdyak’s comment – if 40% of young patients with leukemia didn’t have physician follow-up in a month after their cancer diagnosis.

We also look at the discussion around a new federal-provincial accord with an op ed written by Michael Wilson, the chair of the Mental Health Commission of Canada – particularly timely as the ministers of health met this week with an eye on a new accord.

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Reading of the Week: Kurdyak’s New Paper on Access

From the Editor

As medical school classes have grown, the supply of physicians has increased across the country. Has this helped address access issues in psychiatry?

How have practice patterns changed over time?

This week’s Reading seeks to answer some basic and important questions around physician supply and access in psychiatry. Following up on a major paper written in 2014, Kurdyak et al. have written another important and relevant paper.

The long and the short of it: there are significant problems with access – and they aren’t getting any better with time.

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Reading of the Week: Values and Schizophrenia, and More

From the Editor

Welcome to first Reading of the Week of 2016.

Continuing the format started in December, I’ve made several selections here. This week: the obituary of an influential psychiatrist, a clever paper on values and schizophrenia, and a report that considers the use of psychiatric services in Ontario.

In general, Readings in this format don’t have a common theme. That said, this week, a common thread runs through the three selections: challenging assumptions.

Dr. Agid and his co-authors look at the values of those with schizophrenia, challenging the assumption that our patients value what we value; the HQO-ICES report challenges what we think we know about psychiatric care and care delivery in Canada’s largest province. And what can be said of Dr. Robert Spitzer? Well, he made a career out of challenging psychiatric assumptions – much to his credit, and to our benefit.

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