TagCanadian Journal of Psychiatry

Canadian Journal of Psychiatry: “Telepsychiatry 2.0”

‘Closed-circuit television has been introduced into the field of mental hygiene as a medium for the administration of therapy to a mass audience. The present evidence indicates that that the use of this type of television may promote the development of new and more effective methods for the treatment of the mentally ill.’ This hopeful statement appeared at the beginning of a 1957 peer-reviewed paper. Four years later, the potential of telepsychiatry ‘as a means of extending mental health services to areas that are remote from psychiatric centers’ was described. Six decades later, where are we?

So begins an editorial in the current issue of The Canadian Journal of Psychiatry.  I’ve co-authored the paper; Dr. David Goldbloom is the first author.

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Drawing on the Serhal et al. paper on telepsychiatry in Ontario, we consider the current state:

Consider: of the more than 48,000 people in need of psychiatric care (defined by the authors as psychiatric or primary care within a year after a psychiatric hospitalisation), fewer than 1% saw a psychiatrist through telepsychiatry—and 39% saw no psychiatrist. We note the marked contrast with the United States, where telepsychiatry has been rapidly growing.

And we consider how to move forward. We propose a four-point plan, including “a province-wide strategy that has defined clinical priorities, geographic rationales, and measured outcomes.”

You can find our editorial here:

http://journals.sagepub.com/doi/full/10.1177/0706743717714469

Note: open access.

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: “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: Is Psychoanalysis Relevant? Paris vs. Ravitz

From the Editor

“Today, psychoanalysis has been marginalized and is struggling to survive in a hostile academic and clinical environment. This raises the question as to whether the paradigm is still relevant in psychiatric science and practice.”

This week, we consider the relevance of psychoanalysis.

Drawing from the May issue of The Canadian Journal of Psychiatry, we look at two papers.

Freud and analysis: debating his relevance

In a Perspectives piece, Dr. Joel Paris argues that psychoanalysis is part our legacy – but not much more. In an Editorial, Dr. Paula Ravitz responds. She opens by writing: “My concern is that by unnecessarily pitting psychiatry against psychoanalysis, we may throw out the baby with the bathwater.”

It’s a great and important debate.

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Reading of the Week: Violence & Mental Illness

From the Editor

What’s the connection between mental illness and violence?

For years, the Hollywood depiction was black and white: mental illness caused brutal violent behaviour. And maybe society held those views, too – think of the old newspaper headlines talking about ‘psycho killers.’ Times have changed. Hollywood is slowly abandoning the caricatures; newspapers discuss violence against the mentally ill. But to answer this question, of course, we need to look to studies and journals, not the silver screen and journalism, and understand that the relationship between mental illness and violence is much more nuanced.

Hollywood and mental illness: room for improvement

This week, we review two papers. The first, from Psychiatric Services, considers different types of violence and mental illness. No surprise here: like other studies, the authors show that those with mental disorders are more likely to be victims of violence rather than violent to others. But the authors note a larger picture of violence. This short paper is far-reaching in its findings.

The Canadian Journal of Psychiatry’s February issue considers violence and schizophrenia (part of the In Review Series). The Quinn and Kolla paper presents a thoughtful review of the literature for evidence-based treatments for violence in schizophrenia.

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Reading of the Week: Pushing Past the Headlines – Substances & Health Services, and Medically Assisted Death & Cost Savings

From the Editor

It makes sense that those with substance use problems and mental illness consume more health resources – but how much more? As Canadians opt for medical assistance in dying, what will the impact be on health spending?

Readings don’t necessarily follow a theme. But this week, we push past newspaper headlines to consider two topical issues in more detail, tapping the latest in the literature.

Pushing past the headlines

In the first paper, Graham et al. consider health costs and utilization for people with mental health and/or substance use problems. Spoiler alert: these individuals are much more likely to use health services, resulting in higher costs. That’s not exactly a surprise, but Graham et al. provide a detailed analysis in an area that has been understudied.

In the second paper, drawing from Dutch data, Trachtenberg and Manns estimate the savings from medically assisted death.

Both papers are timely. Both reach interesting conclusions.

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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: The New CANMAT Guidelines for Depression

From the Editor

What’s new in depression treatment?

The new guidelines

This week, we look at the new CANMAT guidelines. Published in September in The Canadian Journal of Psychiatry, the papers – six in all – speak to the latest in depression management.

What should you think about the new antidepressants? What alternatives are there to CBT? What to do when everything else fails? Spoiler alert: this week’s Reading answers all these questions and more.

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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: What’s New in Psychotherapy – Paul Garfinkel’s Book

From the Editor

What’s new in psychotherapy?

Psychotherapy is an area of psychiatry transformed over the past years.

Dr. Aaron Beck: not a Freudian

Last week, we looked at a major new paper on IPT. This week, we return to Dr. Paul Garfinkel’s book – the source of two past Readings – for an excellent chapter on psychotherapy.

Last week. A major new review of IPT.

This week. An overview of psychotherapy developments.

This chapter describes the evolution of psychotherapy, and its importance. It also notes the excellent opportunity for the mental health field – to embrace evidence-based treatments and to offer better care for our patients.

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