TagCanadian Journal of Psychiatry

Reading of the Week: Rurality and Suicide (CJP); Also, COVID and Digital Practice (Quick Takes) and Haughton & Bromberg on Policing (Tor Star)

From the Editor

At times, it seems that we understand little about suicide.

That statement is vast, sweeping – and painfully true for us clinicians who aspire to do better with very blunt instruments. This week, we have three selections; the first is a systematic review and meta-analysis focused on suicide. In a new Canadian Journal of Psychiatry paper, Rebecca Barry (of the University of Toronto) and her co-authors consider the potential link between suicide and rurality. Spoiler alert: they find a connection, at least for men. What are the implications for practice and policy?

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In the second selection, we consider a new podcast discussing our digital future. I talk with Dr. Jay Shore (of the University of Colorado), who chairs the APA’s Telepsychiatry Committee. We discuss the virtualization of mental health services, and contemplate a future of hybrid care. And, yes, he has tips on how to avoid “Zoom fatigue.”

In the third selection, activists Asante Haughtonand Rachel Bromberg discuss alternatives to police responding to mental health crises, seeing a dedicated team tasked with “on-the-spot risk assessments, de-escalation, and safety planning for clients in crisis” and more. “By taking on these important tasks, this team will enable Toronto policing resources to be more effectively directed toward solving crimes, rather than providing social services.”

DG

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Reading of the Week: What do Google Searches Tell Us about Suicide & COVID? (CJP) Also, Bullock on Suicide (NEJM)

From the Editor

How will the pandemic impact mental health? Will we see more people with depression and PTSD? What about suicides?

In a recent JAMA Psychiatry paper, Mark A. Reger (of the University of Washington) and his co-authors argued that we may see a “perfect storm” with COVID-19, increasing the risk of suicide. A BMJ blog speculated that we could have a “pandemic after the pandemic,” as mental health problems grow even as the virus fades.

This week, we have two selections; the first focuses on suicide and the pandemic. Using an innovative approach – that is, considering Google searches for suicide and related terms, as a proxy for completions – the authors draw on American and international data. In a new Canadian Journal of Psychiatry paper, Dr. Mark Sinyor (of the University of Toronto) and his co-authors find surprisingly “that the initial stages of the pandemic were accompanied by a substantial reduction in searches related to suicide, anxiety, and hopelessness with no change in searches for depression.”

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In the second selection, Dr. Justin L. Bullock (of the University of California, San Francisco) discusses suicide in The New England Journal of Medicine. The young doctor is very personal, describing his own struggles with mental illness. “‘I’m starting to get depressed,’ I told my sister emotionlessly. She began to cry, probably flashing back to the last time I was severely depressed, attempted suicide, and ended up in the ICU. I told her I was sad that my 2-year-old niece wouldn’t remember me. ‘Do you think I would ever let her forget you?’ she responded. We both cried.”

DG

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Reading of the Week: Can Light Therapy Help with Bipolar Depression? Also, the Racism of COVID (BJP) & Gottlieb on the Toilet as the New Couch (NYT)

From the Editor

After his manic episode, the first patient I treated with bipolar disorder was low in mood for months, able to get out of bed, but not able to work. I remember him sitting in my office talking about feeling overwhelmed. For many people with bipolar disorder, the depressive episodes are long and debilitating. And for us clinicians, these episodes are difficult to treat. (I remember feeling overwhelmed, too.)

Can light therapy help?

The first selection seeks to answer that question. Light therapy, after all, has shown its utility in depression, including for those with a seasonal pattern to their lows. But bipolar depression? In a new Canadian Journal of Psychiatry paper, Dr. Raymond W. Lam (of UBC) and his co-authors do a systematic review and meta-analysis. They included seven papers. “This meta-analysis of RCTs found positive but nonconclusive evidence that light therapy is efficacious and well tolerated as adjunctive treatment for depressive episodes in patients with BD.”

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Is the virus racist? In the second selection, we look at a provocative paper from The British Journal of Psychiatry written by Drs. Anuj Kapilashrami and Kamaldeep Bhui (both of Queen Mary University of London). Considering how COVID-19 affects certain groups more than others, they also note that mental illness is more common among minorities, and they argue that: “societal structures and disadvantage generate and can escalate inequalities in crises.” They offer a word of caution: “What is surprising is it takes a crisis to highlight these inequalities and for us to take note, only to revert to the status quo once the crisis is over. ”

Finally, we consider an essay from The New York Times. Lori Gottlieb, a psychotherapist, discusses her practice in a world of pandemic. “Suddenly, her sobs were drowned out by a loud whooshing sound.” She wonders if the toilet is the new couch.

DG

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Reading of the Week: What Now? CJP on Mental Health of Communities; also, Telepsychiatry Post-COVID (JAMA Psych), and Gold on Stigma (Time)

From the Editor

What now? COVID is part of our new reality. But as we move forward – as a nation that is past peak, and slowly beginning the task of reopening – how do we understand the mental health needs, challenges, and opportunities of the post-pandemic world? This week, we have three selections considering that question.

The first is a new editorial. In The Canadian Journal of Psychiatry, Dr. Daniel Vigo (of the University of British Columbia) and his co-authors note that “epidemics & pandemics have long been known to impact mental health: The mental problems triggered by viral outbreaks have been described as a ‘parallel epidemic.’” Understanding that subpopulations have different needs, they argue for an approach that focuses on those at greater risk. They make specific recommendations in an impressive paper that includes 52 references.

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Will our digital moment continue? In the second selection, we look at a new JAMA Psychiatry paper by Dr. Jay H. Shore (of the University of Colorado) and his co-authors, who argue that it should. They note that many clinics and hospitals have embraced telepsychiatry. He argues that, with the right approach, we could have “a golden era for technology in psychiatry in which we are able to harmonize the benefits of telepsychiatry and virtual care while maintaining the core of our treatment: that of human connectedness.”

Finally, in the third selection, Dr. Jessica Gold (of the University of Washington in St. Louis) considers stigma around mental illness. In this time of COVID, she wonders if it will fade further, providing some evidence from social media. She sees opportunity for better: “Instead of looking at the post-COVID-19 mental health future through a lens of inevitable doom, we can, and should, use this moment as the impetus for the changes that mental health care has always pushed for.”

DG

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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?”

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.

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: Postsecondary Students & Mental Illness (CJP), a New Podcast (CAMH), and Bipolar & Social Media (NYT)

From the Editor

Social media. An uncertain job market. Increasing academic demands.

Is life for our postsecondary students harder than ever? And are we seeing a surge in mental health disorders as a result?

In the first selection, we consider a new Canadian Journal of Psychiatry paper on postsecondary education and mental illness. While many have opinions on this topic, the University of Toronto’s Kathryn Wiens and her co-authors seek to add data to the discussion. Drawing on the Canadian Community Health Survey, they find: “The results do not imply the emergence of a mental health crisis among postsecondary students.”

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In the second selection, we look at a new podcast considering technology and education. I interview some accomplished educators, including the University of Toronto’s David Goldbloom. “This is about challenging our own norms, values and expectations as clinicians.”

And in the final selection, we consider a New York Times essay on bipolar and social media. “Facebook snitched our big family secret: Roland, the literary prodigy, the tenderhearted musician, the Ivy League grad, was bipolar.”

DG

 

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Reading of the Week: Care – At the System Level, At the Individual Level

From the Editor

As stigma fades, there is increasing interest in mental health care. But how can we best help those who need help?

This week, we consider three selections. From an opinion piece written by a politician to a study in a leading journal, there is a common thread: how to improve care, whether at the individual level or at the system level.

In our first selection, we consider a new paper from The Canadian Journal of Psychiatry. Evgenia Gatov (a senior epidemiologist at ICES) and her co-authors consider trauma in the inpatient population, with a big finding. “In this population-based study of adult psychiatric inpatients in Ontario, Canada, almost one in three individuals reported prior experiences of interpersonal trauma.”

19609_mainInpatient Care: a need for trauma care?

In our second selection, Dr. Adam Philip Stern (of Harvard Medical School) discusses the challenges of being a patient and a psychiatrist. Dr. Stern – ill with cancer – is in psychotherapy. He discusses much, including the value of connectedness.

And, in our third selection, we look at an essay by Boris Johnson (the new Prime Minister of the United Kingdom) who discusses depression and work. He advocates for tax changes making it easier for companies to help mentally ill employees.

Enjoy.

DG

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Reading of the Week: Who is at Risk for Daily Cannabis Use? What Should Every Physician Know About Global Psychiatry? And Hussein on Her Psychotic Break

From the Editor

It’s legal. It’s also addictive.

As clinician, we worry about who may be at risk of heavier use of cannabis. In a new paper published in The Canadian Journal of Psychiatry, the University of Montreal’s Erika Nicole Dugas and her co-authors draw on data to try to identify early risk factors for daily use, drawing on 23 potential risk factors. Their findings are plausible – could the list be used for early interventions?

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At risk?

Also, this week, we consider my podcast interview with Harvard University’s Vikram Patel, who talks about mental health services in low-income nations. Dr. Patel is fresh off his win of the John Dirks Canada Gairdner Global Health Award, called the Canadian Nobel by some. (I do ask him what he plans to do with the prize money.)

And, in our third selection, singer Ladan Hussein discusses her psychosis – “I returned home to Toronto in January 2018, broken, dishevelled and deranged” – and her recovery.

DG

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