Tagcannabis

Reading of the Week: Is Adult Mental Illness More Common? The New Acta Paper; Also, Hill on Cannabis & Neustadter’s Med School Experience

From the Editor

Family physician colleagues talk about how many patients now disclose mental health problems. Our EDs see more patients with mental illness than ever. Antidepressant use has doubled between 2000 and 2015 across OECD countries.

So is mental illness more common than before?

Just last week, a CBC reporter asked me this question. She noted that the rise of businesses offering mindfulness and the proliferation of mental health apps. But as stigma fades and people are more comfortable talking about mental illness, it’s also possible that more people are seeking care, but that there aren’t more people with illness.

depressionintcover0807Mental illness: more commonly discussed, more common?

In our first selection, we consider a new paper from Acta Psychiatrica Scandinavica. Dirk Richter (of Bern University of Applied Sciences) and his co-authors use a systematic review and meta-analysis to see if adult mental illness is increasing over time. “We conclude that the prevalence increase of adult mental illness is small and we assume that this increase is mainly related to demographic changes.”

In the second selection, we consider a new JAMA review of the evidence – or lack of evidence – for medical use of cannabis. Dr. Kevin P. Hill (of Harvard Medical School) writes: “Insufficient evidence exists for the use of medical cannabis for most conditions for which its use is advocated.”

In the third selection, Yale School of Medicine med student Eli Neustadter discusses a challenging patient and the connection they form. “MB and I also found time to meet weekly in a quiet room with nothing but two chairs, two guitars, and two picks.”

There will be no Readings for the next two weeks. The conversation will continue after Labour Day.

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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Reading of the Week: How Do University Students Use Cannabis? Also, the Life and Legacy of Richard Green, and Scott Gottlieb on E-Cigs

From the Editor

I don’t quite remember when I changed my interview questions, but at some point – more than a decade ago – I stopped assuming that if I asked about street drugs, patients would tell me about cannabis. Long before legalization, people stopped seeing cannabis as illicit. Today, not only is cannabis legal for recreational use, many see it as a drug to be taken for their health.

In a new Canadian Journal of Psychiatry paper, the authors write about cannabis use for medicinal purposes among Canadian university students. Drawing on a survey, they find wide use – but not exactly the use that follows the guidelines.

We also consider two other pieces: an obituary for Dr. Richard Green, a prominent psychiatrist who challenged the DSM’s inclusion of homosexuality, and an interview with Dr. Scott Gottlieb, the outgoing FDA Commissioner, who worries about e-cigarettes.

508221091 Use – but medicinal use?

Enjoy these selections.

And an invitation: the Reading of the Week series invites guest contributions. If this is of interest to you, please let me know.

DG

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Reading of the Week: Is Cannabis Helpful? Can We Prevent Depression? What’s It Like to be Depressed & in Medicine?

From the Editor

In most Readings of the Week, a paper or essay is selected and then discussed. This week, we return to an older format, and look at several selections, offering an overview of a few topics.

The selections ask thought-provoking questions:

Is cannabis helpful?

Can we prevent depression?

What’s it like to be depressed – and in medicine?

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Cannabis: Hype or Help?

Enjoy.

DG

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Reading of the Week: “The Name of the Dog” – Dr. Tafder’s Excellent NEJM Paper & More

From the Editor

There is something often dehumanizing about the health-care experience – the way patients can be reduced to medical-record numbers, the way lives can be summarized in disease names and a few demographic details (“a 30 year old woman with schizophrenia”).

This week, we consider two essays that are about people who happen to be patients – and the lessons that our colleagues have drawn from their stories.

In the first selection, we look at a paper written by Dr. Taimur Safder that was published in The New England Journal of Medicine. It’s about the name of a dog – and much more. During his training, Dr. Safder presents the case of a person who develops chest pain when walking his dog. When the supervisor asks the name of the dog, the physician isn’t sure. “Four years later, I’m not sure anything I’ve carried from residency has been more useful than that question.”

dy_wosjwsamveozNo, this Reading isn’t really about dogs

And, in the second selection, we consider a short essay by Dr. Lee Lu. The Texas doctor describes her experiences working with a patient with substance use problems – and wrestling with her own biases.

Finally, returning to the topic of cannabis legalization, we consider some responses to last week’s Reading, and a CMAJ editorial on the topic.

DG

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Reading of the Week: Cannabis Legalization – Clinical Implications & Major Papers

From the Editor

It’s legal.

After decades of debate, Canada has legalized recreational marijuana, joining an exclusive club of nations with just one other member: Uruguay.

In the coming weeks, many details will be sorted out – some small (the regulation of edibles), some not so small (driving and use). But starting this week, we clinicians work in a different world.

What are the clinical implications of legalization? Will we see more use? How will people present to our EDs and clinics? What should we ask on a history? And how do we treat cannabinoid hyperemesis syndrome? (Spoiler alert: ginger stat.)

In the first selection, I highlight comments by CAMH’s Dr. Jonathan Bertram made in an interview with me. We discuss what every clinician should know about legalization.

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And then with an eye on the journals, I pick a few essential articles on cannabis, drawing from The New England Journal, JAMA, and other major publications, considering topics from the adverse effects of marijuana to the implications for pain management.

DG

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Reading of the Week: Marijuana Policy After Legalization; Also, Remembering Charles Krauthammer

From the Editor

Last week, the Senate voted 52 to 29 in favour of Bill C-45, clearing the last hurdle for marijuana legalization. The federal government is aiming for implementation in the fall.

So, what now?

In the first selection, the University of Toronto’s Tony P. George et al. discuss a “framework” for cannabis policy post-legalization. This Canadian Journal of Psychiatry perspective paper is prescriptive, aiming to reduce the negative effects of the legal change. They make six recommendations, including a national strategy for education.


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Also, in this week’s Reading, we consider the life and psychiatric contributions of Charles Krauthammer, who died last week at age 68. Dr. Krauthammer is best known for his political commentary, but he had a career in psychiatry before becoming a prominent essayist, and penned a classic paper on “secondary mania.”

Please note that there will be no Reading next week.

DG

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