TagCBT

Reading of the Week: Can We Prevent Psychosis? Part 2 of 2

From the Editor

Is an ounce of prevention worth a pound of cure? As noted last week, psychiatry tends to emphasize the treatment of illness, not its prevention. But preventing illness is our ultimate goal.

Can we prevent psychotic illness?

Prevention is built on two things: we need to identify at risk individuals, and then we need to use appropriate measures to prevent the illness.

Last week. The psychosis risk calculator.

This week. Cost-effective prevention.

In this week’s Reading, we look at a paper that considers CBT to prevent psychosis in an ultra high-risk group; the paper also considers the cost-effectiveness of the intervention. So is Ben Franklin right in arguing that an ounce of prevention is worth a pound of cure? The paper doesn’t weigh in on Franklin, of course, but it does find that CBT is economically sound with an 83% likelihood of reducing the transition to psychosis and at a lower cost.

DG Continue reading

Reading of the Week: I Can’t Sleep – Insomnia, Part I of II

From the Editor

It’s one of the most common patient complaints: I can’t sleep.

What many of our patients aspire to…

Insomnia affects 6 to 10% of the population. It’s a common problem – and often chronic. But are we mishandling insomnia?

In a two-part, two-week series, we look at the latest in insomnia research.

This week. Fewer Pills, More Therapy. The new Clinical Practice Guideline.

Next week. Insomnia, Is There an App for That? The GoodNight Study.

This week, we look at the new American College of Physicians Clinical Practice Guideline on insomnia that suggests that CBT-Insomnia should be the first-line treatment.

DG Continue reading

Our New Paper: “Making Evidence-Based Psychotherapy More Accessible in Canada”

Happy to see that our paper has just been published (online first) in The Canadian Journal of Psychiatry. And what a great project. My co-author, Dr. David Goldbloom, is a former supervisor from my training, a mentor, and a friend. Back in residency, we talked about a joint project – so glad that, after a few years, it happened.

As usual, I learned much from working with him.

You can find the paper here:

http://cpa.sagepub.com/content/early/2016/04/05/0706743716642416.full.pdf+html

Reading of the Week: To Screen or Not to Screen – Pregnancy & Depression Screening

From the Editor

“Panel Calls for Depression Screenings During and After Pregnancy”

A government health-care panel making a revision to a past recommendation seems pretty ‘inside baseball’ – and hardly the stuff of international headlines. Last week, though, the decision of the U.S. Preventive Services Task Force to now recommend the screening of pregnant and post-partum women for depression was reported from New York to New Delhi.

For the record, The New York Times story (whose headline appears above) ran on the front page.

Why the change and what are the implications?

To screen or not to screen…

This week’s Reading looks at the big decision and we consider: is it a big bust?

DG Continue reading

Reading of the Week: Freud Is Dead – Are His Ideas Dead, Too?

From the Editor

Sigmund Freud is dead.

Are his ideas dead, too?

Sigmund Freud – Irrelevant?

Psychiatry has left much of Freudian analysis behind. Is that a good thing? This week’s Reading ponders this question – first, with an excellent essay by The Guardian’s Oliver Burkeman that considers “the revenge of Freud,” then with a response from New York Magazine’s Jesse Singal, and, finally, with a recent paper from The American Journal of Psychiatry comparing patients with bulimia who received psychoanalysis and who received CBT.

DG Continue reading

Reading of the Week: The Suicidal Doctor

From the Editor

In December, the Readings included the Mata et al. paper from JAMA considering depression and residents. The review – which included more than 50 papers – found that the prevalence of depression or depressive symptoms among resident physicians was 28.8%.

Dr. David Goldbloom’s comment on the paper is worth repeating: “it is a sobering reminder that the white coat is not Kevlar against the illnesses we treat, and our professional culture still has a long way to go in recognizing, accepting and supporting that we get sick, too.”

This week we look again at physicians and mental health. The first selection is an essay by a doctor in which he discusses his suicidal thoughts. Then, with an eye on practical interventions to help doctors at risk, we consider the JAMA Psychiatry study on CBT for interns (with a modern twist).

DG Continue reading

Reading of the Week: Physician, Heal Thyself: Residents and Depression, and More

From the Editor

This week – like last week – we pick a few interesting readings to consider.

This week’s selections: a chef and his addiction, a major new JAMA paper on resident physicians and depressive symptoms, and a big paper from BMJ comparing CBT and meds for depression.

Next week: the best of the year (the annual tradition). Suggestions are welcome for the best papers of 2015.

DG

Selection 1

“Three years after his mysterious disappearance, former Langdon Hall chef breaks his silence”

Mark Schatzker, The Globe and Mail, 1 December 2015

On the night of Dec. 28, 2012, Jonathan Gushue, one of Canada’s most decorated chefs, disappeared. He finished a dinner service at Langdon Hall that included pickerel in crème fraîche with black radish and black-pepper honey, got into his car and never arrived home.

No one, including Gushue’s wife, his sous chefs and his friends, knew what had happened to the 41-year-old father of three who, just two years earlier, had put Langdon Hall, in Cambridge, Ont., on the prestigious San Pellegrino World’s Best Restaurants list. As the chef’s disappearance made headlines from coast to coast, mysterious details began leaking out – his phone was found at an upscale Toronto hotel – but nothing more.

Thirteen days later, Gushue was found and reported safe. Several months later, he left Langdon Hall, then vanished from public life.

Jonathan Gushue

Gushue had it all – a young family and a soaring career. He also had alcoholism. Continue reading

Reading of the Week: Depression and Primary Care (Depression: Week 2 of 3)

Depression is a common psychiatric disorder and a major contributor to mortality and morbidity worldwide. Over the past decade in Sweden, work absence because of mental ill health has risen markedly and depression is a major factor. Substantial societal costs are associated with the disorder, which affects up to 15% of the population at any one time and tends to be recurrent. There are compelling reasons to investigate alternative treatments for depression. Although effective treatments exist, most people with the disorder never seek professional help. Among those that do, only half appear to benefit. Adherence with medication is often poor and waiting times for cognitive–behavioural therapy (CBT) can be lengthy, resulting in more entrenched symptoms and a worse long-term prognosis. As general medical practitioners are frequently the main care providers for depression, treatment options that are non-stigmatising, have few side-effects and can readily be prescribed in community healthcare settings are needed.

So begins a new paper that considers depression treatment in Sweden. These issues sound very familiar. Reading over this list of problems – the burden of illness, the inaccessibility of care, etc. – we could replace Sweden with Canada. And that’s why this paper is so relevant to us.

This week’s Reading: “Physical exercise and internet-based cognitive–behavioural therapy in the treatment of depression: randomised controlled trial” by Mats Hallgren et al., which was just published in the British Journal of Psychiatry.

Mats Hallgren

A quick summary: this is a smart paper seeking ways to improve the treatment of depression in the primary care setting. How to achieve better results? Hallgren et al. consider exercise and Internet-based CBT, and compare such interventions to the usual care. Continue reading

Reading of the Week: Is CBT Losing Its Effectiveness? The Johnsen and Friborg Paper

Depressive disorders (DDs) can be highly disabling and are ranked third in terms of disease burden as defined by the World Health Organization, and first among all psychiatric disorders in terms of disability adjusted life years. In addition, DDs seem to be rising globally, and a 20% annual increase in its incidence has been predicted. Improvements in treatment methods and prevention measures, and the availability of community psychiatric services are, therefore, as important as ever before.

So begins, without much controversy, this week’s Reading – which happens to be one of the most controversial papers of the year.

This meta-analysis has been mentioned in newspapers and blogs. No wonder – in 22 pages, it raises questions about the effectiveness of a major psychiatric treatment: cognitive behavioural therapy.

The Reading: “The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis” by Tom J. Johnsen and Oddgeir Friborg, recently published in the prestigious Psychological Bulletin.

The full paper can be found here:

https://uit.no/Content/418448/The%20effect%20of%20CBT%20is%20falling.pdf

Tom J. Johnsen

A quick summary: analyzing data from 70 studies over nearly four decades, Johnsen and Fribourg find CBT to have become less effective at reducing depressive symptoms. Continue reading

Reading of the Week: Insomnia and Its Treatment

Cognitive behavioral therapy for insomnia (CBT-I) is a multicomponent treatment package that usually includes stimulus control, sleep restriction, and cognitive therapy and has emerged as the most prominent nonpharmacologic treatment for chronic insomnia. Previous meta-analyses have found that CBT-I improves sleep parameters and sleep quality at post treatment and follow-up for adults and older adults. Most of these studies selected individuals with primary insomnia, excluding patients with co-morbid psychiatric and medical conditions. However, patients with insomnia who present to internists and primary care physicians are likely to report comorbid conditions associated with the sleep disturbance. Furthermore, insomnia was previously conceptualized as a symptom arising from the comorbid disorder and treatment was targeted at the underlying disorder. However, accumulating evidence indicates that insomnia can have a distinct and independent trajectory from the comorbid disorder, thus indicating a need for separate treatment from the comorbid condition.

So begins this week’s Reading, which considers CBT-I for people with insomnia. Here’s a quick summary: big study, big journal – and big relevance to your patients.

This week’s Reading: “Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis” by Jade Q. Wu et al. was just published in JAMA Internal Medicine. Find the paper here.

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Wu et al. consider a very common problem: insomnia. Many patients – whether they have mental health issues or physical health issues – struggle with insomnia. Boston University health economist Austin Frakt has written about his insomnia for The New York Times. He notes that he decided to receive treatment when:

One weekend afternoon a couple of years ago, while turning a page of the book I was reading to my daughters, I fell asleep. Continue reading