TagCOVID-19

Reading of the Week: Perceived Helpfulness of Depression Treatment – the New JAMA Psych Paper; Also, Friedman on Boredom & the Pandemic (NYT)

From the Editor

How helpful do people find treatment for depression?

This question is broad but new work (drawing on WHO surveys) ambitiously attempts to answer it across different countries, including some that are low income.

In the first selection, we consider a paper from JAMA Psychiatry. Meredith G. Harris (of The University of Queensland) and her co-authors report on WHO data. The good news? Many people do find treatment for depression helpful. The bad news? Many providers are needed for people to believe that they had received helpful treatment.

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In the second selection, we look at a new essay by Dr. Richard A. Friedman (of Weill Cornell Medical College). Writing in The New York Times, he discusses the pandemic and the possibility of “a mental health epidemic of depression and anxiety.” Dr. Friedman argues that we are seeing mass boredom, not a rise in disorders like depression. While he can’t fully rule out that the pandemic will bring about an increase in mental health problems, he writes: “let’s not medicalize everyday stress.”

DG
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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 Haughton and 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 Can Past Coronaviruses Teach Us? Also, Sharing Notes (Lancet Psych) & Sediqzadah on Therapy in a Digital World (Globe)

From the Editor

As we consider the psychiatric needs arising from COVID-19, are there lessons to be drawn from past severe coronavirus infections?

The first selection seeks to answer that question.

In The Lancet Psychiatry, Dr. Jonathan P. Rogers (of the University College London) and his co-authors do a systematic review and meta-analysis of severe coronavirus infections with a focus on psychiatric presentations. They included papers covering SARS and MERS. “This review suggests, first, that most people do not suffer from a psychiatric disorder following coronavirus infection, and second, that so far there is little to suggest that common neuropsychiatric complications beyond short-term delirium are a feature.”

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Should mental health notes be shared with patients? In the second selection, we look at paper from The Lancet Psychiatry. Charlotte R. Blease (of Harvard Medical School) and her co-authors champion the idea. “Sharing clinical notes in mental health settings will be more complex than in other clinical specialties; however, for most patients it will be feasible and, if carefully implemented, an empowering tool that could improve care.”

Finally, we consider an essay from The Globe and Mail. Dr. Saadia Sediqzadah (of the University of Toronto), who is graduating from her psychiatry residency this month, discusses her training and the expectation that patients “present to the clinic.” Now practicing in a COVID-19 world, she writes about psychotherapy and her patients. “What would Freud say? I care less about that as we now contend with a very different world than his. The question I ask now is, how will we go back?”

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: Physician Burnout, Interrupted (NEJM); also, COVID and Schizophrenia (Schiz Bulletin) and a Reader Responds on Inpatient Care

From the Editor

As we come to understand the new normal – a world of PPEs and precautions – we need to consider not just the implications of the virus on today’s work, but tomorrow’s.

In the first selection, we look at a new paper on physician burnout. In The New England of Journal, Drs. Pamela Hartzband and Jerome Groopman (both of Harvard Medical School) argue that burnout will not be remedied by offers of exercise classes and the other usual prescriptions. Drawing on organizational psychology, they call for a fundamentally different approach, built on autonomy, competence, and relatedness. At a time of COVID, “health care professionals are responding with an astounding display of selflessness, caring for patients despite the risk of profound personal harm. Our efforts are recognized and applauded.” Now, they argue, is the moment for action.

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Are people with schizophrenia at particular risk during this pandemic? In the second selection, we consider a new Schizophrenia Bulletin paper by Dr. Nicole Kozloff (of the University of Toronto) and her co-authors, who answer this question with a convincing yes. “We suggest that thoughtful consideration of the implications of COVID-19 for people with schizophrenia may not only reduce the burden of the global pandemic on people with schizophrenia, but also on the population as a whole.” They offer recommendations.

Finally, in the third selection, a reader responds to last week’s Reading. Rachel Cooper (of the University of Toronto) considers the inpatient experience. “Those of us who have spent time on psychiatric units, particularly while on forms (or held involuntarily), can speak to the immense isolation and feelings of violation of having our basic liberties removed. In this time of COVID, those with the privilege of not having had the experience of being in hospital involuntarily are getting a small taste of that isolation.”

Please note that there will be no Reading next week.

DG

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Reading of the Week: COVID & Mental Health Access in China (AJP); also, Transformational Care (EBMH) and Psych Wards (New Yorker)

From the Editor

What’s the latest in the literature on COVID and mental health? This week, we focus again on the pandemic with three selections.

In the first, we consider a paper on mental health services at a Chinese hospital during the pandemic. In this American Journal of Psychiatry study, Dr. Junying Zhou (of Sichuan University) and co-authors report on a survey of existing and new outpatients, finding major problems with access. Among the findings: one in five found that their mental health had deteriorated due to a lack of access to care. The authors advocate further study to “ameliorate the negative impact of viral outbreaks in the general public, especially among those vulnerable patients with mental problems.”

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Will COVID change health care once the virus has burned out? In the second selection, we consider a new EBMH editorial by Dr. Katharine Smith (of Oxford University) and her co-authors. They write: “In order to reappraise effectively our new ways of working, both in the immediate management of issues during the pandemic and also during the longer-term aftermath, we need fast-track implementation of evidence-based medicine techniques in mental health to supply the best evidence to clinicians on specific questions in real time.”

Finally, in the third selection, we look at an essay from The New Yorker. Reporter Masha Gessen argues that psychiatric wards are particularly vulnerable during the pandemic. Gessen speaks to several doctors who offer a similar if haunting story: “how a lack of testing, P.P.E., and seclusion protocols were making a difficult task – maintaining the safety of a highly vulnerable population and their care workers during a pandemic – virtually impossible.”

DG

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Reading of the Week: COVID & Mental Health (NEJM); also, Helping Health Workers (CMAJ) and Caring Contact for the Elderly (Globe)

From the Editor

This week’s Reading – like the last few – focuses on the latest in the literature on COVID and mental health care with three selections. As life with the pandemic continues, more and more journals have published about it, with some discussing the implications for mental health services.

In the first selection, we consider a paper on mental health services and the pandemic. In a NEJM paper, Drs. Betty Pfefferbaum (of University of Oklahoma Health Sciences Center) and Carol S. North (University of Texas Southwestern Medical Center) argue for an integrated and measured approach. In responding to COVID, they advocate that: “already stretched health care providers have an important role in monitoring psychosocial needs and delivering psychosocial support to their patients, health care providers, and the public – activities that should be integrated into general pandemic health care.”

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How can we help health workers? In the second selection, we consider a new CMAJ paper by Dr. Peter E. Wu (of the University of Toronto)and co-authors. They write: “Taking care of ourselves is vital so that we may continue to take care of others.”

Finally, in the third selection, we look at a news article from The Globe and Mail. Reporter Erin Anderssen describes how “caring contacts,” a psychiatric intervention, is used by volunteers to connect with the elderly. “The spontaneous initiatives expanding now are prompted more by what we instinctively know: Human contact motivated purely by compassion is essential to our well-being.”

DG

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Reading of the Week: COVID & Serious Mental Illness (JAMA Psych); also, Mental Health Care (Lancet Psych) and Hospital Care (Neurosci Bull)

From the Editor

In a heavy moment, a colleague of mine observed that spring is finally here, but none of us can enjoy it. This comment is one of many made over these past weeks about our new life. Our businesses are closed; our elderly are hiding; our colleagues are on the front lines and at risk. And, yes, the simple pleasure of enjoying a spring day – the warmth in the air, the song of the birds – has been lost, at least for now.

This week’s Reading has three selections, and each touches on the intersection between the pandemic and mental health care. Our new life means new challenges as we attempt to deliver mental health care services.

In the first selection, we consider a paper on COVID and serious mental illness. In a JAMA Psychiatry paper, Dr. Benjamin G. Druss (of Emory University) writes: “Disasters disproportionately affect poor and vulnerable populations, and patients with serious mental illness may be among the hardest hit.”

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What is the role of mental health care during this pandemic? In the second selection, we consider a new Lancet Psychiatry editorial. The editors write: “Although the mental health field’s interest in trauma has greatly expanded in recent decades, our scientific understanding of trauma has lagged far behind, including our understanding of its definition and aetiology, and, importantly, of how to effectively intervene.”

Finally, in the third selection, we look at a letter by Dr. Yuncheng Zhu (of Shanghai Jiao Tong University School of Medicine) and his co-authors. They discuss inpatient care and the risk and prevention of infection. “Panic is inevitable among patients and medical staff and timely mental health care for dealing with the novel coronavirus outbreak is urgently needed.”

DG

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