TagJAMA Psychiatry

Reading of the Week: Suicide Prevention in the Acute Care Setting (JAMA Psychiatry); Also, Gottlieb on Racism (Wash Post)

From the Editor

In the year before they suicide, more than 90% of people have had contact with some type of acute care – an ED visit, a trip to the family doctor, or an appointment at an outpatient specialty clinic. So how can we help people better? Given the contact, what can we do to reduce suicides?

This week, we have two selections; the first focuses on this question. In a new JAMA Psychiatry paper, Dr. Stephanie K. Doupnik (of the University of Pennsylvania) and her co-authors do a systematic review and meta-analysis of 14 studies that used brief suicide prevention interventions in acute care settings (think brief contact interventions like a phone call after an ED visit). They find an encouraging result: “In this meta-analysis, brief suicide prevention interventions were associated with reduced subsequent suicide attempts.” We consider the big paper, and the editorial that accompanies it.

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In the other selection, therapist Lori Gottlieb discusses race and therapy in a Washington Post essay. She examines her own biases, and the way they play out in her therapy session. “Here’s what we didn’t talk about [in school]: the racism that might take place inside the supposedly ‘safe space’ of our therapy rooms – our patients’ racism and our own.”

Please note that there will be no Reading next week. Happy Canada Day.

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: COVID & Suicide (JAMA Psych); also, Digital Mental Health (JMIR) and Solomon on COVID & Depression (NYT)

From the Editor

Will suicide rates rise with COVID? How will mental health care delivery change? Are we overlooking the most vulnerable?

This week’s Reading will focus on the latest in the literature on the COVID and mental health care, with three selections.

In the first, we consider a paper on COVID and suicide. In a JAMA Psychiatry paper, Mark A. Reger (of University of Washington) and his co-authors consider the impact of the global emergency on suicide. They are practical, and explain that there are clear opportunities for suicide prevention. In responding to COVID, they call for a “comprehensive approach that considers multiple US public health priorities, including suicide prevention.”

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What is the role of digital mental health during and after this pandemic? In the second selection, we consider a new JMIR Mental Health paper. Dr. John Torous (of Harvard University) and his co-authors note the greater use of telemental health, apps, and other forms of e-mental health care. They write: “The COVID-19 crisis and global pandemic may be the defining moment for digital mental health, but what that definition will be remains unknown.”

Finally, in the third selection, we look at an essay by Andrew Solomon. The Pulitzer Prize-finalist author discusses pandemic and mental health, worrying that those in need may be overlooked. “When everyone else is experiencing depression and anxiety, real, clinical mental illness can get erased.”

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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Reading of the Week: ED Visits & Follow Ups – the New Psych Services Paper; Also, Antipsychotics and Brains (JAMA Psych) and Physician Biases (NEJM)

From the Editor

How accessible is urgent outpatient mental health care in Canada? Do antipsychotics affect the brain structure of people with psychotic depression? How can physician biases change cardiac care?

This week, we consider three very different selections, drawing from the latest in the literature.

Outpatient Sign over a Hospital Outpatient Services Entrance

In the first selection, Dr. Lucy C. Barker (University of Toronto) and her co-authors look at follow-ups after an ED visit. As the authors note: “Urgent outpatient mental health care is crucial for ongoing assessment and management and for preventing repeat visits to the ED and other negative outcomes.” Drawing on Ontario data, they find that “fewer than half had a physician follow-up visit within 14 days of the ED visit for outpatient mental health care.” Ouch.

In the second selection, we consider a new paper by Dr. Aristotle N. Voineskos (University of Toronto) et al. In an impressive study across multiple sites, they find a connection between cortical thinning and the use of antipsychotics: “olanzapine exposure was associated with a significant reduction compared with placebo exposure for cortical thickness.” Ouch.

Finally, it’s said about health care that “geography is destiny” – so much of the patient experience is tied to her or his place of care, with incredible variations in services between, say, rural and urban centres. In an unusual research letter for The New England Journal of Medicine, Andrew R. Olenski (Columbia University) and his co-authors consider heart surgery and patient age – that is, within two weeks of a patient’s 80th birthday. They argue that numbers are destiny, with heart surgery influenced by “the occurrence of left-digit bias in clinical decision-making…” Ouch.

Please note that there will be no Readings for the next two weeks.

DG

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Reading of the Week: COVID-19 & Mental Health (Lancet Psych); Also, Depression & Online Mindfulness (JAMA Psych) and Help for Youth (Globe)

From the Editor

Earlier this week, a patient mentioned that, until recent events, he hadn’t heard of Wuhan, China. Today, it would seem, we are all familiar with this city.

Much reporting and commentary have focused on infections and deaths. But what are the psychiatric implications of the outbreak? This week, we have three selections. In the first, we look at a short and thoughtful paper from The Lancet Psychiatry that tries to answer this question. Dr. Yu-Tao Xiang (University of Macao) and his colleagues note: “In any biological disaster, themes of fear, uncertainty, and stigmatisation are common and may act as barriers to appropriate medical and mental health interventions.”

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In the second selection, we review a new study that uses an online mindfulness-based cognitive therapy aimed at patients with residual depressive symptoms, involving 460 participants. Zindel V. Segal (University of Toronto) and his co-authors find that the intervention “resulted in significant improvement in depression and functional outcomes compared with [usual depression care] only.”

And in the third selection, Drs. Pier Bryden and Peter Szatmari, both of the University of Toronto, discuss their new book. They open their Globe essay with a simple question: “What can I do to help my child?”

DG

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Reading of the Week: Better PTSD Symptom Control, Less Diabetes (JAMA Psych)? Also, Buckley on Cannabis (Quick Takes), and the Life of Kajander (Globe)

From the Editor

Better PTSD symptom control, less diabetes? How do we talk to our patients about cannabis (and cannabis use disorder)? Who was Dr. Ruth Kajander?

This week, there are three selections. The first two deal with timely and relevant topics: the intersection of physical and mental health and the use of cannabis post-legalization. The third reminds us of the youth of our field.

In the first selection, Saint Louis University School of Medicine’s Jeffrey F. Scherrer and his co-authors consider PTSD and diabetes, asking if improvement with the mental health disorder results in a lower risk of type 2 diabetes. Drawing on Veterans Health Affairs data involving nearly 1 600 people, they find that “clinically meaningful reductions in PTSD symptoms are associated with a lower risk of type 2 diabetes.”

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In the second selection, we draw on a podcast interview with the University of Toronto’s Dr. Leslie Buckley, the chief of addictions division at CAMH, on cannabis. What advice would she give clinicians about cannabis use? “Try to have that long conversation with [patients] about their use and make sure that they know the harms – because I feel like most people don’t.”

Finally, with an eye on yesterday and not today, we look at the recent Globe obituary for Dr. Ruth Kajander, a psychiatrist who served in many roles, and was a member of the Order of Canada.

DG

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Reading of the Week: Cannabis in America (and Canada) – the New JAMA Psychiatry Paper with Commentary

From the Editor

It’s legal. Are people using more? And has cannabis use disorder become more common?

This week, we look at a new paper considering cannabis legalization and use. The authors draw on American data where legalization is increasingly found across different states though not as extensively as in Canada; to date, 11 US states have legalized recreational cannabis, with 33 (and D.C.) having legalized medical marijuana.

In a new JAMA Psychiatry paper, Magdalena Cerdá and her co-authors use the National Survey on Drug Use, a major survey involving more than half a million participants, considering marijuana use, frequent use, and cannabis use disorder. What effect does legalization have? They find that cannabis use disorder is more common in adolescents after legalization and for adults who are 26 years of age and older, use, frequent use, and substance use are all up.

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We consider the paper. We also discuss the commentary that accompanies it. Finally, with an eye closer to home, we ask: are the findings relevant here in Canada?

DG

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Reading of the Week: Are the Pills Safe? JAMA Psychiatry on Antidepressants, NICE on Withdrawal Symptoms

From the Editor

They are popular, but are they safe?

It’s the question that patients often ask about antidepressants. Though SSRIs have been on the market for decades – and older antidepressants for much longer – people continue to question their overall safety. Online forums relate stories of problems; news articles have linked them to suicidal thoughts in youth and other issues; regulatory agencies have acted on their doubts – the FDA, as an example, issued a black box warning for SSRIs use in adolescents.

This week, in our first selection, we consider a new paper from Linköping University’s Elena Dragioti and her co-authors. In this JAMA Psychiatry paper, the authors use a systematic umbrella review, drawing on meta-analyses of observational studies. “This study’s findings suggest that claimed adverse health outcomes associated with antidepressants may not be supported by strong evidence and may be exaggerated by confounding by indication; no absolute contraindication to the use of antidepressants was found to be currently supported by convincing evidence.”

We discuss the paper and the methodology.

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In the second selection, we draw from the recently revised UK NICE guideleines, which provide advice on withdrawal symptoms and tapering strategies. “There is substantial variation in people’s experience…”

DG

 

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Reading of the Week: Can Machine Learning Improve Psychotherapy? The New JAMA Psychiatry Paper; Also, Santa Ono on His Mental Illness

From the Editor

“Compared with treatment of physical conditions, the quality of care of mental health disorders remains poor, and the rate of improvement in treatment is slow. Outcomes for many mental disorders have stagnated or even declined since the original treatments were developed.”

Are there two sentences more disappointing to read? One in five Canadians will experience a mental health problem this year – and yet we have basic problems with quality (and access).

Could AI and machine learning help?

In the first selection, we consider a new JAMA Psychiatry paper which opens with the two sentences above. The University of Cambridge’s Michael P. Ewbankand his co-authors don’t simply bemoan the status quo but seek to change it – they “developed a method of objectively quantifying psychotherapy using a deep learning approach to automatically categorize therapist utterances from approximately 90  000 hours of [internet-delivered CBT]…” In other words, by breaking therapy down into a couple of dozen techniques and then employing machine learning, they attempt to match techniques with outcomes (patient improvement and engagement), with an eye on finding what works and what doesn’t. And, yes, you read that right: they drew on 90 000 hours of therapy. They show: “factors specific to CBT, as well as factors common to most psychotherapies, are associated with increased odds of reliable improvement in patient symptoms.”

machinelearninginmarketing-1621x1000Can computers (and machine learning) improve human therapy?

In the second selection, we consider the comments of University of British Columbia President Santa Ono about school and the stresses of school. Ono speaks about his own struggle with depression. “I’ve been there at the abyss.”

DG

 

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