TagJAMA Psychiatry

Reading of the Week: How to Change Docs? Send Them a Letter. The New JAMA Psychiatry Paper on Prescribing

From the Editor

How do we get doctors to practice better medicine?

Here’s a simple idea: what if we send them a sternly written letter? In this week’s Reading, we consider a paper by Columbia University’s Adam Sacarny and his co-authors who did just that. Targeting primary care physicians who were heavily prescribing quetiapine (or Seroquel), they looked at the effects of letters written by government officials, comparing prescribing habits of these physicians with their peers. The result? In the new JAMA Psychiatry paper, they find that prescriptions of quetiapine dropped markedly.

nudge

A little nudge, better care?

The core of the idea is that a nudge – that is, the behavioural economic idea of a positive reinforcement and/or an indirect suggestion – can change outcomes. In this Reading, we consider doctors and nudges (and behavioural economics). We also look at a recent study on opioid prescribing, also involving letters.

DG

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Reading of the Week: Mental Illness & Crime Victimization – the New JAMA Psychiatry Paper

From the Editor

After the mass shooting on Toronto’s Danforth, mental illness has been much in the news. The Canadian Psychiatric Association went so far as to warn against stigmatizing those with mental illness.

Despite stereotypes, studies show that people with mental disorders are more likely to be victims of violent crime rather than perpetrators. That said, the literature is light on how much crime patients experience, and the diagnoses of these patients.

This week, we look at a new paper just published by JAMA Psychiatry. Drawing on databases from Denmark, the University of New South Wales’ Kimberlie Dean and her co-authors consider crime (including violent crime) in a cohort study involving more than two million people. What do they find? Those with mental illness are much more likely to be victims than the general population.

gettyimages-126140612_superDenmark: old buildings and not-so-old data

In an accompanying editorial, Duke University School of Medicine’s Jeffrey W. Swanson and Charles M. Beldendiscuss the paper, and contrast it with American data. Their piece begins memorably: “The media-driven notion that mentally ill people pose a danger to others appears to be encrusted like a barnacle on the concept of mental illness submerged in the public mind.” They also weigh in on difference in rates of violence between Denmark and the United States.

DG

 

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Reading of the Week: Common Medications and the Link to Depression – the New JAMA Psychiatry Paper

From the Editor

“Many may be surprised to learn that their medications, despite having nothing to do with mood or anxiety or any other condition normally associated with depression, can increase their risk of experiencing depressive symptoms, and may lead to a depression diagnosis.”

JAMA Psychiatry papers rarely make international news. A new paper by the University of Illinois’ Dima Mazen Qato (who is quoted above) and her co-authors has, however. In looking at prescribed drugs like proton pump inhibitors, they find that many are linked to depressive symptoms. One online news report began with the headline: “37% of US Adults Are Using Common Meds They Don’t Realise Could Cause Depression: It’s even worse if you use several medications together.”

It’s a big study with a big result. For the record, a couple of patients have already brought up the findings with me.

statin_2819148bMany small pills, one big problem?

What to think and how should it affect patient care? In this week’s Reading, we consider the paper.

DG

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Reading of the Week: Is Lithium Underrated? Preventing Rehospitalization with Bipolar – the New JAMA Psychiatry Paper

From the Editor

From the perspective of the treatment team, a rehospitalization is a failure – a patient returning to the system, unwell again. From the perspective of the patient and her or his family, a rehospitalization can be frightening and humiliating.

How best to keep people with bipolar affective disorder out of hospital? In a new JAMA Psychiatry paper, the University of Eastern Finland’s Markku Lähteenvuo and his co-authors attempt to answer this question – not by using a RCT, but instead by tapping Finnish national databases.

For the record, they find one medication works better than the others: lithium.

800px-central_hospital_of_central_finlandFinland’s Central Hospital: adequate architecture but good data

In this Reading, we consider the new paper by Lähteenvuo et al., and also consider their approach.

DG

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Reading of the Week: Depression, Pills & Adherence – the Sirey et al. Study on Improving Depression Treatment

From the Editor

The patient is depressed. The doctor has prescribed medications. But the patient doesn’t take them.

As a clinician, this scenario is too familiar with results that are too familiar – the patient doesn’t get better. What can we do to improve adherence?

In this week’s selection, we look at a new paper by Weil Cornell Medicine’s Jo Anne Sirey et al., considering this question. The authors do a randomized controlled trial with “a brief psychosocial intervention designed to improve adherence to pharmacotherapy for patients with depression.” So, is this intervention a game-changer? The authors find a five-fold increase in adherence during the first 6 weeks of care – but not much change in overall depressive symptoms.

153745515Pretty pill bottle: But how can we get patients to take the pills?

In this Reading, we review the paper.

DG

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Reading of the Week: Can Lithium in Drinking Water Help Prevent Dementia? The Kessing et al. Paper from JAMA Psychiatry

From the Editor

Since the extraordinary work of John Cade some seven decades ago, lithium has been used as a medication to help people with bipolar. But the history of lithium use is longer – for many years, people have understood that it has medicinal value, and bottled water containing lithium was popular at the turn of the twentieth century (long before Dr. Cade started medical school).

We know that lithium affects the brain in many ways (for example, it slows apoptosis, or programmed cell death); we also that know that dementia can work on those same pathways, but in a negative way (it may sped up apoptosis). In this week’s selection, the authors wonder if lithium can prevent dementia. It’s a big question – and the authors tap a big national database. They find a non-linear correlation between lithium in drinking water and dementia.

Tap water: A potential prevention for dementia if it has lithium in it?

So – does this paper represent something of a breakthrough? We look at the paper and an editorial to answer that question.

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Reading of the Week: ECT and Inpatients – An Underused Tool?

From the Editor

It’s a powerful tool that helps people with refractory depression and other illnesses.

It’s a treatment that carries a heavy stigma, and is used less today than even a decade ago.

Both statements describe electroconvulsive therapy (or ECT) – perhaps the most controversial intervention in psychiatry. And while it has been studied for decades, little work has been done considering the impact of ECT on inpatient readmissions. In this week’s Reading, we look at a new JAMA Psychiatry paper that studies ECT and readmissions.

Spoiler alert: the study authors found it decreased readmits.

Electroconvulsive therapy at Winwick Hospital in 1957: relevant then as now?

The paper begs a larger question: is an important tool in the treatment of those with mental illness being underutilized as newer (and less effective) treatments are chosen?

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Reading of the Week: Is ‘New’ Overrated? Antipsychotics in the Real World

From the Editor

Is new better?

You may be reading this on an iPhone 7, having driven to work this morning in a 2017 Hybrid Prius. So should your patients be taking a medication that became available four-and-a-half decades ago – when people drove gus-gusling eight-cylinder Oldsmobiles and smartphones didn’t even exist in science fiction novels.

This week, we look at a just-published JAMA Psychiatry paper which promises to look at the “real-world” effectiveness of antipsychotics. The authors tapped Swedish databases to consider outcomes for nearly thirty thousand people with schizophrenia.

Sweden: elaborate welfare state, beautiful historic buildings, and – yes – rich databases

Spoiler alert: new wasn’t better. That is, newer antipsychotics tended to underperform clozapine and depot medications.

We also look at similar “real-world” work drawing from a Finnish database considering treatment of depression.

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Reading of the Week: Better Treatment, Safer Roads? The New JAMA Psychiatry Paper on ADHD & Driving

From the Editor

How can we reduce the number of car accidents?

We often speak about treating mental illness in terms of reducing personal suffering. Recent selections have looked at the economic cost of mental illness. But what are the implications to public health?

This week, we look at a new JAMA Psychiatry paper; this national cohort study involved more than 2.3 million people with ADHD, and considered motor vehicle crashes (as measured by emergency department visits) and whether or not they were taking medications.

Yes, he has a plaid shirt, but should he be taking his prescription meds?

Spoiler alert: The authors find “medication use for the disorder was associated with a significantly reduced risk” of vehicle accidents.

We also look at an editorial that finds “clinical pearls” in this paper.

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Reading of the Week: Effective Therapy for Anxious & Depressed Youth in a Peds Clinic? The New Weersing Study

From the Editor

“Anxiety and depression in youth are widely prevalent, highly impairing, and woefully undertreated.”

So writes San Diego State University’s V. Robin Weersing and her co-authors in a new JAMA Psychiatry paper. In this study, they compare a pediatric clinic-based brief behavioural treatment to referral to outpatient services for depression and anxiety. It’s a novel approach – and one with significant advantages (housing treatment in a primary care setting, to name just one).

So does this work? Spoiler alert: the brief behavioural treatment (BBT) comes out on top.

Anxiety treatment in the peds office: would Norman Rockwell approve?

As an accompanying Editorial notes: “The efficacy of BBT is particularly telling given the low response rate to treatment as usual in the control condition (57% vs 28%), especially for Hispanic populations (76% vs 7%).”

Please note: there will be no Reading next week because of the APA Annual Meeting. (I hope to see you in California.)

DG

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