TagJAMA

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: On D-Day, Three Papers on Shell Shock, One by Dr. Charles Myers

From the Editor

Today is the 75th anniversary of D-Day.

Ceremonies are planned across the country, and across Europe; Prime Minister Justin Trudeau is in France. During these anniversaries, people comment on the importance of the moment. US President Barack Obama noted: “much of the progress that would define the 20th century, on both sides of the Atlantic, came down to the battle for a slice of beach only six miles long and two miles wide.” And people speak of the loss of life. US President Ronald Reagan, on a past anniversary, talked about “the boys of Pointe du Hoc” who had tried to take “these cliffs” off the beaches, noting that the majority were killed.

But the damage of war is not only in the loss of life.

In this week’s Reading, we consider shell shock and PTSD starting with the first paper on the topic, written by Dr. Charles S. Myers for The Lancet, published just over a century ago. Dr. Myers writes about three cases of shell shock, noting the similarities in their presentations.

La pointe du Hoc en Normandie (Calvados, Basse-Normandie, France)

We also consider a recent paper, published in JAMA Internal Medicine, discussing a more modern presentation – but perhaps not a profoundly different presentation. Finally, we consider a summary of recent published guidelines.

DG

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Reading of the Week: Dr. Farrell on Her Medical School Days & Her Depression

From the Editor

It’s been 19 years since I finished medical school. Though almost two decades have passed, medical schools are very similar today – the anatomy lessons, the white coat ceremony, the Hippocratic Oath.

But things appeared different then. No one seemed to have struggled with depression or anxiety. Except, of course, that people did – they struggled quietly, and with shame.

This week’s selection is short and moving, and was just published in JAMA. Dr. Colleen Farrell, a resident of internal medicine at NYU, writes about her depression during her med school days – and the lessons she has learned.

premednav_sinai_white_coat-jpg__750x325_q85_crop_subsampling-2_upscaleA white coat ceremony: 1 in 5 adults has a mental health problem – even here

This week, we consider Dr. Farrell’s essay.

DG

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Reading of the Week: “It was scary and sad, but it was also a terrible sort of relief” – Dr. Danziger on Her Father’s Suicide

From the Editor

“By the time my father died, it wasn’t a surprise. It was scary and sad, but it was also a terrible sort of relief.”

So begins a short and honest essay by Dr. Phoebe Danziger. Our American colleague’s JAMA paper doesn’t require much of an introduction. She speaks about her father, his mental illness, and his death. She also touches on her own depression. And she speaks candidly of a childhood coloured by her father’s illness.

36yts2xd_400x400Phoebe Danziger

In this Reading, we consider Dr. Danziger’s essay.

DG

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Reading of the Week: How to Improve Depression Treatment? Cuijpers in JAMA. Also, Kurdyak on Access & Goodman on Mental Health Screening for Docs

From the Editor

This week, we consider three provocative but thoughtful essays.

In the first selection, Vrije Universiteit Amsterdam’s Pim Cuijpers – a highly published researcher in depression – wonders what needs to be done to improve depression outcomes. In this JAMA paper, he notes the importance of the task: “One estimate suggests that approximately 30% of patients with depressive disorders have a chronic course with limited response to treatment.”

ketamine-a-miracle-drug-for-depression-or-not-rm-1440x810Is ketamine a possible breakthrough for depression? Cuijpers ask.

In the second selection, the University of Toronto’s Dr. Paul Kurdyak considers how to address the shortage of psychiatrists – and notes, in this healthydebate.ca essay, that the problem is more complicated than some would suggest; he argues that the supply of psychiatrists across Ontario has little impact on access because of practice styles.

Finally, in the third selection, Columbia University’s Matthew L. Goldman and his co-authors note that doctors are screened for TB. They ask: “Should physicians also be screened for mental health conditions such as depression or burnout?”

DG

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Reading of the Week: Vulnerable Youth & ‘13 Reasons Why’ — the New Psych Services Paper; Also, Dr. Orford Considers his Brother’s Suicide in JAMA

From the Editor

It’s a hit show. Is it dangerous?

Since its launch, 13 Reasons Why has been highly controversial; the storyline of the Netflix series revolves around a teenager’s decision to suicide – which is graphically depicted over three minutes in one episode.

In this week’s Reading, we look at a new Psychiatric Services paper. University of Michigan’s Dr. Victor Hong and his co-authors consider the impact of the show on youth seeking psychiatric care for suicide-related risk. While other studies have analyzed the response in the larger community (including google searches), this study focuses on a vulnerable population. They find: “For certain youths, watching the series correlated with a perceived nonzero elevation in their suicide risk; identification with the main female character and strong affective reactions may be markers of increased risk associated with viewing the show.”

13-reasons-picBig buzz, big problem?

In the other selection, we look at a short essay recently published in JAMA. In “Grief After Suicide,” Dr. Orford discusses the suicide of his brother. The Deakin University intensivist notes that: “As a physician, I have cared for thousands of patients and families in the last hours and days of life. I have listened, watched, and learned.” The loss of his brother, however, continues to have a major effect on his life, three decades later.

DG

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Reading of the Week: Antidepressants after Acute Coronary Syndrome and Depression – A Lifesaver? The New JAMA Paper

From the Editor

State-of-the-art care for acute coronary syndrome includes oxygen and clot-busting drugs. Should it also include a depression screen and an antidepressant if necessary?

In this week’s Reading, we look at a new JAMA paper showing a response to escitalopram for patients post-ACS (Acute Coronary Syndrome) with depression. Though work has been done in this area before, this paper is an important contribution: it’s well designed, and offers a long follow-up period. Chonnam National University Medical School’s Jae-Min Kim and his co-authors conclude: “In this median 8.1-year follow-up of a randomized 24-week clinical trial of treatment for depression in patients with recent ACS, MACE [major adverse cardiac event] incidence was significantly lower in patients receiving escitalopram than those receiving placebo.”

We consider the paper and its implications.

norm_2xGood EKG, good antidepressant?

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

DG
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Reading of the Week: Rahael Gupta on Medical Students & Depression (& her Depression)

From the Editor

Once—and I have never shared this before—I stepped into the street on my walk home from the library. I knew that the bus hurtling through the night would not have time to stop before colliding with my darkly dressed frame, fracturing my bones and scattering my belongings. I imagined my head hitting the asphalt and my brain banging around inside of my skull, bruising irreparably with each impact. I imagined the bus driver’s horror as he turned off the ignition with shaking hands and leapt out of the vehicle to locate my body. It would be a catastrophe that the trauma surgeons could not salvage. I would die.

Rahael Gupta is many things. She’s a graduate of Stanford University, and also Columbia. She’s a medical student. She’s a self-described optimistic. She’s a marathon runner.

And she’s a person who has struggled with depression.

michigan-med-l-med-student-depression-keyvisual

In this week’s Reading, we consider her essay in JAMA. It’s moving and clever and important.

DG

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Reading of the Week: “Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy?” JAMA on Psychotherapy

From the Editor

Is CBT overrated? The authors of a new JAMA paper raise this question in a cutting Viewpoint.

In this two-part Reading of the Week series, we look at two papers, both published in JAMA. These Viewpoint pieces make interesting, provocative arguments.

Last week, we looked at conversational agents.

This week, we ask: is CBT really the gold standard for psychotherapy?

University of Giessen’s Falk Leichsenring and Medical School Berlin’s Christiane Steinert consider CBT and the research that has been done in the area. “CBT is usually considered the gold standard for the psychotherapeutic treatment of many or even most mental disorders.” But should it be? Leichsenring and Steinert argue no.

beck_aaron_t-_112798Aaron Beck: Great bowtie, but is his CBT really so great?

In this Reading, we review their paper, and consider their argument.

DG

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Reading of the Week: “Talking to Machines About Personal Mental Health Problems.” JAMA on Therapy & AI

From the Editor

Will people seek therapy with computers one day, getting care from programs built with Artificial Intelligence?

The authors of a new JAMA paper consider this in a short, clever piece, titled “Talking to Machines About Personal Mental Health Problems.”

In this two-part Reading of the Week series, we look at two papers, both published in JAMA. These Viewpoint pieces make interesting, provocative arguments.

This week, we look at conversational agents.

Next week, we ask: is CBT really the gold standard for psychotherapy?

Stanford University’s Adam S. Miner and his co-authors consider conversational agents – that is software programs that “use conversational artificial intelligence to interact with users through voice or text.” Could there be therapeutic value in such a program? What are the ethical challenges?

Robot and human hands almost touching - 3D render. A modern take on the famous Michelangelo painting in the Sistine Chapel; titled, "The Creation of Adam".

In this Reading, we review the paper, and consider the potential of conversational agents, with an eye on what’s currently available.

DG

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