TagNEJM

Reading of the Week: Cuijpers on Depression Treatment (WP); Also, Suicide (NEJM), and Sinyor on DeRozan & Depression (Star)

From the Editor

How to treat depression? How do we approach suicide? Who is the greatest Raptor of all time?

This week, we consider three pieces.

In the first selection, Pim Cuijpers (Vrije Universiteit Amsterdam) and his co-authors do a network meta-analysis of depression treatment, weighing psychotherapy, pharmacotherapy, and the combination of the two. They find: “combined treatment is more effective than psychotherapy or pharmacotherapy alone in the short‐term treatment of moderate depression, and there are no significant differences between psychotherapy and pharmacotherapy.”

In a short New England Journal of Medicine paper, Drs. Seena Fazel (Oxford University) and Bo Runeson (Karolinska Institutet) review a topic of relevance to all clinicians: suicide. “Management of suicidality calls for a comprehensive approach to assessment and treatment.”

TORONTO, ON - SEPTEMBER, 25 DeMar DeRozen poses for photos. It was media day for the Toronto Raptors at their training facility, the BioSteel Centre. Coaches and players met with media, answered questions and had a variety of photographs taken. (Richard Lautens/Toronto Star via Getty Images)Yes, we talk about basketball this week

Finally, in the third selection, the University of Toronto’s Dr. Mark Sinyor writes about basketball and his favourite Raptor – and, yes, stigma.

DG

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Reading of the Week: A Century After Osler, Is He Relevant (NEJM)? Also, AI & Diagnosis (CMAJ) and Ketamine & Safety (JAD)

From the Editor

A century after his death, is Dr. Osler still relevant?

This week, there are three selections. First, we start with a look back with an essay on Dr. William Osler. We then look forward: with papers on AI and ketamine.

In the first selection, Drs. Charles S. Bryan (the University of South Carolina) and Scott H. Podolsky (Harvard University) write in The New England Journal of Medicine about Dr. Osler on the 100th anniversary of his death. Contemplating his life and views, they note that he “gave physicians what certain national historians gave their countries: warm feelings of togetherness, pride, and purpose.”

nlc012022-v6William Osler

In the second selection, we look at a CMAJ paper. Considering AI and health care, University of Strasbourg’s Dr. Thierry Pelaccia and his co-authors write about the reasoning of mind and machine. They see a bright future: “AI can assume its place as a routine tool in medical practice.”

Finally, for the third selection, we consider a new paper on ketamine and safety from the Journal of Affective Disorders. Drawing on several studies, NIMH’s Elia E. Acevedo-Diaz and her co-authors conclude: “The results indicate that a single intravenous subanesthetic-dose ketamine infusion was relatively safe for the treatment of [treatment-resistant depression].”

DG

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Reading of the Week: Cutting-Edge Care – Esketamine for Depression (NEJM), Digital Psychiatry for Suicide Prevention (JAMA Psych), Asylums for All (AJP)

From the Editor

This time of year, many doctors take to social media to offer advice to young colleagues as they start their specialty training (#TipsForNewDocs). Generally, the tweets give solid suggestions on everything from the importance of mentorship to doing regular exercise. For those new grads beginning psychiatry training, I offer: read more, the field is evolving. Since I started my psychiatry residency 19 years ago this month, we have seen new antidepressants placed into the drug cabinets of our patients, mental-health apps populate their smart phones, and clinical guidelines enter our practices, helping us better manage their mental illness.

This week’s Reading focuses on cutting-edge care, and there is plenty to read.

In our first selection, we consider a new paper from The New England Journal of Medicine. Written by Dr. Jean Kim and four other FDA officials, the authors discuss esketamine for depression. “The drug represents an important addition to the treatment options for patients with treatment-resistant depression.”

nasal-spray-sEsketamine: from club drug to depression care

In our second selection, Dr. John Torous (of Harvard Medical School) and Rheeda Walker (of the University of Houston) consider digital psychiatry and suicide prevention, reviewing the field with cautious optimism. The paper opens with a single sentence that puts these efforts in perspective: “Because the rates of suicide attempts and deaths have recently increased to 50-year highs,new solutions are needed.”

And, in our third selection, we look at a not-so-new editorial from The American Journal of Insanity that calls for better treatment of the poor.

Enjoy.

DG

 

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Reading of the Week: ‘Sister First, Doctor Second’ – Dr. Sediqzadah’s NEJM Paper on Her Brother and His Illness

From the Editor

“‘I think your brother has schizophrenia,’ she said.

“I was entering my third year of medical school when I received a phone call from my brother’s friend.”

So begins a perspective paper published in today’s issue of The New England Journal of Medicine. The essay is deeply moving. Written by Dr. Saadia Sediqzadah, a fifth year psychiatry resident at the University of Toronto, the author discusses her brother’s schizophrenia and her family’s efforts to get him care – for Dr. Sediqzadah, dealing with mental illness is not just part of her training.

inclusion-programs-18Saadia Sediqzadah

This week, we consider Dr. Sediqzadah’s paper.

Note that for some of our younger colleagues who have just finished their medical training and begun their specialty training in psychiatry, this week will be your first Reading. Welcome to the conversation.

DG

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Reading of the Week: Do E-Cigarettes Help with Smoking Cessation? The New NEJM Paper

From the Editor

Last week, I spoke to a patient who wanted passes off the ward so that he could smoke. When I suggested that we could help him reduce his nicotine use – and maybe even help him quit – he responded: “I’ve been smoking for 40 years. I’ll never quit.”

As much as the comment is disappointing, it is all too familiar. Nicotine is highly addictive, and it’s very challenging for our patients to quit.

What then to make of e-cigarettes? While they have been marketed well for smoking cessation, the evidence to date has been lacking. Do they offer a pathway to ending nicotine use? Or are e-cigarettes another type of nicotine product – addictive and ultimately unhelpful?

This week, we look at a paper just published in The New England Journal of Medicine. Queen Mary University of London’s Peter Hajek and his co-authors report on a “pragmatic, multicenter, individually randomized, controlled trial” comparing e-cigarettes to nicotine replacement therapy (NRT). It’s the first adequately powered study on this topic. And this Very Big Paper comes with a Very Big Result: e-cigarettes offered a strong advantage over NRTs.

e-cigGreat ad, great product?

In this week’s Reading, we look at the Hayek et al. paper and consider e-cigarettes.

Have thoughts on the Readings of the Week? Please take this 15-question survey to make the Readings better: https://www.surveymonkey.com/r/GP5XXMB.

DG

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Reading of the Week: How to Cope With a Patient’s Suicide? What to do When Nudges Don’t Work? Can Technology Bring Physicians Together?

From the Editor

“We talk about the toll suicide takes on families… We talk about the tragedy for the people who’ve died… What we don’t openly talk about is suicide’s toll on the doctors who have treated these patients.”

So writes Dr. Dinah Miller, a psychiatrist affiliated with Johns Hopkins Medicine. She discusses the death of a patient and the impact on her life.

Dr. Miller’s essay is one of three selections in this week’s Reading.

The papers are different and look at different issues. The one common thread: they were all published in The New England Journal of Medicine.

And they all ask important, thought-provoking questions:

How to cope with a patient’s suicide?

What to do when nudges don’t work?

Can technology bring physicians together?

p17Dr. Dinah Miller

Enjoy.

DG

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Reading of the Week: “The Name of the Dog” – Dr. Tafder’s Excellent NEJM Paper & More

From the Editor

There is something often dehumanizing about the health-care experience – the way patients can be reduced to medical-record numbers, the way lives can be summarized in disease names and a few demographic details (“a 30 year old woman with schizophrenia”).

This week, we consider two essays that are about people who happen to be patients – and the lessons that our colleagues have drawn from their stories.

In the first selection, we look at a paper written by Dr. Taimur Safder that was published in The New England Journal of Medicine. It’s about the name of a dog – and much more. During his training, Dr. Safder presents the case of a person who develops chest pain when walking his dog. When the supervisor asks the name of the dog, the physician isn’t sure. “Four years later, I’m not sure anything I’ve carried from residency has been more useful than that question.”

dy_wosjwsamveozNo, this Reading isn’t really about dogs

And, in the second selection, we consider a short essay by Dr. Lee Lu. The Texas doctor describes her experiences working with a patient with substance use problems – and wrestling with her own biases.

Finally, returning to the topic of cannabis legalization, we consider some responses to last week’s Reading, and a CMAJ editorial on the topic.

DG

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Reading of the Week: Smoking Cessation & Incentives – the NEJM Paper

From the Editor

“So to put it simply, forcing people to choose is not always wise, and remaining neutral is not always possible.” University of Chicago economist Richard H. Thaler and Harvard Law School Professor Cass R. Sunstein write this comment in their widely-read book Nudge: Improving Decisions about Health, Wealth and Happiness. They argue that people could be nudged in a certain direction, improving outcomes. Among the book’s fans: former UK Prime Minister David Cameron and former US President Barack Obama.

Thaler and Sunstein write about shaping basic decisions, like encouraging people to choose among their company’s pension plans. Retirement planning can significantly help people with their finances in their twilight years. But what about substance use? The stakes seem higher: smoking cessation can prevent major health problems long before retirement.

This week, we look at a new paper by University of Pennsylvania Perelman School of Medicine’s Dr. Scott D. Halpern and his co-authors. Published in The New England Journal of Medicine, they consider smoking cessation and find “financial incentives added to free cessation aids resulted in a higher rate of sustained smoking abstinence than free cessation aids alone…”

file-20170804-6503-18ujgw6Nudging people to butt out?

In this week’s Reading, we consider the paper and its implications. (There is, however, no financial incentive offered here.)

DG

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Reading of the Week: Mukherjee on Why Checklists Save Lives – Except When They Don’t

From the Editor

“How could an idea that worked so effectively in so many situations fail to work in this one? The most likely answer is the simplest: Human behavior changed, but it didn’t change enough.”

Readings of the Week generally focus on psychiatric topics. But here’s a task for all of us in health care: improving the quality of care. This week, we look at a new essay written by oncologist Siddhartha Mukherjee, the Pulitzer Prize-winning writer. In it, he talks about the success of using checklists in reducing complications in some places – but not in others. The above quotation comes from this provocative essay.

checklist-850x476 Checklists: Shown to save lives, except when they don’t

Why do checklists work some of the time? In this Reading, we consider the essay, and the larger questions it raises.

DG

 

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Reading of the Week: Three Essays on Mental Illness

From the Editor

As stigma fades, we are as a society talking more and more about mental illness. And we are also writing more on the topic.

This week, the Reading features three essays that ask three provocative questions. Does naloxone access save lives? What’s it like to be depressed and in medical school? How do involuntary commitment laws affect the families of those with mental illness?

These essays are very different in part because they reflect very different perspectives on our collective experience with mental illness: the perspectives of providers, patients, and families.

notebook-1840276_1280

Enjoy.

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