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Reading of the Week: Smoking, Cognitive Performance, & Mental Illness: Quitting Matters – the New AJP Study

From the Editor

I don’t quite know when the shift occurred, but somewhere between the zeal of residency and the busyness of life as an attending physician, I stopped documenting nicotine use disorder. Indeed, working with severely ill patients, it was a given that they did smoke, and thus hardly worth mentioning. (Studies suggest that smoking is thrice as prevalent among those with schizophrenia compared to the general population.)

For many of our patients, tobacco use is a deadly problem – a major reason why people with severe, persistent mental illness have a life expectancy much shorter than ours.

This week, we consider a new paper from The American Journal of Psychiatry. The University of Academisch Medisch Centrum Universiteit van Amsterdam’s Dr. Jentien M. Vermeulen and her co-authors consider smoking in those with psychosis, their families and a control group, studying the impact on smoking on cognition – and also the impact of smoking cessation on cognition. Though work has been done in this area, the Vermenulen et al. paper is strong: they consider two comparison groups and follow people for six years. Spoiler alert: smoking cessation improved cognition in people with psychosis.

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In this Reading, we consider the paper, as well as the editorial by the University of Miami’s Philip D. Harvey, who raises some good points about what is – and isn’t – in the data.

We close the Reading with a couple of housekeeping items, including my new podcast (which may be of interest to Ontario doctors).

DG

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Reading of the Week: Cannabis Legalization – Clinical Implications & Major Papers

From the Editor

It’s legal.

After decades of debate, Canada has legalized recreational marijuana, joining an exclusive club of nations with just one other member: Uruguay.

In the coming weeks, many details will be sorted out – some small (the regulation of edibles), some not so small (driving and use). But starting this week, we clinicians work in a different world.

What are the clinical implications of legalization? Will we see more use? How will people present to our EDs and clinics? What should we ask on a history? And how do we treat cannabinoid hyperemesis syndrome? (Spoiler alert: ginger stat.)

In the first selection, I highlight comments by CAMH’s Dr. Jonathan Bertram made in an interview with me. We discuss what every clinician should know about legalization.

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And then with an eye on the journals, I pick a few essential articles on cannabis, drawing from The New England Journal, JAMA, and other major publications, considering topics from the adverse effects of marijuana to the implications for pain management.

DG

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