Tagpsychiatric services

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

 

Continue reading

Reading of the Week: Mental Health & the Opinion Pages – Mental Health Reform (Star), ECT (Guardian), and Suicide and “13 Reasons Why” (LA Times)

From the Editor

“Mental health is out of the closet. Now that we’ve opened the door, time for a closer look at what’s been out of sight for so long.”

This week, we consider three selections. They appeared in newspapers in recent days, and discuss mental health topics. The opening quotation – which is from the first essay – applies to all of them; a closer look: calls for more debate about how mental health services are organized, the care that patients are offered, and the way mental illness is portrayed in our culture.

In our first selection, we consider an op ed from Toronto Star columnist Martin Regg Cohn. He wonders about improving access to mental health care. In a provocative essay, he mulls the mismatch between the supply and demand of services (particularly psychiatric services). He argues: “We might as well accept that our mental health spending will increase significantly over the years. All the more reason to start reallocating funds wisely now.”

newspapersThree Selections, Three Newspapers

In the second selection, we look at an essay by Dr. Mariam Alexander, an NHS psychiatrist, who discusses ECT. She opens simply: “It might come as quite a surprise to learn that, as a psychiatrist, if I ever had the misfortune to develop severe depression, my treatment of choice would be electroconvulsive therapy (ECT).”

And in our third selection, the University of Toronto’s Dr. Mark Sinyor considers the popular show “13 Reasons Why” and offers a cautionary note about the portrayal of suicide. The LA Times op ed notes that Netflix and others have “the potential to do good in the world when handling sensitive mental health issues.”

Enjoy.

DG

 

Continue reading

Reading of the Week: Should You Google Your Patients? Can Telemedicine Help with Medication Adherence?

From the Editor

A few years ago, a patient told me that he had won the lottery. When I expressed some surprise (and skepticism), he replied: google my name. I did, and he had won the lottery.

We google restaurant suggestions, people in the news, and our partner’s new bff.  But is googling your patients ethical? Is it advisable?

In the first selection, we look at a new paper from Psychiatric Services. Yale University’s Charles C. Dike and his co-authors consider these questions and more. They conclude: “Except in emergencies, it is advisable to obtain a patient’s informed consent before performing an Internet or social media search for information about the patient or the patient’s family and significant others.”

3888Does a good history include a good google of your patients?

For the second selection, we consider another paper from Psychiatric Services; the authors ask whether telemedicine can help with medication adherence. In this study, the University of Greifswald’s Lara N. Schulze and her co-authors use texting and phone calls. Spoiler alert: the intervention worked.

And a quick request: I’m looking for feedback on the Reading series. Please take a few minutes to complete the (anonymous) online survey: https://www.surveymonkey.com/r/GP5XXMB.

Note: there will be no Readings for the next two weeks.

DG

Continue reading

Reading of the Week: How to Think about Practice Today – And Tomorrow? A New CJP Paper, a Podcast, and a Report

From the Editor

How do we practice today – and how will we practice in the future?

This week’s Reading includes three selections.

In the first selection, we consider how we practice today, with a new paper by University of Ontario Institute of Technology’s David Rudoler and his co-authors. Drawing on administrative data, they look for practice patterns, finding three distinct ones. Spoiler alert: practice patterns are very different, with 30% of psychiatrists seeing just two or fewer patients per month.

Then, we look ahead. In the second selection, we consider a new podcast discussing digital psychiatry. I talk with Dr. John Torous of the Harvard-affiliated Beth Israel Deaconess Medical Center. And, yes, he has tips on good apps for your patients.

Finally, in the third selection, we consider the recent Ontario government report on ending hallway medicine. The authors look to the future, and make several suggestions, including embracing the potential of digital health care.

messaging-appsApps – the future?

Enjoy.

DG

Continue reading

Reading of the Week: Measurement-based Care – Big Idea, Not-So-Big Reality

From the Editor

Imagine the excitement if a new antidepressant came to market that boasted that it could achieve the symptom reduction of other antidepressants in about half the time, yet had no significant new side effects.

There is no new antidepressant, but there is a study to mull: In 2015, The American Journal of Psychiatry published a paper on measurement-based care for people with depression, and the patients in the measurement group achieved remission in about half the time compared to people seeing a psychiatrist without the guidance of measurement. Though the paper has limitations, it also suggests the incredible potential of measurement-based care.

The measuring tape isolated on white backgroundThe measuring tape isolated on white background

In the first selection, we consider a new review paper published in JAMA Psychiatry. Kaiser Permanente Washington Health Research Institute’s Cara C. Lewis and her co-authors contemplate the potential of measurement-based care – and its reality (greatly underused). They make six points of observation and discussion before going on to propose an agenda.

In the second selection, we look at a paper by the University of Pennsylvania’s David W. Oslin and his co-authors who use survey data to consider the use of measurement-based care in a paper published by Psychiatric Services.

DG

Continue reading

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

Continue reading

Reading of the Week: Social Media & Paranoia — the new Acta Paper; Also, How Do We Change Docs? A Reader Responds

From the Editor

Politicians tweet about townhall meetings; celebrities put vacation pictures on Instagram; your cousin in Europe has her own YouTube channel.

Our world is very different than it was just a few short years ago. (Fun fact: Facebook – a decade and a half old – claims to have more than 2 billion active monthly users.)

But how has social media affected those with mental illness? While this is much discussed in the media, there is little in the literature. In this week’s Reading, we consider a new paper that looks at social media and mental illness, in particular psychosis. Tweet this: the University of Manchester’s Natalie Berry and her co-authors didn’t find a connection between use of social media and increased paranoia.

BELCHATOW POLAND - MAY 02 2013: Modern white keyboard with colored social network buttons.

In this week’s Reading, we consider this new paper from Acta Psychiatrica Scandinavica. We also wonder about the role of the Internet and social media for those with psychosis, drawing from a Psychiatric Services paper.

Also, the University of Toronto’s Dr. Ivan Silver writes a letter to the editor about a previous Reading.

DG

 
Continue reading

Reading of the Week: Appointment Letters & Focused Therapies – Thinking Outside the Box

From the Editor

When we speak of improving the quality of mental health care, we often think about cutting-edge innovation – wearables, virtual reality, genetics, to name a few things.

This week, there are two selections. Both discuss innovations aimed at improving care – but neither could be considered particularly “cutting edge.”

In the first selection, researchers sought to improve outpatient appointment attendance with a decidedly low-tech idea: appointment letters reminding patients of the importance of follow up. Spoiler alert: it worked.

In the second selection, drawn from The New York Times, reporter Andrea Petersen discusses clinics that use a short, intense version of CBT.

Thinking outside the box

Together, these two selections illustrate some thinking outside the box.

DG

 
Continue reading

Reading of the Week: Higher Volume, Better Care? The Rasmussen Paper

From the Editor

How do we improve mental health services?

Past Readings have explored many topics from measurement-based care to better access. This week, we consider a new paper by Aalborg University’s Line Ryberg Rasmussen et al. The study authors look at volume and quality of mental health care, drawing on Danish inpatient admissions.

Their finding? “This nationwide, population-based cohort study demonstrated that patients with depression who were admitted to psychiatric hospitals with very-high-volume wards were more likely to receive care in accordance with clinical guidelines, compared with those admitted to low-volume wards.”

ptelemnursing01High volume, better care (if not better cafeteria food)?

This week, we look at the Rasmussen et al. paper and consider its implications.

DG

Continue reading

Reading of the Week: ECT in America – Uncommon, Uneven, and Underappreciated? The New Wilkinson Paper; Also, Cope’s Challenge to Corporate Canada

From the Editor

It’s difficult not to be excited about Bell Let’s Talk. Last week’s event set a fundraising record. Pause for a moment and appreciate how far we have traveled: a major Canadian corporation is promoting mental health awareness, raising millions of dollars in the process, and gathering praise from many, including the Prime Minister. The decline of stigma is seen across the west, with talk of tackling the opioid epidemic in New Hampshire, US, and of bettering psychological interventions in Hampshire, UK.

But how accessible is evidence-based care?

In the first selection, we consider a paper just published on ECT in the United States. Drawing on a massive database, the authors of this Psychiatric Services paper find ECT is used rarely and unevenly. In this Reading, we compare the American data to Canada’s – and draw a similar conclusion.

flag_map_of_the_contiguous_united_states_1912-1959A large country with many people – but not much ECT

And speaking of Bell Canada, in our second selection, we consider a Globe article on CEO George Cope’s recent Canada Club speech. In it, Cope challenges other businesses to implement a mental health strategy. “For business leaders… here’s the call-out: The numbers are self-funding. There’s no reason not to adopt a program in your company.”

DG

Continue reading