TagSchizophrenia

Reading of the Week: Psychotherapy at a Distance; Also, Rakoff Remembered (Globe) and Horton on Her Brother (LA Times)

From the Editor

Mental health care has markedly changed since the pandemic began. What is the impact of COVID-19 on psychotherapy?

This week, we have three selections.

In the first, published in The American Journal of Psychiatry, Dr. John C. Markowitz (of Columbia University) and his co-authors write about psychotherapy and virtual care. The paper reviews the literature and also considers practical considerations. They note: “Therapists should acknowledge the crisis, and perhaps that teletherapy is a limited substitute for more direct contact.”

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In the second selection, reporter Wency Leung writes about Dr. Vivian Rakoff, who died earlier this month. In the Globe obituary, Leung writes about his various roles, including as psychiatrist-in-chief of the Clarke Institute (now part of CAMH). “To the many he inspired, he is remembered for his extraordinary intellect, kindness, sense of wonder and the agility with which he wove together ideas from a vast range of disciplines, from classic literature and philosophy to politics and pop culture.”

Finally, in our third selection, we consider an essay by Dr. Jillian Horton (of the University of Manitoba). In this LA Times essay, the internist writes about her brother and his mental illness, discussing the emotional and geographic distance of their relationship. “My brother died 40 years ago and he died in April.”

DG

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Reading of the Week: Physician Burnout, Interrupted (NEJM); also, COVID and Schizophrenia (Schiz Bulletin) and a Reader Responds on Inpatient Care

From the Editor

As we come to understand the new normal – a world of PPEs and precautions – we need to consider not just the implications of the virus on today’s work, but tomorrow’s.

In the first selection, we look at a new paper on physician burnout. In The New England of Journal, Drs. Pamela Hartzband and Jerome Groopman (both of Harvard Medical School) argue that burnout will not be remedied by offers of exercise classes and the other usual prescriptions. Drawing on organizational psychology, they call for a fundamentally different approach, built on autonomy, competence, and relatedness. At a time of COVID, “health care professionals are responding with an astounding display of selflessness, caring for patients despite the risk of profound personal harm. Our efforts are recognized and applauded.” Now, they argue, is the moment for action.

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Are people with schizophrenia at particular risk during this pandemic? In the second selection, we consider a new Schizophrenia Bulletin paper by Dr. Nicole Kozloff (of the University of Toronto) and her co-authors, who answer this question with a convincing yes. “We suggest that thoughtful consideration of the implications of COVID-19 for people with schizophrenia may not only reduce the burden of the global pandemic on people with schizophrenia, but also on the population as a whole.” They offer recommendations.

Finally, in the third selection, a reader responds to last week’s Reading. Rachel Cooper (of the University of Toronto) considers the inpatient experience. “Those of us who have spent time on psychiatric units, particularly while on forms (or held involuntarily), can speak to the immense isolation and feelings of violation of having our basic liberties removed. In this time of COVID, those with the privilege of not having had the experience of being in hospital involuntarily are getting a small taste of that isolation.”

Please note that there will be no Reading next week.

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: Prevention Works – the New JAMA Psychiatry Paper on MIs & Mortality in Patients with Schizophrenia

From the Editor

Statistically, people with major mental illness have a life expectancy that is decades shorter than those without. Not only is that gap significant, but it may be growing. In a 2013 paper, drawing on Danish data, Nielsen et al. showed that the expansion of life expectancy seen in the general population over the past 30 years hasn’t been enjoyed by those with schizophrenia.

Why the gap? And what can be done? A major new paper in JAMA Psychiatry considers the treatment of myocardial infarction. Like Nielsen et al., Aalborg University’s Pirathiv Kugathasan and his co-authors use Danish national databases. They focus on the use (or lack of use) of cardioprotective medications, like statins, after MI. Interestingly, they find that when people with schizophrenia have cardioprotective medications, they can match the outcomes of those without mental illness.

Female doctor with the stethoscope holding heartIs heart health the way to address the gap?

In this week’s Reading, we consider the Kugathasan et al. paper, as well as the accompanying editorial. Then we consider the big question: what can be done?

DG

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Reading of the Week: Weight Loss for People with Schizophrenia? STEPWISE Didn’t Work. On the Big Paper, the Not-So-Big Result & Negative Results

From the Editor

Years ago, I worked with a patient who lost 70 pounds with an aggressive regiment of exercise. His determination was exceptional but his struggles with obesity weren’t. People with schizophrenia are twice as likely as the general population to deal with weight problems.

In the first selection, we consider a paper on weight loss for those with schizophrenia and related illnesses. STEPWISE offered these patients a thoughtful approach to weight management. The paper is remarkable for its finding: the intervention didn’t work. As the University of Southampton’s Dr. Richard I. G. Holt and his co-authors write: “the intervention was neither clinically nor cost-effective over the 12-month intervention period.”

In this Reading, we consider the paper, but also the larger issue of negative trials and their lack of presence in the literature.

bank-failure-lw-schwenk-locWe often read about bank failures; medical study failures, not so much

In the second selection, we draw on a New York Times essay by pediatrician Aaron E. Carroll who calls for the publication of more negative trials. “These actions might make for more boring news and more tempered enthusiasm. But they might also lead to more accurate science.”

DG

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Reading of the Week: Alastair Campbell on his Brother, his Life and his Schizophrenia

From the Editor

“So, my schizophrenia story. Well, the story is mine, but the schizophrenia was Donald’s. He would happily have told you his story himself, for he was very proud of the life he led, given the seriousness of the condition. Sadly, he can’t, as he is dead. So I will tell his story instead.”

Alastair Campbell is many things. He is the author of more than a dozen books. He is a former press secretary and director of communications for UK Prime Minister Tony Blair. He is the father of three.

And he’s the brother of a person who had schizophrenia.

In this week’s Reading, we consider his speech for the Schizophrenia International Research Society, “The Shittiest of all the Shitty Illnesses.” He discusses his brother’s illness and its impact on his family – and he also talks about his brother.

stream_imgAlastair Campbell

In this Reading, we consider Campbell’s comments, and also the larger issue of reduced life expectancy for those with severe mental illness.

DG

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Reading of the Week: Is AVATAR Therapy a Breakthrough for Those Who Hear Voices? The New Lancet Psychiatry Paper

From the Editor

“The voices won’t leave me alone.”

A patient made this comment to me recently. And it’s an experience many patients have had. Despite medications and follow up, the voices continue to be problematic.

This week, we look at a new paper from The Lancet Psychiatry which considers a novel approach: AVATAR therapy.

In this study, patients who experienced auditory hallucinations created a computerized simulation (avatar) of the voice they most wanted to influence, including what the voice said, how it sounded, and how the “entity” with the voice looked like. Patients, working with a therapist who controlled the avatar, then had therapy sessions in which they could talk to it. Patients were compared on several measures to those who only received supportive therapy.

The paper has received significant media attention including CNN and BBC.

1124avatar2The Face of the Voice – and a Step Toward Healing?

Spoiler alert: the therapy helped – at least initially – but the results are complicated. (And, no, this isn’t “fake news,” to borrow a phrase from an American politician.)

In this Reading, we consider the paper and its findings.

DG

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Reading of the Week: The Pill That Talks to Doctors, & More

From the Editor

The pill. The criticism. The question.

Readings have covered everything from new books to political speeches. This week, we consider a few thought-provoking pieces. Is there a common theme? Maybe this: the world of mental health care is changing – and fast.

In these three selections, we look at: the pill that talks to doctors and family, the criticism of digital health, the question about the true nature of schizophrenia.

Enjoy.

DG

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Reading of the Week: Mental Health Care – Doing Bad, Feeling Good? The Hayes et al. Study

From the Editor

Greetings from Ottawa. This morning, the Canadian Psychiatric Association’s 67th Annual Conference opens here. And the agenda looks great, and includes the release of the new Canadian guidelines for the treatment of schizophrenia.

It’s difficult not to feel upbeat, as people from coast to coast to coast gather to discuss new findings and new ideas on problems like refractory depression and chronic pain and, yes, schizophrenia. And this is a great time to be involved in mental health care – as stigma fades and societal recognition grows.

But how are we doing in terms of actual outcomes? This week, we look at a new British Journal of Psychiatry paper. Hayes et al. consider mortality for those with severe mental illness and the rest of us. Unfortunately, the authors find that the mortality gap has grown with time.

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Ottawa: Host city of this year’s CPA Annual Conference

In this Reading, we review the paper and an editorial, and consider the larger context.

DG

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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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