TagSchizophrenia

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.

49472-rideau-canal

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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Reading of the Week: Schizophrenia & Diabetes: The Gap in Care; Also, Swedish Health Care

From the Editor 

“The pain in my feet. It’s killing me.”

That’s what John told me when I asked him what he needed help with. It’s not quite the answer I thought he’d give – John has schizophrenia and he has significant side effects from his medications. But, like many people with mental illness, he also struggles with physical illness (diabetes and the accompanying neuropathy).

Many of our patients have both physical and mental illnesses. When faced with these twin challenges, how do they fair?

In this week’s first selection, we look at a new paper that considers people with schizophrenia and diabetes. The study authors find a significant gap between the care received by those with and without mental illness.

insulinAn old drug, an old illness, and a big problem for those with mental illness

In our second selection, drawing from a lively blog written by medical student Ali Damji, we look at Swedish health care.

DG
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Reading of the Week: Are Cats Making Us Sick? The Solmi et al. Paper, and Prescribing Housing in Hawaii

From the Editor

A few years ago, Czech scientist Jaroslav Flegr made a splash by arguing that our feline friends were causing psychosis in people – The Atlantic provocatively titled their article on him: “How Your Cat is Making You Sick.” Flegr’s argument was based in part on several papers (including by prominent researcher E. Fuller Torrey) noting that cat ownership confers an increased risk of psychotic disorders like schizophrenia.

So, are cats safe for household use?

In our first selection, we look at a new Psychological Medicine paper that, with a cohort study, finds no connection between cat ownership and psychotic symptoms.

Good news, tabby: you can stay

How to help the homeless? In our second selection, drawing from The Guardian, we look at a Hawaiian effort to prescribe the housing to the homeless – literally.

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

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Reading of the Week: Violence & Mental Illness

From the Editor

What’s the connection between mental illness and violence?

For years, the Hollywood depiction was black and white: mental illness caused brutal violent behaviour. And maybe society held those views, too – think of the old newspaper headlines talking about ‘psycho killers.’ Times have changed. Hollywood is slowly abandoning the caricatures; newspapers discuss violence against the mentally ill. But to answer this question, of course, we need to look to studies and journals, not the silver screen and journalism, and understand that the relationship between mental illness and violence is much more nuanced.

Hollywood and mental illness: room for improvement

This week, we review two papers. The first, from Psychiatric Services, considers different types of violence and mental illness. No surprise here: like other studies, the authors show that those with mental disorders are more likely to be victims of violence rather than violent to others. But the authors note a larger picture of violence. This short paper is far-reaching in its findings.

The Canadian Journal of Psychiatry’s February issue considers violence and schizophrenia (part of the In Review Series). The Quinn and Kolla paper presents a thoughtful review of the literature for evidence-based treatments for violence in schizophrenia.

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Reading of the Week: Does Psychiatry Need Rebranding?

From the Editor

Is psychiatry in need of rebranding?

Time for a new name?

It’s easy to think about the incredible progress our field has made in the past decades: the rise of more evidence-based treatments; the fading of stigma; the political dialogue that has begun.

But is “psychiatry” holding psychiatry back? That is, is our old name cutting into our new reality.

In this week’s Reading, we take a look at a short but provocative blog that argues for a rebranding.

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