TagSchizophrenia

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.

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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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Reading of the Week: Can We Prevent Psychosis? Part 1 of 2

From the Editor

Here’s a quick statistical summary of the Readings for the past 12 months.

Total: 48.

Number discussing the prevention of mental illness: One.

Is an ounce of prevention really worth a pound of cure?

Like all of medicine, psychiatry tends to emphasize the treatment of illness, not its prevention. This isn’t the result of a vast medical-industrial conspiracy, of course, but the reality that our field is young and the causes of mental illness aren’t well understood.

But preventing illness is our ultimate goal. Consider the suffering and cost that could be avoided if a person at risk of psychosis didn’t convert, as an example.

Can we prevent psychotic illness?

Prevention is built on two things: we need to identify at risk individuals, and then we need to use appropriate measures to prevent the illness.

Over the next two weeks, we look at a few papers that seek to identify at risk individuals and prevent psychosis in them.

This week. The psychosis risk calculator.

Next week. Cost-effective prevention.

In this week’s paper from The American Journal of Psychiatry, Cannon et al. develop a risk calculator to predict psychotic disorder. The tool they develop has an accuracy rate of 71% – comparable to calculators used for determining cancer recurrence.

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Reading of the Week: Mukherjee’s Essay on Schizophrenia, Genetics, and His Uncle

From the Editor

This is a moving essay about family and loss – and the long shadow of mental illness.

It’s lengthy, but worth the time.

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Reading of the Week: Values and Schizophrenia, and More

From the Editor

Welcome to first Reading of the Week of 2016.

Continuing the format started in December, I’ve made several selections here. This week: the obituary of an influential psychiatrist, a clever paper on values and schizophrenia, and a report that considers the use of psychiatric services in Ontario.

In general, Readings in this format don’t have a common theme. That said, this week, a common thread runs through the three selections: challenging assumptions.

Dr. Agid and his co-authors look at the values of those with schizophrenia, challenging the assumption that our patients value what we value; the HQO-ICES report challenges what we think we know about psychiatric care and care delivery in Canada’s largest province. And what can be said of Dr. Robert Spitzer? Well, he made a career out of challenging psychiatric assumptions – much to his credit, and to our benefit.

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