TagThe Globe and Mail

Reading of the Week: COVID-19 & Mental Health (Lancet Psych); Also, Depression & Online Mindfulness (JAMA Psych) and Help for Youth (Globe)

From the Editor

Earlier this week, a patient mentioned that, until recent events, he hadn’t heard of Wuhan, China. Today, it would seem, we are all familiar with this city.

Much reporting and commentary have focused on infections and deaths. But what are the psychiatric implications of the outbreak? This week, we have three selections. In the first, we look at a short and thoughtful paper from The Lancet Psychiatry that tries to answer this question. Dr. Yu-Tao Xiang (University of Macao) and his colleagues note: “In any biological disaster, themes of fear, uncertainty, and stigmatisation are common and may act as barriers to appropriate medical and mental health interventions.”

coronavirus-s1-what-is-coronavirus

In the second selection, we review a new study that uses an online mindfulness-based cognitive therapy aimed at patients with residual depressive symptoms, involving 460 participants. Zindel V. Segal (University of Toronto) and his co-authors find that the intervention “resulted in significant improvement in depression and functional outcomes compared with [usual depression care] only.”

And in the third selection, Drs. Pier Bryden and Peter Szatmari, both of the University of Toronto, discuss their new book. They open their Globe essay with a simple question: “What can I do to help my child?”

DG

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Reading of the Week: Too Few Psychiatrists? Anderssen on the Gap in Access (Globe); Also, Cuijpers on Success in Depression Treatment (Expert Review)

From the Editor

After a break, the Readings are back. In the coming weeks, we will consider important papers on depression treatment, cannabis, help for the homeless, and more.

This week, there are two selections.

In the first selection, we consider the new Globe and Mail essay by reporter Erin Anderssen on the supply (or the lack of supply) of psychiatrists across Canada. This essay does a sparkling job of pulling together stories and reports, and includes an overview of the literature. It paints a familiar, if unsettling, picture of need unmatched by availability, and includes interviews and original data analysis.

She writes: “The modern psychiatrist can’t be everywhere. So they should be where Canadians need them most.”

We summarize the essay and some of the larger questions raised.

anderssenErin Anderssen

In the second selection, the Vrije Universiteit Amsterdam’s Pim Cuijpers writes about depression and treatment. Thinking about successful care, he asks a simple question: “When patients seek treatment, is a reduction of depressive symptoms really what they want, or do patients have other goals as well?”

DG

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Reading of the Week: Better PTSD Symptom Control, Less Diabetes (JAMA Psych)? Also, Buckley on Cannabis (Quick Takes), and the Life of Kajander (Globe)

From the Editor

Better PTSD symptom control, less diabetes? How do we talk to our patients about cannabis (and cannabis use disorder)? Who was Dr. Ruth Kajander?

This week, there are three selections. The first two deal with timely and relevant topics: the intersection of physical and mental health and the use of cannabis post-legalization. The third reminds us of the youth of our field.

In the first selection, Saint Louis University School of Medicine’s Jeffrey F. Scherrer and his co-authors consider PTSD and diabetes, asking if improvement with the mental health disorder results in a lower risk of type 2 diabetes. Drawing on Veterans Health Affairs data involving nearly 1 600 people, they find that “clinically meaningful reductions in PTSD symptoms are associated with a lower risk of type 2 diabetes.”

treating-ptsd-may-help-reduce-risk-of-type-2-diabetes-696x464

In the second selection, we draw on a podcast interview with the University of Toronto’s Dr. Leslie Buckley, the chief of addictions division at CAMH, on cannabis. What advice would she give clinicians about cannabis use? “Try to have that long conversation with [patients] about their use and make sure that they know the harms – because I feel like most people don’t.”

Finally, with an eye on yesterday and not today, we look at the recent Globe obituary for Dr. Ruth Kajander, a psychiatrist who served in many roles, and was a member of the Order of Canada.

DG

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Reading of the Week: Can Psychotherapy Help Inpatients? Why did Michael Wilson Speak Out? Are Patients Experts?

From the Editor

Almost two decades ago, I was invited to a conference. The keynote speaker was Michael Wilson, the former federal Minister of Finance, who died earlier this month. I remember two things about this presentation: first, the audience was perfectly still – as Wilson spoke about his son’s suicide, no one shuffled her papers or chatted with his neighbour; second, I remember thinking how unusual this presentation was: he spoke about suicide at a time when suicide wasn’t discussed.

This week, we look at three selections, including an interview in which Wilson discusses his decision to speak out.

We also consider two other pieces: a new study on psychotherapy for inpatients with depression and an essay considering whether patients are experts.

pjimage-11Michael Wilson

Enjoy.

And I hope you will take a few minutes to complete our survey, aimed at improving the Readings.

https://www.surveymonkey.com/r/GP5XXMB

DG

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Reading of the Week: Can Computerized CBT Help People with Substance Problems? The New AJP Paper. Also, How Many People Really Have Mental Illness?

From the Editor

More than ever, we are talking about substance use problems. But as with other mental health services, people struggle to get care, particularly evidence-based therapies.

In the first selection, we consider a new paper from The American Journal of Psychiatry, published last week. Yale University’s Brian Kiluk and his co-authors compare traditional CBT (done with a therapist and in-person) with a computer-based therapy program, CBT4CBT. They conclude: “This computerized version of CBT thus appears to be an engaging and attractive approach for persons with substance use disorders.”

typingTyping to Treat Substance Use?

In the second selection, we consider an essay by The Globe and Mail’s André Picard who asks a simple question: How many people actually suffer from mental illness? Picard cautions us on “pathologizing normal emotions.”

DG

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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

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Our Globe Essay: “For better mental-health care in Canada, look to Britain”

It may be the biggest change to mental-health-care services in five decades. Earlier this month, Quebec Minister of Health Gaétan Barrette announced that his province would publicly fund psychotherapy for people with depression and anxiety provided by psychologists, nurses and social workers. Ontario made a similar, if smaller, promise earlier this year and other provinces are considering similar initiatives. But how can we turn these big promises into big help for the hundreds of thousands of Canadians who could benefit? Two words of advice: go British.

So begins my new op ed, co-written with CAMH’s David Goldbloom, from Monday’s Globe and Mail.

The full piece can be found here:

https://www.theglobeandmail.com/opinion/for-better-mental-health-care-in-canada-look-to-britain/article37358415/

Reading of the Week: “All Aboard the Bipolar Express” – Beth Beattie on Her Illness & Her Decision to Speak Out

From the Editor

“I was a victim of mental-health stigma – both societal and self-imposed.”

Lawyer Beth Beattie makes that observation in her essay about her experience with bipolar. Her piece – which was just published by The Globe and Mail – is moving and thoughtful.

Bipolar Express: Beattie writes about her journey

In this Reading, we highlight her essay, and comment further on the importance of people speaking out about their illness.

DG

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Reading of the Week: Drugs, Drugs, Drugs – Vermont Tries To Break The Addiction Cycle, and Minister Philpott Weighs In On Opioids

From the Editor

“I don’t think that we can sit back and be complacent for one moment,” said Toronto Mayor John Tory in a media interview in which he called for an ‘all hands on deck’ approach to dealing with opioids.

It’s a comment on our times when the mayor of Canada’s largest city is focused on the use (and abuse) of opioids. And so are others – opioid addiction has sparked conversations across North America, from big city Canada to rural America. In 2014, Peter Shumlin, governor of the second smallest state in the U.S., devoted his annual address to the opioid problem striking “every corner” of Vermont.

Vermont: hills, lakes, opioids

How we deal with opioids is complicated, touching on everything from drug regulation to clinician education. But the legal response is particularly interesting – the intersection of the law, addiction, and public policy. And so, in this Reading, we look at the Green Mountain State. In a Wall Street Journal essay, reporters Jennifer Levitz and Scott Calvert discuss Vermont’s experimentation with mandatory treatment for minor drug-related crimes – and the struggles of a young user.

We also consider federal Minister of Health Jane Philpott’s recent essay on the opioid issue, which ran in The Globe and Mail last week. She calls on us to address the roots of the issue – which “are tangled and deep.”

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