TagThe New York Times

Reading of the Week: Innovation & Pandemics (NEJM); Also, Telemental Health & Practice (QuickTakes) and Scott on Isolation (NYT)

 

From the Editor

After a short break, the Readings are back. And the world has changed over these past weeks.

We are all dealing with the stress of the pandemic, both at home and at work. I spoke recently with a physician who is a young mother, and she talked about balancing her different obligations, and working to keep her patients and family safe.

These are challenging times.

I want to acknowledge the frustration that we all have, particularly the PGY5, who are so close to completing their studies but have had their Royal College examination postponed. It’s a tough moment for our young colleagues. But I have a few grey hairs, and have seen tough moments come and go – and I believe that things will work out just fine.

This week’s Reading includes three selections.

In the first selection, we consider innovation in the age of pandemic, with a new NEJM paper by Drs. Judd E. Hollander (of Thomas Jefferson University) and Brendan G. Carr (of Sinai). They discuss telemedicine and COVID. “Disasters and pandemics pose unique challenges to health care delivery. Though telehealth will not solve them all, it’s well suited for scenarios in which infrastructure remains intact and clinicians are available to see patients.”

mobile_phone_with_stethoscope_showing_technology_and_health_stock_photo_slide01

Then, we take a practical turn. Many of us clinicians use telemental health; with COVID, many more are thinking about taking the virtual care plunge. In the second selection, we consider a new podcast discussing telemental health. I talk with Dr. Allison Crawford of the University of Toronto. And, yes, she has tips on how to up your virtual care game. And to those thinking about using telemental health, she offers simple advice: “Do it. Try it.”

Finally, in the third selection, we look at a NYT essay by an astronaut. Thinking about his time and isolation in space, Scott Kelly provides some clever advice. “I’ve found that most problems aren’t rocket science, but when they are rocket science, you should ask a rocket scientist.”

DG

Continue reading

Reading of the Week: Social Media & Youth Mental Health – the New CMAJ Paper; Also, Antonetta and Her Illness (NYT)

From the Editor

Politicians tout their opinions on social media. Celebrities use it to tell us about their lives. And for everything from cute kid pics to debates over big issues, social media is part of our way of communicating with the world.

But what are the implications to the mental health of adolescents? Many have an opinion, but what can we glean from the literature? This week, we have a couple of selections. In the first and main selection, we look at a review paper from CMAJ. Dr. Elia Abi-Jaoude (University of Toronto) and his co-authors consider the literature on social media. Then, pulling the different studies together, they offer some clinical advice.

social_media_picSocial media: many options, many problems?

In the second selection, we look at an essay by author Susanne Antonetta. She discusses her psychosis and recovery. “There’s difference between psychosis and physical ailments: In the case of psychosis, no one is likely to stop by with a casserole.”

DG

Continue reading

Reading of the Week: More Sleep, Fewer Suicidal Thoughts? New AJP Paper; Also, Is Depression like Cancer (NYT)? Admissions & Ethnic Minorities (EPS)

From the Editor

Can a sleep intervention reduce suicidal thoughts in those with depression and insomnia?

When seeing people with depression, we often tend to focus on the Big Problem: that is, the major depressive disorder itself. But should we also consider trying to provide early symptomatic relief, with, say, a sleep medication?

In the first selection, we look at a new paper from The American Journal of Psychiatry. Dr. William V. McCall of the Medical College of Georgia at Augusta University and his co-authors write about the REST-IT study, a randomized controlled trial of zolpidem-CR for those with MDD and insomnia. “The results do not support the routine prescription of hypnotic medication for mitigating suicidal ideation in all depressed outpatients with insomnia…”

sleeping-babySleeping Like a Baby: Fewer Suicidal Thoughts?

In the second selection, the University of Western Ontario’s Rebecca Rodrigues and her co-authors consider involuntary psychiatric admissions and ethnic minority groups in the context of early psychosis. Spoiler alert: “African and Caribbean groups were the most likely to experience an involuntary admission…”

And in the third selection, phyisician Jill Halper wonders: is depression like cancer? “My rabbi said that my husband, like a dying cancer patient, had been in hospice care. We just didn’t realize it.”

DG

 

Continue reading

Reading of the Week: Postsecondary Students & Mental Illness (CJP), a New Podcast (CAMH), and Bipolar & Social Media (NYT)

From the Editor

Social media. An uncertain job market. Increasing academic demands.

Is life for our postsecondary students harder than ever? And are we seeing a surge in mental health disorders as a result?

In the first selection, we consider a new Canadian Journal of Psychiatry paper on postsecondary education and mental illness. While many have opinions on this topic, the University of Toronto’s Kathryn Wiens and her co-authors seek to add data to the discussion. Drawing on the Canadian Community Health Survey, they find: “The results do not imply the emergence of a mental health crisis among postsecondary students.”

graduation-feature-20131011

In the second selection, we look at a new podcast considering technology and education. I interview some accomplished educators, including the University of Toronto’s David Goldbloom. “This is about challenging our own norms, values and expectations as clinicians.”

And in the final selection, we consider a New York Times essay on bipolar and social media. “Facebook snitched our big family secret: Roland, the literary prodigy, the tenderhearted musician, the Ivy League grad, was bipolar.”

DG

 

Continue reading

Reading of the Week: PTSD – More Common in High-Income Countries? The New BJP Open Paper; Also, the Trauma of 911 & Torrey on His Sister

From the Editor

Is there more PTSD in countries like Norway and Canada?

The question seems odd since we typically don’t associate major mental illness with affluence (though, of course, not everyone in an affluent society is affluent). Yet there is a literature suggesting that high-income countries may have more PTSD.

This week, we look at a new paper on the topic. The University of Oslo’s Trond Heir and co-authors consider PTSD in Norway. Drawing on a survey, they find significant rates of PTSD, higher than found in low-income countries. “A possible explanation may be that high expectations for a risk-free life or a happy life can lead to a low threshold for perceiving adverse events as life-threatening or as violating integrity.”

norway-aurlands-fjordenNorway: High incomes, universal health care, many fiords, and more PTSD?

In the next selection and continuing on the topic of PTSD, New York Times reporter James Barron writes about the other victims of September 11 – those who survived, but have struggled with PTSD. As a Long Island clinician notes: “So many suffer in silence. It’s 18 years later, and to some it’s pretty new.”

And in the third selection, Dr. E. Fuller Torrey, a psychiatrist and accomplished researcher, considers his career. He notes that his sister’s psychosis pushed him to choose psychiatry, though he had originally planned to be a family doc.

DG

  Continue reading

Reading of the Week: Care – At the System Level, At the Individual Level

From the Editor

As stigma fades, there is increasing interest in mental health care. But how can we best help those who need help?

This week, we consider three selections. From an opinion piece written by a politician to a study in a leading journal, there is a common thread: how to improve care, whether at the individual level or at the system level.

In our first selection, we consider a new paper from The Canadian Journal of Psychiatry. Evgenia Gatov (a senior epidemiologist at ICES) and her co-authors consider trauma in the inpatient population, with a big finding. “In this population-based study of adult psychiatric inpatients in Ontario, Canada, almost one in three individuals reported prior experiences of interpersonal trauma.”

19609_mainInpatient Care: a need for trauma care?

In our second selection, Dr. Adam Philip Stern (of Harvard Medical School) discusses the challenges of being a patient and a psychiatrist. Dr. Stern – ill with cancer – is in psychotherapy. He discusses much, including the value of connectedness.

And, in our third selection, we look at an essay by Boris Johnson (the new Prime Minister of the United Kingdom) who discusses depression and work. He advocates for tax changes making it easier for companies to help mentally ill employees.

Enjoy.

DG

Continue reading

Reading of the Week: Can British Reforms Prevent Mental Illness? What Should Every Physician Know About Burnout? Also, Cardiac Surgery (and Us)

From the Editor

Governments in Canada and across the west have committed themselves to spending more on mental health care. But how should we spend this new money? Should we focus on people earlier in the illness experience? Should we fund evidence-based treatments like CBT? Should education campaigns aimed at reducing stigma be the priority?

UK Prime Minister Theresa May recently announced new mental health reforms. She explained: “It’s time to rethink how we tackle this issue, which is why I believe the next great revolution in mental health should be in prevention.” In this week’s first selection, we look at Prime Minister May’s announcement, and we ask: should Canadian policymakers look to 10 Downing Street for mental health ideas?

larry-cat-10-downing-street10 Downing Street

Also, this week, we consider an interview with Dr. Treena Wilkie, CAMH’s Deputy Physician-in-Chief for Medical Affairs and Practice, who talks about physician burnout. Dr. Wilkie closes with a few words of advice for our colleagues: “There’s help available.”

And, in our third selection, The New York Times investigates deaths in an American hospital. The article isn’t about psychiatry (it’s about health care). But could it be about the problems in your hospital?

This will be the last Reading of the academic year. To my young colleagues who have just graduated: I hope you enjoy your careers in psychiatry as much as I have.

There will be no Reading next week. Should you fall off the distribution list of these Readings, please don’t hesitate to pop me an email.

DG

 

Continue reading

Reading of the Week: Can Social Connectedness Prevent Suicides? The New JAMA Psychiatry Paper on Caring Contacts in the Military

From the Editor

Social disconnectedness contributes to suicide. Past studies have tried to connect with people at risk, using simple tools like postcards.

This week, we look at a JAMA Psychiatry paper. The University of Washington’s Katherine Anne Comtois and her co-authors use a text message-based intervention (Caring Contacts) to try to reduce suicidal thoughts and behaviours in active military personal. They find: “Although the primary hypotheses were not supported, Caring Contacts was found to be a simple, scalable intervention that may be effective in reducing the occurrence of suicide ideation and attempts.”

Military man texts using smart phone in the city Suicide prevention by text: clever? Too clever?

We consider the paper and two editorials. We also consider a New York Times essay that asks: “If suicide is preventable, why are so many people dying from it?”

DG

 

Continue reading

Reading of the Week: How Do University Students Use Cannabis? Also, the Life and Legacy of Richard Green, and Scott Gottlieb on E-Cigs

From the Editor

I don’t quite remember when I changed my interview questions, but at some point – more than a decade ago – I stopped assuming that if I asked about street drugs, patients would tell me about cannabis. Long before legalization, people stopped seeing cannabis as illicit. Today, not only is cannabis legal for recreational use, many see it as a drug to be taken for their health.

In a new Canadian Journal of Psychiatry paper, the authors write about cannabis use for medicinal purposes among Canadian university students. Drawing on a survey, they find wide use – but not exactly the use that follows the guidelines.

We also consider two other pieces: an obituary for Dr. Richard Green, a prominent psychiatrist who challenged the DSM’s inclusion of homosexuality, and an interview with Dr. Scott Gottlieb, the outgoing FDA Commissioner, who worries about e-cigarettes.

508221091 Use – but medicinal use?

Enjoy these selections.

And an invitation: the Reading of the Week series invites guest contributions. If this is of interest to you, please let me know.

DG

Continue reading

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

  Continue reading