Reading of the Week: The Best of 2015 — Books, Papers, and Hope

From the Editor

This will be the last Reading of the Week for 2015. (The Readings will resume in a fortnight.)

A bit of housekeeping: the Reading of the Week is a labour of love. There is no industry support for this project – or, in fact, any funding. Still, it’s hardly my project. Many readers (particularly residents) suggested papers and made comments over this past year. I’m also deeply grateful for the support of several colleagues; Drs. David Goldbloom and Mark Fefergrad deserve particular mention. And my father and wife have been great editorial supports.

It’s a Reading of the Week tradition to close the year by highlighting the best of the past 12 months.

Looking over the Readings of this year, I’m struck by the diversity of the publications that I could draw selections from. Sure, the Readings of 2015 included papers from The New England Journal of Medicine and JAMA Psychiatry. But they also included moving personal essays that were published in newspapers; The Economist (yes, The Economist) covered mental illness and the burden of disease well and thoughtfully; the best articles on global psychiatry appeared in The New York Times.

It wasn’t that long ago that we hoped that discussion of mental illness would move out of the shadows. Today, slowly but surely, it is. And so, 2015 closes after 48 Readings and on this hopeful note.

DG

The Paper That I Wish Everyone Read

“Measurement-Based Care Versus Standard Care for Major Depression: A Randomized Controlled Trial With Blind Raters”

Tong Guo et al., The American Journal of Psychiatry

http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2015.14050652?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed

One of the biggest problems facing psychiatric practice is the uneven quality of care. How to resolve this? Guo et al. offer up a simple paper with a profound result: in a head-to-head comparison, patients with depression did better with an algorithm-based treatment than with standard psychiatrist-based care. Significantly more patients in the measurement-based care group than in the standard treatment group achieved response (86.9% compared with 62.7%) and – wow – they achieved response faster (5.6 weeks compared with 11.6 weeks).

The Recommendations That I Wish Everyone Read

“Psychiatry: Thirteen Things Physicians and Patients Should Question”

Various Authors, Choosing Wisely Canada

http://www.choosingwiselycanada.org/recommendations/psychiatry/

Choosing Wisely is an excellent health-care campaign, aimed at reducing unnecessary tests and treatments. Working with the Canadian Psychiatric Association, the Canadian Academy of Geriatric Psychiatry, and the Canadian Academy of Child and Adolescent Psychiatry, Choosing Wisely Canada released 13 recommendations for psychiatry this summer. They are thoughtful and reasonable. For the record, my fav is number 9.

The Paper That Will Change Practice

“Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial”

Willem Kuyken et al., The Lancet

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62222-4/abstract

Depression is a chronic disease – how else to explain the high relapse rates? And how can we prevent these relapses? Ongoing medication management is an option but are there other tools in the toolkit? Kuyken and his co-authors designed a beautiful and elegant study comparing medications to mindfulness. Published in The Lancet, their ‘Zen vs. Zoloft’ paper finds this psychological intervention works as well as the pills.

The Paper That Will Change Public Policy

“Effect of Scattered-Site Housing Using Rent Supplements and Intensive Case Management on Housing Stability Among Homeless Adults With Mental Illness: A Randomized Trial”

Vicky Stergiopoulos et al., JAMA

http://jama.jamanetwork.com/article.aspx?articleid=2174029

As you head home this evening, consider this: some 150,000 Canadians don’t have the luxury of stable housing. How to solve chronic homelessness? Funded and initiated by the Mental Health Commission of Canada, At Home/Chez Soi is a Canadian effort to answer that question, with more than $110 million for its initial funding (more than STAR-D, CATIE, and STEP BD put together). The project has generated 80 papers and counting. This JAMA paper provides a nice overview of their groundbreaking work into a lower-cost model for Housing First.

The Most Controversial (and Smart) Commentary of the Year

“Improving Long-term Psychiatric Care: Bring Back the Asylum”

Dominic A. Sisti et al., JAMA

http://jama.jamanetwork.com/article.aspx?articleID=2091312

In this Viewpoint piece, published in JAMA, University of Pennsylvania ethicist Dominic Sisti and his co-authors (including a physician advisor to President Obama) argue that deinstitutionalization – the movement of mentally ill out of hospitals and into the community – has really been transinstitutionalization – with people moving out of hospitals and into the jail system (and to homelessness). They call for a return to the asylum. Needless to say, the solution has produced much response – but the piece is well crafted and identifies a major problem.

Reportage of the Year

“The Chains of Mental Illness in West Africa”

Benedict Carey, The New York Times

http://www.nytimes.com/2015/10/12/health/the-chains-of-mental-illness-in-west-africa.html

Benedict Carey reports from West Africa where psychiatry for the chronically mentally ill is often limited to prayers and chains. There are several articles in the series, and they are collectively a reminder of the deep problems faced by psychiatric patients outside the west. Carney’s writing is beautiful and haunting.

Book of the Year (by a Non-Psychiatrist)

Open Heart, Open Mind

Clara Hughes

Clara Hughes stands as one of Canada’s most decorated Olympians. Her autobiography literally opens by talking about her experience as our country’s flag bearer for the Olympic opening ceremonies. The book also discusses substance misuse and depression, making it a moving story of illness and recovery.

Book of the Year (by a Psychiatrist)

The Other Side of Silence: A Psychiatrist’s Memoir of Depression

Linda Gask

Dr. Gask’s autobiography is about her life in psychiatry – literally. The accomplished psychiatrist, who has excelled both clinically and academically, writes about her own experiences as a person who has struggled with mental illness. This book is raw and powerful.

Op Ed of the Year

“Mr. Trudeau, Canada’s mentally ill need a new approach to care”

Drs. David Gratzer and Goldbloom, The Globe and Mail

http://www.theglobeandmail.com/globe-debate/a-new-approach-to-helping-canadas-mentally-ill/article27629866/

Well, I’m biased, but the central point is important: a new federal government has committed itself to more funding for mental health, but the history of federal health funding increases is that good intentions aren’t matched by good results. Our suggested approach: scale up existing programs that are innovative and evidence-based. We highlight four programs that deserve a national scope.

Reading of the Week. Every week I pick a reading — often an article or a paper — from the world of Psychiatry.

2 Comments

  1. Evidence based medicine seems obvious to those outside the medical system but appears abhorrent to practitioners. Why?

    Irony doesn’t escape me. Us lawyers have awkward metrics.

  2. David,
    Sincere thanks for your recognition.
    Dominic Sisti

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