Dr. David Gratzer

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Reading of the Week: How Has Mental Health Changed Over COVID? Also, Goldbloom on Practice & the Pandemic (Globe) and a Reader Responds to Psilocybin

May 13, 2021 / / 0 Comments

From the Editor

Even our language has changed. Last winter, we didn’t think about lockdowns and the term social distancing was confined to sociology textbooks. The world is different.

And in our new reality, we can ask: How has the pandemic affected mental health? While there have been many small surveys (and much speculation), until now we have lacked a major, large scale survey.

This week, we look at a new paper from The Lancet Psychiatry. Matthias Pierce (of the University of Manchester) and his co-authors draw on the UK Household Longitudinal Study – a large, national survey that offers us pandemic and pre-pandemic data. The good news: “Between April and October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels…” but they also found that one in nine people in the UK “had deteriorating or consistently poor mental health.” We consider the big study and discuss resilience with an essay by Dr. Richard A. Friedman (of Cornell University).

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In the second selection, we consider an essay by Dr. David Goldbloom (of the University of Toronto) on how the pandemic has changed psychiatry. He focuses on the biggest change: that is, the embrace of virtual care. He begins: “We are all telepsychiatrists now…” He notes the advantages and disadvantages of the transformation. While some providers express ambivalence, he writes: “What counts, ultimately, is what helps our patients.”

Finally, a reader responds to our take on The New England Journal of Medicine paper on psilocybin. Dr. Craig P. Stewart (of Western University) writes: “One area I did not see mentioned in the psilocybin paper review was a discussion of confirmation bias, which I believe also should be mentioned to contextualize the results.”

DG

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Reading of the Week: How Will Venture Capital Change Psychiatry? Also, Gambling in Canada (CJP) and Dr. Bagley on Her Anxiety (JAMA)

May 6, 2021 / / 0 Comments

From the Editor

Recently, one of patients raved about an app that she started to use. Talkspace offers her access to psychotherapy, unbound by geography, with a variety of therapist options.

The catch: she’s paying for it. In her opinion, it’s a good investment in her mental health. In Wall Street’s opinion, it’s a good investment in their financial health: that app has raised more than $110 million (USD) in venture capital. Other popular apps have also caught the eye and the backing of Wall Street – think Calm ($144 million USD) and Headspace ($167 million USD).

Is venture capital changing mental health care? And what are the potential problems? In the first selection, we consider a new Viewpoint paper by Drs. Ravi N. Shah (of Columbia University) and Obianuju O. Berry (of New York University). They write: “Although the value of this trend is yet to be fully realized, the rise in venture capital investment in mental health care offers an opportunity to scale treatments that work and address mental illness at the population level. However, quality control, privacy concerns, and severe mental illness are major issues that need to be addressed.”

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In our second selection, we look at a new paper by Robert J. Williams (of the University of Lethbridge) and his co-authors on gambling and problem gambling in Canada. Drawing on survey data, they find a surprising result: “Gambling and problem gambling have both decreased in Canada from 2002 to 2018 although the provincial patterns are quite similar between the 2 time periods.”

Finally, in our third selection, Dr. Sarah M. Bagley (of Boston University) discusses the problems of a newborn baby and its impact on his mother. The pediatrician isn’t writing about anyone – she is writing about her own experiences, and the resulting anxiety she experienced. “My story continues, but I hope that by sharing the issue of postpartum health can be better addressed among my colleagues and patients.”

DG

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Reading of the Week: Psilocybin for Depression – The New NEJM Paper

April 29, 2021 / / Comments Off on Reading of the Week: Psilocybin for Depression – The New NEJM Paper

From the Editor

Is this the breakthrough we have been waiting for?

This week, we look at the new study from The New England Journal of Medicine considering psilocybin (a naturally occurring psychedelic compound found in some mushrooms) and escitalopram for depression. The paper, written by Robin Carhart-Harris (of Imperial College) and his co-authors, has received much attention. One online news source quipped: “Tripping may be as effective as your antidepressants.”

In this study, psilocybin was compared to the SSRI with a double-blind, randomized, controlled trial. Carhart-Harris et al. find: “On the basis of the change in depression scores on the QIDS-SR-16 at week 6, this trial did not show a significant difference in antidepressant effects between psilocybin and escitalopram in a selected group of patients.”

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We consider the paper and the editorial that runs with it by Dr. Jeffrey A. Lieberman (of Columbia University). We also ask Dr. Ishrat Husain (of the University of Toronto) for his thoughts. Finally, we mention other cutting-edge treatments.

DG

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Reading of the Week: Aromatherapy for Insomnia? Also, Ramadan and Mental Health and Responding to Vaccine History

April 15, 2021 / / Comments Off on Reading of the Week: Aromatherapy for Insomnia? Also, Ramadan and Mental Health and Responding to Vaccine History

From the Editor

“Sleep is one of the indispensable needs of human beings and is essential for maintaining physical and mental health.”

So writes Yueheng Tang (of the Huazhong University of Science and Technology) and co-authors in a new paper on insomnia. That topic is always relevant; with a third wave and the ongoing stresses of the pandemic, more people than ever seem to be struggling with insomnia. In the past few weeks, I’ve received a flurry of questions from patients and non-patients about remedies for insomnia.

What to make of aromatherapy? It’s trendy – but is it evidence based? In a new paper for the Journal of Affective Disorders, Tang et al. consider aromatherapy which “has a long history in China, and it has been used to strengthen the body and treat diseases since ancient times.” They conduct a meta-analysis, drawing on sixteen articles. They find: “Aromatherapy has a significant effect on improving sleep quality.” We consider the paper and ask: should we recommend this to our patients?

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In the second selection, we look at a new podcast that explores Ramadan and its clinical implications. In this Quick Takes episode, I’m joined by Drs. Juveria Zaheer and Zainab Furqan (both of the University of Toronto). They discuss fasting, mental disorders, and offer some suggestions. For example, with drug regiments: “if a medication is dosed twice daily, we can ask if it can be given safely during the interval when the interval between doses is shortened? So can we give it then in the evening or at dawn and then at sunset again? Or can we give it as one dose? And we need to think about the side effects of the medication.”

Finally, in our third selection, a reader writes us. Dr. Suze G. Berkhout (of the University of Toronto) responds to the paper by Drs. Angela Desmond and Paul A. Offit considering the history of vaccines. “The story the authors tell is history as it is written by the victors: emphasizing the hard work and successes of scientists, while failing to acknowledge the ways in which vaccine technologies have also been part of an exclusionary politics of biomedicine.”

Note that there will be no Reading next week.

DG

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Reading of the Week: A Therapy for Pandemic Loneliness? Also, Getting Digital Psychiatry Right (Lancet Psych) and the History of Vaccines (NEJM)

April 1, 2021 / / Comments Off on Reading of the Week: A Therapy for Pandemic Loneliness? Also, Getting Digital Psychiatry Right (Lancet Psych) and the History of Vaccines (NEJM)

From the Editor

I saw an older patient in the emergency room recently. He described feeling overwhelmed. Fearful of the pandemic, he explained that he had rarely left his apartment since it began. “I’m so isolated.”

Many find themselves in a similar situation. What could help? In a new JAMA Psychiatry paper, Maninder K. Kahlon (of The University of Texas at Austin) and co-authors describe a focused intervention involving laypeople doing an empathy-focused program by phone. Do the calls work? They found it reduced loneliness, anxiety, and depression. They note the potential: “The use of lay callers, deliberate but brief approach on training, and the use of ubiquitous telephones made the approach easily deployable and scalable.”

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In an editorial, The Lancet Psychiatry considers our digital moment. Though they note the trendiness of the idea of digital psychiatry, they urge us to push: “Come 2 years or 20, we want to stop talking about digital psychiatry’s potential for improving public mental health and start marking its clear clinical progress.”

Finally, in our third selection, we look at a new paper from The New England Journal of Medicine. Drs. Angela Desmond and Paul A. Offit (both of the University of Pennsylvania) consider the history of vaccines, and look ahead: “With the recent authorization of mRNA vaccines, we have entered the fifth era of vaccinology.”

Please note that there will be no Reading next week.

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On a pivot –

Since 2014, the Reading of the Week has been providing summaries and commentary on the latest in the psychiatric literature. Two years ago, we conducted a short survey to get your feedback. We are hoping to get feedback again to improve the Readings.

We would like to invite you to join one of our online focus groups to hear your opinions and suggestions. If you are interested in participating, please email smit.mistry@camh.ca by April 12 with your preferred time slots from the following options – psychiatrists: April 21 at 4 pm or April 22 at 4 pm; residents: April 28 at 4 pm and April 29 at 4 pm. (Note: all times are in EST.) Time commitment: under an hour. If the above time slots do not work for you, please email Smit to arrange an interview time at your convenience, preferably between April 21 and April 30, 2021.

DG

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Reading of the Week: The Resident’s Suicide – a New Paper from NEJM; Also, Help Seeking in Medical Education (JAMA Int Med)

March 25, 2021 / / Comments Off on Reading of the Week: The Resident’s Suicide – a New Paper from NEJM; Also, Help Seeking in Medical Education (JAMA Int Med)

From the Editor

“Bobby became my intern, and I was his senior resident. It was a role I cherished, and I tried to teach him all I could about caring for multiple sick patients simultaneously and navigating the systems, personalities, and politics of a large Manhattan hospital.”

Dr. Richard E. Leiter (of Harvard University) writes these words in a New England Journal of Medicine paper, this week’s first selection. He discusses loss – specifically, the death by suicide of the junior resident he was working with. On Twitter, Dr. Leiter commented that it took him six years to write about this death. Reading over the paper, we can understand why; the essay is deeply personal and moving. It also seeks to be constructive: Dr. Leiter calls for change. “Seeking to improve the lives of others shouldn’t cost our trainees their own.”

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Of course, the NEJM article isn’t just about Bobby; it touches on the culture of medicine. Suicide, while always tragic, is rare in health care; untreated depression and substance problems are too common. In the second selection this week, we consider a paper recently published in JAMA Internal Medicine. Dr. Erene Stergiopoulos (of the University of Toronto) and her co-authors note the mixed message of medical education: at once encouraging “wellness” but also criticizing time away. “Stigma surrounding depression is deeply embedded in medicine.” Importantly, Dr. Stergiopoulos and her co-authors makes three practical suggestions.

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On a pivot –

Since 2014, the Reading of the Week (ROTW) has been providing summaries and commentary on the latest in the psychiatric literature. Two years ago, we conducted a short survey to get your feedback. We are hoping to get more feedback to improve the Readings further.

We would invite you to join one of our online focus groups to hear your opinions and suggestions for improvement. If you are interested in participating, please email smit.mistry@camh.ca by April 12 with your preferred time slots from the following options – psychiatrists: April 21 at 4 pm or April 22 at 4 pm; residents: April 28 at 4 pm and April 29 at 4 pm. (Note: all times are in EST.) Time commitment: under an hour. If the above time slots do not work for you, please email Smit to arrange an interview time at your convenience, ideally between April 21 and April 30, 2021.

DG

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Reading of the Week: Our Pandemic Reality – How It Affected Our Patients, How It Changed Our Practice, How It Changed Us

March 18, 2021 / / 1 Comment

From the Editor

A year ago this week, provinces across the country ordered the first lockdown. In the days that followed, I remember driving to the hospital and noting the eerie quiet of the streets with almost no cars or trucks on the morning commute.

Now, a year later, we can ask some questions. How has the pandemic affected our patients? How did it change our practice? How has it changed us?

This week, we have four selections that explore our pandemic reality.

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We begin by focusing on patients. In the first selection, we look at a paper from Annals of Internal Medicine. Dr. Jonathan S. Zipursky (of the University of Toronto) and his co-authors consider alcohol sales and ED visits. They find that there was an increase in alcohol sales of 38% at the start of the pandemic. They write: “Higher alcohol sales during the lockdown are worrisome because alcohol consumption can cause poor judgment, medical complications, and immune suppression.”

In the second selection, we consider an editorial from BMJ. Though some have predicated a significant increase in suicide completions, there is little evidence. Still, the authors write: “We must remain vigilant and responsive, sharing evidence early and internationally… in these evolving uncertain times.”

Then we pivot and look at providers. In the third selection, Dr. Daniel Guinart (of Hofstra/Northwell) and his co-authors report on the findings of a survey on telepsychiatry. “In this study, we report highly favorable attitudes toward telepsychiatry in its diverse forms, across a large and wide array of mental health care professionals.”

In the fourth selection, Andrea Frolic (of McMaster University) talks about the pain of the past year. After breaking a toe, she notes about the psychological injuries of our pandemic life. “As a health care leader, I am supposed to be a cheerleader, a silver-lining finder, an opportunity-seeker – a hero, not a human.”

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Some good news: the Reading of the Week was just awarded the Ivan Silver Innovation Award by Continuing Professional Development of the University of Toronto’s Faculty of Medicine. Many thanks to Drs. Rajeevan Rasasingham and Sanjeev Sockalingam for the nomination.

But I’m committed to developing this program further, not resting on our laurels – in late April, we will be conducting focus groups to better understand what works and what needs improvement. Interested in being involved? Please contact smit.mistry@camh.ca. Time commitment: under one hour.

DG

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Reading of the Week: Tweets for a Good Cause, But Suicide Prevention? Also, Racism in Mental Health (QT), and Rap & Awareness (JAMA Peds)

March 11, 2021 / / 1 Comment

From the Editor

It’s an incredible campaign. With each passing year, Bell Let’s Talk Day gains more recognition, with many, including the Prime Minister, tweeting for a good cause.

But does the campaign affect suicide? In the first selection, we look at new paper from The Canadian Journal of Psychiatry. David Côté (of the University of Toronto) and his co-authors study the tweet contents of Bell Let’s Talk Day and suicide completions. “There was no associated change in suicide counts.” We mull the big campaign and the big paper.

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In the second selection, we look at a new podcast that explores race and racism in mental health. In this Quick Takes episode, I’m joined by Drs. Amy Gajaria and Saadia Sediqzadah (both of the University of Toronto). “Racism exists and it exists in the lives of our patients.” The podcast covers some big topics – but it is also practical, with solid clinical advice.

And in the third selection, Alex Kresovich (of the University of North Carolina) and his co-authors wonder about the cultural discussion of mental health. To that end, they review popular rap songs in a JAMA Pediatrics paper. “The findings of this qualitative study suggest that mental health discourse has been increasing during the past 2 decades within the most popular rap music in the US.”

DG

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Reading of the Week: Mass Murder & Mental Illness – the New Psych Med Study; Also, Vaccinations in the EU (Lancet Psych), and Domise on MAiD and His Illness

March 4, 2021 / / Comments Off on Reading of the Week: Mass Murder & Mental Illness – the New Psych Med Study; Also, Vaccinations in the EU (Lancet Psych), and Domise on MAiD and His Illness

From the Editor

“Mental illness may have been a factor.”

It’s just seven words, but they so often accompany reports of mass murder. And psychosis is mentioned more often than not. The message is clear: mental disorders, particularly psychotic disorders, are highly tied to violence.

In the first selection, we look at a new paper that reviews 120 years worth of mass murder, and distinguishes between gun violence and non-gun violence. Just published in Psychological Medicine, Gary Brucato (of Columbia University) and his co-authors have written an extraordinary paper. They also reach an important conclusion: “These results suggest that policies aimed at preventing mass shootings by focusing on serious mental illness, characterized by psychotic symptoms, may have limited impact.” We look at the big paper.

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In the second selection, from The Lancet Psychiatry, Dr. Livia J. De Picker (of the University of Antwerp) and her co-authors consider European countries and vaccination prioritization, with a focus on mental disorders. “Only four countries (Denmark, Germany, the Netherlands, and the UK) had some form of higher vaccination priority for outpatients with severe mental illness.”

And, in the third selection, writer Andray Domise considers mental illness and medical assistance in dying. In a personal essay for The Globe and Mail, he raises objections. Start here: he would have opted to die when he was unwell. He argues the whole legislative approach is wrong: “This is a country that continues to fail in respecting the humanity of people with disabilities. And rather than find strength of character to improve ourselves, the Canadian government is set to fall back on egregious historical precedent by offering death instead.”

DG

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Reading of the Week: Cannabis and Inpatients – the New CJP Paper; Also, Alexander on Her Loss and Her Patient’s (JAMA)

February 25, 2021 / / Comments Off on Reading of the Week: Cannabis and Inpatients – the New CJP Paper; Also, Alexander on Her Loss and Her Patient’s (JAMA)

From the Editor

First, there was decriminalization; then, legalization.

How have these major legal shifts influenced the presentation of our patients? In the first selection, we consider a new paper from The Canadian Journal of Psychiatry. Taylor McGuckin (of the University of Waterloo) and her co-authors look at cannabis use and inpatient care, drawing on databases. “This study identified a significant increase in the proportion of patients who used cannabis within 30 days of their first admission to inpatient psychiatry in Ontario, Canada, between 2009 and 2017, compared to 2007.”

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How do our biases affect the care we provide? In a moving and personal essay, Karen Alexander (of Thomas Jefferson University) discusses the loss of her baby. She thinks about another time, when a patient of hers was in a similar situation, and she mulls her own views and biases. “The weeping woman was always much more than someone who was grieving, but I never really knew her as a person until I mourned the loss of my own child.”

DG

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