Dr. David Gratzer

Reading of the Week: ECT at 82

From the Editor

If you were ill with depression, would you consider electroconvulsive therapy? What if you had a manic episode?

In April 1938, the first treatment of ECT was administered in Rome. Now, 82 years later, ECT continues to be used. But, as Dr. David Goldbloom (of CAMH) notes: “ECT has the unusual status of being one of the most vilified and validated treatments in all of psychiatry and indeed in all of medicine.” The treatment has fallen out of favour, and is not even offered in certain centres.

But would you consider ECT?

In the first selection, we look at a new paper from Psychiatric Services. Dr. Rebecca E. Barchas, a retired psychiatrist, discusses her experiences with ECT – as a patient, not as a physician. She notes the depths of her depression and the decision to receive ECT, which she didn’t know much about despite many years of practice. “If reading these thoughts can help even one more patient who needs ECT accept it or help one more physician to consider recommending it when appropriate, I will have accomplished my goal of helping to destigmatize ECT.”

birthday-cake-1200 ECT at 82: Still relevant?

In the second selection, we consider a narrative review from The American Journal of Psychiatry. ECT for patients experiencing manic episodes is used less and less often; in several recent surveys, no patient with mania received ECT. But what’s the evidence? Dr. Alby Elias (of the University of Melbourne) and his co-authors review decades’ worth of literature, from RCTs to retrospective studies, finding the treatment is safe and effective. But is it relevant in an era of pharmacology?

Reading of the Week: Are Those with Mental Illness at More Risk of COVID? Also, a Podcast on Apps (QT) and Horton on Advocacy & Doctors (Macleans)

November 19, 2020 / David Gratzer / Comments Off

From the Editor

Are people with mental illness more likely to contract COVID-19? Are they at greater risk of dying?

With the pandemic in its eighth month, we think we have answers to these questions, but data is lacking. In the first selection, we consider a new paper, just published in World Psychiatry. QuanQiu Wang (of Case Western Reserve) and her co-authors analyzed a nation‐wide database of electronic health records of 61 million American patients, aiming to assess the impact of mental illness. “These findings identify individuals with a recent diagnosis of a mental disorder as being at increased risk for COVID‐19 infection, which is further exacerbated among African Americans and women, and as having a higher frequency of some adverse outcomes of the infection.”

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In the second selection, we consider a new podcast discussing digital tools. I talk with Dr. John Torous (of Harvard University). We discuss apps and mental health. And, yes, he has tips on how to pick apps for your patients and their families.

Finally, in the third selection, we look at a new essay by Dr. Jillian Horton (of the University of Manitoba). Should doctors “stay in their lanes?” She argues against the idea, championing a new activism. “So, to my brothers and sisters in medicine: forget about staying in our lane. This is our call to flood the freeways. We cannot stay parked in neutral. There is no more time.”

Please note: there will be no Reading next week.

Reading of the Week: Substance Problem, Quality of Care Problem? Also, Interventional Psychiatry (CJP) and an Underused Addiction Treatment (NYT)

November 5, 2020 / David Gratzer / Comments Off

From the Editor

In terms of depression treatment, do people with substance use problems get worse care than those without?

The answer should be a resounding no. In the first selection, we consider a new paper, just published in The American Journal of Psychiatry, which suggests otherwise. Lara N. Coughlin (of the University of Michigan) and her co-authors draw on Veterans Affairs data involving more than 53,000 patients. “In this large national sample, we found that patients with comorbid depression and substance use disorders receive lower quality care than those with depression but without substance use disorders.”

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In the second selection, we consider a Canadian Journal of Psychiatry research letter. Dr. Peter Giacobbe (of the University of Toronto) and his co-authors surveyed senior residents, asking about their familiarity and comfort with first line recommendations for the treatment of depression. Spoiler alert: just one in four felt that they had achieved competency in ECT.

Finally, in the third selection, we look at a new essay by journalist Abby Goodnough. With many Americans (and Canadians) struggling with substance problems, she writes about contingency management – that is, rewarding substance users with cash and prizes for sobriety. The concept has evidence in the literature, but lacks political support. She quotes a patient: “Even just to stop at McDonald’s when you have that little bit of extra money, to get a hamburger and a fries when you’re hungry. That was really big to me.”

Note: there will be no Reading next week.

Reading of the Week: Trump on Trump & the Goldwater Rule; Also, Chatbots Reviewed (CJP)

October 29, 2020 / David Gratzer / Comments Off

From the Editor

Should psychiatrists comment on the possible mental health problems of President Donald Trump? His niece thinks so.

In our first selection, we consider an essay by Mary L. Trump. In this Washington Post essay, the psychologist discusses the Goldwater Rule, which prevents members of the American Psychiatric Association from commenting on political figures. Trump feels that psychiatrists should speak up. “Adopting a notionally neutral stance in this case doesn’t just create a void where professional expertise should be – it serves to normalize dysfunctional behavior.” We consider the essay and the questions it raises.

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In the other selection, we pick another current topic, but this time we draw from a journal, not a newspaper, considering a new paper from The Canadian Journal of Psychiatry. Aditya Nrusimha Vaidyam (of Harvard University) and his co-authors do a review of chatbots for mental health; that is, “digital tools capable of holding natural language conversations and mimicking human-like behavior in task-oriented dialogue with people” (think Siri or Alexa, but for mental disorders). “This review revealed few, but generally positive, outcomes regarding conversational agents’ diagnostic quality, therapeutic efficacy, or acceptability.”

Reading of the Week: COVID and a Mental-Health Second Wave; Also, Harry Potter & Suicide Prevention (CJP), and Bennett on Bipolar (Walrus)

October 22, 2020 / David Gratzer / Comments Off

From the Editor

There are more COVID-19 cases in the community – and in our hospitals and ICUs. What does it mean for mental health?

This week, we have three selections.

In the first, published in JAMA, Dr. Naomi M. Simon (of the NYU Grossman School of Medicine) and her co-authors write about the pandemic and the implications for mental health. They argue that there will be a second wave of mental health problems. “The magnitude of this second wave is likely to overwhelm the already frayed mental health system, leading to access problems, particularly for the most vulnerable persons.” Are they right – and what’s to be done?

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In the second selection, we look at a research letter from The Canadian Journal of Psychiatry. Paula Conforti (of the University of Toronto) and her co-authors consider a CBT intervention for school-age children to reduce suicidality and increase wellbeing. There’s a twist in the plot: the intervention is based on a Harry Potter novel. “This study found that a teacher-delivered, literature-based CBT skills curriculum was feasible and associated with reduced suicidality (ideation and behavior) in middle school-aged youth.”

Finally, in our third selection, we consider an essay by Andrea Bennett. In this Walrus essay, the writer discusses the possible link between bipolar and creativity. The essay is deeply personal. “I don’t dream about not being bipolar, because I don’t know where my self ends and where the illness begins – and if there is even really a difference.”

Reading of the Week: Psychotherapy at a Distance; Also, Rakoff Remembered (Globe) and Horton on Her Brother (LA Times)

October 15, 2020 / David Gratzer / Comments Off

From the Editor

Mental health care has markedly changed since the pandemic began. What is the impact of COVID-19 on psychotherapy?

This week, we have three selections.

In the first, published in The American Journal of Psychiatry, Dr. John C. Markowitz (of Columbia University) and his co-authors write about psychotherapy and virtual care. The paper reviews the literature and also considers practical considerations. They note: “Therapists should acknowledge the crisis, and perhaps that teletherapy is a limited substitute for more direct contact.”

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In the second selection, reporter Wency Leung writes about Dr. Vivian Rakoff, who died earlier this month. In the Globe obituary, Leung writes about his various roles, including as psychiatrist-in-chief of the Clarke Institute (now part of CAMH). “To the many he inspired, he is remembered for his extraordinary intellect, kindness, sense of wonder and the agility with which he wove together ideas from a vast range of disciplines, from classic literature and philosophy to politics and pop culture.”

Finally, in our third selection, we consider an essay by Dr. Jillian Horton (of the University of Manitoba). In this LA Times essay, the internist writes about her brother and his mental illness, discussing the emotional and geographic distance of their relationship. “My brother died 40 years ago and he died in April.”

Reading of the Week: Does COVID Affect Outcomes? Also, Depression & Behavioural Economics (JAMA Psych), and Crawford on Virtual Care (Walrus)

October 8, 2020 / David Gratzer / Comments Off

From the Editor

As we head into the second wave, are there lessons from the spring?

This week, we have three selections.

In the first, published in The Lancet Psychiatry, Dr. Seung Won Lee (of the Sejong University College of Software Convergence) and co-authors look at mental illness and COVID-19 in South Korea. Doing a cohort study, drawing on national databases, they wonder about diagnosis and clinical outcomes for those with mental illness. “Diagnosis of a mental illness was not associated with increased likelihood of testing positive for SARS-CoV-2.” It’s a big finding – but is it relevant on this side of the Pacific?

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Can we nudge patients with depression to take medications? In the second selection, we look at a new JAMA Psychiatry research letter. Steven C. Marcus (of the University of Pennsylvania) and his co-authors offer financial incentives for medication compliance. They conclude: “In this pilot study, escalating incentives for daily antidepressant adherence significantly improved adherence compared with a control group during the critical first 6 weeks of treatment.”

Finally, in our third selection, we consider an essay by Dr. Allison Crawford (of the University of Toronto) from The Walrus. She writes about the change in mental health care with COVID-19, as virtual care has become the norm. “I take off my shoes so that I can enter softly and with an open heart. My patients can’t see my bare feet.”

Reading of the Week: Should Police Respond to Mental Health Crises? Also, Apps & College Students (Psych Services) and the Life of DJ Jaffe (NYT)

October 1, 2020 / David Gratzer / 1 Comment

From the Editor

Another tragedy, another headline.

And there have been too many. The stories differ, but there is a common thread: mental illness and a crisis, a 911 call, death. Can we do better?

In the first selection, we consider a new essay by Dr. Sally Satel (of Yale University). Dr. Satel, a psychiatrist, notes recent tragic outcomes with mental health crises. “Nationwide, a person with a psychotic illness is 16 times more likely to be killed during a police encounter than a person without such a condition.” She wonders about an alternative to police responses.

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In the second selection, we look at apps and college students. In a Psychiatric Services paper, Jennifer Melcher and John Torous (of Harvard Medical School) review the recommendations of mental health apps of several university counselling programs. They conclude: “the findings indicated that many counseling centers are suggesting apps that are inaccessible, outdated, potentially dangerous, and without research backing.”

Finally, in our third selection, we consider The New York Times obituary for D.J. Jaffe – the title is a good summary of his life: “Ad Man Turned Mental Health Crusader.” Jaffe, whose sister-in-law has major mental illness, was a strong advocate of various mental health causes, with his influence felt on state and national legislation.

Reading of the Week: Trends in Suicide Mortality in Canada (CJP); also, Suicide Prevention (Quick Takes) and Lawrence on Her Depression (Guardian)

September 24, 2020 / David Gratzer / Comments Off

From the Editor

Suicide is often discussed, but what do we know about the overall rate of completions? We hear that there are more suicides in the United States over the past few years – but was does the Canadian data say?

In the first selection, we consider a new paper by Mélanie Varin (of Indigenous Services Canada) and her co-authors. Drawing on a Canadian database, they consider suicide mortality. The good news: the suicide rate in Canada decreased by 24.0% between 1981 and 2017. But, in recent years, there hasn’t been a further decline.So – is the glass half full or half empty?

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In the second selection, we look further at suicide, considering a new podcast discussing suicide and suicide prevention. I talk with Dr. Juveria Zaheer (of the University of Toronto) about COVID-19, the literature, and, yes, her suggestions for clinical interviews. “If you have a room of one hundred people, one hundred people in that room have been affected by suicide.”

Dr. Rebecca Lawrence is a UK psychiatrist and we can assume that she has done many suicide risk assessments. In a Guardian essay – our third selection – she tells her story: as a person who struggled with mental illness, then made the decision to become a psychiatrist. “If my story helps anyone unsure of their capacity to take on the job, or worried about the ‘dark secret’ of their own psychological troubles, then I think it’s worth telling.”

Reading of the Week: Cannabis for Mental Illness (CJP)? Also, Cannabidiol for the Cannabis Use Disorder (Lancet Psych) & Love on the Police (Globe)

September 17, 2020 / David Gratzer / Comments Off

From the Editor

“Should I take cannabis for my mental illness?”

Our patients ask this question – in our EDs, inpatient wards, and outpatient clinics. We shouldn’t be surprised. Cannabis is now legal, and private industry pushes the medicinal benefits of cannabis. But what does the literature say?

This week, we have three selections.

The first is a new Canadian Psychiatric Association position statement that considers cannabis and mental illness. Dr. Philip G. Tibbo (of Dalhousie University) and his co-authors systematically reviewed the literature. They found 29 RCTs, including for anxiety and psychotic disorders. “Use of cannabis or a cannabinoid product should never delay (or replace) more evidence-based forms of treatment.”

marijuana-candy-sized Many products, little evidence?

But is there emerging evidence for cannabis? Tom P. Freeman (of the University College London) and his co-authors did a phase 2a trial using CBD to address cannabis use disorder, which is written up in The Lancet Psychiatry. “In the first randomised clinical trial of cannabidiol for cannabis use disorder, cannabidiol 400 mg and 800 mg were safe and more efficacious than placebo at reducing cannabis use.”

Finally, on a pivot, in the third selection, we consider an essay from The Globe and Mail. Rebeccah Love writes about her own experiences with psychosis and her recovery. She also considers whether police should be involved in mental health crises. “The image of a police officer – often a big white man with a gun – is interpreted as a threat, an agent of death, an oppressor.”

Dr. David Gratzer

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Reading of the Week: ECT at 82

Reading of the Week: Are Those with Mental Illness at More Risk of COVID? Also, a Podcast on Apps (QT) and Horton on Advocacy & Doctors (Macleans)

Reading of the Week: Substance Problem, Quality of Care Problem? Also, Interventional Psychiatry (CJP) and an Underused Addiction Treatment (NYT)

Reading of the Week: Trump on Trump & the Goldwater Rule; Also, Chatbots Reviewed (CJP)

Reading of the Week: COVID and a Mental-Health Second Wave; Also, Harry Potter & Suicide Prevention (CJP), and Bennett on Bipolar (Walrus)

Reading of the Week: Psychotherapy at a Distance; Also, Rakoff Remembered (Globe) and Horton on Her Brother (LA Times)

Reading of the Week: Does COVID Affect Outcomes? Also, Depression & Behavioural Economics (JAMA Psych), and Crawford on Virtual Care (Walrus)

Reading of the Week: Should Police Respond to Mental Health Crises? Also, Apps & College Students (Psych Services) and the Life of DJ Jaffe (NYT)

Reading of the Week: Trends in Suicide Mortality in Canada (CJP); also, Suicide Prevention (Quick Takes) and Lawrence on Her Depression (Guardian)

Reading of the Week: Cannabis for Mental Illness (CJP)? Also, Cannabidiol for the Cannabis Use Disorder (Lancet Psych) & Love on the Police (Globe)