Month: June 2017

Reading of the Week: Do Suicide Barriers Work? Sinyor et al. on the Bloor Viaduct and Toronto Suicides

June 29, 2017 /

From the Editor

Do suicide barriers really work, or do they cost money that could have been better spent elsewhere?

This debate raged in Toronto about a decade and a half ago when some argued that a suicide barrier must be added to the Bloor Viaduct. That bridge, which connects downtown Toronto with its east end, was considered a “suicide magnet” – a place that proved popular for suicide attempts. In North America, only the Golden Gate Bridge in San Francisco had more suicides associated with it. Media coverage of the debate included an article in The New York Times; it ran with the dramatic headline: “A Veil of Deterrence for a Bridge With a Dark Side.”

And in 2003, the barrier went up.

So did the suicide rate go down?

This week, we look at a new paper just published by Sunnybrook’s Mark Sinyor et al. Drawing on years of data, they consider the utility of the Bloor Viaduct suicide barrier. They find that it has saved lives. The paper obviously has implications for other bridges and cities.

The Bloor Viaduct: big debate, big outcome?

The authors also looked at media reporting on suicide.

DG Continue reading

Reading of the Week: Is ‘New’ Overrated? Antipsychotics in the Real World

June 22, 2017 /

From the Editor

Is new better?

You may be reading this on an iPhone 7, having driven to work this morning in a 2017 Hybrid Prius. So should your patients be taking a medication that became available four-and-a-half decades ago – when people drove gus-gusling eight-cylinder Oldsmobiles and smartphones didn’t even exist in science fiction novels.

This week, we look at a just-published JAMA Psychiatry paper which promises to look at the “real-world” effectiveness of antipsychotics. The authors tapped Swedish databases to consider outcomes for nearly thirty thousand people with schizophrenia.

Sweden: elaborate welfare state, beautiful historic buildings, and – yes – rich databases

Spoiler alert: new wasn’t better. That is, newer antipsychotics tended to underperform clozapine and depot medications.

We also look at similar “real-world” work drawing from a Finnish database considering treatment of depression.

DG Continue reading

Reading of the Week: Dreams of My Uncle – Husock on His “Unmentionable” Uncle & His Mental Illness

June 15, 2017 /

From the Editor

“To say that I didn’t know my great-uncle, Wolfe Levine, would understate things. I didn’t even know of such an uncle, brother of my mother’s father (a grandfather with whom I was close). In retrospect, it’s clear that my great-uncle was simply unmentionable.”

So begins Howard Husock, Vice President of the Manhattan Institute for Public Policy, in a long essay that traces the illness and institutionalization of his great uncle.

The author’s great uncle

The piece asks a simple question: “Are we treating the mentally ill better today than we did a century ago?”

It’s a beautiful essay, that touches on history, psychiatry, and a family member who was “unmentionable.”

DG Continue reading

Award of Excellence in Mental Health

June 14, 2017 /

Individuals in need of Cognitive Behavioral Therapy (CBT) typically face challenges like long wait lists, a shortage of therapists, and lack of access to a therapist outside of regular business hours. Now, adult outpatient clients of Scarborough and Rouge Hospital’s Mental Health department can access treatment for anxiety and depression any time and place that is most convenient for them.

My Scarborough and Rouge Hospital team was awarded the 2017 Award of Excellence in Mental Health and Quality Improvement from the Canadian College of Health Leaders.

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Our  team won this honour for our e-therapy work. The gala dinner was in Vancouver this Sunday.

Full details here: https://www.cchl-ccls.ca/site/awards_mentalhealth_quality

Nice.

Reading of the Week: Better Treatment, Safer Roads? The New JAMA Psychiatry Paper on ADHD & Driving

June 8, 2017 /

From the Editor

How can we reduce the number of car accidents?

We often speak about treating mental illness in terms of reducing personal suffering. Recent selections have looked at the economic cost of mental illness. But what are the implications to public health?

This week, we look at a new JAMA Psychiatry paper; this national cohort study involved more than 2.3 million people with ADHD, and considered motor vehicle crashes (as measured by emergency department visits) and whether or not they were taking medications.

Yes, he has a plaid shirt, but should he be taking his prescription meds?

Spoiler alert: The authors find “medication use for the disorder was associated with a significantly reduced risk” of vehicle accidents.

We also look at an editorial that finds “clinical pearls” in this paper.

DG Continue reading

Reading of the Week: Is Psychoanalysis Relevant? Paris vs. Ravitz

June 1, 2017 /

From the Editor

“Today, psychoanalysis has been marginalized and is struggling to survive in a hostile academic and clinical environment. This raises the question as to whether the paradigm is still relevant in psychiatric science and practice.”

This week, we consider the relevance of psychoanalysis.

Drawing from the May issue of The Canadian Journal of Psychiatry, we look at two papers.

Freud and analysis: debating his relevance

In a Perspectives piece, Dr. Joel Paris argues that psychoanalysis is part our legacy – but not much more. In an Editorial, Dr. Paula Ravitz responds. She opens by writing: “My concern is that by unnecessarily pitting psychiatry against psychoanalysis, we may throw out the baby with the bathwater.”

It’s a great and important debate.

DG Continue reading