MonthOctober 2020

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

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.

barrygoldwater-58fab94e5f9b581d596956b2Goldwater of the Goldwater Rule

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.”

DG

Continue reading

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

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?

istock-523360241-696x392

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.”

DG

Continue reading

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

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.”

computer-image

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.”

DG

Continue reading

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

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?

wave-1

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.”

DG

Continue reading

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

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.

l7vtguy5tljo72po6pk2tkd3iq

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.

DG

Continue reading