MonthJuly 2022

Reading of the Week: Prevention With Mindfulness for Kids? The New EBMH Study; Also, Ending Seclusion (Psych Services) & Morrison on Her Silence (CBC)

From the Editor

Our patients tell similar stories about their experiences with depression: of strained and lost relationships, of job opportunities that didn’t work out, of the pain of the illness itself.

Could all this be avoided? The attractiveness of prevention is obvious. In the first selection, Willem Kuyken (of the University of Oxford) and his co-authors describe a program focused on those 11 to 16 years of age. In this new EBMH paper, they use mindfulness training. The intervention is randomized, involving 84 schools. They conclude: “In a fully powered, rigorous, cluster randomised controlled trial we found no support for our hypothesis that school-based mindfulness training is superior in terms of mental health and well-being compared with usual provision over 1 year of follow-up in young people in secondary schools.” We consider the paper and its implications.

In the second selection from Psychiatric Services, Gregory M. Smith (of the Allentown State Hospital) and his co-authors analyze Pennsylvania’s move to eliminate seclusion and restraint events. Drawing on nine years of data, they conclude: “The findings of this study provide compelling evidence that uses of seclusion and restraints can be reduced or eliminated in both civil and forensic populations, with benefits to both the persons being served and their support staff.”

And, in the third selection, lawyer Helen Morrison considers mental illness and stigma. In this essay for CBC First Person, she notes her own journey and her fears about how people would react to her having bipolar disorder. She finds support with her faith group and others. She writes: “I want people to know that being diagnosed with a mental illness need not be earth-shattering. Faulty brain chemistry should be seen as just another chronic medical condition.”

DG

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Reading of the Week: ECT & Suicide – the New Lancet Psych Paper; Also, Violence & Psych Trainees (Acad Psych) and Dr. Murthy on Burnout (NEJM)

From the Editor

In a recent survey, 20% identified fear of death as a major concern with ECT. One of the oldest treatments in psychiatry is also its most stigmatized and feared.

And is it also underappreciated? Is ECT a lifesaver for those who are suicidal? In the first selection, Dr. Tyler S. Kaster (of the University of Toronto) and his co-authors attempt to answer that question with a propensity score-weighted, retrospective cohort study comparing those who received ECT and those who didn’t, using Ontario data. In The Lancet Psychiatry, they write: “1 year after discharge from a psychiatric hospital, patients with depression who were exposed to electroconvulsive therapy had a nearly 50% reduction in the relative risk of death by suicide when compared with those who had not been exposed.” We consider the paper and its clinical implications.

We aren’t talking about candy

In the second selection, Dr. Victor Pereira-Sanchez (of the New York University) and his co-authors look at violence against European psychiatric trainees. In this Academic Psychiatry paper, drawing on survey data, they conclude: “Violence from patients is reported by many psychiatric trainees across countries in Europe, with very frequent verbal abuse and worrisome figures of physical and sexual assaults.”

Finally, in the third selection, Dr. Vivek H. Murthy (the US Surgeon General) writes about burnout and American health care workers. In The New England Journal of Medicine, he offers a practical plan, with an emphasis on reducing administrative burden, bettering mental health for health care workers, and changing culture to support well-being. He argues that action is needed: “we cannot allow ourselves to fail health workers and the communities they serve.”

DG

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Reading of the Week: Online DBT – the New JAMA Paper; Also, Prediabetes and Preaddiction, and Greenberg on the Delusional Ones (Acad Psych)

From the Editor

He cut himself out of frustration with a break-up. She came to the ED with suicidal thoughts after losing her job.

Some patients need help with ongoing self-harm and suicidal thoughts – but access to care is challenging, particularly for dialectal behavioural therapy. Could a simple intervention help? Could it be delivered virtually?

In the first selection, Dr. Gregory E. Simon (of Kaiser Permanente Washington Health Research Institute) and his co-authors detail a pragmatic randomized trial that evaluated two low-intensity outreach programs, aiming to reduce risk of self-harm and suicidal behaviour. In this new JAMA study, they conclude: “Compared with usual care, offering care management did not significantly reduce the risk of self-harm, and offering brief online dialectical behavior therapy skills training increased the risk of self-harm among at-risk adults.” We look at the study.

In the second selection, Thomas McLellan (of the University of Pennsylvania) and his co-authors note the failings of substance treatment and then mull a way forward: considering the approach to diabetic care and the concept of prediabetes. Should we embrace preaddiction? They write: “the diabetes example shows that an early intervention approach can work given a comprehensive, sustained effort.”

And in the third selection, Dr. Norman R. Greenberg (of Yale University) contemplates his patient’s psychosis and his approach. Drawing on an old Hasidic tale, this resident of psychiatry stops debating with his patient; he chooses to listen to him instead. He writes: “I may not always be able to convince others of my perspective, I hope that I am able to convince others that we share similar goals and that I care about them.”

DG


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Reading of the Week: Bipolar and Lithium – the New BJP Paper; Also, Inpatient Therapy (Psych Service) and Stulberg on His OCD (NYT)

From the Editor

What’s the best medication for bipolar disorder? Today, we have a variety of options from the old (lithium) to the new (modern antipsychotics). But what to prescribe?

In the first selection from The British Journal of Psychiatry, Cecilie Fitzgerald (of the Danish Research Institute for Suicide Prevention) and her co-authors try to answer these questions with a cohort study including those diagnosed with bipolar and living in Denmark between 1995 and 2016. They employ two types of analyses and focus on suicide, self-harm, and psychiatric hospital admissions. They conclude: “Although confounding by indication cannot be excluded, lithium seems to have better outcomes in the treatment of bipolar disorder than other mood stabilisers.” We consider the paper and its implications.

Lithium: not just for Teslas?

In the second selection, Stef Kouvaras (of the South London and Maudsley NHS Foundation Trust) and her co-authors consider a single-session psychotherapy intervention for an inpatient unit. In this recently published brief report for Psychiatric Services, they do a feasibility and acceptability study of positive psychotherapy. “The findings of this study indicate that positive psychotherapy is feasible and acceptable on acute psychiatric wards and that service users with severe and complex mental health conditions find the intervention helpful.”

In the final selection, executive coach Brad Stulberg writes about his experiences with OCD for The New York Times. He notes that his diagnosis helped him find care – but he worries about labels. “The stigma around mental illness has certainly not disappeared. But increasingly, mental health diagnoses are being embraced as identity statements.”

DG

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