MonthOctober 2022

Reading of the Week: Lithium & Renal Health – the New Lancet Psych Paper; Also, COVID & Suicides (ANZJP)

From the Editor

After starting lithium in the hospital, his life was transformed. My patient didn’t have another hospitalization, and he went back to excelling at his job and raising his young family.

There are many lithium success stories. But how safe is it for our patients’ kidneys? Though lithium has been used for decades, there is still controversy. We know that lithium can affect the kidneys, but how much renal change is naturally occurring (aging), due to psychiatric illnesses (like bipolar), or the medication itself?

In a new paper just published in The Lancet Psychiatry, Filip Fransson (of King’s College London) and his co-authors attempt to answer these questions with a cross-sectional cohort study drawing on 2,200 people from Sweden. They review kidney function over time for the general population, those with schizoaffective disorder and bipolar, and compare them to those on lithium. They find a significant connection between lithium and renal decline, but only after a decade of use. We consider the paper and its clinical implications.

In the second selection, Dr. Nick Glozier (of The University of Sydney) and his co-authors consider suicide rates during the pandemic in a new research article for the Australian & New Zealand Journal of Psychiatry. They note the dire predictions – of a “suicide epidemic” – that weren’t realized, and consider why, noting several factors, including that the economic downturn was mitigated by government action. Ultimately, though, they write: “suicide is an inherently difficult (stochastic) event to predict.”

DG

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Reading of the Week: Twitter & Suicide – the New ANZJP Paper; Also, Crystal Meth Use (Quick Takes) and Patients and Physicians’ Names (JAMA Net Open)

From the Editor

More and more, people use social media to debate current events, share personal experiences, and maybe enjoy a cat video or two. But if people are disclosing much, are they discussing suicidal thoughts? Could certain social media posts encourage people to get help?

In the first selection, Dr. Thomas Niederkrotenthaler (of the Medical University of Vienna) and his co-authors attempt to answer these questions with a new paper just published in the Australian & New Zealand Journal of Psychiatry. Drawing on more than 7.15 million tweets (from Twitter) and employing a machine learning approach, they divide content into several categories, then review volumes of calls to a suicide hotline and completed suicides. “This is the first large-scale study to suggest that daily volume of specific suicide-prevention-related social media content on Twitter corresponds to higher daily levels of help-seeking behaviour and lower daily number of suicide deaths.” We mull the paper and its implications.

Social media: more than cat videos?

In this week’s second selection, we consider a new Quick Takes podcast interview with Dr. David Castle (of the University of Toronto). Dr. Castle discusses crystal methamphetamine, a drug used more and more in Canada. Drawing on his Australian experience and noting the rise in use here, he comments: “it’s highly prevalent, highly available, highly pure and highly destructive.”

Finally, in the third selection, Dr. Jamison A. Harvey (of the Mayo Clinic) and her co-authors take a look at communication between patients and their physicians. Drawing on nearly 30,000 email messages, they consider the way patients address their physicians in a new JAMA Network Open research letter. “This is the first study to objectively identify patterns of addressing physicians through electronic messaging and may reveal potential bias. We found that women physicians… and primary care physicians were addressed by their first name more frequently.”

DG

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Reading of the Week: rTMS – the New JAMA Psych Paper; Also, Opioid Overdoses (JAMA Net Open) and Green on Peak Mental Health (NYT)

From the Editor

She’s an accomplished person who had succeeded in business and then writing, all the while raising three children; she also has an amazing smile and lights up the room when talking about her kids. But in my office, sick with depression, she can only focus on her losses and failings; the smile is absent.

Depression is common and disabling. Those who are affected in late-life are particularly challenging to treat. Is there a better way? In the first selection from JAMA Psychiatry, Dr. Daniel Blumberger (of the University of Toronto) and his co-authors consider theta burst stimulation, a newer form of rTMS which has shown promise in earlier work. Their study is a randomized noninferiority trial, directly comparing the two versions of rTMS in elderly patients with depression. The result? “We showed that bilateral TBS was noninferior to standard bilateral rTMS in improving depression, and similarly well tolerated, in a real-world sample of older adults with TRD [treatment resistant depression]…” We review the paper and its clinical implications.

In the second selection, Lori Ann Post (of Northwestern University) and her co-authors draw on CDC data to look at opioid overdoses in the United States with a focus on geography. In a JAMA Network Open research letter, they find: “Overall, opioid-involved overdose deaths rates increased steadily in counties of every urbanicity type, although there were distinct temporal wave patterns by urbanicity.”

And in the third selection, Huw Green (of the University of Cambridge) wonders about mental health and mental illness – and worries that the terms are becoming blurred together. Writing in The New York Times, the psychologist concludes: “When we move away from a focus on psychological problems and toward ‘mental health’ more broadly, clinicians stumble into terrain that extends beyond our expertise. We ought to be appropriately humble.”  

This month, the Reading of the Week enters its ninth year. A quick word of thanks for your ongoing interest.

DG



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Reading of the Week: Anxiety Screening for Adults – Helpful or Not? Also, Bram on His Depression & His Chatbot (NYT)

From the Editor

“A panel of medical experts on Tuesday recommended for the first time that doctors screen all adult patients under 65 for anxiety, guidance that highlights the extraordinary stress levels that have plagued the United States since the start of the pandemic.”

So reports The New York Times late last month with news of the US Preventive Services Task Force’s draft recommendation. The article quotes panelist Lori Pbert (of the University of Massachusetts): “Our only hope is that our recommendations throw a spotlight on the need to create greater access to mental health care – and urgently.”

In the first selection, we look at the recommendation. In making it, the USPSTF reviewed the literature and weighted the advantages and disadvantages of screening. If finalized, the recommendation would have implications on primary care in the United States – and beyond. “The USPSTF concludes with moderate certainty that screening for anxiety in adults, including pregnant and postpartum persons, has a moderate net benefit.” Is this a step in the right direction? Is this well intentioned but problematic?

In the second selection, Barclay Bram writes about his experiences with a therapist bot, working with the Woebot app. In a long New York Times essay, he talks about his depression and his therapy bot. He writes: “Using Woebot was like reading a good book of fiction. I never lost the sense that it was anything more than an algorithm – but I was able to suspend my disbelief and allow the experience to carry me elsewhere.”

DG

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