Month: February 2023

Reading of the Week: Delirium in the ICU – the New NEJM Paper; Also, Admissions and COVID (CJP) and Dr. Boulay on Our Own (NEJM)

February 23, 2023 /

From the Editor

Is there a role for haloperidol in the treatment of delirium in ICU settings? That may seem like an unusual question since many patients receive this medication, perhaps half. But evidence is light.

In the first selection, Dr. Nina C. Andersen-Ranberg (of the University of Southern Denmark) and her co-authors consider ICU delirium with a new RCT, published in The New England Journal of Medicine. In this elegant study, half of the patients were randomized to receive haloperidol (in the IV form) and the other half received a placebo. They find: “Among patients in the ICU with delirium, treatment with haloperidol did not lead to a significantly greater number of days alive and out of the hospital at 90 days than placebo.” We consider the paper.

In the second selection, Dr. Scott B. Patten (of the University of Calgary) and his co-authors analyze hospital admissions and psychiatric diagnoses before and after the start of the pandemic. In this Canadian Journal of Psychiatry paper, they draw on Alberta data. Noting an existing literature on eating disorders, they also find an increase in patients with personality disorders being admitted. “[T]he increase was more pronounced than the widely reported increase in admissions for eating disorders.”

And, in the third selection, Dr. Richard M. Boulay (of St. Luke’s University Health Network) weighs in on physician mental health. In this highly personal New England Journal of Medicine paper, the gynecologic oncologist describes the problems of a second-year surgery resident who almost dies by suicide. He feels that she was failed by her program and medical culture itself. He writes: “[S]olutions are available. It’s time we began looking after our own.”

DG

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Reading of the Week: RCTs & Mental Health – the New CJP Paper; Also, AI and Discharge Summaries (Lancet DH), and Mehler Paperny on Action (Globe)

February 16, 2023 /

From the Editor

How has psychiatric research changed over time?

In the first selection, Sheng Chen (of CAMH) and co-authors attempt to answer this question by focusing on randomized controlled trials in mental health in a new paper for The Canadian Journal of Psychiatry. Using the Cochrane Database of Systematic Reviews, they look at almost 6,700 RCTs published over the past decades. They find: “the number of mental health RCTs increased exponentially from 1965 to 2009, reaching a peak in the years 2005–2009,” and observe a shift away from pharmacologic studies.

RCTs: the gold standard of research

In the second selection, Sajan B. Patel (of St Mary’s Hospital) et al. consider ChatGPT and health care in a new Lancet Digital Health Comment. Noting that discharge summaries tend to be under-prioritized, they wonder if this AI program may help in the future, freeing doctor to do other things. “The question for the future will be how, not if, we adopt this technology.”

And in the third selection, writer Anna Mehler Paperny focuses on campaigns to reduce stigma in a hard-hitting essay for The Globe and Mail. She argues that action is urgently needed to address mental health problems. She writes: “We need more than feel-good bromides. Every time someone prominent utters something about how important mental health is, the follow should be: So what? What are you doing about it? And when?”

DG

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Reading of the Week: Dr. Scott Patten on ChatGPT

February 9, 2023 /

From the Editor

Having only written four papers, the author wouldn’t seem particularly noteworthy. Yet the work is causing a buzz. Indeed, JAMA published an Editorial about the author, the papers, and the implications.

That author is ChatGPT, who isn’t human, of course – and that’s why it has made something of a splash. More than a million people tried this AI program in the week after its November launch, utilizing it to do everything from composing poetry to drafting essays for school assignments. 

What to make of ChatGPT? What are the implications for psychiatry? And for our journals?

To the last question, some are already reacting; as noted above, last week, JAMA published an Editorial and also updated its Instructions to Authors with several changes, including: “Nonhuman artificial intelligence, language models, machine learning, or similar technologies do not qualify for authorship.”

This week, we feature an original essay by Dr. Scott Patten (of the University of Calgary) for the Reading of the Week. Dr. Patten, who serves as the Editor Emeritus of The Canadian Journal of Psychiatry, considers ChatGPT and these three questions, drawing on his own use of the program.

(And we note that the field is evolving quickly. Since Dr. Patten’s first draft, Microsoft has announced a chatbot for the search engine Bing.)

DG

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Reading of the Week: Mental Health & Recidivism – the New CJP Paper; Also, Virtual Care in Canada (CIHI) and Dr. McKenzie on Health Service (Tor Star)

February 2, 2023 /

From the Editor

He explained to me that he has often been in the “system” – in and out of correctional institutions (and hospitals and shelters) – since he was first diagnosed with schizophrenia in his late adolescence, with charges like failure to appear. The story is too familiar. 

How common is recidivism with those who have mental disorders like my patient? What’s a way forward? In the first selection, Michael Lebenbaum (of the University of Toronto) and his co-authors try to answer these questions in a new paper for The Canadian Journal of Psychiatry. Drawing on Ontario administrative databases, they conducted a population-based cohort study with a sample of almost 46 000 people. They find: “Despite a high risk of recidivism and acute MHA [mental health and addiction] utilization post-release, we found low access to MHA outpatient care, highlighting the necessity for greater efforts to facilitate access to care and care integration for individuals with mental health needs in correctional facilities.” We consider the paper and its clinical implications.

In the second selection, the authors detail different aspects of mental health services and the rise of virtual care in recent years. This new CIHI report highlights physician services. They note the general increase of virtual care with the start of the pandemic: “in 2019–2020, virtual services accounted for 4% of mental health services provided by physicians, while in 2020–2021, they accounted for 57%.” They also consider income (by analyzing neighbourhood data) and geography. 

And in the third selection, Dr. Kwame McKenzie (of the University of Toronto) writes about the health care system in a new Toronto Star essay. While many focus on public versus private provision, Dr. McKenzie sees this debate as a diversion from more fundamental issues. He argues: “If we do not focus on right-sizing the health service and building in redundancy, it is only a matter of time before we see the system crashing.”

DG

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