Month: March 2023

Reading of the Week: Amphetamines & ED Visits – the New CJP Paper; Also, Psilocybin for Depression (QT) and Anti-NMDAR Encephalitis (CMAJ)

March 30, 2023 /

From the Editor

Agitated, excited, violent – when intoxicated. But my patient is also pleasant and engaging when not using substance (crystal methamphetamine).

Amphetamine use seems more and more common. What does the data show? In a new paper for The Canadian Journal of Psychiatry, James A. G. Crispo (of the University of British Columbia) and his co-authors look at amphetamine-related ED visits in Ontario. Drawing on administrative databases, they find a sharp rise over time: a 15-fold increase between 2003 and 2020. They write: “Increasing rates of amphetamine-related ED visits in Ontario are cause for concern.”

In the second selection, Dr. Ishrat Husain (of the University of Toronto) comments on psilocybin and depression in a new Quick Takes podcast. He goes into detail on the new NEJM study – which he co-authored. Dr. Husain discusses the literature and unanswered research questions. “It’s not necessarily all sunshine and rainbows.”

And in the third selection, Dr. Candace Marsters (of the University of Alberta) and her colleagues consider the unusual presentation of young adult with first-episode psychosis in a new paper for CMAJ. With time and diagnostic testing, they conclude that she has anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, and offer observations about that diagnosis and the limitations of testing. “Anti-NMDAR encephalitis is a rare but important differential diagnosis of first-episode psychosis among young adults.”

DG

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Reading of the Week: The Cutting Edge – Pharmacotherapy for Depression, Apps for Mental Health & AI for Everything (or Maybe Not)

March 9, 2023 /

From the Editor

He’s been depressed for years and you are considering augmentation. Should you choose an antipsychotic? Which one?

These are good questions, especially when treating patients with treatment-resistant depression. In the first selection, Drs. Manish K. Jha (of the University of Texas) and Sanjay J. Mathew (of Baylor College of Medicine) look at four antipsychotics in an American Journal of Psychiatry paper. They review the literature for augmentation, including the use of cariprazine, which has just received FDA approval for this purpose. They find evidence, but “their long-term safety in patients with MDD is not well established, and they are potentially concerning regarding weight gain, metabolic dysfunction, extrapyramidal symptoms, and tardive dyskinesia.” We consider the paper and its clinical implications.

In the second selection, S. E. Stoeckl (of Harvard University) and her co-authors consider the evolution of mental health apps in a new paper for the Journal of Technology in Behavioral Science. Looking at hundreds of apps, they analyze data on updates, including new features. They find: “This study highlights the dynamic nature of the app store environments, revealing rapid and substantial changes that could present challenges for app selection, consumer safety, and assessing the economic value of apps.”

And in the third selection, Dr. Dhruv Khullar (of Cornell University) writes for The New Yorker about AI and mental health. In a long essay that touches on chatbots for therapy and screening tools for suicide prevention, he wonders if AI can help clinicians (and non-clinicians) overcome issues around access. “Can artificial minds heal real ones? And what do we stand to gain, or lose, in letting them try?”

Note: there will be no Readings for the next two weeks.

DG

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Reading of the Week: Peer Support – the New Psych Services Paper; Also, BMJ on Dr. Smith & Drs. Stergiopoulos and Hwang on TTC Violence (Tor Star)

March 2, 2023 /

From the Editor

Anxiety provoking. That’s how a patient recently described the first few days of hospitalization in an unfamiliar environment and feeling unwell. Would peer support have helped?

In the first selection, Cecilie Høgh Egmose (of the University of Copenhagen) and her colleagues conduct a systematic review and meta-analysis for Psychiatric Services. In this study, they analyzed 49 RCTs involving more than 12,000 participants and with different types of services and peer support. They find: “peer support interventions generally but only slightly improve outcomes of personal recovery and slightly reduce symptoms of anxiety among individuals with any mental illness.” We look at the paper and its clinical implications.

In the second selection, writer Adele Waters interviews the incoming president of the UK’s Royal College of Psychiatrists in a front cover article for The BMJ. Dr. Lade Smith’s new position is like a British combination of two Canadian presidencies: of the Royal College of Physicians and Surgeons and of the Canadian Psychiatric Association. She has had a big career as an educator, clinician, and researcher. And Dr. Smith is clear in her advocacy: “The chronic underfunding of mental health care must be tackled urgently. We have the evidence to make the case. Investing in mental healthcare is cost effective, saves lives, and enhances our economy.”

And in the third selection, Drs. Vicky Stergiopoulos and Stephen Hwang (both of the University of Toronto) mull violence and Toronto’s transit system. In an essay for the Toronto Star, they push past the headlines and suggest that we address core issues. They write: “Simply adding police officers and security guards on the TTC will not be sufficient. This is not a TTC problem but, rather, a whole system problem.”

DG

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