Month: July 2023

Reading of the Week: ADHD & Substance Outcomes – the New JAMA Psych Paper; Also, Suicide & the Impact on Psychiatrists and Foulkes on Her Anxiety & Our Times

July 27, 2023 /

From the Editor

Stimulants are commonly prescribed to children with ADHD. Do they protect kids against future substance misuse? Or, having been exposed early to stimulants, are these patients more likely to develop substance problems in adulthood?

Past studies have attempted to answer these questions but have been limited by study design. In a new JAMA Psychiatry paper, Brooke S. G. Molina (of the University of Pittsburgh) and her co-authors take a fresh look. In a cohort study involving 547 students, some of whom were treated with stimulants while others received behavioural therapy during the first period, Molina et al. look at outcomes when these participants are in their mid 20s. “This study found no evidence that stimulant treatment was associated with increased or decreased risk for later frequent use of alcohol, marijuana, cigarette smoking, or other substances used for adolescents and young adults with childhood ADHD.” We consider the study and its implications.

In the second selection, Dr. Juveria Zaheer (of the University of Toronto) discusses patient suicide in a new Quick Takes podcast interview. Focusing on the impact on psychiatrists and residents of psychiatry, she draws from the literature, including a study she recently senior authored for The Canadian Journal of Psychiatry. She notes common reactions by psychiatrists and residents, including guilt and shock. And Dr. Zaheer talks about her own experience. “I’ll never forget when it happened.” 

And in the third selection, Lucy Foulkes (of the University of Oxford) writes about anxiety and current approaches. In a Guardian essay, she notes her own history as an “anxious teen” and wonders if life is better for today’s adolescents, with awareness campaigns but not necessarily meaningful services. “We are now in a situation where many teens know or believe they are anxious but aren’t getting the help they need to manage it.”

The Reading of the Week has formal partnerships with 14 postgraduate programs and, today, we welcome PGY1s who are joining us from across Canada.

DG

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Reading of the Week: tDCS vs Sham for Depression – the New Lancet Paper; Also, US Ketamine Seizures and Dr. Lamas on Medical Practice & AI

July 13, 2023 /

From the Editor

He’s tried several medications, but still struggles with his depression. The story is too familiar. Transcranial direct current stimulation (tDCS) is an option, and increasingly the focus of research. With relatively few side effects and the possibility of doing the treatment at home, the advantages of tDCS are clear.

But how do patients taking antidepressants respond? In the first selection, from the pages of The Lancet, Dr. Gerrit Burkhardt (of the University of Munich) and his co-authors report the findings of an impressive study, with a comparison against sham treatment, across eight sites, and involving triple blinding. “Active tDCS was not superior to sham stimulation during a 6-week period. Our trial does not support the efficacy of tDCS as an additional treatment to SSRIs in adults with MDD.” We consider the paper, an accompanying Comment, and the implications.

In the second selection, Joseph J. Palamar (of New York University) and his colleagues analyze data on US ketamine seizures in a Research Letter for JAMA Psychiatry. They view seizures as a measure of recreational and nonmedical use, and conclude: “These data suggest increasing availability of illicit ketamine.”

And in this week’s third selection, Dr. Daniela J. Lamas (of Harvard University), an internist, writes about AI for The New York Times. In thinking about medical practice, she sees artificial intelligence doing more and more, and ultimately helping with diagnosis. She also sees trade-offs. Still, she concludes: “Beyond saving us time, the intelligence in A.I. – if used well – could make us better at our jobs.”

Note that there will be no Reading next week.

DG

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Reading of the Week: Pricing and Alcohol – the New Lancet Paper; Also, Mental Health & the Music Industry and Dr. O’Riordan on Her Depression

July 6, 2023 /

From the Editor

How to reduce alcohol consumption? That question is more relevant than ever, given evidence of increased use in Canada during the pandemic. Recently, Scotland has experimented with minimum unit pricing (MUP) – unlike a tax increase that raises the cost of all alcohol, MUP disproportionally affects low-cost wines and ciders, more likely to be consumed by heavy drinkers. 

In the first selection, Grant M. A. Wyper (of the University of Glasgow) and his co-authors consider the Scottish data. In a new paper for The Lancet, they do an impressive analysis, with a controlled interrupted time series, looking at time before and after the MUP, and contrasting Scottish and (non-MUP) English data. They find: “The implementation of MUP legislation was associated with significant reductions in deaths, and reductions in hospitalisations…” We look at the paper and its implications.

Scotland: a land of hills, lakes, and excessive alcohol consumption

In the second selection, George Musgrave (of the University of London) and his co-authors consider the connection between musicians and mental health. In a Comment for The Lancet Psychiatry, they note: “Great advances have been made in the field of musicians’ mental health.” But they argue that “further dialogue between all major stakeholders is needed if, collectively, we are to shape this emerging intervention landscape to serve the target population effectively, both the musicians themselves and the teams around them.”

And in the third selection, from the pages of the Daily Mail, Dr. Liz O’Riordan describes her career as a surgeon – and her secret battle with depression. In a personal essay, she talks about her decision to speak out. “I’ve got better at asking for help and looking after myself. But I’m not ashamed of depression. It’s part of me, and that’s OK.”

DG


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