Month: December 2023

Reading of the Week: Depression & Lived Experience – the new World Psych Paper; Also, the Life of Dr. John Talbott and Chairs & Patient Satisfaction

December 21, 2023 /

From the Editor

“For me, it feels like gravity just starts working on my body harder than it works everywhere else in the world.”

So comments a person with depression about his experience. Typically, we describe depression with a list of symptoms from the DSM-5. But how do patients understand their illness? In a new World Psychiatry paper, Dr. Paolo Fusar-Poli (of King’s College London) and his co-authors attempt to answer that question with a “bottom-up” approach. “To our best knowledge, no [depression] studies have adopted a bottom-up approach (from the lived experience to theory), whereby a global network of experts by experience and academics are mutually engaged in co-writing a joint narrative.” We look at the paper and its implications.

In the second selection, from The New York Times, reporter Trip Gabriel writes an obituary for Dr. John A. Talbott, an American psychiatrist who had championed deinstitutionalization, only to later regret the move away from hospital care. Dr. Talbott once wrote: “The disaster occurred because our mental health delivery system is not a system but a non-system.”

At this time of year, The BMJ runs its light-hearted Christmas issue, featuring much British humour. In the third selection, Ruchita Iyer (of the University of Texas Southwestern) and her co-authors describe a deception trial that increased patient satisfaction without increasing physician time. The “nudge” intervention involved: “Chair placement, defined as positioning the chair within 3 feet (0.9 m) of the bedside and facing the bed.” 

There will be no Readings for the next two weeks. We will return with force (though no British humour) on 11 January 2024.

All the best in the holiday season.

DG

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Reading of the Week: MST vs ECT – the new JAMA Psych Study; Also, Dr. Niall Boyce on Frasier and the Latest in the News

December 14, 2023 /

From the Editor

Electroconvulsive therapy, or ECT, is a highly effective treatment for depression. But patients often complain about side effects, including cognitive problems.

Could magnetic seizure therapy, or MST, provide the benefits of ECT without these issues? In a new paper for JAMA Psychiatry, Zhi-De Deng (of Duke University) and co-authors attempt to answer that question. In a study where 73 patients with depression were given ECT or MST, they found similar results. “This randomized clinical trial found that the efficacy of MST was indistinguishable from that of ultrabrief pulse [right unilateral] ECT, the safest form of ECT currently available.” We consider the paper and its implications.

In the second selection, Dr. Niall Boyce (of the Wellcome Trust) mulls the return of Frasier Crane, the “pompous but kind-hearted American psychiatrist.” In a Lancet perspective, he writes about the original TV comedy and the new revival of Frasier – and also notes the change in perception of psychiatry over the years. His assessment of the show: “Is the new Frasier worth watching? On the early evidence, I would say yes.”

And, finally, we explore the latest in the news with consideration of recent articles from The Globe and Mail and other publications. Among the topics: the (over) prescription of antidepressants, safe supply, and hairdressers and psychotherapy in Togo.

DG


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Reading of the Week: Improving Self-Esteem in Youth – the New JAMA Psych Paper; Also, Black Females & Suicide and Dr. Jon Hunter on the End

December 7, 2023 /

From the Editor

Can we help youth before the onset of full disorders to build skills and avoid deeper problems? Several school-based efforts, offering DBT and mindfulness skills, have been tried without much success. Ecological momentary interventions (EMIs) – provided to patients during their everyday lives and in natural settings, giving unstructured recommendations with structured interventions – is a newer therapy that has gained attention.

But does it work? In a new paper for JAMA Psychiatry, Ulrich Reininghaus (of the University of Heidelberg) and his co-authors describe an RCT focused on youth with low self-esteem who have had past adversity, involving 174 Dutch participants. “A transdiagnostic, blended EMI demonstrated efficacy on the primary outcome of self-esteem and signaled beneficial effects on several secondary outcomes.” We consider the paper and its implications.

In the second selection, Victoria A. Joseph (of Columbia University) and her co-authors look at US suicide rates in Black females. In their American Journal of Psychiatry letter, they analyze suicides over two decades, drawing data on age and region from a national database. They conclude that: “increasing trends in suicide death among Black females born in recent years and underscores the need to increase mental health care access among Black girls and women, and to reduce other forms of structural racism.”

And in the third selection, Dr. Jon Hunter (of the University of Toronto) contemplates endings – including his ending – in a personal and moving paper for CMAJ. He notes the need to clean up his possessions. But what about his practice and the many patients that he has followed for years? “I’d rather not shy away from the uncertainty and loss of the ending, and to try to help one more time.”

DG

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