Month: February 2024

Reading of the Week: Acupuncture for PTSD – the New JAMA Psych Study; Also, Chronic Homelessness & Hope, and Dr. Suzanne Koven on Mentorship

February 29, 2024 /

From the Editor

He survived a terrible car accident and recalls his worst memory: being pinned for hours in his Honda as rescuers attempted to free him, eventually with the Jaws of Life. The mental recovery proved more complicated than the physical one, with flashbacks and nightmares and the resulting substance misuse. He tried different therapies, but would he have benefitted from alternative treatments?

Dr. Michael Hollifield (of George Washington University) and his co-authors look at acupuncture for PTSD in a new JAMA Psychiatry study. They did an impressive randomized clinical trial involving 93 combat veterans with PTSD who received either verum or sham acupuncture. “[V]erum acupuncture had a large pretreatment to posttreatment effect and was statistically superior to sham needling for reducing PTSD symptoms and enhancing fear extinction.” We consider the paper and its clinical implications.

Across North America, there are more people than ever before who are chronically homeless. Who are they? What psychiatric problems do they have? How can we help them? In the second selection, Dr. Vicky Stergiopoulos (of the University of Toronto) considers those who are chronically homeless in a podcast interview for Quick Takes. “The problem is visible. It’s in our streetcars and buses, our subways, our streets, and it’s hard to ignore.”

And in the third selection, Dr. Suzanne Koven (of Harvard University) writes about mentorship in The New England Journal of Medicine. She discusses how a mentor’s advice transformed her career and then considers what makes for good mentorship. “A mentor is someone who has more imagination about you than you have about yourself.”

DG

Continue reading

Reading of the Week: Exercise for Depression – the new BMJ Study; Also, Pogue on Her Career & Illness

February 22, 2024 /

From the Editor

Studies have shown that exercise is helpful for those with depression. But is one type of exercise better than the others? How much exercise? And what should you tell your patients when they ask?

Michael Noetel (of the University of Queensland) and his co-authors attempt to answer these questions in a new study for The BMJ. They did a systematic review and network meta-analysis, drawing on 218 studies with almost 14  200 participants. “Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense.” We look at the study, the accompanying editorial, and consider the implications for practice.

And, in the other selection from Psychiatric Services, Ye Zhang Pogue (of RTI International) writes about her advocacy for those with mental illness and her hesitation in disclosing her own diagnosis. In a personal essay, she talks about her aspirations, her fears, and her experiences with discrimination. She calls for a change to corporate culture. “Changing corporate culture will be a slow process, but the cumulative efforts of individuals will make a difference on a systemic level.” Note that this was the most-read paper in any APA journal in 2023.

DG

Continue reading

Reading of the Week: Can Chatbots & AI Help Access? The new Nature Med Paper; Also, Telepsych in the US and the Latest in the News

February 15, 2024 /

From the Editor

More and more organizations use AI; today, a chatbot might assist you in ordering a pizza or tracking a package. But could a chatbot help our patients find the mental health care that they need? Could it help self-identified members of ethnic groups – who historically do less well in getting services – with access?

Johanna Habicht (of Limbic) and her co-authors try to answer these questions in a new study for Nature Medicine. They looked at the use of a chatbot for self-referral against the standard option in the UK’s NHS when patients seek psychological care. The resulting multisite observational study involved almost 130 000 people. They found that AI increased referrals (especially, in terms of diversity). “Here we demonstrate that digital tools can reduce the accessibility gap by addressing several key barriers.” We look at the study and mull its implications.

As we move past the pandemic, we ask: is virtual care routinely offered for mental disorders? In the second selection from JAMA Health Forum, Jonathan Cantor (of the RAND Corporation) and his colleagues consider mental telehealth – or telepsychiatry, to use the older term – in the United States. With a secret shopper approach, trained callers phoned more than 1 400 US clinics, posing as potential clients with mental health problems. They found most offered virtual care. Further: “There were no differences in the availability of mental telehealth services based on the prospective patient’s clinical condition, perceived race or ethnicity, or sex.”

And, finally, we explore the latest in the news with recent articles from The Guardian and The New York Times. Among the topics: the mental health struggles of rising political star Lina Hidalgo, privacy and mental health apps, and help for those with schizophrenia and homelessness in Cameroon.

DG

Continue reading

Reading of the Week: Cannabis-Related Disorders – the new NEJM Paper; Also, Surgeons & Opioid Prescribing and MAiD & Mental Illness

February 8, 2024 /

From the Editor

Cannabis use is increasingly common. Should you be screening for misuse? What’s the role of drug testing? Do short interventions work?

In the first selection, we look at the new paper on cannabis-related disorders, published in The New England Journal of Medicine. Dr. David A. Gorelick (of the University of Maryland) comments on cannabis use disorder, offering practical suggestions, drawing on the latest in the literature (with 76 references). “Cannabis use disorder and heavy or long-term cannabis use have adverse effects on physical and psychological health.” We discuss the paper and its takeaways.

In the second selection, Jason Zhang (of the University of Michigan) and his co-authors consider surgeons and the prescribing of opioids. Given past problems, are surgeons more frugal when they reach for the prescription pad? Drawing on an impressive US database, they analyzed dispensed opioids from 2016 to 2022 in a new JAMA Network Open research letter, finding a step in the right direction – but just a step. “Despite large reductions in opioid prescribing, surgical opioid stewardship initiatives remain important.”

And in the third selection, The Globe and Mail weighs in on the recent decision to delay the expansion of medical assistance in dying, or MAiD, for mental disorders. In an unsigned editorial, the authors recognize the suffering of some, but argue that not enough has been done to define the term irremediable. “A delay is not enough.”

DG

Continue reading

Reading of the Week: Housing First & Mental Health Care – the new Health Affairs Paper; Also, Safe Supply & Outcomes and Antipsychotics for Delirium

February 1, 2024 /

From the Editor

With the shelter system overcrowded, my patient slept the previous four nights in the train station. “Where else was I to go?” Many major cities across North America have seen a rise in the number of those who are chronically homeless. Housing First – the idea that stable housing is needed for people to better access health care – is one option, though the concept has been increasingly criticized. Is it a good fit for our urban problems?

In the first selection from Health Affairs, Devlin Hanson and Sarah Gillespie (both of the Urban Institute) consider Housing First for a specific population: the chronically homeless population who have had frequent arrests and jail stays; most of them, not surprisingly, have major mental illness or substance problems. Hanson and Gillespie analyzed data from Denver, Colorado, where people were randomized into Housing First or a control group. “We found that within the two-year study period, people in the intervention group had significantly more office-based care for psychiatric diagnoses, fewer ED visits, more unique medications, and greater use of other health care than people in the control group.” We review the study and its implications.

Denver: mountains, fresh air, and Housing First

In the second selection, Hai V. Nguyen (of Memorial University) and his co-authors look at safe supply and opioid outcomes in British Columbia. In a JAMA Internal Medicine paper, they used data from that province, contrasting it with Manitoba and Saskatchewan, and focused on the number of prescriptions and hospitalizations. “Two years after its launch, the Safer Opioid Supply Policy in British Columbia was associated with higher rates of prescribing of opioids but also with a significant increase in opioid-related hospitalizations.”

Delirium is common in the elderly admitted to hospital, and antipsychotics are often prescribed. In the third selection, Dr. Christina Reppas-Rindlisbacher (of the University of Toronto) and her co-authors comment on use of this medication in aCMAJ Practice paper. They offer much advice, including: “They should be prescribed at the lowest effective dose for the shortest possible duration and be reevaluated at or shortly after discharge.”

DG

Continue reading