Author: David Gratzer

Reading of the Week: Guest Contribution – Dr. David Goldbloom on Involuntary Hospitalizations

September 8, 2016 /

From a Contributing Editor, Colleague and Friend of the Editor

All of us psychiatrists have exercised our responsibility for the involuntary admission of patients. Some patients (and many families) have expressed gratitude for this temporary but fundamental abrogation of civil freedoms – the freedom of movement – but for many patients it may be a source of fear and of loss of control and autonomy (even though the illnesses that they are experiencing also undermine control and autonomy). It may also reflect an upstream failure of less intrusive and earlier interventions to treat mental illness.

Involuntary admission: is there an alternative?

In an era of being patient-centred and recovery-focused, is a reduction in rates of involuntary hospitalization desirable? If you’re a human rights lawyer, the answer may be “well, yes, obviously”. If you’re a clinician, the answer may be “that depends on whether the patient ends up better or worse”. Nevertheless, there are a number of clinical initiatives in place whose goal would be to reduce the frequency of involuntary hospitalization (which does not preclude an increase in the rate of voluntary hospitalization).

So along comes a careful systematic review and meta-analysis of randomized trials to examine four categories of intervention that have, as their explicit primary or secondary outcome, a reduction in the rates of involuntary admission to psychiatric inpatient units. The interventions will seem familiar to any reader who has been involved in the care of people with severe and persistent mental illness. But the results are surprising.

– David Goldbloom, OC, MD, FRCP(C) Continue reading

Reading of the Week: Doing Things Differently – Clozapine and More

September 1, 2016 /

From the Editor

“When a Cape Breton cousin of mine was hospitalized at the main asylum for Nova Scotia in the 1940s with psychotic symptoms, his sister told me the family received a phone call from the treating physician telling them to give up all hope for their brother’s future.”

In his new book written with Dr. Pier Bryden, Dr. David Goldbloom – past Chair of the Mental Health Commission of Canada and Senior Medical Advisor of the Centre for Addiction and Mental Health – recalls the story.

Psychiatry is so much better today.

But there is room for much improvement. Uneven outcomes. Provider-focused care. Can we do things differently?

New approach, better results?

This week, we look at a blog published by HealthAffairs.org, considering the use of clozapine for people with schizophrenia. Dr. Adam Rose, drawing on the research, including his own research, wonders why we don’t use more of this effective treatment.

Then, turning to The Globe and Mail, we look at the life and death of Dr. Kate Granger – a physician who has challenged us health care providers to be more compassionate.

DG Continue reading

Reading of the Week: Hospitalizations and Ethnicity (and Stigma)

August 25, 2016 /

From the Editor

Younger and sicker.

This week, we look at a new paper published in The Journal of Clinical Psychiatry considering ethnicity and hospitalizations. Drawing on Ontario data, researchers looked at psychiatric hospitalizations for people of Chinese and South Asian descent, finding that they were younger and more ill at the time of admission.

Hospitalizations, ethnicity… and access

Lead author Maria Chiu of the Institute for Clinical Evaluative Sciences told the Toronto Star:

Cultural factors play a big role in these findings. While Asian people tend to have stronger family support, they are also faced with a higher level of stigma and it prevents people from seeking help early. Families may try to cope and keep the illness within the family until there is no choice but to go to hospital.

This paper is well designed. It’s also important, speaking to larger issues about access, stigma, and ethnicity.

DG Continue reading

Reading of the Week: Olympics and Mental Illness

August 18, 2016 /

From the Editor

This is the Olympics edition of the Reading of the Week.

We will remember Rio for much – the big smile on Penny Oleksiak face when she won gold; the grit of the Canadian women’s soccer team; the achievements of American Michael Phelps.

For me, there is also the amazing story of swimmer Allison Schmitt. I’ll remember her not just as an Olympian who competed. That’s memorable of course. But she is also memorable for being an athlete willing to talk about her struggles with mental illness.

For the record, Schmitt won gold and silver in the pool in Rio.

DG Continue reading

Reading of the Week: Do Cities Make Us Sick?

August 11, 2016 /

From the Editor

Do cities make us sick?

It’s a question people have been asking for years with many advocating that we should – to steal a line from Huckleberry Finn – get the lights fantastic out of town.

Big city, big mental illness?

This week, we look at a new paper just published in The Canadian Journal of Psychiatry that looks at urban vs. rural populations and depression.

Then, turning to The Atlantic, we consider an essay written by a psychologist that looks at the connection between psychosis and cities.

DG Continue reading

Yes or No on tPSA

August 10, 2016 /

In the last few days, I’ve received more than a dozen emails and read a score of tweets – and that’s just from the two organized campaigns. As Ontario doctors get ready to weigh in on the Ontario government offer, there are many opinions being offered up.

I’ll disclose that I’m a member of the OMA’s Section on Psychiatry Executive.

How to cast your ballot on the three questions?

I’d like to focus on two letters that are relevant to Ontario psychiatrists. The goal here isn’t to lobby you but to help inform you.

The next two posts are worth reading and considering.

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Paper with an N of 14 Lands NYT Story

August 9, 2016 /

There is more to this story than a paper with a tiny sample of people — yes, just 14 — landing in The New York Times.

Benedict Carey is an excellent reporter and he looks at the Hearing Voices Network, which attempts to help people with psychosis without labels like patients. And without medications.

Benedict Carey

Here’s the link for “An Alternative Form of Mental Health Care Gains a Foothold”:

http://nyti.ms/2avgwX6

And, yes, the article closes by mentioning a Psychiatric Services paper with an n of 14.

Quick question: if we were talking about a group promoting, say, breast cancer treatment without chemo or radiation, would they have gotten so much attention?

A Podcast Worth Listening To

August 8, 2016 /

I’m a big fan of the National Elf Service — a nice collection of bloggers writing about the literature.

Recently, they have started doing Podcasts, and the project doesn’t disappoint.

There are several good Podcasts in the series, but I particularly like the interview with Oxford’s Willem Kuryken on mindfulness.

Kuryken, as you will recall, has been the first author of a couple of excellent new papers that I have been highlighted in the Reading of the Week. Here, he talks thoughtfully about the topic he knows best. There are good insights on depression and relapse prevention — and more.

https://soundcloud.com/national-elf-service/mindfulness-with-willem-kuyken

Willem Kurken