Author: gratz3r

Reading of the Week: Suicide and Ethnic Groups – the New Lancet Psychiatry Paper; Also, Cannabis & the Differential (JAMA Int Med)

December 9, 2021 /

From the Editor

Discrimination. Microaggression. Stigma. Patients in ethnic groups often face greater challenges and stresses than others. Do suicide rates differ? What are the implications for interventions?

These are good and important questions, yet the literature is thin. In a new paper for The Lancet Psychiatry, Isabelle M. Hunt (of the University of Manchester) and her co-authors consider suicide rates by ethnic group in the UK, focused on those who have had contact with mental health care. Drawing on a large database, they find lower rates of suicide completions compared to White patients, but significant variation among the different groups. The authors see potential clinical implications: “Clinicians and the services in which they work should be aware of the common and distinct social and clinical needs of minority ethnic patients with mental illness.”

fd1c8d415f97df29c61ed70a727e8974The Death of Socrates – and, yes, White patients died by suicide more

In the second selection, Dr. Anees Bahji (of the University of Calgary) and his co-authors consider cannabis use disorder in a patient who presents with cannabis hyperemesis syndrome. Their JAMA Internal Medicine paper is very practical; they suggest: “a multidisciplinary approach that incorporates psychotherapy, withdrawal symptom management, and close follow-up in the primary care setting is recommended for treatment of cannabis-related harms.”

DG

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Reading of the Week: Dr. Ari Zaretsky on the Life & Legacy of Dr. Aaron Beck

November 11, 2021 /

From the Editor  

The fourth child of Russian Jewish immigrants. A Yale medicine graduate. A snappy dresser who loved bow ties.  

Dr. Aaron Beck, who died last week at the age of 100, was also a psychiatrist who significantly changed the way we treat patients and learn to treat them. Today, millions have broken the shackles of mood and anxiety problems by using cognitive behavioural therapy; residents of psychiatry learn about the Beck’s Cognitive Triad as a core part of their training.  

aaron_beck_2016Dr. Aaron Beck 

I asked Dr. Ari Zaretsky, the Psychiatrist-in-Chief and Vice President Education of the Sunnybrook Health Sciences Centre, to write about him – his work and legacy. In his essay, Dr. Zaretsky notes: “His life story is that of a former psychoanalyst who rejected the dogmatism of mainstream Freudian psychoanalysis during the 1950s and 1960s and in doing so permanently changed the paradigm and transformed psychotherapy.” 

For those who wish to read more about Dr. Beck, I’ve included links, including to The New York Times obituary.  

DG   Continue reading

Reading of the Week: Measurement-based Care – What’s the Evidence? Also, Goldbloom on the Joy of Jabbing

November 4, 2021 /

From the Editor

Well, he looks better.

So often our conversations about patients – in our emergency rooms, wards, and clinics – focus on soft evidence of improvement. No wonder: psychiatry lacks biomarkers. And so, while our colleagues in medicine talk about blood sugars and white blood cell counts, we often discuss other things, like how our patients look and sound.

The promise of measurement-based care: objective evidence of change (or lack thereof). The idea is having a moment, with more and more interest. But what does the literature say?

In the first selection, Maria Zhu (of the University of British Columbia) and her colleagues consider RCTs. In a systematic review and meta-analysis, they look at the efficacy of measurement-based care for depressive disorders. They conclude: “Although benefits for clinical response are unclear, MBC is effective in decreasing depression severity, promoting remission, and improving medication adherence in patients with depressive disorders treated with pharmacotherapy. The results are limited by the small number of included trials, high risk of bias, and significant study heterogeneity.” We discuss the big paper.

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The pandemic has changed much with day-to-day practice, including with the rapid virtualization of mental health care. Remember a time when you didn’t need to talk about “being on mute?” And some psychiatrists have been on the front lines of the vaccine effort. In the second selection, Dr. David Goldbloom (of the University of Toronto) writes about his experiences working in a vaccine clinic. His Toronto Lifeessay details the YouTube video he watched to remind himself of how to administer shots, his family ties to vaccinations, and his fondness for the work. “I will always be grateful to have experienced the joy of jabbing.”

DG

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Reading of the Week: Dr. David Goldbloom’s New Book on Innovation and Mental Health Care

September 2, 2021 /

From the Editor

“There’s one fact on which we all agree: people are suffering. People with mental illnesses, their families and friends, and society at large are all touched by a set of disorders that affect one in five people globally. What is also evident – to every worried parent or partner, to every citizen strolling down a busy downtown street, to every guard working in a prison, to every teacher spending the majority of children’s weekday waking hours with them – is that the status quo is unacceptable.”

Dr. David Goldbloom (of the University of Toronto), who serves as the Senior Medical Advisor at the Centre for Addiction and Mental Health, makes these comments in his new book.

Can we do better? Those with mental health problems wait for almost all care, and the quality of care is uneven. This week’s Reading is an excerpt from Dr. Goldbloom’s new book, We Can Do Better: Urgent Innovations to Improve Mental Health Access and Care. The excerpt, like the book itself, strikes an optimistic note, observing the incredible innovation already present in mental health care.

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A special word of thanks to Catherine Whiteside of Simon & Schuster Canada for making this Reading possible.

DG

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Reading of the Week: Stigmatizing Language & Patient Records – a New Qualitative Analysis; Also, Dr. Termini on Her Lie by Omission (JAMA)

July 29, 2021 /

From the Editor

After the hospitalization ends, a detailed summary. A quick note outlining the psychotherapy session. Written comments about the patient’s care as she or he begins work with another clinician. Medical records include all of the above.

But do they also include stigmatizing language?

In this week’s first selection, the authors consider such language in a new paper for JAMA Network Open. Jenny Park (of Oregon Health and Science University) and her co-authors look at 600 notes, and find the categories of positive and negative language using a qualitative analysis. They write: “Language has a powerful role in influencing subsequent clinician attitudes and behavior. Attention to this language could have a large influence on the promotion of respect and reduction of disparities for disadvantaged groups.”

 1024px-edwin_smith_papyrus_v2Ancient Egyptian medical records – stigmatizing language then too?

In our other selection, Dr. Katherine A. Termini (of Vanderbilt University) writes about self-disclosure. In a very personal essay, the psychiatrist discusses her own mental health problems – and her decision not to tell others in the medical profession. She then writes about changing her mind. “I encourage you to ask yourself: How have I contributed to this stigma and what can I do about it? If physicians step forward to tell their personal experiences with mental illness to an audience of colleagues willing to listen empathetically, we can make progress on the arduous task of destigmatizing mental health.”

DG

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Reading of the Week: Alcohol – with Papers from Lancet Oncology and CJP, and Coverage from NYT

July 22, 2021 /

From the Editor

This week, we focus on alcohol, with two papers and a news article. Obviously, alcohol isn’t new – distilling probably started in the 13th century – but the three selections offer fresh and important information that is clinically relevant.

In the first selection, we consider the link to cancer. In a new Lancet Oncology paper, Harriet Rumgay (of the International Agency for Research on Cancer) and her co-authors conduct a population-based study. “Globally, about 741 000, or 4.1%, of all new cases of cancer in 2020 were attributable to alcohol consumption.” We review the big paper and mull its clinical implications.

alcohol

In the second selection, Dr. Daniel Myran (of the University of Ottawa) and his co-authors look at ED visits due to alcohol. Drawing on administrative data, they write: “We found that that current patterns and temporal trends in ED visits due to alcohol show large disparities between urban and rural regions of Canada and by socioeconomic status.”

And in the third selection, reporter Anahad O’Connor writes about alcohol use disorder for The New York Times. In this highly readable article, he focuses on the struggles of a retired manager: “But this past winter, with the stress of the pandemic increasingly weighing on him, he found himself craving beer every morning, drinking in his car and polishing off two liters of Scotch a week.” O’Connor writes about several resources that may be helpful to patients and their families.

DG

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Reading of the Week: Shamiri Layperson-Provided Therapy in Kenya – Big Study, But Ethical? Also, a Reader Comments on Chatbots

June 17, 2021 /

From the Editor 

“There are more psychiatrists of African origin in the US than in the whole of Africa. And I could actually say similar examples from the Philippines, or India, or many other countries. There is an enormous shortage of mental health resources…” 

So comments Dr. Vikram Patel (of Harvard University). Across low-income nations, mental health care services are profoundly difficult to access. Could Shamir (Kiswahili for thrive) – an intervention built on simple psychological concepts and delivered by laypersons – be part of the solution? 

This week, we look at a new paper from JAMA Psychiatry. Tom L.  Osborn (of Kenya’s Shamiri Institute) and his co-authors describe the results of a study involving adolescents with depression and anxiety symptoms. “To our knowledge, this is one of the first adequately powered tests in this population of a scalable intervention grounded in simple positive psychological elements.” We look at the big paper. 

kenya-tanzania-africa-uganda-map-300x200

 But is the work ethical? In our second selection, we consider the editorial that accompanies the Osborn et al. paper. JAMA Psychiatry Editor Dr. Dost  Öngür (of Harvard University) defends the study and his decision to publish it: “Because this trial was already conducted, we considered the obligations of the journal to be different than those of investigators and prospective reviewers. The question for us was whether there is a benefit to society by publishing the study as it was conducted.” 

Finally, in our third selection, a reader writes us. Giorgio A. Tasca (of the University of Ottawa) responds to The New York Times article by Karen Brown considering chatbots. “Is scaling up an intervention with dubious research support – that results in low adherence and high dropout (and perhaps more demoralization as a result) – worth it?” 

Please note that there will be no Reading next week. 

DG  Continue reading

Reading of the Week: ECT & Equity (CJP); also, COVID and Mental Health Surveys (Policy Options) and Farrell on Witnessing the Pandemic (Nation)

July 23, 2020 /

From the Editor

Who has better access to care?

This week, we have three selections. The first is a paper about inpatient ECT – an important topic. And the study – just published in The Canadian Journal of Psychiatry – has interesting findings, including that ECT is not particularly commonly performed (for just 1 out of 10 inpatients with depression). But this new paper by Dr. Tyler S. Kaster (of the University of Toronto) and his co-authors also touches on the larger issue of equity. We consider it – and the questions the study raises.

ect-maching

The second selection is an essay from Policy Options. Drs. Scott Patten (of the University of Calgary) and Stan Kutcher (of Dalhousie University) bemoan the state of mental health data during the pandemic. “There has been a disturbing acceptance of trivial and often misrepresented information, delivered from sub-optimal surveys and problematic interpretation of results.”

Finally, we consider an essay by Dr. Colleen M. Farrell (of Cornell University). She discusses COVID-19 – she is working in the ICU of a major New York City hospital during the pandemic – but also ties to the larger issues of public health, advocacy, and the role of medicine. “As I tend to my patients in the Covid ICU, I struggle to process reality. The attending physicians who are my teachers have few answers; this disease is new to all of us.”

Please note that there will be no Reading next week.

DG

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Reading of the Week: Rurality and Suicide (CJP); Also, COVID and Digital Practice (Quick Takes) and Haughton & Bromberg on Policing (Tor Star)

July 9, 2020 /

From the Editor

At times, it seems that we understand little about suicide.

That statement is vast, sweeping – and painfully true for us clinicians who aspire to do better with very blunt instruments. This week, we have three selections; the first is a systematic review and meta-analysis focused on suicide. In a new Canadian Journal of Psychiatry paper, Rebecca Barry (of the University of Toronto) and her co-authors consider the potential link between suicide and rurality. Spoiler alert: they find a connection, at least for men. What are the implications for practice and policy?

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In the second selection, we consider a new podcast discussing our digital future. I talk with Dr. Jay Shore (of the University of Colorado), who chairs the APA’s Telepsychiatry Committee. We discuss the virtualization of mental health services, and contemplate a future of hybrid care. And, yes, he has tips on how to avoid “Zoom fatigue.”

In the third selection, activists Asante Haughton and Rachel Bromberg discuss alternatives to police responding to mental health crises, seeing a dedicated team tasked with “on-the-spot risk assessments, de-escalation, and safety planning for clients in crisis” and more. “By taking on these important tasks, this team will enable Toronto policing resources to be more effectively directed toward solving crimes, rather than providing social services.”

DG

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Reading of the Week: David Goldbloom on Research & Clinical Practice

January 25, 2018 /

 From a Contributing Editor, Colleague, and Friend of the Editor

This week’s selection is a brief paper with long implications. For all of us clinicians who turn to the peer-reviewed literature (either directly or through the filter of Reading of The Week) for guidance on how to help our patients, this paper is worth a read.

It is impossible to stay current on the treatment research results that emerge daily, and we look to those randomized controlled trials published in high-impact peer-reviewed journals for evidence of what works for people with the diagnoses that we find ourselves addressing in the office, the clinic, the ER or the inpatient unit. But who are those patients who sign consent forms to take part in these studies, and how much do they resemble the people sitting across from us?

Great clipboard but relevant to clinical work? 

– David Goldbloom, OC, MD, FRCP(C)
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