Category: Reading of the Week

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

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

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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

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

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

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

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

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

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Reading of the Week: Employee Well-being & Corporate Strategies – the new Industrial Relations Paper; Also, Physician Burnout and Moyles on Suicide

From the Editor

Mindfulness programs, apps for sleep, resilience training. More and more corporations are offering these types of wellness interventions. Indeed, employee mental health services have become a billion-dollar industry. As reporter Ellen Barry recently observed in The New York Times: “These programs are a point of pride for forward-thinking human resource departments, evidence that employers care about their workers.” But are employees actually feeling better?

In a new paper for Industrial Relations Journal, William J. Fleming (of the University of Oxford) used survey data involving more than 46 000 British employees from 233 organizations, and considered several well-being efforts – including, yes, mindfulness programs, apps for sleep, and resilience training. He looked at several subjective well-being indicators. “Results suggest interventions are not providing additional or appropriate resources in response to job demands.” We look at the study and its implications.

In the second selection, Marcus V. Ortega (of Harvard University) and his co-authors look at physician burnout over time, drawing on US survey data for JAMA Network Open. With the pandemic, not unexpectedly, they found that physicians reported more burnout. “Findings of this survey study suggest that the physician burnout rate in the US is increasing.”

And in the third selection, author Trina Moyles writes about her brother and his suicide in a deeply personal essay for The Globe and Mail. She discusses her grief, the reaction of others, and her attempts at finding closure. She argues that we need to speak more openly about this topic. “Suicide: The word fires like a gunshot, so I’ve found myself whispering it.”

DG

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Reading of the Week: Clozapine & Neutropenia – the new Lancet Psych Paper; Also, a Letter to the Editor and Bialik on Mental Health

From the Editor

Clozapine is special.

Almost seven decades after its release, that statement – from a new Lancet Psychiatry Editorial – remains true. Clozapine is the best antipsychotic for those who are treatment refractory in their schizophrenia. But there is the risk of potentially life-threatening neutropenia. And so its use is clunky, with much blood work and monitoring, off-putting to some who would benefit from this medication.

Are we too cautious with clozapine? In the first selection, Dr. Korinne Northwood (of The University of Queensland) and her co-authors consider that question in a new Lancet Psychiatry paper. Drawing from a major clozapine database for Australia and New Zealand patients, they analyzed 32 years of data involving 2.6 million blood tests and looked at neutropenic events. “Our results support greater flexibility in prescribing of clozapine and a more balanced approach to risk…” We review the paper and mull its clinical implications.

Australia: cool architecture and good clozapine data

In the second selection, in a letter to the editor, Clement Ma and Dr. Peter Szatmari (both of the University of Toronto) write about the recent MST vs. ECT paper from JAMA Psychiatry. They offer some hesitation on the authors’ wording: “a non-significant result in a superiority trial does not imply that the two treatments are equivalent.”

And in the third selection, actress and former Jeopardy! host Mayim Bialik writes personally about her mental health problems for Trend Magazine. She describes the challenges of getting help and her decision to speak out. She also notes the societal shift in thinking about mental illness. “[S]haring our own personal struggles is not a sign of weakness; it is a sign of strength. We all want to feel better, live better, and experience more joy and less suffering.”

DG

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Reading of the Week: The Best of 2023

From the Editor

Welcome 2024.

It’s our tradition that we begin the New Year by reviewing the best of the past one.

So, this week, we consider the best papers of 2023.

Of course, the list is hardly definitive. The 10 papers selected are interesting and relevant to your clinical work. But another 10 – or 20 or 30 – could have been picked. 

These papers cover everything from AI to virtual care. The one common thread: they are all clinically relevant. 

And I name a person of the year, a remarkable advocate.

DG

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

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

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

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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