Category: Reading of the Week

Reading of the Week: How Do University Students Use Cannabis? Also, the Life and Legacy of Richard Green, and Scott Gottlieb on E-Cigs

May 2, 2019 / David Gratzer

From the Editor

I don’t quite remember when I changed my interview questions, but at some point – more than a decade ago – I stopped assuming that if I asked about street drugs, patients would tell me about cannabis. Long before legalization, people stopped seeing cannabis as illicit. Today, not only is cannabis legal for recreational use, many see it as a drug to be taken for their health.

In a new Canadian Journal of Psychiatry paper, the authors write about cannabis use for medicinal purposes among Canadian university students. Drawing on a survey, they find wide use – but not exactly the use that follows the guidelines.

We also consider two other pieces: an obituary for Dr. Richard Green, a prominent psychiatrist who challenged the DSM’s inclusion of homosexuality, and an interview with Dr. Scott Gottlieb, the outgoing FDA Commissioner, who worries about e-cigarettes.

508221091 Use – but medicinal use?

Enjoy these selections.

And an invitation: the Reading of the Week series invites guest contributions. If this is of interest to you, please let me know.

Reading of the Week: CBT for Depression – What Really Works? The New JAMA Psychiatry Paper

April 25, 2019 / David Gratzer

From the Editor

“It changed my life.”

A few years ago, a patient described to me how helpful cognitive behavioural therapy was for him. CBT wasn’t his only treatment – he had a couple of medication trials – but he found the psychotherapy to be very helpful.

Others have had a similar experience, but CBT isn’t widely available in Canada; Puyat et al. found in a Canadian Journal of Psychiatry paper that the vast majority of people with depression don’t receive any form of psychotherapy or counseling. How can we address this access gap? Could different forms of CBT work including those that are less resource intensive? What to make of self-help?

In this Reading, we consider a new paper by Vrije Universiteit Amsterdam’s Pim Cuijpers and his co-authors that seeks to answer these questions. They use a network meta-analysis to compare five treatment formats with each other and control conditions (waiting list, care as usual, and pill placebo). Their conclusion: “This study suggests that group, telephone, and guided self-help treatments are effective interventions that may be considered as alternatives to individual CBT.”

dr-aaron-beck-at-work-595048284-5af62b4dae9ab80036aca7fa Aaron Beck: How to deliver the CBT he has championed (and should we all wear a bow tie)?

In this Reading, we consider the big paper and its big result, and the accompanying editorial by the University of Pittsburgh’s Dr. Holly A. Swartz and Jay Fournier.

Reading of the Week: Dr. Norman Doidge’s Essay on Psychotherapy, and Responses

April 18, 2019 / David Gratzer

From the Editor

Earlier this month, the University of Toronto Department of Psychiatry held a one-day conference on the Future of Psychotherapy. Speakers included Harvard University’s Dr. Vikram Patel, who has worked to expand access to care in low-income countries, and the University of Oxford’s Dr. David Clark, who has co-led the world’s largest program to improve access to evidence-based psychotherapy.

Here in Ontario, the future of psychotherapy will be influenced by several factors, including government payment. The day after the conference, when Drs. Patel and Clark were travelling home, a long essay ran in The Globe and Mail discussing a provincial government proposal to limit physician compensation for psychotherapy to 24 sessions a year; currently, there are no restrictions on the number of psychotherapy sessions billable per patient, allowing public funding of psychoanalysis. Dr. Norman Doidge, a psychoanalyst with affiliation with both the University of Toronto and Columbia University, argues strongly against the proposal. Psychiatry, he writes, will be left with “diagnose, and adios” – or worse, “diagnose, overdose, and adios.” Dr. Doidge – a bestselling author who has written on topics as diverse as the Palestinian conflict and brain plasticity, and who wrote the introduction to Jordan Peterson’s popular book – puts forward a well-crafted case.

terapia-kxsb-u11004258755405xyb-1024x576lastampa-it The past of psychotherapy – but not its future?

In this Reading, we consider Dr. Doidge’s essay and some responses to it.

Reading of the Week: Cancer and Suicide – the New JAMA Psychiatry Paper

April 11, 2019 / David Gratzer

From the Editor

When I worked closely with cancer patients, we would often speak of that moment – the moment they were diagnosed, when they officially became cancer patients. Many recalled their first emotions: the disbelief, the shock, the anger. A few could even tell me sparkling details, like the way the doctor looked at them or what she was wearing. And, for all, that moment had been life altering.

That moment is followed by challenges, and for some, depression and even suicide.

What is the risk of suicide after the cancer diagnosis? In this week’s Reading, we look at a new JAMA Psychiatry paper. Drawing on English data, and involving 4.7 million people, Public Health England’s Katherine Henson and her co-authors look at cancer and suicide. They find: “Despite low absolute numbers, the elevated risk of suicide in patients with certain cancers is a concern, representing potentially preventable deaths.”

popepainting Big diagnosis, big risk?

In this Reading, we consider the paper on this important topic, as well as an editorial.

Reading of the Week: VR for Phobias? The New JAMA Psychiatry Paper. Also: Lancet Psychiatry on the Potential & Pitfalls of Digital Health

April 4, 2019 / David Gratzer

From the Editor

At the end of medical school, I spent some time working with an attending psychiatrist who was keen on behavioural interventions. He asked me to see a patient with acrophobia, a fear of heights, and told me to take the patient for an elevator ride for a “real-world experience.” For the record, the patient declined. (Having had no background in behavioural interventions, I’m not sure who was more anxious about that possible elevator ride, the patient or me.)

For people with phobias, exposure can be helpful. And so, therapists have taken their patients on plane trips and to visit tall buildings, and encouraged them to sign up for public speaking classes. As technology advances, we can ask: could virtual reality, or VR, work?

In the first selection, we consider a new paper from JAMA Psychiatry. Vrije Universiteit Amsterdam’s Tara Donker and her co-authors use VR for acrophobia. They choose a very basic intervention – an app and cardboard google glasses. They find: “A low-cost fully self-guided app-based virtual reality cognitive behavioral therapy with rudimentary virtual reality goggles can produce large acrophobia symptom reductions.”

googlecardboard-580x358

The future of psychiatry? Maybe – and certainly recyclable

In the second selection, we look at a new editorial from The Lancet Psychiatry. While the authors are keen on digital psychiatry – the sort of work that Donker and her team do – they also warn about potential problems.

Reading of the Week: How to Think about Practice Today – And Tomorrow? A New CJP Paper, a Podcast, and a Report

March 7, 2019 / David Gratzer

From the Editor

How do we practice today – and how will we practice in the future?

This week’s Reading includes three selections.

In the first selection, we consider how we practice today, with a new paper by University of Ontario Institute of Technology’s David Rudoler and his co-authors. Drawing on administrative data, they look for practice patterns, finding three distinct ones. Spoiler alert: practice patterns are very different, with 30% of psychiatrists seeing just two or fewer patients per month.

Then, we look ahead. In the second selection, we consider a new podcast discussing digital psychiatry. I talk with Dr. John Torous of the Harvard-affiliated Beth Israel Deaconess Medical Center. And, yes, he has tips on good apps for your patients.

Finally, in the third selection, we consider the recent Ontario government report on ending hallway medicine. The authors look to the future, and make several suggestions, including embracing the potential of digital health care.

messaging-apps Apps – the future?

Enjoy.

Reading of the Week: Can Psychotherapy Help Inpatients? Why did Michael Wilson Speak Out? Are Patients Experts?

February 28, 2019 / David Gratzer

From the Editor

Almost two decades ago, I was invited to a conference. The keynote speaker was Michael Wilson, the former federal Minister of Finance, who died earlier this month. I remember two things about this presentation: first, the audience was perfectly still – as Wilson spoke about his son’s suicide, no one shuffled her papers or chatted with his neighbour; second, I remember thinking how unusual this presentation was: he spoke about suicide at a time when suicide wasn’t discussed.

This week, we look at three selections, including an interview in which Wilson discusses his decision to speak out.

We also consider two other pieces: a new study on psychotherapy for inpatients with depression and an essay considering whether patients are experts.

pjimage-11 Michael Wilson

Enjoy.

And I hope you will take a few minutes to complete our survey, aimed at improving the Readings.

https://www.surveymonkey.com/r/GP5XXMB

Reading of the Week: Do E-Cigarettes Help with Smoking Cessation? The New NEJM Paper

February 21, 2019 / David Gratzer

From the Editor

Last week, I spoke to a patient who wanted passes off the ward so that he could smoke. When I suggested that we could help him reduce his nicotine use – and maybe even help him quit – he responded: “I’ve been smoking for 40 years. I’ll never quit.”

As much as the comment is disappointing, it is all too familiar. Nicotine is highly addictive, and it’s very challenging for our patients to quit.

What then to make of e-cigarettes? While they have been marketed well for smoking cessation, the evidence to date has been lacking. Do they offer a pathway to ending nicotine use? Or are e-cigarettes another type of nicotine product – addictive and ultimately unhelpful?

This week, we look at a paper just published in The New England Journal of Medicine. Queen Mary University of London’s Peter Hajek and his co-authors report on a “pragmatic, multicenter, individually randomized, controlled trial” comparing e-cigarettes to nicotine replacement therapy (NRT). It’s the first adequately powered study on this topic. And this Very Big Paper comes with a Very Big Result: e-cigarettes offered a strong advantage over NRTs.

e-cig Great ad, great product?

In this week’s Reading, we look at the Hayek et al. paper and consider e-cigarettes.

Have thoughts on the Readings of the Week? Please take this 15-question survey to make the Readings better: https://www.surveymonkey.com/r/GP5XXMB.

Reading of the Week: “It was scary and sad, but it was also a terrible sort of relief” – Dr. Danziger on Her Father’s Suicide

February 14, 2019 / David Gratzer

From the Editor

“By the time my father died, it wasn’t a surprise. It was scary and sad, but it was also a terrible sort of relief.”

So begins a short and honest essay by Dr. Phoebe Danziger. Our American colleague’s JAMA paper doesn’t require much of an introduction. She speaks about her father, his mental illness, and his death. She also touches on her own depression. And she speaks candidly of a childhood coloured by her father’s illness.

Phoebe Danziger

In this Reading, we consider Dr. Danziger’s essay.

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Category: Reading of the Week

Reading of the Week: How Do University Students Use Cannabis? Also, the Life and Legacy of Richard Green, and Scott Gottlieb on E-Cigs

Reading of the Week: CBT for Depression – What Really Works? The New JAMA Psychiatry Paper

Reading of the Week: Dr. Norman Doidge’s Essay on Psychotherapy, and Responses

Reading of the Week: Cancer and Suicide – the New JAMA Psychiatry Paper

Reading of the Week: VR for Phobias? The New JAMA Psychiatry Paper. Also: Lancet Psychiatry on the Potential & Pitfalls of Digital Health

Reading of the Week: How to Think about Practice Today – And Tomorrow? A New CJP Paper, a Podcast, and a Report

Reading of the Week: Can Psychotherapy Help Inpatients? Why did Michael Wilson Speak Out? Are Patients Experts?

Reading of the Week: Do E-Cigarettes Help with Smoking Cessation? The New NEJM Paper

Reading of the Week: “It was scary and sad, but it was also a terrible sort of relief” – Dr. Danziger on Her Father’s Suicide