Category: Reading of the Week

Reading of the Week: The Best of 2017

December 28, 2017 /

From the Editor

No one should feel abandoned when their child is in a mental health crisis. Yet, sadly, I’ve met with families who’ve felt like they were. I’ve met with families who have had the courage to seek help, and have been sent away. I’ve heard of cases where brave souls have come forward, but without accessible and timely [care], have taken their own lives. I know of cases where parents miss out on work to support their kids. And where 18 year olds fall through the gaps when transitioning to adulthood.

It’s an annual tradition. At the end of each year, we take stock, reviewing the best of the past year.

And this past year has been remarkable in terms of good news.

Consider:

  • Earlier this year, the federal and provincial governments agreed to big investments in mental health.
  • In December, the Quebec Minister of Health committed his province to publicly funded psychotherapy for people with depression and anxiety provided by nurses, social workers and psychologists.
  • Ontario had made a similar if smaller commitment in the fall.

And the political push for mental health reform continues. Just this past weekend, Ontario PC Leader Patrick Brown wrote the above quotation in an opinion piece for the Postmedia Network. He called for a massive infusion of money into the mental health care system above the federal commitment.

The promises are big, but paper after paper shows that there is much work to be done. Studies this year found people with schizophrenia die at a rate eight times higher than that of the general population; that ECT use is declining despite its efficacy; that the vast majority of people post-suicide attempt aren’t seen by a psychiatrist within six months.

And so, we end 2017 in an usual position – those of us in mental health who have longed for a day when funding would improve and political interest would grow can feel satisfied. We should also feel a bit anxious. We now have a remarkable opportunity. We shouldn’t waste it.

And so with an eye on the future, let’s look back at the last year. In this final Reading of 2017, there are six selections, covering everything from the effectiveness of antipsychotics to the journey of a great uncle through Ohio asylums. Enjoy.

Please note that there will be no Reading next week.

DG

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Reading of the Week: Better Pay, Better Service? The CMAJ Paper on Pay for Performance in Psychiatry. Also, a Father’s Memory

December 21, 2017 /

From the Editor

Does pay for performance work for psychiatry?

This week’s first selection is a paper just published by CMAJ that considers that question. Drawing on Ontario data, the authors looked at practice patterns when financial incentives were introduced for psychiatrists to take care of patients after discharge and after suicide attempts. Spoiler alert: they didn’t work.

http-i-huffpost-com-gen-1291505-images-n-free-health-care-canada-628x314Paying for Performance – Getting Performance?

In this Reading, we consider the paper and the larger debate.

We also consider a short, moving essay by radio host Charles Adler on the memory of his father – and his father’s memory. The award-winning broadcaster describes his father and his Alzheimer.

DG

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Reading of the Week: Ethics & Medical Assistance in Dying – the new Simpson Paper. Also, Exercise for the Cognitive Symptoms of Depression?

December 14, 2017 /

From the Editor

It may soon be the law… but is it ethical?

In 2016, Parliament passed Bill C-14, legalizing doctor-assisted suicide. The legislation represents a major change in many ways: from public policy to the practice of medicine. And, in the coming years, it’s quite possible that the scope of this legislation will be expanded, and could include those with mental illness.

In this week’s Reading, Dr. Wayne (Sandy) Simpson of CAMH weighs in on the ethics of medical assistance in dying (MAiD) and mental illness in this provocative “perspective” paper just published by The Canadian Journal of Psychiatry. He considers the nature of mental illness before concluding: “[A]cting as a partner in helping people recover as well as acting as an agent in a patient’s death is an impossible burden that is not ethically justifiable or legally necessary.”

ethics-cert

Also, this week, we consider another recent paper by The Canadian Journal of Psychiatry that considers the impact of exercise on cognition in patients with depression.

DG

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Reading of the Week: Do Patients with Cancer Struggle with PTSD? Yes – the new Cancer Paper. Also, Quebec Covers Therapy

December 7, 2017 /

From the Editor

I spent a dozen years working at a community hospital. One of my richest experiences was working with cancer patients and their families. For so many patients, not surprisingly, cancer isn’t just a physical illness, but a psychiatric one, too – patients often experience depression and anxiety.

How common is PTSD in cancer patients? Surprisingly little work has been done in the area. In this week’s Reading, we look at a new study that considers PTSD and cancer. The study is particularly impressive in that patients were followed for years after diagnosis.

Big diagnosis, big treatment, big psychiatric problems?

In this Reading, we consider the paper and its findings.

And, with an eye on treatment for those with or without cancer, we consider a good news story: on Sunday, the Quebec government committed itself to cover psychotherapy for those with depression and anxiety in the public system.

DG

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Reading of the Week: Is AVATAR Therapy a Breakthrough for Those Who Hear Voices? The New Lancet Psychiatry Paper

November 30, 2017 /

From the Editor

“The voices won’t leave me alone.”

A patient made this comment to me recently. And it’s an experience many patients have had. Despite medications and follow up, the voices continue to be problematic.

This week, we look at a new paper from The Lancet Psychiatry which considers a novel approach: AVATAR therapy.

In this study, patients who experienced auditory hallucinations created a computerized simulation (avatar) of the voice they most wanted to influence, including what the voice said, how it sounded, and how the “entity” with the voice looked like. Patients, working with a therapist who controlled the avatar, then had therapy sessions in which they could talk to it. Patients were compared on several measures to those who only received supportive therapy.

The paper has received significant media attention including CNN and BBC.

1124avatar2The Face of the Voice – and a Step Toward Healing?

Spoiler alert: the therapy helped – at least initially – but the results are complicated. (And, no, this isn’t “fake news,” to borrow a phrase from an American politician.)

In this Reading, we consider the paper and its findings.

DG

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Reading of the Week: The Pill That Talks to Doctors, & More

November 23, 2017 /

From the Editor

The pill. The criticism. The question.

Readings have covered everything from new books to political speeches. This week, we consider a few thought-provoking pieces. Is there a common theme? Maybe this: the world of mental health care is changing – and fast.

In these three selections, we look at: the pill that talks to doctors and family, the criticism of digital health, the question about the true nature of schizophrenia.

Enjoy.

DG

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Reading of the Week: Better Sleep, Less Psychosis? The Freeman et al. Study on Sleep & CBT

November 16, 2017 /

From the Editor

If students sleep better, are they less likely to have mental health problems like paranoia?

In this week’s Reading, we look at a new study from The Lancet Psychiatry. In this single-blind, randomized controlled trial, Oxford professor Daniel Freeman et al. consider students from 26 universities with insomnia, assigning them CBT (offered over the internet) or the usual care.

Spoiler alert: the students with CBT did better.

Sleep: good for babies, teddy bears, and students

In this Reading, we review that paper and consider the broader implications.

DG

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Reading of the Week: ECT – Safe, Effective but Declining Use. The Lemasson et al. Study on ECT in Quebec

November 2, 2017 /

From the Editor

It’s an effective treatment for depression – maybe the most effective. Yet ECT remains highly controversial. Patients routinely ask about its safety; the media portrayal is tough.

This week, we look at two new studies on electroconvulsive therapy. In the first, just published in The Canadian Journal of Psychiatry, the authors consider the use of ECT in Quebec over a 15-year period, finding a decline over time.

An ECT Machine: going the way of the dodo bird?

We also look at a new paper from Acta Psychiatrica Scandinavica considering the safety of ECT, tapping a rich database.

These new papers point to a public health problem: the treatment is incredibly safe (and effective) but used less and less often.

Note: there will be no Reading next week.

DG

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Reading of the Week: Are the Kids Alright? NYT on Severe Anxiety & Adolescents

October 26, 2017 /

From the Editor

“The disintegration of Jake’s life took him by surprise.”

This quotation is from a long, moving essay about a young patient with a big problem. The piece begins with Jake in his junior year of high school with much on his plate: three Advanced Placement courses, a spot on the cross-country team, invitations to Model U.N. conferences – and significant anxiety.

The essay explores his anxiety, and the anxiety of teens like Jake.

The essay, which recently ran in The New York Times Magazine, traces the struggles of Jake, and the writer puts these problems in a larger context.

Teen anxiety: A growing problem?

In this Reading, we review this essay.

DG

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Reading of the Week: Depression, Pills & Adherence – the Sirey et al. Study on Improving Depression Treatment

October 19, 2017 /

From the Editor

The patient is depressed. The doctor has prescribed medications. But the patient doesn’t take them.

As a clinician, this scenario is too familiar with results that are too familiar – the patient doesn’t get better. What can we do to improve adherence?

In this week’s selection, we look at a new paper by Weil Cornell Medicine’s Jo Anne Sirey et al., considering this question. The authors do a randomized controlled trial with “a brief psychosocial intervention designed to improve adherence to pharmacotherapy for patients with depression.” So, is this intervention a game-changer? The authors find a five-fold increase in adherence during the first 6 weeks of care – but not much change in overall depressive symptoms.

153745515Pretty pill bottle: But how can we get patients to take the pills?

In this Reading, we review the paper.

DG

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