Category: Reading of the Week

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

Reading of the Week: Mental Illness and Bay St., and More

July 21, 2016 /

From the Editor

Recently, I spoke with a woman I hadn’t met before – a friend of a friend, gathered over coffee by a kitchen table. When she found out that I was a psychiatrist, she talked about her daughter’s struggle with mental illness and I thought how rarely people spoke to me about such things just a decade ago.

As people grow more comfortable talking about their experiences and their family’s experiences with mental illness and as stigma slowly fades, these conversations on Main Street, so to speak – at our kitchen tables and at our kids’ baseball games – are growing more and more common. But people in the corporate world are also growing more aware of the need for us to address mental health problems. No wonder. Consider that the single biggest reason for people to be on disability in Canada is mental illness. And so, there are conversations on Bay Street, too.

In this week’s Reading, we consider a new essay from the Harvard Business Review. In it, CEO Kelsey Meyer talks about her company’s development of a mental health policy.

Also in the Reading: journalist Scott Stossel reviews Dr. Peter Kramer new book on antidepressants – and his own experience with medications.

Please note that the Readings will be “going fishing” for the next two weeks, returning on 11 August.

DG Continue reading

Reading of the Week: Can We Prevent Psychosis? Part 2 of 2

July 14, 2016 /

From the Editor

Is an ounce of prevention worth a pound of cure? As noted last week, psychiatry tends to emphasize the treatment of illness, not its prevention. But preventing illness is our ultimate goal.

Can we prevent psychotic illness?

Prevention is built on two things: we need to identify at risk individuals, and then we need to use appropriate measures to prevent the illness.

Last week. The psychosis risk calculator.

This week. Cost-effective prevention.

In this week’s Reading, we look at a paper that considers CBT to prevent psychosis in an ultra high-risk group; the paper also considers the cost-effectiveness of the intervention. So is Ben Franklin right in arguing that an ounce of prevention is worth a pound of cure? The paper doesn’t weigh in on Franklin, of course, but it does find that CBT is economically sound with an 83% likelihood of reducing the transition to psychosis and at a lower cost.

DG Continue reading

Reading of the Week: Can We Prevent Psychosis? Part 1 of 2

July 7, 2016 /

From the Editor

Here’s a quick statistical summary of the Readings for the past 12 months.

Total: 48.

Number discussing the prevention of mental illness: One.

Is an ounce of prevention really worth a pound of cure?

Like all of medicine, psychiatry tends to emphasize the treatment of illness, not its prevention. This isn’t the result of a vast medical-industrial conspiracy, of course, but the reality that our field is young and the causes of mental illness aren’t well understood.

But preventing illness is our ultimate goal. Consider the suffering and cost that could be avoided if a person at risk of psychosis didn’t convert, as an example.

Can we prevent psychotic illness?

Prevention is built on two things: we need to identify at risk individuals, and then we need to use appropriate measures to prevent the illness.

Over the next two weeks, we look at a few papers that seek to identify at risk individuals and prevent psychosis in them.

This week. The psychosis risk calculator.

Next week. Cost-effective prevention.

In this week’s paper from The American Journal of Psychiatry, Cannon et al. develop a risk calculator to predict psychotic disorder. The tool they develop has an accuracy rate of 71% – comparable to calculators used for determining cancer recurrence.

DG Continue reading

Reading of the Week: Do the Meds Work? Peter Kramer’s Essay, and More

June 30, 2016 /

From the Editor

Do the pills really work?

It’s a question that we clinicians are repeatedly asked. Antidepressants are widely prescribed, but often doubted – by our patients and by people in general.

This week, we look at an essay penned by Dr. Peter Kramer, an American psychiatrist. Dr. Kramer, you may recall, made a name for himself two decades ago by extolling the super-therapeutic powers of Prozac. Today, he has a more modest goal: explaining the role of antidepressants in the treatment of depression.

Then, looking to The New England Journal of Medicine, we consider a paper that discusses the rise and, perhaps, fall of randomized controlled trials as the “gold standard” of medical research.

DG Continue reading

Reading of the Week: C-14 and Medically Assisted Dying

June 23, 2016 /

From the Editor

Over the years, Readings have considered big papers and big essays. This week’s Reading considers big legislation.

Last Friday, C-14 was given Royal Assent, having finally achieved Senate approval, thereby becoming law.

The Parliament of Canada

“An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)” is unlikely to be the end of this debate. Indeed, it is likely to be part of the beginning of a larger societal debate on death and medicine.

In this Reading, we look at C-14 and, as well, an essay by Dr. Sonu Gaind on mental illness and physician-assisted death.

DG Continue reading

Reading of the Week: I Can’t Sleep – Insomnia, Part II of II

June 16, 2016 /

From the Editor

It’s one of the most common patient complaints: I can’t sleep.

What many of our patients aspire to…

Insomnia affects 6 to 10% of the population. It’s a common problem – and often chronic. But are we mishandling insomnia?

In a two-part, two-week series, we look at the latest in insomnia research.

Last week. Fewer Pills, More Therapy. The new Clinical Practice Guidelines.

This week. Insomnia, Is There an App for That? The GoodNight Study.

This week, turning to a new paper from The Lancet Psychiatry, we consider an online insomnia program to prevent depression relapse.

DG Continue reading