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Reading of the Week: Prevention With Mindfulness for Kids? The New EBMH Study; Also, Ending Seclusion (Psych Services) & Morrison on Her Silence (CBC)

July 28, 2022 /

From the Editor

Our patients tell similar stories about their experiences with depression: of strained and lost relationships, of job opportunities that didn’t work out, of the pain of the illness itself.

Could all this be avoided? The attractiveness of prevention is obvious. In the first selection, Willem Kuyken (of the University of Oxford) and his co-authors describe a program focused on those 11 to 16 years of age. In this new EBMH paper, they use mindfulness training. The intervention is randomized, involving 84 schools. They conclude: “In a fully powered, rigorous, cluster randomised controlled trial we found no support for our hypothesis that school-based mindfulness training is superior in terms of mental health and well-being compared with usual provision over 1 year of follow-up in young people in secondary schools.” We consider the paper and its implications.

In the second selection from Psychiatric Services, Gregory M. Smith (of the Allentown State Hospital) and his co-authors analyze Pennsylvania’s move to eliminate seclusion and restraint events. Drawing on nine years of data, they conclude: “The findings of this study provide compelling evidence that uses of seclusion and restraints can be reduced or eliminated in both civil and forensic populations, with benefits to both the persons being served and their support staff.”

And, in the third selection, lawyer Helen Morrison considers mental illness and stigma. In this essay for CBC First Person, she notes her own journey and her fears about how people would react to her having bipolar disorder. She finds support with her faith group and others. She writes: “I want people to know that being diagnosed with a mental illness need not be earth-shattering. Faulty brain chemistry should be seen as just another chronic medical condition.”

DG

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Reading of the Week: ECT & Suicide – the New Lancet Psych Paper; Also, Violence & Psych Trainees (Acad Psych) and Dr. Murthy on Burnout (NEJM)

July 21, 2022 /

From the Editor

In a recent survey, 20% identified fear of death as a major concern with ECT. One of the oldest treatments in psychiatry is also its most stigmatized and feared.

And is it also underappreciated? Is ECT a lifesaver for those who are suicidal? In the first selection, Dr. Tyler S. Kaster (of the University of Toronto) and his co-authors attempt to answer that question with a propensity score-weighted, retrospective cohort study comparing those who received ECT and those who didn’t, using Ontario data. In The Lancet Psychiatry, they write: “1 year after discharge from a psychiatric hospital, patients with depression who were exposed to electroconvulsive therapy had a nearly 50% reduction in the relative risk of death by suicide when compared with those who had not been exposed.” We consider the paper and its clinical implications.

We aren’t talking about candy

In the second selection, Dr. Victor Pereira-Sanchez (of the New York University) and his co-authors look at violence against European psychiatric trainees. In this Academic Psychiatry paper, drawing on survey data, they conclude: “Violence from patients is reported by many psychiatric trainees across countries in Europe, with very frequent verbal abuse and worrisome figures of physical and sexual assaults.”

Finally, in the third selection, Dr. Vivek H. Murthy (the US Surgeon General) writes about burnout and American health care workers. In The New England Journal of Medicine, he offers a practical plan, with an emphasis on reducing administrative burden, bettering mental health for health care workers, and changing culture to support well-being. He argues that action is needed: “we cannot allow ourselves to fail health workers and the communities they serve.”

DG

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Reading of the Week: Online DBT – the New JAMA Paper; Also, Prediabetes and Preaddiction, and Greenberg on the Delusional Ones (Acad Psych)

July 14, 2022 /

From the Editor

He cut himself out of frustration with a break-up. She came to the ED with suicidal thoughts after losing her job.

Some patients need help with ongoing self-harm and suicidal thoughts – but access to care is challenging, particularly for dialectal behavioural therapy. Could a simple intervention help? Could it be delivered virtually?

In the first selection, Dr. Gregory E. Simon (of Kaiser Permanente Washington Health Research Institute) and his co-authors detail a pragmatic randomized trial that evaluated two low-intensity outreach programs, aiming to reduce risk of self-harm and suicidal behaviour. In this new JAMA study, they conclude: “Compared with usual care, offering care management did not significantly reduce the risk of self-harm, and offering brief online dialectical behavior therapy skills training increased the risk of self-harm among at-risk adults.” We look at the study.

In the second selection, Thomas McLellan (of the University of Pennsylvania) and his co-authors note the failings of substance treatment and then mull a way forward: considering the approach to diabetic care and the concept of prediabetes. Should we embrace preaddiction? They write: “the diabetes example shows that an early intervention approach can work given a comprehensive, sustained effort.”

And in the third selection, Dr. Norman R. Greenberg (of Yale University) contemplates his patient’s psychosis and his approach. Drawing on an old Hasidic tale, this resident of psychiatry stops debating with his patient; he chooses to listen to him instead. He writes: “I may not always be able to convince others of my perspective, I hope that I am able to convince others that we share similar goals and that I care about them.”

DG


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Reading of the Week: Bipolar and Lithium – the New BJP Paper; Also, Inpatient Therapy (Psych Service) and Stulberg on His OCD (NYT)

July 7, 2022 /

From the Editor

What’s the best medication for bipolar disorder? Today, we have a variety of options from the old (lithium) to the new (modern antipsychotics). But what to prescribe?

In the first selection from The British Journal of Psychiatry, Cecilie Fitzgerald (of the Danish Research Institute for Suicide Prevention) and her co-authors try to answer these questions with a cohort study including those diagnosed with bipolar and living in Denmark between 1995 and 2016. They employ two types of analyses and focus on suicide, self-harm, and psychiatric hospital admissions. They conclude: “Although confounding by indication cannot be excluded, lithium seems to have better outcomes in the treatment of bipolar disorder than other mood stabilisers.” We consider the paper and its implications.

Lithium: not just for Teslas?

In the second selection, Stef Kouvaras (of the South London and Maudsley NHS Foundation Trust) and her co-authors consider a single-session psychotherapy intervention for an inpatient unit. In this recently published brief report for Psychiatric Services, they do a feasibility and acceptability study of positive psychotherapy. “The findings of this study indicate that positive psychotherapy is feasible and acceptable on acute psychiatric wards and that service users with severe and complex mental health conditions find the intervention helpful.”

In the final selection, executive coach Brad Stulberg writes about his experiences with OCD for The New York Times. He notes that his diagnosis helped him find care – but he worries about labels. “The stigma around mental illness has certainly not disappeared. But increasingly, mental health diagnoses are being embraced as identity statements.”

DG

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Reading of the Week: Cannabis for Mood Disorders – the New CJP Paper; Also, Dr. Insel on Mental Health (QT) and Transgender Adolescents & Suicidality (CMAJ)

June 23, 2022 /

From the Editor

He smokes before bed to help with sleep; she finds that the edibles take an edge off from her lows.

Our patients routinely tell us about the benefits of cannabis for mood disorders. But is there any evidence in the literature? In the first selection from The Canadian Journal of Psychiatry, Dr. Smadar V. Tourjman (of the Université de Montréal) and her co-authors consider that question with a systematic review, drawing on data from 56 studies, focused on bipolar and major depressive disorders, for a CANMAT task force report. They conclude: “cannabis use is associated with worsened course and functioning of bipolar disorder and major depressive disorder.” We consider the paper and its implications.

In this week’s second selection, we look at new Quick Takes podcast interview with Dr. Thomas Insel (of the Steinberg Institute). Dr. Insel, a psychiatrist and former director of NIMH, speaks about the progress in neuroscience but the need for mental health reform. “We must think about more than just the classic medical model borrowed from infectious disease: simple bug, simple drug.”

Finally, in the third selection, Mila Kingsbury (of the University of Ottawa) and her co-authors consider the risk of suicidality among trangender and sexual minority adolescents; they draw from a nationally representative, cross-sectional survey. “Gender and sexual minority adolescents, particularly those who identify as transgender and gender-nonconforming, appear to be at greater risk of suicidal ideation and suicide attempt than their cisgender and heterosexual peers.”

There will be no Reading next week.

DG

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Reading of the Week: Mental Health Literacy & Skills for Students – the New CJP Paper; Also, Benzodiazepine Use and the Latest Mental Health Headlines

June 16, 2022 /

From the Editor

Postsecondary education can be incredibly stressful for students – and, not surprisingly, mental health problems may surface. Is it possible to inform (and thus empower) students with a simple intervention?

In the first selection, Yifeng Wei (of the University of Alberta) and her co-authors consider a trial of Transitions, a program that includes both mental health literacy and comprehensive life skills resources “for those transitioning from secondary to postsecondary education.” In a new Canadian Journal of Psychiatry paper, they describe a study involving nearly 2 400 students across five institutions. “Students in the intervention significantly improved mental health knowledge, decreased stigma against mental illness, increased positive attitudes toward help-seeking, improved help-seeking behaviours, and decreased perceived stress compared to the control group.” We review the paper.

Beautiful campus – and a place to reduce stigma?

In the second selection, Christine Timko (of Stanford University) and her co-authors consider benzodiazepine use. In a new Psychiatric Services paper, they note: “This study’s findings suggest that challenges remain in discontinuing long-term benzodiazepine use among patients who are older than 45 years, White, taking higher doses for longer, and diagnosed as having anxiety, PTSD, bipolar disorder, or psychosis.”

And finally, in a new section, we consider some recent news items relevant to those of us in mental health care. Our aim: not simply to draw from interesting reports, but to include those that our patients may read and bring up. This week: the focus (and TikTok videos) on the vagus nerve, the Freud who hated Freud, and ADHD in adults.

DG

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Reading of the Week: No Better Than Placebo? Debating Antidepressants and ECT, with Papers from Psychological Medicine

June 9, 2022 /

From the Editor

Antidepressants don’t work. Medications fail to address the real cause of depression. ECT is basically a placebo.

These statements are controversial, but they are mentioned often – including by some of our patients. But what does the literature say about depression management? This week, we look at the debate over antidepressants and ECT, drawing on two recent papers from Psychological Medicine.

In the first selection, John Read (of the University of East London) and Dr. Joanna Moncrieff (of University College) argue that our approach to depression is flawed. In a longer paper that draws on more than 120 references, they challenge basic assumptions about mental health care, arguing against antidepressants and ECT. They advocate for an alternative: “Understanding depression and anxiety as emotional reactions to life circumstances, rather than the manifestations of supposed brain pathology, demands a combination of political action and common sense.”

Were Ali and Frazier having a fight over depression management?

In the other selection, Dr. Carmine M. Pariante (of the King’s College London) agrees to disagree. In a Psychological Medicine paper, he responds. “I have written a piece that tries to put together their point of view with the available evidence, while acknowledging the complexity of the debate.” 

DG

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Reading of the Week: Suicide & Physicians – the New CJP Paper; Also, Cannabis and Psychiatry (BJP) and Tom Insel on Mental Health Care (Atlantic)

June 2, 2022 /

From the Editor

Despite what we may wish to believe, physicians are mortal. We can develop illnesses – even mental disorders. And some (too many) suicide. Past studies have shown that doctors die by suicide more than the general population. But the data wasn’t Canadian.

In the first selection, Dr. Manish M. Sood (of the University of Ottawa) and his co-authors consider suicide by Canadian physicians. In a new Canadian Journal of Psychiatry paper, they do a population-based, retrospective cohort study drawing on more than a decade and a half of data. They write: “Physicians in Ontario are at a similar risk of suicide deaths and a lower risk of self-harm requiring health care relative to nonphysicians.” We look at the paper.

In the second selection, Dr. Julia Jiyeon Woo (of McMaster University) and her co-authors review cannabis from the perspectives of clinicians and patients. In a new British Journal of Psychiatry paper, they note: “This growing discrepancy between clinicians’ and patients’ perspectives on cannabinoids can be extremely damaging to the therapeutic alliance.” They offer practical suggestions.

And in the third selection, Dr. Thomas Insel (of the Steinberg Institute) considers what’s right and what’s wrong with mental health care. As the director of NIMH, he oversaw $20 billion of funding; in his new book, excerpted in the pages of The Atlantic, he calls for mental health reform. He writes: “There are only two kinds of families in America: those who are struggling with mental illness and those who are not struggling with mental illness yet. To ensure that we serve all families well, we don’t necessarily need to know more to do better.”

DG

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Reading of the Week: Screen Time and Kids’ Mental Health – the New JAMA Psych Paper; Also, Carol Smith on Her Grief (Wash Post)

May 26, 2022 /

From the Editor

Gaming. Apps. Streaming videos.

Children today have endless options at their fingertips, allowing them to entertain themselves for hours – which means less time for reading, playing, and physical activity. What effect does this have on their mental health? That question has sparked much debate: some argue that screen time is inherently problematic while others feel that it opens doors for creativity and connection to others. But what does the literature say? 

In the first selection, Rachel Eirich (of the University of Calgary) and her co-authors consider screen time and behavioural problems in children with a new systematic review and meta-analysis, just published in JAMA Psychiatry. Pulling together 87 studies, they focus on several variables. The big finding? “This study found small but significant correlations between screen time and children’s internalizing and externalizing behavior problems.” We look at the study.

And in the second selection, continuing our consideration of the first update to the DSM series in nine years, journalist Carol Smith mulls DSM-5-TR and the new diagnosis of prolonged grief disorder. In The Washington Post, she writes about her personal experience with grief: she lost her son when he was just 7. “I never thought to ask for help. I wish I had.”

DG

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Reading of the Week: Lived Experience & Psychosis – the New World Psych Paper; Also, the Evidence for Cannabis (QT) and Bob Bell on Psychotherapy (Globe)

May 19, 2022 /

From the Editor

“Something as basic as grocery shopping was both frightening and overwhelming for me. I remember my mom taking me along to do grocery shopping as a form of rehabilitation… Everything seemed so difficult.”

So comments a patient on the experience of a relapse of psychosis.

Typically, we describe psychosis with lists of symptoms. But how do patients understand these experiences? In a new World Psychiatry paper, Dr. Paolo Fusar-Poli (of King’s College) and his co-authors attempt to answer this question with a “bottom-up” approach. As they explain: “To our best knowledge, there are no recent studies that have successfully adopted a bottom-up approach (i.e., from lived experience to theory), whereby individuals with the lived experience of psychosis (i.e., experts by experience) primarily select the subjective themes and then discuss them with academics to advance broader knowledge.” We discuss their paper.

In the second selection, we consider a new Quick Takes podcast. Dr. Kevin Hill (of Harvard University) reviews the cannabis literature and weighs the evidence. He notes the hazards of CBD, the lack of evidence for cannabis and sleep, and his fondness for the Chicago Bears. “There are very strong proponents for cannabis and there are people who are entirely sceptical about it. And the answers to a lot of these questions are somewhere in the middle.”

Finally, in the third selection, Dr. Robert Bell (of the University of Toronto) and his co-authors advocate for the expansion of public health care to cover psychotherapy. Dr. Bell, who is a former Deputy Minister of Health of Ontario, makes a clear case drawing on international examples. “Canadians understand that good health requires mental-health support, and co-ordinated investment in mental-health treatment would pay dividends in reducing the impact of mental-health disability on the economy.”

DG

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