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Reading of the Week: Cancer & Suicide – the New Nature Medicine Paper; Also, Dr. Natasha Steele on Her Cancer (NEJM)

From the Editor

The big diagnosis. Even years after the fact and even in cases of good outcomes, so many still remember the exact moment when they were told that they had cancer. A patient once recalled with great detail the floor tiles in his doctor’s office (he couldn’t bear looking at his spouse or his doctor). He also remembered feeling so overwhelmed that suicide seemed like an option.

But what is the risk of suicide? In the first selection, Michael Heinrich (of the University of Regensburg) and his co-authors seek to answer that question, drawing on an impressive number of studies including more than 22 million patients. In a new paper for Nature Medicine, they report on a systematic review and meta-analysis; they found that “patients with cancer have an almost twofold increased risk of dying by suicide compared with the general population.” They write: “Despite immense progress in cancer therapy and prognosis in the past decades, suicide remains an important cause of death in patients with cancer.” We consider the paper and its clinical implications.

In the second selection, Dr. Natasha Z. Rabinowitz Steele (of Stanford University) considers her experiences in a New England Journal of Medicine paper. She writes about her cancer diagnosis and treatment, and the impact on her clinical work. She concludes: “Though all of our journeys will have beginnings and endings, our lives are what we choose to do with the precious, unpredictable, terrifying, and beautiful moments in between.”

DG


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Reading of the Week: Way Up – Alcohol-Related Deaths During the Pandemic (JAMA); Also, Addressing the Opioid Crisis (CJP) and the NYT on Grief

From the Editor

Three patients have recently told their stories to me. With his business failing, he turned to alcohol. When she couldn’t get hours at the restaurant because of the lockdown, she started drinking in the mornings. After a decade of sobriety, he explained that he found comfort in alcohol after his job loss.

These stories aren’t, unfortunately, surprising. With the pandemic, substance use appears to be on the rise. But what about substance-related deaths? In the first selection, we look at a new research letter from JAMA. Aaron M. White (of the National Institute on Alcohol Abuse and Alcoholism) and his co-authors examine alcohol-related deaths in the United States and the impact of the pandemic. They conclude: “The number and rate of alcohol-related deaths increased approximately 25% between 2019 and 2020, the first year of the COVID-19 pandemic.” We consider the paper and its clinical implications.

In the second selection, Dr. Tony P. George (of the University of Toronto) and his co-authors focus on the opioid crisis. In this Canadian Journal of Psychiatry commentary, they argue for a stronger approach to help those with opioid use disorder (OUD), specifically by improving the psychosocial interventions available. “While psychosocial interventions are often expensive and time consuming, they do make a difference in the lives of patients with OUD and those at risk for fatal opioid overdoses, especially when combined with broad psychosocial supports that address social determinants of health.”

And in the third selection, continuing our consideration of the first update to the DSM series in nine years, we look at a New York Times article, just published. Reporter Ellen Barry writes about prolonged grief disorder: “The new diagnosis was designed to apply to a narrow slice of the population who are incapacitated, pining and ruminating a year after a loss, and unable to return to previous activities.”

DG

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Reading of the Week: Resilience after Disaster – Lessons from Japan; Also, Schizophrenia & Spending (CJP) and Dr. Brandeland on Her Father & His Addiction (JAMA)

From the Editor

My patient was involved in a terrible car accident. Though physically unharmed, she’s never really recovered (mentally). Her co-worker, sitting in the seat beside her, barely took off any time from work.

Why are some people resilient and others aren’t?

In The British Journal of Psychiatry, Dr. Taku Saito (of the National Defense Medical College) and his co-authors explore this question, focusing on a natural disaster. Drawing on an impressive database of first responders involved in the 2011 Japanese earthquake rescue/recovery effort, they do a seven-year prospective cohort study. They find: “The majority of first responders… were resilient and developed few or no PTSD symptoms.” Of course, some did develop mental health problems. The risk factors? Older age, personal disaster experiences, and working conditions. We consider the big paper.

In the second selection, Andrew J. Stewart (of the University of Calgary) and his co-authors analyze health spending in a new Canadian Journal of Psychiatry paper. They focus on people with schizophrenia, looking at a 10-year period. “Healthcare spending among patients with schizophrenia continues to increase and may be partially attributable to growing rates of multimorbidity within this population.”

And, in the third selection, Dr. Megan Ann Brandeland (of Stanford University) writes about her father’s death. In JAMA, she discusses his struggles and notes that – early in his career as a physician – a patient had a tragic outcome. “My hope in sharing this story is to encourage more physicians to share their own stories, to reduce the stigma around mental health, trauma, and addiction among physicians, and to honor my father’s life and the goodness he brought to the world.”

Please note that there will be no Reading next week; we will resume on 31 March 2022.

DG

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Reading of the Week: ECT – the New NEJM Review; Also, Ethnicity & Drug Overdoses (JAMA) and Neil Seeman on His Father (CMAJ)

From the Editor

He has tried different medications, and yet he continues to struggle. The months have turned into years. When he was last well, he worked two jobs and was physically active, hoping to run the Boston marathon one day. When I saw him, he explained that he has difficulty following the plot of a TV show. Asked if he had ever considered ECT, his eyes widened. “They still do that?”

In the first selection, we look at a new review paper on ECT from The New England Journal of Medicine. Drs. Randall T. Espinoza (of the University of California, Los Angeles) and Charles H. Kellner (of the Medical University of South Carolina) provide a concise summary of the latest evidence. They conclude: “ECT is a valuable treatment for several severe psychiatric illnesses, particularly when a rapid response is critical and when other treatments have failed.” We consider the paper and the ongoing stigma associated with the treatment.

In the second selection, Joseph R. Friedman and Dr. Helena Hansen (both of the University of California, Los Angeles) draw on American data to consider overdose deaths and ethnicity. The JAMA Psychiatry paper concludes: “In this cross-sectional study, we observed that Black individuals had the largest percentage increase in overdose mortality rates in 2020, overtaking the rate among White individuals for the first time since 1999, and American Indian or Alaska Native individuals experienced the highest rate of overdose mortality in 2020 of any group observed.”

And in the third selection, Neil Seeman (of the University of Toronto) considers the life and death of his father, Dr. Philip Seeman, the celebrated scientist who studied schizophrenia. In this CMAJ essay, he comments on dopamine and his father’s life work. And he also writes about his relationship and dying. “It was that giving ice chips to my father will forever remind me of how the sensation of touch can stir love, fetch memories, and offer solace.”

DG

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Reading of the Week: TikTok is Popular & Cool But Good Mental Health Information? Also, Telemedicine and Practice (Psych Services)

From the Editor

Clever cats. Cool dancing videos. Tips on everything from calligraphy to home decorations.

A billion people are estimated to use TikTok on a monthly basis. The social media platform is incredibly popular here – and around the globe. And, as with other social media, people increasingly use it as a source of medical information.

To date, little research has been done on the credibility of that information. In a new Canadian Journal of Psychiatry paper, Dr. Anthony Yeung (of the University of British Columbia) and his co-authors focus on ADHD. They find uneven results: “In this analysis of popular TikTok videos about ADHD, there were over 2.8 million views per video and each video was shared on average 31,000 times. Approximately half of the videos analyzed (52%) were misleading…” We consider the paper and its clinical implications.

Continuing on the theme of technology and practice, in the second selection, we look at a new Psychiatric Services paper. Lori Uscher-Pines (of the RAND Corporation) and her co-authors do a qualitative analysis of why psychiatrists choose telemedicine for some patients and not others. The authors conclude: “psychiatrists did not perceive intermittent in-person visits as essential for high-quality care.”

DG

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Reading of the Week: E-Cigs and Cessation – the New JAMA Paper; Also, Green Space & Schizophrenia (CJP) and Dr. Jessica Gregg on Needed Care (NEJM)

From the Editor

How to help him quit?

We often speak to our patients about the dangers of smoking – with middling success, especially with those who aren’t interested in cessation. Are e-cigarettes part of the solution? In a new JAMA Network Open paper, Karin A. Kasza (of the Roswell Park Comprehensive Cancer Center) and her co-authors report on a cohort study focused on this refractory population. “In this US nationally representative cohort study of 1600 adult daily cigarette smokers who did not initially use e-cigarettes and had no plans to ever quit smoking, subsequent daily e-cigarette use was significantly associated with an 8-fold greater odds of cigarette discontinuation compared with no e-cigarette use.”

In the second selection, we consider a new Canadian Journal of Psychiatry research letter. Dr. Martin Rotenberg (of the University of Toronto) and his co-authors look at green space and schizophrenia. A connection? They find one. “We found that residing in an area with the lowest amount of green space was associated with an increased risk of developing schizophrenia, independent of other sociodemographic and socioenvironmental factors.”

Finally, in the third selection, Dr. Jessica Gregg (of the Oregon Health and Science University) writes about her experiences as a physician and as a patient. In this New England of Journal paper, she talks personally about sudden illness and unsatisfactory health care. “I knew – and know – that our system of not-care for the sick and scared is broken. I knew – and know – that our system of un-care for people affected by addiction or poverty, for those who make bad choices and those who were never offered fair choices in the first place, is even more fractured.”

DG

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Reading of the Week: Physician, Heal Thyself – the New JAMA Paper on Visits for Mental Health; Also, the History of Physician Wellness (NEJM)

From the Editor

The days have been long. As we enter the third year of the pandemic, many are feeling it. 

What has the impact been on the mental health of us physicians? We have anecdotal evidence, but data has been lacking. In the first selection, we consider a new paper by Dr. Daniel T. Myran (of the University of Ottawa) and his co-authors. Drawing on data from 34,000 Ontario doctors, the authors considered MD visits for mental health and substance (in other words, doctors visiting their doctors), finding that such appointments were up 27% during the first year of the COVID-19 pandemic. “These findings may signal that the mental health of physicians has been negatively affected by the pandemic.” We look at the paper and the invited commentary that accompanies it.

In the second selection, Agnes Arnold-Forster (of the London School of Hygiene and Tropical Medicine) and her co-authors consider the evolving understanding of physician health by looking to history. They argue that three concepts – medical exceptionalism, medicalization, and an emphasis on individual responsibility – have harmed physicians, creating “excessive commitment and complete personal sacrifice.” They suggest an alternative. “By attending to the lessons of the past, we can envision a better future for patients and their physicians.”

DG


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Reading of the Week: Cannabis & Driving – a New RCT; Also, Prolonged Grief Disorder (JAMA Psych) and the Life and Legacy of Alan A. Stone (NYT)

From the Editor

It’s legal. It’s readily available. What are the implications for road safety?

Cannabis is the focus of more and more research. Little, though, has been studied for its effects on driving. In the first selection, Thomas D. Marcotte (of the University of California San Diego) and his co-authors consider cannabis and driving performance. In a new paper for JAMA Psychiatry, they report on an RCT: “In a placebo-controlled parallel study of regular cannabis users smoking cannabis with different THC content ad libitum, there was statistically significant worsening on driving simulator performance in the THC group compared with the placebo group.” We consider the paper and its clinical implications.

Next month, the American Psychiatric Association releases DSM-5-TR, the first major update to the DSM series in nine years. Though the diagnostic criteria of several disorders have been revised, there is only one new disorder: prolonged grief disorder. In the second selection, Holly G. Prigerson (of Cornell University) and her co-authors write about it for JAMA Psychiatry. “PGD is a serious mental disorder that puts the patient at risk for intense distress, poor physical health, shortened life expectancy, and suicide.”

Finally, in the third selection, we consider the life and legacy of Dr. Alan A. Stone, a psychiatrist who passed at the age of 92. In his obituary for The New York Times, reporter Clay Risen describes his incredible career – as a psychoanalyst, a Harvard professor (in both the faculties of law and medicine), and a former president of the American Psychiatric Association who championed dropping homosexuality as a psychiatric disorder.

DG

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Reading of the Week: Who’s Left Out of RCTs for Schizophrenia? (JAMA Psych) Also, Inman on Being the Mother of a Person with Schizophrenia (Medium)

From the Editor

Recently during a family meeting, a patient’s father leaned forward, looked me directly in the eye, and asked: “what would be the best for my son?”

As clinicians, we draw from many sources: personal experience, clinical guidelines, expert opinion, studies. For the latter, randomized clinical trials are considered to be the gold standard. But do such trials capture well the complexity of the patient sitting in front of you?

In the first selection, Heidi Taipale (of the University of Eastern Finland) and her co-authors offer new data to answer that question. Drawing on impressive databases (over 25 000 people diagnosed with schizophrenia spectrum disorders), they consider patients with schizophrenia in RCTs against real-world populations in a JAMA Psychiatry paper. They find: “In this study, we applied typical inclusion and exclusion criteria of RCTs to the real-world populations of individuals with schizophrenia in Finnish and Swedish national registries. We found that almost 80% of individuals with schizophrenia would be ineligible to participate in typical RCTs and are therefore not represented in them.”

Finland: Big Northern Lights and big databases

In this week’s other selection, we also consider schizophrenia but with a different perspective. What could we do better to support patients and their families? Susan Inman writes: “Mothers, like me, who provide caregiving for adult children with schizophrenia do not have much of a voice.” In a thoughtful essay for Medium.com, she speaks about problems that hinder an effective mental health system, including a lack of mental health literacy campaigns.

DG

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Reading of the Week: Less & Less – Psychiatrists & Psychotherapy; Also, Transgender Individuals & Care (Psych Services) and Digital Mental Health (ANZJP)

From the Editor

“For much of the 20th century, psychotherapy was viewed as synonymous with psychiatry and was the primary treatment modality employed by outpatient psychiatrists.” 

Daniel Tadmon and Dr. Mark Olfson (both of Columbia University) observe this in a new paper. But times have changed; has the practice of psychiatry moved away from psychotherapy?

This week, there are three selections. The first is a new paper from The American Journal of Psychiatry that looks at psychotherapy provided by US psychiatrists. Drawing on decades of data, Tadmon and Olfson find: “While a small group of psychiatrists (11% – 15%) continued to provide psychotherapy in all patient visits, in the 2010s, about half of psychiatrists did not provide psychotherapy at all, and those who provided psychotherapy in some patient visits came to do so more and more rarely.” We consider the paper and its implications.

Sorry Freud: most psychiatrists don’t practice psychotherapy

In the second selection, Dr. June Sing Hong Lam and his co-authors consider the mental health experiences of transgender individuals. In a Psychiatric Services paper, they draw on administrative databases focusing on both ED visits and hospitalizations. They conclude: “This study found that transgender individuals presenting for acute mental health care were more likely to experience marginalization than cisgender individuals and to present to acute care with different diagnostic patterns.”

Finally, in the third selection, Dr. Aswin Ratheesh and Mario Alvarez-Jimenez (both of the University of Melbourne) consider digital mental health and the post-pandemic world. In the Australian & New Zealand Journal of Psychiatry, they write about various problems (for instance, with digital privacy). Still, they see much potential: “Effective digital tools, especially when blended and responsive can radically improve the availability of mental health care in our corner of resource-rich, yet manpower-poor world.”

Please note that there will be no Reading next week.

DG

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