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Award of Excellence in Mental Health

June 14, 2017 /

Individuals in need of Cognitive Behavioral Therapy (CBT) typically face challenges like long wait lists, a shortage of therapists, and lack of access to a therapist outside of regular business hours. Now, adult outpatient clients of Scarborough and Rouge Hospital’s Mental Health department can access treatment for anxiety and depression any time and place that is most convenient for them.

My Scarborough and Rouge Hospital team was awarded the 2017 Award of Excellence in Mental Health and Quality Improvement from the Canadian College of Health Leaders.

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Our  team won this honour for our e-therapy work. The gala dinner was in Vancouver this Sunday.

Full details here: https://www.cchl-ccls.ca/site/awards_mentalhealth_quality

Nice.

Reading of the Week: Better Treatment, Safer Roads? The New JAMA Psychiatry Paper on ADHD & Driving

June 8, 2017 /

From the Editor

How can we reduce the number of car accidents?

We often speak about treating mental illness in terms of reducing personal suffering. Recent selections have looked at the economic cost of mental illness. But what are the implications to public health?

This week, we look at a new JAMA Psychiatry paper; this national cohort study involved more than 2.3 million people with ADHD, and considered motor vehicle crashes (as measured by emergency department visits) and whether or not they were taking medications.

Yes, he has a plaid shirt, but should he be taking his prescription meds?

Spoiler alert: The authors find “medication use for the disorder was associated with a significantly reduced risk” of vehicle accidents.

We also look at an editorial that finds “clinical pearls” in this paper.

DG Continue reading

Reading of the Week: Is Psychoanalysis Relevant? Paris vs. Ravitz

June 1, 2017 /

From the Editor

“Today, psychoanalysis has been marginalized and is struggling to survive in a hostile academic and clinical environment. This raises the question as to whether the paradigm is still relevant in psychiatric science and practice.”

This week, we consider the relevance of psychoanalysis.

Drawing from the May issue of The Canadian Journal of Psychiatry, we look at two papers.

Freud and analysis: debating his relevance

In a Perspectives piece, Dr. Joel Paris argues that psychoanalysis is part our legacy – but not much more. In an Editorial, Dr. Paula Ravitz responds. She opens by writing: “My concern is that by unnecessarily pitting psychiatry against psychoanalysis, we may throw out the baby with the bathwater.”

It’s a great and important debate.

DG Continue reading

Reading of the Week: Effective Therapy for Anxious & Depressed Youth in a Peds Clinic? The New Weersing Study

May 18, 2017 /

From the Editor

“Anxiety and depression in youth are widely prevalent, highly impairing, and woefully undertreated.”

So writes San Diego State University’s V. Robin Weersing and her co-authors in a new JAMA Psychiatry paper. In this study, they compare a pediatric clinic-based brief behavioural treatment to referral to outpatient services for depression and anxiety. It’s a novel approach – and one with significant advantages (housing treatment in a primary care setting, to name just one).

So does this work? Spoiler alert: the brief behavioural treatment (BBT) comes out on top.

Anxiety treatment in the peds office: would Norman Rockwell approve?

As an accompanying Editorial notes: “The efficacy of BBT is particularly telling given the low response rate to treatment as usual in the control condition (57% vs 28%), especially for Hispanic populations (76% vs 7%).”

Please note: there will be no Reading next week because of the APA Annual Meeting. (I hope to see you in California.)

DG

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Reading of the Week: Can We Reduce Suicide in the Emergency Department Population? Also, Drugs & Crime

May 11, 2017 /

From the Editor

He presents to the Emergency Department a few days after a suicide attempt. What can we do to help keep this man safe today – and moving forward?

Emergency Departments: noisy, busy, and an opportunity for suicide prevention?

It’s a scenario that repeats itself at EDs across the country with regularity. This week, in our first selection, we consider a new JAMA Psychiatry paper that has just been published looking at suicide prevention in the ED population. The authors claim “this study is the largest suicide intervention trial ever conducted in the United States,” and they show that, with an intervention, they can reduce suicides and suicide attempts.

And, in the other selection, we look at a short New York Times essay in which economist Austin Frakt argues that substance programs pay for themselves in crime reduction.

DG Continue reading

Reading of the Week: Economics & Mental Health – the New MHCC Paper; Also, Dr. Beck on Marijuana Legalization

May 4, 2017 /

From the Editor

Does investing in mental health make economic sense?

We often speak of mental health spending in terms of human terms – that people will have the opportunity to recover. But what about the economics of mental health?

Economics & mental health: worth considering?

This week, we look at a new report from the Mental Health Commission of Canada. In it, the authors consider the impact of mental illness on our society, and then look at options for spending with an eye on economic returns.

In the other selection, we consider marijuana and public health with a blog by Dr. Gail Beck, a psychiatrist affiliated with The Royal. As Ottawa moves towards legalization, she offers a cautionary note: “Most physicians hope that the federal government will approach the legalization of marijuana emphasizing public health concerns as the most important consideration in the drafting of legislation.”

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Reading of the Week: Technology & Mental Health – Depression and Internet-based CBT; Also, Finnish e-Therapy

April 27, 2017 /

From the Editor

VR. e-therapies.

New technology is changing the way we think about the delivery of psychiatric services. But new isn’t necessarily better. Can care really be transformed? What does the literature say?computere-therapy: more than clever pictures of computers and stethoscopes?

In a two-part Reading of the Week, we look at technology and psychiatry.

Last week, Virtual Reality.

This week, e-therapies.

This week, we consider a new paper that has just been published. Its looks at self-guided Internet-based CBT showing that for every eight people treated, one benefits (consider this in the context of minimal cost).

And, in the other selection, we look at the Finnish experience with Internet-based CBT.

DG Continue reading

Reading of the Week: Technology & Psychiatry – Can Virtual Reality Help with Pain? Or Social Anxiety?

April 20, 2017 /

From the Editor

VR. e-therapies.

New technology is changing the way we think about the delivery of psychiatric services. But new isn’t necessarily better. Can care really be transformed? What does the literature say?

U.S. President Barack Obama tries virtual reality glasses as he and German Chancellor Angela Merkel (R) tour Hanover Messe Trade Fair in Hanover, Germany April 25, 2016. REUTERS/Kevin Lamarque

VR: more than just a presidential photo op?

In a two-part Reading of the Week series, we look at technology and psychiatry.

This week, Virtual Reality.

Next week, e-therapies.

This week, we consider a new paper that looks at virtual reality to treat pain in hospitalized patients. The authors find that people utilizing VR have less pain as compared to controls. This finding leads us to another recent paper on VR; in this second study, patients with social anxiety are treated with a VR intervention.

DG

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Reading of the Week: Breaking the Stigma – Dr. Adam B. Hill on his Depression and Addiction

April 13, 2017 /

From the Editor

“My name is Adam. I am a human being, a husband, a father, a pediatric palliative care physician, and an associate residency director. I have a history of depression and suicidal ideation and am a recovering alcoholic.”

So begins this week’s selection, which is an essay written with remarkable candor and honesty.

1docDiscussing what we should discuss

In this Reading, Dr. Adam Hill writes in The New England Journal of Medicine about his struggle with mental illness.

It is moving and important.

DG Continue reading

Reading of the Week: Schizophrenia & Diabetes: The Gap in Care; Also, Swedish Health Care

April 6, 2017 /

From the Editor 

“The pain in my feet. It’s killing me.”

That’s what John told me when I asked him what he needed help with. It’s not quite the answer I thought he’d give – John has schizophrenia and he has significant side effects from his medications. But, like many people with mental illness, he also struggles with physical illness (diabetes and the accompanying neuropathy).

Many of our patients have both physical and mental illnesses. When faced with these twin challenges, how do they fair?

In this week’s first selection, we look at a new paper that considers people with schizophrenia and diabetes. The study authors find a significant gap between the care received by those with and without mental illness.

insulinAn old drug, an old illness, and a big problem for those with mental illness

In our second selection, drawing from a lively blog written by medical student Ali Damji, we look at Swedish health care.

DG
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