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Reading of the Week: How Successful Are We at Treating Canadians with Depression? And More

March 10, 2016 /

From the Editor

How successful are we at treating Canadians with depression? How could Canada’s health care system serve these patients better?

This is the ‘all Canadian’ issue of the Reading of the Week.

Readings don’t necessarily follow a theme – but we do this week. The two papers are written by Canadian authors; they tackle Canadian topics; they were published in a Canadian journal, The Canadian Journal of Psychiatry.

The first paper considers depression in Canada, looking at prevalence and treatment over a decade. The second paper champions more effective care for Canadians. Both are readable and relevant.

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Reading of the Week: Chains and the Mentally Ill, and More

March 3, 2016 /

From the Editor

How to free the mentally ill from their chains?

This week, I’ve selected three Readings. We open with a moving essay about a man who works to free the mentally ill from their chains – literally – in Africa. In an op ed, Mental Health Commission of Canada’s Michael Wilson argues that the federal budget must make suicide prevention a priority. Finally, we look at a new study considering an old problem: access to mental health services.

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Reading of the Week: Doctor-Assisted Suicide: The Dutch Experience

February 25, 2016 /

From the Editor

Is the practice of psychiatry about to change?

We often think of change in terms of treatment developments – new drugs and therapies. But mental health services are delivered in a larger societal context, and our work is shaped by laws and court rulings. With that in mind, Carter v. Canada has the potential to reshape our work. As you know, last year, the Supreme Court of Canada struck down the provision of the Criminal Code prohibiting doctor-assisted suicide. Later today, a special joint parliamentary committee will issue its report, guiding the drafting of legislation that will legalize doctor-assisted suicide.

How will this future legislation affect those with mental illness? What will it mean for people like us who do clinical work? Obviously, it’s not possible to comment on legislation that hasn’t been drafted yet. But it is possible to look to other countries and consider their experience. In this week’s Reading, Kim et al. consider physician-assisted suicide and euthanasia in the Netherlands. In their study of a country across the ocean, there are lessons for our patients here.

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Reading of the Week: The Good Life of Oliver Sacks, and More

February 18, 2016 /

From the Editor

Is the incidence of dementia falling?

What makes a good clinician?

This week, I’ve selected two Readings. We open with a NEJM paper suggesting a big trend: a decline in the incidence of dementia. That paper obviously has major implications for public policy. We then move on to a big and eloquent essay on a famous doctor, Oliver Sacks.

There isn’t much connecting these selections – except that both were suggested by readers, and they both raise big questions.

Enjoy.

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Reading of the Week: Biron’s Illness and Recovery

February 11, 2016 /

From the Editor

Drug breakthroughs, better imaging, less invasive procedures. There are many amazing health-care stories from the past three decades but perhaps the most important one is decidedly low tech: the decline of stigma about mental illness, allowing millions of Canadians to discuss their problems and seek care.

That’s not to suggest that stigma doesn’t exist, of course. In November, we considered the Dabby et al. paper from The Canadian Journal of Psychiatry, which showed bias even on the part of psychiatrists and psychiatric residents. Though the problem continues, it’s difficult not to believe that we have turned a significant corner: late last month, for instance, Bell Canada Let’s Talk campaign managed to raise more than $6 million in a single day.

In terms of reducing stigma, it helps immeasurably when people come forward and discuss their mental health illness. I remember talking to a patient who had struggled with her diagnosis. Inspired by Olympian Clara Hughes, she posted on Facebook that she has Bipolar. In my office, she wept when describing the outpouring of support – from friends and families, yes, but also from strangers.

Stigma still exists; it takes great courage to come forward – but it’s incredibly important that people do.

This week’s Reading is one person’s story of mental illness and recovery, and his choice to tell his story.

He also happens to be the President and CEO of my hospital. And I’ve never been prouder to work at The Scarborough Hospital.

DG Continue reading

Reading of the Week: To Screen or Not to Screen – Pregnancy & Depression Screening

February 4, 2016 /

From the Editor

“Panel Calls for Depression Screenings During and After Pregnancy”

A government health-care panel making a revision to a past recommendation seems pretty ‘inside baseball’ – and hardly the stuff of international headlines. Last week, though, the decision of the U.S. Preventive Services Task Force to now recommend the screening of pregnant and post-partum women for depression was reported from New York to New Delhi.

For the record, The New York Times story (whose headline appears above) ran on the front page.

Why the change and what are the implications?

To screen or not to screen…

This week’s Reading looks at the big decision and we consider: is it a big bust?

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Reading of the Week: Freud Is Dead – Are His Ideas Dead, Too?

January 28, 2016 /

From the Editor

Sigmund Freud is dead.

Are his ideas dead, too?

Sigmund Freud – Irrelevant?

Psychiatry has left much of Freudian analysis behind. Is that a good thing? This week’s Reading ponders this question – first, with an excellent essay by The Guardian’s Oliver Burkeman that considers “the revenge of Freud,” then with a response from New York Magazine’s Jesse Singal, and, finally, with a recent paper from The American Journal of Psychiatry comparing patients with bulimia who received psychoanalysis and who received CBT.

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Reading of the Week: The Suicidal Doctor

January 21, 2016 /

From the Editor

In December, the Readings included the Mata et al. paper from JAMA considering depression and residents. The review – which included more than 50 papers – found that the prevalence of depression or depressive symptoms among resident physicians was 28.8%.

Dr. David Goldbloom’s comment on the paper is worth repeating: “it is a sobering reminder that the white coat is not Kevlar against the illnesses we treat, and our professional culture still has a long way to go in recognizing, accepting and supporting that we get sick, too.”

This week we look again at physicians and mental health. The first selection is an essay by a doctor in which he discusses his suicidal thoughts. Then, with an eye on practical interventions to help doctors at risk, we consider the JAMA Psychiatry study on CBT for interns (with a modern twist).

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Reading of the Week: Values and Schizophrenia, and More

January 14, 2016 /

From the Editor

Welcome to first Reading of the Week of 2016.

Continuing the format started in December, I’ve made several selections here. This week: the obituary of an influential psychiatrist, a clever paper on values and schizophrenia, and a report that considers the use of psychiatric services in Ontario.

In general, Readings in this format don’t have a common theme. That said, this week, a common thread runs through the three selections: challenging assumptions.

Dr. Agid and his co-authors look at the values of those with schizophrenia, challenging the assumption that our patients value what we value; the HQO-ICES report challenges what we think we know about psychiatric care and care delivery in Canada’s largest province. And what can be said of Dr. Robert Spitzer? Well, he made a career out of challenging psychiatric assumptions – much to his credit, and to our benefit.

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Reading of the Week: The Best of 2015 — Books, Papers, and Hope

December 24, 2015 /

From the Editor

This will be the last Reading of the Week for 2015. (The Readings will resume in a fortnight.)

A bit of housekeeping: the Reading of the Week is a labour of love. There is no industry support for this project – or, in fact, any funding. Still, it’s hardly my project. Many readers (particularly residents) suggested papers and made comments over this past year. I’m also deeply grateful for the support of several colleagues; Drs. David Goldbloom and Mark Fefergrad deserve particular mention. And my father and wife have been great editorial supports.

It’s a Reading of the Week tradition to close the year by highlighting the best of the past 12 months.

Looking over the Readings of this year, I’m struck by the diversity of the publications that I could draw selections from. Sure, the Readings of 2015 included papers from The New England Journal of Medicine and JAMA Psychiatry. But they also included moving personal essays that were published in newspapers; The Economist (yes, The Economist) covered mental illness and the burden of disease well and thoughtfully; the best articles on global psychiatry appeared in The New York Times.

It wasn’t that long ago that we hoped that discussion of mental illness would move out of the shadows. Today, slowly but surely, it is. And so, 2015 closes after 48 Readings and on this hopeful note.

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