From the Editor
It’s a Reading of the Week tradition to begin the new year by reviewing the best of the past one. And so, today, we look back at the selections from the previous 12 months.
2020 was tough, dominated by the pandemic.
The selections aren’t all about COVID-19, however. Papers shed light on the pandemic, yes, but much research helped further our understanding of mental health, relevant in the world that pre-dated the pandemic, and the world after the pandemic.
Looking over the past year of Readings, I would like to make two observations.
First, about the literature: the overall quality of scholarship remains high. As has been the case year after year, I liked the papers highlighted in this series – but also realize that many more papers could have been picked. Psychiatry continues to grow more sophisticated with each passing year.
Second, about the pandemic: COVID is understood to be a threat to physical health, but also to mental health. As a person with a few grey hairs, I remember SARS well. Mental health wasn’t discussed during that viral outbreak. The public dialogue has changed much in these past 17 years. While I wish more attention were paid to mental health and COVID, there have been national and provincial announcements on the topic, and much media attention too. #Progress
The Best Paper on the Post-Pandemic World
“Telepsychiatry and the Coronavirus Disease 2019 Pandemic – Current and Future Outcomes of the Rapid Virtualization of Psychiatric Care”
Jay H. Shore, Christopher D. Schneck, Matthew C. Mishkind
JAMA Psychiatry, 11 May 2020 Online First
2020 saw an incredible rise in virtual mental health care. “Historically, full implementation of telepsychiatry, especially in large organizations, could take months to years. Rapid virtualization has shown that clinicians, patients, and systems can quickly adapt to telepsychiatry, although not without challenges and lessons learned.”
What to make of it all?
Jay H. Shore
Dr. Jay H. Shore and his co-authors consider the pandemic and mental health care in this short, thoughtful commentary.
They ask a handful of questions that we should all consider:
“What will the lessons of the COVID-19 pandemic be, in terms of what can vs should be done in person or through telepsychiatry or other technologies? How much virtual care is too much? Is there a virtual saturation point, at which the benefits of a virtual relationship decrease or patients request more in-person interactions? What data need to be captured now to better understand this and identify current lessons learned?”
The COVID Paper for Everyone
“Achieving Good Mental Health during COVID-19 Social Isolation”
Rowan Diamond and John Willan
The British Journal of Psychiatry, 4 May 2020 Online First
How to stay well during periods of self-isolation?
Diamon and Willan tap the literature. “We suggest ways in which all those who are self-isolating can attend to, or perhaps even improve, their mental and physical well-being under these most unusual of circumstances.” They offer six practical suggestions: Learn, Take Notice, Connect, Give, Be Active, and Building a Routine.
This paper is worth sharing with patients – and friends and family.
The Best Paper: Clinical Relevance at a Time of COVID
“The psychological impact of quarantine and how to reduce it: rapid review of the evidence”
Samantha K. Brooks, Rebecca K. Webster, Louise E. Smith, et al.
The Lancet, 26 February 2020
“The word quarantine was first used in Venice, Italy in 1127 with regards to leprosy and was widely used in response to the Black Death, although it was not until 300 years later that the UK properly began to impose quarantine in response to plague.”
So notes this short but important rapid review of the psychological impact of quarantine.
“Overall, this Review suggests that the psychological impact of quarantine is wide-ranging, substantial, and can be long lasting.” They make six recommendations about reducing that impact: Keep it as short as possible, Give people as much information as possible, Provide adequate supplies, Reduce the boredom and improve the communication, Health-care workers deserve special attention, and Altruism is better than compulsion.
The Paper I Wish Everyone Would Read
“Identifying outcomes for depression that matter to patients, informal caregivers, and health-care professionals: qualitative content analysis of a large international online survey”
Astrid Chevance, Philippe Ravaud, Anneka Tomlinson,et al.
The Lancet Psychiatry, August 2020
The editors of Lancet Psychiatry note: “US Food and Drug Administration accepts only three outcome measures as primary endpoints in phase 3 studies to support an indication for major depressive disorder: the Hamilton Depression Rating Scale, the Montgomery-Åsberg Depression Rating Scale, or the Children’s Depression Rating Scale.” Their concern: the FDA view is very narrow and confined to these three scales.
This paper considers outcomes that are important to patients, caregivers, and providers. Spoiler alert: none of the three scales were mentioned. Instead, the paper offers a glimpse in the aspirational hopes of us providers, yes, but also our patients and their caregivers.
The Best Paper: Clinical Relevance
“Cannabidiol as a Treatment for Mood Disorders: A Systematic Review”
Jairo Vinícius Pinto, Gayatri Saraf, Christian Frysch, et al.
The Canadian Journal of Psychiatry, April 2020
“Should I take CBD for my depression?”
UBC’s Jairo Vinícius Pinto and his co-authors consider cannabidiol in the treatment of mood disorders, reviewing the existing literature. Does CBD help? “The methodology varied in several aspects and the level of evidence is not enough to support its indication as a treatment for mood disorders.”
They note: “In general, these studies showed a good safety profile of cannabidiol, without inducing dysphoria, anxiety, or psychotic symptoms and with few adverse effects. However, regarding the mood symptoms, the results were conflicting, showing both significant improvements in depressive symptoms and absence of significant differences.” The paper calls for more research. It also offers an important reference that can be noted in conversations with our patients.
The Best Paper: Clinical Research
“Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive Symptoms: A Randomized Clinical Trial”
Zindel V. Segal, Sona Dimidjian, Arne Beck, et al.
JAMA Psychiatry, 29 January 2020 Online First
“Despite the availability of antidepressant medication, most patients with depression who achieve a clinical response to antidepressant medications experience residual depressive symptoms.”
Segal et al. use an online therapy to attempt to help people with such symptoms. The RCT finds a promising result: “greater reductions in depressive and anxiety symptoms, higher rates of remission, and lower rates of relapse compared with participants who received usual care only.” Bonus? The cost: “$96.67 for a mean of 2.34 hours per participant… and included orientation and follow-up telephone calls, emails, website tracking, and supervision.”
The Best Paper: Health Services
“Mortality among patients with frequent emergency department use for alcohol-related reasons in Ontario: a population-based cohort study”
Jennifer Hulme, Hasan Sheikh, Edward Xie, et al.
CMAJ, 23 November 2020
“Alcohol is a leading driver of morbidity and mortality worldwide. An estimated 3 million deaths in 2016 – 5% of all global deaths – were attributable to alcohol consumption…”
So begins this CMAJ paper. Drawing on 25,000 patient records, the authors found a clear pattern: “One in 20 Ontarians who had two or more alcohol-related ED visits in a 12-month period die within a year of their last ED visit. But the risk of death doubled for those who had 5 or more visits to the ED for alcohol-related reasons.”
Unfortunately, the paper hasn’t been considered in a Reading yet. But I hope it will be considered by government officials.
The Person of the Year
In selecting a Person of the Year, I consider people who have made contributions to scholarship or advocacy or clinical work. Past selections have included a former Minister of Finance, the CEO of major hospital, and the former chair of university department of psychiatry.
This is the year of COVID – of long hours, uncertainty, and angst. It’s also the year when countless physicians volunteered to take extra shifts for colleagues unable to work and when health care professionals adopted new ways of reaching patients when clinics needed to be closed.
I will remember 2020 as the year of the pandemic. I’m also going to remember how many of my colleagues texted me silly jokes and offered to shop for me when I was in self-isolation.
And so, there is no Person of the Year – but, rather, People of the Year. I pay tribute to the work done by clinicians like you today, and every day.
There are many good papers and articles about working during COVID.
The short essay by our Boston colleague Dr. Zheala Qayyum was particularly moving, right from its first sentences: “Lately I’ve found myself giving people directions to the hospital morgue… It’s not what I expected to do as a physician. I’m a highly trained Boston-area psychiatrist, recently called to active duty by the Army Reserves, to fight the COVID-19 pandemic in New York. But in my new role – as an emergency room psychiatrist at a hospital in Queens – I get stopped in the hallways and asked, ‘which way?’”
And The Lancet printed an obituary for the physicians who lost their lives due to COVID, including a young Spanish primary care doc.
Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.