Tag: ADHD

Reading of the Week: Culturally-Adapted CBT for Postnatal Depression – the New Lancet Study; Also, ADHD in Adults (JAMA Psych) and the Latest in the News

October 31, 2024 /

From the Editor

She was offered CBT through our outpatient program. Though we encouraged her to come, she didn’t even attend one session. Was the problem partly with the rigidity of our program which wasn’t tailored to her cultural background or language? Can we do better? 

Dr. Nusrat Husain (of the University of Manchester) and his co-authors attempt to answer these questions in a new RCT published in The Lancet. In their study, British south Asian women with postnatal depression were randomized to a culturally-adapted form of CBT or treatment as usual. “Participants in the [intervention] group were estimated to be almost twice as likely to have recovered at 4 months than those in the control group.” We consider the paper, the accompanying Comment, and the implications for clinical care.

In the second selection, Drs. Carlos Blanco (of the National Institutes of Health) and Craig B. H. Surman (of Harvard University) write about ADHD for adults. In a new JAMA Psychiatry Viewpoint, they argue that more needs to be done, especially given the adverse outcomes of untreated ADHD. “A tension exists between undertreatment of adults with ADHD and overuse of addictive treatments for the condition.”

Finally, we explore the latest news with recent articles from The Washington Post, The Globe and Mail, and The New York Times. The topics: ChatGPT for psychotherapy, the generosity of Bruce McKean, and the street psychiatry in LA.

DG

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Reading of the Week: Do ADHD Meds Reduce Mortality? The New JAMA Psych Study; Also, Dr. Rebecca Lawrence on Her Husband & His Support

April 4, 2024 /

From the Editor

For my patient, ADHD medications transformed his life, helping him focus at school and at work – and even drive better. Many have had similar experiences. Do ADHD medications also reduce mortality? We know that those with ADHD have higher mortality rates and thus it’s reasonable to ask about the possible benefits of methylphenidate and sister drugs.

Lin Li (of the Karolinska Institutet) and her co-authors try to answer that question in a new JAMA Psychiatry paper. Drawing on Swedish databases, they analyzed data from almost 150 000 people with ADHD and looked at two-year mortality, including for those who die by unintentional injuries, suicide, or poisonings, by doing a target trial emulsion – simulating a randomized trial. “Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes.” We consider the paper, the editorial that accompanies it, and the clinical implications.

ADHD meds: life saver?

And in the other selection, Dr. Rebecca Lawrence writes about support in a blog for Doctor and Patient. She is personal – besides working as psychiatrist, Dr. Lawrence has been treated for depression, including with ECT. She notes the incredible help her husband has given her over the years. “I look at myself in the mirror and am appalled, but he still smiles at me.

DG

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Reading of the Week: ADHD & Substance Outcomes – the New JAMA Psych Paper; Also, Suicide & the Impact on Psychiatrists and Foulkes on Her Anxiety & Our Times

July 27, 2023 /

From the Editor

Stimulants are commonly prescribed to children with ADHD. Do they protect kids against future substance misuse? Or, having been exposed early to stimulants, are these patients more likely to develop substance problems in adulthood?

Past studies have attempted to answer these questions but have been limited by study design. In a new JAMA Psychiatry paper, Brooke S. G. Molina (of the University of Pittsburgh) and her co-authors take a fresh look. In a cohort study involving 547 students, some of whom were treated with stimulants while others received behavioural therapy during the first period, Molina et al. look at outcomes when these participants are in their mid 20s. “This study found no evidence that stimulant treatment was associated with increased or decreased risk for later frequent use of alcohol, marijuana, cigarette smoking, or other substances used for adolescents and young adults with childhood ADHD.” We consider the study and its implications.

In the second selection, Dr. Juveria Zaheer (of the University of Toronto) discusses patient suicide in a new Quick Takes podcast interview. Focusing on the impact on psychiatrists and residents of psychiatry, she draws from the literature, including a study she recently senior authored for The Canadian Journal of Psychiatry. She notes common reactions by psychiatrists and residents, including guilt and shock. And Dr. Zaheer talks about her own experience. “I’ll never forget when it happened.” 

And in the third selection, Lucy Foulkes (of the University of Oxford) writes about anxiety and current approaches. In a Guardian essay, she notes her own history as an “anxious teen” and wonders if life is better for today’s adolescents, with awareness campaigns but not necessarily meaningful services. “We are now in a situation where many teens know or believe they are anxious but aren’t getting the help they need to manage it.”

The Reading of the Week has formal partnerships with 14 postgraduate programs and, today, we welcome PGY1s who are joining us from across Canada.

DG

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

March 3, 2022 /

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: 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: ADHD and Overdiagnosis

July 16, 2015 /

Overdiagnosis in psychiatry occurs where patients are identified with a mental disorder when they do not have significant impairment and would not be expected to benefit from treatment. These problems can arise even when diagnostic criteria are met, that is, in the presence of milder symptoms that fall close to, or within, a normal range on a diagnostic spectrum. Overdiagnosis can lead to unnecessary labelling, unneeded tests, unnecessary therapies, and inflated health care costs. In medicine, with the best of intentions, practice has come to favour more tests and more treatments, all of which tend to drive overdiagnosis. This problem may be worsened by a prevailing cultural ethos that more is better.

Outside of psychiatry, there are clear examples of overdiagnosis. For example, screening programs designed to detect early stages of certain cancers appear to increase incidence estimates, but may have no discernable effect on mortality…

Psychiatry has followed this trend. It has been estimated that at least 40% to 50% of the population will meet criteria for at least 1 psychiatric diagnosis during their lifetime. The current system of nosology in psychiatry, based on phenomenology, that is, subjective reports and clinical observations, encourages overdiagnosis. The presence or absence of mental disorders is not defined by biomarkers, allowing diagnostic constructs to describe broad spectra that cross over into normality.

So begins a short, sharp article on overdiagnosis in psychiatry that has just been published. The authors raise significant issues about psychiatry in general and adult ADHD in particular – they argue that the DSM diagnosis is flawed and impractical; they take aim at patients (yes, patients); they then turn their sites on researchers and industry.

The comments of sensational journalists? The skewed opinion of Scientologists on a blog? Actually, the Reading comes from the pages of The Canadian Journal of Psychiatry and, for the record, the paper’s first author is one of the most prominent psychiatrists in the country; Dr. Joel Paris is the past chair of McGill’s Department of Psychiatry and the author of more than a dozen books.

This week’s Reading: “Is Adult Attention-Deficit Hyperactivity Disorder Being Overdiagnosed?” by Paris et al.

Here’s the link:

http://www.ncbi.nlm.nih.gov/pubmed/26175391

The Canadian Journal of Psychiatry has always been worth reading, but its new editor, Dr. Scott Patten, has taken this journal to the next level. And, in my opinion, this “perspective” paper is a must-read – one of the most important papers written this year. Continue reading