Tag: adolescent

Reading of the Week: School-based CBT for Teens – the New Lancet Psych Study; Also, Rural vs Urban Readmissions, and Dr. Horton on Fighters (and Biden)

July 18, 2024 /

From the Editor

Though many years have passed, he clearly remembers his first depressive episode, which occurred before his 18th birthday. My patient often wonders how things could have been different had he been offered care earlier. School-based initiatives are much discussed – indeed, they are having a moment. Public schools, for example, in New York City, offer students a few minutes daily of teacher-led mindful breathing. Such efforts are unlikely to yield significant results, in part because they lack focus.

What if we offered psychotherapy skills to interested high school students? Could it help alleviate symptoms of mood and anxiety? Would it be cost effective? June Brown (of King’s College London) and her co-authors address these questions in a new study just published in The Lancet Psychiatry. They report on a randomized controlled trial involving 900 UK adolescents who self-referred and received CBT or treatment-as-usual. “[T]he DISCOVER intervention is modestly clinically effective and economically viable and could be a promising early intervention in schools.” We consider the paper and its implications.

In the second selection, drawing on US data, Hefei Wen (of Harvard University) and co-authors examine hospital readmissions in the United States for mental health. In this new research letter published in JAMA Psychiatry, they find that rural readmissions – historically lower than urban ones – now exceed their urban counterparts. “This reversal and worsening of rural and urban gaps in mental health readmission was primarily concentrated in schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, and depressive disorders.”

And in the third selection from the Los Angeles Times, Dr. Jillian Horton (of the University of Manitoba) discusses time, aging, and resilience in a personal essay. Our internist colleague touches on the debate over the US president and his health but focuses on the story of her sister, who faced major problems after neurosurgery. She notes that her sister was able to “beat the odds” many times, until she couldn’t. “[W]e can’t change the reality of what comes next.”

DG

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Reading of the Week: Are Mental Disorders Contagious in Teens? The New JAMA Psych Study; Also, Edibles & Older Adults, and Harmon on Discrimination

May 30, 2024 /

From the Editor

People with mental disorders often have family members who have been touched by illness – a genetic tie, well established in the literature. But what about the influence of peer groups? A small body of literature suggests a connection between social circles and diagnosis. How can we understand this? Are mental disorders contagious?

In the first selection, Jussi Alho (of the University of Helsinki) and her co-authors attempt to answer those questions in a new study for JAMA Psychiatry. They did a cohort study, drawing on Finnish databases, and involving more than 700 000 people. They considered individuals who had a classmate diagnosed with a mental disorder in grade 9. “We found an association between having peers diagnosed with a mental disorder during adolescence and an increased risk of receiving a mental disorder diagnosis later in life.” We analyze the study and its implications.

How have cannabis poisonings increased with the legalization of edibles in Canada? In the second selection, a research letter for JAMA Internal Medicine, Dr. Nathan M. Stall (of the University of Toronto) and his co-authors looked at an 8-year period and focused on older adults, finding 2 322 ED visits in Ontario. “The largest increases occurred after edible cannabis became legally available for retail sale, a phenomenon similarly observed in Canadian children.”

And in the third selection, Caroline Payton Harmon, who is a PhD candidate at Rutgers University, describes the people she met in substance use treatment. The essay, published in The Lancet Psychiatry, is personal and notes the contrasts between those of different socioeconomic backgrounds. “The health-care system sees money and sees patients who are not worth the cost of treatment.”

DG

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Reading of the Week: Adolescent Experience with Illness – the World Psych Paper; Also, the CANMAT Depression Update and a Letter to the Editor

May 16, 2024 /

From the Editor

I’m separated from everyone else.

These are the words of a young patient with depression. We often use diagnoses and lists of symptoms to understand patients. But how do patients themselves understand their illness? In the first selection, Dr. Paolo Fusar-Poli (of King’s College London) and his co-authors attempt to answer that question with a “bottom-up” approach. In a new World Psychiatry paper, they describe the experiences of adolescents with mental disorders. “The study was co-designed, co-conducted and co-written by junior experts by experience – representing different genders, ethnic and cultural backgrounds, and continents – and academics, refining an earlier method developed by our group to investigate the lived experience of psychosis and depression.” We examine the paper and its implications.

Childhood depression by Marc-Anthony Macon

Much has changed over the past eight years – who was talking about pandemics in 2016? Last week, the Canadian Network for Mood and Anxiety Treatments (CANMAT) released its first major depression update in eight years. So how has depression management changed? In the second selection, Dr. Raymond Lam (of the University of British Columbia), the co-first author, discusses the update in a Quick Takes podcast interview. “They really are the most widely used guidelines in the world.” 

And in the third selection, in a letter to the editor, Nick Kerman (of the University of Toronto) writes about the recent homelessness paper from JAMA Psychiatry, summarized in a Reading earlier this month. He notes the striking finding: 26% meet the criteria for antisocial personality disorder. “Could it really be 1 in 4 or is there something else that could explain the finding?”

DG

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Reading of the Week: Global Burden of Schizophrenia – the new Molecular Psych Study; Also, MedEd’s Evolution & Saxbe on Helping Depressed Teens

November 30, 2023 /

From the Editor

Is there more mental illness than before? Or is there greater awareness? 

Dr. Marco Solmi (of the University of Ottawa) and his co-authors attempt to answer these questions in a new paper for Molecular Psychiatry that focuses on schizophrenia. Drawing on 30 years of data globally, they consider prevalence (how many have the illness), incidence (the number who develop it each year), and the disability-adjusted life-years (the loss of one healthy year of life) using more than 86 000 points of data. They find: “Globally, we show that, from 1990 to 2019, raw prevalence increased by over 65%, incidence by 37.11%, DALYs by over 65%, but age-adjusted prevalence and incidence estimates showed a slight decrease, and burden did not change.” We consider the paper and its implications.

Textbooks, highlighters, and classrooms? The world of medical education is changing. Today, we have AI, sim, and e-learning. In the second selection, we look at the new Quick Takes podcast with Dr. Ivan Silver (of the University of Toronto), former vice president of education at CAMH who marvels at the potential. “This is the renaissance period for health professional education.” 

And in the third selection, psychologist Darby Saxbe (of the University of Southern California) writes in The New York Times about ways to help depressed adolescents. Drawing on recent studies showing the failure of school-based psychosocial interventions, she argues for a different approach. “It’s critical to keep pace with the evidence and attend to the first principle of all health care providers: First, do no harm.”

DG

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Reading of the Week: Clozapine Monitoring – the New BJP Paper; Also, Suicide Trends Among Adolescents (CJP) and Van Gogh’s Ear & Iconography (ANZJP)

June 15, 2023 /

From the Editor

“Despite its strong evidence base, clozapine remains grossly under-prescribed in clinical practice. Although reasons for this are multifaceted, a commonly cited influence is the need for mandatory haematological monitoring.” So notes Ebenezer Oloyede (of the University of Oxford) and his co-authors in a new British Journal of Psychiatry paper. Could the requirements be simplified? 

In the first selection, Oloyede et al. look at outcomes of 569 patients on clozapine when, during the pandemic, routine blood monitoring was changed. In this mirror-image cohort study, they find: “[E]xtending the haematological monitoring interval from 4-weekly to 12-weekly did not increase the incidence of life-threatening agranulocytosis in people taking clozapine.” We consider the paper and its implications.

In the second selection, Dr. Rachel H. B. Mitchell (of the University of Toronto) and her co-authors analyze Canadian data on suicide and sex differences. In this Canadian Journal of Psychiatry research article, they find that suicide rates among female adolescents aged 10 to 14 years surpassed similarly aged males in 2011. “The marked and consistent trend of rising suicide rates among adolescent females aged 10 to 14 years in Canada signals increased distress and/or maladaptive coping in this segment of the population.” 

And in the third selection, Alexander Smith (of the University of Bern) and his co-authors write about Vincent van Gogh. In an Editorial for the Australian and New Zealand Journal of Psychiatry, they describe his mental health struggles but also their commercialization. “Vincent van Gogh’s ear has generated an intrinsic cultural currency. Yet, the psychiatric vulnerabilities encompassed by his act of self-harm are not always sensitively considered or acknowledged.”

DG

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Reading of the Week: Shamiri Layperson-Provided Therapy in Kenya – Big Study, But Ethical? Also, a Reader Comments on Chatbots

June 17, 2021 /

From the Editor 

“There are more psychiatrists of African origin in the US than in the whole of Africa. And I could actually say similar examples from the Philippines, or India, or many other countries. There is an enormous shortage of mental health resources…” 

So comments Dr. Vikram Patel (of Harvard University). Across low-income nations, mental health care services are profoundly difficult to access. Could Shamir (Kiswahili for thrive) – an intervention built on simple psychological concepts and delivered by laypersons – be part of the solution? 

This week, we look at a new paper from JAMA Psychiatry. Tom L.  Osborn (of Kenya’s Shamiri Institute) and his co-authors describe the results of a study involving adolescents with depression and anxiety symptoms. “To our knowledge, this is one of the first adequately powered tests in this population of a scalable intervention grounded in simple positive psychological elements.” We look at the big paper. 

kenya-tanzania-africa-uganda-map-300x200

 But is the work ethical? In our second selection, we consider the editorial that accompanies the Osborn et al. paper. JAMA Psychiatry Editor Dr. Dost  Öngür (of Harvard University) defends the study and his decision to publish it: “Because this trial was already conducted, we considered the obligations of the journal to be different than those of investigators and prospective reviewers. The question for us was whether there is a benefit to society by publishing the study as it was conducted.” 

Finally, in our third selection, a reader writes us. Giorgio A. Tasca (of the University of Ottawa) responds to The New York Times article by Karen Brown considering chatbots. “Is scaling up an intervention with dubious research support – that results in low adherence and high dropout (and perhaps more demoralization as a result) – worth it?” 

Please note that there will be no Reading next week. 

DG  Continue reading

Reading of the Week: Are the Kids Alright? NYT on Severe Anxiety & Adolescents

October 26, 2017 /

From the Editor

“The disintegration of Jake’s life took him by surprise.”

This quotation is from a long, moving essay about a young patient with a big problem. The piece begins with Jake in his junior year of high school with much on his plate: three Advanced Placement courses, a spot on the cross-country team, invitations to Model U.N. conferences – and significant anxiety.

The essay explores his anxiety, and the anxiety of teens like Jake.

The essay, which recently ran in The New York Times Magazine, traces the struggles of Jake, and the writer puts these problems in a larger context.

Teen anxiety: A growing problem?

In this Reading, we review this essay.

DG

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