Tag: alcohol

Reading of the Week: Cancer & Suicide & Good News – the New Transl Psychiatry Study; Also, AI & Therapy Dropouts, and Bland on Her Father & His D-Day

June 13, 2024 /

From the Editor

He was so overwhelmed by the cancer diagnosis that he didn’t eat or sleep for days. “It was my worst nightmare.” My patient isn’t alone in that devastating experience, of course – the diagnosis and treatment of cancer is a major life event. Not surprisingly, the suicide rate is roughly double that of the general population in the United States. But with increasing psychosocial interventions, how has this changed over time?

In the first selection, Qiang Liu (of the Chinese Academy of Medical Sciences) and his co-authors attempt to answer that question in a new paper for Translational Psychiatry. Drawing on 40 years of data and a major US database, they analyzed the journeys of five million cancer patients, discovering good news. “We revealed a gradual increase in cancer-related suicide rates from 1975 to 1989, followed by a gradual decrease from 1989 to 2013, and a marked decrease from 2013 to 2017.” Indeed, between 2013 and 2017, the rate dropped by 27%. We consider the paper and its implications.

In the second selection, Sakiko Yasukawa (of the Sony Corporation) and her co-authors aimed to reduce dropouts from psychotherapy using AI. In a new paper for BMJ Mental Health, they describe an RCT involving 149 people. “The results suggest that the personalised messages sent by the chatbot helped participants control their pace in attending lessons and improve programme adherence without human guidance.”

Last week marked the anniversary of D-Day with ceremonies, including in Normandy. What was the toll on those who returned home? In the third selection, an essay published in The Globe and Mail, Normanne Bland describes her father and his time in Europe. She writes about him with mixed feelings, coloured by his mental health problems, including PTSD. “I had a complicated relationship with my father. I was proud of his service but I loathed his drinking.”

There will be no Reading next week.

DG

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Reading of the Week: Suicide Attempts in the Healthy – the New JAMA Psych Study; Also, Polypharmacy & Youth, and Coyle on His Sobriety & Mulroney’s

March 7, 2024 /

From the Editor

Overwhelmed by the divorce, she made a serious attempt on her life, saved from certain death by a police officer who was running late for work and drove through an industrial area of Scarborough. After days of observation, I concluded that she had an unfortunate life circumstance, but not a psychiatric disorder.

How commonly do people without mental disorders attempt suicide? What can be done to help them? Dr. Maria A. Oquendo (of the University of Pennsylvania) and her co-authors try to answer these questions in a new JAMA Psychiatry paper. In their study of healthy individuals and suicide attempts, they drew on a US database involving more than 36 000 people who had attempted suicide. “An estimated 19.6% of individuals who attempted suicide did so despite not meeting criteria for an antecedent psychiatric disorder.” We consider the study and its implications.

A healthy individual – at risk for a suicide attempt?

In the second selection, Yueh-Yi Chiang (of the University of Maryland) and her co-authors focus on youth and polypharmacy in a new JAMA Network Open research letter. Concerningly, past work has suggested that polypharmacy is growing more common in the young. Chiang et al. tapped Medicaid data from one US state including almost 127 000 youth. “In this cross-sectional study, we observed a 4% increased odds of psychotropic polypharmacy per year from 2015 to 2020, indicating growing concomitant use of multiple psychotropic classes.”

And in the third selection, reporter Jim Coyle writes about former Prime Minister Brian Mulroney in the Toronto Star. The essay is deeply personal – Coyle discusses his own problems with alcohol and his connection with the former prime minister, who had also struggled with it. “Mulroney knew that alcoholism is no respecter of rank or status, that alcoholics understand each other across any divide, and better than anyone else can.”

There will be no Readings for the next two weeks.

DG

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Reading of the Week: Pricing and Alcohol – the New Lancet Paper; Also, Mental Health & the Music Industry and Dr. O’Riordan on Her Depression

July 6, 2023 /

From the Editor

How to reduce alcohol consumption? That question is more relevant than ever, given evidence of increased use in Canada during the pandemic. Recently, Scotland has experimented with minimum unit pricing (MUP) – unlike a tax increase that raises the cost of all alcohol, MUP disproportionally affects low-cost wines and ciders, more likely to be consumed by heavy drinkers. 

In the first selection, Grant M. A. Wyper (of the University of Glasgow) and his co-authors consider the Scottish data. In a new paper for The Lancet, they do an impressive analysis, with a controlled interrupted time series, looking at time before and after the MUP, and contrasting Scottish and (non-MUP) English data. They find: “The implementation of MUP legislation was associated with significant reductions in deaths, and reductions in hospitalisations…” We look at the paper and its implications.

Scotland: a land of hills, lakes, and excessive alcohol consumption

In the second selection, George Musgrave (of the University of London) and his co-authors consider the connection between musicians and mental health. In a Comment for The Lancet Psychiatry, they note: “Great advances have been made in the field of musicians’ mental health.” But they argue that “further dialogue between all major stakeholders is needed if, collectively, we are to shape this emerging intervention landscape to serve the target population effectively, both the musicians themselves and the teams around them.”

And in the third selection, from the pages of the Daily Mail, Dr. Liz O’Riordan describes her career as a surgeon – and her secret battle with depression. In a personal essay, she talks about her decision to speak out. “I’ve got better at asking for help and looking after myself. But I’m not ashamed of depression. It’s part of me, and that’s OK.”

DG


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Reading of the Week: Ethnicity, Bias, and Alcohol – the New AJP Paper; Also, Global Mental Health & AI (JAMA Psych) and Halprin on Her Mother (Globe)

May 25, 2023 /

From the Editor

He drinks heavily, but does he have a diagnosed alcohol use disorder?

Does the answer to that question tie to ethnicity and biases? In a new American Journal of Psychiatry paper, Rachel Vickers-Smith (of the University of Kentucky) and her co-authors suggest it does. Drawing on US Veterans Affairs’ data with over 700,000 people, they analyzed the scores of a screening tool and the diagnoses with ethnicity recorded in the EMR. “We identified a large, racialized difference in AUD diagnosis, with Black and Hispanic veterans more likely than White veterans to receive the diagnosis at the same level of alcohol consumption.” We look at the paper and mull its implications.

In the second selection, Alastair C. van Heerden (of the University of the Witwatersrand) and his co-authors consider AI and its potential for global mental health services in a new JAMA Psychiatry Viewpoint. They focus on large language models (think ChatGPT) which could do several things, including helping to train and supervise humans. “Large language models and other forms of AI will fundamentally change how we treat mental disorders, allowing us to move away from the current model in which most of the world’s population does not have access to quality mental health services.”

And, in the third selection, Paula Halprin discusses her mother’s alcohol use in an essay for The Globe and Mail. In a moving piece that touches on anger, trauma, and regret, Halprin writes about her re-examination of her mother’s life. “I now understand my mother drank not because of a weak character, but to cope with a body wearing out before its time from unremitting pregnancy and as a way to swallow her anger and disappointment. It was also a way to mourn a loss of self.”

DG

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Reading of the Week: Can a Phone Intervention Reduce Alcohol? Also, Dr. Goldbloom on His Career & Retirement (QT) and Ending the Term AMA (Annals)

December 15, 2022 /

From the Editor

During the first wave, alone and isolated, he started to drink significantly more. Now, many months later, he continues to struggle with an alcohol use disorder. This patient’s journey – as he told me in the ED last week – is a familiar story that we as clinicians have heard many times in these past few years. What can be done to help? Could we better reach those who are misusing alcohol?

In JAMA Psychiatry, Dan I. Lubman (of Monash University) and his co-authors describe an intervention that is very relevant. In this Australian RCT, some participants received 4-6 sessions of telephone-provided, manualized cognitive and behavioural intervention that included mindfulness. They found that: “this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control.” We discuss the paper and its clinical implications.

Dr. David Goldbloom has had a storied career: senior medical advisor at CAMH, professor at the University of Toronto, former chair of the Mental Health Commission of Canada, former editor of The Canadian Journal of Psychiatry. And tomorrow, he adds another title to that long list: retiree. This week’s second selection is a new Quick Takes podcast interview with him in which he comments on career and retirement and more. “I’m not an entirely gloomy or nihilistic person, either by temperament or based on what I’ve witnessed over the last 40 years.”

Finally, in the third selection, Dr. Robert A. Kleinman (of the University of Toronto) and his co-authors argue that “against medical advice” is a dated term. In Annals of Internal of Medicine, they argue for a new approach: “Shifting away from the ‘AMA’ terminology and toward more collaborative approaches to these discharges would improve the treatment of patients who are too often stigmatized by the clinicians and health systems that are meant to care for them.”

DG

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Reading of the Week: Way Up – Alcohol-Related Deaths During the Pandemic (JAMA); Also, Addressing the Opioid Crisis (CJP) and the NYT on Grief

March 31, 2022 /

From the Editor

Three patients have recently told their stories to me. With his business failing, he turned to alcohol. When she couldn’t get hours at the restaurant because of the lockdown, she started drinking in the mornings. After a decade of sobriety, he explained that he found comfort in alcohol after his job loss.

These stories aren’t, unfortunately, surprising. With the pandemic, substance use appears to be on the rise. But what about substance-related deaths? In the first selection, we look at a new research letter from JAMA. Aaron M. White (of the National Institute on Alcohol Abuse and Alcoholism) and his co-authors examine alcohol-related deaths in the United States and the impact of the pandemic. They conclude: “The number and rate of alcohol-related deaths increased approximately 25% between 2019 and 2020, the first year of the COVID-19 pandemic.” We consider the paper and its clinical implications.

In the second selection, Dr. Tony P. George (of the University of Toronto) and his co-authors focus on the opioid crisis. In this Canadian Journal of Psychiatry commentary, they argue for a stronger approach to help those with opioid use disorder (OUD), specifically by improving the psychosocial interventions available. “While psychosocial interventions are often expensive and time consuming, they do make a difference in the lives of patients with OUD and those at risk for fatal opioid overdoses, especially when combined with broad psychosocial supports that address social determinants of health.”

And in the third selection, continuing our consideration of the first update to the DSM series in nine years, we look at a New York Times article, just published. Reporter Ellen Barry writes about prolonged grief disorder: “The new diagnosis was designed to apply to a narrow slice of the population who are incapacitated, pining and ruminating a year after a loss, and unable to return to previous activities.”

DG

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Reading of the Week: Alcohol – with Papers from Lancet Oncology and CJP, and Coverage from NYT

July 22, 2021 /

From the Editor

This week, we focus on alcohol, with two papers and a news article. Obviously, alcohol isn’t new – distilling probably started in the 13th century – but the three selections offer fresh and important information that is clinically relevant.

In the first selection, we consider the link to cancer. In a new Lancet Oncology paper, Harriet Rumgay (of the International Agency for Research on Cancer) and her co-authors conduct a population-based study. “Globally, about 741 000, or 4.1%, of all new cases of cancer in 2020 were attributable to alcohol consumption.” We review the big paper and mull its clinical implications.

alcohol

In the second selection, Dr. Daniel Myran (of the University of Ottawa) and his co-authors look at ED visits due to alcohol. Drawing on administrative data, they write: “We found that that current patterns and temporal trends in ED visits due to alcohol show large disparities between urban and rural regions of Canada and by socioeconomic status.”

And in the third selection, reporter Anahad O’Connor writes about alcohol use disorder for The New York Times. In this highly readable article, he focuses on the struggles of a retired manager: “But this past winter, with the stress of the pandemic increasingly weighing on him, he found himself craving beer every morning, drinking in his car and polishing off two liters of Scotch a week.” O’Connor writes about several resources that may be helpful to patients and their families.

DG

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Reading of the Week: Our Pandemic Reality – How It Affected Our Patients, How It Changed Our Practice, How It Changed Us

March 18, 2021 /

From the Editor

A year ago this week, provinces across the country ordered the first lockdown. In the days that followed, I remember driving to the hospital and noting the eerie quiet of the streets with almost no cars or trucks on the morning commute.

Now, a year later, we can ask some questions. How has the pandemic affected our patients? How did it change our practice? How has it changed us?

This week, we have four selections that explore our pandemic reality.

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We begin by focusing on patients. In the first selection, we look at a paper from Annals of Internal Medicine. Dr. Jonathan S. Zipursky (of the University of Toronto) and his co-authors consider alcohol sales and ED visits. They find that there was an increase in alcohol sales of 38% at the start of the pandemic. They write: “Higher alcohol sales during the lockdown are worrisome because alcohol consumption can cause poor judgment, medical complications, and immune suppression.”

In the second selection, we consider an editorial from BMJ. Though some have predicated a significant increase in suicide completions, there is little evidence. Still, the authors write: “We must remain vigilant and responsive, sharing evidence early and internationally… in these evolving uncertain times.”

Then we pivot and look at providers. In the third selection, Dr. Daniel Guinart (of Hofstra/Northwell) and his co-authors report on the findings of a survey on telepsychiatry. “In this study, we report highly favorable attitudes toward telepsychiatry in its diverse forms, across a large and wide array of mental health care professionals.”

In the fourth selection, Andrea Frolic (of McMaster University) talks about the pain of the past year. After breaking a toe, she notes about the psychological injuries of our pandemic life. “As a health care leader, I am supposed to be a cheerleader, a silver-lining finder, an opportunity-seeker – a hero, not a human.”

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Some good news: the Reading of the Week was just awarded the Ivan Silver Innovation Award by Continuing Professional Development of the University of Toronto’s Faculty of Medicine. Many thanks to Drs. Rajeevan Rasasingham and Sanjeev Sockalingam for the nomination.

But I’m committed to developing this program further, not resting on our laurels – in late April, we will be conducting focus groups to better understand what works and what needs improvement. Interested in being involved? Please contact smit.mistry@camh.ca. Time commitment: under one hour.

DG

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Reading of the Week: The New AJP on Alcohol & Subjective Response; Also, Remembering Philip Seeman (Globe) and Sharma on His Godmother

February 4, 2021 /

From the Editor

My patient could recognize the damage done by alcohol. The lost friendships. The failed marriage. The firing of her job of 15 years. And yet, she was still puzzled. “How did I get into this mess?”

In a new American Journal of Psychiatry paper, Andrea King (of the University of Chicago) and her co-authors explore the draw of alcohol with a major new study that measures the subjective response to alcohol challenges at five and ten year follow ups. “Initial stimulant and rewarding effects of alcohol predicted heavy alcohol use, and the magnitude of these positive subjective effects increased over a 10-year period in those who developed alcohol use disorder compared with those who did not develop the disorder.” We discuss this big paper.

ipoct17-alcohol

Dr. Philip Seeman had an extraordinary career with major achievements. Some argue that he should have shared the Nobel prize. He died on 9 January 2021 at his home. The Globe obituary is our second selection. Dr. Seeman was a generous mentor of many young scientists, and a husband, father, and grandfather. And his work was impactful: Dr. Seeman’s interest in dopamine helped change the way we practice today.

And in our final selection, we look at a new essay by Dr. Gaurav Sharma, a resident of psychiatry at the University of Toronto. The disaster of Ontario’s long term care homes has made many headlines. For this young doctor, the problems are close to home, affecting his godmother. He writes about her life and her downward turn. “In my training as a psychiatry resident, a basic principle I’ve learned is that every mental health crisis has its triggers. In Lucy’s case, the crisis that led to her hospitalization was prompted by a precarious housing situation.”

DG

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Reading of the Week: Alcohol Use, ED Visits & Mortality – the New CMAJ Paper; Also, Dr. Lawrence on Diagnoses and Her Diagnosis (Guardian)

January 21, 2021 /

From the Editor:

“He’s here again.”

The staff would roll their eyes. Harold was back. Many of us had encountered him – a person with alcohol use disorder who frequently came to the emergency department of the hospital where I did my internship year. He would usually get a sandwich and a lecture. But what are the outcomes for people like him? And what could be done?

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In the first selection, we consider a new CMAJ paper. Dr. Jennifer Hulme (of the University of Toronto) and her co-authors study outcomes for those presenting to Ontario EDs for alcohol-related reasons. The major finding: “The all-cause 1-year mortality rate was 5.4% overall.” We review the paper and its implications.

In the second selection, we look at a new essay by Dr. Rebecca Lawrence from The Guardian. The UK psychiatrist, who has written about her experiences as a mental health patient, notes the challenges of psychiatric diagnoses. “There are many words in the field of mental illness that have been discarded and are now viewed as stigmatising and inappropriate – words such as ‘cretin’, or ‘lunatic’, or ‘mental’. It’s interesting to consider whether our current crop of acceptable words will end up in that category, and it’s salutary to know that many probably will.”

DG

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