Tag: anxiety

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: Anxiety Screening for Adults – Helpful or Not? Also, Bram on His Depression & His Chatbot (NYT)

October 6, 2022 /

From the Editor

“A panel of medical experts on Tuesday recommended for the first time that doctors screen all adult patients under 65 for anxiety, guidance that highlights the extraordinary stress levels that have plagued the United States since the start of the pandemic.”

So reports The New York Times late last month with news of the US Preventive Services Task Force’s draft recommendation. The article quotes panelist Lori Pbert (of the University of Massachusetts): “Our only hope is that our recommendations throw a spotlight on the need to create greater access to mental health care – and urgently.”

In the first selection, we look at the recommendation. In making it, the USPSTF reviewed the literature and weighted the advantages and disadvantages of screening. If finalized, the recommendation would have implications on primary care in the United States – and beyond. “The USPSTF concludes with moderate certainty that screening for anxiety in adults, including pregnant and postpartum persons, has a moderate net benefit.” Is this a step in the right direction? Is this well intentioned but problematic?

In the second selection, Barclay Bram writes about his experiences with a therapist bot, working with the Woebot app. In a long New York Times essay, he talks about his depression and his therapy bot. He writes: “Using Woebot was like reading a good book of fiction. I never lost the sense that it was anything more than an algorithm – but I was able to suspend my disbelief and allow the experience to carry me elsewhere.”

DG

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Reading of the Week: How Will Venture Capital Change Psychiatry? Also, Gambling in Canada (CJP) and Dr. Bagley on Her Anxiety (JAMA)

May 6, 2021 /

From the Editor

Recently, one of patients raved about an app that she started to use. Talkspace offers her access to psychotherapy, unbound by geography, with a variety of therapist options.

The catch: she’s paying for it. In her opinion, it’s a good investment in her mental health. In Wall Street’s opinion, it’s a good investment in their financial health: that app has raised more than $110 million (USD) in venture capital. Other popular apps have also caught the eye and the backing of Wall Street – think Calm ($144 million USD) and Headspace ($167 million USD).

Is venture capital changing mental health care? And what are the potential problems? In the first selection, we consider a new Viewpoint paper by Drs. Ravi N. Shah (of Columbia University) and Obianuju O. Berry (of New York University). They write: “Although the value of this trend is yet to be fully realized, the rise in venture capital investment in mental health care offers an opportunity to scale treatments that work and address mental illness at the population level. However, quality control, privacy concerns, and severe mental illness are major issues that need to be addressed.”

wall-street

In our second selection, we look at a new paper by Robert J. Williams (of the University of Lethbridge) and his co-authors on gambling and problem gambling in Canada. Drawing on survey data, they find a surprising result: “Gambling and problem gambling have both decreased in Canada from 2002 to 2018 although the provincial patterns are quite similar between the 2 time periods.”

Finally, in our third selection, Dr. Sarah M. Bagley (of Boston University) discusses the problems of a newborn baby and its impact on his mother. The pediatrician isn’t writing about anyone – she is writing about her own experiences, and the resulting anxiety she experienced. “My story continues, but I hope that by sharing the issue of postpartum health can be better addressed among my colleagues and patients.”

DG

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Reading of the Week: Yoga vs CBT – What’s Best for Anxiety? (JAMA Psych) Also, COVID & Mental Health (Lancet Psych) and Whitley on Cannabis Stigma (Van Sun)

January 28, 2021 /

From the Editor

Anxiety disorders are common, and often disabling to our patients. While treatments have improved, there is unmet need – and the desire to find new, scalable interventions. Increasingly, our patients look to different types of treatments, like yoga. But is trendy effective? Is yoga the not-so-new intervention we need?

Dr. Naomi M. Simon (of New York University) and her co-authors look at the treatment of generalized anxiety disorder with a sophisticated study. They compare yoga and cognitive behavioral therapy (CBT) against a psychological control condition, and against each other. So how do the treatments compare? “Kundalini yoga can reduce anxiety for adults with generalized anxiety disorder, but study results support CBT remaining first-line treatment.” We look at the big study and its big implications.

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What have we learned about COVID-19 and mental health? In the second selection, we consider a new editorial from The Lancet Psychiatry. Mulling the state of the literature after almost a year of the pandemic, they write: “The good news is that by October, 2020, mental health was top of the charts in terms of published papers and preprints on the effects of COVID-19. The bad news is that the quantity of papers is not matched by quality.”

And in our final selection, we consider an essay by Rob Whitley (of McGill University). He notes that 27% of Canadians had used cannabis in the last year, about half of them for medical reasons. He worries about the stigma around medical cannabis and champions more public education. “This can help create a climate of acceptance and inclusion for the growing number of Canadians with mental illness who use cannabis to improve their well-being.”

On another note: in a past Reading, we featured an essay by Toronto filmmaker Rebeccah Love who wrote about her mental illness. Her new film, “Parlour Love,” has its premiere this Saturday at 7 pm EST through Zoom. In this short, powerful film, she draws from her own experiences of bipolar mania and psychosis, and paints a portrait of a woman in crisis. RSVP – palmpremiere@gmail.com.

DG

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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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Reading of the Week: “The Secret to My Success? Antidepressants”

July 6, 2017 /

From the Editor

With the end of the academic year and the start of the new one, I’ll spend the next few days updating the distribution lists for the Reading of the Week series. I’m using this opportunity to make a few technical changes, too. This is the Reading of the Week equivalent of a spring clean-up – though it’s July, and I’m not touching a dustpan.

Spring cleaning, at least before computers

In any clean-up, we can mistakenly throw away something valuable – it’s possible that some of you may stop receiving these emails (if you are getting our emails). If that happens and you would like to continue to get the Readings, simply pop me a message.

This week, I’ve picked an entertaining and yet moving essay from writer Julia Fierro talking about her illness and her recovery. Enjoy.

Oh, and congratulations to our colleagues who have finished their studies. I hope you enjoy your career in medicine as much as I have.

DG

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Reading of the Week: Mood & Anxiety in Four Countries – More Care, Better Outcomes? The Jorm et al. Paper

February 23, 2017 /

From the Editor

Earlier this month, the Commonwealth Fund released a report that surveyed 11 countries for the performance of their health-care systems; it received much media attention. Their work helps provide perspective on our system’s strengths and weaknesses.

International comparisons are relevant in mental health, of course. As stigma fades and as evidence-based treatment options have expanded, we can ask: are people with common mental health problems getting better? And are there lessons to learn from our national experiences?

Four countries, one big problem?

This week, we look at a study that has just been published in World Psychiatry, drawing data from four countries. In the paper, Jorm et al. find that – looking at the prevalence of mood and anxiety disorders and symptoms – people aren’t better off today. The authors consider several explanations.

This paper hasn’t gather much attention here in Canada. But as we look to increase funding for mental health services, it’s an important and relevant paper.

DG Continue reading

Reading of the Week: Thinking Globally and Acting Locally – Scaling Up Depression and Anxiety Treatment

April 21, 2016 /

From the Editor

Tim Evans doesn’t mince his words: “The situation with mental health today is like HIV-AIDS two decades ago.”

Tim Evans is a senior director at the World Bank Group. He made these comments after the release of a major new study suggesting that depression and anxiety are undertreated – and costing the world’s economy hundreds of billions of dollars a year.

But this paper has good news: an investment in mental health services will offer a return (counting health benefits) in the range of 3.3 to 5.7.

This week’s Reading: this new paper from The Lancet Psychiatry, and the reaction to it. Note that coverage has included The Guardian and The New York Times (Evans comments are from The New York Times).

I also follow up on last week’s popular Reading on the Goldbloom-Bryden book.

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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