Tag: apps

Reading of the Week: The Insomnia Issue with Papers from NEJM & Sleep Med, and Dr. Cannon on Her Cure for Insomnia

September 5, 2024 /

From the Editor

With his depressive episode, he can’t sleep. While he thinks cannabis may be worsening his anxiety, in his view, a couple of joints before bed is the only thing that seems to help with the insomnia.

My patient’s problems are common. So many of our patients struggle with insomnia. How should we assess it? What’s evidence-based care? And what can we suggest to replace that cannabis? This week, we open with the new review from The New England Journal of Medicine. Charles M. Morin (of Université Laval) and Dr. Daniel J. Buysse (of the University of Pittsburgh) provide timely advice in their paper. They consider scales that could be incorporated into practice, evidence for CBT-I, and different medications. “Recommended therapies for insomnia produce clinically meaningful reductions in insomnia symptoms, sleep-onset latency, and time awake after sleep onset.” We summarize the paper and weigh its implications.

Counting sheep may not always work

With growing evidence for CBT-I, digital options are increasingly appealing due to their convenience and accessibility. In the second selection, Jake Linardon (of Deakin University) and his co-authors report on a study looking at the effectiveness of app-based interventions for insomnia, just published in Sleep Medicine. In this meta-analysis, they drew on 19 RCTs including different treatments like CBT. “Findings suggest that stand-alone app-based interventions can effectively address insomnia and sleep disturbances, and may play an important role in the management of these symptoms.”

And in the third selection, Dr. Joanna Cannon, a UK physician and bestselling author, discusses her insomnia in an essay for The Guardian. She describes the impact on her life and her unusual way of coping. She also notes the origin of the problem: “It was when I started training as a doctor that my atypical sleeping habits became embedded.”

DG

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Reading of the Week: Can Chatbots & AI Help Access? The new Nature Med Paper; Also, Telepsych in the US and the Latest in the News

February 15, 2024 /

From the Editor

More and more organizations use AI; today, a chatbot might assist you in ordering a pizza or tracking a package. But could a chatbot help our patients find the mental health care that they need? Could it help self-identified members of ethnic groups – who historically do less well in getting services – with access?

Johanna Habicht (of Limbic) and her co-authors try to answer these questions in a new study for Nature Medicine. They looked at the use of a chatbot for self-referral against the standard option in the UK’s NHS when patients seek psychological care. The resulting multisite observational study involved almost 130 000 people. They found that AI increased referrals (especially, in terms of diversity). “Here we demonstrate that digital tools can reduce the accessibility gap by addressing several key barriers.” We look at the study and mull its implications.

As we move past the pandemic, we ask: is virtual care routinely offered for mental disorders? In the second selection from JAMA Health Forum, Jonathan Cantor (of the RAND Corporation) and his colleagues consider mental telehealth – or telepsychiatry, to use the older term – in the United States. With a secret shopper approach, trained callers phoned more than 1 400 US clinics, posing as potential clients with mental health problems. They found most offered virtual care. Further: “There were no differences in the availability of mental telehealth services based on the prospective patient’s clinical condition, perceived race or ethnicity, or sex.”

And, finally, we explore the latest in the news with recent articles from The Guardian and The New York Times. Among the topics: the mental health struggles of rising political star Lina Hidalgo, privacy and mental health apps, and help for those with schizophrenia and homelessness in Cameroon.

DG

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Reading of the Week: The Cutting Edge – Pharmacotherapy for Depression, Apps for Mental Health & AI for Everything (or Maybe Not)

March 9, 2023 /

From the Editor

He’s been depressed for years and you are considering augmentation. Should you choose an antipsychotic? Which one?

These are good questions, especially when treating patients with treatment-resistant depression. In the first selection, Drs. Manish K. Jha (of the University of Texas) and Sanjay J. Mathew (of Baylor College of Medicine) look at four antipsychotics in an American Journal of Psychiatry paper. They review the literature for augmentation, including the use of cariprazine, which has just received FDA approval for this purpose. They find evidence, but “their long-term safety in patients with MDD is not well established, and they are potentially concerning regarding weight gain, metabolic dysfunction, extrapyramidal symptoms, and tardive dyskinesia.” We consider the paper and its clinical implications.

In the second selection, S. E. Stoeckl (of Harvard University) and her co-authors consider the evolution of mental health apps in a new paper for the Journal of Technology in Behavioral Science. Looking at hundreds of apps, they analyze data on updates, including new features. They find: “This study highlights the dynamic nature of the app store environments, revealing rapid and substantial changes that could present challenges for app selection, consumer safety, and assessing the economic value of apps.”

And in the third selection, Dr. Dhruv Khullar (of Cornell University) writes for The New Yorker about AI and mental health. In a long essay that touches on chatbots for therapy and screening tools for suicide prevention, he wonders if AI can help clinicians (and non-clinicians) overcome issues around access. “Can artificial minds heal real ones? And what do we stand to gain, or lose, in letting them try?”

Note: there will be no Readings for the next two weeks.

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: Are Those with Mental Illness at More Risk of COVID? Also, a Podcast on Apps (QT) and Horton on Advocacy & Doctors (Macleans)

November 19, 2020 /

From the Editor

Are people with mental illness more likely to contract COVID-19? Are they at greater risk of dying?

With the pandemic in its eighth month, we think we have answers to these questions, but data is lacking. In the first selection, we consider a new paper, just published in World Psychiatry. QuanQiu Wang (of Case Western Reserve) and her co-authors analyzed a nation‐wide database of electronic health records of 61 million American patients, aiming to assess the impact of mental illness. “These findings identify individuals with a recent diagnosis of a mental disorder as being at increased risk for COVID‐19 infection, which is further exacerbated among African Americans and women, and as having a higher frequency of some adverse outcomes of the infection.”

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In the second selection, we consider a new podcast discussing digital tools. I talk with Dr. John Torous (of Harvard University). We discuss apps and mental health. And, yes, he has tips on how to pick apps for your patients and their families.

Finally, in the third selection, we look at a new essay by Dr. Jillian Horton (of the University of Manitoba). Should doctors “stay in their lanes?” She argues against the idea, championing a new activism. “So, to my brothers and sisters in medicine: forget about staying in our lane. This is our call to flood the freeways. We cannot stay parked in neutral. There is no more time.”

Please note: there will be no Reading next week.

DG

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Reading of the Week: Should Police Respond to Mental Health Crises? Also, Apps & College Students (Psych Services) and the Life of DJ Jaffe (NYT)

October 1, 2020 /

From the Editor

Another tragedy, another headline.

And there have been too many. The stories differ, but there is a common thread: mental illness and a crisis, a 911 call, death. Can we do better?

In the first selection, we consider a new essay by Dr. Sally Satel (of Yale University). Dr. Satel, a psychiatrist, notes recent tragic outcomes with mental health crises. “Nationwide, a person with a psychotic illness is 16 times more likely to be killed during a police encounter than a person without such a condition.” She wonders about an alternative to police responses.

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In the second selection, we look at apps and college students. In a Psychiatric Services paper, Jennifer Melcher and John Torous (of Harvard Medical School) review the recommendations of mental health apps of several university counselling programs. They conclude: “the findings indicated that many counseling centers are suggesting apps that are inaccessible, outdated, potentially dangerous, and without research backing.”

Finally, in our third selection, we consider The New York Times obituary for D.J. Jaffe – the title is a good summary of his life: “Ad Man Turned Mental Health Crusader.” Jaffe, whose sister-in-law has major mental illness, was a strong advocate of various mental health causes, with his influence felt on state and national legislation.

DG

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Reading of the Week: Mental Health — Is There an App For That? & More

April 28, 2016 /

From the Editor

Sigmund Freud, Aaron Beck, Steve Jobs?

Do apps have the potential to reshape mental health?

It’s a hot topic and Nature – the prestigious British journal – explores the potential and pitfalls of mental health apps.

In this week’s Reading, we consider “Pocket Psychiatry.”

Also: journalist John Stossel discusses his lung cancer – and health-care delivery.

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Reading of the Week: Depression: Is There an App for That?

July 9, 2015 /

Depression is a serious, common, and recurring disorder linked to diminished functioning, quality of life, medical morbidity, and mortality. There has been a 37.5% increase in health life years lost to depression over the past two decades. Depression was the third-leading cause of global burden of disease in 2004 and the leading cause of burden of disease in high- and middle-income countries. It is projected to be the leading cause globally in 2030. While effective treatments for depression are available, they are underused. Barriers to treatment include geography, socioeconomic status, system capacity, treatment costs (direct and indirect), low mental health literacy, cultural beliefs, and stigma. A 2010 study found that 75% of primary care patients with depression in urban areas could identify more than one structural, psychological, cultural, or emotional barrier to accessing behavioral treatments. The rate was substantially higher in rural areas.

So begins a new paper that considers an old problem – the difficulty of patients accessing mental health care.

But this paper is different. It considers a modern approach to access: smartphone and tablet applications (or apps) for depression. And it’s not just the topic that is so modern with this week’s Reading. Consider: the paper was published in a new journal, JMIR mHealth and uHealth, available only on-line, and focused on the very modern topic of mobile health. (This journal is a spin-off of JMIR, the Journal of Medical Internet Research, itself a relatively new journal, which boasts an impact factor of 4.7 in 2013.)

This week’s Reading: “Finding a Depression App: A Review and Content Analysis of the Depression App Marketplace” by Nelson Shen et al. In it, the authors seek to shed light on a poorly studied area. As they note early in the paper, despite the incredible popularity of apps, only one recent systemic review looked at depression apps, and included just 4 papers. And so, Shen et al. consider apps for depression, drawing out common characteristics and purposes.

This is, then, an important topic. The potential here is great: with so many of our patients empowering themselves with apps, those with depression could potentially access good information, screening tools and even treatments such as CBT.

What did Shen et al. find in their paper? It’s best summarized by the old Roman phrase caveat emptor (let the buyer beware). Continue reading