Tag: behavioural economics

Reading of the Week: Vaccinations & Mental Disorders; Also, Nudging Patients (Psych Services)

October 7, 2021 /

From the Editor

By international standards, we are doing well. As a percentage of the population, more Canadians are doubly vaccinated than people in many other nations.

But let’s not be too pleased. Some Canadians haven’t received both shots – or even one. As is often the case with public health efforts (think smoking cessation and flu shots), those with mental disorders are harder to reach than the general population.

This week, there are two selections. In the first, Noel T. Brewer (of the University of North Carolina at Chapel Hill) and Neetu Abad (of the US Centers for Disease Control and Prevention) discuss ways that we can boost the rate of vaccination of those with mental health problems in a new JAMA Psychiatry paper. They recognize the unique challenges of reaching this population – and the clear opportunities for mental health professionals. “Although mental health is not the first thing that comes to mind when thinking about vaccination, strategic use of mental health professionals’ expertise could provide new opportunities to encourage COVID-19 vaccination.” We consider the paper and its clinical implications.

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In the second selection, also on the theme of nudging our patients to get better outcomes, Gabriela K. Khazanov (of Veterans Affairs) and her co-authors consider using behavioural economics. In this Psychiatric Services paper, they note that Veterans Affairs (VA) “has successfully implemented a financial incentive program aimed at improving psychiatric treatment engagement…”

DG
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Reading of the Week: Lithium vs. Newer Meds for Bipolar – What’s Best? Also, Nudging Vaccines and Beale on Her Illness Experience & Being a Doctor (BMJ)

February 18, 2021 /

From the Editor

In the past, lithium had a large role – in the treatment of bipolar, yes, and before that, as a general remedy for a variety of conditions. Indeed, lithium could be found in various things, including pop (see the picture of the ad for 7 Up below). But times have changed. Lithium prescriptions are less common, and bipolar management increasingly involves other medications. (And, no, 7 Up doesn’t contain that salt anymore.)

How does lithium compare to these medications for people with bipolar? Dr. Jens Bohlken (of the University of Leipzig) and his co-authors do a retrospective study drawing on a national database from Germany. “When treatment failure was defined as discontinuing medication or the add-on of a mood stabilizer, or antipsychotic, antidepressant, or benzodiazepine, lithium appears to be more successful as monotherapy maintenance treatment than olanzapine, citalopram, quetiapine, valproate, and venlafaxine.” We look at the big study, and mull its implications on this side of the Atlantic.

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Can we nudge people to vaccinate? As the world works to get more shots in arms, Dr. Mitesh Patel (of the University of Pennsylvania) argues that behavioural economics will be important. In Nature, he writes that we have a golden opportunity to learn from the vaccine roll-out: “Each institution should report its vaccination efforts and performance, and conduct rapid experiments on how best to encourage people to get their vaccines – especially their second doses.”

Finally, some physicians have commented that being touched by illness has helped them become better doctors. Dr. Chloe Beale, a British psychiatrist, agrees to disagree in a blog for BMJ. “I can’t give the expected, tidy narrative of emerging stronger for having my illness.”

DG

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Reading of the Week: Substance Problem, Quality of Care Problem? Also, Interventional Psychiatry (CJP) and an Underused Addiction Treatment (NYT)

November 5, 2020 /

From the Editor

In terms of depression treatment, do people with substance use problems get worse care than those without?

The answer should be a resounding no. In the first selection, we consider a new paper, just published in The American Journal of Psychiatry, which suggests otherwise. Lara N. Coughlin  (of the University of Michigan) and her co-authors draw on Veterans Affairs data involving more than 53,000 patients. “In this large national sample, we found that patients with comorbid depression and substance use disorders receive lower quality care than those with depression but without substance use disorders.”

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In the second selection, we consider a Canadian Journal of Psychiatry research letter. Dr. Peter Giacobbe (of the University of Toronto) and his co-authors surveyed senior residents, asking about their familiarity and comfort with first line recommendations for the treatment of depression. Spoiler alert: just one in four felt that they had achieved competency in ECT.

Finally, in the third selection, we look at a new essay by journalist Abby Goodnough. With many Americans (and Canadians) struggling with substance problems, she writes about contingency management – that is, rewarding substance users with cash and prizes for sobriety. The concept has evidence in the literature, but lacks political support. She quotes a patient: “Even just to stop at McDonald’s when you have that little bit of extra money, to get a hamburger and a fries when you’re hungry. That was really big to me.”

Note: there will be no Reading next week.

DG

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Reading of the Week: Does COVID Affect Outcomes? Also, Depression & Behavioural Economics (JAMA Psych), and Crawford on Virtual Care (Walrus)

October 8, 2020 /

From the Editor

As we head into the second wave, are there lessons from the spring?

This week, we have three selections.

In the first, published in The Lancet Psychiatry, Dr. Seung Won Lee (of the Sejong University College of Software Convergence) and co-authors look at mental illness and COVID-19 in South Korea. Doing a cohort study, drawing on national databases, they wonder about diagnosis and clinical outcomes for those with mental illness. “Diagnosis of a mental illness was not associated with increased likelihood of testing positive for SARS-CoV-2.” It’s a big finding – but is it relevant on this side of the Pacific?

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Can we nudge patients with depression to take medications? In the second selection, we look at a new JAMA Psychiatry research letter. Steven C. Marcus (of the University of Pennsylvania) and his co-authors offer financial incentives for medication compliance. They conclude: “In this pilot study, escalating incentives for daily antidepressant adherence significantly improved adherence compared with a control group during the critical first 6 weeks of treatment.”

Finally, in our third selection, we consider an essay by Dr. Allison Crawford (of the University of Toronto) from The Walrus. She writes about the change in mental health care with COVID-19, as virtual care has become the norm. “I take off my shoes so that I can enter softly and with an open heart. My patients can’t see my bare feet.”

DG

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Reading of the Week: Behavioural Economics & Mental Illness – the New JAMA Psychiatry Paper; Also, the Strange History of Lithium

September 5, 2019 /

From the Editor

Can we nudge people to better choices? Economists, psychologists, and psychiatrists have all considered this idea. Though early work looked at pensions and finance, more recent studies in behavioural economics have considered topics in health care, like helping smokers quit.

This week, we open with a new paper that considers the concept of delay discounting in people with major mental illness. “Delay discounting” is a clunky term for the value that people place on rewards over time. Take two individuals, Paul and Peter, offered the same deal: they can be given $100 today or $200 in three months – Paul wants the $100 now while Peter is willing to wait for the bigger reward of $200. Paul, then, has more delay discounting than Peter.

Existing literature shows delayed discounting for people who have addiction and ADHD diagnoses. But what about others with mental disorders? McMaster University’s Michael Amlung and his co-authors study delay discounting by doing a meta-analysis, pulling data from 43 studies involving eight psychiatric disorders in this new JAMA Psychiatry paper. “To our knowledge, this meta-analysis is the first quantitative synthesis of delay discounting findings in psychiatric disorders, except ADHD and addictive disorders. This meta-analysis provides relatively strong evidence that delay discounting is a transdiagnostic process in psychiatric disorders.”

4-nudge_elephantBehavioural economics (and nudging): different for those with mental disorders

In our second selection, we consider a longer essay on lithium for bipolar and its first champion. The University of Groningen’s Douwe Draaisma, a professor of the history of psychology, writes about urine, guinea pigs, and the beginning of the psychopharmacological era.

DG

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Reading of the Week: Social Media & Paranoia — the new Acta Paper; Also, How Do We Change Docs? A Reader Responds

October 4, 2018 /

From the Editor

Politicians tweet about townhall meetings; celebrities put vacation pictures on Instagram; your cousin in Europe has her own YouTube channel.

Our world is very different than it was just a few short years ago. (Fun fact: Facebook – a decade and a half old – claims to have more than 2 billion active monthly users.)

But how has social media affected those with mental illness? While this is much discussed in the media, there is little in the literature. In this week’s Reading, we consider a new paper that looks at social media and mental illness, in particular psychosis. Tweet this: the University of Manchester’s Natalie Berry and her co-authors didn’t find a connection between use of social media and increased paranoia.

BELCHATOW POLAND - MAY 02 2013: Modern white keyboard with colored social network buttons.

In this week’s Reading, we consider this new paper from Acta Psychiatrica Scandinavica. We also wonder about the role of the Internet and social media for those with psychosis, drawing from a Psychiatric Services paper.

Also, the University of Toronto’s Dr. Ivan Silver writes a letter to the editor about a previous Reading.

DG

 
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Reading of the Week: How to Change Docs? Send Them a Letter. The New JAMA Psychiatry Paper on Prescribing

September 20, 2018 /

From the Editor

How do we get doctors to practice better medicine?

Here’s a simple idea: what if we send them a sternly written letter? In this week’s Reading, we consider a paper by Columbia University’s Adam Sacarny and his co-authors who did just that. Targeting primary care physicians who were heavily prescribing quetiapine (or Seroquel), they looked at the effects of letters written by government officials, comparing prescribing habits of these physicians with their peers. The result? In the new JAMA Psychiatry paper, they find that prescriptions of quetiapine dropped markedly.

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A little nudge, better care?

The core of the idea is that a nudge – that is, the behavioural economic idea of a positive reinforcement and/or an indirect suggestion – can change outcomes. In this Reading, we consider doctors and nudges (and behavioural economics). We also look at a recent study on opioid prescribing, also involving letters.

DG

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Reading of the Week: Smoking Cessation & Incentives – the NEJM Paper

June 21, 2018 /

From the Editor

“So to put it simply, forcing people to choose is not always wise, and remaining neutral is not always possible.” University of Chicago economist Richard H. Thaler and Harvard Law School Professor Cass R. Sunstein write this comment in their widely-read book Nudge: Improving Decisions about Health, Wealth and Happiness. They argue that people could be nudged in a certain direction, improving outcomes. Among the book’s fans: former UK Prime Minister David Cameron and former US President Barack Obama.

Thaler and Sunstein write about shaping basic decisions, like encouraging people to choose among their company’s pension plans. Retirement planning can significantly help people with their finances in their twilight years. But what about substance use? The stakes seem higher: smoking cessation can prevent major health problems long before retirement.

This week, we look at a new paper by University of Pennsylvania Perelman School of Medicine’s Dr. Scott D. Halpern and his co-authors. Published in The New England Journal of Medicine, they consider smoking cessation and find “financial incentives added to free cessation aids resulted in a higher rate of sustained smoking abstinence than free cessation aids alone…”

file-20170804-6503-18ujgw6Nudging people to butt out?

In this week’s Reading, we consider the paper and its implications. (There is, however, no financial incentive offered here.)

DG

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Reading of the Week: Better Pay, Better Service? The CMAJ Paper on Pay for Performance in Psychiatry. Also, a Father’s Memory

December 21, 2017 /

From the Editor

Does pay for performance work for psychiatry?

This week’s first selection is a paper just published by CMAJ that considers that question. Drawing on Ontario data, the authors looked at practice patterns when financial incentives were introduced for psychiatrists to take care of patients after discharge and after suicide attempts. Spoiler alert: they didn’t work.

http-i-huffpost-com-gen-1291505-images-n-free-health-care-canada-628x314Paying for Performance – Getting Performance?

In this Reading, we consider the paper and the larger debate.

We also consider a short, moving essay by radio host Charles Adler on the memory of his father – and his father’s memory. The award-winning broadcaster describes his father and his Alzheimer.

DG

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Reading of the Week: NEJM and Smoking Cessation

June 18, 2015 /

More than 50 years after the release of the first Surgeon General’s report on the harmful effects of smoking, national policies, behavioral programs, and pharmacologic approaches have helped reduce smoking rates in the United States. However, the need for new approaches is clear because smoking remains the leading cause of preventable illness and death.

So begins a big paper from The New England Journal with a simple aim: getting people to butt out. It raises two important questions: If we are serious about promoting smoking cessation, are we willing to put ‘our money where our mouth is’ – literally? And how could we do this?

“Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation” by Dr. Scott D. Halpern et al. is this week’s Reading; it has just been published.

Though other papers have been written on this topic, the Halpern et al. paper is clever and interesting – and the results are surprising.

And, don’t tell the editors of The New England Journal of Medicine: the results are also disappointing. Continue reading