TagCanadian Journal of Psychiatry

Reading of the Week: Are Involuntary Admissions on the Rise? The New CJP Paper; Also, Telepsychiatry (JAMA Psych) and Dr. Oh on Suicide (Acad Psych)

From the Editor

A recent New York Times article notes that adolescents are increasingly looking for information on mental health and turning to TikTok. Such is life at a time when stigma fades: people are curious, though not necessarily going to the best places for information.

But are we reaching people earlier in their illness experience? We hope that the answer is yes – a new paper with British Columbian data, however, suggests that police apprehensions are more common, as are involuntary admissions, indicating that more people are in crisis. In the first selection from The Canadian Journal of Psychiatry, Jackson P. Loyal (of Simon Fraser University) and his co-authors draw on administrative databases and find a major shift: “While roughly half of the people hospitalized for mental health and substance use disorders were admitted voluntarily in 2008/2009, by 2017/2018 this fell to approximately one-third.” We look at the paper and its clinical implications.

British Columbia: a province of rivers, whales, and involuntary admissions

In the second selection, Dr. Carlos Blanco (of the National Institute on Drug Abuse, United States) and his co-authors consider the rise of telepsychiatry, noting that 39% of mental health care in the US is now virtual. In this new JAMA Psychiatry Viewpoint, “Expansion of telepsychiatry creates new opportunities to increase treatment access, while it poses overlapping challenges to multiple stakeholders…”

And in the third selection, Dr. Nicholas Zhenwei Oh (of the Ministry of Health Holdings, Singapore) writes personally and thoughtfully about the loss of a patient by suicide. He goes into detail on his own experience during training. “Patient suicide is possibly the great equaliser amongst psychiatrists, psychiatry trainees, and perhaps any other clinician who has experienced a patient’s suicide. My own experience came suddenly and unexpectedly, and it will likely leave a psychological scar as a grim reminder of one of the lowest points of my career.”

DG

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Reading of the Week: Psychiatrists & Patient Suicide – the New CJP Paper; Brain Wellness Spas (JAMA Psych) and Dr. Heidari on Her Mantra (NEJM)

From the Editor

It’s the call we dread, perhaps from a relative or the family doctor. The news catches us by surprise: the patient has died and suicide is suspected.

In the first selection from The Canadian Journal of Psychiatry, Dr. Zainab Furqan (of the University of Toronto) and her co-authors consider psychiatrists’ experiences with patients who die by suicide. In this qualitative analysis drawing on 17 interviews, they explore the emotional response. They conclude: “patient suicide is often associated with grief, shock, anxiety and guilt; emotions which are mediated by physician, patient, relational and institutional factors and have important ramifications on psychiatrists’ well-being and clinical practice.” We consider the paper and its implications.

In this week’s second selection, Anna Wexler and Dominic Sisti (both of the University of Pennsylvania) write about the potential and problems of off-label use for psychedelic drugs in light of likely FDA approval. In a JAMA PsychiatryViewpoint, they note: “With high public enthusiasm, extremely bullish investors, and hundreds of newly established brain wellness clinics, all the pieces are now in place for expansive off-label promotion and use of psychedelics to quickly mushroom beyond what is safe.”

Finally, in the third selection from The New England Journal of Medicine, Dr. Shireen N. Heidari (of Stanford University) notes the incredible challenges of working during the pandemic – and the psychological toll. She describes her decision to seek care and her own recovery: “A year after making the decision to talk to my family and my doctor, I know that advocating for my own mental health was the best decision I could have made.”

DG

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Reading of the Week: African Nova Scotian Youth & Stigma; Also, Engaging Health Care Workers (Psych Services) and Therapy & Psychiatry (Psych Times)

From the Editor

Many with mental disorders don’t engage in psychiatric care or, if they do, it is after significant delays – problematic for obvious reasons. Some groups are less likely to engage, including young Black individuals with psychosis.

Why the hesitation? What are the concerns of these patients and their larger communities? In the first selection, a paper just published by the Canadian Journal of Psychiatry, Ingrid Waldron (of McMaster University) and her co-authors take a qualitative interpretive narrative approach, to engage African Nova Scotians – including those in a first episode psychosis program – attempting to answer these questions and more. Among their key findings: “barriers include a lack of trust in health care services and a dearth of African Nova Scotian service providers.” We discuss the paper and its implications.

In this week’s second selection, Dr. Doron Amsalem (of Columbia University) and his co-authors aim to improve health care workers treatment seeking; in a paper for Psychiatric Services, they describe an RCT for a brief video intervention, finding positive results. They write: “This easily administered intervention could increase the likelihood of care seeking by proactively encouraging health care workers with mental health challenges to pursue treatment.”

Finally, in the third selection, Mark L. Ruffalo (of the University of Central Florida College of Medicine) and Dr. Daniel Morehead (of the Tufts Medical Center) consider psychotherapy and psychiatry. In an essay for Psychiatric Times, they argue that this is “the great divorce that never happened.” They write: “For decades, critics and leading psychiatrists have worried that psychotherapy among psychiatrists will one day die out and be forgotten. Yet for decades, reports of its demise have been greatly exaggerated.”

DG

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Reading of the Week: Buprenorphine for Opioids – the New AJP Paper; Also, Cannabis & Hospitalizations (CJP) and Dr. Rosenberg’s Career & Illness (NYT)

From the Editor

A rise in substance use. Staff shortages and burnout. Waits for care.

The problems of the pandemic on mental health care have been clear and unfortunate. But how has care changed – and possibly improved – over the pandemic? In the first selection, Lewei Lin (of the University of Michigan) and her co-authors look at buprenorphine treatment before and during the pandemic. In a new paper for The American Journal of Psychiatry, they find a shift in care and a success story: “The number of patients receiving buprenorphine continued to increase after the COVID-19 policy changes, but the delivery of care shifted to telehealth visits…” We consider the paper and its clinical implications.

In the second selection, drawing on Canadian data, Chungah Kim (of Brock University) and her co-authors look at cannabis legalization and cannabis-related hospitalizations. In this new Canadian Journal of Psychiatry brief report, they find: “the initial legalization was followed by clinically significant increases in cannabis-related hospitalizations; however, the subsequent increase in retail stores, availability of cannabis edibles, and COVID-19 pandemic was not associated with a further increase in hospitalizations in Ontario.”

In the third selection, we consider the life and legacy of Dr. Leon E. Rosenberg with the obituary from The New York Times. Dr. Rosenberg had a storied career – a pioneer in genetics research, a dean of Yale, and the chief science officer at Bristol Myers Squibb. He’s also a person who had bipolar disorder and took lithium. “I am proof that it is possible to live a highly successful career in medicine and science, and to struggle with a complex, serious mental illness at the same time.”

Please note that there will be no Readings for the next two weeks.

DG


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Reading of the Week: Cannabis for Mood Disorders – the New CJP Paper; Also, Dr. Insel on Mental Health (QT) and Transgender Adolescents & Suicidality (CMAJ)

From the Editor

He smokes before bed to help with sleep; she finds that the edibles take an edge off from her lows.

Our patients routinely tell us about the benefits of cannabis for mood disorders. But is there any evidence in the literature? In the first selection from The Canadian Journal of Psychiatry, Dr. Smadar V. Tourjman (of the Université de Montréal) and her co-authors consider that question with a systematic review, drawing on data from 56 studies, focused on bipolar and major depressive disorders, for a CANMAT task force report. They conclude: “cannabis use is associated with worsened course and functioning of bipolar disorder and major depressive disorder.” We consider the paper and its implications.

In this week’s second selection, we look at new Quick Takes podcast interview with Dr. Thomas Insel (of the Steinberg Institute). Dr. Insel, a psychiatrist and former director of NIMH, speaks about the progress in neuroscience but the need for mental health reform. “We must think about more than just the classic medical model borrowed from infectious disease: simple bug, simple drug.”

Finally, in the third selection, Mila Kingsbury (of the University of Ottawa) and her co-authors consider the risk of suicidality among trangender and sexual minority adolescents; they draw from a nationally representative, cross-sectional survey. “Gender and sexual minority adolescents, particularly those who identify as transgender and gender-nonconforming, appear to be at greater risk of suicidal ideation and suicide attempt than their cisgender and heterosexual peers.”

There will be no Reading next week.

DG

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Reading of the Week: Mental Health Literacy & Skills for Students – the New CJP Paper; Also, Benzodiazepine Use and the Latest Mental Health Headlines

From the Editor

Postsecondary education can be incredibly stressful for students – and, not surprisingly, mental health problems may surface. Is it possible to inform (and thus empower) students with a simple intervention?

In the first selection, Yifeng Wei (of the University of Alberta) and her co-authors consider a trial of Transitions, a program that includes both mental health literacy and comprehensive life skills resources “for those transitioning from secondary to postsecondary education.” In a new Canadian Journal of Psychiatry paper, they describe a study involving nearly 2 400 students across five institutions. “Students in the intervention significantly improved mental health knowledge, decreased stigma against mental illness, increased positive attitudes toward help-seeking, improved help-seeking behaviours, and decreased perceived stress compared to the control group.” We review the paper.

Beautiful campus – and a place to reduce stigma?

In the second selection, Christine Timko (of Stanford University) and her co-authors consider benzodiazepine use. In a new Psychiatric Services paper, they note: “This study’s findings suggest that challenges remain in discontinuing long-term benzodiazepine use among patients who are older than 45 years, White, taking higher doses for longer, and diagnosed as having anxiety, PTSD, bipolar disorder, or psychosis.”

And finally, in a new section, we consider some recent news items relevant to those of us in mental health care. Our aim: not simply to draw from interesting reports, but to include those that our patients may read and bring up. This week: the focus (and TikTok videos) on the vagus nerve, the Freud who hated Freud, and ADHD in adults.

DG

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Reading of the Week: Suicide & Physicians – the New CJP Paper; Also, Cannabis and Psychiatry (BJP) and Tom Insel on Mental Health Care (Atlantic)

From the Editor

Despite what we may wish to believe, physicians are mortal. We can develop illnesses – even mental disorders. And some (too many) suicide. Past studies have shown that doctors die by suicide more than the general population. But the data wasn’t Canadian.

In the first selection, Dr. Manish M. Sood (of the University of Ottawa) and his co-authors consider suicide by Canadian physicians. In a new Canadian Journal of Psychiatry paper, they do a population-based, retrospective cohort study drawing on more than a decade and a half of data. They write: “Physicians in Ontario are at a similar risk of suicide deaths and a lower risk of self-harm requiring health care relative to nonphysicians.” We look at the paper.

In the second selection, Dr. Julia Jiyeon Woo (of McMaster University) and her co-authors review cannabis from the perspectives of clinicians and patients. In a new British Journal of Psychiatry paper, they note: “This growing discrepancy between clinicians’ and patients’ perspectives on cannabinoids can be extremely damaging to the therapeutic alliance.” They offer practical suggestions.

And in the third selection, Dr. Thomas Insel (of the Steinberg Institute) considers what’s right and what’s wrong with mental health care. As the director of NIMH, he oversaw $20 billion of funding; in his new book, excerpted in the pages of The Atlantic, he calls for mental health reform. He writes: “There are only two kinds of families in America: those who are struggling with mental illness and those who are not struggling with mental illness yet. To ensure that we serve all families well, we don’t necessarily need to know more to do better.”

DG

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Reading of the Week: Exercise & Depression – the New JAMA Psychiatry Paper; Also, Passes & Inpatients (CJP) and Dr. Khadilkar on Suicide (JAMA Neuro)

From the Editor

We often tell our patients about the importance of exercise. But how much exercise? And is this advice really evidence based?

In the first selection from JAMA Psychiatry, Matthew Pearce (of the University of Cambridge) and his co-authors consider exercise and depression with a systematic review and meta-analysis, drawing on data from more than 190 000 people. They conclude: “This systematic review and meta-analysis of associations between physical activity and depression suggests significant mental health benefits from being physically active, even at levels below the public health recommendations.” We consider the paper and its implications.

In the second selection, we look at a new research letter by Natalia Docteur (of the Sunnybrook Research Institute) and her co-authors. In The Canadian Journal of Psychiatry, they consider passes for inpatients, wondering about the effect on length of stay and re-admissions. Interestingly, they conclude: “Overall, passes were associated with poorer post-discharge outcomes including prolonged length of stay and increased psychiatric readmissions.”

Finally, in the third selection, Dr. Amole Khadilkar (of Indigenous Services Canada) writes about his mental health problems. In a deeply personal essay, he notes the challenges of residency and warns against the culture of stoicism. “This is an important lesson to anyone who may be contemplating suicide during what seems like an irreversibly hopeless point in their life. You never know what the next day, the next month, or the next year may bring.”

Please note that there will be no Reading next week.

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

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: Resilience after Disaster – Lessons from Japan; Also, Schizophrenia & Spending (CJP) and Dr. Brandeland on Her Father & His Addiction (JAMA)

From the Editor

My patient was involved in a terrible car accident. Though physically unharmed, she’s never really recovered (mentally). Her co-worker, sitting in the seat beside her, barely took off any time from work.

Why are some people resilient and others aren’t?

In The British Journal of Psychiatry, Dr. Taku Saito (of the National Defense Medical College) and his co-authors explore this question, focusing on a natural disaster. Drawing on an impressive database of first responders involved in the 2011 Japanese earthquake rescue/recovery effort, they do a seven-year prospective cohort study. They find: “The majority of first responders… were resilient and developed few or no PTSD symptoms.” Of course, some did develop mental health problems. The risk factors? Older age, personal disaster experiences, and working conditions. We consider the big paper.

In the second selection, Andrew J. Stewart (of the University of Calgary) and his co-authors analyze health spending in a new Canadian Journal of Psychiatry paper. They focus on people with schizophrenia, looking at a 10-year period. “Healthcare spending among patients with schizophrenia continues to increase and may be partially attributable to growing rates of multimorbidity within this population.”

And, in the third selection, Dr. Megan Ann Brandeland (of Stanford University) writes about her father’s death. In JAMA, she discusses his struggles and notes that – early in his career as a physician – a patient had a tragic outcome. “My hope in sharing this story is to encourage more physicians to share their own stories, to reduce the stigma around mental health, trauma, and addiction among physicians, and to honor my father’s life and the goodness he brought to the world.”

Please note that there will be no Reading next week; we will resume on 31 March 2022.

DG

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