TagCOVID-19

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)

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

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.

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

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: Vaccines, Vaccine Hesitation & Mental Illness, with Papers from JAMA Psychiatry and NEJM, and More

From the Editor:

It’s here. Less than a year after COVID-19 arrived in North America, two vaccines have been created, approved, and given (at least to some).

In the coming months, as the supply improves, people – including our patients – will have the opportunity to get a vaccine. But what are the challenges? First, some will hesitate. In a recent essay, Dr. Nadia Alam notes that: “Vaccine hesitancy is a significant issue with only 57.5% of Canadians saying they are very likely to be vaccinated for COVID-19.” And special populations will present further challenges – such as those with major mental illness.

This week, we focus on vaccinations with two papers and an article.

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In the first selection, drawing from JAMA Psychiatry, we consider a paper by Dr. Nicola Warren (of the University of Queensland) and her co-authors. They note the challenges of reaching people with serious mental illness – just one in four get a flu vaccine. “It is vital to commence planning and development of appropriate policies to ensure rapid delivery of a COVID-19 vaccine when it becomes available.”

In a New England Journal of Medicine paper, Dr. Joshua A. Barocas (of the Boston University School of Medicine) thinks about the needs of those with substance use disorders. “Officials devising vaccination strategies and allocation plans would be wise to do so from the perspective of the virus, rather than that of stigmatizing personal beliefs.”

How to speak to our patients? In the final selection, we look at a short piece by Dr. Joshua C. Morganstein (of the Uniformed Services University of the Health Sciences).  His advice is very practical, and emphasizes that we should tailor our approach not by diagnosis but by patient interest in the vaccination. He also urges us to be careful in our choice of language: “Health care professionals are trained to use complex medical terminology, though more understandable and down-to-earth language often serves to enhance trust and build rapport.”

DG
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Reading of the Week: More COVID, More Mental Health Problems? Also, e-Cigarette Use (CJP) and Pappas on Her Olympics & Her Depression (NYT)

From the Editor

Will there be a pandemic after the pandemic? Some have wondered about the mental health consequences of COVID-19 – speculating that, in the future, there will be significant mental health problems. In a recent JAMA paper, Simon et al. argued: “The magnitude of this [mental health] second wave is likely to overwhelm the already frayed mental health system, leading to access problems, particularly for the most vulnerable persons.” (That paper was discussed in a past Reading.)

In the first selection, we consider a new paper from Lancet Psychiatry. Kuan-Yu Pan (of Vrije Universiteit) and co-authors did a survey of people with psychiatric disorders, as well as people without. “We did not find evidence that there was a strong increase in symptoms during the COVID-19 pandemic in those with a higher burden of disorders. In fact, changes in scores from before to during the pandemic indicated increasing symptom levels in people without mental health disorders, whereas changes of symptom levels were minimal or even negative in individuals with the most severe and chronic mental health disorders.” Should we be reassured by the Pan et al. study?

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In the second selection, we consider a research letter from Dr. Scott B. Patten (of the University of Calgary) and his co-authors. Drawing on survey data, they describe the pattern of use of e-cigarettes, noting that they were originally intended for harm reduction. “In 2017, 15.5% of e-cigarette users reported that they had never smoked, suggesting a de novo pattern of substance use. By 2019, this proportion had more than doubled to 36.7%.”

Finally, in the third selection, Olympian Alexi Pappas speaks about her mental health in a New York Times opinion video. The comments are very personal, and touch on her illness and recovery. “After the Olympics, I was diagnosed with severe clinical depression. And it nearly cost me my life. But it doesn’t have to be that way.”

Please note that there will be no Reading for the next two weeks. Enjoy the holidays. And if you are looking for a last-minute gift for, perhaps, Hanukkah or Christmas or a way to thank co-workers after a tough year, consider CAMH’s Pet Therapy Calendar, available for just $15 (with the promotion code). Proceeds go to a good cause: the CAMH Volunteer Resources Pet Therapy Program. The calendar is beautifully done, and features great dogs, including Toulouse (my BFF). Here’s the link: https://store-camh.myshopify.com/products/pvol-cal.

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)

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: COVID and a Mental-Health Second Wave; Also, Harry Potter & Suicide Prevention (CJP), and Bennett on Bipolar (Walrus)

From the Editor

There are more COVID-19 cases in the community – and in our hospitals and ICUs. What does it mean for mental health?

This week, we have three selections.

In the first, published in JAMA, Dr. Naomi M. Simon (of the NYU Grossman School of Medicine) and her co-authors write about the pandemic and the implications for mental health. They argue that there will be a second wave of mental health problems. “The magnitude of this second wave is likely to overwhelm the already frayed mental health system, leading to access problems, particularly for the most vulnerable persons.” Are they right – and what’s to be done?

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In the second selection, we look at a research letter from The Canadian Journal of Psychiatry. Paula Conforti (of the University of Toronto) and her co-authors consider a CBT intervention for school-age children to reduce suicidality and increase wellbeing. There’s a twist in the plot: the intervention is based on a Harry Potter novel. “This study found that a teacher-delivered, literature-based CBT skills curriculum was feasible and associated with reduced suicidality (ideation and behavior) in middle school-aged youth.”

Finally, in our third selection, we consider an essay by Andrea Bennett. In this Walrus essay, the writer discusses the possible link between bipolar and creativity. The essay is deeply personal. “I don’t dream about not being bipolar, because I don’t know where my self ends and where the illness begins – and if there is even really a difference.”

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)

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: Perceived Helpfulness of Depression Treatment – the New JAMA Psych Paper; Also, Friedman on Boredom & the Pandemic (NYT)

From the Editor

How helpful do people find treatment for depression?

This question is broad but new work (drawing on WHO surveys) ambitiously attempts to answer it across different countries, including some that are low income.

In the first selection, we consider a paper from JAMA Psychiatry. Meredith G. Harris (of The University of Queensland) and her co-authors report on WHO data. The good news? Many people do find treatment for depression helpful. The bad news? Many providers are needed for people to believe that they had received helpful treatment.

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In the second selection, we look at a new essay by Dr. Richard A. Friedman (of Weill Cornell Medical College). Writing in The New York Times, he discusses the pandemic and the possibility of “a mental health epidemic of depression and anxiety.” Dr. Friedman argues that we are seeing mass boredom, not a rise in disorders like depression. While he can’t fully rule out that the pandemic will bring about an increase in mental health problems, he writes: “let’s not medicalize everyday stress.”

DG
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Reading of the Week: Rurality and Suicide (CJP); Also, COVID and Digital Practice (Quick Takes) and Haughton & Bromberg on Policing (Tor Star)

From the Editor

At times, it seems that we understand little about suicide.

That statement is vast, sweeping – and painfully true for us clinicians who aspire to do better with very blunt instruments. This week, we have three selections; the first is a systematic review and meta-analysis focused on suicide. In a new Canadian Journal of Psychiatry paper, Rebecca Barry (of the University of Toronto) and her co-authors consider the potential link between suicide and rurality. Spoiler alert: they find a connection, at least for men. What are the implications for practice and policy?

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In the second selection, we consider a new podcast discussing our digital future. I talk with Dr. Jay Shore (of the University of Colorado), who chairs the APA’s Telepsychiatry Committee. We discuss the virtualization of mental health services, and contemplate a future of hybrid care. And, yes, he has tips on how to avoid “Zoom fatigue.”

In the third selection, activists Asante Haughton and Rachel Bromberg discuss alternatives to police responding to mental health crises, seeing a dedicated team tasked with “on-the-spot risk assessments, de-escalation, and safety planning for clients in crisis” and more. “By taking on these important tasks, this team will enable Toronto policing resources to be more effectively directed toward solving crimes, rather than providing social services.”

DG

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