Tag: COVID

Reading of the Week: Mental Health Tsunami? The New BMJ Study on COVID; Also, Burnout & Professionalism (JAMA Health) and Buprenorphine (CMAJ)

April 6, 2023 /

From the Editor

How has COVID-19 impacted mental health? What to make of the forecasts of a mental health tsunami?

In a new BMJ paper, Ying Sun (of the Jewish General Hospital) and her co-authors do a systematic review and meta-analysis to try to answer these questions. Drawing on 137 studies, they consider mental and the pandemic. They find: “Most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to zero and not statistically significant, and significant changes were of minimal to small magnitudes…” We look at the paper and its clinical implications.

In the second selection, Dr. Dhruv Khullar (of Cornell University) writes about burnout and professionalism for JAMA Health Forum. He argues that burnout is common and costly, and points a way forward, in part by reducing clerical tasks. “A better path is one that strenuously removes the obstacles to physician and patient well-being and that actively promotes the deep work of doctoring.”

In the third selection, Dr. Ari B. Cuperfain (of the University of Toronto) and his colleagues consider extended-release buprenorphine, a subcutaneous monthly depot injection used to treat opioid use disorder in a short CMAJ paper. They make several observations about titration, effectiveness, and safety.

DG

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Reading of the Week: Delirium in the ICU – the New NEJM Paper; Also, Admissions and COVID (CJP) and Dr. Boulay on Our Own (NEJM)

February 23, 2023 /

From the Editor

Is there a role for haloperidol in the treatment of delirium in ICU settings? That may seem like an unusual question since many patients receive this medication, perhaps half. But evidence is light.

In the first selection, Dr. Nina C. Andersen-Ranberg (of the University of Southern Denmark) and her co-authors consider ICU delirium with a new RCT, published in The New England Journal of Medicine. In this elegant study, half of the patients were randomized to receive haloperidol (in the IV form) and the other half received a placebo. They find: “Among patients in the ICU with delirium, treatment with haloperidol did not lead to a significantly greater number of days alive and out of the hospital at 90 days than placebo.” We consider the paper.

In the second selection, Dr. Scott B. Patten (of the University of Calgary) and his co-authors analyze hospital admissions and psychiatric diagnoses before and after the start of the pandemic. In this Canadian Journal of Psychiatry paper, they draw on Alberta data. Noting an existing literature on eating disorders, they also find an increase in patients with personality disorders being admitted. “[T]he increase was more pronounced than the widely reported increase in admissions for eating disorders.”

And, in the third selection, Dr. Richard M. Boulay (of St. Luke’s University Health Network) weighs in on physician mental health. In this highly personal New England Journal of Medicine paper, the gynecologic oncologist describes the problems of a second-year surgery resident who almost dies by suicide. He feels that she was failed by her program and medical culture itself. He writes: “[S]olutions are available. It’s time we began looking after our own.”

DG

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Reading of the Week: PTSD & Healthcare Workers – the New Lancet Psych Paper; Also, Social Media and Youth (Aust Psych) and BMJ’s Xmas Call to Action

December 22, 2022 /

From the Editor

We talk about the virus’ effects on our patients, both in terms of physical and mental health. But what has it done to us?

Health-care workers have been on the front lines of this pandemic and have experienced the psychological toll. While past studies have considered mental disorders of health-care workers, their methodology hasn’t been strong, often relying on online surveys. In the first selection, Hannah Scott (of King’s College London) and her co-authors look at mental disorders and the pandemic in a new Lancet Psychiatry paper. Importantly, they did a two-phase, cross-sectional study comprising of diagnostic interviews. They write: “The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools.” Still, they found that about one in five met threshold for a mental disorder and “thus might benefit from clinical intervention.” We consider the paper and its implications.

In the second selection, Beatrice Webb (of Flinders University) and her co-authors look at social media and young people. In a Point of View paper for Australasian Psychiatry, they note problems with mental health including the rise in psychological distress – something tied to social media. They also observe some benefits to Instagram and other online platforms. The paper is practical and offers advice, including: “We encourage clinicians to explore social media use in the assessment of young people, due to potential impacts on depression, anxiety and self-harm.”

At this time of year, The BMJ runs its Christmas issue, meant to be light-hearted and with liberal use of British humour. In the third selection, Ryan Essex (of the University of Greenwich) considers calls to action in the medical literature. In an Editorial, he opines: “The call to action has several obvious advantages over actually acting. Making that call allows you to salve your conscience, to ‘do something’ without the hard work of actually doing something.”

There will be no Readings for the next two weeks. We will return with force (but a lack of British humour) on 12 January 2023 when we will review the best papers of the year. A quick word of thanks for your continuing interest.

All the best in the holiday season.

DG

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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)

November 3, 2022 /

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: How Has Mental Health Changed Over COVID? Also, Goldbloom on Practice & the Pandemic (Globe) and a Reader Responds to Psilocybin

May 13, 2021 /

From the Editor

Even our language has changed. Last winter, we didn’t think about lockdowns and the term social distancing was confined to sociology textbooks. The world is different.

And in our new reality, we can ask: How has the pandemic affected mental health? While there have been many small surveys (and much speculation), until now we have lacked a major, large scale survey.

This week, we look at a new paper from The Lancet Psychiatry. Matthias Pierce (of the University of Manchester) and his co-authors draw on the UK Household Longitudinal Study – a large, national survey that offers us pandemic and pre-pandemic data. The good news: “Between April and October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels…” but they also found that one in nine people in the UK “had deteriorating or consistently poor mental health.” We consider the big study and discuss resilience with an essay by Dr. Richard A. Friedman (of Cornell University).

covid-pic

In the second selection, we consider an essay by Dr. David Goldbloom (of the University of Toronto) on how the pandemic has changed psychiatry. He focuses on the biggest change: that is, the embrace of virtual care. He begins: “We are all telepsychiatrists now…” He notes the advantages and disadvantages of the transformation. While some providers express ambivalence, he writes: “What counts, ultimately, is what helps our patients.”

Finally, a reader responds to our take on The New England Journal of Medicine paper on psilocybin. Dr. Craig P. Stewart (of Western University) writes: “One area I did not see mentioned in the psilocybin paper review was a discussion of confirmation bias, which I believe also should be mentioned to contextualize the results.”

DG

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Reading of the Week: ECT & Equity (CJP); also, COVID and Mental Health Surveys (Policy Options) and Farrell on Witnessing the Pandemic (Nation)

July 23, 2020 /

From the Editor

Who has better access to care?

This week, we have three selections. The first is a paper about inpatient ECT – an important topic. And the study – just published in The Canadian Journal of Psychiatry – has interesting findings, including that ECT is not particularly commonly performed (for just 1 out of 10 inpatients with depression). But this new paper by Dr. Tyler S. Kaster (of the University of Toronto) and his co-authors also touches on the larger issue of equity. We consider it – and the questions the study raises.

ect-maching

The second selection is an essay from Policy Options. Drs. Scott Patten (of the University of Calgary) and Stan Kutcher (of Dalhousie University) bemoan the state of mental health data during the pandemic. “There has been a disturbing acceptance of trivial and often misrepresented information, delivered from sub-optimal surveys and problematic interpretation of results.”

Finally, we consider an essay by Dr. Colleen M. Farrell (of Cornell University). She discusses COVID-19 – she is working in the ICU of a major New York City hospital during the pandemic – but also ties to the larger issues of public health, advocacy, and the role of medicine. “As I tend to my patients in the Covid ICU, I struggle to process reality. The attending physicians who are my teachers have few answers; this disease is new to all of us.”

Please note that there will be no Reading next week.

DG

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Reading of the Week: How to Achieve Good Mental Health During Isolation (BJP)? Also, Bipolar Meds (AJP) & Qayyum on the Way to the Morgue (WBUR)

May 28, 2020 /

From the Editor

Millions of people are isolating themselves in North America, and across the world. We know that quarantine is linked to mental health problems like depression. So what advice should we be giving our patients – and our family and neighbours?

The first selection seeks to answer this question.
In The British Journal of Psychiatry, Rowan Diamond (of Warneford Hospital) and Dr. John Willan (of Oxford University Hospitals NHS Foundation Trust) provide six suggestions, drawing from the literature and taking into account our collective situation. “Dame Vera Lynn, at the age of 103, said of this pandemic that ‘even if we’re isolated in person we can still be united in spirit,’ and the sense of purpose that may be engendered in self-isolation may paradoxically lead to improvements in the mental health of some individuals who may otherwise feel that they have lost their role in society.”

language-2345801_1280Learning is linked to better mental health

How are we managing bipolar affective disorder? In the second selection, we look at a new American Journal of Psychiatry paper by Taeho Greg Rhee (of the University of Connecticut) and his co-authors, who draw on 20 years worth of data. “There has been a substantial increase in the use of second-generation antipsychotics in the outpatient psychiatric management of adults diagnosed with bipolar disorder, accompanied by a decrease in the use of lithium and other mood stabilizers.”

Finally, in the third selection, Dr. Zheala Qayyum (of the US Army) considers her time working in New York City during the pandemic. “The first thing that struck me when I stepped into the hospital in Queens was the smell that hung in the air, in these seemingly sterile hospital corridors. It was death and disease.”

DG

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