Tag: Goldbloom

Reading of the Week: The Best of 2022

January 12, 2023 /

From the Editor

Welcome 2023.

It’s our tradition that we begin the New Year by reviewing the best of the past year; so, this week, we look back at 2022.

But a bit of a break from tradition: this year, we haven’t organized the papers by different categories, instead choosing eight great papers. Some have been published in big journals; others, not so big. They cover a variety of topics, from prevention to cutting-edge treatments. The one common thread: all are clinically relevant. And, yes, there is a Person of the Year. Spoiler alert: he had a big career and likes to mention Groucho Marx.

An observation about this past year: the quality of scholarship was very high. We’ve picked good papers – but could have picked scores of others. It’s a comment we’ve made in past years, and a good reason for optimism as our field grows more sophisticated and relevant.

DG

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Reading of the Week: Can a Phone Intervention Reduce Alcohol? Also, Dr. Goldbloom on His Career & Retirement (QT) and Ending the Term AMA (Annals)

December 15, 2022 /

From the Editor

During the first wave, alone and isolated, he started to drink significantly more. Now, many months later, he continues to struggle with an alcohol use disorder. This patient’s journey – as he told me in the ED last week – is a familiar story that we as clinicians have heard many times in these past few years. What can be done to help? Could we better reach those who are misusing alcohol?

In JAMA Psychiatry, Dan I. Lubman (of Monash University) and his co-authors describe an intervention that is very relevant. In this Australian RCT, some participants received 4-6 sessions of telephone-provided, manualized cognitive and behavioural intervention that included mindfulness. They found that: “this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control.” We discuss the paper and its clinical implications.

Dr. David Goldbloom has had a storied career: senior medical advisor at CAMH, professor at the University of Toronto, former chair of the Mental Health Commission of Canada, former editor of The Canadian Journal of Psychiatry. And tomorrow, he adds another title to that long list: retiree. This week’s second selection is a new Quick Takes podcast interview with him in which he comments on career and retirement and more. “I’m not an entirely gloomy or nihilistic person, either by temperament or based on what I’ve witnessed over the last 40 years.”

Finally, in the third selection, Dr. Robert A. Kleinman (of the University of Toronto) and his co-authors argue that “against medical advice” is a dated term. In Annals of Internal of Medicine, they argue for a new approach: “Shifting away from the ‘AMA’ terminology and toward more collaborative approaches to these discharges would improve the treatment of patients who are too often stigmatized by the clinicians and health systems that are meant to care for them.”

DG

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Reading of the Week: Measurement-based Care – What’s the Evidence? Also, Goldbloom on the Joy of Jabbing

November 4, 2021 /

From the Editor

Well, he looks better.

So often our conversations about patients – in our emergency rooms, wards, and clinics – focus on soft evidence of improvement. No wonder: psychiatry lacks biomarkers. And so, while our colleagues in medicine talk about blood sugars and white blood cell counts, we often discuss other things, like how our patients look and sound.

The promise of measurement-based care: objective evidence of change (or lack thereof). The idea is having a moment, with more and more interest. But what does the literature say?

In the first selection, Maria Zhu (of the University of British Columbia) and her colleagues consider RCTs. In a systematic review and meta-analysis, they look at the efficacy of measurement-based care for depressive disorders. They conclude: “Although benefits for clinical response are unclear, MBC is effective in decreasing depression severity, promoting remission, and improving medication adherence in patients with depressive disorders treated with pharmacotherapy. The results are limited by the small number of included trials, high risk of bias, and significant study heterogeneity.” We discuss the big paper.

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The pandemic has changed much with day-to-day practice, including with the rapid virtualization of mental health care. Remember a time when you didn’t need to talk about “being on mute?” And some psychiatrists have been on the front lines of the vaccine effort. In the second selection, Dr. David Goldbloom (of the University of Toronto) writes about his experiences working in a vaccine clinic. His Toronto Lifeessay details the YouTube video he watched to remind himself of how to administer shots, his family ties to vaccinations, and his fondness for the work. “I will always be grateful to have experienced the joy of jabbing.”

DG

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Reading of the Week: Suicidal Ideation in a 37-Year-Old Woman – A NEJM Case; Also, Goldbloom on Innovation (QT) and Purdy on Her Brother (CMAJ)

September 23, 2021 /

From the Editor

She presents with suicidal thoughts and had a challenging course with COVID-19.

She could be a patient in your afternoon clinic. In fact, she was seen and treated at Massachusetts General Hospital. And her case was discussed at psychiatry grand rounds, and then written up for The New England Journal of Medicine.

In our first selection, Dr. Carol S. North (of the University of Texas Southwestern) and her co-authors consider this patient’s story. They detail her history and course in hospital. They also note the complexities: “This case highlights the importance of attending to the intricate, multilevel, systemic factors that affect the mental health experience and clinical presentation of patients, especially among patients such as this one, who identified as Latina.”

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Dr. David Goldbloom (of the University of Toronto) joins me for a Quick Takes podcast interview. We discuss his new book about innovations in mental health care. “I wrote the book because like so many people who work in our profession, so many people who are on the receiving end of care, and for the families who support those individuals, there is a shared sense that the status quo isn’t good enough.”

In the third selection, Dr. Kaylynn Purdy (of the University of Alberta), a resident of neurology, writes about her brother and his illness in the pages of the CMAJ. He develops schizophrenia and becomes homeless in Vancouver. She talks about his life and death. “When you meet somebody living on the streets, remember my brother.”

DG

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Reading of the Week: Dr. David Goldbloom’s New Book on Innovation and Mental Health Care

September 2, 2021 /

From the Editor

“There’s one fact on which we all agree: people are suffering. People with mental illnesses, their families and friends, and society at large are all touched by a set of disorders that affect one in five people globally. What is also evident – to every worried parent or partner, to every citizen strolling down a busy downtown street, to every guard working in a prison, to every teacher spending the majority of children’s weekday waking hours with them – is that the status quo is unacceptable.”

Dr. David Goldbloom (of the University of Toronto), who serves as the Senior Medical Advisor at the Centre for Addiction and Mental Health, makes these comments in his new book.

Can we do better? Those with mental health problems wait for almost all care, and the quality of care is uneven. This week’s Reading is an excerpt from Dr. Goldbloom’s new book, We Can Do Better: Urgent Innovations to Improve Mental Health Access and Care. The excerpt, like the book itself, strikes an optimistic note, observing the incredible innovation already present in mental health care.

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A special word of thanks to Catherine Whiteside of Simon & Schuster Canada for making this Reading possible.

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).

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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: The Advocates – Beattie on Her Illness (Lexpert), Goldbloom on Progress Made (CBC Radio)

November 28, 2019 /

From the Editor

Sick with depression, he decided that the burden was too great. The suicide attempt failed, but after he was admitted – when I met him on the inpatient ward – he told me that his family wouldn’t visit. He explained that they couldn’t accept that he had mental illness.

He was right.

Times have changed, but stigma continues. This week, we consider the comments of two advocates.

In the first selection, lawyer Beth G. Beattie describes her illness and her fears. She also discusses her decision to speak out. Noting how few lawyers talk about mental illness – in part, because of the fear of job loss – she has written for a law publication. “The profession is in desperate need of role models, namely, lawyers who live with mental illness and are well established in our positions and prepared to share our stories.”

A waiting crowd in front of a microphone and podium

In the second selection, the University of Toronto’s Dr. David Goldbloom, a CAMH psychiatrist, remembers the silence on the topic of mental illness not so long ago. In an interview with CBC Radio’s Metro Morning, he notes that the silence was due to “secrecy, shame, stigma.” He weighs the progress that’s been made in recent years and he mulls the work to be done, particularly to reach “all communities.”

DG

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Reading of the Week: Postsecondary Students & Mental Illness (CJP), a New Podcast (CAMH), and Bipolar & Social Media (NYT)

October 3, 2019 /

From the Editor

Social media. An uncertain job market. Increasing academic demands.

Is life for our postsecondary students harder than ever? And are we seeing a surge in mental health disorders as a result?

In the first selection, we consider a new Canadian Journal of Psychiatry paper on postsecondary education and mental illness. While many have opinions on this topic, the University of Toronto’s Kathryn Wiens and her co-authors seek to add data to the discussion. Drawing on the Canadian Community Health Survey, they find: “The results do not imply the emergence of a mental health crisis among postsecondary students.”

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In the second selection, we look at a new podcast considering technology and education. I interview some accomplished educators, including the University of Toronto’s David Goldbloom. “This is about challenging our own norms, values and expectations as clinicians.”

And in the final selection, we consider a New York Times essay on bipolar and social media. “Facebook snitched our big family secret: Roland, the literary prodigy, the tenderhearted musician, the Ivy League grad, was bipolar.”

DG

 

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Open for Business: Chatbots, E-therapies, and the Future of Psychiatry

May 19, 2019 /

While not offering a solution for every patient in every circumstance, digital psychiatry may even be attractive to a subset of patients who would prefer a digital interaction to a human one, whether for financial and other pragmatic considerations (e.g., a single parent of 3 children, on public assistance, for whom getting to an office appointment is a major logistical problem and even financial hardship) or for more psychological and interpersonal reasons (e.g., someone with autism spectrum disorder for whom the lack of human connection with a chatbot may be helpful).

I’ve just edited an “in review” series for The Canadian Journal of Psychiatry considering digital psychiatry.

With my colleague Dr. David Goldbloom, I’ve co-written an editorial to open the series.

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You can find our paper (which is open access) here:

https://journals.sagepub.com/doi/full/10.1177/0706743719850057

The Andersson et al. paper is here:

https://journals.sagepub.com/doi/full/10.1177/0706743719839381

The Vaidyam et al. paper is here:

https://journals.sagepub.com/doi/full/10.1177/0706743719828977

Reading of the Week: Rahael Gupta on Medical Students & Depression (& her Depression)

February 22, 2018 /

From the Editor

Once—and I have never shared this before—I stepped into the street on my walk home from the library. I knew that the bus hurtling through the night would not have time to stop before colliding with my darkly dressed frame, fracturing my bones and scattering my belongings. I imagined my head hitting the asphalt and my brain banging around inside of my skull, bruising irreparably with each impact. I imagined the bus driver’s horror as he turned off the ignition with shaking hands and leapt out of the vehicle to locate my body. It would be a catastrophe that the trauma surgeons could not salvage. I would die.

Rahael Gupta is many things. She’s a graduate of Stanford University, and also Columbia. She’s a medical student. She’s a self-described optimistic. She’s a marathon runner.

And she’s a person who has struggled with depression.

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In this week’s Reading, we consider her essay in JAMA. It’s moving and clever and important.

DG

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