TagGuardian

Reading of the Week: Which Antipsychotics are Patients Less Likely to Discontinue? The New AJP Paper; Also, Dr. Lawrence on Mental Health (Guardian)

From the Editor

Is new really better?

With several new antipsychotic medications on the market, this question is very relevant clinically. For the patient in your office, should you opt for a new antipsychotic or something older?

In the first selection, Dr. Mark Weiser (of the Stanley Medical Research Institute) and his co-authors draw on a large database – and the experience of tens of thousands of people – to compare antipsychotics. “Among veterans with schizophrenia, those who initiated antipsychotic treatment with clozapine, long-acting injectable second-generation medications, and antipsychotic polypharmacy experienced longer episodes of continuous therapy and lower rates of treatment discontinuation.” We consider this paper, and the clinical implications.

new-2Is new better – or just eye catching?

In the other selection, Dr. Rebecca Lawrence, a practicing psychiatrist, writes for The Guardian. In her essay, she distinguishes between mental health and mental illness, noting that they are not the same thing, and worrying that we are increasingly as a society focused on the former at the expense of the latter. She thinks about her work as a physician: “As a doctor, I can talk with someone and give them pills, but I can’t easily get them any help with losing weight or trying to exercise. I can tell them it would be good for them, but I don’t necessarily have any practical ways to help.”

DG

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Reading of the Week: Alcohol Use, ED Visits & Mortality – the New CMAJ Paper; Also, Dr. Lawrence on Diagnoses and Her Diagnosis (Guardian)

From the Editor:

“He’s here again.”

The staff would roll their eyes. Harold was back. Many of us had encountered him – a person with alcohol use disorder who frequently came to the emergency department of the hospital where I did my internship year. He would usually get a sandwich and a lecture. But what are the outcomes for people like him? And what could be done?

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In the first selection, we consider a new CMAJ paper. Dr. Jennifer Hulme (of the University of Toronto) and her co-authors study outcomes for those presenting to Ontario EDs for alcohol-related reasons. The major finding: “The all-cause 1-year mortality rate was 5.4% overall.” We review the paper and its implications.

In the second selection, we look at a new essay by Dr. Rebecca Lawrence from The Guardian. The UK psychiatrist, who has written about her experiences as a mental health patient, notes the challenges of psychiatric diagnoses. “There are many words in the field of mental illness that have been discarded and are now viewed as stigmatising and inappropriate – words such as ‘cretin’, or ‘lunatic’, or ‘mental’. It’s interesting to consider whether our current crop of acceptable words will end up in that category, and it’s salutary to know that many probably will.”

DG

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Reading of the Week: Trends in Suicide Mortality in Canada (CJP); also, Suicide Prevention (Quick Takes) and Lawrence on Her Depression (Guardian)

From the Editor

Suicide is often discussed, but what do we know about the overall rate of completions? We hear that there are more suicides in the United States over the past few years – but was does the Canadian data say?

In the first selection, we consider a new paper by Mélanie Varin (of Indigenous Services Canada) and her co-authors. Drawing on a Canadian database, they consider suicide mortality. The good news: the suicide rate in Canada decreased by 24.0% between 1981 and 2017. But, in recent years, there hasn’t been a further decline.So – is the glass half full or half empty?

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In the second selection, we look further at suicide, considering a new podcast discussing suicide and suicide prevention. I talk with Dr. Juveria Zaheer (of the University of Toronto) about COVID-19, the literature, and, yes, her suggestions for clinical interviews. “If you have a room of one hundred people, one hundred people in that room have been affected by suicide.”

Dr. Rebecca Lawrence is a UK psychiatrist and we can assume that she has done many suicide risk assessments. In a Guardian essay – our third selection – she tells her story: as a person who struggled with mental illness, then made the decision to become a psychiatrist. “If my story helps anyone unsure of their capacity to take on the job, or worried about the ‘dark secret’ of their own psychological troubles, then I think it’s worth telling.”

DG

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Reading of the Week: Technology & Mental Health – Depression and Internet-based CBT; Also, Finnish e-Therapy

From the Editor

VR. e-therapies.

New technology is changing the way we think about the delivery of psychiatric services. But new isn’t necessarily better. Can care really be transformed? What does the literature say?computere-therapy: more than clever pictures of computers and stethoscopes?

In a two-part Reading of the Week, we look at technology and psychiatry.

Last week, Virtual Reality.

This week, e-therapies.

This week, we consider a new paper that has just been published. Its looks at self-guided Internet-based CBT showing that for every eight people treated, one benefits (consider this in the context of minimal cost).

And, in the other selection, we look at the Finnish experience with Internet-based CBT.

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Reading of the Week: Are Cats Making Us Sick? The Solmi et al. Paper, and Prescribing Housing in Hawaii

From the Editor

A few years ago, Czech scientist Jaroslav Flegr made a splash by arguing that our feline friends were causing psychosis in people – The Atlantic provocatively titled their article on him: “How Your Cat is Making You Sick.” Flegr’s argument was based in part on several papers (including by prominent researcher E. Fuller Torrey) noting that cat ownership confers an increased risk of psychotic disorders like schizophrenia.

So, are cats safe for household use?

In our first selection, we look at a new Psychological Medicine paper that, with a cohort study, finds no connection between cat ownership and psychotic symptoms.

Good news, tabby: you can stay

How to help the homeless? In our second selection, drawing from The Guardian, we look at a Hawaiian effort to prescribe the housing to the homeless – literally.

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

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