Taghomelessness

Reading of the Week: Can We Prevent Depression in Older Adults? The New JAMA Psych Paper; Also, Homeless Youth and Mental Health (CJP)

From the Editor

It’s disabling and difficult to treat.

Can we prevent depression in older adults? Prevention is, of course, an important goal for any psychiatric disorder, reducing distress and health care costs. And the morbidity of major depressive disorder is great. A patient recently commented on his depressive episode: “I wouldn’t wish this on my worst enemy.”

Dr. Michael R. Irwin (of the University of California, Los Angeles) and his co-authors offer interesting data in a new JAMA Psychiatry paper. Focused on elderly adults with insomnia, they provided a form of CBT in an RCT. They find: “In this trial of older adults without depression but with insomnia disorder, delivery of CBT-I prevented incident and recurrent major depressive disorder by more than 50% compared with SET, an active comparator.” We review this big paper and its clinical implications.

unknownLess time with depression, more time for dancing

In the other selection, we consider homeless youth. In a new Canadian Journal of Psychiatry paper, Sean A. Kidd (of the University of Toronto) et al. draw on national survey data. “Youth homelessness is a wicked social problem with variable definitions, multiple determinants, corollaries, and outcomes.” They note the connection to sexual violence and make policy recommendations.

DG

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Reading of the Week: “Your Smartphone Will See You Now” – Torous on Digital Psychiatry; Also, the Costs of Homelessness

From the Editor

A few weeks ago, a patient’s daughter called. She was deeply concerned: the patient was acting differently, she explained. “He’s sick again.” She noted that he was starting to go on long walks at night, and to different neighbourhoods – something he does when he’s starting to get ill with his bipolar. She feared that, without a change in medications and careful follow up, he would end up in the hospital again. As a psychiatrist, that type of information can be invaluable – a clue that a patient is doing less well.

Could technology help us find clues for emerging illness, maybe even before family members or patients themselves?

This week, the first selection weighs this question. Harvard University’s Dr. John Torous considers big data and mental health. In his essay, “Your Smartphone Will See You Now,” he reviews current trends and writes: “I predict that this technology will have an enormous impact on psychiatry.”

mjkxndi1nwClever cover – promising future?

In the second selection, we consider a new paper that looks at the costs of homelessness in Canada. As part of the work of At Home/Chez Soi, the authors answer a basic and important question: what are the costs of homelessness?

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

DG

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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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Reading of the Week: The NEJM on “Our Struggle to Care for People with Serious Mental Illness”

From the Editor

What can we do for those with severe mental illness?

Homelessness: can we do better?

This week, we look at a series of excellent essays that have run on mental illness in The New England Journal of Medicine. They are well written and insightful. We particularly focus on the first of the three essays, which considers treatment and rights.

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Reading of the Week: A Father Mourns His Son, and More

Note from the Editor

In most Readings of the Week, a paper or essay is selected and then discussed in the commentary.

This week, we try something a bit different: a few pieces are selected and briefly discussed. We can cover more ground this way, and consider some pieces that may not have warranted a “full” Reading, but are still worthy of consideration.

DG

 

Selection 1: “How to Help Save the Mentally Ill From Themselves”

Norman J. Ornstein, The New York Times, 17 November 2015

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My older son, Matthew Ornstein, died at age 34 on Jan. 3 from carbon monoxide poisoning. It was accidental — he fell asleep in a tent with a propane lantern — but his death was shaped by a lack of judgment driven by a 10-year struggle with mental illness.

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National Post essay: Our next great national project: let’s end homelessness

In today’s National Post, I have an op ed on homelessness and Housing First in light of our national effort to take in and house 25,000 refugees.

Here’s the link:

http://news.nationalpost.com/full-comment/david-gratzer-our-next-great-national-project-lets-end-homelessness

The article follows. Continue reading

Reading of the Week: Housing First and At Home/Chez Soi

Homelessness is a significant social problem in Toronto, Canada’s largest and most ethnically diverse urban center, where approximately 29,000 individuals use shelters each year and roughly 5,000 people are homeless on any given night.

So opens this week’s Reading. The sentence is simple and direct; the facts conveyed are haunting. But this week’s Reading is ultimately a good news story. Actually, it’s a very good news story.

The Reading: “Effectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial” by Vicky Stergiopoulos et al., which has just been published in PLOS ONE.

Dr. Vicky Stergiopoulos

Here’s a quick summary: offer the homeless housing, and they not only gain housing stability but end up drinking less and are hospitalized less. Continue reading

Reading of the Week: Ending Chronic Homelessness

Can we end chronic homelessness?

Just a few years ago, that question would have seemed absurd. Chronic homelessness was, well, chronic. Today, a re-think of an old problem is yielding incredible results. And here’s the best part: Canadian researchers and the Mental Health Commission of Canada are playing crucial roles.

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