Taginpatient

Reading of the Week: Helping Healthcare Workers Seek Help; Also, Smoking Cessation for Inpatients & Priebe on Why Patients Should Be Called Patients

From the Editor

How do we connect with them?

With the worst of the third wave now behind us, we are beginning to look forward. But for some, the problems of the pandemic aren’t fading. They will continue to struggle with mental health problems.

Healthcare workers are particularly at risk. They are also, collectively, a group that is difficult to engage. In the first selection, we look at a new paper from The British Journal of Psychiatry. Dr. Doron Amsalem (of Columbia University) and his co-authors do a video intervention to increase treatment seeking. The resulting RCT is impressive. The authors write: “The high proportion of healthcare workers surveyed in this study who reported symptoms of probable generalised anxiety, depression and/or PTSD emphasises the need for intervention aimed at increasing treatment-seeking among US healthcare workers. A three-minute online social contact-based video intervention effectively increased self-reported treatment-seeking intentions among healthcare workers.”

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In the second selection, Richard A. Brown (of the University of Texas at Austin) and his co-authors look at a new approach to an old problem: high smoking rates among people with severe mental illness. Focusing on inpatient hospitalizations, they design an intervention built on motivational interviewing. We consider their JAMA Psychiatry paper.

Is the term patient antiquated? Should we use other terms, like client or service user? In a BJPsych Bulletin paper, Dr. Stefan Priebe (of Queen Mary University of London) argues that we serve patients – and that words matter. “Mental healthcare is based on shared values and scientific evidence. Both require precise thinking, and precise thinking requires an exact and consistent terminology.”

DG

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Reading of the Week: Cannabis and Inpatients – the New CJP Paper; Also, Alexander on Her Loss and Her Patient’s (JAMA)

From the Editor

First, there was decriminalization; then, legalization.

How have these major legal shifts influenced the presentation of our patients? In the first selection, we consider a new paper from The Canadian Journal of Psychiatry. Taylor McGuckin (of the University of Waterloo) and her co-authors look at cannabis use and inpatient care, drawing on databases. “This study identified a significant increase in the proportion of patients who used cannabis within 30 days of their first admission to inpatient psychiatry in Ontario, Canada, between 2009 and 2017, compared to 2007.”

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How do our biases affect the care we provide? In a moving and personal essay, Karen Alexander (of Thomas Jefferson University) discusses the loss of her baby. She thinks about another time, when a patient of hers was in a similar situation, and she mulls her own views and biases. “The weeping woman was always much more than someone who was grieving, but I never really knew her as a person until I mourned the loss of my own child.”

DG

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Reading of the Week: Physician Burnout, Interrupted (NEJM); also, COVID and Schizophrenia (Schiz Bulletin) and a Reader Responds on Inpatient Care

From the Editor

As we come to understand the new normal – a world of PPEs and precautions – we need to consider not just the implications of the virus on today’s work, but tomorrow’s.

In the first selection, we look at a new paper on physician burnout. In The New England of Journal, Drs. Pamela Hartzband and Jerome Groopman (both of Harvard Medical School) argue that burnout will not be remedied by offers of exercise classes and the other usual prescriptions. Drawing on organizational psychology, they call for a fundamentally different approach, built on autonomy, competence, and relatedness. At a time of COVID, “health care professionals are responding with an astounding display of selflessness, caring for patients despite the risk of profound personal harm. Our efforts are recognized and applauded.” Now, they argue, is the moment for action.

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Are people with schizophrenia at particular risk during this pandemic? In the second selection, we consider a new Schizophrenia Bulletin paper by Dr. Nicole Kozloff (of the University of Toronto) and her co-authors, who answer this question with a convincing yes. “We suggest that thoughtful consideration of the implications of COVID-19 for people with schizophrenia may not only reduce the burden of the global pandemic on people with schizophrenia, but also on the population as a whole.” They offer recommendations.

Finally, in the third selection, a reader responds to last week’s Reading. Rachel Cooper (of the University of Toronto) considers the inpatient experience. “Those of us who have spent time on psychiatric units, particularly while on forms (or held involuntarily), can speak to the immense isolation and feelings of violation of having our basic liberties removed. In this time of COVID, those with the privilege of not having had the experience of being in hospital involuntarily are getting a small taste of that isolation.”

Please note that there will be no Reading next week.

DG

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Reading of the Week: COVID & Mental Health Access in China (AJP); also, Transformational Care (EBMH) and Psych Wards (New Yorker)

From the Editor

What’s the latest in the literature on COVID and mental health? This week, we focus again on the pandemic with three selections.

In the first, we consider a paper on mental health services at a Chinese hospital during the pandemic. In this American Journal of Psychiatry study, Dr. Junying Zhou (of Sichuan University) and co-authors report on a survey of existing and new outpatients, finding major problems with access. Among the findings: one in five found that their mental health had deteriorated due to a lack of access to care. The authors advocate further study to “ameliorate the negative impact of viral outbreaks in the general public, especially among those vulnerable patients with mental problems.”

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Will COVID change health care once the virus has burned out? In the second selection, we consider a new EBMH editorial by Dr. Katharine Smith (of Oxford University) and her co-authors. They write: “In order to reappraise effectively our new ways of working, both in the immediate management of issues during the pandemic and also during the longer-term aftermath, we need fast-track implementation of evidence-based medicine techniques in mental health to supply the best evidence to clinicians on specific questions in real time.”

Finally, in the third selection, we look at an essay from The New Yorker. Reporter Masha Gessen argues that psychiatric wards are particularly vulnerable during the pandemic. Gessen speaks to several doctors who offer a similar if haunting story: “how a lack of testing, P.P.E., and seclusion protocols were making a difficult task – maintaining the safety of a highly vulnerable population and their care workers during a pandemic – virtually impossible.”

DG

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Reading of the Week: Can Psychotherapy Help Inpatients? Why did Michael Wilson Speak Out? Are Patients Experts?

From the Editor

Almost two decades ago, I was invited to a conference. The keynote speaker was Michael Wilson, the former federal Minister of Finance, who died earlier this month. I remember two things about this presentation: first, the audience was perfectly still – as Wilson spoke about his son’s suicide, no one shuffled her papers or chatted with his neighbour; second, I remember thinking how unusual this presentation was: he spoke about suicide at a time when suicide wasn’t discussed.

This week, we look at three selections, including an interview in which Wilson discusses his decision to speak out.

We also consider two other pieces: a new study on psychotherapy for inpatients with depression and an essay considering whether patients are experts.

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Enjoy.

And I hope you will take a few minutes to complete our survey, aimed at improving the Readings.

https://www.surveymonkey.com/r/GP5XXMB

DG

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Reading of the Week: Higher Volume, Better Care? The Rasmussen Paper

From the Editor

How do we improve mental health services?

Past Readings have explored many topics from measurement-based care to better access. This week, we consider a new paper by Aalborg University’s Line Ryberg Rasmussen et al. The study authors look at volume and quality of mental health care, drawing on Danish inpatient admissions.

Their finding? “This nationwide, population-based cohort study demonstrated that patients with depression who were admitted to psychiatric hospitals with very-high-volume wards were more likely to receive care in accordance with clinical guidelines, compared with those admitted to low-volume wards.”

ptelemnursing01High volume, better care (if not better cafeteria food)?

This week, we look at the Rasmussen et al. paper and consider its implications.

DG

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Reading of the Week: ECT and Inpatients – An Underused Tool?

From the Editor

It’s a powerful tool that helps people with refractory depression and other illnesses.

It’s a treatment that carries a heavy stigma, and is used less today than even a decade ago.

Both statements describe electroconvulsive therapy (or ECT) – perhaps the most controversial intervention in psychiatry. And while it has been studied for decades, little work has been done considering the impact of ECT on inpatient readmissions. In this week’s Reading, we look at a new JAMA Psychiatry paper that studies ECT and readmissions.

Spoiler alert: the study authors found it decreased readmits.

Electroconvulsive therapy at Winwick Hospital in 1957: relevant then as now?

The paper begs a larger question: is an important tool in the treatment of those with mental illness being underutilized as newer (and less effective) treatments are chosen?

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