Tag: JAMA Internal Medicine

Reading of the Week: Are Mental Disorders Contagious in Teens? The New JAMA Psych Study; Also, Edibles & Older Adults, and Harmon on Discrimination

May 30, 2024 /

From the Editor

People with mental disorders often have family members who have been touched by illness – a genetic tie, well established in the literature. But what about the influence of peer groups? A small body of literature suggests a connection between social circles and diagnosis. How can we understand this? Are mental disorders contagious?

In the first selection, Jussi Alho (of the University of Helsinki) and her co-authors attempt to answer those questions in a new study for JAMA Psychiatry. They did a cohort study, drawing on Finnish databases, and involving more than 700 000 people. They considered individuals who had a classmate diagnosed with a mental disorder in grade 9. “We found an association between having peers diagnosed with a mental disorder during adolescence and an increased risk of receiving a mental disorder diagnosis later in life.” We analyze the study and its implications.

How have cannabis poisonings increased with the legalization of edibles in Canada? In the second selection, a research letter for JAMA Internal Medicine, Dr. Nathan M. Stall (of the University of Toronto) and his co-authors looked at an 8-year period and focused on older adults, finding 2 322 ED visits in Ontario. “The largest increases occurred after edible cannabis became legally available for retail sale, a phenomenon similarly observed in Canadian children.”

And in the third selection, Caroline Payton Harmon, who is a PhD candidate at Rutgers University, describes the people she met in substance use treatment. The essay, published in The Lancet Psychiatry, is personal and notes the contrasts between those of different socioeconomic backgrounds. “The health-care system sees money and sees patients who are not worth the cost of treatment.”

DG

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Reading of the Week: Housing First & Mental Health Care – the new Health Affairs Paper; Also, Safe Supply & Outcomes and Antipsychotics for Delirium

February 1, 2024 /

From the Editor

With the shelter system overcrowded, my patient slept the previous four nights in the train station. “Where else was I to go?” Many major cities across North America have seen a rise in the number of those who are chronically homeless. Housing First – the idea that stable housing is needed for people to better access health care – is one option, though the concept has been increasingly criticized. Is it a good fit for our urban problems?

In the first selection from Health Affairs, Devlin Hanson and Sarah Gillespie (both of the Urban Institute) consider Housing First for a specific population: the chronically homeless population who have had frequent arrests and jail stays; most of them, not surprisingly, have major mental illness or substance problems. Hanson and Gillespie analyzed data from Denver, Colorado, where people were randomized into Housing First or a control group. “We found that within the two-year study period, people in the intervention group had significantly more office-based care for psychiatric diagnoses, fewer ED visits, more unique medications, and greater use of other health care than people in the control group.” We review the study and its implications.

Denver: mountains, fresh air, and Housing First

In the second selection, Hai V. Nguyen (of Memorial University) and his co-authors look at safe supply and opioid outcomes in British Columbia. In a JAMA Internal Medicine paper, they used data from that province, contrasting it with Manitoba and Saskatchewan, and focused on the number of prescriptions and hospitalizations. “Two years after its launch, the Safer Opioid Supply Policy in British Columbia was associated with higher rates of prescribing of opioids but also with a significant increase in opioid-related hospitalizations.”

Delirium is common in the elderly admitted to hospital, and antipsychotics are often prescribed. In the third selection, Dr. Christina Reppas-Rindlisbacher (of the University of Toronto) and her co-authors comment on use of this medication in aCMAJ Practice paper. They offer much advice, including: “They should be prescribed at the lowest effective dose for the shortest possible duration and be reevaluated at or shortly after discharge.”

DG

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Reading of the Week: Fatal Overdoses & Drug Decriminalization – the new JAMA Psych Paper; Also, ChatGPT vs Residents, and Chang on Good Psychiatry

October 5, 2023 /

From the Editor

Does decriminalizing the possession of small amounts of street drugs reduce overdoses? Proponents argue yes because those who use substances can seek care – including in emergency situations – without fear of police involvement and charges. Opponents counter that decriminalization means fewer penalties for drug use, resulting in more misuse and thus more overdoses. The debate can be shrill – but lacking in data.

Spruha Joshi (of New York University) and co-authors bring numbers to the policy discussion with a new JAMA Psychiatry paper. They analyze the impact of decriminalization in two states, Oregon and Washington, contrasting overdoses there and in other US states that didn’t decriminalize. “This study found no evidence of an association between legal changes that removed or substantially reduced criminal penalties for drug possession in Oregon and Washington and fatal drug overdose rates.” We consider the paper and its implications.

In the second selection, Dr. Ashwin Nayak (of Stanford University) and his co-authors look at AI for the writing of patient histories. In a new research letter for JAMA Internal Medicine, they do a head-to-head (head-to-CPU?) comparison with ChatGPT and residents both writing patient histories (specifically, the history of present illness, or HPI). “HPIs generated by a chatbot or written by senior internal medicine residents were graded similarly by internal medicine attending physicians.”

And in the third selection, medical student Howard A. Chang (of Johns Hopkins University) wonders about “good” psychiatry in a paper for Academic Psychiatry. He reflects on the comments of surgeons, pediatricians, and obstetricians, and then mulls the role of our specialty. “I have gleaned that a good psychiatrist fundamentally sees and cares about patients with mental illness as dignified human beings, not broken brains. The good psychiatrist knows and treats the person in order to treat the disease.”

DG

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Reading of the Week: Lithium Prescribing – the New CJP Paper; Also, AI vs. Doctors (JAMA Int Med) and Bergner on Compulsory Mental Health (NYT)

June 8, 2023 /

From the Editor

For patients with bipolar disorder, lithium is an important medication, shown to reduce hospitalizations and suicides better than newer agents. But has it fallen out of fashion? International reports suggest that it has.

In the first selection, Samreen Shafiq (of the University of Calgary) and her co-authors try to answer this question with Canadian data in a new paper for The Canadian Journal of Psychiatry. They draw on a decade of Alberta prescription data with more than 580,000 lithium scripts. “This population-based study suggests that the overall number of new and prevalent lithium users is decreasing in Alberta between the years of 2009 and 2018, but the observed pattern suggests that this decrease may have stopped by the end of our study interval.” We consider the paper and its clinical implications.

In the second selection, John W. Ayers (of University of California San Diego) considers AI-generated responses to health care questions posted on social media, like the need to seek medical attention after a minor head injury with a presentation of a lump and a headache. In a JAMA Internal Medicine paper, they compare ChatGPT answers to those of physicians in terms of quality and empathy. “In this cross-sectional study, a chatbot generated quality and empathetic responses to patient questions posed in an online forum.”

The debate over coercive care is hot, with proposals to rebalance patients’ rights actively discussed in New York City, Alberta, and California. In the third selection, author Daniel Bergner writes that we should look for alternatives to medications. In a New York Times essay, he argues that antipsychotics are problematic. “By doubling down on existing methods, we’re only beckoning more failure.”

DG

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Reading of the Week: Suicide and Ethnic Groups – the New Lancet Psychiatry Paper; Also, Cannabis & the Differential (JAMA Int Med)

December 9, 2021 /

From the Editor

Discrimination. Microaggression. Stigma. Patients in ethnic groups often face greater challenges and stresses than others. Do suicide rates differ? What are the implications for interventions?

These are good and important questions, yet the literature is thin. In a new paper for The Lancet Psychiatry, Isabelle M. Hunt (of the University of Manchester) and her co-authors consider suicide rates by ethnic group in the UK, focused on those who have had contact with mental health care. Drawing on a large database, they find lower rates of suicide completions compared to White patients, but significant variation among the different groups. The authors see potential clinical implications: “Clinicians and the services in which they work should be aware of the common and distinct social and clinical needs of minority ethnic patients with mental illness.”

fd1c8d415f97df29c61ed70a727e8974The Death of Socrates – and, yes, White patients died by suicide more

In the second selection, Dr. Anees Bahji (of the University of Calgary) and his co-authors consider cannabis use disorder in a patient who presents with cannabis hyperemesis syndrome. Their JAMA Internal Medicine paper is very practical; they suggest: “a multidisciplinary approach that incorporates psychotherapy, withdrawal symptom management, and close follow-up in the primary care setting is recommended for treatment of cannabis-related harms.”

DG

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Reading of the Week: The Resident’s Suicide – a New Paper from NEJM; Also, Help Seeking in Medical Education (JAMA Int Med)

March 25, 2021 /

From the Editor

“Bobby became my intern, and I was his senior resident. It was a role I cherished, and I tried to teach him all I could about caring for multiple sick patients simultaneously and navigating the systems, personalities, and politics of a large Manhattan hospital.”

Dr. Richard E. Leiter (of Harvard University) writes these words in a New England Journal of Medicine paper, this week’s first selection. He discusses loss – specifically, the death by suicide of the junior resident he was working with. On Twitter, Dr. Leiter commented that it took him six years to write about this death. Reading over the paper, we can understand why; the essay is deeply personal and moving. It also seeks to be constructive: Dr. Leiter calls for change. “Seeking to improve the lives of others shouldn’t cost our trainees their own.”

grief

Of course, the NEJM article isn’t just about Bobby; it touches on the culture of medicine. Suicide, while always tragic, is rare in health care; untreated depression and substance problems are too common. In the second selection this week, we consider a paper recently published in JAMA Internal Medicine. Dr. Erene Stergiopoulos (of the University of Toronto) and her co-authors note the mixed message of medical education: at once encouraging “wellness” but also criticizing time away. “Stigma surrounding depression is deeply embedded in medicine.” Importantly, Dr. Stergiopoulos and her co-authors makes three practical suggestions.

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On a pivot –

Since 2014, the Reading of the Week (ROTW) has been providing summaries and commentary on the latest in the psychiatric literature. Two years ago, we conducted a short survey to get your feedback. We are hoping to get more feedback to improve the Readings further.

We would invite you to join one of our online focus groups to hear your opinions and suggestions for improvement. If you are interested in participating, please email smit.mistry@camh.ca by April 12 with your preferred time slots from the following options – psychiatrists: April 21 at 4 pm or April 22 at 4 pm; residents: April 28 at 4 pm and April 29 at 4 pm. (Note: all times are in EST.) Time commitment: under an hour. If the above time slots do not work for you, please email Smit to arrange an interview time at your convenience, ideally between April 21 and April 30, 2021.

DG

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Reading of the Week: On D-Day, Three Papers on Shell Shock, One by Dr. Charles Myers

June 6, 2019 /

From the Editor

Today is the 75th anniversary of D-Day.

Ceremonies are planned across the country, and across Europe; Prime Minister Justin Trudeau is in France. During these anniversaries, people comment on the importance of the moment. US President Barack Obama noted: “much of the progress that would define the 20th century, on both sides of the Atlantic, came down to the battle for a slice of beach only six miles long and two miles wide.” And people speak of the loss of life. US President Ronald Reagan, on a past anniversary, talked about “the boys of Pointe du Hoc” who had tried to take “these cliffs” off the beaches, noting that the majority were killed.

But the damage of war is not only in the loss of life.

In this week’s Reading, we consider shell shock and PTSD starting with the first paper on the topic, written by Dr. Charles S. Myers for The Lancet, published just over a century ago. Dr. Myers writes about three cases of shell shock, noting the similarities in their presentations.

La pointe du Hoc en Normandie (Calvados, Basse-Normandie, France)

We also consider a recent paper, published in JAMA Internal Medicine, discussing a more modern presentation – but perhaps not a profoundly different presentation. Finally, we consider a summary of recent published guidelines.

DG

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Reading of the Week: Physician Burnout and Depression – and Patient Safety. New Papers from the AJP and JAMA Internal Medicine

September 13, 2018 /

From the Editor

Not so many years ago, no one seemed to discuss physician burnout.

Today, we speak much more about physician health and wellness.

In this week’s Reading, we consider a new American Journal of Psychiatry paper written by Dr. Erick Messias and Victoria Flynn of the University of Arkansas for Medical Sciences. In this highly readable Clinical Case Conference, the authors discuss the case of a mid-career psychiatrist – and then weigh the larger problem of burnout, and its overlap with depression.

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Also, we consider the literature around burnout, and highlight a new JAMA Internal Medicine paper. “The pooled outcomes of the main analysis indicated that physician overall burnout is associated with twice the odds of involvement in patient safety incidents (OR, 1.96…).”

DG

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Reading of the Week: “13 Reasons Why” – Is This TV Show Glamorizing Suicide?

August 17, 2017 /

From the Editor

Is a popular TV show glamorizing suicide?

13 Reasons Why is a Netflix series in which the main character suicides – depicted graphically in the show. We will leave it to critics to judge the value of the show as a cultural contribution. Here’s a relevant question for those of us in mental health: is this show promoting suicide?

San Diego State University John W. Ayers and his co-authors consider google searches after the show’s premiere aired, bringing data to this discussion.

13 Reason Why: Popular Show, Problematic Effect?

In this Reading, we consider their research letter and an editorial responding to it – and the larger debate about the series.

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Reading of the Week: Insomnia and Its Treatment

July 23, 2015 /

Cognitive behavioral therapy for insomnia (CBT-I) is a multicomponent treatment package that usually includes stimulus control, sleep restriction, and cognitive therapy and has emerged as the most prominent nonpharmacologic treatment for chronic insomnia. Previous meta-analyses have found that CBT-I improves sleep parameters and sleep quality at post treatment and follow-up for adults and older adults. Most of these studies selected individuals with primary insomnia, excluding patients with co-morbid psychiatric and medical conditions. However, patients with insomnia who present to internists and primary care physicians are likely to report comorbid conditions associated with the sleep disturbance. Furthermore, insomnia was previously conceptualized as a symptom arising from the comorbid disorder and treatment was targeted at the underlying disorder. However, accumulating evidence indicates that insomnia can have a distinct and independent trajectory from the comorbid disorder, thus indicating a need for separate treatment from the comorbid condition.

So begins this week’s Reading, which considers CBT-I for people with insomnia. Here’s a quick summary: big study, big journal – and big relevance to your patients.

This week’s Reading: “Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis” by Jade Q. Wu et al. was just published in JAMA Internal Medicine. Find the paper here.

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Wu et al. consider a very common problem: insomnia. Many patients – whether they have mental health issues or physical health issues – struggle with insomnia. Boston University health economist Austin Frakt has written about his insomnia for The New York Times. He notes that he decided to receive treatment when:

One weekend afternoon a couple of years ago, while turning a page of the book I was reading to my daughters, I fell asleep. Continue reading