Tag: Lawrence

Reading of the Week: Do ADHD Meds Reduce Mortality? The New JAMA Psych Study; Also, Dr. Rebecca Lawrence on Her Husband & His Support

April 4, 2024 /

From the Editor

For my patient, ADHD medications transformed his life, helping him focus at school and at work – and even drive better. Many have had similar experiences. Do ADHD medications also reduce mortality? We know that those with ADHD have higher mortality rates and thus it’s reasonable to ask about the possible benefits of methylphenidate and sister drugs.

Lin Li (of the Karolinska Institutet) and her co-authors try to answer that question in a new JAMA Psychiatry paper. Drawing on Swedish databases, they analyzed data from almost 150 000 people with ADHD and looked at two-year mortality, including for those who die by unintentional injuries, suicide, or poisonings, by doing a target trial emulsion – simulating a randomized trial. “Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes.” We consider the paper, the editorial that accompanies it, and the clinical implications.

ADHD meds: life saver?

And in the other selection, Dr. Rebecca Lawrence writes about support in a blog for Doctor and Patient. She is personal – besides working as psychiatrist, Dr. Lawrence has been treated for depression, including with ECT. She notes the incredible help her husband has given her over the years. “I look at myself in the mirror and am appalled, but he still smiles at me.

DG

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

August 12, 2021 /

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)

January 21, 2021 /

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)

September 24, 2020 /

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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