Tag: lived experience

Reading of the Week: Suicide – with Papers from AJP and BJPsych Int; Also, O’Brien on His Brother’s Suicide & His Family

June 12, 2025 /

From the Editor

She came into our ED feeling overwhelmed. After a recent breakup, she felt suicidal; the academic demands of grade 12 further stressed her. As a clinician, this type of adolescent presentation seems to be increasingly common.

But is it? Many people have opinions. Dr. Tanner J. Bommersbach (of the University of Wisconsin) and his co-authors attempt to shed light on the state of teen mental health with a new and important paper focused on suicidal ideation, plans, and attempts. In the first selection, we examine their American Journal of Psychiatry paper, involving almost 120 000 high school students, drawing on US survey data, and covering a decade and a half. “In this nationally representative sample… significant increases occurred in the percentage reporting past-year suicidal thoughts, suicide plans, and suicide attempts from 2007 to 2021.” We consider the paper and its implications.

In the second selection from BJPsych International, Dr. Rachel Gibbons (of the Royal College of Psychiatrists) writes about suicide. In a controversial paper, she argues that we make too many assumptions about suicide, which colour our research and undermine our understanding of patients. “Embracing the complexity of suicide may not only refine prevention but also deepen our understanding of suffering, resilience, and meaning.”

And in the third selection, playwright Dan O’Brien writes about his brother’s suicide for Esquire. In a deeply personal essay, he discusses his brother’s mental health problems and his parents’ desire to hide them. He wonders what could have been. “I would like to be helpful to some who might read this, if only to deny that the suffering of mental illness is a disgrace, and to assert that such suffering is common and survivable.”

DG

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Reading of the Week: Glucagon-Like Peptide 1 Receptor Agonists & Mental Health – the New JAMA Psych Study; Also, Innovation and Lee on His Depression

May 29, 2025 /

From the Editor

These medications are widely discussed – and, yes, our patients ask about them. But how do glucagon-like peptide 1 receptor agonists impact mental health and overall wellness? Should we hesitate before reaching for the prescription pad?

Aureliane C. S. Pierret (of King’s College London) and her co-authors attempt to answer these questions in a new paper just published in JAMA Psychiatry. In their systematic review and meta-analysis, they included more than 107 000 patients, comparing treatment with GLP1-RAs to placebo, looking at psychiatric, cognitive, and quality of life outcomes in those who are overweight, obese, or have diabetes. “Our results provide reassurance regarding the psychiatric safety profile of GLP1-RAs and suggest that GLP1-RA treatment is associated with improved mental well-being, in addition to the known physical health improvements.” We consider the paper and its implications.

When we hear innovations in mental healthcare, we tend to think of apps or wearables. In the second selection from Quick Takes, Daisy Singla (of the University of Toronto) discusses her recent study that expanded access to psychotherapy for perinatal women, reducing symptoms of depression and anxiety by drawing a page from work done in low-income countries. The key concept: training up laypeople to deliver therapy (task sharing). “It’s one of the largest psychotherapy trials in the world.”

And in the third selection, from The Globe and Mail, Joe Lee writes about his realization that he has depression and that it has affected his life for years. In a personal essay, he talks about his illness and the impact on his life. “Depression is weird like that. For some people, it sneaks in. For me, it’s always been there – like blood in my body.”

DG

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Reading of the Week: Lived Experience of Postpartum Depression & Psychosis – the New World Psych Paper; Also, Involuntary Treatment and Family Stress

May 15, 2025 /

From the Editor

“You are normal and then the next thing, you know, you’re crazy.”

So comments a woman about her postpartum depression. Typically, we describe this illness with a list of symptoms. But how do patients experience it? In a new World Psychiatry paper, Dr. Paolo Fusar-Poli (of King’s College London) and his co-authors attempt to answer this question with a “bottom-up” approach, looking at both postpartum depression and psychosis. “To the best of our knowledge, this is the first bottom-up review of the lived experience of postpartum depression and psychosis. Experts by experience co-designed, co-conducted and co-wrote the study, leveraging an established methodological template developed by our group to investigate the lived experience of psychosis [and] depression…” We look at the paper and its implications.

Should people with substance problems be forced into treatment? Across North America, some are proposing this idea, including governments in British Columbia and Alberta. In a new Canadian Journal of Psychiatry paper, Benedikt Fischer (of the University of Toronto) and his co-authors look at the issue and the evidence. “Involuntary treatment for severe SUD is a complex and contentious concept that requires careful in-depth consideration before its adoption.”

In the third selection, a paper written anonymously for The BMJ, the author describes the challenges for families of those with severe mental disorders. He notes his deep frustration with visits to the ward, often leaving him in tears. “Perhaps family support needs to become part of the culture on mental health wards, and we should recognise the need for help in communicating.”

DG


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Reading of the Week: When Does Grief Become a Disorder? The Lancet Review; Also, Time to End Daylight Saving Time? And Dr. Hickey on Her Anxiety

May 8, 2025 /

From the Editor

After the unexpected loss of his spouse, my patient sank deeply into grief. He was tearful during our sessions, explaining that a part of him had died, too. Weeks turned to months. Was this a normal response to a profound loss? Or something more problematic? DSM-5 seeks to clarify the issue by recognizing prolonged grief disorder – though the disorder is controversial and has attracted much criticism. When The New York Times covered the topic in 2022, Joanne Cacciatore (of Arizona State University) commented: “I completely, utterly disagree that grief is a mental illness.”

Clare Killikelly (of the University of Zurich) and her co-authors shed light on prolonged grief disorder with a new review, just published in The Lancet. They write about the disorder, the differences from grief, its treatment, and more, drawing on 142 citations. “Grief is a universal experience. However, for a minority of individuals, grief becomes a debilitating, devastating mental health disorder with serious implications on a personal and societal level.” We examine the review, highlight four take-aways, and reflect on the broader debate.

Spring forward, fall back. Twice a year, we adjust our clocks (and our brains) to and from daylight saving time. In the second selection, Dr. David Dongkyung Kim (of the University of Toronto) and his co-authors argue that daylight saving time should be eliminated. In their JAMA Commentary, they draw on the literature. “Daylight saving time transitions cause acute disruptions in human circadian rhythm, and the medical literature shows detrimental effects for public health.”

Finally, in the third selection, Dr. Joanne Hickey (of Memorial University) discusses anxiety and her expectations. In a personal CMAJ paper, the hematologist reflects on her work – and on her own journey, including her anxiety, the decision to take medications, and her need to come to terms with her perfectionism. “Anxiety has been my life companion, though I often didn’t recognize it. It masqueraded as that internalized need to control.”

DG

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Reading of the Week: ADHD – with Papers from JAMA Psych, PLOS One & Psych Services

April 3, 2025 /

From the Editor

He had struggled for years with mood and ADHD. While we discussed different medication options, my patient was very focused on psychedelics; he explained that his friends had found microdosing to be helpful, especially for their attentional problems.

Psychedelics have entered the mainstream: research is active; patients seem increasingly interested; and, yes, investors offer up billions in the rush to find potential treatments (and profit). But is there evidence for psychedelics for those with ADHD?  Dr. Lorenz Mueller (of the University of Basel) and his colleagues attempt to answer that question with a new paper, just published in JAMA Psychiatry. They describe the first double-blind, placebo-controlled phase 2A randomized clinical trial. 52 participants received repeated doses of LSD (twice weekly) or placebo over six weeks. “In this randomized clinical trial, repeated low-dose LSD administration was safe in an outpatient setting, but it was not more efficacious than placebo in reducing ADHD symptoms.” We consider the paper and its implications.

The molecular structure of LSD – pretty but useful for ADHD?

In the second selection, Vasileia Karasavva (of the University of British Columbia) and her co-authors look at ADHD and social media in a new paper for PLOS One. In a two-part study, they analyzed 100 popular videos on ADHD, finding many views but uneven quality. While they note the “democratizing” of mental health information, they warn: “TikTok’s anecdotal content could lead some viewers to misattribute normal behaviors or those better explained by other conditions to be signs of ADHD…”

In the third selection, Dr. Zilin Cui (of Boston University) writes about ADHD – as a provider and also as a patient. In a personal Psychiatric Services paper, the physician discloses long-standing problems and a diagnosis. She also writes about cultural considerations. “Instead of continuing to dwell on what I cannot do, I now have different tools and strategies to chart my path forward. Now, I can finally tell myself that I am enough.”

DG


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Reading of the Week: Psychiatric Care in 21 Countries – The JAMA Psych Study; Also, Industry Payments to Psychiatrists and Batterman on Relating

February 13, 2025 /

From the Editor

Our patients often struggle to access care. But what is the global experience? What percentage of patients in other countries receive care that meets basic standards?

In the first selection, Dr. Daniel V. Vigo (of the University of British Columbia) and his co-authors attempt to answer these questions in a new paper for JAMA Psychiatry. They analyzed effective treatment and its key components for nine mental disorders drawing on the World Mental Health surveys which included structured interviews. Vigo et al. cover familiar ground, but the study stands out due to its unusually robust dataset which includes almost 57 000 people in 21 countries. “The proportion of 12-month person-disorders receiving effective treatment was 6.9%.” We consider the paper and its implications.

In the second selection, Dr. John L. Havlik (of Stanford University) and his co-authors weigh in on industry payment to US psychiatrists. In this Psychiatric Services paper, they analyzed six years of data covering nearly 60 000 physicians, drawing on government databases, finding: “a small number of psychiatrists (<600 psychiatrists per year) received approximately 75% of industry’s compensation to psychiatrists each year.”

And, in the third selection, medical student Alexander I. Batterman (of Rowan University) writes about a patient encounter for Academic Psychiatry. He notes the challenges of connecting with a patient who has psychosis and is dismissive. Batterman persists – and understands. “As a former epilepsy patient who is intimately aware of what it is like to be questioned and observed by clinicians and students in the emergency department, as if I were an animal at the zoo on display, I could relate to the human experience of being judged.”

DG

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Reading of the Week: ECT & Maintenance – the New JAMA Psych Paper; Also, Social Contagion & Psychiatry and Dr. Julie Trivedi on Resilience

December 12, 2024 /

From the Editor

He didn’t get better despite several medication trials. Exhausted and feeling suicidal, he chose ECT. The change was incredible. When he returned to the clinic after discharge – bright and energetic – a member of the outpatient team didn’t recognize him. 

But how can we keep people like my patient well and out of hospital? How strong is the evidence supporting maintenance ECT? Dr. Anders Jørgensen (of the University of Copenhagen) and his co-authors attempt to answer these questions in a new JAMA Psychiatry paper. Drawing on a Danish national database and spanning almost two decades of data, they analyzed outcomes for nearly 20 0000 patients who began ECT, including the risk of hospitalizations. “In this cohort study involving patients who had ECT, continuing ECT was associated with a decreased risk of rehospitalization after the acute ECT series and also associated with reduced treatment costs.” We consider the paper and its implications.

Denmark: a land of islands, picturesque cities, and maintenance ECT

In the second selection, Dr. Joel Paris (of McGill University) ponders the societal increase in psychiatric problems, arguing that social contagion may be a factor. In a new BJPsych Bulletin paper, he focuses on non-suicidal self-injurious behaviour. “When clinical symptoms or mental disorders rapidly increase in prevalence, social contagion should be considered as a likely mechanism shaping changes in the form of psychopathology.”

And in the third selection from JAMA, Dr. Julie B. Trivedi (of The University of Texas System) discusses her depression and its treatment. She notes her hospitalization – and her coming to terms with her illness, as a physician, a parent, and a person. “Today, I am focused on bringing light to topics that are stigmatized, talking about topics like mental health and burnout in health care workers that everyone wants to fix but are without an adequate solution, raising awareness of how to recognize mental health challenges among health care professionals, being an advocate for others, and reminding everyone that help is needed.”

DG

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Reading of the Week: Antipsychotics – the New, the Old & the Patient Experience, with Papers from JAMA Psych, BJP and Schiz Bulletin

October 10, 2024 /

From the Editor

“FDA approves a novel drug for schizophrenia, a potential ‘game changer’”

– The Washington Post

“Will ‘Game Changer’ Antipsychotic Live Up to the Hype?”

– Medscape

Two weeks ago, for the first time in decades, the FDA approved an antipsychotic for schizophrenia with a novel mode of action. What does the data show for this medication, xanomeline-trospium chloride? Is it a “game changer” as some headlines suggest? 

In the first selection, Dr. Inder Kaul (of Karuna Therapeutics) and his co-authors report on a double-blind, randomized, placebo-controlled trial that was published in JAMA Psychiatry. 256 people with schizophrenia were given the antipsychotic or the placebo and followed for five weeks. “Xanomeline-trospium was efficacious and well tolerated in people with schizophrenia experiencing acute psychosis.” We consider the study and its implications.

In contrast to this week’s first selection, the second selection looks at an older antipsychotic: clozapine. Drawing on Canadian databases, Lloyd Balbuena (of the University of Saskatchewan) and his co-authors put the risks and benefits of this medication in a new light in a paper for The British Journal of Psychiatry. They analyzed data on admissions and adverse events, with almost 50 000 participants. “Clozapine was associated with lower relapse overall, but this was accompanied by higher adverse events for adults. For children/youth, clozapine was associated with lower relapse all throughout and had no difference in adverse events compared with other antipsychotics.”

And in the third selection, Susan Weiner writes about antipsychotics for Schizophrenia Bulletin. She discusses her first psychotic break, her long journey, and her ultimate recovery. In a personal essay, she also describes the connection she made with her psychiatrist and the medication that transformed her life. “The right medicine for the right person can produce sanity like a miracle drug, and all is once again bright.”

DG

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Reading of the Week: The Insomnia Issue with Papers from NEJM & Sleep Med, and Dr. Cannon on Her Cure for Insomnia

September 5, 2024 /

From the Editor

With his depressive episode, he can’t sleep. While he thinks cannabis may be worsening his anxiety, in his view, a couple of joints before bed is the only thing that seems to help with the insomnia.

My patient’s problems are common. So many of our patients struggle with insomnia. How should we assess it? What’s evidence-based care? And what can we suggest to replace that cannabis? This week, we open with the new review from The New England Journal of Medicine. Charles M. Morin (of Université Laval) and Dr. Daniel J. Buysse (of the University of Pittsburgh) provide timely advice in their paper. They consider scales that could be incorporated into practice, evidence for CBT-I, and different medications. “Recommended therapies for insomnia produce clinically meaningful reductions in insomnia symptoms, sleep-onset latency, and time awake after sleep onset.” We summarize the paper and weigh its implications.

Counting sheep may not always work

With growing evidence for CBT-I, digital options are increasingly appealing due to their convenience and accessibility. In the second selection, Jake Linardon (of Deakin University) and his co-authors report on a study looking at the effectiveness of app-based interventions for insomnia, just published in Sleep Medicine. In this meta-analysis, they drew on 19 RCTs including different treatments like CBT. “Findings suggest that stand-alone app-based interventions can effectively address insomnia and sleep disturbances, and may play an important role in the management of these symptoms.”

And in the third selection, Dr. Joanna Cannon, a UK physician and bestselling author, discusses her insomnia in an essay for The Guardian. She describes the impact on her life and her unusual way of coping. She also notes the origin of the problem: “It was when I started training as a doctor that my atypical sleeping habits became embedded.”

DG

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Reading of the Week: Mental Healthcare in Rural India – the New JAMA Psych Study; Also, Conflict & Psychiatry, and Morén on Her Father

August 29, 2024 /

From the Editor

Many in high-income nations don’t receive needed mental healthcare. Moreover, problems run deeper in countries like India, where only about 4% of patients with depression receive minimally adequate treatment, due to the higher prevalence of stigma and the limited number of providers. 

Could anti-stigma campaigns make a difference? Could technology be leveraged to reach those at high risk? In the first selection, Dr. Pallab K. Maulik (of the University of New South Wales) and his co-authors seek to answer these questions in a new paper for JAMA Psychiatry. They report the findings of a major study involving 44 primary health centres and nearly 10 000 participants across the states of Haryana and Andhra Pradesh in India. The interventions included both anti-stigma campaigns and an app designed to guide and prioritize care. “There was a significant difference in mean depression scores between intervention vs control groups at 12 months, with lower scores in high-risk cohort.” We discuss the paper and its implications.

In the second selection, Dr. Neil Krishan Aggarwal (of Columbia University) bemoans global conflicts and wonders about the role of psychiatry in a Viewpoint for JAMA Psychiatry. Noting that psychiatry helped create a less formal type of diplomacy, called Track II, he questions what role psychiatry might play in the future. “Mental health professionals can encourage dialog among foreign policy elites to reduce the possibility for military conflict.”

And in the third selection from Schizophrenia Bulletin, Constanza Morén (of the University of Barcelona) writes about her father who was a “magnificent person.” He was also an individual with schizophrenia. She discusses his journey and his challenges he faced within the healthcare system. “Patients live with their own voices, but, in a way, they need the rest of us to also give them a voice.”

DG

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