Tag: lived experience

Reading of the Week: MAiD, Suicide & the Patient-Family Perspective – the new CJP Paper; Also, AI & Misinformation, and Palus on Mental Health Merch 

November 9, 2023 /

From the Editor

In March, medical assistance in dying will be expanded in Canada to include those with mental illness. Not surprisingly, many people feel strongly about it, with some seeing the change as a natural extension of basic rights and others arguing that it will be a profound mistake. 

What do patients and family members think? How does it relate to their views of suicide in general? Lisa Hawke (of the University of Toronto) and her co-authors attempt to answer these questions in a new Canadian Journal of Psychiatry paper. They do a qualitative analysis, interviewing 30 people with mental illness and 25 family members on medical assistance in dying when the sole underlying medical condition is mental illness (or MAiD MI-SUMC). “Participants acknowledge the intersections between MAiD MI-SUMC and suicidality and the benefits of MAiD MI-SUMC as a more dignified way of ending suffering, but also the inherent complexity of considering [such] requests in the context of suicidality.” We consider the paper and its implications.

In the second selection, Dr. Scott Monteith (of Michigan State University) and his co-authors write about artificial intelligence and misinformation in a new British Journal of Psychiatry paper. They note the shift in AI – from predictive models to generative AI – and its implications for patients. “Misinformation created by generative AI about mental illness may include factual errors, nonsense, fabricated sources and dangerous advice.”

And in the third selection, writer Shannon Palus discusses the rise of “mental health merch” – clothing items and other merchandise that tout mental health problems, including a pricey sweatshirt with “Lexapro” written on the front (the US brand name for escitalopram). In Slate, Palus discusses her coolness to such things. “As a person who struggles with her own mental health, as a Lexapro taker – well, I hate this trend, honestly! I find it cloying and infantilizing.”

Note that there will be no Reading next week.

DG

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Reading of the Week: Running vs SSRIs for Depression – the new JAD Paper; Also, Climate Change & Mental Health, and Understanding My Schizophrenia

October 26, 2023 /

From the Editor

“Go for a Run to Beat Depression – It’s Just As Effective As Taking Medication”

– New York Post

“Running could be just as effective at treating depression as medication, scientists find”

– The Independent

Patients often ask what they can do to get better from their depression. Should we be advising them to put on a pair of runners and go for a jog? A new paper published in the Journal of Affective Disorders seems to suggest as much – and it’s caused a bit of media buzz. In the first selection, Josine E. Verhoeven (of Vrije Universiteit Amsterdam) and her co-authors describe this 16-week study that offered 141 people with depression and/or anxiety either a running intervention or medications, and looked at several mental and physical health outcomes. “We showed that while antidepressant medication and running therapy did not statistically significantly differ on mental health outcomes… the interventions had a significantly different and often contrasting impact on several physical health outcomes, with more favorable outcomes for those in the exercise intervention.” We consider the paper and its implications.

In the second selection, Pim Cuijpers (of Vrije Universiteit Amsterdam) and his co-authors discuss climate change and mental health in a new viewpoint for JAMA Psychiatry. Though they note the lack of high-quality research in the area, they argue that it would disproportionately affect low and middle-income nations. They then point a way forward. “There is no doubt that climate change will have a major impact on mental health in the coming decades.”

And in the third selection which is written anonymously, a person with schizophrenia talks about his experiences in a paper for Schizophrenia Bulletin. He tries to empower himself, working to limit side effects and cope with the voices. “My brain disease is incurable, but it is not an excuse for me to be irresponsible or to give up on life.” 

DG

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Reading of the Week: DBT for Youth with Bipolar – the New JAMA Psych Paper; Also, Involuntary Care and Dr. Gibbons on the Truths About Suicide

September 28, 2023 /

From the Editor

Nine! 

This month, the Reading of the Week celebrates a big birthday, its ninth. The first Reading was emailed out in September 2014. Many thanks for your ongoing interest and support. I’m looking forward to the next nine years.

Many young people with bipolar attempt suicide. What can be done to help them? In the first selection, Tina R. Goldstein (of the University of Pittsburgh) and her co-authors attempt to answer that question in a just-published JAMA Psychiatry paper. In their RCT involving youth with bipolar spectrum disorder, participants were enrolled in DBT or they received standard-of-care psychological support. “These findings support DBT as the first psychosocial intervention with demonstrated effects on suicidal behavior for adolescents with bipolar spectrum disorder.” We consider the paper and its clinical implications.

In the second selection, journalist and bestselling author Anna Mehler Paperny discusses coercive care in a new Quick Takes podcast interview. Mehler Paperny’s perspective on involuntary care is informed by her writing on the issue – and her lived experience. She worries that public debate may be driven by a desire to address public disorder rather than genuinely prioritizing the well-being of those with mental illness. “Coercive care is having a moment.”

And in the third selection, Dr. Rachel Gibbons (of the UK Royal College of Psychiatrists) considers suicide in a new BJPsych Bulletin paper. She opens by disclosing that three of her patients died by suicide early in her career. She then reviews “truths” about suicide. “In research we conducted, around two-thirds of psychiatrists and other clinicians felt it was their job to predict suicide. Our fantasy that we can do this, and our fear that we can’t, becomes a constant preoccupation in our work, distracts us from providing therapeutic care and closes our hearts to those in distress.”

DG

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Reading of the Week: Virtual Care & Schizophrenia – the New CJP Paper; Also, the Psychedelic Hype Bubble (JAMA Psych) and Aiello on Stigma (Walrus)

December 8, 2022 /

From the Editor 

At the start of the pandemic, the shift to virtual care was important and necessary, allowing us to reach our patients during the lockdowns. As we slowly move past COVID-19, there are big questions to ask. What’s lost in the virtual world? What’s right and what’s to be done?

In the first selection, Ellen Stephenson (of the University of Toronto) and her co-authors look at patients with schizophrenia. In a new paper just published in The Canadian Journal of Psychiatry, they analyze different aspects of care, including prevention. They find: “There were substantial decreases in preventive care after the onset of the pandemic, although primary care access was largely maintained through virtual care.” We consider the paper and its clinical implications.

Virtual care, real-world gaps?

In the second selection, David B. Yaden (of Johns Hopkins University) and his co-authors weigh in on the enthusiasm and criticism of psychedelics. In this Viewpoint for JAMA Psychiatry, they argue that interest has reached a “hype bubble.” They make a call for action: “As scientists and clinicians, we have an ethical mandate to dispute claims not supported by available evidence. We encourage our colleagues to help deflate the psychedelic hype bubble in a measured way…”

And in the third selection, K. J. Aiello – who has lived experience – writes about mental illness and stigma in an essay for The Walrus. While noting some progress in the acceptance of mental disorders, the writer wonders how much has really changed. “Even as the stigma around mental illness has faded, it has become clear that this compassion and effort extend only so far, and that they are not available to everyone. Often those fault lines appear around class – and around the type of mental illness.”

DG

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Reading of the Week: Health Care Workers’ Mental Health – There’s an App for That; Also, Treating Opioids (BMJ) & Dr. Bhushan on Her Bipolar (LA Times)

September 15, 2022 /

From the Editor

With the pandemic dragging on, health care workers report more and more burnout; some complain of depression and anxiety.

What could help? Dr. Sam N. Gnanapragasam (of King’s College London) and his co-authors consider an app designed to provide CBT and mindfulness techniques in a new British Journal of Psychiatry paper. The RCT study involves 16 English sites with over 1000 health care workers. They conclude: “our study suggests that the app was of modest benefit with no adverse effects for a sample of HCWs in England.” We look at the paper.

How to respond to the opioid crisis? In a new analysis paper for BMJ, Dr. Robert A. Kleinman (of the University of Toronto) and his colleagues argue for a different approach to the prescribing of opioid agonist therapy, drawing on the changes made in response to the pandemic. “Embracing a more flexible model of buprenorphine-naloxone dosing would allow better alignment of prescribing practices with the needs and preferences of clients.”

And in the third selection, Dr. Devika Bhushan writes about bipolar disorder for the Los Angeles Times. The essay is very personal: the pediatrician, who serves as California’s acting surgeon general and graduated from Harvard, describes her own experiences. As she notes, during her training, she “had a secret.” Now, however, she speaks openly about her illness. “Today, I live with bipolar disorder as a chronic and manageable health condition.” 

DG

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Reading of the Week: Prevention With Mindfulness for Kids? The New EBMH Study; Also, Ending Seclusion (Psych Services) & Morrison on Her Silence (CBC)

July 28, 2022 /

From the Editor

Our patients tell similar stories about their experiences with depression: of strained and lost relationships, of job opportunities that didn’t work out, of the pain of the illness itself.

Could all this be avoided? The attractiveness of prevention is obvious. In the first selection, Willem Kuyken (of the University of Oxford) and his co-authors describe a program focused on those 11 to 16 years of age. In this new EBMH paper, they use mindfulness training. The intervention is randomized, involving 84 schools. They conclude: “In a fully powered, rigorous, cluster randomised controlled trial we found no support for our hypothesis that school-based mindfulness training is superior in terms of mental health and well-being compared with usual provision over 1 year of follow-up in young people in secondary schools.” We consider the paper and its implications.

In the second selection from Psychiatric Services, Gregory M. Smith (of the Allentown State Hospital) and his co-authors analyze Pennsylvania’s move to eliminate seclusion and restraint events. Drawing on nine years of data, they conclude: “The findings of this study provide compelling evidence that uses of seclusion and restraints can be reduced or eliminated in both civil and forensic populations, with benefits to both the persons being served and their support staff.”

And, in the third selection, lawyer Helen Morrison considers mental illness and stigma. In this essay for CBC First Person, she notes her own journey and her fears about how people would react to her having bipolar disorder. She finds support with her faith group and others. She writes: “I want people to know that being diagnosed with a mental illness need not be earth-shattering. Faulty brain chemistry should be seen as just another chronic medical condition.”

DG

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Reading of the Week: Lived Experience & Psychosis – the New World Psych Paper; Also, the Evidence for Cannabis (QT) and Bob Bell on Psychotherapy (Globe)

May 19, 2022 /

From the Editor

“Something as basic as grocery shopping was both frightening and overwhelming for me. I remember my mom taking me along to do grocery shopping as a form of rehabilitation… Everything seemed so difficult.”

So comments a patient on the experience of a relapse of psychosis.

Typically, we describe psychosis with lists of symptoms. But how do patients understand these experiences? In a new World Psychiatry paper, Dr. Paolo Fusar-Poli (of King’s College) and his co-authors attempt to answer this question with a “bottom-up” approach. As they explain: “To our best knowledge, there are no recent studies that have successfully adopted a bottom-up approach (i.e., from lived experience to theory), whereby individuals with the lived experience of psychosis (i.e., experts by experience) primarily select the subjective themes and then discuss them with academics to advance broader knowledge.” We discuss their paper.

In the second selection, we consider a new Quick Takes podcast. Dr. Kevin Hill (of Harvard University) reviews the cannabis literature and weighs the evidence. He notes the hazards of CBD, the lack of evidence for cannabis and sleep, and his fondness for the Chicago Bears. “There are very strong proponents for cannabis and there are people who are entirely sceptical about it. And the answers to a lot of these questions are somewhere in the middle.”

Finally, in the third selection, Dr. Robert Bell (of the University of Toronto) and his co-authors advocate for the expansion of public health care to cover psychotherapy. Dr. Bell, who is a former Deputy Minister of Health of Ontario, makes a clear case drawing on international examples. “Canadians understand that good health requires mental-health support, and co-ordinated investment in mental-health treatment would pay dividends in reducing the impact of mental-health disability on the economy.”

DG

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Reading of the Week: Clozapine Prescribing & Demographics; Also, HBR on Equity in Telemedicine, and Eichler on Her Uncle & His Disappearances

October 21, 2021 /

From the Editor

Is clozapine prescribing effected by demographics?

In the first selection, from Psychiatric Services, Natalie Bareis (of Columbia University) and her co-authors consider medication prescriptions for those with psychotic disorders, drawing on US Medicaid data. “Our results indicate significant variation across states and among racial-ethnic groups in prescription patterns of six types of psychotropic medications, even after we had adjusted for multiple patient factors.” Indeed, they find that clozapine is much more commonly prescribed for those who are White. We consider the paper and its implications.

unknownClozapine: a simple molecule but complicated availability in the US?

In the second selection, Dr. Jonathan Rogg (of the University of Texas) and his co-authors consider equity and telemedicine. In a paper for the Harvard Business Review, they describe the services offered in a low-income area of Texas, and the lessons learned. “The Covid-19 pandemic has forced a rapid evolution in technology with the potential to help the most disadvantaged patients. Our experience during the pandemic has demonstrated that telemedicine can overcome access-related challenges faced by indigent populations. By allowing them to access care in their homes or even their jobs, it can help them address health issues expeditiously with minimal disruption to their lives.”

Finally, in the third selection from The Globe and Mail, writer Leah Eichler writes about her uncle, who probably had an undiagnosed mental illness. She writes about his disappearances and erratic behaviour. “We like to believe our relationships are solid, that love is somehow inextricably linked to permanence. Missing our loved ones, if anything, highlights how impermanent even our closest relationships can be.”

Please note that there will be no Reading next week.

DG

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Reading of the Week: Depression Outcomes: What Matters to Patients (Lancet Psych)? Also, NYT on Mental Health Apps and Startup Culture

August 13, 2020 /

From the Editor

“US Food and Drug Administration accepts only three outcome measures as primary endpoints in phase 3 studies to support an indication for major depressive disorder: the Hamilton Depression Rating Scale, the Montgomery-Åsberg Depression Rating Scale, or the Children’s Depression Rating Scale.”

The editors of The Lancet Psychiatry make this point in in the August issue of that journal. Their concern: the FDA view is very narrow and confined to these three scales.

In the first selection, we look at a new paper from The Lancet Psychiatry. Dr. Astrid Chevance (of the Center for Epidemiology and Statistics Paris Sorbonne) and her co-authors consider depression outcomes. To understand different perspectives, they draw on three groups: providers, patients, and caregivers. For the record, the resulting paper is fascinating and includes outcome measures that aren’t captured by these three scales. We consider the paper and the editorial that runs with it.

depression

In the second selection – also on the topic of depression – Kashmir Hill and Aaron Krolik report for The New York Times on a popular therapy app. They note that Talkspace has good marketing and a growing client base. But should you recommend the app to your patients?

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

May 7, 2020 /

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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