Tag: lived experience

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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Reading of the Week: ED Visits & Suicide Attempts – the New AJP Study; Also, Smoking Cessation, and Pappas on Her Genes & Her Olympic Drive

August 8, 2024 /

From the Editor

Are ED visits for suicide attempts becoming more frequent? What are the implications for care?

In the first selection from The American Journal of Psychiatry, Dr. Tanner J. Bommersbach (of the Mayo Clinic) and his co-authors attempt to answer these questions by considering US trends in ED visits for suicide attempts and intentional self-harm. Using national survey data collected over a 10-year period, they estimate that the absolute number of suicide attempts tripled to 5.3 million. “A significant national increase in emergency department visits for suicide attempts and intentional self-harm occurred from 2011 to 2020, as a proportion of total emergency department visits and as visits per capita.” We analyze this study.

In the second selection, Drs. Robert A. Kleinman (of the University of Toronto) and Brian S. Barnett (of the Cleveland Clinic) write about smoking cessation and mental illness in a Viewpoint just published in JAMA Psychiatry. They note societal progress – smoking rates are sharply down over the past five decades – yet many with mental illness still use tobacco. They argue that psychiatrists have a significant role to play in addressing this problem. “Patients who stop smoking can limit tobacco-related illness, avoid the distressing effects of nicotine withdrawal and craving, and live longer.”

Later this week, the Olympics conclude in Paris. In the third selection, former Olympian Alexi Pappas discusses her mother’s suicide and her own struggles with depression. In a deeply personal essay from The New York Times, she contemplates genes and destiny and healing. “My future – the universe where my fear lives – was never set in stone, and neither was my mom’s. I’m more than my genes, and I would not reroll the dice if given the option.”

There will be no Readings for the next two weeks.

DG

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Reading of the Week: Cancer & Suicide & Good News – the New Transl Psychiatry Study; Also, AI & Therapy Dropouts, and Bland on Her Father & His D-Day

June 13, 2024 /

From the Editor

He was so overwhelmed by the cancer diagnosis that he didn’t eat or sleep for days. “It was my worst nightmare.” My patient isn’t alone in that devastating experience, of course – the diagnosis and treatment of cancer is a major life event. Not surprisingly, the suicide rate is roughly double that of the general population in the United States. But with increasing psychosocial interventions, how has this changed over time?

In the first selection, Qiang Liu (of the Chinese Academy of Medical Sciences) and his co-authors attempt to answer that question in a new paper for Translational Psychiatry. Drawing on 40 years of data and a major US database, they analyzed the journeys of five million cancer patients, discovering good news. “We revealed a gradual increase in cancer-related suicide rates from 1975 to 1989, followed by a gradual decrease from 1989 to 2013, and a marked decrease from 2013 to 2017.” Indeed, between 2013 and 2017, the rate dropped by 27%. We consider the paper and its implications.

In the second selection, Sakiko Yasukawa (of the Sony Corporation) and her co-authors aimed to reduce dropouts from psychotherapy using AI. In a new paper for BMJ Mental Health, they describe an RCT involving 149 people. “The results suggest that the personalised messages sent by the chatbot helped participants control their pace in attending lessons and improve programme adherence without human guidance.”

Last week marked the anniversary of D-Day with ceremonies, including in Normandy. What was the toll on those who returned home? In the third selection, an essay published in The Globe and Mail, Normanne Bland describes her father and his time in Europe. She writes about him with mixed feelings, coloured by his mental health problems, including PTSD. “I had a complicated relationship with my father. I was proud of his service but I loathed his drinking.”

There will be no Reading next week.

DG

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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: Adolescent Experience with Illness – the World Psych Paper; Also, the CANMAT Depression Update and a Letter to the Editor

May 16, 2024 /

From the Editor

I’m separated from everyone else.

These are the words of a young patient with depression. We often use diagnoses and lists of symptoms to understand patients. But how do patients themselves understand their illness? In the first selection, Dr. Paolo Fusar-Poli (of King’s College London) and his co-authors attempt to answer that question with a “bottom-up” approach. In a new World Psychiatry paper, they describe the experiences of adolescents with mental disorders. “The study was co-designed, co-conducted and co-written by junior experts by experience – representing different genders, ethnic and cultural backgrounds, and continents – and academics, refining an earlier method developed by our group to investigate the lived experience of psychosis and depression.” We examine the paper and its implications.

Childhood depression by Marc-Anthony Macon

Much has changed over the past eight years – who was talking about pandemics in 2016? Last week, the Canadian Network for Mood and Anxiety Treatments (CANMAT) released its first major depression update in eight years. So how has depression management changed? In the second selection, Dr. Raymond Lam (of the University of British Columbia), the co-first author, discusses the update in a Quick Takes podcast interview. “They really are the most widely used guidelines in the world.” 

And in the third selection, in a letter to the editor, Nick Kerman (of the University of Toronto) writes about the recent homelessness paper from JAMA Psychiatry, summarized in a Reading earlier this month. He notes the striking finding: 26% meet the criteria for antisocial personality disorder. “Could it really be 1 in 4 or is there something else that could explain the finding?”

DG

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Reading of the Week: The Homeless – Who Are They? How Can We Help Them? Also, Shannon Jones on Her Son & His Homelessness

May 2, 2024 /

From the Editor

For much of her admission, she was disorganized and, at times, agitated. But when the medications started to work, Tanya talked about her years of homelessness and the stresses of finding a warm place to stay on a cold night, which often involved sleeping on buses – and “that’s not easy, I’m almost elderly.” 

This week, we take a closer look at homelessness and mental illness.

In the first selection, Richard Barry (of the University of Calgary) and his co-authors describe a systematic review and meta-analysis of mental disorders and homelessness for JAMA Psychiatry. They included 85 studies involving more than 48 000 people globally. “The findings demonstrate that most people experiencing homelessness have mental health disorders.” We explore the paper and its implications.

Street art in Quebec City

In the second selection, Nick Kerman and Dr. Vicky Stergiopoulos (both of the University of Toronto) examine different aspects of homelessness. In a comprehensive review for Nature Mental Health, they analyze the origins of the problem in high-income nations: focusing on deinstitutionalization. They also point to a way forward, noting the successes of Housing First and other interventions. “Homelessness among people with mental illness is a prevalent and persisting problem.”

And in the third selection, Shannon Jones writes about her son, who was homeless, in a deeply personal essay for The Washington Post. She discusses his childhood and the trips they took as a family. Also, she describes his illness and his death. “There are an estimated 600,000 homeless people in America, 75,000 of them in Los Angeles County. The number who die each year is increasing, with drug overdoses the leading cause. And every one of them has a story.”

DG

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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: How Problematic are Benzodiazepines? The New AJP Study; Also, Dickson on His Illness & Humility

March 28, 2024 /

From the Editor

Singer Olivia Rodrigo may have a catchy song about getting a driver’s license and Ariana Grande has a ditty about past relationships, but, in the late 1960s, the Rolling Stones wrote a whole song about diazepam, “Mother’s Little Helper.” The choice of topic isn’t so surprising: between 1968 and 1982, diazepam was the most prescribed medication in the United States and commonly used around the world.

But the pendulum has swung in the other direction. Today, we hesitate on prescribing benzodiazepines like diazepam, in part because of concerns about substance misuse and dose escalation. But how addictive are these meds? How significant is dose escalation over time? Though smaller studies have sought to answer these questions, Dr. Thomas Wolff Rosenqvist (of the University of Copenhagen) and his co-authors drew on Danish databases in an important, new study published in The American Journal of Psychiatry. They looked at two decades of data involving almost a million Danes who have used benzodiazepines. “A limited portion of the population that received benzodiazepines prescriptions were classified as continuous users, and only a small proportion of this group escalated to doses higher than those recommended in clinical guidelines.” We consider the study, the editorial that accompanies it, and the implications for practice.

Denmark: beautiful buildings, rich history, great data on benzodiazepines

In this week’s other selection, Michael Dickson (of the University of South Carolina) writes about the symptoms of schizophrenia. Dickson, who is a professor of philosophy, touches on philosophical concepts but, also, on personal experience – as an individual with the illness. In a paper published by Schizophrenia Bulletin, he recalls a psychotic episode, his ongoing symptoms, and how he came to terms with the disorder. “This attitude has made life better and has made the ‘near-collapses’ much rarer.”

DG

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