Tag: lived experience

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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Reading of the Week: Exercise for Depression – the new BMJ Study; Also, Pogue on Her Career & Illness

February 22, 2024 /

From the Editor

Studies have shown that exercise is helpful for those with depression. But is one type of exercise better than the others? How much exercise? And what should you tell your patients when they ask?

Michael Noetel (of the University of Queensland) and his co-authors attempt to answer these questions in a new study for The BMJ. They did a systematic review and network meta-analysis, drawing on 218 studies with almost 14  200 participants. “Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense.” We look at the study, the accompanying editorial, and consider the implications for practice.

And, in the other selection from Psychiatric Services, Ye Zhang Pogue (of RTI International) writes about her advocacy for those with mental illness and her hesitation in disclosing her own diagnosis. In a personal essay, she talks about her aspirations, her fears, and her experiences with discrimination. She calls for a change to corporate culture. “Changing corporate culture will be a slow process, but the cumulative efforts of individuals will make a difference on a systemic level.” Note that this was the most-read paper in any APA journal in 2023.

DG

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Reading of the Week: Clozapine & Neutropenia – the new Lancet Psych Paper; Also, a Letter to the Editor and Bialik on Mental Health

January 18, 2024 /

From the Editor

Clozapine is special.

Almost seven decades after its release, that statement – from a new Lancet Psychiatry Editorial – remains true. Clozapine is the best antipsychotic for those who are treatment refractory in their schizophrenia. But there is the risk of potentially life-threatening neutropenia. And so its use is clunky, with much blood work and monitoring, off-putting to some who would benefit from this medication.

Are we too cautious with clozapine? In the first selection, Dr. Korinne Northwood (of The University of Queensland) and her co-authors consider that question in a new Lancet Psychiatry paper. Drawing from a major clozapine database for Australia and New Zealand patients, they analyzed 32 years of data involving 2.6 million blood tests and looked at neutropenic events. “Our results support greater flexibility in prescribing of clozapine and a more balanced approach to risk…” We review the paper and mull its clinical implications.

Australia: cool architecture and good clozapine data

In the second selection, in a letter to the editor, Clement Ma and Dr. Peter Szatmari (both of the University of Toronto) write about the recent MST vs. ECT paper from JAMA Psychiatry. They offer some hesitation on the authors’ wording: “a non-significant result in a superiority trial does not imply that the two treatments are equivalent.”

And in the third selection, actress and former Jeopardy! host Mayim Bialik writes personally about her mental health problems for Trend Magazine. She describes the challenges of getting help and her decision to speak out. She also notes the societal shift in thinking about mental illness. “[S]haring our own personal struggles is not a sign of weakness; it is a sign of strength. We all want to feel better, live better, and experience more joy and less suffering.”

DG

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Reading of the Week: Depression & Lived Experience – the new World Psych Paper; Also, the Life of Dr. John Talbott and Chairs & Patient Satisfaction

December 21, 2023 /

From the Editor

“For me, it feels like gravity just starts working on my body harder than it works everywhere else in the world.”

So comments a person with depression about his experience. Typically, we describe depression with a list of symptoms from the DSM-5. But how do patients understand their illness? In a new World Psychiatry paper, Dr. Paolo Fusar-Poli (of King’s College London) and his co-authors attempt to answer that question with a “bottom-up” approach. “To our best knowledge, no [depression] studies have adopted a bottom-up approach (from the lived experience to theory), whereby a global network of experts by experience and academics are mutually engaged in co-writing a joint narrative.” We look at the paper and its implications.

In the second selection, from The New York Times, reporter Trip Gabriel writes an obituary for Dr. John A. Talbott, an American psychiatrist who had championed deinstitutionalization, only to later regret the move away from hospital care. Dr. Talbott once wrote: “The disaster occurred because our mental health delivery system is not a system but a non-system.”

At this time of year, The BMJ runs its light-hearted Christmas issue, featuring much British humour. In the third selection, Ruchita Iyer (of the University of Texas Southwestern) and her co-authors describe a deception trial that increased patient satisfaction without increasing physician time. The “nudge” intervention involved: “Chair placement, defined as positioning the chair within 3 feet (0.9 m) of the bedside and facing the bed.” 

There will be no Readings for the next two weeks. We will return with force (though no British humour) on 11 January 2024.

All the best in the holiday season.

DG

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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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