Tag: Myran

Reading of the Week: ED Visits, Hallucinogens & the Risk of Schizophrenia – the New JAMA Psych Study; Also, Alcohol After COVID and Diab on Being Open

November 21, 2024 /

From the Editor

For my patient who had tried several antidepressants, psilocybin offered hope. He’s not alone; hallucinogens are gaining attention, with many using them for purposes ranging from treating mental disorders to recreation. But how safe are these drugs, especially as their use increasingly occurs outside of clinical settings? What’s the connection with psychosis?

In the first selection, Dr. Daniel T. Myran (of the University of Ottawa) and his co-authors attempt to answer these questions in a new study published in JAMA Psychiatry. The population-based study included over nine million people who had visited an ED in Ontario, Canada over a 13-year period. The researchers compared individuals with an ED visit involving hallucinogen use to the general population and to those with ED visits involving other substances, analyzing the risk of developing a psychotic disorder. “Individuals with an ED visit involving hallucinogen use had a 21-fold greater risk of developing a schizophrenia spectrum disorder compared with the general population…” We consider the study and its implications.

Substance use rose during the early days of the pandemic. Did this trend change after lockdowns and social isolation ended? Dr. Divya Ayyala-Somayajula (of Thomas Jefferson University) and her co-authors analyzed US data related to alcohol use in a research letter for Annals of Internal Medicine. They compared the prevalence of alcohol use and heavy alcohol use before the pandemic, during the pandemic, and in 2020, finding “absolute increases of 2.7% (relative increase, 4.0%) and 1.0% (relative increase, 20.2%) and that the increases were sustained in 2022.”

And in the third selection, writer Saddal Diab discusses her decision to publicly acknowledge her mental disorder. Though people were initially supportive, things changed when she has a manic episode. She considers stigma and acceptance in this Globe and Mail essay. “Whatever gushy feelings had surfaced when I came out did not withstand the reality of mania. This left me feeling ashamed, deserted and questioning the nature of my relationships (which I concluded were flimsier than I had anticipated).”

DG

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Reading of the Week: Cannabis Potency & Mental Health – the New Lancet Psych Paper; Also, Legalization & Poisonings (NEJM) and Nicholson on Her Son (CBC)

September 8, 2022 /

From the Editor

“In the USA and Europe, the concentration of THC has more than doubled over the past 10 years…”

So notes a new paper in The Lancet Psychiatry.

Canada legalized cannabis for recreational purposes four years ago; other countries have done the same, as have almost two dozen US states. But how has cannabis itself changed over time? What are the implications for mental health disorders? And public policy? In the first selection, quoted above, Kat Petrilli (of the University of Bath) and her co-authors do a systematic review of cannabis potency and mental health and attempt to answer these questions. Drawing on 20 studies, they find: “Overall, the evidence suggests that the use of higher potency cannabis, compared with lower potency cannabis, is associated with an increased risk of psychosis, and this risk is higher in people who use cannabis daily.” We look at the paper and weigh its clinical implications.

In the second selection, using Ontario data, Dr. Daniel T. Myran (of the University of Ottawa) and his co-authors consider the effect of edible cannabis legalization on poisonings of children. Writing for The New England Journal of Medicine, they compare jurisdictions with legal sales (Alberta, British Columbia, and Ontario) with a province that hasn’t legalized that form of cannabis (Quebec). “Our data indicate that legalization was associated with marked increases in hospitalizations for cannabis poisoning in children.”

And, in the third selection, Shirley Nicholson writes about substance and stigma with a deeply personal essay. In this piece for CBC First Person, she discusses her son’s struggles and his death from an overdose. She writes: “He didn’t plan to die at 27. He was more than his addictions. He was our son, our brother, our grandson, our nephew, our cousin and we all loved him so.”

DG

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Reading of the Week: Physician, Heal Thyself – the New JAMA Paper on Visits for Mental Health; Also, the History of Physician Wellness (NEJM)

February 17, 2022 /

From the Editor

The days have been long. As we enter the third year of the pandemic, many are feeling it. 

What has the impact been on the mental health of us physicians? We have anecdotal evidence, but data has been lacking. In the first selection, we consider a new paper by Dr. Daniel T. Myran (of the University of Ottawa) and his co-authors. Drawing on data from 34,000 Ontario doctors, the authors considered MD visits for mental health and substance (in other words, doctors visiting their doctors), finding that such appointments were up 27% during the first year of the COVID-19 pandemic. “These findings may signal that the mental health of physicians has been negatively affected by the pandemic.” We look at the paper and the invited commentary that accompanies it.

In the second selection, Agnes Arnold-Forster (of the London School of Hygiene and Tropical Medicine) and her co-authors consider the evolving understanding of physician health by looking to history. They argue that three concepts – medical exceptionalism, medicalization, and an emphasis on individual responsibility – have harmed physicians, creating “excessive commitment and complete personal sacrifice.” They suggest an alternative. “By attending to the lessons of the past, we can envision a better future for patients and their physicians.”

DG


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Reading of the Week: Alcohol – with Papers from Lancet Oncology and CJP, and Coverage from NYT

July 22, 2021 /

From the Editor

This week, we focus on alcohol, with two papers and a news article. Obviously, alcohol isn’t new – distilling probably started in the 13th century – but the three selections offer fresh and important information that is clinically relevant.

In the first selection, we consider the link to cancer. In a new Lancet Oncology paper, Harriet Rumgay (of the International Agency for Research on Cancer) and her co-authors conduct a population-based study. “Globally, about 741 000, or 4.1%, of all new cases of cancer in 2020 were attributable to alcohol consumption.” We review the big paper and mull its clinical implications.

alcohol

In the second selection, Dr. Daniel Myran (of the University of Ottawa) and his co-authors look at ED visits due to alcohol. Drawing on administrative data, they write: “We found that that current patterns and temporal trends in ED visits due to alcohol show large disparities between urban and rural regions of Canada and by socioeconomic status.”

And in the third selection, reporter Anahad O’Connor writes about alcohol use disorder for The New York Times. In this highly readable article, he focuses on the struggles of a retired manager: “But this past winter, with the stress of the pandemic increasingly weighing on him, he found himself craving beer every morning, drinking in his car and polishing off two liters of Scotch a week.” O’Connor writes about several resources that may be helpful to patients and their families.

DG

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