Tagpsychiatric services

Reading of the Week: Smoking Cessation – Doing Bad, Feeling Good? Also, Ethnicity & Opioids (JAMA Psych) and Dr. Freedman on Lunches (Acad Psych)

From the Editor

We ask our patients about cannabis. We inquire about illicit drugs. But are we forgetting tobacco? A new paper in Psychiatric Services helps answer that question – and, perhaps, raises other questions, including about how we could do better. 

In the first selection, Sarah A. White (of Johns Hopkins University) and her co-authors draw on American data to look at smoking cessation medications in a new Psychiatric Services paper. Among more than 55,000 smokers (many of whom have mental illness), they find that: “Cessation pharmacotherapy for smokers remained vastly underprescribed across all groups. At least 83% of smokers with or without mental illness did not receive varenicline, NRT, or bupropion during the 14-year study period.” We consider the paper and its clinical implications.

In the second selection, Huiru Dong (of Harvard University) and her co-authors look at buprenorphine treatment and demographics in the United States. Their JAMA Psychiatry research letter, which was just published, finds a growing gap. “The observed heterogeneity in buprenorphine treatment duration among racial and ethnic groups may reflect disproportionate structural barriers in treatment retention for Opioid Use Disorder.”

In the third selection, Dr. David Freedman (of the University of Toronto) writes about resident lunches for Academic Psychiatry. Dr. Freedman, who is a resident, notes that in-person lunches shifted to virtual ones for more than two years because of the pandemic – something that was necessary but unfortunate. He argues that the gatherings are important. “Yet, as a collective of residents munch on the last bites of their sandwiches, say goodbye, and return to work, I am struck by the camaraderie. Funded resident lunches nurture the professional identities of psychiatry trainees – an essential element of medical education.”

DG

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Reading of the Week: African Nova Scotian Youth & Stigma; Also, Engaging Health Care Workers (Psych Services) and Therapy & Psychiatry (Psych Times)

From the Editor

Many with mental disorders don’t engage in psychiatric care or, if they do, it is after significant delays – problematic for obvious reasons. Some groups are less likely to engage, including young Black individuals with psychosis.

Why the hesitation? What are the concerns of these patients and their larger communities? In the first selection, a paper just published by the Canadian Journal of Psychiatry, Ingrid Waldron (of McMaster University) and her co-authors take a qualitative interpretive narrative approach, to engage African Nova Scotians – including those in a first episode psychosis program – attempting to answer these questions and more. Among their key findings: “barriers include a lack of trust in health care services and a dearth of African Nova Scotian service providers.” We discuss the paper and its implications.

In this week’s second selection, Dr. Doron Amsalem (of Columbia University) and his co-authors aim to improve health care workers treatment seeking; in a paper for Psychiatric Services, they describe an RCT for a brief video intervention, finding positive results. They write: “This easily administered intervention could increase the likelihood of care seeking by proactively encouraging health care workers with mental health challenges to pursue treatment.”

Finally, in the third selection, Mark L. Ruffalo (of the University of Central Florida College of Medicine) and Dr. Daniel Morehead (of the Tufts Medical Center) consider psychotherapy and psychiatry. In an essay for Psychiatric Times, they argue that this is “the great divorce that never happened.” They write: “For decades, critics and leading psychiatrists have worried that psychotherapy among psychiatrists will one day die out and be forgotten. Yet for decades, reports of its demise have been greatly exaggerated.”

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)

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: Bipolar and Lithium – the New BJP Paper; Also, Inpatient Therapy (Psych Service) and Stulberg on His OCD (NYT)

From the Editor

What’s the best medication for bipolar disorder? Today, we have a variety of options from the old (lithium) to the new (modern antipsychotics). But what to prescribe?

In the first selection from The British Journal of Psychiatry, Cecilie Fitzgerald (of the Danish Research Institute for Suicide Prevention) and her co-authors try to answer these questions with a cohort study including those diagnosed with bipolar and living in Denmark between 1995 and 2016. They employ two types of analyses and focus on suicide, self-harm, and psychiatric hospital admissions. They conclude: “Although confounding by indication cannot be excluded, lithium seems to have better outcomes in the treatment of bipolar disorder than other mood stabilisers.” We consider the paper and its implications.

Lithium: not just for Teslas?

In the second selection, Stef Kouvaras (of the South London and Maudsley NHS Foundation Trust) and her co-authors consider a single-session psychotherapy intervention for an inpatient unit. In this recently published brief report for Psychiatric Services, they do a feasibility and acceptability study of positive psychotherapy. “The findings of this study indicate that positive psychotherapy is feasible and acceptable on acute psychiatric wards and that service users with severe and complex mental health conditions find the intervention helpful.”

In the final selection, executive coach Brad Stulberg writes about his experiences with OCD for The New York Times. He notes that his diagnosis helped him find care – but he worries about labels. “The stigma around mental illness has certainly not disappeared. But increasingly, mental health diagnoses are being embraced as identity statements.”

DG

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Reading of the Week: Mental Health Literacy & Skills for Students – the New CJP Paper; Also, Benzodiazepine Use and the Latest Mental Health Headlines

From the Editor

Postsecondary education can be incredibly stressful for students – and, not surprisingly, mental health problems may surface. Is it possible to inform (and thus empower) students with a simple intervention?

In the first selection, Yifeng Wei (of the University of Alberta) and her co-authors consider a trial of Transitions, a program that includes both mental health literacy and comprehensive life skills resources “for those transitioning from secondary to postsecondary education.” In a new Canadian Journal of Psychiatry paper, they describe a study involving nearly 2 400 students across five institutions. “Students in the intervention significantly improved mental health knowledge, decreased stigma against mental illness, increased positive attitudes toward help-seeking, improved help-seeking behaviours, and decreased perceived stress compared to the control group.” We review the paper.

Beautiful campus – and a place to reduce stigma?

In the second selection, Christine Timko (of Stanford University) and her co-authors consider benzodiazepine use. In a new Psychiatric Services paper, they note: “This study’s findings suggest that challenges remain in discontinuing long-term benzodiazepine use among patients who are older than 45 years, White, taking higher doses for longer, and diagnosed as having anxiety, PTSD, bipolar disorder, or psychosis.”

And finally, in a new section, we consider some recent news items relevant to those of us in mental health care. Our aim: not simply to draw from interesting reports, but to include those that our patients may read and bring up. This week: the focus (and TikTok videos) on the vagus nerve, the Freud who hated Freud, and ADHD in adults.

DG

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Reading of the Week: Equity & Mental Health Care – Post-Partum Follow Up After ED Visits (Lancet Psych) and Race and Prescribing (Psych Services)

From the Editor

We often speak of the challenges patients face in accessing mental health care. But, of course, such challenges may vary greatly, depending on demographics – think rural versus urban, young versus older, White versus non-White. How equitable is care? This week, we look at two new papers; one draws on Canadian data while the other on American. And though the studies are different, they point in a similar direction: unique populations face significant challenges accessing care.

In the first selection, Dr. Lucy C. Barker (of the University of Toronto) and her co-authors consider follow-up after an ED visit for patients in the post-partum period. In a new Lancet Psychiatry paper, they drew on Ontario databases, with more than 12 000 visits analyzed. They write: “Fewer than half of emergency department visits for a psychiatric reason in the post-partum period were followed by timely outpatient care, with social-determinants-of-health-based disparities in access to care.” We consider the paper and its implications.

In the second selection, Jocelyn E. Remmert (of the U.S. Department of Veterans Affairs) and her co-authors consider depression care and race. In a new Psychiatric Services paper, they look at antidepressant prescribing, finding big differences between White and Black veterans. “Among veterans, Black patients were almost two times less likely than White patients to have an antidepressant prescription, even after the analyses controlled for depression symptoms, demographic characteristics, psychosocial variables, and other clinical symptoms.”

DG

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Reading of the Week: TikTok is Popular & Cool But Good Mental Health Information? Also, Telemedicine and Practice (Psych Services)

From the Editor

Clever cats. Cool dancing videos. Tips on everything from calligraphy to home decorations.

A billion people are estimated to use TikTok on a monthly basis. The social media platform is incredibly popular here – and around the globe. And, as with other social media, people increasingly use it as a source of medical information.

To date, little research has been done on the credibility of that information. In a new Canadian Journal of Psychiatry paper, Dr. Anthony Yeung (of the University of British Columbia) and his co-authors focus on ADHD. They find uneven results: “In this analysis of popular TikTok videos about ADHD, there were over 2.8 million views per video and each video was shared on average 31,000 times. Approximately half of the videos analyzed (52%) were misleading…” We consider the paper and its clinical implications.

Continuing on the theme of technology and practice, in the second selection, we look at a new Psychiatric Services paper. Lori Uscher-Pines (of the RAND Corporation) and her co-authors do a qualitative analysis of why psychiatrists choose telemedicine for some patients and not others. The authors conclude: “psychiatrists did not perceive intermittent in-person visits as essential for high-quality care.”

DG

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Reading of the Week: Less & Less – Psychiatrists & Psychotherapy; Also, Transgender Individuals & Care (Psych Services) and Digital Mental Health (ANZJP)

From the Editor

“For much of the 20th century, psychotherapy was viewed as synonymous with psychiatry and was the primary treatment modality employed by outpatient psychiatrists.” 

Daniel Tadmon and Dr. Mark Olfson (both of Columbia University) observe this in a new paper. But times have changed; has the practice of psychiatry moved away from psychotherapy?

This week, there are three selections. The first is a new paper from The American Journal of Psychiatry that looks at psychotherapy provided by US psychiatrists. Drawing on decades of data, Tadmon and Olfson find: “While a small group of psychiatrists (11% – 15%) continued to provide psychotherapy in all patient visits, in the 2010s, about half of psychiatrists did not provide psychotherapy at all, and those who provided psychotherapy in some patient visits came to do so more and more rarely.” We consider the paper and its implications.

Sorry Freud: most psychiatrists don’t practice psychotherapy

In the second selection, Dr. June Sing Hong Lam and his co-authors consider the mental health experiences of transgender individuals. In a Psychiatric Services paper, they draw on administrative databases focusing on both ED visits and hospitalizations. They conclude: “This study found that transgender individuals presenting for acute mental health care were more likely to experience marginalization than cisgender individuals and to present to acute care with different diagnostic patterns.”

Finally, in the third selection, Dr. Aswin Ratheesh and Mario Alvarez-Jimenez (both of the University of Melbourne) consider digital mental health and the post-pandemic world. In the Australian & New Zealand Journal of Psychiatry, they write about various problems (for instance, with digital privacy). Still, they see much potential: “Effective digital tools, especially when blended and responsive can radically improve the availability of mental health care in our corner of resource-rich, yet manpower-poor world.”

Please note that there will be no Reading next week.

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

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: Vaccinations & Mental Disorders; Also, Nudging Patients (Psych Services)

From the Editor

By international standards, we are doing well. As a percentage of the population, more Canadians are doubly vaccinated than people in many other nations.

But let’s not be too pleased. Some Canadians haven’t received both shots – or even one. As is often the case with public health efforts (think smoking cessation and flu shots), those with mental disorders are harder to reach than the general population.

This week, there are two selections. In the first, Noel T. Brewer (of the University of North Carolina at Chapel Hill) and Neetu Abad (of the US Centers for Disease Control and Prevention) discuss ways that we can boost the rate of vaccination of those with mental health problems in a new JAMA Psychiatry paper. They recognize the unique challenges of reaching this population – and the clear opportunities for mental health professionals. “Although mental health is not the first thing that comes to mind when thinking about vaccination, strategic use of mental health professionals’ expertise could provide new opportunities to encourage COVID-19 vaccination.” We consider the paper and its clinical implications.

medical-syringes-and-needles

In the second selection, also on the theme of nudging our patients to get better outcomes, Gabriela K. Khazanov (of Veterans Affairs) and her co-authors consider using behavioural economics. In this Psychiatric Services paper, they note that Veterans Affairs (VA) “has successfully implemented a financial incentive program aimed at improving psychiatric treatment engagement…”

DG
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