Tagpsychosis

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: Online DBT – the New JAMA Paper; Also, Prediabetes and Preaddiction, and Greenberg on the Delusional Ones (Acad Psych)

From the Editor

He cut himself out of frustration with a break-up. She came to the ED with suicidal thoughts after losing her job.

Some patients need help with ongoing self-harm and suicidal thoughts – but access to care is challenging, particularly for dialectal behavioural therapy. Could a simple intervention help? Could it be delivered virtually?

In the first selection, Dr. Gregory E. Simon (of Kaiser Permanente Washington Health Research Institute) and his co-authors detail a pragmatic randomized trial that evaluated two low-intensity outreach programs, aiming to reduce risk of self-harm and suicidal behaviour. In this new JAMA study, they conclude: “Compared with usual care, offering care management did not significantly reduce the risk of self-harm, and offering brief online dialectical behavior therapy skills training increased the risk of self-harm among at-risk adults.” We look at the study.

In the second selection, Thomas McLellan (of the University of Pennsylvania) and his co-authors note the failings of substance treatment and then mull a way forward: considering the approach to diabetic care and the concept of prediabetes. Should we embrace preaddiction? They write: “the diabetes example shows that an early intervention approach can work given a comprehensive, sustained effort.”

And in the third selection, Dr. Norman R. Greenberg (of Yale University) contemplates his patient’s psychosis and his approach. Drawing on an old Hasidic tale, this resident of psychiatry stops debating with his patient; he chooses to listen to him instead. He writes: “I may not always be able to convince others of my perspective, I hope that I am able to convince others that we share similar goals and that I care about them.”

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)

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: Mass Murder & Mental Illness – the New Psych Med Study; Also, Vaccinations in the EU (Lancet Psych), and Domise on MAiD and His Illness

From the Editor

“Mental illness may have been a factor.”

It’s just seven words, but they so often accompany reports of mass murder. And psychosis is mentioned more often than not. The message is clear: mental disorders, particularly psychotic disorders, are highly tied to violence.

In the first selection, we look at a new paper that reviews 120 years worth of mass murder, and distinguishes between gun violence and non-gun violence. Just published in Psychological Medicine, Gary Brucato (of Columbia University) and his co-authors have written an extraordinary paper. They also reach an important conclusion: “These results suggest that policies aimed at preventing mass shootings by focusing on serious mental illness, characterized by psychotic symptoms, may have limited impact.” We look at the big paper.

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In the second selection, from The Lancet Psychiatry, Dr. Livia J. De Picker (of the University of Antwerp) and her co-authors consider European countries and vaccination prioritization, with a focus on mental disorders. “Only four countries (Denmark, Germany, the Netherlands, and the UK) had some form of higher vaccination priority for outpatients with severe mental illness.”

And, in the third selection, writer Andray Domise considers mental illness and medical assistance in dying. In a personal essay for The Globe and Mail, he raises objections. Start here: he would have opted to die when he was unwell. He argues the whole legislative approach is wrong: “This is a country that continues to fail in respecting the humanity of people with disabilities. And rather than find strength of character to improve ourselves, the Canadian government is set to fall back on egregious historical precedent by offering death instead.”

DG

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Reading of the Week: Better Sleep, Less Psychosis? The Freeman et al. Study on Sleep & CBT

From the Editor

If students sleep better, are they less likely to have mental health problems like paranoia?

In this week’s Reading, we look at a new study from The Lancet Psychiatry. In this single-blind, randomized controlled trial, Oxford professor Daniel Freeman et al. consider students from 26 universities with insomnia, assigning them CBT (offered over the internet) or the usual care.

Spoiler alert: the students with CBT did better.

Sleep: good for babies, teddy bears, and students

In this Reading, we review that paper and consider the broader implications.

DG

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Reading of the Week: Are Cats Making Us Sick? The Solmi et al. Paper, and Prescribing Housing in Hawaii

From the Editor

A few years ago, Czech scientist Jaroslav Flegr made a splash by arguing that our feline friends were causing psychosis in people – The Atlantic provocatively titled their article on him: “How Your Cat is Making You Sick.” Flegr’s argument was based in part on several papers (including by prominent researcher E. Fuller Torrey) noting that cat ownership confers an increased risk of psychotic disorders like schizophrenia.

So, are cats safe for household use?

In our first selection, we look at a new Psychological Medicine paper that, with a cohort study, finds no connection between cat ownership and psychotic symptoms.

Good news, tabby: you can stay

How to help the homeless? In our second selection, drawing from The Guardian, we look at a Hawaiian effort to prescribe the housing to the homeless – literally.

Please note that there will be no Readings for the next two weeks. Enjoy the March break.

DG Continue reading

Reading of the Week: Do Cities Make Us Sick?

From the Editor

Do cities make us sick?

It’s a question people have been asking for years with many advocating that we should – to steal a line from Huckleberry Finn – get the lights fantastic out of town.

Big city, big mental illness?

This week, we look at a new paper just published in The Canadian Journal of Psychiatry that looks at urban vs. rural populations and depression.

Then, turning to The Atlantic, we consider an essay written by a psychologist that looks at the connection between psychosis and cities.

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Reading of the Week: Can We Prevent Psychosis? Part 1 of 2

From the Editor

Here’s a quick statistical summary of the Readings for the past 12 months.

Total: 48.

Number discussing the prevention of mental illness: One.

Is an ounce of prevention really worth a pound of cure?

Like all of medicine, psychiatry tends to emphasize the treatment of illness, not its prevention. This isn’t the result of a vast medical-industrial conspiracy, of course, but the reality that our field is young and the causes of mental illness aren’t well understood.

But preventing illness is our ultimate goal. Consider the suffering and cost that could be avoided if a person at risk of psychosis didn’t convert, as an example.

Can we prevent psychotic illness?

Prevention is built on two things: we need to identify at risk individuals, and then we need to use appropriate measures to prevent the illness.

Over the next two weeks, we look at a few papers that seek to identify at risk individuals and prevent psychosis in them.

This week. The psychosis risk calculator.

Next week. Cost-effective prevention.

In this week’s paper from The American Journal of Psychiatry, Cannon et al. develop a risk calculator to predict psychotic disorder. The tool they develop has an accuracy rate of 71% – comparable to calculators used for determining cancer recurrence.

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Reading of the Week: Immigration and Psychosis (and Canada)

Meta-analytic reviews suggest that international migrants have a two to threefold increased risk of psychosis compared with the host population, and the level of risk varies by country of origin and host country. This increased risk may persist into the second and third generations. Incidence rates are not typically found to be elevated in the country of origin; therefore it is believed that the migratory or postmigration experience may play a role in the etiology.

The migration-related emergence of psychotics disorders is a potential concern in Canada, which receives 250,000 new immigrates and refugees each year. However, there is a notable lack of current epidemiological information on the incidence of psychosis among these groups.

So begins a new paper that seeks to answer a basic question: are there certain migrant groups more at risk of psychotic disorders in Canada?

This week’s Reading: “Incidence of psychotic disorders among first-generation immigrants and refugees in Ontario” by Kelly K. Anderson et al., which was published in the CMAJ in June.

Kelly K. Anderson

Of course, studying the incidence of psychotic disorders in immigrant populations isn’t exactly novel – there is a rich literature in this field. And the Canadian angle isn’t novel either – as the paper points out, previous studies have considered B.C. hospital admission rates for schizophrenia in European migrants in the early 1900s.

But this paper aims to consider recent data and Canadian data – relevant in a country that takes in 250,000 migrants a year. The paper focuses on Ontario, where first generation migrants constitute almost a third of the population.

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