Tag: Quick Takes

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 / / 1 Comment

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: ADHD & Substance Outcomes – the New JAMA Psych Paper; Also, Suicide & the Impact on Psychiatrists and Foulkes on Her Anxiety & Our Times

July 27, 2023 /

From the Editor

Stimulants are commonly prescribed to children with ADHD. Do they protect kids against future substance misuse? Or, having been exposed early to stimulants, are these patients more likely to develop substance problems in adulthood?

Past studies have attempted to answer these questions but have been limited by study design. In a new JAMA Psychiatry paper, Brooke S. G. Molina (of the University of Pittsburgh) and her co-authors take a fresh look. In a cohort study involving 547 students, some of whom were treated with stimulants while others received behavioural therapy during the first period, Molina et al. look at outcomes when these participants are in their mid 20s. “This study found no evidence that stimulant treatment was associated with increased or decreased risk for later frequent use of alcohol, marijuana, cigarette smoking, or other substances used for adolescents and young adults with childhood ADHD.” We consider the study and its implications.

In the second selection, Dr. Juveria Zaheer (of the University of Toronto) discusses patient suicide in a new Quick Takes podcast interview. Focusing on the impact on psychiatrists and residents of psychiatry, she draws from the literature, including a study she recently senior authored for The Canadian Journal of Psychiatry. She notes common reactions by psychiatrists and residents, including guilt and shock. And Dr. Zaheer talks about her own experience. “I’ll never forget when it happened.” 

And in the third selection, Lucy Foulkes (of the University of Oxford) writes about anxiety and current approaches. In a Guardian essay, she notes her own history as an “anxious teen” and wonders if life is better for today’s adolescents, with awareness campaigns but not necessarily meaningful services. “We are now in a situation where many teens know or believe they are anxious but aren’t getting the help they need to manage it.”

The Reading of the Week has formal partnerships with 14 postgraduate programs and, today, we welcome PGY1s who are joining us from across Canada.

DG

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Reading of the Week: Ketamine vs. ECT – the New NEJM Paper; Also, Burnout & Depression (QT) and Rehab for Schizophrenia (Wash Post)

June 1, 2023 /

From the Editor

“Ketamine Shows Promise for Hard-to-Treat Depression in New Study”

 – The New York Times

The gold standard for treatment-refractory depression has been ECT. Last week, The New England Journal of Medicine published a new study by Dr. Amit Anand (of Harvard University) and his co-authors comparing ketamine with ECT. They did a noninferiority trial, with more than 400 people. The results have been widely reported, including in The New York Times. They write: “This randomized trial evaluating the comparative effectiveness of ketamine and ECT in patients with treatment-resistant depression without psychosis showed noninferiority of ketamine to ECT…” We discuss the paper and the accompanying Editorial.

A recent Canadian Medical Association survey found that the majority of physicians reported experiencing high levels of burnout. In the second selection, Dr. Srijan Sen (of the University of Michigan) discusses this timely topic in a new Quick Takes podcast. He talks about the definition(s) of burnout, and the overlap with depression. “Burnout has become a loose term that means different things to different people.”

And in the third selection, Dr. Thomas Insel (of the Steinberg Institute) and his co-authors discuss the life and death of New Yorker Jordan Neely. In an essay for The Washington Post, they argue for better care, in particular with a focus on rehabilitation services for those with schizophrenia. “People with other brain disorders are not abandoned to become homeless or incarcerated rather than receive medical help.”

DG

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Reading of the Week: Bipolar & Med Adherence – the New Journal of Affective Disorders Study; Also, Sleep (QT) and Sheff on Involuntary Treatment (NYT)

April 27, 2023 /

From the Editor

You wrote a prescription, but did he actually take the medications? For those with bipolar disorder, pharmacotherapy is an essential part of care. Studies have noted poor adherence. 

To date, though, there hasn’t been a big cohort study. And there are good questions to ask: what drugs are more linked with adherence? Who is more likely not to take the medications? In a new paper just published in the Journal of Affective Disorders, Dr. Jonne Lintunen (of the University of Eastern Finland) and his co-authors attempt to answer these questions. They draw on Finnish data, covering more than three decades and including over 33 000 patients. “The majority of patients with bipolar disorder do not use their medications as prescribed.” We consider the paper and its clinical implications.

In the second selection, Dr. Michael Mak (of the University of Toronto) comments on sleep in a new Quick Takes podcast interview. In this sleep “update,” we talk about meds, CBT, and the mobile apps that he recommends to patients and their families. We also explore the history of sleep medicine and mull the growing role apps and wearables are playing in both diagnosis and therapy. “The lines between sleep, health, and mental health in general are blurred.”

In the third selection, author David Sheff talks about his son’s addiction and recovery – and involuntary treatment. In a New York Times’ essay, he notes the challenges of engaging those with substance problems. He sees several ways forward, including involuntary treatment. “Many people in the traditional recovery world believe that we must wait for people who are addicted to hit bottom, with the hope that they’ll choose to enter treatment. It’s an archaic and dangerous theory.”

DG

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Reading of the Week: Amphetamines & ED Visits – the New CJP Paper; Also, Psilocybin for Depression (QT) and Anti-NMDAR Encephalitis (CMAJ)

March 30, 2023 /

From the Editor

Agitated, excited, violent – when intoxicated. But my patient is also pleasant and engaging when not using substance (crystal methamphetamine).

Amphetamine use seems more and more common. What does the data show? In a new paper for The Canadian Journal of Psychiatry, James A. G. Crispo (of the University of British Columbia) and his co-authors look at amphetamine-related ED visits in Ontario. Drawing on administrative databases, they find a sharp rise over time: a 15-fold increase between 2003 and 2020. They write: “Increasing rates of amphetamine-related ED visits in Ontario are cause for concern.”

In the second selection, Dr. Ishrat Husain (of the University of Toronto) comments on psilocybin and depression in a new Quick Takes podcast. He goes into detail on the new NEJM study – which he co-authored. Dr. Husain discusses the literature and unanswered research questions. “It’s not necessarily all sunshine and rainbows.”

And in the third selection, Dr. Candace Marsters (of the University of Alberta) and her colleagues consider the unusual presentation of young adult with first-episode psychosis in a new paper for CMAJ. With time and diagnostic testing, they conclude that she has anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, and offer observations about that diagnosis and the limitations of testing. “Anti-NMDAR encephalitis is a rare but important differential diagnosis of first-episode psychosis among young adults.”

DG

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Reading of the Week: Can a Phone Intervention Reduce Alcohol? Also, Dr. Goldbloom on His Career & Retirement (QT) and Ending the Term AMA (Annals)

December 15, 2022 /

From the Editor

During the first wave, alone and isolated, he started to drink significantly more. Now, many months later, he continues to struggle with an alcohol use disorder. This patient’s journey – as he told me in the ED last week – is a familiar story that we as clinicians have heard many times in these past few years. What can be done to help? Could we better reach those who are misusing alcohol?

In JAMA Psychiatry, Dan I. Lubman (of Monash University) and his co-authors describe an intervention that is very relevant. In this Australian RCT, some participants received 4-6 sessions of telephone-provided, manualized cognitive and behavioural intervention that included mindfulness. They found that: “this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control.” We discuss the paper and its clinical implications.

Dr. David Goldbloom has had a storied career: senior medical advisor at CAMH, professor at the University of Toronto, former chair of the Mental Health Commission of Canada, former editor of The Canadian Journal of Psychiatry. And tomorrow, he adds another title to that long list: retiree. This week’s second selection is a new Quick Takes podcast interview with him in which he comments on career and retirement and more. “I’m not an entirely gloomy or nihilistic person, either by temperament or based on what I’ve witnessed over the last 40 years.”

Finally, in the third selection, Dr. Robert A. Kleinman (of the University of Toronto) and his co-authors argue that “against medical advice” is a dated term. In Annals of Internal of Medicine, they argue for a new approach: “Shifting away from the ‘AMA’ terminology and toward more collaborative approaches to these discharges would improve the treatment of patients who are too often stigmatized by the clinicians and health systems that are meant to care for them.”

DG

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Reading of the Week: Twitter & Suicide – the New ANZJP Paper; Also, Crystal Meth Use (Quick Takes) and Patients and Physicians’ Names (JAMA Net Open)

October 20, 2022 /

From the Editor

More and more, people use social media to debate current events, share personal experiences, and maybe enjoy a cat video or two. But if people are disclosing much, are they discussing suicidal thoughts? Could certain social media posts encourage people to get help?

In the first selection, Dr. Thomas Niederkrotenthaler (of the Medical University of Vienna) and his co-authors attempt to answer these questions with a new paper just published in the Australian & New Zealand Journal of Psychiatry. Drawing on more than 7.15 million tweets (from Twitter) and employing a machine learning approach, they divide content into several categories, then review volumes of calls to a suicide hotline and completed suicides. “This is the first large-scale study to suggest that daily volume of specific suicide-prevention-related social media content on Twitter corresponds to higher daily levels of help-seeking behaviour and lower daily number of suicide deaths.” We mull the paper and its implications.

Social media: more than cat videos?

In this week’s second selection, we consider a new Quick Takes podcast interview with Dr. David Castle (of the University of Toronto). Dr. Castle discusses crystal methamphetamine, a drug used more and more in Canada. Drawing on his Australian experience and noting the rise in use here, he comments: “it’s highly prevalent, highly available, highly pure and highly destructive.”

Finally, in the third selection, Dr. Jamison A. Harvey (of the Mayo Clinic) and her co-authors take a look at communication between patients and their physicians. Drawing on nearly 30,000 email messages, they consider the way patients address their physicians in a new JAMA Network Open research letter. “This is the first study to objectively identify patterns of addressing physicians through electronic messaging and may reveal potential bias. We found that women physicians… and primary care physicians were addressed by their first name more frequently.”

DG

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Reading of the Week: After COVID – the New Lancet Psychiatry Paper; Also, Clark on Therapy (QT) and Physicians, Heal Thyselves (JAMA Net Open)

September 1, 2022 /

From the Editor

The first reported cases were almost three years ago. Yet, with this pandemic, many questions remain. No wonder. The patient experience is so varied. Some of our patients complain of time-limited, mild symptoms. Others seem affected by ongoing, non-physical symptoms. And many haven’t had any symptoms.

How common are neurological and psychiatric problems? Do they last? Are they less common with newer variants? This week, in the first selection, we consider a new Lancet Psychiatry paper; Max Taquet (of the University of Oxford) and his co-authors try to answer these questions and others. Drawing on the health records of almost 1.3 million people with a recorded diagnosis of COVID-19 and focusing on 14 different outcomes (including anxiety and mood disorders) across eight nations, they find: “post-COVID neurological and psychiatric outcomes followed different risk trajectories: the risk of cognitive deficit, dementia, psychotic disorder, and epilepsy or seizures remained increased at 2 years after a COVID-19 diagnosis, while the risks of other diagnoses (notably, mood and anxiety disorders) subsided early and showed no overall excess over the 2-year follow-up.” We look at the paper and its clinical implications.

In this week’s second selection, we consider a new Quick Takes podcast interview with David Clark (of the University of Oxford). Prof. Clark speaks about IAPT, the UK’s program to expand access to psychotherapy, which he co-founded. “We’ve still got some distance to go, though, but the IAPT services are seeing about a million people a year who wouldn’t have previously had psychological therapy.”

Primary care has an essential role in our health care system. In the third selection, Emily Rhodes (of the Ottawa Hospital Research Institute) and her co-authors mull physicians and their personal connection to primary care in a new JAMA Network Open paper. They find: physicians are less likely to be rostered with family docs, and less likely to visit them. They conclude: “Emphasis on the importance and improvement of access to primary care for physicians is a potential means to improve overall health for physicians and patients.”

DG

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Reading of the Week: Cannabis for Mood Disorders – the New CJP Paper; Also, Dr. Insel on Mental Health (QT) and Transgender Adolescents & Suicidality (CMAJ)

June 23, 2022 /

From the Editor

He smokes before bed to help with sleep; she finds that the edibles take an edge off from her lows.

Our patients routinely tell us about the benefits of cannabis for mood disorders. But is there any evidence in the literature? In the first selection from The Canadian Journal of Psychiatry, Dr. Smadar V. Tourjman (of the Université de Montréal) and her co-authors consider that question with a systematic review, drawing on data from 56 studies, focused on bipolar and major depressive disorders, for a CANMAT task force report. They conclude: “cannabis use is associated with worsened course and functioning of bipolar disorder and major depressive disorder.” We consider the paper and its implications.

In this week’s second selection, we look at new Quick Takes podcast interview with Dr. Thomas Insel (of the Steinberg Institute). Dr. Insel, a psychiatrist and former director of NIMH, speaks about the progress in neuroscience but the need for mental health reform. “We must think about more than just the classic medical model borrowed from infectious disease: simple bug, simple drug.”

Finally, in the third selection, Mila Kingsbury (of the University of Ottawa) and her co-authors consider the risk of suicidality among trangender and sexual minority adolescents; they draw from a nationally representative, cross-sectional survey. “Gender and sexual minority adolescents, particularly those who identify as transgender and gender-nonconforming, appear to be at greater risk of suicidal ideation and suicide attempt than their cisgender and heterosexual peers.”

There will be no Reading next week.

DG

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Reading of the Week: Cool but Useful? VR Therapy for Psychosis; Also, Preventing Child Abuse (QT) and Renaming Schizophrenia (Lancet Psych)

April 14, 2022 /

From the Editor

Asking for a coffee. Passing strangers on a bus. Making eye contact at a grocery store. These tasks don’t seem particularly daunting but for those with major mental illness, they can be deeply unsettling. Some are left homebound.

In this week’s first selection, we look at a new Lancet Psychiatry paper by Daniel Freeman (of Oxford University) and his co-authors; in it, they detail an intervention where participants work through several tasks, like the ones named above. The coolness factor? It’s done through virtual reality (or VR). They find: “Automated VR therapy led to significant reductions in anxious avoidance of, and distress in, everyday situations compared with usual care alone.” We consider the paper and the larger implications.

Passing strangers on a bus: one of several tasks in gameChange

In the second selection, we weigh prevention in mental health care. Ainslie Heasman (of the Center for Addiction and Mental Health) joins me for a Quick Takes podcast interview. We discuss Talking for Change, which aims to prevent child sexual abuse with evidence-based interventions focused on high-risk populations – that is, “moving prevention upstream” in the words of the psychologist.

Finally, in the third selection, Dr. Bruce M. Cohen (of Harvard University) and his co-authors consider psychiatric terms, noting that some are outdated. In a Lancet Psychiatry paper, they discuss schizophrenia and personality disorders. They write: “Any label can stigmatise, and there are no perfect terms, but that should not prevent changing to better ones. Words communicate how we conceptualise a disorder.”

DG

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