Quick Takes | Dr. David Gratzer

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Reading of the Week: Suicidal Ideation in a 37-Year-Old Woman – A NEJM Case; Also, Goldbloom on Innovation (QT) and Purdy on Her Brother (CMAJ)

From the Editor

She presents with suicidal thoughts and had a challenging course with COVID-19.

She could be a patient in your afternoon clinic. In fact, she was seen and treated at Massachusetts General Hospital. And her case was discussed at psychiatry grand rounds, and then written up for The New England Journal of Medicine.

In our first selection, Dr. Carol S. North (of the University of Texas Southwestern) and her co-authors consider this patient’s story. They detail her history and course in hospital. They also note the complexities: “This case highlights the importance of attending to the intricate, multilevel, systemic factors that affect the mental health experience and clinical presentation of patients, especially among patients such as this one, who identified as Latina.”

Dr. David Goldbloom (of the University of Toronto) joins me for a Quick Takes podcast interview. We discuss his new book about innovations in mental health care. “I wrote the book because like so many people who work in our profession, so many people who are on the receiving end of care, and for the families who support those individuals, there is a shared sense that the status quo isn’t good enough.”

In the third selection, Dr. Kaylynn Purdy (of the University of Alberta), a resident of neurology, writes about her brother and his illness in the pages of the CMAJ. He develops schizophrenia and becomes homeless in Vancouver. She talks about his life and death. “When you meet somebody living on the streets, remember my brother.”

Reading of the Week: Suicide and Schizophrenia – Across Life Span; Also, Transgender-Inclusive Care (QT), and the NYT on Chatbots

June 10, 2021 / David Gratzer / Comments Off

From the Editor

This week, we have three selections.

In the first, we consider suicide and schizophrenia. In a new JAMA Psychiatry paper, Dr. Mark Olfson (of Columbia University) and his co-authors do a cohort study across life-span, tapping a massive database. They find: “the risk of suicide was higher compared with the general US population and was highest among those aged 18 to 34 years and lowest among those 65 years and older.” The authors see clear clinical implications: “These findings suggest that suicide prevention efforts for individuals with schizophrenia should include a focus on younger adults with suicidal symptoms and substance use disorders.”

In the second selection, we consider transgender-inclusive care, looking at a new Quick Takes podcast. Drs. June Lam and Alex Abramovich (both of the University of Toronto) comment on caring for members of this population. “Trans individuals are medically underserved and experience, poor mental health outcomes, high rates of disease burden – compared to cisgender individuals.”

Finally, in our third selection from The New York Times, reporter Karen Brown writes about chatbots for psychotherapy, focusing on Woebot. The writer quotes psychologist Alison Darcy about the potential of these conversational agents: “If we can deliver some of the things that the human can deliver, then we actually can create something that’s truly scalable, that has the capability to reduce the incidence of suffering in the population.”

Reading of the Week: Aromatherapy for Insomnia? Also, Ramadan and Mental Health and Responding to Vaccine History

April 15, 2021 / David Gratzer / Comments Off

From the Editor

“Sleep is one of the indispensable needs of human beings and is essential for maintaining physical and mental health.”

So writes Yueheng Tang (of the Huazhong University of Science and Technology) and co-authors in a new paper on insomnia. That topic is always relevant; with a third wave and the ongoing stresses of the pandemic, more people than ever seem to be struggling with insomnia. In the past few weeks, I’ve received a flurry of questions from patients and non-patients about remedies for insomnia.

What to make of aromatherapy? It’s trendy – but is it evidence based? In a new paper for the Journal of Affective Disorders, Tang et al. consider aromatherapy which “has a long history in China, and it has been used to strengthen the body and treat diseases since ancient times.” They conduct a meta-analysis, drawing on sixteen articles. They find: “Aromatherapy has a significant effect on improving sleep quality.” We consider the paper and ask: should we recommend this to our patients?

aromatherapy

In the second selection, we look at a new podcast that explores Ramadan and its clinical implications. In this Quick Takes episode, I’m joined by Drs. Juveria Zaheer and Zainab Furqan (both of the University of Toronto). They discuss fasting, mental disorders, and offer some suggestions. For example, with drug regiments: “if a medication is dosed twice daily, we can ask if it can be given safely during the interval when the interval between doses is shortened? So can we give it then in the evening or at dawn and then at sunset again? Or can we give it as one dose? And we need to think about the side effects of the medication.”

Finally, in our third selection, a reader writes us. Dr. Suze G. Berkhout (of the University of Toronto) responds to the paper by Drs. Angela Desmond and Paul A. Offit considering the history of vaccines. “The story the authors tell is history as it is written by the victors: emphasizing the hard work and successes of scientists, while failing to acknowledge the ways in which vaccine technologies have also been part of an exclusionary politics of biomedicine.”

Note that there will be no Reading next week.

Reading of the Week: Tweets for a Good Cause, But Suicide Prevention? Also, Racism in Mental Health (QT), and Rap & Awareness (JAMA Peds)

March 11, 2021 / David Gratzer / 1 Comment

From the Editor

It’s an incredible campaign. With each passing year, Bell Let’s Talk Day gains more recognition, with many, including the Prime Minister, tweeting for a good cause.

But does the campaign affect suicide? In the first selection, we look at new paper from The Canadian Journal of Psychiatry. David Côté (of the University of Toronto) and his co-authors study the tweet contents of Bell Let’s Talk Day and suicide completions. “There was no associated change in suicide counts.” We mull the big campaign and the big paper.

In the second selection, we look at a new podcast that explores race and racism in mental health. In this Quick Takes episode, I’m joined by Drs. Amy Gajaria and Saadia Sediqzadah (both of the University of Toronto). “Racism exists and it exists in the lives of our patients.” The podcast covers some big topics – but it is also practical, with solid clinical advice.

And in the third selection, Alex Kresovich (of the University of North Carolina) and his co-authors wonder about the cultural discussion of mental health. To that end, they review popular rap songs in a JAMA Pediatrics paper. “The findings of this qualitative study suggest that mental health discourse has been increasing during the past 2 decades within the most popular rap music in the US.”

Reading of the Week: Are Those with Mental Illness at More Risk of COVID? Also, a Podcast on Apps (QT) and Horton on Advocacy & Doctors (Macleans)

November 19, 2020 / David Gratzer / Comments Off

From the Editor

Are people with mental illness more likely to contract COVID-19? Are they at greater risk of dying?

With the pandemic in its eighth month, we think we have answers to these questions, but data is lacking. In the first selection, we consider a new paper, just published in World Psychiatry. QuanQiu Wang (of Case Western Reserve) and her co-authors analyzed a nation‐wide database of electronic health records of 61 million American patients, aiming to assess the impact of mental illness. “These findings identify individuals with a recent diagnosis of a mental disorder as being at increased risk for COVID‐19 infection, which is further exacerbated among African Americans and women, and as having a higher frequency of some adverse outcomes of the infection.”

coronavirus-covid-19-updates-for-canadians

In the second selection, we consider a new podcast discussing digital tools. I talk with Dr. John Torous (of Harvard University). We discuss apps and mental health. And, yes, he has tips on how to pick apps for your patients and their families.

Finally, in the third selection, we look at a new essay by Dr. Jillian Horton (of the University of Manitoba). Should doctors “stay in their lanes?” She argues against the idea, championing a new activism. “So, to my brothers and sisters in medicine: forget about staying in our lane. This is our call to flood the freeways. We cannot stay parked in neutral. There is no more time.”

Please note: there will be no Reading next week.

Reading of the Week: Rurality and Suicide (CJP); Also, COVID and Digital Practice (Quick Takes) and Haughton & Bromberg on Policing (Tor Star)

July 9, 2020 / gratz3r / Comments Off

From the Editor

At times, it seems that we understand little about suicide.

That statement is vast, sweeping – and painfully true for us clinicians who aspire to do better with very blunt instruments. This week, we have three selections; the first is a systematic review and meta-analysis focused on suicide. In a new Canadian Journal of Psychiatry paper, Rebecca Barry (of the University of Toronto) and her co-authors consider the potential link between suicide and rurality. Spoiler alert: they find a connection, at least for men. What are the implications for practice and policy?

In the second selection, we consider a new podcast discussing our digital future. I talk with Dr. Jay Shore (of the University of Colorado), who chairs the APA’s Telepsychiatry Committee. We discuss the virtualization of mental health services, and contemplate a future of hybrid care. And, yes, he has tips on how to avoid “Zoom fatigue.”

In the third selection, activists Asante Haughton and Rachel Bromberg discuss alternatives to police responding to mental health crises, seeing a dedicated team tasked with “on-the-spot risk assessments, de-escalation, and safety planning for clients in crisis” and more. “By taking on these important tasks, this team will enable Toronto policing resources to be more effectively directed toward solving crimes, rather than providing social services.”

Reading of the Week: Innovation & Pandemics (NEJM); Also, Telemental Health & Practice (QuickTakes) and Scott on Isolation (NYT)

March 26, 2020 / David Gratzer / Comments Off

From the Editor

After a short break, the Readings are back. And the world has changed over these past weeks.

We are all dealing with the stress of the pandemic, both at home and at work. I spoke recently with a physician who is a young mother, and she talked about balancing her different obligations, and working to keep her patients and family safe.

These are challenging times.

I want to acknowledge the frustration that we all have, particularly the PGY5s, who are so close to completing their studies but have had their Royal College examination postponed. It’s a tough moment for our young colleagues. But I have a few grey hairs, and have seen tough moments come and go – and I believe that things will work out just fine.

This week’s Reading includes three selections.

In the first selection, we consider innovation in the age of pandemic, with a new NEJM paper by Drs. Judd E. Hollander (of Thomas Jefferson University) and Brendan G. Carr (of Sinai). They discuss telemedicine and COVID. “Disasters and pandemics pose unique challenges to health care delivery. Though telehealth will not solve them all, it’s well suited for scenarios in which infrastructure remains intact and clinicians are available to see patients.”

mobile_phone_with_stethoscope_showing_technology_and_health_stock_photo_slide01

Then, we take a practical turn. Many of us clinicians use telemental health; with COVID, many more are thinking about taking the virtual care plunge. In the second selection, we consider a new podcast discussing telemental health. I talk with Dr. Allison Crawford of the University of Toronto. And, yes, she has tips on how to up your virtual care game. And to those thinking about using telemental health, she offers simple advice: “Do it. Try it.”

Finally, in the third selection, we look at a NYT essay by an astronaut. Thinking about his time and isolation in space, Scott Kelly provides some clever advice. “I’ve found that most problems aren’t rocket science, but when they are rocket science, you should ask a rocket scientist.”

Reading of the Week: Better PTSD Symptom Control, Less Diabetes (JAMA Psych)? Also, Buckley on Cannabis (Quick Takes), and the Life of Kajander (Globe)

December 5, 2019 / David Gratzer / Comments Off

From the Editor

Better PTSD symptom control, less diabetes? How do we talk to our patients about cannabis (and cannabis use disorder)? Who was Dr. Ruth Kajander?

This week, there are three selections. The first two deal with timely and relevant topics: the intersection of physical and mental health and the use of cannabis post-legalization. The third reminds us of the youth of our field.

In the first selection, Saint Louis University School of Medicine’s Jeffrey F. Scherrer and his co-authors consider PTSD and diabetes, asking if improvement with the mental health disorder results in a lower risk of type 2 diabetes. Drawing on Veterans Health Affairs data involving nearly 1 600 people, they find that “clinically meaningful reductions in PTSD symptoms are associated with a lower risk of type 2 diabetes.”

treating-ptsd-may-help-reduce-risk-of-type-2-diabetes-696x464

In the second selection, we draw on a podcast interview with the University of Toronto’s Dr. Leslie Buckley, the chief of addictions division at CAMH, on cannabis. What advice would she give clinicians about cannabis use? “Try to have that long conversation with [patients] about their use and make sure that they know the harms – because I feel like most people don’t.”

Finally, with an eye on yesterday and not today, we look at the recent Globe obituary for Dr. Ruth Kajander, a psychiatrist who served in many roles, and was a member of the Order of Canada.

Reading of the Week: Postsecondary Students & Mental Illness (CJP), a New Podcast (CAMH), and Bipolar & Social Media (NYT)

October 3, 2019 / David Gratzer / Comments Off

From the Editor

Social media. An uncertain job market. Increasing academic demands.

Is life for our postsecondary students harder than ever? And are we seeing a surge in mental health disorders as a result?

In the first selection, we consider a new Canadian Journal of Psychiatry paper on postsecondary education and mental illness. While many have opinions on this topic, the University of Toronto’s Kathryn Wiens and her co-authors seek to add data to the discussion. Drawing on the Canadian Community Health Survey, they find: “The results do not imply the emergence of a mental health crisis among postsecondary students.”

In the second selection, we look at a new podcast considering technology and education. I interview some accomplished educators, including the University of Toronto’s David Goldbloom. “This is about challenging our own norms, values and expectations as clinicians.”

And in the final selection, we consider a New York Times essay on bipolar and social media. “Facebook snitched our big family secret: Roland, the literary prodigy, the tenderhearted musician, the Ivy League grad, was bipolar.”

Reading of the Week: Can British Reforms Prevent Mental Illness? What Should Every Physician Know About Burnout? Also, Cardiac Surgery (and Us)

June 27, 2019 / David Gratzer / Comments Off

From the Editor

Governments in Canada and across the west have committed themselves to spending more on mental health care. But how should we spend this new money? Should we focus on people earlier in the illness experience? Should we fund evidence-based treatments like CBT? Should education campaigns aimed at reducing stigma be the priority?

UK Prime Minister Theresa May recently announced new mental health reforms. She explained: “It’s time to rethink how we tackle this issue, which is why I believe the next great revolution in mental health should be in prevention.” In this week’s first selection, we look at Prime Minister May’s announcement, and we ask: should Canadian policymakers look to 10 Downing Street for mental health ideas?

larry-cat-10-downing-street 10 Downing Street

Also, this week, we consider an interview with Dr. Treena Wilkie, CAMH’s Deputy Physician-in-Chief for Medical Affairs and Practice, who talks about physician burnout. Dr. Wilkie closes with a few words of advice for our colleagues: “There’s help available.”

And, in our third selection, The New York Times investigates deaths in an American hospital. The article isn’t about psychiatry (it’s about health care). But could it be about the problems in your hospital?

This will be the last Reading of the academic year. To my young colleagues who have just graduated: I hope you enjoy your careers in psychiatry as much as I have.

There will be no Reading next week. Should you fall off the distribution list of these Readings, please don’t hesitate to pop me an email.

Dr. David Gratzer

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TagQuick Takes

Reading of the Week: Suicidal Ideation in a 37-Year-Old Woman – A NEJM Case; Also, Goldbloom on Innovation (QT) and Purdy on Her Brother (CMAJ)

Reading of the Week: Suicide and Schizophrenia – Across Life Span; Also, Transgender-Inclusive Care (QT), and the NYT on Chatbots

Reading of the Week: Aromatherapy for Insomnia? Also, Ramadan and Mental Health and Responding to Vaccine History

Reading of the Week: Tweets for a Good Cause, But Suicide Prevention? Also, Racism in Mental Health (QT), and Rap & Awareness (JAMA Peds)

Reading of the Week: Are Those with Mental Illness at More Risk of COVID? Also, a Podcast on Apps (QT) and Horton on Advocacy & Doctors (Macleans)

Reading of the Week: Rurality and Suicide (CJP); Also, COVID and Digital Practice (Quick Takes) and Haughton & Bromberg on Policing (Tor Star)

Reading of the Week: Innovation & Pandemics (NEJM); Also, Telemental Health & Practice (QuickTakes) and Scott on Isolation (NYT)

Reading of the Week: Better PTSD Symptom Control, Less Diabetes (JAMA Psych)? Also, Buckley on Cannabis (Quick Takes), and the Life of Kajander (Globe)

Reading of the Week: Can British Reforms Prevent Mental Illness? What Should Every Physician Know About Burnout? Also, Cardiac Surgery (and Us)