Tag: Schizophrenia Bulletin

Reading of the Week: Effectiveness of Omega-3 – the New Schiz Bulletin Paper; Also, Weight Loss Meds in Psychiatry & the Latest in the News

December 5, 2024 /

From the Editor

When my patient’s father heard that there is some evidence that omega-3 fatty acids can help in the prevention of psychotic illness, he left my office, walked to the pharmacy down the street, and purchased the largest bottle of the fish oil supplement that he could find. It’s hard to fault his logic: omega-3 fatty acids may be helpful and have few side effects. Clinicians have shared this enthusiasm. No wonder: in 2010, a major study found that patients who took it had a lower transition rate to psychosis for those at ultra-high risk. 

But what does the latest evidence say? Are omega-3 fatty acids helpful? In the first selection, Inge Winter-van Rossum (of the Utrecht University) and her co-authors attempt to answer these questions in a paper for Schizophrenia Bulletin. They report on a double-blind, randomized, placebo-controlled study of ultra-high risk (UHR) patients for psychosis who received either omega-3 supplements or placebo for six months, then followed for 18 months. “The transition rate to psychosis in a sample of subjects at UHR for psychosis was not reduced compared to placebo.” We consider the study and its implications.

Pretty pills – but relevant?

In the second selection, Drs. Sri Mahavir Agarwal and Margaret Hahn (both of the University of Toronto) write about semaglutide in a new Viewpoint for JAMA Psychiatry. They note great opportunities, but caution about challenges, including access to that medication. In a thoughtful paper, they review the relevant literature. “Semaglutide and similar drugs represent the culmination of decades of diabetes and obesity research, and their arrival has already resulted in a paradigm shift in the management of these disorders in the general population.”

Finally, we explore the latest news with articles from The Globe and Mail, Time, and The New York Times. The topics: ADHD and TikTok diagnoses, an app for peer support, and public libraries in a time of homelessness and substance.

DG

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Reading of the Week: Antipsychotics – the New, the Old & the Patient Experience, with Papers from JAMA Psych, BJP and Schiz Bulletin

October 10, 2024 /

From the Editor

“FDA approves a novel drug for schizophrenia, a potential ‘game changer’”

– The Washington Post

“Will ‘Game Changer’ Antipsychotic Live Up to the Hype?”

– Medscape

Two weeks ago, for the first time in decades, the FDA approved an antipsychotic for schizophrenia with a novel mode of action. What does the data show for this medication, xanomeline-trospium chloride? Is it a “game changer” as some headlines suggest? 

In the first selection, Dr. Inder Kaul (of Karuna Therapeutics) and his co-authors report on a double-blind, randomized, placebo-controlled trial that was published in JAMA Psychiatry. 256 people with schizophrenia were given the antipsychotic or the placebo and followed for five weeks. “Xanomeline-trospium was efficacious and well tolerated in people with schizophrenia experiencing acute psychosis.” We consider the study and its implications.

In contrast to this week’s first selection, the second selection looks at an older antipsychotic: clozapine. Drawing on Canadian databases, Lloyd Balbuena (of the University of Saskatchewan) and his co-authors put the risks and benefits of this medication in a new light in a paper for The British Journal of Psychiatry. They analyzed data on admissions and adverse events, with almost 50 000 participants. “Clozapine was associated with lower relapse overall, but this was accompanied by higher adverse events for adults. For children/youth, clozapine was associated with lower relapse all throughout and had no difference in adverse events compared with other antipsychotics.”

And in the third selection, Susan Weiner writes about antipsychotics for Schizophrenia Bulletin. She discusses her first psychotic break, her long journey, and her ultimate recovery. In a personal essay, she also describes the connection she made with her psychiatrist and the medication that transformed her life. “The right medicine for the right person can produce sanity like a miracle drug, and all is once again bright.”

DG

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Reading of the Week: Mental Healthcare in Rural India – the New JAMA Psych Study; Also, Conflict & Psychiatry, and Morén on Her Father

August 29, 2024 /

From the Editor

Many in high-income nations don’t receive needed mental healthcare. Moreover, problems run deeper in countries like India, where only about 4% of patients with depression receive minimally adequate treatment, due to the higher prevalence of stigma and the limited number of providers. 

Could anti-stigma campaigns make a difference? Could technology be leveraged to reach those at high risk? In the first selection, Dr. Pallab K. Maulik (of the University of New South Wales) and his co-authors seek to answer these questions in a new paper for JAMA Psychiatry. They report the findings of a major study involving 44 primary health centres and nearly 10 000 participants across the states of Haryana and Andhra Pradesh in India. The interventions included both anti-stigma campaigns and an app designed to guide and prioritize care. “There was a significant difference in mean depression scores between intervention vs control groups at 12 months, with lower scores in high-risk cohort.” We discuss the paper and its implications.

In the second selection, Dr. Neil Krishan Aggarwal (of Columbia University) bemoans global conflicts and wonders about the role of psychiatry in a Viewpoint for JAMA Psychiatry. Noting that psychiatry helped create a less formal type of diplomacy, called Track II, he questions what role psychiatry might play in the future. “Mental health professionals can encourage dialog among foreign policy elites to reduce the possibility for military conflict.”

And in the third selection from Schizophrenia Bulletin, Constanza Morén (of the University of Barcelona) writes about her father who was a “magnificent person.” He was also an individual with schizophrenia. She discusses his journey and his challenges he faced within the healthcare system. “Patients live with their own voices, but, in a way, they need the rest of us to also give them a voice.”

DG

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Reading of the Week: How Problematic are Benzodiazepines? The New AJP Study; Also, Dickson on His Illness & Humility

March 28, 2024 /

From the Editor

Singer Olivia Rodrigo may have a catchy song about getting a driver’s license and Ariana Grande has a ditty about past relationships, but, in the late 1960s, the Rolling Stones wrote a whole song about diazepam, “Mother’s Little Helper.” The choice of topic isn’t so surprising: between 1968 and 1982, diazepam was the most prescribed medication in the United States and commonly used around the world.

But the pendulum has swung in the other direction. Today, we hesitate on prescribing benzodiazepines like diazepam, in part because of concerns about substance misuse and dose escalation. But how addictive are these meds? How significant is dose escalation over time? Though smaller studies have sought to answer these questions, Dr. Thomas Wolff Rosenqvist (of the University of Copenhagen) and his co-authors drew on Danish databases in an important, new study published in The American Journal of Psychiatry. They looked at two decades of data involving almost a million Danes who have used benzodiazepines. “A limited portion of the population that received benzodiazepines prescriptions were classified as continuous users, and only a small proportion of this group escalated to doses higher than those recommended in clinical guidelines.” We consider the study, the editorial that accompanies it, and the implications for practice.

Denmark: beautiful buildings, rich history, great data on benzodiazepines

In this week’s other selection, Michael Dickson (of the University of South Carolina) writes about the symptoms of schizophrenia. Dickson, who is a professor of philosophy, touches on philosophical concepts but, also, on personal experience – as an individual with the illness. In a paper published by Schizophrenia Bulletin, he recalls a psychotic episode, his ongoing symptoms, and how he came to terms with the disorder. “This attitude has made life better and has made the ‘near-collapses’ much rarer.”

DG

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Reading of the Week: Running vs SSRIs for Depression – the new JAD Paper; Also, Climate Change & Mental Health, and Understanding My Schizophrenia

October 26, 2023 /

From the Editor

“Go for a Run to Beat Depression – It’s Just As Effective As Taking Medication”

– New York Post

“Running could be just as effective at treating depression as medication, scientists find”

– The Independent

Patients often ask what they can do to get better from their depression. Should we be advising them to put on a pair of runners and go for a jog? A new paper published in the Journal of Affective Disorders seems to suggest as much – and it’s caused a bit of media buzz. In the first selection, Josine E. Verhoeven (of Vrije Universiteit Amsterdam) and her co-authors describe this 16-week study that offered 141 people with depression and/or anxiety either a running intervention or medications, and looked at several mental and physical health outcomes. “We showed that while antidepressant medication and running therapy did not statistically significantly differ on mental health outcomes… the interventions had a significantly different and often contrasting impact on several physical health outcomes, with more favorable outcomes for those in the exercise intervention.” We consider the paper and its implications.

In the second selection, Pim Cuijpers (of Vrije Universiteit Amsterdam) and his co-authors discuss climate change and mental health in a new viewpoint for JAMA Psychiatry. Though they note the lack of high-quality research in the area, they argue that it would disproportionately affect low and middle-income nations. They then point a way forward. “There is no doubt that climate change will have a major impact on mental health in the coming decades.”

And in the third selection which is written anonymously, a person with schizophrenia talks about his experiences in a paper for Schizophrenia Bulletin. He tries to empower himself, working to limit side effects and cope with the voices. “My brain disease is incurable, but it is not an excuse for me to be irresponsible or to give up on life.” 

DG

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Reading of the Week: Physician Burnout, Interrupted (NEJM); also, COVID and Schizophrenia (Schiz Bulletin) and a Reader Responds on Inpatient Care

May 7, 2020 /

From the Editor

As we come to understand the new normal – a world of PPEs and precautions – we need to consider not just the implications of the virus on today’s work, but tomorrow’s.

In the first selection, we look at a new paper on physician burnout. In The New England of Journal, Drs. Pamela Hartzband and Jerome Groopman (both of Harvard Medical School) argue that burnout will not be remedied by offers of exercise classes and the other usual prescriptions. Drawing on organizational psychology, they call for a fundamentally different approach, built on autonomy, competence, and relatedness. At a time of COVID, “health care professionals are responding with an astounding display of selflessness, caring for patients despite the risk of profound personal harm. Our efforts are recognized and applauded.” Now, they argue, is the moment for action.

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Are people with schizophrenia at particular risk during this pandemic? In the second selection, we consider a new Schizophrenia Bulletin paper by Dr. Nicole Kozloff (of the University of Toronto) and her co-authors, who answer this question with a convincing yes. “We suggest that thoughtful consideration of the implications of COVID-19 for people with schizophrenia may not only reduce the burden of the global pandemic on people with schizophrenia, but also on the population as a whole.” They offer recommendations.

Finally, in the third selection, a reader responds to last week’s Reading. Rachel Cooper (of the University of Toronto) considers the inpatient experience. “Those of us who have spent time on psychiatric units, particularly while on forms (or held involuntarily), can speak to the immense isolation and feelings of violation of having our basic liberties removed. In this time of COVID, those with the privilege of not having had the experience of being in hospital involuntarily are getting a small taste of that isolation.”

Please note that there will be no Reading next week.

DG

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

July 14, 2016 /

From the Editor

Is an ounce of prevention worth a pound of cure? As noted last week, psychiatry tends to emphasize the treatment of illness, not its prevention. But preventing illness is our ultimate goal.

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.

Last week. The psychosis risk calculator.

This week. Cost-effective prevention.

In this week’s Reading, we look at a paper that considers CBT to prevent psychosis in an ultra high-risk group; the paper also considers the cost-effectiveness of the intervention. So is Ben Franklin right in arguing that an ounce of prevention is worth a pound of cure? The paper doesn’t weigh in on Franklin, of course, but it does find that CBT is economically sound with an 83% likelihood of reducing the transition to psychosis and at a lower cost.

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