Tag: Schizophrenia Bulletin

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

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

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

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

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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