Tag: Schizophrenia

Reading of the Week: Psychological Interventions for Schizophrenia – the New Lancet Psych Study; Also, Service Dogs for PTSD, and the Latest in the News

From the Editor

She was distressed by the voices and the paranoid thoughts. Many nights, my patient could barely sleep. She had tried several medications without much improvement. Is there a role for psychological interventions? Would CBT help? What is the evidence for this population?

In the first selection, Nurul Husna Salahuddin (of the Technical University of Munich) and co-authors attempt to answer these questions in a new systematic review and network meta-analysis, just published in Lancet Psychiatry. The analyzed 52 RCTs with 5 034 participants. “We provide robust findings that CBTp can reduce the overall symptoms of patients with treatment-resistant schizophrenia, and therefore clinicians can prioritise this intervention in their clinical practice.” We consider the paper and its clinical implications.

In the second selection from JAMA Network Open, Sarah C. Leighton (of the University of Arizona) and her co-authors describe a study involving service dogs for those with PTSD. In a nonrandomized controlled trial involving 156 military members and veterans, they examined outcomes after three months. “[C]ompared with usual care alone, partnership with a trained psychiatric service dog was associated with lower PTSD symptom severity and higher psychosocial functioning in veterans.”

Finally, we explore the latest news with recent articles from The Guardian, the Ottawa Citizen, and The New York Times. Among the topics: “honest” obituaries and the opioid crisis, antidepressants and withdrawal, and care for pregnant women with substance problems.

DG

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Reading of the Week: Visual Hallucinations & Outcomes – the New Schizophrenia Study; Also, Opioid Deaths in Canada and Dr. Roy Perlis on Antidepressants

From the Editor

Last week, I met a person who had deeply unsettling auditory hallucinations. I asked him the questions that we all ask: When did the voices start? How many voices do you hear? Do the voices tell you to do things? In contrast, while we know that people with psychotic illnesses can have visual hallucinations, we rarely inquire about them and if we do, it’s in a perfunctory manner, as I did with him. Clinicians aren’t the only ones to gloss over visual hallucinations; they tend to be under-researched, especially with regard to long-term outcomes.

In the first selection, Isabel Kreis (of the University of Oslo) and her co-authors look at outcomes and visual hallucinations in an impressive, new study published in Schizophrenia. They report on 184 people from Norway with first-episode psychosis, followed for ten years, with a focus on visual hallucinations and functionality, suicide attempts, and childhood trauma. “These findings highlight the relevance of assessing visual hallucinations and monitoring their development over time.” We consider the paper and its implications.

In the second selection from CMAJ, Shaleesa Ledlie (of the University of Toronto) and her co-authors report on opioid-related deaths in Canada. They drew from a national database and looked at several years of data, including over the start of the pandemic. “Across Canada, the burden of premature opioid-related deaths doubled between 2019 and 2021, representing more than one-quarter of deaths among younger adults.”

And in the third selection, Dr. Roy Perlis (of Harvard University) argues that the time has come for over-the-counter antidepressants in a STAT essay. He notes that many people with depression are untreated and that increasing the availability of these medications would be helpful. “With part of the solution hiding in plain sight, it’s time to do everything possible to give Americans another way to get treatment.”

DG

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Reading of the Week: Global Burden of Schizophrenia – the new Molecular Psych Study; Also, MedEd’s Evolution & Saxbe on Helping Depressed Teens

From the Editor

Is there more mental illness than before? Or is there greater awareness? 

Dr. Marco Solmi (of the University of Ottawa) and his co-authors attempt to answer these questions in a new paper for Molecular Psychiatry that focuses on schizophrenia. Drawing on 30 years of data globally, they consider prevalence (how many have the illness), incidence (the number who develop it each year), and the disability-adjusted life-years (the loss of one healthy year of life) using more than 86 000 points of data. They find: “Globally, we show that, from 1990 to 2019, raw prevalence increased by over 65%, incidence by 37.11%, DALYs by over 65%, but age-adjusted prevalence and incidence estimates showed a slight decrease, and burden did not change.” We consider the paper and its implications.

Textbooks, highlighters, and classrooms? The world of medical education is changing. Today, we have AI, sim, and e-learning. In the second selection, we look at the new Quick Takes podcast with Dr. Ivan Silver (of the University of Toronto), former vice president of education at CAMH who marvels at the potential. “This is the renaissance period for health professional education.” 

And in the third selection, psychologist Darby Saxbe (of the University of Southern California) writes in The New York Times about ways to help depressed adolescents. Drawing on recent studies showing the failure of school-based psychosocial interventions, she argues for a different approach. “It’s critical to keep pace with the evidence and attend to the first principle of all health care providers: First, do no harm.”

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

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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Reading of the Week: Resilience after Disaster – Lessons from Japan; Also, Schizophrenia & Spending (CJP) and Dr. Brandeland on Her Father & His Addiction (JAMA)

From the Editor

My patient was involved in a terrible car accident. Though physically unharmed, she’s never really recovered (mentally). Her co-worker, sitting in the seat beside her, barely took off any time from work.

Why are some people resilient and others aren’t?

In The British Journal of Psychiatry, Dr. Taku Saito (of the National Defense Medical College) and his co-authors explore this question, focusing on a natural disaster. Drawing on an impressive database of first responders involved in the 2011 Japanese earthquake rescue/recovery effort, they do a seven-year prospective cohort study. They find: “The majority of first responders… were resilient and developed few or no PTSD symptoms.” Of course, some did develop mental health problems. The risk factors? Older age, personal disaster experiences, and working conditions. We consider the big paper.

In the second selection, Andrew J. Stewart (of the University of Calgary) and his co-authors analyze health spending in a new Canadian Journal of Psychiatry paper. They focus on people with schizophrenia, looking at a 10-year period. “Healthcare spending among patients with schizophrenia continues to increase and may be partially attributable to growing rates of multimorbidity within this population.”

And, in the third selection, Dr. Megan Ann Brandeland (of Stanford University) writes about her father’s death. In JAMA, she discusses his struggles and notes that – early in his career as a physician – a patient had a tragic outcome. “My hope in sharing this story is to encourage more physicians to share their own stories, to reduce the stigma around mental health, trauma, and addiction among physicians, and to honor my father’s life and the goodness he brought to the world.”

Please note that there will be no Reading next week; we will resume on 31 March 2022.

DG

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Reading of the Week: E-Cigs and Cessation – the New JAMA Paper; Also, Green Space & Schizophrenia (CJP) and Dr. Jessica Gregg on Needed Care (NEJM)

From the Editor

How to help him quit?

We often speak to our patients about the dangers of smoking – with middling success, especially with those who aren’t interested in cessation. Are e-cigarettes part of the solution? In a new JAMA Network Open paper, Karin A. Kasza (of the Roswell Park Comprehensive Cancer Center) and her co-authors report on a cohort study focused on this refractory population. “In this US nationally representative cohort study of 1600 adult daily cigarette smokers who did not initially use e-cigarettes and had no plans to ever quit smoking, subsequent daily e-cigarette use was significantly associated with an 8-fold greater odds of cigarette discontinuation compared with no e-cigarette use.”

In the second selection, we consider a new Canadian Journal of Psychiatry research letter. Dr. Martin Rotenberg (of the University of Toronto) and his co-authors look at green space and schizophrenia. A connection? They find one. “We found that residing in an area with the lowest amount of green space was associated with an increased risk of developing schizophrenia, independent of other sociodemographic and socioenvironmental factors.”

Finally, in the third selection, Dr. Jessica Gregg (of the Oregon Health and Science University) writes about her experiences as a physician and as a patient. In this New England of Journal paper, she talks personally about sudden illness and unsatisfactory health care. “I knew – and know – that our system of not-care for the sick and scared is broken. I knew – and know – that our system of un-care for people affected by addiction or poverty, for those who make bad choices and those who were never offered fair choices in the first place, is even more fractured.”

DG

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Reading of the Week: Who’s Left Out of RCTs for Schizophrenia? (JAMA Psych) Also, Inman on Being the Mother of a Person with Schizophrenia (Medium)

From the Editor

Recently during a family meeting, a patient’s father leaned forward, looked me directly in the eye, and asked: “what would be the best for my son?”

As clinicians, we draw from many sources: personal experience, clinical guidelines, expert opinion, studies. For the latter, randomized clinical trials are considered to be the gold standard. But do such trials capture well the complexity of the patient sitting in front of you?

In the first selection, Heidi Taipale (of the University of Eastern Finland) and her co-authors offer new data to answer that question. Drawing on impressive databases (over 25 000 people diagnosed with schizophrenia spectrum disorders), they consider patients with schizophrenia in RCTs against real-world populations in a JAMA Psychiatry paper. They find: “In this study, we applied typical inclusion and exclusion criteria of RCTs to the real-world populations of individuals with schizophrenia in Finnish and Swedish national registries. We found that almost 80% of individuals with schizophrenia would be ineligible to participate in typical RCTs and are therefore not represented in them.”

Finland: Big Northern Lights and big databases

In this week’s other selection, we also consider schizophrenia but with a different perspective. What could we do better to support patients and their families? Susan Inman writes: “Mothers, like me, who provide caregiving for adult children with schizophrenia do not have much of a voice.” In a thoughtful essay for Medium.com, she speaks about problems that hinder an effective mental health system, including a lack of mental health literacy campaigns.

DG

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

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.”

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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.”

DG

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