Tag: smith

Reading of the Week: Placebo & Mental Disorders – the New JAMA Psych Study; Also, Children Who Lost a Parent to Overdose, and the Latest in the News

June 6, 2024 /

From the Editor 

It’s day three of his hospitalization, and he insists that the medication trial (a low dose of an SSRI) has been transformative. It’s difficult to explain his experience pharmacologically. 

How significant is the placebo response? How much does it vary among mental disorders? These questions aren’t new. In the first selection, Dr. Tom Bschor (of the Technical University of Dresden) and his co-authors tread on a familiar path with a study just published in JAMA Psychiatry. Focusing on nine psychiatric disorders, they examined high-quality RCTs for a systematic review and meta-analysis, finding “significant improvement under placebo treatment for all 9 disorders, but the degree of improvement varied significantly among diagnoses.” We consider the study and its implications.

In the second selection, Christopher M. Jones (of the Substance Abuse and Mental Health Services Administration) and his co-authors used US databases to calculate how many children have lost a parent to drug overdoses. The resulting JAMA Psychiatry study is haunting. “We estimated that more than 320 000 US children lost a parent to drug overdose between 2011 and 2021, providing new insight into the multigenerational impacts of the ongoing overdose crisis in the US.”

Finally, we explore the latest news with recent articles from The Guardian, The Globe and Mail, and The New York Times. Among the topics: the mental health struggles of a cancer patient, the beliefs of Marshall Smith, and whether we are talking too much about mental health.

DG

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Reading of the Week: Clozapine Monitoring – the New BJP Paper; Also, Suicide Trends Among Adolescents (CJP) and Van Gogh’s Ear & Iconography (ANZJP)

June 15, 2023 /

From the Editor

“Despite its strong evidence base, clozapine remains grossly under-prescribed in clinical practice. Although reasons for this are multifaceted, a commonly cited influence is the need for mandatory haematological monitoring.” So notes Ebenezer Oloyede (of the University of Oxford) and his co-authors in a new British Journal of Psychiatry paper. Could the requirements be simplified? 

In the first selection, Oloyede et al. look at outcomes of 569 patients on clozapine when, during the pandemic, routine blood monitoring was changed. In this mirror-image cohort study, they find: “[E]xtending the haematological monitoring interval from 4-weekly to 12-weekly did not increase the incidence of life-threatening agranulocytosis in people taking clozapine.” We consider the paper and its implications.

In the second selection, Dr. Rachel H. B. Mitchell (of the University of Toronto) and her co-authors analyze Canadian data on suicide and sex differences. In this Canadian Journal of Psychiatry research article, they find that suicide rates among female adolescents aged 10 to 14 years surpassed similarly aged males in 2011. “The marked and consistent trend of rising suicide rates among adolescent females aged 10 to 14 years in Canada signals increased distress and/or maladaptive coping in this segment of the population.” 

And in the third selection, Alexander Smith (of the University of Bern) and his co-authors write about Vincent van Gogh. In an Editorial for the Australian and New Zealand Journal of Psychiatry, they describe his mental health struggles but also their commercialization. “Vincent van Gogh’s ear has generated an intrinsic cultural currency. Yet, the psychiatric vulnerabilities encompassed by his act of self-harm are not always sensitively considered or acknowledged.”

DG

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Reading of the Week: Peer Support – the New Psych Services Paper; Also, BMJ on Dr. Smith & Drs. Stergiopoulos and Hwang on TTC Violence (Tor Star)

March 2, 2023 /

From the Editor

Anxiety provoking. That’s how a patient recently described the first few days of hospitalization in an unfamiliar environment and feeling unwell. Would peer support have helped?

In the first selection, Cecilie Høgh Egmose (of the University of Copenhagen) and her colleagues conduct a systematic review and meta-analysis for Psychiatric Services. In this study, they analyzed 49 RCTs involving more than 12,000 participants and with different types of services and peer support. They find: “peer support interventions generally but only slightly improve outcomes of personal recovery and slightly reduce symptoms of anxiety among individuals with any mental illness.” We look at the paper and its clinical implications.

In the second selection, writer Adele Waters interviews the incoming president of the UK’s Royal College of Psychiatrists in a front cover article for The BMJ. Dr. Lade Smith’s new position is like a British combination of two Canadian presidencies: of the Royal College of Physicians and Surgeons and of the Canadian Psychiatric Association. She has had a big career as an educator, clinician, and researcher. And Dr. Smith is clear in her advocacy: “The chronic underfunding of mental health care must be tackled urgently. We have the evidence to make the case. Investing in mental healthcare is cost effective, saves lives, and enhances our economy.”

And in the third selection, Drs. Vicky Stergiopoulos and Stephen Hwang (both of the University of Toronto) mull violence and Toronto’s transit system. In an essay for the Toronto Star, they push past the headlines and suggest that we address core issues. They write: “Simply adding police officers and security guards on the TTC will not be sufficient. This is not a TTC problem but, rather, a whole system problem.”

DG

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Reading of the Week: Screen Time and Kids’ Mental Health – the New JAMA Psych Paper; Also, Carol Smith on Her Grief (Wash Post)

May 26, 2022 /

From the Editor

Gaming. Apps. Streaming videos.

Children today have endless options at their fingertips, allowing them to entertain themselves for hours – which means less time for reading, playing, and physical activity. What effect does this have on their mental health? That question has sparked much debate: some argue that screen time is inherently problematic while others feel that it opens doors for creativity and connection to others. But what does the literature say? 

In the first selection, Rachel Eirich (of the University of Calgary) and her co-authors consider screen time and behavioural problems in children with a new systematic review and meta-analysis, just published in JAMA Psychiatry. Pulling together 87 studies, they focus on several variables. The big finding? “This study found small but significant correlations between screen time and children’s internalizing and externalizing behavior problems.” We look at the study.

And in the second selection, continuing our consideration of the first update to the DSM series in nine years, journalist Carol Smith mulls DSM-5-TR and the new diagnosis of prolonged grief disorder. In The Washington Post, she writes about her personal experience with grief: she lost her son when he was just 7. “I never thought to ask for help. I wish I had.”

DG

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Reading of the Week: High Tech and Low Tech Opportunities for Mental Health Care

September 30, 2021 /

From the Editor

Social media. Bots. VR.

When I applied to psychiatry residency programs in my last year of medical school at the University of Manitoba, none of these were mentioned when we talked about mental health care. But technology is changing our world. We are seeing a digital boom in mental health care – or is it really a digital mirage?

In the first selection, we move past the big rhetoric with a thoughtful paper by Dr. John Torous (of Harvard University) and his co-authors. In World Psychiatry, they review the literature and make insightful comments about the potential and reality of digital mental health care. “It now seems inevitable that digital technologies will change the face of mental health research and treatment.” We discuss the paper and its implications.

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Woebot: Too cool to be clinical?

If the first selection considers cutting-edge technology for bettering patient care, the second is very different. Dr. Thomas E. Smith (of Columbia University) and his co-authors study “the strength of associations between scheduling aftercare appointments during routine psychiatric inpatient discharge planning and postdischarge follow-up care varied by level of patient engagement in outpatient psychiatric care before hospital admission” in a paper for Psychiatric Services. Spoiler alert: there are no chatbots mentioned. “Discharge planning activities, such as scheduling follow-up appointments, increase the likelihood of patients successfully transitioning to outpatient care, regardless of their level of engagement in care prior to psychiatric inpatient admission.”

DG

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Reading of the Week: COVID & Mental Health Access in China (AJP); also, Transformational Care (EBMH) and Psych Wards (New Yorker)

April 30, 2020 /

From the Editor

What’s the latest in the literature on COVID and mental health? This week, we focus again on the pandemic with three selections.

In the first, we consider a paper on mental health services at a Chinese hospital during the pandemic. In this American Journal of Psychiatry study, Dr. Junying Zhou (of Sichuan University) and co-authors report on a survey of existing and new outpatients, finding major problems with access. Among the findings: one in five found that their mental health had deteriorated due to a lack of access to care. The authors advocate further study to “ameliorate the negative impact of viral outbreaks in the general public, especially among those vulnerable patients with mental problems.”

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Will COVID change health care once the virus has burned out? In the second selection, we consider a new EBMH editorial by Dr. Katharine Smith (of Oxford University) and her co-authors. They write: “In order to reappraise effectively our new ways of working, both in the immediate management of issues during the pandemic and also during the longer-term aftermath, we need fast-track implementation of evidence-based medicine techniques in mental health to supply the best evidence to clinicians on specific questions in real time.”

Finally, in the third selection, we look at an essay from The New Yorker. Reporter Masha Gessen argues that psychiatric wards are particularly vulnerable during the pandemic. Gessen speaks to several doctors who offer a similar if haunting story: “how a lack of testing, P.P.E., and seclusion protocols were making a difficult task – maintaining the safety of a highly vulnerable population and their care workers during a pandemic – virtually impossible.”

DG

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Reading of the Week: How Do University Students Use Cannabis? Also, the Life and Legacy of Richard Green, and Scott Gottlieb on E-Cigs

May 2, 2019 /

From the Editor

I don’t quite remember when I changed my interview questions, but at some point – more than a decade ago – I stopped assuming that if I asked about street drugs, patients would tell me about cannabis. Long before legalization, people stopped seeing cannabis as illicit. Today, not only is cannabis legal for recreational use, many see it as a drug to be taken for their health.

In a new Canadian Journal of Psychiatry paper, the authors write about cannabis use for medicinal purposes among Canadian university students. Drawing on a survey, they find wide use – but not exactly the use that follows the guidelines.

We also consider two other pieces: an obituary for Dr. Richard Green, a prominent psychiatrist who challenged the DSM’s inclusion of homosexuality, and an interview with Dr. Scott Gottlieb, the outgoing FDA Commissioner, who worries about e-cigarettes.

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Enjoy these selections.

And an invitation: the Reading of the Week series invites guest contributions. If this is of interest to you, please let me know.

DG

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