Tag: Stergiopoulos

Reading of the Week: The Homeless – Who Are They? How Can We Help Them? Also, Shannon Jones on Her Son & His Homelessness

From the Editor

For much of her admission, she was disorganized and, at times, agitated. But when the medications started to work, Tanya talked about her years of homelessness and the stresses of finding a warm place to stay on a cold night, which often involved sleeping on buses – and “that’s not easy, I’m almost elderly.” 

This week, we take a closer look at homelessness and mental illness.

In the first selection, Richard Barry (of the University of Calgary) and his co-authors describe a systematic review and meta-analysis of mental disorders and homelessness for JAMA Psychiatry. They included 85 studies involving more than 48 000 people globally. “The findings demonstrate that most people experiencing homelessness have mental health disorders.” We explore the paper and its implications.

Street art in Quebec City

In the second selection, Nick Kerman and Dr. Vicky Stergiopoulos (both of the University of Toronto) examine different aspects of homelessness. In a comprehensive review for Nature Mental Health, they analyze the origins of the problem in high-income nations: focusing on deinstitutionalization. They also point to a way forward, noting the successes of Housing First and other interventions. “Homelessness among people with mental illness is a prevalent and persisting problem.”

And in the third selection, Shannon Jones writes about her son, who was homeless, in a deeply personal essay for The Washington Post. She discusses his childhood and the trips they took as a family. Also, she describes his illness and his death. “There are an estimated 600,000 homeless people in America, 75,000 of them in Los Angeles County. The number who die each year is increasing, with drug overdoses the leading cause. And every one of them has a story.”

DG

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Reading of the Week: Acupuncture for PTSD – the New JAMA Psych Study; Also, Chronic Homelessness & Hope, and Dr. Suzanne Koven on Mentorship

From the Editor

He survived a terrible car accident and recalls his worst memory: being pinned for hours in his Honda as rescuers attempted to free him, eventually with the Jaws of Life. The mental recovery proved more complicated than the physical one, with flashbacks and nightmares and the resulting substance misuse. He tried different therapies, but would he have benefitted from alternative treatments?

Dr. Michael Hollifield (of George Washington University) and his co-authors look at acupuncture for PTSD in a new JAMA Psychiatry study. They did an impressive randomized clinical trial involving 93 combat veterans with PTSD who received either verum or sham acupuncture. “[V]erum acupuncture had a large pretreatment to posttreatment effect and was statistically superior to sham needling for reducing PTSD symptoms and enhancing fear extinction.” We consider the paper and its clinical implications.

Across North America, there are more people than ever before who are chronically homeless. Who are they? What psychiatric problems do they have? How can we help them? In the second selection, Dr. Vicky Stergiopoulos (of the University of Toronto) considers those who are chronically homeless in a podcast interview for Quick Takes. “The problem is visible. It’s in our streetcars and buses, our subways, our streets, and it’s hard to ignore.”

And in the third selection, Dr. Suzanne Koven (of Harvard University) writes about mentorship in The New England Journal of Medicine. She discusses how a mentor’s advice transformed her career and then considers what makes for good mentorship. “A mentor is someone who has more imagination about you than you have about yourself.”

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)

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: The Resident’s Suicide – a New Paper from NEJM; Also, Help Seeking in Medical Education (JAMA Int Med)

From the Editor

“Bobby became my intern, and I was his senior resident. It was a role I cherished, and I tried to teach him all I could about caring for multiple sick patients simultaneously and navigating the systems, personalities, and politics of a large Manhattan hospital.”

Dr. Richard E. Leiter (of Harvard University) writes these words in a New England Journal of Medicine paper, this week’s first selection. He discusses loss – specifically, the death by suicide of the junior resident he was working with. On Twitter, Dr. Leiter commented that it took him six years to write about this death. Reading over the paper, we can understand why; the essay is deeply personal and moving. It also seeks to be constructive: Dr. Leiter calls for change. “Seeking to improve the lives of others shouldn’t cost our trainees their own.”

grief

Of course, the NEJM article isn’t just about Bobby; it touches on the culture of medicine. Suicide, while always tragic, is rare in health care; untreated depression and substance problems are too common. In the second selection this week, we consider a paper recently published in JAMA Internal Medicine. Dr. Erene Stergiopoulos (of the University of Toronto) and her co-authors note the mixed message of medical education: at once encouraging “wellness” but also criticizing time away. “Stigma surrounding depression is deeply embedded in medicine.” Importantly, Dr. Stergiopoulos and her co-authors makes three practical suggestions.

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On a pivot –

Since 2014, the Reading of the Week (ROTW) has been providing summaries and commentary on the latest in the psychiatric literature. Two years ago, we conducted a short survey to get your feedback. We are hoping to get more feedback to improve the Readings further.

We would invite you to join one of our online focus groups to hear your opinions and suggestions for improvement. If you are interested in participating, please email smit.mistry@camh.ca by April 12 with your preferred time slots from the following options – psychiatrists: April 21 at 4 pm or April 22 at 4 pm; residents: April 28 at 4 pm and April 29 at 4 pm. (Note: all times are in EST.) Time commitment: under an hour. If the above time slots do not work for you, please email Smit to arrange an interview time at your convenience, ideally between April 21 and April 30, 2021.

DG

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Reading of the Week: Is Yoga Useful for Depression (CJP)? Also, Women & COVID (JAMA) and Stergiopoulos on Masks & Medicine (UofTMed)

From the Editor

Complementary and alternative medicines are trendy – but are they helpful?

“Depressed patients… often perceive CAMs [complementary and alternative medicines] as safer, accessible, more tolerable, and easily acceptable compared to pharmaceuticals. It has been estimated that 10% to 30% of depressed patients use CAM therapies, often in tandem with conventional treatments and frequently without the knowledge of their physician. This percentage is even higher amongst those with bipolar disorder (up to 50%) and in clinic populations (up to 86%).”

So writes Dr. Arun V. Ravindran (of the University of Toronto) and his co-authors in a new Canadian Journal of Psychiatry paper. That study – our first selection this week –considers the use of one type of CAM: yoga. They find that it “may be helpful as an adjunctive intervention.”

yoga-beach-sunset-relax

In the second selection, writing in JAMA, Dr. Linda Brubaker (of the University of California, San Diego) considers gender and roles in medicine. While she is careful not to over-generalize, she notes that: “As a group, women physicians spend proportionately more time on home and family care activities.” With the disruptions of COVID-19, she wonders what must be done to support all physicians. “Women and men physicians should be able to share the joy and the work of their lives equally.”

And, in the third selection, University of Toronto psychiatry resident Dr. Erene Stergiopoulos considers masks – and humility – in a time of COVID-19. In a personal essay that turns on a split-second decision, she notes: “These days it’s hard to remember a time before masks. And some days, it’s just as hard to imagine a future without them.”

DG

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Reading of the Week: “Your Smartphone Will See You Now” – Torous on Digital Psychiatry; Also, the Costs of Homelessness

From the Editor

A few weeks ago, a patient’s daughter called. She was deeply concerned: the patient was acting differently, she explained. “He’s sick again.” She noted that he was starting to go on long walks at night, and to different neighbourhoods – something he does when he’s starting to get ill with his bipolar. She feared that, without a change in medications and careful follow up, he would end up in the hospital again. As a psychiatrist, that type of information can be invaluable – a clue that a patient is doing less well.

Could technology help us find clues for emerging illness, maybe even before family members or patients themselves?

This week, the first selection weighs this question. Harvard University’s Dr. John Torous considers big data and mental health. In his essay, “Your Smartphone Will See You Now,” he reviews current trends and writes: “I predict that this technology will have an enormous impact on psychiatry.”

mjkxndi1nwClever cover – promising future?

In the second selection, we consider a new paper that looks at the costs of homelessness in Canada. As part of the work of At Home/Chez Soi, the authors answer a basic and important question: what are the costs of homelessness?

Please note: there will be no Readings for the next two weeks.

DG

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Reading of the Week: Housing First and At Home/Chez Soi

Homelessness is a significant social problem in Toronto, Canada’s largest and most ethnically diverse urban center, where approximately 29,000 individuals use shelters each year and roughly 5,000 people are homeless on any given night.

So opens this week’s Reading. The sentence is simple and direct; the facts conveyed are haunting. But this week’s Reading is ultimately a good news story. Actually, it’s a very good news story.

The Reading: “Effectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial” by Vicky Stergiopoulos et al., which has just been published in PLOS ONE.

Dr. Vicky Stergiopoulos

Here’s a quick summary: offer the homeless housing, and they not only gain housing stability but end up drinking less and are hospitalized less. Continue reading