Tag: suicide

Reading of the Week: Bipolar and Lithium – the New BJP Paper; Also, Inpatient Therapy (Psych Service) and Stulberg on His OCD (NYT)

July 7, 2022 /

From the Editor

What’s the best medication for bipolar disorder? Today, we have a variety of options from the old (lithium) to the new (modern antipsychotics). But what to prescribe?

In the first selection from The British Journal of Psychiatry, Cecilie Fitzgerald (of the Danish Research Institute for Suicide Prevention) and her co-authors try to answer these questions with a cohort study including those diagnosed with bipolar and living in Denmark between 1995 and 2016. They employ two types of analyses and focus on suicide, self-harm, and psychiatric hospital admissions. They conclude: “Although confounding by indication cannot be excluded, lithium seems to have better outcomes in the treatment of bipolar disorder than other mood stabilisers.” We consider the paper and its implications.

Lithium: not just for Teslas?

In the second selection, Stef Kouvaras (of the South London and Maudsley NHS Foundation Trust) and her co-authors consider a single-session psychotherapy intervention for an inpatient unit. In this recently published brief report for Psychiatric Services, they do a feasibility and acceptability study of positive psychotherapy. “The findings of this study indicate that positive psychotherapy is feasible and acceptable on acute psychiatric wards and that service users with severe and complex mental health conditions find the intervention helpful.”

In the final selection, executive coach Brad Stulberg writes about his experiences with OCD for The New York Times. He notes that his diagnosis helped him find care – but he worries about labels. “The stigma around mental illness has certainly not disappeared. But increasingly, mental health diagnoses are being embraced as identity statements.”

DG

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Reading of the Week: Cannabis for Mood Disorders – the New CJP Paper; Also, Dr. Insel on Mental Health (QT) and Transgender Adolescents & Suicidality (CMAJ)

June 23, 2022 /

From the Editor

He smokes before bed to help with sleep; she finds that the edibles take an edge off from her lows.

Our patients routinely tell us about the benefits of cannabis for mood disorders. But is there any evidence in the literature? In the first selection from The Canadian Journal of Psychiatry, Dr. Smadar V. Tourjman (of the Université de Montréal) and her co-authors consider that question with a systematic review, drawing on data from 56 studies, focused on bipolar and major depressive disorders, for a CANMAT task force report. They conclude: “cannabis use is associated with worsened course and functioning of bipolar disorder and major depressive disorder.” We consider the paper and its implications.

In this week’s second selection, we look at new Quick Takes podcast interview with Dr. Thomas Insel (of the Steinberg Institute). Dr. Insel, a psychiatrist and former director of NIMH, speaks about the progress in neuroscience but the need for mental health reform. “We must think about more than just the classic medical model borrowed from infectious disease: simple bug, simple drug.”

Finally, in the third selection, Mila Kingsbury (of the University of Ottawa) and her co-authors consider the risk of suicidality among trangender and sexual minority adolescents; they draw from a nationally representative, cross-sectional survey. “Gender and sexual minority adolescents, particularly those who identify as transgender and gender-nonconforming, appear to be at greater risk of suicidal ideation and suicide attempt than their cisgender and heterosexual peers.”

There will be no Reading next week.

DG

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Reading of the Week: Suicide & Physicians – the New CJP Paper; Also, Cannabis and Psychiatry (BJP) and Tom Insel on Mental Health Care (Atlantic)

June 2, 2022 /

From the Editor

Despite what we may wish to believe, physicians are mortal. We can develop illnesses – even mental disorders. And some (too many) suicide. Past studies have shown that doctors die by suicide more than the general population. But the data wasn’t Canadian.

In the first selection, Dr. Manish M. Sood (of the University of Ottawa) and his co-authors consider suicide by Canadian physicians. In a new Canadian Journal of Psychiatry paper, they do a population-based, retrospective cohort study drawing on more than a decade and a half of data. They write: “Physicians in Ontario are at a similar risk of suicide deaths and a lower risk of self-harm requiring health care relative to nonphysicians.” We look at the paper.

In the second selection, Dr. Julia Jiyeon Woo (of McMaster University) and her co-authors review cannabis from the perspectives of clinicians and patients. In a new British Journal of Psychiatry paper, they note: “This growing discrepancy between clinicians’ and patients’ perspectives on cannabinoids can be extremely damaging to the therapeutic alliance.” They offer practical suggestions.

And in the third selection, Dr. Thomas Insel (of the Steinberg Institute) considers what’s right and what’s wrong with mental health care. As the director of NIMH, he oversaw $20 billion of funding; in his new book, excerpted in the pages of The Atlantic, he calls for mental health reform. He writes: “There are only two kinds of families in America: those who are struggling with mental illness and those who are not struggling with mental illness yet. To ensure that we serve all families well, we don’t necessarily need to know more to do better.”

DG

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Reading of the Week: Exercise & Depression – the New JAMA Psychiatry Paper; Also, Passes & Inpatients (CJP) and Dr. Khadilkar on Suicide (JAMA Neuro)

May 5, 2022 /

From the Editor

We often tell our patients about the importance of exercise. But how much exercise? And is this advice really evidence based?

In the first selection from JAMA Psychiatry, Matthew Pearce (of the University of Cambridge) and his co-authors consider exercise and depression with a systematic review and meta-analysis, drawing on data from more than 190 000 people. They conclude: “This systematic review and meta-analysis of associations between physical activity and depression suggests significant mental health benefits from being physically active, even at levels below the public health recommendations.” We consider the paper and its implications.

In the second selection, we look at a new research letter by Natalia Docteur (of the Sunnybrook Research Institute) and her co-authors. In The Canadian Journal of Psychiatry, they consider passes for inpatients, wondering about the effect on length of stay and re-admissions. Interestingly, they conclude: “Overall, passes were associated with poorer post-discharge outcomes including prolonged length of stay and increased psychiatric readmissions.”

Finally, in the third selection, Dr. Amole Khadilkar (of Indigenous Services Canada) writes about his mental health problems. In a deeply personal essay, he notes the challenges of residency and warns against the culture of stoicism. “This is an important lesson to anyone who may be contemplating suicide during what seems like an irreversibly hopeless point in their life. You never know what the next day, the next month, or the next year may bring.”

Please note that there will be no Reading next week.

DG


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Reading of the Week: Cancer & Suicide – the New Nature Medicine Paper; Also, Dr. Natasha Steele on Her Cancer (NEJM)

April 7, 2022 /

From the Editor

The big diagnosis. Even years after the fact and even in cases of good outcomes, so many still remember the exact moment when they were told that they had cancer. A patient once recalled with great detail the floor tiles in his doctor’s office (he couldn’t bear looking at his spouse or his doctor). He also remembered feeling so overwhelmed that suicide seemed like an option.

But what is the risk of suicide? In the first selection, Michael Heinrich (of the University of Regensburg) and his co-authors seek to answer that question, drawing on an impressive number of studies including more than 22 million patients. In a new paper for Nature Medicine, they report on a systematic review and meta-analysis; they found that “patients with cancer have an almost twofold increased risk of dying by suicide compared with the general population.” They write: “Despite immense progress in cancer therapy and prognosis in the past decades, suicide remains an important cause of death in patients with cancer.” We consider the paper and its clinical implications.

In the second selection, Dr. Natasha Z. Rabinowitz Steele (of Stanford University) considers her experiences in a New England Journal of Medicine paper. She writes about her cancer diagnosis and treatment, and the impact on her clinical work. She concludes: “Though all of our journeys will have beginnings and endings, our lives are what we choose to do with the precious, unpredictable, terrifying, and beautiful moments in between.”

DG


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Reading of the Week: Suicide and Ethnic Groups – the New Lancet Psychiatry Paper; Also, Cannabis & the Differential (JAMA Int Med)

December 9, 2021 /

From the Editor

Discrimination. Microaggression. Stigma. Patients in ethnic groups often face greater challenges and stresses than others. Do suicide rates differ? What are the implications for interventions?

These are good and important questions, yet the literature is thin. In a new paper for The Lancet Psychiatry, Isabelle M. Hunt (of the University of Manchester) and her co-authors consider suicide rates by ethnic group in the UK, focused on those who have had contact with mental health care. Drawing on a large database, they find lower rates of suicide completions compared to White patients, but significant variation among the different groups. The authors see potential clinical implications: “Clinicians and the services in which they work should be aware of the common and distinct social and clinical needs of minority ethnic patients with mental illness.”

fd1c8d415f97df29c61ed70a727e8974The Death of Socrates – and, yes, White patients died by suicide more

In the second selection, Dr. Anees Bahji (of the University of Calgary) and his co-authors consider cannabis use disorder in a patient who presents with cannabis hyperemesis syndrome. Their JAMA Internal Medicine paper is very practical; they suggest: “a multidisciplinary approach that incorporates psychotherapy, withdrawal symptom management, and close follow-up in the primary care setting is recommended for treatment of cannabis-related harms.”

DG

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Reading of the Week: Lithium – Anti-Suicidal Qualities? Also, Dr. Tim Graham on His Illness & Recovery (CMAJ)

November 25, 2021 /

From the Editor

Our patients complain about the hand tremor. Some feel fatigued when they take this medication. And toxicity is always a risk.

Lithium, in other words, is tough to work with – the Callas or Pavarotti of psychotropic medications, if you will. And yet, it’s arguably the best mood stabilizer, helping people with bipolar get back their lives. Some have gone so far as to claim that all of us should take a little lithium.

Among the purported benefits of lithium: anti-suicidal effects. But does this medication really help our suicidal patients? In a new paper, Dr. Ira R. Katz (of the University of Pennsylvania) and his co-authors ask this question, armed with an impressive dataset. In a JAMA Psychiatry paper, they report the findings of a double-blinded, placebo-controlled randomized clinical trial. “The addition of lithium to usual Veterans Affairs mental health care did not reduce the incidence of suicide-related events in veterans with major depression or bipolar disorders who experienced a recent suicide event.” We consider the paper and its clinical implications.

photo-1567693528052-e213227086bbLithium: the psychotropic that’s as old as the earth

In the second selection, Dr. Tim Graham (of the University of Alberta) writes about his training and work as an ED physician, and his burnout. In a raw, highly personal essay for CMAJ, he speaks about his suicidal thoughts – and the decision to get help. He writes: “If you die tomorrow, your employer will replace you, but your loved ones cannot.” Dr. Graham also offers some practical suggestions for staying well.

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

June 10, 2021 /

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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Reading of the Week: Suicide and Gender in Canada; Also, Access and Immigrants (CJP), and Chok on Variations on a Theme (CMAJ)

June 3, 2021 /

From the Editor

This week, we have three selections; all are from Canadian publications.

Suicide rates have been declining in this country. In the first selection, Sara Zulyniak (of the University of Calgary) and her co-authors look at suicide by age and gender, drawing on almost two decades’ worth of data. In their analysis, there is a surprising finding: “The suicide rates in females aged 10 to 19 and 20 to 29 were increasing between 2000 and 2018. In comparison, no male regression results indicated significantly increasing rates.” This research letter, just published in The Canadian Journal of Psychiatry, is short and relevant.

chair

In the second selection, also from The Canadian Journal of Psychiatry, Joanna Marie B. Rivera (of Simon Fraser University) and her co-authors consider access to care. They focus on immigrants and nonimmigrants, noting differences in the way care is provided for those with mood disorders. “People with access to team-based primary care are more likely to report mental health consultations, and this is especially true for immigrants. Unfortunately, immigrants, and especially recent immigrants, are more likely to see a doctor in solo practice or use walk-in clinics as a usual place of care.”

Finally, in our third selection from CMAJ, Dr. Rozalyn Chok (of the University of Alberta), a pianist who is now a resident of paediatrics, describes a performance at a mental hospital. “I still hear exactly how it sounded on that tinny upright piano. I feel the uneven weighting of the keys, remember how difficult it was to achieve the voicing – the balance of melody and harmony – I wanted.” She reflects on the piece she played, and its impact on a patient.

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)

March 25, 2021 /

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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