Tag: Sweden

Reading of the Week: Antipsychotics – Good for Work Ability? Also, Mental Health Research Funding (CJP) and Murdoch on Her Career (CBC)

January 19, 2023 /

From the Editor

As clinicians, we often think about symptoms and symptom scales – important measures of a patient’s journey. Patients may focus on other things, like functionality, including employment.

Do antipsychotics help those with psychosis for their ability to work? Do some antipsychotics provide more advantage than others? Dr. Marco Solmi (of the University of Ottawa) and his co-authors try to answer these questions in a new American Journal of Psychiatry paper. They draw on Swedish databases involving more 21,000 people. They conclude: “Among individuals with first-episode nonaffective psychosis, antipsychotic treatment (with long-acting injectables in particular) was associated with about 30%–50% lower risk of work disability compared with nonuse of antipsychotics in the same individuals, which held true beyond 5 years after first diagnosis.” We consider the paper and its clinical implications.

In the second selection, Florence Dzierszinski (of the University of Ottawa) and her co-authors look at mental health research funding in Canada. In a Commentary for The Canadian Journal of Psychiatry, they argue that funding is lacking and, in fact, declining. They write that: “Adequate research funding could go a long way to addressing prevention, care, and treatment for the one in four Canadians who experience mental health problems in a given year, improving outcomes for individuals and for Canada’s society and economy.”

And in the third selection, published by CBC First Person, Darleen Murdoch talks about her career and retirement – and her diagnosis. She notes that, during her first hospitalization decades before, she was told by her physician she would never work. She writes: “In my own way, I have proven to the medical field that ‘miracles’ can happen.”

DG

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Reading of the Week: Is ‘New’ Overrated? Antipsychotics in the Real World

June 22, 2017 /

From the Editor

Is new better?

You may be reading this on an iPhone 7, having driven to work this morning in a 2017 Hybrid Prius. So should your patients be taking a medication that became available four-and-a-half decades ago – when people drove gus-gusling eight-cylinder Oldsmobiles and smartphones didn’t even exist in science fiction novels.

This week, we look at a just-published JAMA Psychiatry paper which promises to look at the “real-world” effectiveness of antipsychotics. The authors tapped Swedish databases to consider outcomes for nearly thirty thousand people with schizophrenia.

Sweden: elaborate welfare state, beautiful historic buildings, and – yes – rich databases

Spoiler alert: new wasn’t better. That is, newer antipsychotics tended to underperform clozapine and depot medications.

We also look at similar “real-world” work drawing from a Finnish database considering treatment of depression.

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Reading of the Week: Schizophrenia & Diabetes: The Gap in Care; Also, Swedish Health Care

April 6, 2017 /

From the Editor 

“The pain in my feet. It’s killing me.”

That’s what John told me when I asked him what he needed help with. It’s not quite the answer I thought he’d give – John has schizophrenia and he has significant side effects from his medications. But, like many people with mental illness, he also struggles with physical illness (diabetes and the accompanying neuropathy).

Many of our patients have both physical and mental illnesses. When faced with these twin challenges, how do they fair?

In this week’s first selection, we look at a new paper that considers people with schizophrenia and diabetes. The study authors find a significant gap between the care received by those with and without mental illness.

insulinAn old drug, an old illness, and a big problem for those with mental illness

In our second selection, drawing from a lively blog written by medical student Ali Damji, we look at Swedish health care.

DG
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Reading of the Week: Depression and Primary Care (Depression: Week 2 of 3)

September 17, 2015 /

Depression is a common psychiatric disorder and a major contributor to mortality and morbidity worldwide. Over the past decade in Sweden, work absence because of mental ill health has risen markedly and depression is a major factor. Substantial societal costs are associated with the disorder, which affects up to 15% of the population at any one time and tends to be recurrent. There are compelling reasons to investigate alternative treatments for depression. Although effective treatments exist, most people with the disorder never seek professional help. Among those that do, only half appear to benefit. Adherence with medication is often poor and waiting times for cognitive–behavioural therapy (CBT) can be lengthy, resulting in more entrenched symptoms and a worse long-term prognosis. As general medical practitioners are frequently the main care providers for depression, treatment options that are non-stigmatising, have few side-effects and can readily be prescribed in community healthcare settings are needed.

So begins a new paper that considers depression treatment in Sweden. These issues sound very familiar. Reading over this list of problems – the burden of illness, the inaccessibility of care, etc. – we could replace Sweden with Canada. And that’s why this paper is so relevant to us.

This week’s Reading: “Physical exercise and internet-based cognitive–behavioural therapy in the treatment of depression: randomised controlled trial” by Mats Hallgren et al., which was just published in the British Journal of Psychiatry.

Mats Hallgren

A quick summary: this is a smart paper seeking ways to improve the treatment of depression in the primary care setting. How to achieve better results? Hallgren et al. consider exercise and Internet-based CBT, and compare such interventions to the usual care. Continue reading