Tag: Telepsychiatry

Reading of the Week: Can Chatbots & AI Help Access? The new Nature Med Paper; Also, Telepsych in the US and the Latest in the News

February 15, 2024 /

From the Editor

More and more organizations use AI; today, a chatbot might assist you in ordering a pizza or tracking a package. But could a chatbot help our patients find the mental health care that they need? Could it help self-identified members of ethnic groups – who historically do less well in getting services – with access?

Johanna Habicht (of Limbic) and her co-authors try to answer these questions in a new study for Nature Medicine. They looked at the use of a chatbot for self-referral against the standard option in the UK’s NHS when patients seek psychological care. The resulting multisite observational study involved almost 130 000 people. They found that AI increased referrals (especially, in terms of diversity). “Here we demonstrate that digital tools can reduce the accessibility gap by addressing several key barriers.” We look at the study and mull its implications.

As we move past the pandemic, we ask: is virtual care routinely offered for mental disorders? In the second selection from JAMA Health Forum, Jonathan Cantor (of the RAND Corporation) and his colleagues consider mental telehealth – or telepsychiatry, to use the older term – in the United States. With a secret shopper approach, trained callers phoned more than 1 400 US clinics, posing as potential clients with mental health problems. They found most offered virtual care. Further: “There were no differences in the availability of mental telehealth services based on the prospective patient’s clinical condition, perceived race or ethnicity, or sex.”

And, finally, we explore the latest in the news with recent articles from The Guardian and The New York Times. Among the topics: the mental health struggles of rising political star Lina Hidalgo, privacy and mental health apps, and help for those with schizophrenia and homelessness in Cameroon.

DG

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Reading of the Week: Telepsych vs. In-Person Treatment – the new BJP Paper; Also, Rethinking Palliative Care in Psychiatry and Kemp on His Depression

September 21, 2023 /

From the Editor

When the pandemic started in 2020, the webcam sitting on my desk had barely been used. Of course, over the following days, it became an indispensable part of my outpatient practice as terms like “lockdown” and “Zoom fatigue” entered the common lexicon. 

As we move past the pandemic, questions arise. Who benefits from telepsychiatry? And who is better served with in-person visits? Katsuhiko Hagi (of the Sumitomo Pharma Co.) and co-authors attempt to answer these questions with a new systematic review and meta-analysis, just published in The British Journal of Psychiatry. They analyzed 32 papers, involving 3 600 people, across 11 mental illnesses. “Telepsychiatry achieved a symptom improvement effect for various psychiatric disorders similar to that of face-to-face treatment. However, some superiorities/inferiorities were seen across a few specific psychiatric disorders, suggesting that its efficacy may vary according to disease type.” We consider the paper and its implications.

In the second selection, Kwok Ying Chan (of Grantham Hospital) and his co-authors discuss palliative care. In a Viewpoint paper for JAMA Psychiatry, they note that some patients with severe mental illness could benefit from palliative care – yet such care is less available to those with mental disorders than the general population. They highlight challenges and then outline “a more sustainable model for the collaboration between palliative care and psychiatric teams.”

And in the third selection, health care executive Joe Kemp writes about his struggles with suicidal thoughts and substance misuse. In a deeply personal essay for the New York Post, he talks about turning around his life. “I can’t deny my drug-addled past, or that I’m a survivor of two suicide attempts. But I can proudly show the man I am today as someone who has dignity and self-respect; I’ve acquired the most important things to live a happy life. I just followed a different path to get here.”

DG

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Reading of the Week: Are Involuntary Admissions on the Rise? The New CJP Paper; Also, Telepsychiatry (JAMA Psych) and Dr. Oh on Suicide (Acad Psych)

November 3, 2022 /

From the Editor

A recent New York Times article notes that adolescents are increasingly looking for information on mental health and turning to TikTok. Such is life at a time when stigma fades: people are curious, though not necessarily going to the best places for information.

But are we reaching people earlier in their illness experience? We hope that the answer is yes – a new paper with British Columbian data, however, suggests that police apprehensions are more common, as are involuntary admissions, indicating that more people are in crisis. In the first selection from The Canadian Journal of Psychiatry, Jackson P. Loyal (of Simon Fraser University) and his co-authors draw on administrative databases and find a major shift: “While roughly half of the people hospitalized for mental health and substance use disorders were admitted voluntarily in 2008/2009, by 2017/2018 this fell to approximately one-third.” We look at the paper and its clinical implications.

British Columbia: a province of rivers, whales, and involuntary admissions

In the second selection, Dr. Carlos Blanco (of the National Institute on Drug Abuse, United States) and his co-authors consider the rise of telepsychiatry, noting that 39% of mental health care in the US is now virtual. In this new JAMA Psychiatry Viewpoint, “Expansion of telepsychiatry creates new opportunities to increase treatment access, while it poses overlapping challenges to multiple stakeholders…”

And in the third selection, Dr. Nicholas Zhenwei Oh (of the Ministry of Health Holdings, Singapore) writes personally and thoughtfully about the loss of a patient by suicide. He goes into detail on his own experience during training. “Patient suicide is possibly the great equaliser amongst psychiatrists, psychiatry trainees, and perhaps any other clinician who has experienced a patient’s suicide. My own experience came suddenly and unexpectedly, and it will likely leave a psychological scar as a grim reminder of one of the lowest points of my career.”

DG

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Reading of the Week: Buprenorphine for Opioids – the New AJP Paper; Also, Cannabis & Hospitalizations (CJP) and Dr. Rosenberg’s Career & Illness (NYT)

August 11, 2022 /

From the Editor

A rise in substance use. Staff shortages and burnout. Waits for care.

The problems of the pandemic on mental health care have been clear and unfortunate. But how has care changed – and possibly improved – over the pandemic? In the first selection, Lewei Lin (of the University of Michigan) and her co-authors look at buprenorphine treatment before and during the pandemic. In a new paper for The American Journal of Psychiatry, they find a shift in care and a success story: “The number of patients receiving buprenorphine continued to increase after the COVID-19 policy changes, but the delivery of care shifted to telehealth visits…” We consider the paper and its clinical implications.

In the second selection, drawing on Canadian data, Chungah Kim (of Brock University) and her co-authors look at cannabis legalization and cannabis-related hospitalizations. In this new Canadian Journal of Psychiatry brief report, they find: “the initial legalization was followed by clinically significant increases in cannabis-related hospitalizations; however, the subsequent increase in retail stores, availability of cannabis edibles, and COVID-19 pandemic was not associated with a further increase in hospitalizations in Ontario.”

In the third selection, we consider the life and legacy of Dr. Leon E. Rosenberg with the obituary from The New York Times. Dr. Rosenberg had a storied career – a pioneer in genetics research, a dean of Yale, and the chief science officer at Bristol Myers Squibb. He’s also a person who had bipolar disorder and took lithium. “I am proof that it is possible to live a highly successful career in medicine and science, and to struggle with a complex, serious mental illness at the same time.”

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

DG


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Reading of the Week: TikTok is Popular & Cool But Good Mental Health Information? Also, Telemedicine and Practice (Psych Services)

March 3, 2022 /

From the Editor

Clever cats. Cool dancing videos. Tips on everything from calligraphy to home decorations.

A billion people are estimated to use TikTok on a monthly basis. The social media platform is incredibly popular here – and around the globe. And, as with other social media, people increasingly use it as a source of medical information.

To date, little research has been done on the credibility of that information. In a new Canadian Journal of Psychiatry paper, Dr. Anthony Yeung (of the University of British Columbia) and his co-authors focus on ADHD. They find uneven results: “In this analysis of popular TikTok videos about ADHD, there were over 2.8 million views per video and each video was shared on average 31,000 times. Approximately half of the videos analyzed (52%) were misleading…” We consider the paper and its clinical implications.

Continuing on the theme of technology and practice, in the second selection, we look at a new Psychiatric Services paper. Lori Uscher-Pines (of the RAND Corporation) and her co-authors do a qualitative analysis of why psychiatrists choose telemedicine for some patients and not others. The authors conclude: “psychiatrists did not perceive intermittent in-person visits as essential for high-quality care.”

DG

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Reading of the Week: Clozapine Prescribing & Demographics; Also, HBR on Equity in Telemedicine, and Eichler on Her Uncle & His Disappearances

October 21, 2021 /

From the Editor

Is clozapine prescribing effected by demographics?

In the first selection, from Psychiatric Services, Natalie Bareis (of Columbia University) and her co-authors consider medication prescriptions for those with psychotic disorders, drawing on US Medicaid data. “Our results indicate significant variation across states and among racial-ethnic groups in prescription patterns of six types of psychotropic medications, even after we had adjusted for multiple patient factors.” Indeed, they find that clozapine is much more commonly prescribed for those who are White. We consider the paper and its implications.

unknownClozapine: a simple molecule but complicated availability in the US?

In the second selection, Dr. Jonathan Rogg (of the University of Texas) and his co-authors consider equity and telemedicine. In a paper for the Harvard Business Review, they describe the services offered in a low-income area of Texas, and the lessons learned. “The Covid-19 pandemic has forced a rapid evolution in technology with the potential to help the most disadvantaged patients. Our experience during the pandemic has demonstrated that telemedicine can overcome access-related challenges faced by indigent populations. By allowing them to access care in their homes or even their jobs, it can help them address health issues expeditiously with minimal disruption to their lives.”

Finally, in the third selection from The Globe and Mail, writer Leah Eichler writes about her uncle, who probably had an undiagnosed mental illness. She writes about his disappearances and erratic behaviour. “We like to believe our relationships are solid, that love is somehow inextricably linked to permanence. Missing our loved ones, if anything, highlights how impermanent even our closest relationships can be.”

Please note that there will be no Reading next week.

DG

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Reading of the Week: Telepsychiatry – the Reality, the Potential, the Problems

September 16, 2021 /

From the Editor

Just a handful of months ago, mental health work didn’t require a webcam or a lighting ring, and no one talked about Zoom fatigue. The world is different now, obviously. With COVID-19, telepsychiatry is very much part of our clinical work.

This week, we consider three papers focused on telepsychiatry and our new world.

How widespread is the adoption of telepsychiatry in this pandemic era? In the first selection, Jonathan Cantor (of the RAND Corporation) and his co-authors draw on a big American database to answer that question. In Psychiatric Services, they write: “During the COVID-19 pandemic, the percentage of outpatient mental health and substance use disorder treatment facilities offering telehealth has grown dramatically. However, our analyses also indicated that considerable proportions of mental health and substance use disorder treatment facilities still did not offer telehealth as of January 2021…”

theapy

In the second selection, John C. Fortney (of the University of Washington) and his co-authors consider two different types of care: with psychiatrists directly involved in patient care (through televideo) or indirectly, by providing support to primary care. In a JAMA Psychiatry study, they do a comparison. Spoiler alert: both approaches were effective, suggesting great potential, especially for those in rural areas.

Of course, not everyone is enthusiastic about telepsychiatry. In our third selection, Dr. J. Alexander Scott (of the University of Michigan), a resident of psychiatry, describes his ambivalence. His Academic Psychiatry paper starts memorably: “Admittedly, I’ve never liked telemedicine.” He outlines some of the problems with our digital world.

DG

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Reading of the Week: How Has Mental Health Changed Over COVID? Also, Goldbloom on Practice & the Pandemic (Globe) and a Reader Responds to Psilocybin

May 13, 2021 /

From the Editor

Even our language has changed. Last winter, we didn’t think about lockdowns and the term social distancing was confined to sociology textbooks. The world is different.

And in our new reality, we can ask: How has the pandemic affected mental health? While there have been many small surveys (and much speculation), until now we have lacked a major, large scale survey.

This week, we look at a new paper from The Lancet Psychiatry. Matthias Pierce (of the University of Manchester) and his co-authors draw on the UK Household Longitudinal Study – a large, national survey that offers us pandemic and pre-pandemic data. The good news: “Between April and October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels…” but they also found that one in nine people in the UK “had deteriorating or consistently poor mental health.” We consider the big study and discuss resilience with an essay by Dr. Richard A. Friedman (of Cornell University).

covid-pic

In the second selection, we consider an essay by Dr. David Goldbloom (of the University of Toronto) on how the pandemic has changed psychiatry. He focuses on the biggest change: that is, the embrace of virtual care. He begins: “We are all telepsychiatrists now…” He notes the advantages and disadvantages of the transformation. While some providers express ambivalence, he writes: “What counts, ultimately, is what helps our patients.”

Finally, a reader responds to our take on The New England Journal of Medicine paper on psilocybin. Dr. Craig P. Stewart (of Western University) writes: “One area I did not see mentioned in the psilocybin paper review was a discussion of confirmation bias, which I believe also should be mentioned to contextualize the results.”

DG

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Reading of the Week: Our Pandemic Reality – How It Affected Our Patients, How It Changed Our Practice, How It Changed Us

March 18, 2021 /

From the Editor

A year ago this week, provinces across the country ordered the first lockdown. In the days that followed, I remember driving to the hospital and noting the eerie quiet of the streets with almost no cars or trucks on the morning commute.

Now, a year later, we can ask some questions. How has the pandemic affected our patients? How did it change our practice? How has it changed us?

This week, we have four selections that explore our pandemic reality.

screen-shot-2020-04-16-at-12-07-01-pm

We begin by focusing on patients. In the first selection, we look at a paper from Annals of Internal Medicine. Dr. Jonathan S. Zipursky (of the University of Toronto) and his co-authors consider alcohol sales and ED visits. They find that there was an increase in alcohol sales of 38% at the start of the pandemic. They write: “Higher alcohol sales during the lockdown are worrisome because alcohol consumption can cause poor judgment, medical complications, and immune suppression.”

In the second selection, we consider an editorial from BMJ. Though some have predicated a significant increase in suicide completions, there is little evidence. Still, the authors write: “We must remain vigilant and responsive, sharing evidence early and internationally… in these evolving uncertain times.”

Then we pivot and look at providers. In the third selection, Dr. Daniel Guinart (of Hofstra/Northwell) and his co-authors report on the findings of a survey on telepsychiatry. “In this study, we report highly favorable attitudes toward telepsychiatry in its diverse forms, across a large and wide array of mental health care professionals.”

In the fourth selection, Andrea Frolic (of McMaster University) talks about the pain of the past year. After breaking a toe, she notes about the psychological injuries of our pandemic life. “As a health care leader, I am supposed to be a cheerleader, a silver-lining finder, an opportunity-seeker – a hero, not a human.”

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Some good news: the Reading of the Week was just awarded the Ivan Silver Innovation Award by Continuing Professional Development of the University of Toronto’s Faculty of Medicine. Many thanks to Drs. Rajeevan Rasasingham and Sanjeev Sockalingam for the nomination.

But I’m committed to developing this program further, not resting on our laurels – in late April, we will be conducting focus groups to better understand what works and what needs improvement. Interested in being involved? Please contact smit.mistry@camh.ca. Time commitment: under one hour.

DG

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Reading of the Week: Psychotherapy at a Distance; Also, Rakoff Remembered (Globe) and Horton on Her Brother (LA Times)

October 15, 2020 /

From the Editor

Mental health care has markedly changed since the pandemic began. What is the impact of COVID-19 on psychotherapy?

This week, we have three selections.

In the first, published in The American Journal of Psychiatry, Dr. John C. Markowitz (of Columbia University) and his co-authors write about psychotherapy and virtual care. The paper reviews the literature and also considers practical considerations. They note: “Therapists should acknowledge the crisis, and perhaps that teletherapy is a limited substitute for more direct contact.”

computer-image

In the second selection, reporter Wency Leung writes about Dr. Vivian Rakoff, who died earlier this month. In the Globe obituary, Leung writes about his various roles, including as psychiatrist-in-chief of the Clarke Institute (now part of CAMH). “To the many he inspired, he is remembered for his extraordinary intellect, kindness, sense of wonder and the agility with which he wove together ideas from a vast range of disciplines, from classic literature and philosophy to politics and pop culture.”

Finally, in our third selection, we consider an essay by Dr. Jillian Horton (of the University of Manitoba). In this LA Times essay, the internist writes about her brother and his mental illness, discussing the emotional and geographic distance of their relationship. “My brother died 40 years ago and he died in April.”

DG

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