Tag: The American Journal of Psychiatry

Reading of the Week: What’s New in Psychotherapy – The Cuijpers et al. Paper

September 29, 2016 /

From the Editor

What’s new in psychotherapy?

If there is one area of psychiatry that seems to have been transformed in recent years, it’s psychotherapy. Not surprisingly, then, past Readings have looked at the expanded role of short-term, evidenced-based therapies – in particular, Cognitive Behavioural Therapy, or CBT.

Today’s psychotherapy: a long way from Freud

Over the next two weeks, we’ll look in more detail at new developments in psychotherapy.

This week. A major new review of IPT.

Next week. An overview of psychotherapy developments.

This week, we consider a new paper published in The American Journal of Psychiatry on Interpersonal Therapy, or IPT. This paper is clear, lucid, and worth reading.

Is there evidence for IPT? Yes – and more than just for depression.

DG Continue reading

Reading of the Week: Can We Prevent Psychosis? Part 1 of 2

July 7, 2016 /

From the Editor

Here’s a quick statistical summary of the Readings for the past 12 months.

Total: 48.

Number discussing the prevention of mental illness: One.

Is an ounce of prevention really worth a pound of cure?

Like all of medicine, psychiatry tends to emphasize the treatment of illness, not its prevention. This isn’t the result of a vast medical-industrial conspiracy, of course, but the reality that our field is young and the causes of mental illness aren’t well understood.

But preventing illness is our ultimate goal. Consider the suffering and cost that could be avoided if a person at risk of psychosis didn’t convert, as an example.

Can we prevent psychotic illness?

Prevention is built on two things: we need to identify at risk individuals, and then we need to use appropriate measures to prevent the illness.

Over the next two weeks, we look at a few papers that seek to identify at risk individuals and prevent psychosis in them.

This week. The psychosis risk calculator.

Next week. Cost-effective prevention.

In this week’s paper from The American Journal of Psychiatry, Cannon et al. develop a risk calculator to predict psychotic disorder. The tool they develop has an accuracy rate of 71% – comparable to calculators used for determining cancer recurrence.

DG Continue reading

Reading of the Week: Battling The Black Dog

May 12, 2016 /

From the Editor

This week, hundreds of thousands of Canadians will not go to work because of mental health problems, depression being the most common.

But despite the long shadow cast by depression on our society, it’s difficult not to feel that we fall short in terms of our active management. Many people struggle with their symptoms; even when they can beat the “black dog” – to use Winston Churchill’s term – they are at high risk for relapse.

Can we do better with the black dog?

Here are two papers that look at bettering outcomes.

In the first, the authors ask if mindfulness can prevent the relapse of depression. The second paper considers the use of statins to improve the effects of antidepressants.

DG Continue reading

Reading of the Week: Depression and Measurement-Based Care (Depression: Week 1 of 3)

September 10, 2015 /

Major depression is common, leading to marked suffering for patients and families and causing physical and mental disability, with a substantial economic burden. Although major depression is prevalent across different cultures and effective pharmacological and psychosocial interventions are available, low remission rates in clinical practice are discouraging. Poor outcomes are related to inadequate dose and duration of pharmacotherapy, poor treatment adherence, high dropout, and frequent as well as unnecessary medication changes. In addition, inconsistency of treatment strategies among clinicians is common. Even in current, guideline-driven practice, there are often wide variations in clinicians’ behaviors, resulting in practice bias rather than a tailored and individualized treatment algorithm.

So opens a new paper that has a large goal: trying to reduce that “wide variation” and improve patient care.

This week’s Reading: “Measurement-Based Care Versus Standard Care for Major Depression: A Randomized Controlled Trial With Blind Raters” by Tong Guo et al., just published online (and ahead of print) by The American Journal of Psychiatry.

Find the paper here:

http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2015.14050652

Here’s a quick summary: big study, big journal, and big implications for depression management (and, yes, your patients). In a head-to-head comparison, patients did better when depression management included an algorithm for medications rather than regular psychiatrist care. Continue reading