TagThe British Journal of Psychiatry

Reading of the Week: Health Care Workers’ Mental Health – There’s an App for That; Also, Treating Opioids (BMJ) & Dr. Bhushan on Her Bipolar (LA Times)

From the Editor

With the pandemic dragging on, health care workers report more and more burnout; some complain of depression and anxiety.

What could help? Dr. Sam N. Gnanapragasam (of King’s College London) and his co-authors consider an app designed to provide CBT and mindfulness techniques in a new British Journal of Psychiatry paper. The RCT study involves 16 English sites with over 1000 health care workers. They conclude: “our study suggests that the app was of modest benefit with no adverse effects for a sample of HCWs in England.” We look at the paper.

How to respond to the opioid crisis? In a new analysis paper for BMJ, Dr. Robert A. Kleinman (of the University of Toronto) and his colleagues argue for a different approach to the prescribing of opioid agonist therapy, drawing on the changes made in response to the pandemic. “Embracing a more flexible model of buprenorphine-naloxone dosing would allow better alignment of prescribing practices with the needs and preferences of clients.”

And in the third selection, Dr. Devika Bhushan writes about bipolar disorder for the Los Angeles Times. The essay is very personal: the pediatrician, who serves as California’s acting surgeon general and graduated from Harvard, describes her own experiences. As she notes, during her training, she “had a secret.” Now, however, she speaks openly about her illness. “Today, I live with bipolar disorder as a chronic and manageable health condition.” 

DG

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

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

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: Resilience after Disaster – Lessons from Japan; Also, Schizophrenia & Spending (CJP) and Dr. Brandeland on Her Father & His Addiction (JAMA)

From the Editor

My patient was involved in a terrible car accident. Though physically unharmed, she’s never really recovered (mentally). Her co-worker, sitting in the seat beside her, barely took off any time from work.

Why are some people resilient and others aren’t?

In The British Journal of Psychiatry, Dr. Taku Saito (of the National Defense Medical College) and his co-authors explore this question, focusing on a natural disaster. Drawing on an impressive database of first responders involved in the 2011 Japanese earthquake rescue/recovery effort, they do a seven-year prospective cohort study. They find: “The majority of first responders… were resilient and developed few or no PTSD symptoms.” Of course, some did develop mental health problems. The risk factors? Older age, personal disaster experiences, and working conditions. We consider the big paper.

In the second selection, Andrew J. Stewart (of the University of Calgary) and his co-authors analyze health spending in a new Canadian Journal of Psychiatry paper. They focus on people with schizophrenia, looking at a 10-year period. “Healthcare spending among patients with schizophrenia continues to increase and may be partially attributable to growing rates of multimorbidity within this population.”

And, in the third selection, Dr. Megan Ann Brandeland (of Stanford University) writes about her father’s death. In JAMA, she discusses his struggles and notes that – early in his career as a physician – a patient had a tragic outcome. “My hope in sharing this story is to encourage more physicians to share their own stories, to reduce the stigma around mental health, trauma, and addiction among physicians, and to honor my father’s life and the goodness he brought to the world.”

Please note that there will be no Reading next week; we will resume on 31 March 2022.

DG

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Reading of the Week: Helping Healthcare Workers Seek Help; Also, Smoking Cessation for Inpatients & Priebe on Why Patients Should Be Called Patients

From the Editor

How do we connect with them?

With the worst of the third wave now behind us, we are beginning to look forward. But for some, the problems of the pandemic aren’t fading. They will continue to struggle with mental health problems.

Healthcare workers are particularly at risk. They are also, collectively, a group that is difficult to engage. In the first selection, we look at a new paper from The British Journal of Psychiatry. Dr. Doron Amsalem (of Columbia University) and his co-authors do a video intervention to increase treatment seeking. The resulting RCT is impressive. The authors write: “The high proportion of healthcare workers surveyed in this study who reported symptoms of probable generalised anxiety, depression and/or PTSD emphasises the need for intervention aimed at increasing treatment-seeking among US healthcare workers. A three-minute online social contact-based video intervention effectively increased self-reported treatment-seeking intentions among healthcare workers.”

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In the second selection, Richard A. Brown (of the University of Texas at Austin) and his co-authors look at a new approach to an old problem: high smoking rates among people with severe mental illness. Focusing on inpatient hospitalizations, they design an intervention built on motivational interviewing. We consider their JAMA Psychiatry paper.

Is the term patient antiquated? Should we use other terms, like client or service user? In a BJPsych Bulletin paper, Dr. Stefan Priebe (of Queen Mary University of London) argues that we serve patients – and that words matter. “Mental healthcare is based on shared values and scientific evidence. Both require precise thinking, and precise thinking requires an exact and consistent terminology.”

DG

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Reading of the Week: Are Benzodiazepines Misunderstood? Also, Lizotte on Mental Health Support, and The Lancet on Those Doctors Lost to COVID

From the Editor

In a recent conversation with a resident, we discussed benzodiazepines. “I’ve never prescribed one,” he explained.

This class of medications is very much out of fashion. But, after decades of overuse, have we swung to the other extreme, and forgotten an important tool in our pharmacologic toolkit? In the first selection, we consider a British Journal of Psychiatry editorial. Dr. Edward Silberman (of Tufts University School of Medicine) and his co-authors argue that benzodiazepines are underappreciated. The selection ties well into a commentary that recently appeared in The American Journal of Psychiatry. Dr. Jerrold F. Rosenbaum (of Harvard Medical School) writes: “My own son, a first-year resident in psychiatry, looks at me as if I served on the wrong side in the Spanish Civil War when I speak of benzodiazepines.” Is there a clinical takeaway here?

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In the second selection, writer and comedian Andrew Lizotte discusses the challenges of being a patient in our mental health system. He shares some jokes – but, ultimately, notes ongoing stigma and power imbalances. “We see how mental illness is portrayed in the media. We are scared of being shot by police during a ‘routine health check.’ We see the lack of empathy. Then people wonder why we don’t ask for help.”

Finally, with an eye on COVID-19, we look at a short paper in The Lancet about those doctors who have lost their lives in the pandemic. “These lives are also a reminder of the ongoing dedication and service of those who continue to care for patients at a time when COVID-19 cases and deaths are increasing in many countries.”

DG

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Reading of the Week: Can Light Therapy Help with Bipolar Depression? Also, the Racism of COVID (BJP) & Gottlieb on the Toilet as the New Couch (NYT)

From the Editor

After his manic episode, the first patient I treated with bipolar disorder was low in mood for months, able to get out of bed, but not able to work. I remember him sitting in my office talking about feeling overwhelmed. For many people with bipolar disorder, the depressive episodes are long and debilitating. And for us clinicians, these episodes are difficult to treat. (I remember feeling overwhelmed, too.)

Can light therapy help?

The first selection seeks to answer that question. Light therapy, after all, has shown its utility in depression, including for those with a seasonal pattern to their lows. But bipolar depression? In a new Canadian Journal of Psychiatry paper, Dr. Raymond W. Lam (of UBC) and his co-authors do a systematic review and meta-analysis. They included seven papers. “This meta-analysis of RCTs found positive but nonconclusive evidence that light therapy is efficacious and well tolerated as adjunctive treatment for depressive episodes in patients with BD.”

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Is the virus racist? In the second selection, we look at a provocative paper from The British Journal of Psychiatry written by Drs. Anuj Kapilashrami and Kamaldeep Bhui (both of Queen Mary University of London). Considering how COVID-19 affects certain groups more than others, they also note that mental illness is more common among minorities, and they argue that: “societal structures and disadvantage generate and can escalate inequalities in crises.” They offer a word of caution: “What is surprising is it takes a crisis to highlight these inequalities and for us to take note, only to revert to the status quo once the crisis is over. ”

Finally, we consider an essay from The New York Times. Lori Gottlieb, a psychotherapist, discusses her practice in a world of pandemic. “Suddenly, her sobs were drowned out by a loud whooshing sound.” She wonders if the toilet is the new couch.

DG

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Reading of the Week: How to Achieve Good Mental Health During Isolation (BJP)? Also, Bipolar Meds (AJP) & Qayyum on the Way to the Morgue (WBUR)

From the Editor

Millions of people are isolating themselves in North America, and across the world. We know that quarantine is linked to mental health problems like depression. So what advice should we be giving our patients – and our family and neighbours?

The first selection seeks to answer this question.

In The British Journal of Psychiatry, Rowan Diamond (of Warneford Hospital) and Dr. John Willan (of Oxford University Hospitals NHS Foundation Trust) provide six suggestions, drawing from the literature and taking into account our collective situation. “Dame Vera Lynn, at the age of 103, said of this pandemic that ‘even if we’re isolated in person we can still be united in spirit,’ and the sense of purpose that may be engendered in self-isolation may paradoxically lead to improvements in the mental health of some individuals who may otherwise feel that they have lost their role in society.”

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How are we managing bipolar affective disorder? In the second selection, we look at a new American Journal of Psychiatry paper by Taeho Greg Rhee (of the University of Connecticut) and his co-authors, who draw on 20 years worth of data. “There has been a substantial increase in the use of second-generation antipsychotics in the outpatient psychiatric management of adults diagnosed with bipolar disorder, accompanied by a decrease in the use of lithium and other mood stabilizers.”

Finally, in the third selection, Dr. Zheala Qayyum (of the US Army) considers her time working in New York City during the pandemic. “The first thing that struck me when I stepped into the hospital in Queens was the smell that hung in the air, in these seemingly sterile hospital corridors. It was death and disease.”

DG

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Reading of the Week: Should Medical Education Stay in Its Lane? Goldfarb Argues Yes; Also, Problems in Youth (BJP) & Medical Memoirs (Lancet Psych)

From the Editor

What’s the best way of training future doctors?

Medical education has changed much over the years – schools across the country embraced the McMaster model, then cooled to it; efforts have been made to revisit core curriculum topics and add in more timely ones.

In the first selection, the University of Pennsylvania’s Dr. Stanley Goldfarb – a former associate dean of curriculum at the Perelman School of Medicine – bemoans the state of medical education. Controversially, he argues in The Wall Street Journal: “Curricula will increasingly focus on climate change, social inequities, gun violence, bias and other progressive causes only tangentially related to treating illness.”

Is he right? We discuss the essay and responses to the essay.

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In the next selection, we look at a new British Journal of Psychiatry paper. Drawing on a large dataset, the University College London’s Jessica Deighton and her co-authors study the rate of psychiatric problems among youths. “Findings reported here indicate the scale of mental health problems in children across many schools in England is much higher than previous estimates…”

And in the third selection, Dr. Linda Gask, a British psychiatrist, considers autobiographies written by physicians. “These stories can, in turn, inspire, impress, inform, engage, and even shock through the sharing of personal conflict and confessions…”

DG

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Reading of the Week: A Statin a Day Keeps the Doctor Away? The New Hayes et al. JAMA Psych Paper

From the Editor

Statins can help prevent MIs in people with high cholesterol. Can they also prevent psychiatric admissions for those with schizophrenia?

The question may seem odd, but there is evidence that statins can reduce symptoms in people with schizophrenia – though the evidence is light. That may not be as surprising as it seems: statins are anti-inflammatories, and a growing literature suggests neuro-inflammation is involved in major mental illness.

So should our patients receive medications like statins? The concept of repurposing common medications has gained attention.

This week, we look at a paper just published in JAMA Psychiatry. In their study, University College London’s Joseph F. Hayes and his co-authors consider the effect of statins, calcium channel blockers, and biguanides (such as metformin). Spoiler alert: they find that these medications reduce psychiatric hospital admissions and self-harm in people with serious mental illness.

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In this Reading, we review the new paper about the not-so-new meds. We also take a quick look at another paper (on ketamine).

DG

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