TagThe Globe and Mail

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

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.”

*            *            *

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

Continue reading

Reading of the Week: Mass Murder & Mental Illness – the New Psych Med Study; Also, Vaccinations in the EU (Lancet Psych), and Domise on MAiD and His Illness

From the Editor

“Mental illness may have been a factor.”

It’s just seven words, but they so often accompany reports of mass murder. And psychosis is mentioned more often than not. The message is clear: mental disorders, particularly psychotic disorders, are highly tied to violence.

In the first selection, we look at a new paper that reviews 120 years worth of mass murder, and distinguishes between gun violence and non-gun violence. Just published in Psychological Medicine, Gary Brucato (of Columbia University) and his co-authors have written an extraordinary paper. They also reach an important conclusion: “These results suggest that policies aimed at preventing mass shootings by focusing on serious mental illness, characterized by psychotic symptoms, may have limited impact.” We look at the big paper.

flag_at_half_mast_super_portrait

In the second selection, from The Lancet Psychiatry, Dr. Livia J. De Picker (of the University of Antwerp) and her co-authors consider European countries and vaccination prioritization, with a focus on mental disorders. “Only four countries (Denmark, Germany, the Netherlands, and the UK) had some form of higher vaccination priority for outpatients with severe mental illness.”

And, in the third selection, writer Andray Domise considers mental illness and medical assistance in dying. In a personal essay for The Globe and Mail, he raises objections. Start here: he would have opted to die when he was unwell. He argues the whole legislative approach is wrong: “This is a country that continues to fail in respecting the humanity of people with disabilities. And rather than find strength of character to improve ourselves, the Canadian government is set to fall back on egregious historical precedent by offering death instead.”

DG

Continue reading

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?

97748107

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

Continue reading

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

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

Continue reading

Reading of the Week: Cannabis for Mental Illness (CJP)? Also, Cannabidiol for the Cannabis Use Disorder (Lancet Psych) & Love on the Police (Globe)

From the Editor

“Should I take cannabis for my mental illness?”

Our patients ask this question – in our EDs, inpatient wards, and outpatient clinics. We shouldn’t be surprised. Cannabis is now legal, and private industry pushes the medicinal benefits of cannabis. But what does the literature say?

This week, we have three selections.

The first is a new Canadian Psychiatric Association position statement that considers cannabis and mental illness. Dr. Philip G. Tibbo (of Dalhousie University) and his co-authors systematically reviewed the literature. They found 29 RCTs, including for anxiety and psychotic disorders. “Use of cannabis or a cannabinoid product should never delay (or replace) more evidence-based forms of treatment.”

marijuana-candy-sizedMany products, little evidence?

But is there emerging evidence for cannabis? Tom P. Freeman (of the University College London) and his co-authors did a phase 2a trial using CBD to address cannabis use disorder, which is written up in The Lancet Psychiatry. “In the first randomised clinical trial of cannabidiol for cannabis use disorder, cannabidiol 400 mg and 800 mg were safe and more efficacious than placebo at reducing cannabis use.”

Finally, on a pivot, in the third selection, we consider an essay from The Globe and Mail. Rebeccah Love writes about her own experiences with psychosis and her recovery. She also considers whether police should be involved in mental health crises. “The image of a police officer – often a big white man with a gun – is interpreted as a threat, an agent of death, an oppressor.”

DG

Continue reading

Reading of the Week: Apps for the Treatment of Depression (JAMA Psych)? Also, Cannabis & Driving (CJP); Oleynikova on Returning to School (Globe)

From the Editor

The world changed on March 11, the day that the pandemic was declared by the WHO. So did mental health care, with so many of our services becoming virtually delivered. But what’s effective and what should be incorporated into care moving forward?

This week, we have three selections.

The first is a new JAMA Psychiatry paper. With COVID-19, apps are becoming increasingly popular (one therapy app reports a 65% increase in clients over the spring). Can the apps be incorporated into primary care? Andrea K. Graham (of Northwestern University) and her co-authors do a RCT using apps for patients with depression and anxiety. They conclude: “In this trial, a mobile intervention app was effective for depression and anxiety among primary care patients.” But should we be so enthusiastic? And how could apps be used in care?

app-application-application-software-applications

Canada legalized cannabis for non-medical purposes in 2018. In a short research letter – our second selection – medical student Laura A. Rivera and Dr. Scott B. Patten (both of the University of Calgary) consider driving under the influence of cannabis, drawing on national survey data. “Public policy actions toward prevention of DUIC [driving under the influence of cannabis] appear necessary and will have the greatest impact if they are effective in the 15 to 24 age range and in males.”

Finally, in the third selection, we consider an essay from The Globe and Mail. Like many, Vera Oleynikova thinks about the return to school. She writes about her own experiences, noting a complication: she has struggled with depression. “To be sick for a long time and then to feel well again is a magical thing. You feel brand new and capable of anything. You marvel at your own capacity to do the things that for a long time were unavailable to you because of your illness. Which is why going back to school at 31 felt so right.”

DG

Continue reading

Reading of the Week: COVID & Mental Health (NEJM); also, Helping Health Workers (CMAJ) and Caring Contact for the Elderly (Globe)

From the Editor

This week’s Reading – like the last few – focuses on the latest in the literature on COVID and mental health care with three selections. As life with the pandemic continues, more and more journals have published about it, with some discussing the implications for mental health services.

In the first selection, we consider a paper on mental health services and the pandemic. In a NEJM paper, Drs. Betty Pfefferbaum (of University of Oklahoma Health Sciences Center) and Carol S. North (University of Texas Southwestern Medical Center) argue for an integrated and measured approach. In responding to COVID, they advocate that: “already stretched health care providers have an important role in monitoring psychosocial needs and delivering psychosocial support to their patients, health care providers, and the public – activities that should be integrated into general pandemic health care.”

coronavirus,3d render

How can we help health workers? In the second selection, we consider a new CMAJ paper by Dr. Peter E. Wu (of the University of Toronto)and co-authors. They write: “Taking care of ourselves is vital so that we may continue to take care of others.”

Finally, in the third selection, we look at a news article from The Globe and Mail. Reporter Erin Anderssen describes how “caring contacts,” a psychiatric intervention, is used by volunteers to connect with the elderly. “The spontaneous initiatives expanding now are prompted more by what we instinctively know: Human contact motivated purely by compassion is essential to our well-being.”

DG

Continue reading

Reading of the Week: COVID-19 & Mental Health (Lancet Psych); Also, Depression & Online Mindfulness (JAMA Psych) and Help for Youth (Globe)

From the Editor

Earlier this week, a patient mentioned that, until recent events, he hadn’t heard of Wuhan, China. Today, it would seem, we are all familiar with this city.

Much reporting and commentary have focused on infections and deaths. But what are the psychiatric implications of the outbreak? This week, we have three selections. In the first, we look at a short and thoughtful paper from The Lancet Psychiatry that tries to answer this question. Dr. Yu-Tao Xiang (University of Macao) and his colleagues note: “In any biological disaster, themes of fear, uncertainty, and stigmatisation are common and may act as barriers to appropriate medical and mental health interventions.”

coronavirus-s1-what-is-coronavirus

In the second selection, we review a new study that uses an online mindfulness-based cognitive therapy aimed at patients with residual depressive symptoms, involving 460 participants. Zindel V. Segal (University of Toronto) and his co-authors find that the intervention “resulted in significant improvement in depression and functional outcomes compared with [usual depression care] only.”

And in the third selection, Drs. Pier Bryden and Peter Szatmari, both of the University of Toronto, discuss their new book. They open their Globe essay with a simple question: “What can I do to help my child?”

DG

Continue reading

Reading of the Week: Too Few Psychiatrists? Anderssen on the Gap in Access (Globe); Also, Cuijpers on Success in Depression Treatment (Expert Review)

From the Editor

After a break, the Readings are back. In the coming weeks, we will consider important papers on depression treatment, cannabis, help for the homeless, and more.

This week, there are two selections.

In the first selection, we consider the new Globe and Mail essay by reporter Erin Anderssen on the supply (or the lack of supply) of psychiatrists across Canada. This essay does a sparkling job of pulling together stories and reports, and includes an overview of the literature. It paints a familiar, if unsettling, picture of need unmatched by availability, and includes interviews and original data analysis.

She writes: “The modern psychiatrist can’t be everywhere. So they should be where Canadians need them most.”

We summarize the essay and some of the larger questions raised.

anderssenErin Anderssen

In the second selection, the Vrije Universiteit Amsterdam’s Pim Cuijpers writes about depression and treatment. Thinking about successful care, he asks a simple question: “When patients seek treatment, is a reduction of depressive symptoms really what they want, or do patients have other goals as well?”

DG

Continue reading

Reading of the Week: Better PTSD Symptom Control, Less Diabetes (JAMA Psych)? Also, Buckley on Cannabis (Quick Takes), and the Life of Kajander (Globe)

From the Editor

Better PTSD symptom control, less diabetes? How do we talk to our patients about cannabis (and cannabis use disorder)? Who was Dr. Ruth Kajander?

This week, there are three selections. The first two deal with timely and relevant topics: the intersection of physical and mental health and the use of cannabis post-legalization. The third reminds us of the youth of our field.

In the first selection, Saint Louis University School of Medicine’s Jeffrey F. Scherrer and his co-authors consider PTSD and diabetes, asking if improvement with the mental health disorder results in a lower risk of type 2 diabetes. Drawing on Veterans Health Affairs data involving nearly 1 600 people, they find that “clinically meaningful reductions in PTSD symptoms are associated with a lower risk of type 2 diabetes.”

treating-ptsd-may-help-reduce-risk-of-type-2-diabetes-696x464

In the second selection, we draw on a podcast interview with the University of Toronto’s Dr. Leslie Buckley, the chief of addictions division at CAMH, on cannabis. What advice would she give clinicians about cannabis use? “Try to have that long conversation with [patients] about their use and make sure that they know the harms – because I feel like most people don’t.”

Finally, with an eye on yesterday and not today, we look at the recent Globe obituary for Dr. Ruth Kajander, a psychiatrist who served in many roles, and was a member of the Order of Canada.

DG

Continue reading