Tag: The Lancet Psychiatry

Reading of the Week: After COVID – the New Lancet Psychiatry Paper; Also, Clark on Therapy (QT) and Physicians, Heal Thyselves (JAMA Net Open)

September 1, 2022 /

From the Editor

The first reported cases were almost three years ago. Yet, with this pandemic, many questions remain. No wonder. The patient experience is so varied. Some of our patients complain of time-limited, mild symptoms. Others seem affected by ongoing, non-physical symptoms. And many haven’t had any symptoms.

How common are neurological and psychiatric problems? Do they last? Are they less common with newer variants? This week, in the first selection, we consider a new Lancet Psychiatry paper; Max Taquet (of the University of Oxford) and his co-authors try to answer these questions and others. Drawing on the health records of almost 1.3 million people with a recorded diagnosis of COVID-19 and focusing on 14 different outcomes (including anxiety and mood disorders) across eight nations, they find: “post-COVID neurological and psychiatric outcomes followed different risk trajectories: the risk of cognitive deficit, dementia, psychotic disorder, and epilepsy or seizures remained increased at 2 years after a COVID-19 diagnosis, while the risks of other diagnoses (notably, mood and anxiety disorders) subsided early and showed no overall excess over the 2-year follow-up.” We look at the paper and its clinical implications.

In this week’s second selection, we consider a new Quick Takes podcast interview with David Clark (of the University of Oxford). Prof. Clark speaks about IAPT, the UK’s program to expand access to psychotherapy, which he co-founded. “We’ve still got some distance to go, though, but the IAPT services are seeing about a million people a year who wouldn’t have previously had psychological therapy.”

Primary care has an essential role in our health care system. In the third selection, Emily Rhodes (of the Ottawa Hospital Research Institute) and her co-authors mull physicians and their personal connection to primary care in a new JAMA Network Open paper. They find: physicians are less likely to be rostered with family docs, and less likely to visit them. They conclude: “Emphasis on the importance and improvement of access to primary care for physicians is a potential means to improve overall health for physicians and patients.”

DG

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Reading of the Week: ECT & Suicide – the New Lancet Psych Paper; Also, Violence & Psych Trainees (Acad Psych) and Dr. Murthy on Burnout (NEJM)

July 21, 2022 /

From the Editor

In a recent survey, 20% identified fear of death as a major concern with ECT. One of the oldest treatments in psychiatry is also its most stigmatized and feared.

And is it also underappreciated? Is ECT a lifesaver for those who are suicidal? In the first selection, Dr. Tyler S. Kaster (of the University of Toronto) and his co-authors attempt to answer that question with a propensity score-weighted, retrospective cohort study comparing those who received ECT and those who didn’t, using Ontario data. In The Lancet Psychiatry, they write: “1 year after discharge from a psychiatric hospital, patients with depression who were exposed to electroconvulsive therapy had a nearly 50% reduction in the relative risk of death by suicide when compared with those who had not been exposed.” We consider the paper and its clinical implications.

We aren’t talking about candy

In the second selection, Dr. Victor Pereira-Sanchez (of the New York University) and his co-authors look at violence against European psychiatric trainees. In this Academic Psychiatry paper, drawing on survey data, they conclude: “Violence from patients is reported by many psychiatric trainees across countries in Europe, with very frequent verbal abuse and worrisome figures of physical and sexual assaults.”

Finally, in the third selection, Dr. Vivek H. Murthy (the US Surgeon General) writes about burnout and American health care workers. In The New England Journal of Medicine, he offers a practical plan, with an emphasis on reducing administrative burden, bettering mental health for health care workers, and changing culture to support well-being. He argues that action is needed: “we cannot allow ourselves to fail health workers and the communities they serve.”

DG

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Reading of the Week: Equity & Mental Health Care – Post-Partum Follow Up After ED Visits (Lancet Psych) and Race and Prescribing (Psych Services)

April 21, 2022 /

From the Editor

We often speak of the challenges patients face in accessing mental health care. But, of course, such challenges may vary greatly, depending on demographics – think rural versus urban, young versus older, White versus non-White. How equitable is care? This week, we look at two new papers; one draws on Canadian data while the other on American. And though the studies are different, they point in a similar direction: unique populations face significant challenges accessing care.

In the first selection, Dr. Lucy C. Barker (of the University of Toronto) and her co-authors consider follow-up after an ED visit for patients in the post-partum period. In a new Lancet Psychiatry paper, they drew on Ontario databases, with more than 12 000 visits analyzed. They write: “Fewer than half of emergency department visits for a psychiatric reason in the post-partum period were followed by timely outpatient care, with social-determinants-of-health-based disparities in access to care.” We consider the paper and its implications.

In the second selection, Jocelyn E. Remmert (of the U.S. Department of Veterans Affairs) and her co-authors consider depression care and race. In a new Psychiatric Services paper, they look at antidepressant prescribing, finding big differences between White and Black veterans. “Among veterans, Black patients were almost two times less likely than White patients to have an antidepressant prescription, even after the analyses controlled for depression symptoms, demographic characteristics, psychosocial variables, and other clinical symptoms.”

DG

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Reading of the Week: Cool but Useful? VR Therapy for Psychosis; Also, Preventing Child Abuse (QT) and Renaming Schizophrenia (Lancet Psych)

April 14, 2022 /

From the Editor

Asking for a coffee. Passing strangers on a bus. Making eye contact at a grocery store. These tasks don’t seem particularly daunting but for those with major mental illness, they can be deeply unsettling. Some are left homebound.

In this week’s first selection, we look at a new Lancet Psychiatry paper by Daniel Freeman (of Oxford University) and his co-authors; in it, they detail an intervention where participants work through several tasks, like the ones named above. The coolness factor? It’s done through virtual reality (or VR). They find: “Automated VR therapy led to significant reductions in anxious avoidance of, and distress in, everyday situations compared with usual care alone.” We consider the paper and the larger implications.

Passing strangers on a bus: one of several tasks in gameChange

In the second selection, we weigh prevention in mental health care. Ainslie Heasman (of the Center for Addiction and Mental Health) joins me for a Quick Takes podcast interview. We discuss Talking for Change, which aims to prevent child sexual abuse with evidence-based interventions focused on high-risk populations – that is, “moving prevention upstream” in the words of the psychologist.

Finally, in the third selection, Dr. Bruce M. Cohen (of Harvard University) and his co-authors consider psychiatric terms, noting that some are outdated. In a Lancet Psychiatry paper, they discuss schizophrenia and personality disorders. They write: “Any label can stigmatise, and there are no perfect terms, but that should not prevent changing to better ones. Words communicate how we conceptualise a disorder.”

DG

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Reading of the Week: Suicide and Ethnic Groups – the New Lancet Psychiatry Paper; Also, Cannabis & the Differential (JAMA Int Med)

December 9, 2021 /

From the Editor

Discrimination. Microaggression. Stigma. Patients in ethnic groups often face greater challenges and stresses than others. Do suicide rates differ? What are the implications for interventions?

These are good and important questions, yet the literature is thin. In a new paper for The Lancet Psychiatry, Isabelle M. Hunt (of the University of Manchester) and her co-authors consider suicide rates by ethnic group in the UK, focused on those who have had contact with mental health care. Drawing on a large database, they find lower rates of suicide completions compared to White patients, but significant variation among the different groups. The authors see potential clinical implications: “Clinicians and the services in which they work should be aware of the common and distinct social and clinical needs of minority ethnic patients with mental illness.”

fd1c8d415f97df29c61ed70a727e8974The Death of Socrates – and, yes, White patients died by suicide more

In the second selection, Dr. Anees Bahji (of the University of Calgary) and his co-authors consider cannabis use disorder in a patient who presents with cannabis hyperemesis syndrome. Their JAMA Internal Medicine paper is very practical; they suggest: “a multidisciplinary approach that incorporates psychotherapy, withdrawal symptom management, and close follow-up in the primary care setting is recommended for treatment of cannabis-related harms.”

DG

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Reading of the Week: Is ECT Really Safe? The New Lancet Psychiatry Paper; Also, Antrim on His ECT (New Yorker)

August 26, 2021 /

From the Editor

Is it safe?

The first treatment of electroconvulsive therapy (ECT) was administered in 1938. Yet decades later, people still debate the safety of this treatment; a study found that one in five patients reported fear of death as a major concern. (And, yes, so many of our patients have seen that movie.)

In our first selection, we consider a new and important paper on this topic, just published in The Lancet Psychiatry. Dr. Tyler S. Kaster (of the University of Toronto) and his co-authors attempt to answer the safety question by comparing those who received ECT with those who didn’t in the context of depression and inpatient care. “In this population-based study of more than 5000 admissions involving electroconvulsive therapy for inpatients with depression, the rate of serious medical events within 30 days was very low among those exposed to electroconvulsive therapy and a closely matched unexposed group (0.5 events per person-year vs 0.33 events per person-year), with those who received electroconvulsive therapy having a numerically lower risk of medical complications.” We look at the big study, with an eye on clinical implications.

ect-1945ECT machine (cira 1950)

In the other selection, we look at a new essay from The New Yorker. Writer Donald Antrim – an accomplished novelist and a MacArthur fellow – discusses his depression, his suicidal thoughts, and his decision to opt for ECT. He notes that after treatment: “I felt something that seemed brand new in my life, a sense of calm, even happiness.”

DG

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Reading of the Week: A Therapy for Pandemic Loneliness? Also, Getting Digital Psychiatry Right (Lancet Psych) and the History of Vaccines (NEJM)

April 1, 2021 /

From the Editor

I saw an older patient in the emergency room recently. He described feeling overwhelmed. Fearful of the pandemic, he explained that he had rarely left his apartment since it began. “I’m so isolated.”

Many find themselves in a similar situation. What could help? In a new JAMA Psychiatry paper, Maninder K. Kahlon (of The University of Texas at Austin) and co-authors describe a focused intervention involving laypeople doing an empathy-focused program by phone. Do the calls work? They found it reduced loneliness, anxiety, and depression. They note the potential: “The use of lay callers, deliberate but brief approach on training, and the use of ubiquitous telephones made the approach easily deployable and scalable.”

dock-mod

In an editorial, The Lancet Psychiatry considers our digital moment. Though they note the trendiness of the idea of digital psychiatry, they urge us to push: “Come 2 years or 20, we want to stop talking about digital psychiatry’s potential for improving public mental health and start marking its clear clinical progress.”

Finally, in our third selection, we look at a new paper from The New England Journal of Medicine. Drs. Angela Desmond and Paul A. Offit (both of the University of Pennsylvania) consider the history of vaccines, and look ahead: “With the recent authorization of mRNA vaccines, we have entered the fifth era of vaccinology.”

Please note that there will be no Reading next week.

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On a pivot –

Since 2014, the Reading of the Week has been providing summaries and commentary on the latest in the psychiatric literature. Two years ago, we conducted a short survey to get your feedback. We are hoping to get feedback again to improve the Readings.

We would like to invite you to join one of our online focus groups to hear your opinions and suggestions. If you are interested in participating, please email smit.mistry@camh.ca by April 12 with your preferred time slots from the following options – psychiatrists: April 21 at 4 pm or April 22 at 4 pm; residents: April 28 at 4 pm and April 29 at 4 pm. (Note: all times are in EST.) Time commitment: under an hour. If the above time slots do not work for you, please email Smit to arrange an interview time at your convenience, preferably between April 21 and April 30, 2021.

DG

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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

March 4, 2021 /

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

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Reading of the Week: More COVID, More Mental Health Problems? Also, e-Cigarette Use (CJP) and Pappas on Her Olympics & Her Depression (NYT)

December 17, 2020 /

From the Editor

Will there be a pandemic after the pandemic? Some have wondered about the mental health consequences of COVID-19 – speculating that, in the future, there will be significant mental health problems. In a recent JAMA paper, Simon et al. argued: “The magnitude of this [mental health] second wave is likely to overwhelm the already frayed mental health system, leading to access problems, particularly for the most vulnerable persons.” (That paper was discussed in a past Reading.)

In the first selection, we consider a new paper from Lancet Psychiatry. Kuan-Yu Pan (of Vrije Universiteit) and co-authors did a survey of people with psychiatric disorders, as well as people without. “We did not find evidence that there was a strong increase in symptoms during the COVID-19 pandemic in those with a higher burden of disorders. In fact, changes in scores from before to during the pandemic indicated increasing symptom levels in people without mental health disorders, whereas changes of symptom levels were minimal or even negative in individuals with the most severe and chronic mental health disorders.” Should we be reassured by the Pan et al. study?

Alcohol sanitizer and medical mask with copy space,Corona virus,Covid-19 prevention.Protection from physical health problems, but mental health?

In the second selection, we consider a research letter from Dr. Scott B. Patten (of the University of Calgary) and his co-authors. Drawing on survey data, they describe the pattern of use of e-cigarettes, noting that they were originally intended for harm reduction. “In 2017, 15.5% of e-cigarette users reported that they had never smoked, suggesting a de novo pattern of substance use. By 2019, this proportion had more than doubled to 36.7%.”

Finally, in the third selection, Olympian Alexi Pappas speaks about her mental health in a New York Times opinion video. The comments are very personal, and touch on her illness and recovery. “After the Olympics, I was diagnosed with severe clinical depression. And it nearly cost me my life. But it doesn’t have to be that way.”

Please note that there will be no Reading for the next two weeks. Enjoy the holidays. And if you are looking for a last-minute gift for, perhaps, Hanukkah or Christmas or a way to thank co-workers after a tough year, consider CAMH’s Pet Therapy Calendar, available for just $15 (with the promotion code). Proceeds go to a good cause: the CAMH Volunteer Resources Pet Therapy Program. The calendar is beautifully done, and features great dogs, including Toulouse (my BFF). Here’s the link: https://store-camh.myshopify.com/products/pvol-cal.

DG

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

September 17, 2020 /

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

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