Tagvirtual care

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

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: Does COVID Affect Outcomes? Also, Depression & Behavioural Economics (JAMA Psych), and Crawford on Virtual Care (Walrus)

From the Editor

As we head into the second wave, are there lessons from the spring?

This week, we have three selections.

In the first, published in The Lancet Psychiatry, Dr. Seung Won Lee (of the Sejong University College of Software Convergence) and co-authors look at mental illness and COVID-19 in South Korea. Doing a cohort study, drawing on national databases, they wonder about diagnosis and clinical outcomes for those with mental illness. “Diagnosis of a mental illness was not associated with increased likelihood of testing positive for SARS-CoV-2.” It’s a big finding – but is it relevant on this side of the Pacific?

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Can we nudge patients with depression to take medications? In the second selection, we look at a new JAMA Psychiatry research letter. Steven C. Marcus (of the University of Pennsylvania) and his co-authors offer financial incentives for medication compliance. They conclude: “In this pilot study, escalating incentives for daily antidepressant adherence significantly improved adherence compared with a control group during the critical first 6 weeks of treatment.”

Finally, in our third selection, we consider an essay by Dr. Allison Crawford (of the University of Toronto) from The Walrus. She writes about the change in mental health care with COVID-19, as virtual care has become the norm. “I take off my shoes so that I can enter softly and with an open heart. My patients can’t see my bare feet.”

DG

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Reading of the Week: What Can Past Coronaviruses Teach Us? Also, Sharing Notes (Lancet Psych) & Sediqzadah on Therapy in a Digital World (Globe)

From the Editor

As we consider the psychiatric needs arising from COVID-19, are there lessons to be drawn from past severe coronavirus infections?

The first selection seeks to answer that question.

In The Lancet Psychiatry, Dr. Jonathan P. Rogers (of the University College London) and his co-authors do a systematic review and meta-analysis of severe coronavirus infections with a focus on psychiatric presentations. They included papers covering SARS and MERS. “This review suggests, first, that most people do not suffer from a psychiatric disorder following coronavirus infection, and second, that so far there is little to suggest that common neuropsychiatric complications beyond short-term delirium are a feature.”

sars-clinic

Should mental health notes be shared with patients? In the second selection, we look at paper from The Lancet Psychiatry. Charlotte R. Blease (of Harvard Medical School) and her co-authors champion the idea. “Sharing clinical notes in mental health settings will be more complex than in other clinical specialties; however, for most patients it will be feasible and, if carefully implemented, an empowering tool that could improve care.”

Finally, we consider an essay from The Globe and Mail. Dr. Saadia Sediqzadah (of the University of Toronto), who is graduating from her psychiatry residency this month, discusses her training and the expectation that patients “present to the clinic.” Now practicing in a COVID-19 world, she writes about psychotherapy and her patients. “What would Freud say? I care less about that as we now contend with a very different world than his. The question I ask now is, how will we go back?”

DG

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