Mental Health In-Patient & Staff Summer BBQ 2017

moose-burgers-bbq-581x338

Tis’ the season to be Q’ing!!!!

Back by popular demand, the In-Patient MH services will be holding its annual Summer BBQ.

For the past 6 years during the summer months our Mental Health Team spends a lunch with our in-patients enjoying burgers and various summer dishes on the 3C patio.

All of this was birthed to improve our relationships with our patients during a season where being cooped up in a hospital during our short Canadian summers can be increasingly depressing.  Not only do staff enjoy a break from the normal daily grind, but our patients also enjoy this event veering away from the usual hospital experience.  Here at TSRH we strive to improve the patient experience and Mental Health is one department where our patients always come first.

This years summer BBQ kicks off on Friday, June 30th on our wonderful 3C patio.  Like previous years our kick off party will feature musical performances from various former in-patients.  Food will be cooked by our resident BBQ master, Michael M.  And to spice this up for this years kick off party we will be having staff bring in various dishes/desserts to share ala potluck style.

Hope to see you all there!!!

When:  Friday, June 30, 2017 @ 1200hrs

Where:  3C (Birchmount) Patio

Following Dates throughout the summer:  July 14th, 18th & August 11th, 25th.

bbq

Reading of the Week: Is ‘New’ Overrated? Antipsychotics in the Real World

From the Editor

Is new better?

You may be reading this on an iPhone 7, having driven to work this morning in a 2017 Hybrid Prius. So should your patients be taking a medication that became available four-and-a-half decades ago – when people drove gus-gusling 8-cylinder Oldsmobiles and smartphones didn’t even exist in science fiction novels.

This week, we look at a just-published JAMA Psychiatry paper which promises to look at the “real-world” effectiveness of antipsychotics. The authors tapped Swedish databases to consider outcomes for nearly thirty thousand people with schizophrenia.

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Sweden: elaborate welfare state, beautiful historic buildings, and – yes – rich databases

Spoiler alert: the authors found that new wasn’t better. That is, newer antipsychotics tended to underperform clozapine and depot medications.

We also look at similar “real-world” work drawing from a Finnish database considering treatment of depression.

DG

 

Antipsychotics and Outcomes

“Real-World Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of 29 823 Patients With Schizophrenia”

Jari Tiihonen, Ellenor Mittendorfer-Rutz, Maila Majak, Juha Mehtälä, Fabian Hoti, Erik Jedenius, Dana Enkusson, Amy Leval, Jan Sermon, Antti Tanskanen, Heidi Taipale

JAMA Psychiatry, 7 June 2017 Online First

http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2629295

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“The comparative effectiveness of antipsychotic treatments for patients with schizophrenia has remained controversial despite extensive research. Results from randomized clinical trials (RCTs) suggest that clozapine, olanzapine, and amisulpiride are superior to other antipsychotic medications in terms of efficacy. However, the most efficacious drugs such as clozapine and olanzapine frequently induce adverse effects, such as weight gain and dyslipidemia, which may result in severe deterioration of health after long-term treatment. Investigation of these adverse effects or associated outcomes such as hospitalization and death requires thousands of patients and several years of follow-up to achieve enough statistical power, which is not possible for RCTs.

 

“Another major issue in RCTs is the selection of patients. Those included in RCTs represent an atypical minority of the patient population because up to 80% to 90% of patients are excluded because of refusal, substance abuse, suicidal or antisocial behavior, or mental or physical comorbidity. Especially problematic is the comparison of oral antipsychotic medications vs long-acting injections of antipsychotic medications because patients with the poorest adherence (ie, those who would receive the greatest benefit from long-acting injectable antipsychotic medications) are excluded from RCTs because participation is fully voluntary. Because RCTs include only an atypical fraction of the most adherent patients, they do not provide information on the real-world effectiveness of the antipsychotic treatments.”

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Jari Tiihonen

So opens a new paper by Tiihonen et al. In this paper, the authors make an observational study, drawing on national databases. This approach isn’t unique – the authors acknowledge past work shows better outcomes for clozapine, olanzapine and long-acting depot medications – but such work has had the problem of selection bias.

They attempt to address this:

“We aimed to overcome this problem by using within-individual analysis, in which each person is his or her own control. In this approach, the exposure periods of each individual are compared with the nonexposure periods of the same individual. Therefore, the only factors that need to be adjusted are those that change as a function of time, such as time since cohort entry, temporal order of exposure periods, and concomitant medications.”

Here’s what they did:

  • “We used nationwide register-based data to conduct a prospective population-based cohort study of patients with schizophrenia…”
  • Drawing on Swedish databases, they looked at people with a diagnosis of schizophrenia between July 1, 2006, to December 31, 2013. Inclusion criteria included “all individuals residing in Sweden who were 16 to 64 years of age in 2006.”
  • Data on medication use was drawn from the Prescribed Drug Register – which includes outpatient medication, though no inpatient prescriptions. (!)
  • They considered outcomes as follows: “psychiatric rehospitalization” and “treatment failure” (defined as rehospitalization, discontinuation or switch to other antipsychotic medication, or death).
  • They did a more complicated statistical analysis – that is, they used within-individual Cox proportional hazards regression model. “The within-individual model is a stratified Cox proportional hazards regression model in which each individual forms his or her own stratum.” They also looked at covariables.

 

Here’s what they found:

  • There were 29,823 patients.
  • Demographically: more men than women (12,822 women and 17,001 men). The mean age was 44.9.
  • “13,042 of 29,823 patients (43.7%) experienced psychiatric rehospitalization and 20,225 of 28,189 patients (71.7%) had treatment failure.”
  • In terms of drugs used: Oral olanzapine was the most frequently used drug, and zuclopenthixol the most frequently used as a long-acting injectable antipsychotic medication.”
  • In terms of rehospitalization: “The lowest risk of rehospitalization was observed for once-monthly long-acting injectable paliperidone (HR, 0.51), long-acting injectable zuclopenthixol (HR, 0.53), clozapine (HR, 0.53), long-acting injectable perphenazine (HR, 0.58), and long-acting injectable olanzapine (HR, 0.58).” See figure below.
  • In terms of treatment failure: “The lowest risk of treatment failure was observed for clozapine (HR, 0.58), and the second lowest was seen for all long-acting injectable antipsychotic medications (HRs, 0.65-0.80), whereas the highest risk was seen for levomepromazine (HR, 1.15).” See figure below.

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Adjusted Hazard Ratios (HRs) and 95% CIs for Psychiatric Rehospitalization During Monotherapy Compared With No Use of Antipsychotic in Within-Individual Analyses in the Prevalent Population

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Adjusted Hazard Ratios (HRs) and 95% CIs for Treatment Failure During Each Monotherapy Compared With Oral Olanzapine Use

“Our results from a large nationwide cohort show that clozapine and long-acting injectable antipsychotic medications are substantially more effective than other antipsychotics in reducing the risk of rehospitalization or any treatment failure. The most consistent findings were observed for clozapine, being the first in rank order in most of the analyses. These results are in line with those of previous cohort studies using traditional between-individual analyses, although the effect sizes differed to some extent, especially for comparisons between long-acting injectable antipsychotic medications and corresponding oral formulations. Our results showed that the risk of rehospitalization was 22% lower during treatment with long-acting injectable antipsychotic medications compared with treatment with equivalent oral formulations in the total cohort and 32% lower in the incident cohort of newly diagnosed patients.”

 

A few thoughts:

  1. This is a good study, drawing on a huge dataset – not dozens of people with schizophrenia, or even hundreds, but tens of thousands.

 

  1. The findings are strong. Let’s not mince our words: new isn’t necessarily better. Of the five best performing medications for treatment failure that were studied, four were old. And, yes, clozapine topped that list. Depot medications were very strong in terms of rehospitalizations, with robust results for drugs that pre-date Atari’s Pong (the first and only video game in 1972), like perphenazine; though it should be added that paliperidone (new) did the best.

 

  1. There are implications here for practice – how many newly diagnosed patients are on depot medications? There are also implications in terms of health systems – does funding and billing schedules reward depot choices over non-depot choices? Dare I ask about clozapine?!?

 

  1. Has similar work been done for depression? Actually, Lancet Psychiatry has a solid paper with a very similar analysis. That’s not exactly surprising since Tiihonen is the first author. (Wow, he’s having a good month, at least compared to Theresa May.) In this study, he and his co-authors tap Finnish databases. I will quickly summarize “Pharmacological treatments and risk of readmission to hospital for unipolar depression in Finland: a nationwide cohort study”: they looked at the risk of readmission for all patients who had at least one hospitalization for depression, with data from almost 125,000; exclusion criteria included schizophrenia and bipolar. They found: “Lithium use was associated with a lower risk of re-admission to hospital for mental illness than was no lithium use.” Yes, lithium – speaking of older medications, this one is as old as the earth.6
  1. In the accompanying editorial, Allan H. Young of King’s College is enthusiastic about the findings, but calls for more investigation into lithium:

 

“Replication of these findings is needed, and should be possible given that similar databases exist in other countries (e.g., Denmark and Taiwan). These data could be easily assessed to establish whether they replicate the Finnish findings or not. The findings of Tiihonen and colleagues are particularly noteworthy because of recent disquiet about the use of antidepressants in unipolar mood disorders, and they suggest that lithium monotherapy might be the best long-term prophylactic drug.”

 

  1. Big data is changing psychiatry.

 

Reading of the Week. Every week I pick articles and papers from the world of Psychiatry. 

Dr. David Gratzer

 

MSW Seminar Series

It has been an exciting time here at Scarborough Rouge Hospital (SRH) over the past few months. Considering SRH’s commitment to clinical social work education, the department of mental health has been fortunate to have several wonderful Master of Social Work (MSW) students join our team for practicum placements.  These students, along with their field instructors have had and will continue to have a huge impact on our clients, colleagues and the Scarborough community at large.

Recently, a new initiative, entitled, ‘MSW Seminar Series’ has taken off!

What is the MSW Seminar Series?

Recognizing the importance of clinical education, MSW students from the mental health department are invited to gather for one hour each month to openly discuss practicum experiences.  Students are encouraged to discuss how theoretical classroom learning is applied in front line clinical work.  Student are asked to engage in self- reflective practices in order to identify areas of desired and continued development as this seminar series is a place for learning and development to take place.  Given that MSW students are our soon to become colleagues, Jawad B, MSW Educational Coordinator and Melissa D, Social Worker at AOP create an open, fun and warm environment which serves to empower students to  discuss new insights, improvement opportunities and to ask questions!

In the process of continued development and implementation, the MSW Seminar Series provides students the opportunity to increase their knowledge on quality-based social work standards.  Seminars provide pertinent knowledge about Evidence Based Practices and the importance of same in clinical practice, research and policy.  Given that on-going evaluation and feedback is something that us social workers value, student feedback is sought at the conclusions of each seminar.  This feedback is thoroughly taken into consideration as development and implementation of this program continues

-Melissa Donohue, Social Worker

1st Break 2nd Break

1st Break

 

Treatment at Ontario mental health facility  was ‘Torture,’ judge rules. -Toronto Star

An Ontario court has ruled that a provincial mental health facility ran therapeutic programs for years that amounted to torture for the patients involved.

Justice Paul Perell’s ruling came in the midst of a lengthy lawsuit filed by past and present residents of the Oak Ridge division of the Penetang Psychiatric Hospital in Penetanguishene that alleges patients were gravely mistreated. Continue to article….

Ontario mental-health services struggling to keep up with youth demand, report finds – The Globe and Mail

A new report on children and youth mental health and addiction in Ontario paints a bleak picture of the challenges facing today’s youth and the difficulties the health-care system has had in adapting to increased demands. Continue to article…

Demand for youth mental health services is exploding.  How universities and business are scrambling to react – Toronto Star

At age 18, Kimberly could no longer come up with a reason to live.

The Toronto university student locked the door to her parents’ garage, stepped onto a stool in the middle of the room and looped an electrical cord around her neck.

“It’s something I couldn’t explain,” recalls Kimberly, who asked that her last name not be published. “I didn’t understand what was going on in my head . . . You want to give up.”Continue to article…

 

 

2nd Break

Toronto Zoo could open soon after tentative deal reached – BlogTO

The Toronto Zoo might not stay closed for the whole summer, so you’ll finally get a chance to see all the adorable baby animals that now call the zoo home.

The Zoo has been closed to the public since May 11 after around 400 employees, who are members of CUPE Local 1600, walked off the job. Continue to article…

Toronto is finally moving ahead to combat overdose crisis – Torontoist

Despite having developed and approved the Overdose Action Plan to tackle the deepening opioid crisis in Toronto back in March, the City of Toronto has taken steps to now fund the plan, as delays from the province have forced the City to “triage.” Continue to article…

The rise and fall of Toronto’s classiest con man – The Walrus

It was the morning before Canada Day 2016, and James Regan needed somewhere to live. A distinguished, even handsome, man of sixty-two with silver hair and a trim moustache, Regan presented himself at the ­Chestnut Park Real Estate office, a luxury brokerage in the heart of Summerhill, one of Toronto’s most desirable neighbourhoods. Smartly dressed, he approached the receptionist and inquired about renting an apartment. Continue to article…

3 in the Key (May/June)

This months edition of 3 in the Key is special.  Previous editions of this segment focused on front line staff and will continue to do so in the future.

But this month we focus on 3 Mental Health Management members.

1 new Director, 1 new Manager and 1 well known manager who is known to be the biggest Rafael Nadal fan in the UNIVERSE!

So what does eating raw lobster on a Cuban fishing trip, tossing undergarments at a Tom Jones concert and a Car wash/detailing service for staff have in common?  

Lets find out in this months 3 in the Key….

(**Click on any of the RED underlined links for more information**)

Ping R. (Patient Care Manager for In-Patient Mental Health at the Birchmount Campus, 3B/3C/PIOU)

ping

What is your best childhood memory?

Playing with makeshift toys, nothing fancy.

Who would play you in the movie adaptation of your life?

A Chinese actress– Sylvia Chang

What do you feel most proud of?

Baked a non-deflated Chiffon cake

If you could travel anywhere, where would you go and why?

The mysterious Machu Picchu

What are your top three favorite books and why?

All books in Chinese (English links provided)

Dream of the Red Chamber

Journey to the West

Fortress Besieged

If you were prime minister, what is the first thing you would do?

Revisit the legalization and regulation of Cannabis

What is your favorite part of your job?

Opportunities to make staff proud of their work

How long have you worked at TSH?

5 months

How would your friends describe you?

Very practical and creative in getting things done

What does a perfect day look like to you?

Wake up naturally after having a good night sleep

What is a skill you’d like to learn and why?

Better cooking skill for life enjoyment

Fill in the blank: If you really knew me, you’d know________

I don’t like nonsense

What’s your favorite type of cuisine?

Chinese obviously

Who did you first see live in concert?

Some Chinese singers back home

What’s the 1 thing you’ve waited in line the longest for?

Red carpet event to get rush tickets to the Hunger Games movie

If you could choose 1 amenity to add to the workplace, what would it be?

It would have been something from staff feedback

What other languages do you know?

Mandarin & Taiwanese

Do you have any hobbies?

Go to movies and contribute to reviews

Which of your 5 senses is the strongest? Taste.

How about weakest?  Sight and hearing

What was the most incredible exotic place you’ve ever traveled to?

Eating raw lobster meat on a Cuban fishing boat 

 

Shawnna B. (Patient Care Manager for Community Services; Crisis/POP/ACTT/JAMH/ICM/ADHD & Adult Out-Patient Services)

shawnna

What is your best childhood memory?

Playing Lion King with my younger sister and reenacting the “Long live the king scene.” Obviously, I was Scar and my sister was Mufasa. I used to have her hanging off the diving board as I recited the line, and then would push her fingers off and watch her fall into the pool. I also liked playing the “Queen game,” where I would act like the Queen of England (because we share a birthday) and get my sister to run around and do things for me.

Who would play you in the movie adaptation of your life?

I can’t think of any South Asian actresses besides Mindy Kailing. We have the same pitched voice, so that works.

What do you feel most proud of?

I always wanted to pursue a career where I could help marginalized communities in some way, and be able to make meaningful changes. SRH has given me the opportunity to do this. I have been fortunate enough to be able to influence changes in the neighborhood I grew up in. I’m so proud of the achievements we have made, particularly how we have really worked to increase access to quality mental health care in Scarborough.

If you could travel anywhere, where would you go and why?

I love travelling and can’t pinpoint one place. Countries currently on my wish list include: Madagascar, Argentina, Cambodia, Vietnam, Portugal, the smaller non touristy towns of Italy and Spain, and I could really go on and on

What are your top three favorite books and why?

Pride and Prejudice

Why? Mr. Darcy, enough said. (On a side note, Colin Firth is hands down the best Mr. Darcy. Everyone should watch the 6 hour BBC version of Pride and Prejudice).

Emma

One of my favorite lines in all of literature is when Mr. Knightley says, “I cannot make speeches, Emma. . . . If I loved you less, I might be able to talk about it more.”

The Merchant of Venice

This isn’t my favorite play by Shakespeare. King Lear, Macbeth, and Titus Andronicus all surpass The Merchant of Venice for me. But, I fell in love with Shylock’s soliloquy the first time I read it, and it still moves me.

I am a Jew. Hath not a Jew eyes? Hath not a Jew hands,
organs, dimensions, senses, affections, passions; fed with the same
food, hurt with the same weapons, subject to the same diseases,
heal’d by the same means, warm’d and cool’d by the same winter
and summer, as a Christian is? If you prick us, do we not bleed? If
you tickle us, do we not laugh? If you poison us, do we not die?
And if you wrong us, do we not revenge? If we are like you in the
rest, we will resemble you in that.

 If you were prime minister, what is the first thing you would do?

Meet Nadal. We should really work on strengthening our ties with Spain.

 What is your favorite part of your job?

Refer to question 3!

How long have you worked at TSH?

5 years

How would your friends describe you?

Ambitious, loyal, compassionate, hardworking, determined, directionally challenged, and undomesticated.

What does a perfect day look like to you?

Sleep in, go for brunch with friends, grab a flight to watch the French Open in Paris, the end.

What is a skill you’d like to learn and why?

How to fight. Refer to question 1. My sister is taller and stronger than me now, and for some reason she wants revenge.

Fill in the blank: If you really knew me, you’d know

I absolutely hate Jack Armstrong. And everyone knows my number one nemesis is Djokovic.

 What’s your favoThairite type of cuisine?

Currently, it’s .

 Who did you first see live in concert?

My mom took me to see Tom Jones when I was a kid. I was confused as to why so many older women were throwing their undergarments at him.

What’s the 1 thing you’ve waited in line the longest for?

Food. Toronto loves lining up for food.

If you could choose 1 amenity to add to the workplace, what would it be?

Large screen TV for Grand Slams and playoff times.

What other languages do you know?

Tamil, kind of. At times it may just be me speaking in English, but with an accent…

 Do you have any hobbies?

I joined a pottery class, I wasn’t good at it. I joined ball hockey, flag football, dodgeball, volleyball, and softball. I wasn’t good at those.

Does watching sports, drinking wine, and travelling count as hobbies? Because then yes, I have hobbies.

 Which of your 5 senses is the strongest? How about weakest?

Strongest – taste

Weakest – sight

What was the most incredible exotic place you’ve ever traveled to?

Again, I can’t pick. I love travelling and try to go on one big trip each year. I’m fortunate to have friends with similar interests, and parents who took me all over the world from a young age. Some of my favorite “exotic” places have been Oman, South Africa, Israel, Egypt, Ghana, and Sri Lanka.

 

Sari G. (New Director for Mental Health, Seniors Health and Family Medicine Teaching Unit for SRH)

Sari_Greenwood_crop

What is your best childhood memory?

I have always loved animals, especially dogs. I was that kid that went up to every dog I saw despite the warnings from my parents so my best childhood memory was the day I got my very own, not stuffed, puppy for my 7th birthday.

Who would play you in the movie adaptation of your life?

Jennifer Lopez

What do you feel most proud of?

Being the mother of two fantastic amazing kids.

If you could travel anywhere, where would you go and why?

I’d love to go to Spain and Portugal and all around the Mediterranean. Sounds exotic.

What are your top three favorite books and why?

A Man Called Ove

Cutting for Stone

When Breath Becomes Air

If you were prime minister, what is the first thing you would do?

I would never want the job as prime minister so I’d probably resign.

What is your favorite part of your job?

Working with amazing people and contributing to making positive differences in the lives of so many patients, families and staff.

How long have you worked at TSH?

20 years!!

How would your friends describe you?

I think fun to be around, a bit competitive (or maybe extremely competitive), and someone who would do anything for them

What does a perfect day look like to you?

In the summer, a round of golf with my husband and kids followed by lunch, a swim, and then spending time with friends in the evening in the backyard, enjoying a BBQ dinner and some great wine. In the winter, I’d probably exchange the round of golf for a day of skiing, and then dinner in front of the fire…also with some great wine!

What is a skill you’d like to learn and why?

I’d really love to perfect my short game in golf. I need to be able to win.

Fill in the blank: If you really knew me, you’d know_____

I hate losing at any game.

What’s your favorite type of cuisine?

Sushi

Who did you first see live in concert?

Madonna

What’s the 1 thing you’ve waited in line the longest for?

A ride at wonderland

If you could choose 1 amenity to add to the workplace, what would it be?

Car wash service – interior and exterior

What other languages do you know?

A bit of French

Do you have any hobbies?

Golfing, anything that keeps me active. I love to run.

Which of your 5 senses is the strongest? How about weakest?

Smell is my strongest sense; and I think hearing may be my weakest.

What was the most incredible exotic place you’ve ever traveled to?

A week-long sea kayak trip down the Baja peninsula

 

Mental Notes would like to thank Ping, Shawnna and Sari for participating in this months 3 in the Key installment.  You are key players in our department.

Reading of the Week: Is Psychoanalysis Relevant? Paris vs. Ravitz

From the Editor

“Today, psychoanalysis has been marginalized and is struggling to survive in a hostile academic and clinical environment. This raises the question as to whether the paradigm is still relevant in psychiatric science and practice.”

This week, we consider the relevance of psychoanalysis.

Drawing from the May issue of The Canadian Journal of Psychiatry, we look at two papers.

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Freud and analysis: debating his relevance

In a Perspectives piece, Dr. Joel Paris argues that psychoanalysis is part our legacy – but not much more. In an Editorial, Dr. Paula Ravitz responds. She opens by writing: “My concern is that by unnecessarily pitting psychiatry against psychoanalysis, we may throw out the baby with the bathwater.”

It’s a great and important debate.

DG

 

Paris on Therapy

“Is Psychoanalysis Still Relevant to Psychiatry?”

Joel Paris

The Canadian Journal of Psychiatry, May 2017

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http://journals.sagepub.com/doi/full/10.1177/0706743717692306

 

“Psychoanalysis is a theory of psychopathology and a treatment for mental disorders. Fifty years ago, this paradigm had great influence on the teaching and practice of psychiatry. Today, psychoanalysis has been marginalized and is struggling to survive in a hostile academic and clinical environment. This raises the question as to whether the paradigm is still relevant in psychiatric science and practice.

 

“In a difficult climate for the theory and practice of psychoanalysis, several responses have emerged, either by attempting to bridge the gap with science or by redefining the field as lying outside of science. Thus, some analysts have supported revised paradigms, such as attachment theory, that are better supported by evidence. Others have taken the view that Freud’s ideas concerning the unconscious mind are compatible with modern neuroscience. Still others have moved in the opposite direction, arguing that it is sufficient to offer a coherent interpretation of psychological phenomena. This review will briefly examine all these attempts to revive psychoanalysis.”

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Joel Paris

So opens McGill’s Joel Paris in his paper. He predicts a “continued and lingering decline” for psychoanalysis. In a sweeping essay that draws heavily from the literature, he makes several points.

 

  • Psychoanalysis has been undermined by a lack of scientific study. “The absence of solid and persuasive evidence for the theory may be the consequences of self-imposed isolation from the empirical sciences.” (He notes that attachment theory is the “notable exception.”)
  • Even psychoanalysts, he writes, concede there is limited evidence. “Peter Fonagy, a psychoanalyst who is also a respected researcher, has acknowledged that ‘the evidence base for psychoanalytic therapy remains thin.’”
  • Though there is evidence for time-limited dynamic psychotherapies, Dr. Paris argues that this isn’t generalizable to psychoanalysis. With psychoanalysis, “a few reports have attempted to examine” outcomes, but there have been serious limitations.
  • Attempts to tap brain imaging to confirm analytic theories – such as using REM activity – have been “incompatible with empirical data.” Some, like Norman Doidge, have argued that the “brain can change itself” – but Doidge’s books are bestsellers, but “have had little impact in medicine.”

 

“Whatever its limitations, psychoanalysis left an important legacy to psychiatry. It taught a generation of psychiatrists how to understand life histories and to listen attentively to what patients say. In an era dominated by neuroscience, diagnostic checklists, and psychopharmacology, we need to find a way to retain psychotherapy, whose basic concepts can be traced back to the work of Freud, as part of psychiatry.”

 

 

Ravitz Responds

“Contemporary Psychiatry, Psychoanalysis, and Psychotherapy”

Paula Ravitz

The Canadian Journal of Psychiatry, May 2017

http://journals.sagepub.com/doi/full/10.1177/0706743717704762

“In his Perspective, ‘Is Psychoanalysis Still Relevant to Psychiatry?’ Paris presents a critical perspective on psychoanalysis in the context of evidence-based care. Scientific discourse demands critical dialogue, and so in this editorial, I provide alternative perspectives on some of Paris’s arguments and further thoughts on psychoanalytic training, research, and treatment. My concern is that by unnecessarily pitting psychiatry against psychoanalysis, we may throw out the baby with the bathwater.”

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Paula Ravitz

So responds the University of Toronto’s Dr. Paula Ravitz to the Paris paper. She forwards several arguments.

 

  • She notes that psychoanalytic thought is traced to various theories – and that a typical scientific consideration isn’t necessarily appropriate. “[C]urrent psychoanalytic thought is informed by theory of mind, feminist theory, queer theory, sociology, cognitive psychology, nonlinear dynamics, evolutionary biology, political science, anthropology, Buddhism, evolutionary psychology, and ethology. Many aspects of this rich interdisciplinary landscape of influences lie outside the domain of science and its standards of evidence, but not all.”
  • That said, she observes “the strength of evidence” for different psychotherapies. “Canadian position papers and working group papers on psychotherapy published over the past 4 decades highlight that psychotherapy treatments are integral, core components of psychiatric practice.”
  • And she taps the literature, “Although there are fewer controlled studies of psychoanalytic treatment, there is in fact evidence for the efficacy of both short- and long-term psychodynamic psychotherapy (LTPP). Leichsenring and Rabung’s systematic review of 23 studies conducted between 1984 and 2008 identified 11 prospective RCTs and 12 observational studies of >1000 patients receiving LTPP in which there was a large within group effect size of 0.96… for pre- to posttreatment overall outcomes, and for the 8 studies that included a comparison group, the overall between-group effect size was even larger at 1.8…”

 

“Psychotherapy treatments can effectively address suffering and enhance outcomes and the quality of care of mental illnesses across a spectrum of health care settings. As evidence-based practitioners and psychiatrists, we must use what is best for our patients and be trained in a broad range of effective treatments, including psychotherapies and psychoanalytic principles. Based on 40 years of outcome and process research, it is clear that psychotherapy treatments are helpful for patients with psychiatric disorders and therefore a critical component to be preserved in the training and practice of psychiatrists of the 21st century.”

 

A few thoughts:

  1. What a terrific exchange.
  1. Congratulations to the authors – and to The Canadian Journal of Psychiatry for publishing this debate. (And I would encourage readers to look at the papers themselves, since this summary is just that – a summary.)
  1. Though these two psychiatrists take different positions, there is clearly common ground. Note, for instance, that they both acknowledge the contribution of psychoanalysis to current care, including attachment theory. And both acknowledge the incredible importance of psychotherapy in terms of evidence-based care.

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  1. A past Reading considered this topic, drawing on a clever Guardian essay, and then discussing an American Journal of Psychiatry paper that showed that CBT helped patients with bulimia achieve symptom relief faster than those treated with analysis – though the study did show that neither psychotherapy was particularly effective.

 

You can find the Reading here:

ROTW: Freud is Dead are his Ideas Dead Too?

 

  1. In a publicly-funded system, there are larger questions. Does analysis justify its cost given the system’s limited resources? Is it problematic to think in these terms, with government officials then trying to pick winners and losers in treatment, potentially micro-managing patient care?

 

  1. These two selections, then, touch on a broader discussion – the relevance of psychoanalysis has implications for education, clinical practice, and health care financing. I’ll close the way I started: by noting that it’s a great and important debate.

 

 

Reading of the Week. Every week I pick articles and papers from the world of Psychiatry. 

 

-Dr. David Gratzer

3 in the Key (March/April)

Sorry for the delay.

A lot of changes happening at TS(R)H.  We all hope that these changes will maintain the exceptional care we provide to our community as well as push forward with the innovative visions we have put into place.

That being said, here is a semi-late post of 3 in the Key (March/April)

 

So what do these 3 stars have in common?

 

Introducing 3 Key staff members of the MH team at the Scarborough Sites……

(**Click on any of the underlined links for more information**)

 

Nancy R. (Secretary at MH Adult Out-Patient Clinics, 1225 Kennedy Rd.)

Nancy1

 

What is your best childhood memory?

Summers in Portugal

Who would play you in the movie adaptation of your life?

Angelina Joile

What do you feel most proud of?

My three wonderful children

If you could travel anywhere, where would you go and why?

Bora Bora, love the peace of nature and the water

What are your top three favorite books and why?

Receipe books – love to cook and bake,  try new things

If you were prime minister, what is the first thing you would do?

Created programs to support people in need (poverty, disability, single parents, mental health)

What is your favorite part of your job?

My fellow co-workers and patients make me love to work here. I love making people smile.

How long have you worked at TSH?

16 ½ years

How would your friends describe you?

Easy going, friendly, caring, helpful and dependable

What does a perfect day look like to you?

at the cottage, waking up and having my coffee looking out at the lake. Going kayaking on the lake, followed by a BBQ with family and bon fire with a few glasses of wine. lol

What is a skill you’d like to learn and why?

Crisis training, CPR, De-escalating conflict and  info sessions on specific illnesses to increase my understanding and ability to serve my patients.

Fill in the blank: If you really knew me, you’d know_____.

I like to cook

What’s your favorite type of cuisine?

I love a variety, love to try different culture cuisine. I love Indian, Italian, Chinese, Portuguese, greek etc.

Who did you first see live in concert?

Bon Jovi

What’s the 1 thing you’ve waited in line the longest for?

Passport

If you could choose 1 amenity to add to the workplace, what would it be?

Renovate office, a nicer waiting area for patients and no carpet.

What other languages do you know?

Portuguese, understand Italian, Spanish. My patients teach me how to greet them in their language, Polish, Greek and Cantonese.

Do you have any hobbies?

Cooking, and I love the out doors

Which of your 5 senses is the strongest? How about weakest?

Strongest:  Taste

Weakest: sight (I wear glasses lol)

What was the most incredible exotic place you’ve ever traveled to?

Being a single mother, I can’t afford to travel but would love too. I went to Aruba

 

Steve T. (Case Manager, Community Programs Assertive Community Treatment Team, 2425 Eglinton)

steve

What is your best childhood memory?

My Grandmother cooking in the kitchen.  I was just in awe of how many dishes she was able to make.

Who would play you in the movie adaptation of your life?

Paul Sun-Hyung Lee (of Kim’s Convenience) – he seems to channel how I look only he carries it better!

What do you feel most proud of?

At home: My family.

At SRH: Having the privilege of working at the community programs site with some of the best people I have ever met.  Their sense of caring and compassion for clients and colleagues are what I feel most proud of.

If you could travel anywhere, where would you go and why?

I would love to take a cross-country trip across Canada as there is so much to love about our wonderful nation that I haven’t yet had the opportunity to experience seeing it from coast to coast.

What are your top three favorite books and why?

A Wrinkle in Time: This was the first book that made an impression on me in grade 3 and got me interested in the Sci-Fi genre.

The Art of Racing in the Rain: An unexpected book where the author tells the story from an auto-racing loving golden retriever’s perspective and how we develop our inextricable connections with our beloved canines.

Ordinary Moments – The Disabled Experience: A wonderful book of compiled individuals’ accounts of their struggles with various disabilities in their daily lives.

If you were prime minister, what is the first thing you would do?

I would ensure there are more supportive housing resources for people who are at-risk.

What is your favorite part of your job?

Seeing over time how individuals we work with tap into their own strength and resilience to forge ahead and reach their recovery goals.

How long have you worked at TSH?

18 years

How would your friends describe you?

Thoughtful, helpful, with an ok sense of humour.

What does a perfect day look like to you?

Waking up to a warm, sunny spring day and going for a drive with no particular destination in mind and no place I have to be at.

What is a skill you’d like to learn and why?

I would really like to learn to play the guitar as it seems so versatile to be able to take it wherever you want and to play a tune either for yourself or to entertain others.

Fill in the blank: If you really knew me, you’d know_____.

I really like to watch improvisational comedy.

What’s your favorite type of cuisine?

Yes! Cuisine is my favorite…. any.  As long as it’s cooked with care and love.

Who did you first see live in concert?

I think the first concert I saw live was when I was in school and went on a field trip to see the Toronto Symphony Orchestra.  The amazing richness of the live sounds subtle and loud made quite an impression on me.  As for the first live concert I paid money to see, I believe it was Genesis (the band).

What’s the 1 thing you’ve waited in line the longest for?

I seem to remember it was for Krispy Kreme doughnuts when they first opened in Mississauga.  I waited with some friends for two hours to try those “super-delicious” warm classic glazed wonders.  Ahhhh memories……  (see #13)

If you could choose 1 amenity to add to the workplace, what would it be?

Individual hvac controls for each office

What other languages do you know?

Cantonese

Do you have any hobbies?

Aside from food…..?  Does barbecuing count?!  I do like to work on/geek out on cars, music and woodworking.

Which of your 5 senses is the strongest? How about weakest?

I think my strongest sense is of hearing, my weakest – smells.

What was the most incredible exotic place you’ve ever traveled to?

China was amazing as I’ve never been to mainland China until we went there to adopt our eldest son Justin.  The sheer numbers of people in the cities were incredible as was the Great Wall.

 

Ashley M.  (RPN/Case Manager, Community Crisis, Birchmount Campus)

Ashley1

What is your best childhood memory?

Skiing with my grandfather

Who would play you in the movie adaptation of your life?

Cameron Diaz

What do you feel most proud of?

My nursing career

If you could travel anywhere, where would you go and why?

If I could go anywhere, I would travel to Africa. I would really enjoy helping the communities and going on an adventurous safari!

What are your top three favorite books and why?

I don’t have much time to read, however when I do get a chance I enjoy reading Jodi Picoult novels. One of my favourite is “House Rules” which is about a child with Asperger’s syndrome that finds himself involved in a murder. Very intense, had me reading for hours.

If you were prime minister, what is the first thing you would do?

Put more money in to mental health programs in the community

What is your favorite part of your job?

Being a positive influence in my patients lives.

How long have you worked at TSH?

Since 2005, I started on 3C medicine at the general campus

How would your friends describe you?

Well, I asked my friends this question and got many interesting answers…I will go with “Hardworking, genuine, passionate and empathetic”

What does a perfect day look like to you?

Hiking with my dog, cooking a new meal and killing it at the gym!

What is a skill you’d like to learn and why?

How to have better control of a motorcycle so I could get my full M license this year!

Fill in the blank: If you really knew me, you’d know________.

I love ice cream!

What’s your favorite type of cuisine?

I enjoy food in general… but would have to say italian.

Who did you first see live in concert?

The Backstreet Boys

What’s the 1 thing you’ve waited in line the longest for?

Tim Hortons… otherwise I don’t do lines!

If you could choose 1 amenity to add to the workplace, what would it be?

Be able to open the windows in the crisis office on 3B so we could get fresh air

What other languages do you know?

Sadly, none

Do you have any hobbies?

Cooking, hiking with my dog, the gym and travelling

Which of your 5 senses is the strongest? How about weakest?

Strongest- Smell Weakest- Hearing…however maybe I have selective hearing!

What was the most incredible exotic place you’ve ever traveled to?

Been to many places but I would say Santorini, Greece

 

 

Mental Notes would like to thank Nancy, Steve & Ashley for this months contribution.  You are all Key players in our department.