http://www.psych.on.ca/files/nonmembers/mother’s%20day.pdf

http://www.psych.on.ca/files/nonmembers/mental%20health%20week%20.pdf

*British Medical Journal* includes a study: “Continued cannabis use and
risk of incidence and persistence of psychotic symptoms: 10 year follow-
up cohort study.”

The authors are Rebecca Kuepper, research psychologist, Jim van Os,
professor, visiting professor, Roselind Lieb, professor, Hans-Ulrich
Wittchen, professor, Michael Höfler, research statistician, & Cécile
Henquet, lecturer.

Here’s how the article begins: “Cannabis is the most commonly used
illicit drug in the world, particularly among adolescents.1 2 The use of
cannabis is consistently associated with mental illness,3 in particular
psychotic disorder.4 5 6 7 8 9 It remains a matter of debate, however,
whether the association between cannabis and psychosis is causal, or
whether early psychotic experiences might in fact prompt cannabis use as
a means of self medication.10 11 This issue can be resolved only if
incident cannabis use is investigated in relation to later incident
psychotic symptoms or disorder. Rarely have studies been able to examine
the longitudinal relation between cannabis use and psychosis in this
fashion.”

Here’s how the Discussion section starts: “This 10 year follow-up study
showed that incident cannabis use significantly increased the risk of
incident psychotic experiences. The association was independent of age,
sex, socioeconomic status, use of other drugs, urban/rural environment,
and childhood trauma; additional adjustment for other psychiatric
diagnoses similarly did not change the results. There was no evidence
for self medication effects as psychotic experiences did not predict
later cannabis use. The results thus help to clarify the temporal
association between cannabis use and psychotic experiences by
systematically addressing the issue of reverse causality, given that the
long follow-up period allowed exclusion of all individuals with pre-
existing psychotic experiences or pre-existing cannabis use. In
addition, cannabis use was confirmed as an environmental risk factor
impacting on the risk of persistence of psychotic experiences (fig 3).”

To view this article, click here.

The *New York Times* includes an article: “Talk Doesn’t Pay, So
Psychiatry Turns to Drug Therapy” by Gardiner Harris.
Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part
because of changes in how much insurance will pay, no longer provides
talk therapy, the form of psychiatry popularized by Sigmund Freud that
dominated the profession for decades.
Instead, he prescribes medication, usually after a brief consultation
with each patient.
Medicine is rapidly changing in the United States from a cottage
industry to one dominated by large hospital groups and corporations, but
the new efficiencies can be accompanied by a telling loss of intimacy
between doctors and patients. And no specialty has suffered this loss
more profoundly than psychiatry.
Brief consultations have become common in psychiatry, said Dr. Steven S.
Sharfstein, a former president of the American Psychiatric Association
and the president and chief executive of Sheppard Pratt Health System,
Maryland’s largest behavioral health system.
“It’s a practice that’s very reminiscent of primary care,” Dr.
Sharfstein said.
“They check up on people; they pull out the prescription pad; they order
tests.”
The switch from talk therapy to medications has swept psychiatric
practices and hospitals, leaving many older psychiatrists feeling
unhappy and inadequate.
A 2005 government survey found that just 11 percent of psychiatrists
provided talk therapy to all patients, a share that had been falling for
years and has most likely fallen more since.
Psychiatric hospitals that once offered patients months of talk therapy
now discharge them within days with only pills.
Recent studies suggest that talk therapy may be as good as or better
than drugs in the treatment of depression, but fewer than half of
depressed patients now get such therapy compared with the vast majority
20 years ago. Insurance company reimbursement rates and policies that
discourage talk therapy are part of the reason.
A psychiatrist can earn $150 for three 15-minute medication visits
compared with $90 for a 45-minute talk therapy session.
Competition from psychologists and social workers — who unlike
psychiatrists do not attend medical school, so they can often afford to
charge less — is the reason that talk therapy is priced at a lower rate.
There is no evidence that psychiatrists provide higher quality talk
therapy than psychologists or social workers.
Of course, there are thousands of psychiatrists who still offer talk
therapy to all their patients, but they care mostly for the worried
wealthy who pay in cash.
In New York City, for instance, a select group of psychiatrists charge
$600 or more per hour to treat investment bankers, and top child
psychiatrists charge $2,000 and more for initial evaluations.
In a telephone interview from the University of California, Irvine,
where he is completing the last of his training to become a child and
adolescent psychiatrist, Dr. Matthew Levin said, “I’m concerned that I
may be put in a position where I’d be forced to sacrifice patient care
to make a living, and I’m hoping to avoid that.”
The article is online at: http://nyti.ms/KenPopePsychistristsAndMeds