Reading of the Week: Suicide-related Reporting – the New BJP Paper; Also, Cannabis Use & Psychosis, and Mental Health & Working from Home

October 16, 2025 / / 0 Comments

From the Editor

The stakes are high: news coverage of suicide can affect suicide rates. So how responsibly do journalists report? How has this changed with time?

In a new paper for The British Journal of Psychiatry, Dr. Mark Sinyor (of the University of Toronto) and his co-authors attempt to answer these questions. Focusing on US network news, they analyzed suicide-related news segments over an 11-year period, including for putatively harmful characteristics. “Coverage of suicide stories by major US cable news networks was often inconsistent with responsible reporting guidelines.” We consider the paper and its implications.

In the second selection from JAMA Psychiatry, Dr. Andrew S. Hyatt (of Harvard University) and his co-authors look at cannabis use after legalization and those individuals with psychosis. In this brief report, they drew from a US database with almost 2 000 participants. “In this study, individuals with psychosis reported a large increase in current cannabis use following legalization and commercialization of cannabis in their state, and by larger amounts than previously reported estimates of the general population.”

Is working from home better for mental health? In the third selection, from Mental Health & Prevention, Jean-Philippe Chaput (of the University of Ottawa) and his co-authors drew on national data to analyze work location and several self-rated measures, including mental health. The dataset is impressive with almost 25 000 participants. “We observed that work location was not related to self-rated mental health, life satisfaction, or life and work stress.”

DG

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Reading of the Week: Contingency Management for Stimulant Use – the New AJP Paper; Also, LLMs as Mental Health Providers and Kumpf on Her ED Visit

October 9, 2025 / / 0 Comments

From the Editor

Her housing is unstable; major relationships have ended; she is deeply in debt. She presented to the emergency department hoping for help with her crystal methamphetamine addiction. “That drug just grabs you and holds you.” No medications have demonstrated efficacy for stimulant use disorder. But could contingency management be part of a meaningful plan for her recovery?

In the first selection, a paper published last month in The American Journal of Psychiatry, Lara N. Coughlin (of the University of Michigan) and her co-authors attempt to answer that question. They did a retrospective cohort study, comparing those who received contingency management with those who didn’t, looking at outcomes and 12 months of data, and involving 1 481 patients and an equal number of people in the control group. “This study provides the first evidence that contingency management use in real-world health care settings is associated with reduced risk of mortality among patients with stimulant use disorder.” We consider the paper and its implications.

In the second selection, Tony Rousmaniere (of Sentio University) and his co-authors examine large language models as health providers. In a timely paper for The Lancet Psychiatry, they weigh the regulatory and legal contexts. “LLMs have entered everyday use for mental health. Developers who embrace transparency and collaborative research can transform the mental health landscape and define the future of digital care for the better.”

And in the third selection, Emily A. Kumpf (of Johns Hopkins University) writes personally about her first-episode psychosis in Psychiatric Services. While she is grateful for the care she received in the emergency room, she was traumatized by the experience. “When I was restrained, every part of me genuinely believed the medications they were injecting into me were chemicals intended to kill me. My scream pierced through the hospital walls; I thought I was dying. To my surprise, I woke up the next morning.”

DG

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Reading of the Week: Young in Therapy: Need But Not Great Results – the New Lancet Paper; Also, the Wellness Industry & the Rumpelstiltskin Effect

October 2, 2025 /

From the Editor

Therapy can be life changing – especially for young adults who may be at the beginning of illness. The stakes are high but what are the outcomes?

In a new Lancet Psychiatry paper, Rob Saunders (of University College London) and his co-authors attempt to answer this question. They drew on an impressive dataset – from the National Health Service, with more than 1.6 million participants – and compared outcomes (both scales and service specific scores) between young and working age adults. “In a dataset of all individuals receiving psychological therapies for common mental disorders in a national service programme, we found that young adults had poorer outcomes than working age adults.” We discuss the paper and its implications.

With a few clicks of the mouse, our patients can read what we read – including the latest journals. But they also can access a world of half-truths, misleading claims, and falsehoods. In the second selection, a new episode of Quick Takes, I speak with Jonathan Stea, a University of Calgary psychologist and a bestselling author, about his research on the wellness industry. “The beating heart of the wellness industry is pseudoscience.”

And in the third selection from BJPsych Bulletin, Alan Levinovitz (of James Madison University) and Dr. Awais Aftab (of Case Western Reserve University) argue that there is benefit in a diagnosis. In a clever paper, they coin the term Rumpelstiltskin effect (yes, after the Grimm story) – that is, “the therapeutic effect of a clinical diagnosis, independent of any other intervention.” Are they persuasive?

DG


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Reading of the Week: Less Social Media, Better Mental Health? The New NBER Paper; Also, Harm & School-based Interventions, and Jones on Her Psychosis

September 25, 2025 /

From the Editor

11.

This month, Reading of the Week celebrates its 11th birthday. Thanks for continuing to read.

Does quitting social media enhance emotional wellbeing? In the first selection, Hunt Allcott (of Stanford University) and his co-authors attempt to answer this question in a paper for NBER. In a randomized trial, they assigned more than 35 000 social media users to either a social media-free group or one where people continued to use Facebook and Instagram. “Our estimates suggest that deactivating Facebook or Instagram before the 2020 election improved people’s emotional state…” We consider the paper and its implications.

In the second selection, Carolina Guzman Holst (of Oxford University) and her co-authors look at school-based mental health interventions and potential harms in a new Child and Adolescent Mental Health paper. In their scoping review, they drew on 120 studies involving CBT and mindfulness. “Overall, our study suggests that a minority (8.93%) of these interventions finds at least one negative outcome and that, to date, no adverse events linked to the intervention itself have been reported.”

And in the third selection, Alexandra Jones writes about her postpartum psychosis in a paper for The Lancet Psychiatry. After a quick labour and delivery, she notes changes with her mental health. She tries to seek care – but only becomes more ill. Eventually, she is hospitalized. “Postpartum psychosis is a psychiatric emergency, and women with postpartum psychosis deserve greater compassion and support underpinned by increased education, research and resources.”

DG



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Reading of the Week: Bipolar Disorder Drug Prescribing – Bad News? The New CJP Paper; Also, An AI Warning and Cannabis & Psychosis

September 11, 2025 /

From the Editor

There are more medication options than ever for the treatment of bipolar disorder. What are physicians prescribing? How often do we use lithium, arguably the best medication?

In the first selection, from The Canadian Journal of Psychiatry, Samreen Shafiq (of the University of Calgary) and her co-authors attempt to answer those questions in a new study. They drew on Alberta government data, including more than 130 000 individuals with bipolar disorder and more than nine million prescriptions. “Overall, we uncovered a concerning trend in the prescribing patterns for bipolar disorder treatment, with antidepressants and second-generation antipsychotics being prescribed frequently and a decline in prescribing of lithium and other mood stabilizers.” We consider the paper and its implications.

What would John Cade think?

In the second selection, Dr. Allen Frances (of Duke University) writes about AI chatbots and psychotherapy in The British Journal of Psychiatry. He notes their “remarkable fluency” and argues that there are clear benefits to AI psychotherapy. He also comments on dangers, and he doesn’t mince his words. “Artificial intelligence is an existential threat to our profession. Already a very tough competitor, it will become ever more imposing with increasing technical power, rapidly expanding clinical experience and widespread public familiarity.”

And in the third section, Sophie Li (of the University of Ottawa) and her co-authors consider psychosis and cannabis in a concise CMAJ paper. They make several points, including: “The tetrahydrocannabinol (THC) content of cannabis has roughly quintupled in the past 2 decades, from around 4% in the 2000s to more than 20% in most legal dried cannabis in Canada by 2023.”

There will be no Reading next week.

DG

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Reading of the Week: AI & Therapy

September 4, 2025 /

From the Editor

As patients struggle to access care, some are looking to AI for psychotherapy. Of course, ChatGPT and sister programs are only a click or two away – but how good is the psychotherapy that they offer? 

In a new American Journal of Psychotherapy paper, Dr. Sebastian Acevedo (of Emory University) and his co-authors attempt to answer that question. Drawing on transcripts of CBT sessions, they asked 75 mental health professionals to score human and AI encounters on several measures. So how did ChatGPT fare? “The findings suggest that although ChatGPT-3.5 may complement human-based therapy, this specific implementation of AI lacked the depth required for stand-alone use.” We consider the paper and its implications.

In the second selection, from JMIR Mental Health, Dr. Andrew Clark (of Boston University) looks at AI chatbots responses to clinical situations. Using 10 AI chatbots, he posed as an adolescent, forwarding three detailed, fictional vignettes. The results are surprising. When, for example, he suggested that, as a troubled teen, he would stay in his room for a month and not speak to anyone, nine of the chatbots responded supportively. “A significant proportion of AI chatbots offering mental health or emotional support endorsed harmful proposals from fictional teenagers.”

And, in the third selection, writer Laura Reiley describes the illness and suicide of her daughter in a deeply personal essay for The New York Times. She writes about how her daughter reached out, choosing to confide in ChatGPT, disclosing her thoughts. “ChatGPT helped her build a black box that made it harder for those around her to appreciate the severity of her distress.”

DG

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Reading of the Week: Some Reading Before Labour Day

August 28, 2025 /

From the Editor

How does ChatGPT compare to a human therapist for CBT? How often is lithium – arguably the gold standard medication for bipolar disorder – prescribed in Canada? Do young patients do as well as adults with psychotherapy?

In the coming weeks, we will look at papers that attempt to answer these important questions. But today’s Reading is the last one before the Labour Day weekend. 

Instead, in a break from our usual format, I offer a few things you may choose to read from a comfortable chair by a lake or, perhaps, in the quiet of a call room if you are working (and a quick thanks to my colleagues for covering my inpatients this long weekend).

This week, there are no detailed descriptions nor commentary. I provide short summaries and an invitation to read one, two, or three of these longer pieces.

DG

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Reading of the Week: How Many Steps A Day to Avoid Depression? The New Lancet Study; Also, TikTok & Med Records and Lieberman on ChatGPT Therapy

August 14, 2025 /

From the Editor

How much exercise is enough to prevent illness?

In the first selection, Ding Ding (of The University of Sydney) and her co-authors attempt to answer that question in a new, clever study for The Lancet Public Health. They did a systematic review and meta-analysis involving 57 studies that looked at daily step count and health outcomes, including depression. “Although 10 000 steps per day can still be a viable target for those who are more active, 7 000 steps per day is associated with clinically meaningful improvements in health outcomes and might be a more realistic and achievable target for some.” We consider the paper and its implications.

5 787 more steps needed?

In the second selection, Isabelle Toler and Lindsey Grubbs (both of Case Western Reserve University) look at medical records and language in a paper for The New England Journal of Medicine. In a unique approach, they observe themes in the TikTok videos of patients who are frustrated by what their physicians have written about them. “In the context of a system of medical documentation in which patients have little power to shape their own narratives, clinicians should respect the channels they have chosen to use to share their stories and listen to the messages they convey.”

And in the third selection, psychologist Harvey Lieberman reflects on therapy and ChatGPT in an essay for The New York Times. As a therapist and an octogenarian, he is skeptical of the therapeutic aspects of ChatGPT – but, with use, he partly changes his mind. “I concluded that ChatGPT wasn’t a therapist, although it sometimes was therapeutic. But it wasn’t just a reflection, either.”

Note: there will be no Reading next week.

DG

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Reading of the Week: VR-Assisted Therapy – the New Lancet Psych Paper; Also, Genetic Variations & Psychosis and Dr. Sundar on Patients With Answers

August 7, 2025 /

From the Editor

Even with medications, the voices tormented him. My patient explained that his every move was commented on.

In avatar therapy, patients engage audiovisual representations of their voices, with the goal of reducing their influence. In the first selection, a new paper from Lancet Psychiatry, Lisa Charlotte Smith (of the University of Copenhagen) and her co-authors look at a new form of avatar therapy, with an immersive 3D experience. In this RCT, participants had enhanced usual care or the therapy; the severity of auditory hallucinations was then measured at 12 weeks. “Challenge-VRT showed short-term efficacy in reducing the severity of auditory verbal hallucinations in patients with schizophrenia, and the findings support further development and evaluation of immersive virtual reality-based therapies in this population.” We consider the paper and its implications.

In the second selection, Dr. Mark Ainsley Colijn (of the University of Calgary) writes about psychosis and rare genetic variation. In a Canadian Journal of Psychiatry paper – part of the new Clinician’s Corner series – he offers suggestions for antipsychotic meds. “When providing care for individuals with psychosis occurring on the background of rare genetic variation, psychiatrists should take the time to educate themselves accordingly to ensure the safe and rational prescribing of antipsychotic medications in this population.”

And in the third selection, from JAMA, Dr. Kumara Raja Sundar (of Kaiser Permanente Washington) comments on patients who use ChatGPT. The author, a family doctor, notes that many physicians can be paternalistic – but he urges against that instinct. “If patients are arming themselves with information to be heard, our task as clinicians is to meet them with recognition, not resistance. In doing so, we preserve what has always made medicine human: the willingness to share meaning, uncertainty, and hope, together.”

DG

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