Month: April 2024

Reading of the Week: Visual Hallucinations & Outcomes – the New Schizophrenia Study; Also, Opioid Deaths in Canada and Dr. Roy Perlis on Antidepressants

April 25, 2024 /

From the Editor

Last week, I met a person who had deeply unsettling auditory hallucinations. I asked him the questions that we all ask: When did the voices start? How many voices do you hear? Do the voices tell you to do things? In contrast, while we know that people with psychotic illnesses can have visual hallucinations, we rarely inquire about them and if we do, it’s in a perfunctory manner, as I did with him. Clinicians aren’t the only ones to gloss over visual hallucinations; they tend to be under-researched, especially with regard to long-term outcomes.

In the first selection, Isabel Kreis (of the University of Oslo) and her co-authors look at outcomes and visual hallucinations in an impressive, new study published in Schizophrenia. They report on 184 people from Norway with first-episode psychosis, followed for ten years, with a focus on visual hallucinations and functionality, suicide attempts, and childhood trauma. “These findings highlight the relevance of assessing visual hallucinations and monitoring their development over time.” We consider the paper and its implications.

In the second selection from CMAJ, Shaleesa Ledlie (of the University of Toronto) and her co-authors report on opioid-related deaths in Canada. They drew from a national database and looked at several years of data, including over the start of the pandemic. “Across Canada, the burden of premature opioid-related deaths doubled between 2019 and 2021, representing more than one-quarter of deaths among younger adults.”

And in the third selection, Dr. Roy Perlis (of Harvard University) argues that the time has come for over-the-counter antidepressants in a STAT essay. He notes that many people with depression are untreated and that increasing the availability of these medications would be helpful. “With part of the solution hiding in plain sight, it’s time to do everything possible to give Americans another way to get treatment.”

DG

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Reading of the Week: Preventing Postpartum Depression in Pakistan – the New Nature Med Study; Also, Deaths of Despair and ChatGPT & Abstracts

April 18, 2024 /

From the Editor

Imagine that you are asked to design a program to prevent depression in a population at risk. Would you hire psychiatrists? Look to nurses? Tap the expertise of psychologists? All three?

In the first selection from Nature Medicine, Pamela J. Surkan (of Johns Hopkins University) and her co-authors describe a study that focused on prevention. As they worked in Pakistan – a nation with few mental health providers by Western standards – they chose to train lay people, teaching them to deliver CBT. In their single-blind, randomized controlled trial, 1 200 women who were pregnant and had anxiety (but not depression) were given enhanced usual care or CBT. “We found reductions of 81% and 74% in the odds of postnatal MDE and of moderate-to-severe anxiety…” We discuss the paper and its implications.

In the second selection, Joseph Friedman and Dr. Helena Hansen (both of the University of California, Los Angeles) look at deaths of despair in the United States in a research letter for JAMA Psychiatry. Their work builds on the idea that some deaths are related to the hopelessness of a person’s social or economic circumstance; past publications focused largely on White Americans. Friedman and Hansen drew on more than two decades of data, including ethnicity, from a US database, finding a different pattern and that: “Rising inequalities in deaths of despair among American Indian, Alaska Native and Black individuals were largely attributable to disproportionate early mortality from drug- and alcohol-related causes…”

A recent survey finds that psychiatrists see AI as potentially helpful with paperwork and diagnosing patients. But could AI help you keep up with the literature? In the third selection from Annals of Family Medicine, Dr. Joel Hake (of the University of Kansas) and his co-authors used ChatGPT to produce short summaries of studies, then evaluated their quality, accuracy, and bias. “We suggest that ChatGPT can help family physicians accelerate review of the scientific literature.”

DG

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Reading of the Week: tDCS for Depression – the New JAMA Psych Paper; Also, Psychiatrists & AI and Dr. Daniel Gorman on Charlatan Syndrome

April 11, 2024 /

From the Editor

In her autobiography, psychiatrist Linda Gask writes about her struggles with depression and the moment she realized that she was better: she started to hear the birds chirping again. For many of our patients, the songs of the birds remain elusive. Antidepressants work but some patients don’t respond, and others are cool to the idea of medication management. CBT is effective but difficult to access. What about Transcranial Direct Current Stimulation (tDCS) – an intervention that could be done at home?

Dr. Lucas Borrione (of the University of São Paulo) and his co-authors try to answer that question in a new JAMA Psychiatry paper. They report on a randomized clinical trial including 210 Brazilian adults with a major depressive episode who were offered tDCS and a digital intervention; the study featured two sham interventions. “The findings indicate that unsupervised home use tDCS should not be currently recommended in clinical practice.” We consider the paper and its clinical implications.

Would tDCS have helped?

Artificial intelligence is having a moment. Not surprisingly, many are seeing the possibilities for mental health care, from better therapy to reduced paperwork. In the second selection, from Psychiatry Research, Charlotte Blease (of Uppsala University) and her co-authors report on the findings of a survey of 138 psychiatrists with both qualitative and quantitative data. “The foremost interest was around the potential of these tools to assist psychiatrists with documentation.”

And in the third selection, Dr. Daniel Gorman (of the University of Toronto) writes about the struggles of taking a child to Disney World in JAMA. Any parent – or aunt or cousin or older sib – can relate. But Dr. Gorman notes the particular challenges that he faces: he’s a child psychiatrist. “Sometimes I fantasize about sharing with parents my doubts about parenting strategies, but the risks always seem too great – the risk of discrediting myself and my profession and the risk of robbing parents of agency and hope.”

DG

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Reading of the Week: Do ADHD Meds Reduce Mortality? The New JAMA Psych Study; Also, Dr. Rebecca Lawrence on Her Husband & His Support

April 4, 2024 /

From the Editor

For my patient, ADHD medications transformed his life, helping him focus at school and at work – and even drive better. Many have had similar experiences. Do ADHD medications also reduce mortality? We know that those with ADHD have higher mortality rates and thus it’s reasonable to ask about the possible benefits of methylphenidate and sister drugs.

Lin Li (of the Karolinska Institutet) and her co-authors try to answer that question in a new JAMA Psychiatry paper. Drawing on Swedish databases, they analyzed data from almost 150 000 people with ADHD and looked at two-year mortality, including for those who die by unintentional injuries, suicide, or poisonings, by doing a target trial emulsion – simulating a randomized trial. “Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes.” We consider the paper, the editorial that accompanies it, and the clinical implications.

ADHD meds: life saver?

And in the other selection, Dr. Rebecca Lawrence writes about support in a blog for Doctor and Patient. She is personal – besides working as psychiatrist, Dr. Lawrence has been treated for depression, including with ECT. She notes the incredible help her husband has given her over the years. “I look at myself in the mirror and am appalled, but he still smiles at me.

DG

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