Tag: Artificial Intelligence

Reading of the Week: MST vs ECT – the New Lancet Psychiatry Paper; Also, the First AI Drug Prescriber and Dr. Taglienti on Her Cancer & Her Career

April 23, 2026 / / 0 Comments

From the Editor

He began to respond to ECT and felt less depressed than he had in many years. But as the treatments continued, my patient noticed gaps in his memory including family vacations when his children were young. “Those memories are precious.” He stopped ECT and, soon after, was deeply depressed again. 

Smaller studies suggest that Magnetic Seizure Therapy (MST) – where alternating magnetic fields induce seizures – offers relief to patients without the cognitive problems of ECT. In a new study published by The Lancet Psychiatry, Dr. Daniel M. Blumberger (of the University of Toronto) and his co-authors add to the literature with the largest randomized trial comparing these convulsive therapies conducted and the first non-inferiority clinical trial to address efficacy. The study involved 239 participants with depression. “MST showed non-inferior efficacy relative to… ECT in achieving remission of depression, and a more favourable cognitive safety profile.” We consider the paper and its implications.

Should patients receive prescriptions from an AI prescriber? In the second selection, from JAMA, Dr. Daniel G. Aaron (of the University of Utah) and Christopher Robertson (of Boston University) look at a new Utah program allowing AI to prescribe medications without physician involvement. They are cool to the idea. “Although AI offers the promise of increased efficiency and expanded access, the evasion of legal obligations by early movers raises profound concerns. Incorporating AI into modern health care must be evidence based and responsible.”

And in the third selection, Dr. Jenna Taglienti (of Hofstra University) writes personally about her cancer in JAMA. As a psychiatrist and a residency program director, she finds meaning in her work – but illness helps her gain perspective. “Medicine can have extraordinary meaning. But it cannot substitute for being present in your own life.”

DG

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Reading of the Week: Mirtazapine for Methamphetamine – the New JAMA Psych Study; Also, Patients & AI and Delgaram-Nejad on His Meds

April 16, 2026 /

From the Editor

He occasionally used cannabis in his 20s and did not try crystal methamphetamine until after his 35th birthday. He readily admits to problematic use, undermining his relationship and leading to the loss of his job. In my office, he describes his desperation and asks: Is there a medication that could help?

In the first selection, a new paper published in JAMA Psychiatry, Rebecca McKetin (of the University of New South Wales) and her co-authors attempt to answer that question. In an impressive new study, they report the results of a phase 3, parallel-group, double-blind, placebo-controlled RCT involving 344 people with moderate or severe methamphetamine use disorder and a trial of mirtazapine or placebo. “The results of this randomized clinical trial confirm that mirtazapine can be used in routine clinical practice to facilitate a reduction in methamphetamine use among people with a moderate to severe methamphetamine use disorder.” We consider the paper and its implications.

In the second selection, Shaddy K. Saba and Dr. William B. Weeks (both of New York University) write on AI and patients. In a commentary for JAMA Psychiatry, the authors observe that an increasing number of patients are turning to AI and argue that clinicians need to become actively involved. “The question is not whether AI is good or bad for mental health: like many other patient behaviors, it can be both and depends on context. The question for clinicians is whether to help patients navigate its use.”

Finally, in the third selection from Schizophrenia Bulletin, Oliver Delgaram-Nejad – who has schizophrenia – discusses his decision to stop medication. Reviewing his episodes of psychosis, he argues that antipsychotics are too problematic for him. “I have weighed the benefits and risks, and navigated the rather painful tension, of remaining on an antipsychotic and living with the side effects versus accepting the risk of relapse and reclaiming my energy.”

DG

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Reading of the Week: Psychotic Prompts & AI – from JAMA Psych; Also, Lithium Landscape and Dr. Cooke on Growing Up

April 2, 2026 /

From the Editor

Patients, including those with psychosis, may turn to AI chatbots for advice. What are they told? And are they encouraged to seek care?

In a research letter that was recently published in JAMA Psychiatry, Dr. Elaine Shen (of Columbia University) and her co-authors attempt to answer these questions. Using three versions of ChatGPT, they provided 79 statements indicative of positive psychotic symptoms and 79 that were neutral. The responses were then rated by two reviewers. With the free version of ChatGPT – what most people use – psychotic prompts had 43-fold higher cumulative odds of receiving a less appropriate rating than control prompts. We consider the study and its implications.

Lithium has fallen out of fashion; a recent Canadian paper found declining prescriptions in Alberta. In a new American Journal of Psychiatry commentary, Dr. Robert M. Post (of George Washington University) and his co-authors make the case for the old mood stabilizer. They offer several arguments, including that it is a disease-modifying agent. “Clinicians, patients, and the public should be educated about the unique assets of lithium, such that conventional treatment paradigms of bipolar disorder emphasize the greater and earlier use of the drug to achieve a more benign course of illness and less cognitive dysfunction.”

Finally, in the third selection from JAMA, Dr. Emma M. Cooke (of Harvard University) writes about medical school rotations. Now an internist, she remembers the common med school question: “what do you want to do when you grow up?” She mulls her responses – and the simplicity of the question. “For everyone in medicine, not just medical students, our choice of specialty is just a single data point in what makes us who we are.”

DG


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Reading of the Week: Adolescent Mental Health With Papers on School-Based Mindfulness, Firearms & Youth Suicide, and GenAI

February 26, 2026 /

From the Editor

The MYRIAD Trial was ambitious, involving more than 8 300 adolescents at 84 schools, with the aim of preventing depression and improving mental well-being by teaching mindfulness through a universal school program. The only catch? There was no difference in outcomes at one year.

Would it be possible to identify adolescents who would benefit from mindfulness? Christian A. Webb (of Harvard University) and his co-authors attempt to answer that question, using AI. And so, a longstanding objective, prevention, was joined with a modern method, machine learning. In the first selection, a paper from JAMA Psychiatry, the authors detail a secondary analysis using two complementary machine learning approaches and the MYRIAD Trial data. “This study found that analyses using machine learning identified a subgroup of participants with a statistically detectable but clinically trivial differential intervention response. These findings highlight the substantial challenges in achieving clinically useful personalization in universal school-based prevention programs.” We consider the paper and its implications.

In the second selection, from the Journal of the American Academy of Child & Adolescent Psychiatry, Alison Athey (of Johns Hopkins University) and her co-authors evaluate the impact of child access prevention laws on youth suicide deaths by firearms. They drew on more than 30 years of mortality data from the Centers for Disease Control and Prevention. “Laws that require families to store firearms unloaded and secured in a locking device appear to effectively prevent youth suicide deaths and firearm-related youth deaths by accident and homicide.”

And in this week’s third selection, Dr. Scott Monteith (of Michigan State University) and his co-authors write about generative AI and adolescents for The British Journal of Psychiatry. They note a surge in use – some 80% of British teens use generative AI – and consider problems, from cyberbullying to mental healthcare. “There is a need to increase awareness of how GenAI may have a negative impact on the mental health of teenagers.”

DG

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Reading of the Week: AI Scribes in Primary Care – the New JAMA Psych Paper; Also, Antidepressant Prescribing and the Life & Death of Carol Sauer

February 5, 2026 /

From the Editor

More physicians are turning to AI scribes to free up time. But what is the impact on clinical care?

In a new JAMA Psychiatry paper, Victor M. Castro (of Harvard University) and his co-authors attempt to answer that question by looking at scribes in primary care. In a cohort study drawing on more than 20 000 routine annual visits, they compared documentation and management of neuropsychiatric symptoms. “Incorporation of AI ambient scribes in primary care was associated with greater levels of neuropsychiatric symptom documentation but lesser likelihood of documented management of psychiatric symptoms.” We consider the paper and its implications.

In the second selection, a letter published in The Canadian Journal of Psychiatry, Dionzie Ong (of the University of British Columbia) and her co-authors consider antidepressant prescribing and evidence, focusing on citalopram and escitalopram. “Preferential prescribing of escitalopram and claims of superiority are not supported by science.”

Finally, in the third selection, Washington Post reporter Dana Hedgpeth writes about the life and death of Carol Sauer, who spent years experiencing homelessness. She had graduated from high school, attended university, and held jobs until 2000, when she became ill. A person who read her death notice on social media comments: “I cried thinking about her. This beautiful woman sitting for 20 years at a bus stop and nobody could make a difference… It’s a reminder of the power and responsibility we have to help those who are homeless and mentally ill.” 

DG

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Reading of the Week: Yoga for Opioid Withdrawal? The New JAMA Psych Paper; Also, MAOIs & History, and AI-Associated Psychosis

January 29, 2026 /

From the Editor

Yoga is increasingly recognized as having a role in the treatment of those with mood and anxiety problems. But what about substance misuse?

In the first selection, from JAMA Psychiatry, Suddala Goutham (of the National Institute of Mental Health and Neurosciences, Bengaluru, India) and his co-authors attempt to answer that question in a new, early-stage randomized clinical trial. In the study, 59 men were randomized to yoga and buprenorphine or buprenorphine alone. “Those receiving yoga alongside standard buprenorphine treatment achieved withdrawal stabilization 4.4 times faster than controls (median, 5 vs 9 days) and showed significant improvements in heart rate variability, anxiety, sleep, and pain measures.” We consider the study and its implications.

In the second selection, from The Journal of Clinical Psychiatry, Vincent Van den Eynde (of Radboud University) and his co-authors write about the MAOI class of antidepressants. In a commentary paper, they argue that these medications are underappreciated. “We thus emphasize the need for renewed attention to the classic MAOIs in clinical practice and research.”

And in the third selection, Dr. Joseph M. Pierre (of the University of California, San Francisco) and his co-authors write about AI-associated psychosis for Innovations in Clinical Neuroscience. They discuss what they suggest is the first journal-published case report, detailing the struggles of a practicing medical professional. “Although multiple pre-existing risk factors may be associated with psychosis proneness, the sycophancy of AI chatbots together with AI chatbot immersion and deification on the part of users may represent particular red flags for the emergence of AI-associated psychosis.”

DG

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Reading of the Week: Antidepressants & Side Effects – the New Lancet Paper; Also, Medical Cannabis & Addiction, and AI Hallucinations

December 18, 2025 /

From the Editor

What are the physical side effects of antidepressants? In a new, impressive Lancet study, Toby Pillinger (of King’s College London) and his co-authors attempt to answer that old question with a new approach: the first systematic review and meta-analysis. They drew on 168 RCTs that measured physical health effects of antidepressants, including almost 59 000 participants and comparisons of 30 antidepressants. “We found strong evidence that antidepressants differ markedly in their physiological effects, particularly for cardiometabolic parameters.” We consider the paper and its implications.

How safe is cannabis for those taking it for medical purposes? Dr. Beth Han (of NIMH) and her colleagues report findings from a US survey in a new JAMA Psychiatry brief report, focusing on cannabis use disorder (CUD). They report that cannabis use wasn’t less addictive when used for medical reasons. “Clinicians should consider addiction risk before recommending medical cannabis and, if they do, should monitor for CUD emergence.”

The BMJ runs humorous articles in its Christmas issue. The journal doesn’t disappoint this year. Dr. Roberto A. Correa Soto (of the Universidad de los Andes) and his co-authors write about AI hallucinations and doctor BS (yes, you read that correctly). Frankly, the paper is worth reading for the profanity alone. “Both doctors and large language models (LLMs) are driven to produce misinformation – ‘bullshit’ and ‘hallucinations’ – owing to a shared pressure to provide answers, prioritising the appearance of competence over accuracy.”

There will be no Readings for the next three weeks. 

DG

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Reading of the Week: Preventing PTSD – the New AJP Study; Also, AI Hallucinations and Dr. Gollapudi on Stethoscopes

November 27, 2025 /

From the Editor

Though years had passed since his peacekeeping service in Bosnia, my patient lucidly described the flashbacks and nightmares that still haunted him. It raises an important question: is it possible to prevent PTSD in the first place?

In a new, important American Journal of Psychiatry paper, Chelsea Dyan Gober Dykan (of Tel Aviv University) and her co-authors attempt to answer that question by drawing on past work showing the effectiveness of response-time-based attention bias modification (RT-based ABM), a cognitive training technique. They describe a three-arm randomized controlled trial involving more than 500 male combat-bound soldiers who, before combat exposure, received one of two cognitive training techniques (RT-based ABM and a variant focused on gaze) or a sham intervention. Participants then reported on PTSD symptoms after it. “Consistent with a previous randomized controlled trial, RT-based ABM reduced risk for PTSD relative to sham ABM when implemented prior to combat exposure.” We consider the paper and its implications.

How common are AI hallucinations? In the second selection, Jake Linardon (of Deakin University) and his co-authors look at hallucinations through the prism of psychiatry, asking ChatGPT to draft writing on several disorders. In their JMIR Mental Health study, hallucinations were frequent. “Citation fabrication and bibliographic errors remain common in GPT-4o outputs, with nearly two-thirds of citations being fabricated or inaccurate.”

Finally, in the third selection from Academic Psychiatry, Dr. Sheba Gollapudi (of the University of Texas) mulls the power of the stethoscope and its psychiatric equivalent. She describes how she developed her listening skills and her use of silence. “Because even though I will not necessarily use a stethoscope in my everyday practice, I know now that the stethoscope is within me.”

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: Suicide Barriers & Suicide Prevention – the New CJP Study; Also, the Future of Education and AI & Diagnoses

November 28, 2024 /

From the Editor

The idea is simple: if certain locations attract suicidal individuals, making it harder for suicides to occur at those places can help. After much debate, in 2003, the City of Toronto did exactly that, constructing a suicide barrier for the Bloor Viaduct. Suicides immediately declined. 

What has been the long-term effect? And have the means of suicide deaths simply shifted? In the first selection, Dr. Mark Sinyor (of the University of Toronto) and his co-authors attempt to answer these questions. In a new study published in The Canadian Journal of Psychiatry, they drew on over two decades of data to analyze the impact of this suicide barrier. “Contrary to initial findings, these results indicate an enduring suicide prevention effect of the Bloor Viaduct suicide barrier.” We consider the study and its implications.

Pretty but lifesaving?

When it comes to medical education, much has changed over the years – including its name. What was once known as Continuing Medical Education (CME) is now referred to as Continuing Professional Development (CPD). But the changes go far beyond a simple rebranding. After all, the sheer volume of journal articles available today is staggering. How can you keep up? How can technology help? In the second selection, a new Quick Takes podcast, I speak with Dr. Sanjeev Sockalingam (of the University of Toronto) to explore the evolving world of CPD. “It took a pandemic to get us to realize that we could do so much online.”

Finally, in the third selection, from JAMA Network Open, Dr. Ethan Goh (of Stanford University) and his colleagues wonder if AI can assist physicians in making diagnoses. In an RCT, physicians were randomized to either conventional resources or those enhanced by access to AI (specifically, LLM). “In this trial, the availability of an LLM to physicians as a diagnostic aid did not significantly improve clinical reasoning compared with conventional resources.”

DG

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