Tag: Canadian Journal of Psychiatry

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: 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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Reading of the Week: Therapy = More Work + Better Income? The New Psych Medicine Study; Also, Zero Suicide & Melatonin for Kids

June 5, 2025 /

From the Editor

After completing a course of psychotherapy, he felt better and began a part-time job. The employment gave him a sense of purpose. As a physician, I could both sympathize and empathize; for many, work is a meaningful part of life, after all.

But does psychotherapy necessarily result in employment? Does therapy pay for itself with economic benefits? Otto R. F. Smith (of NLA University College) and his co-authors attempt to answer these questions in an impressive new paper in Psychological Medicine. They report on an RCT involving more than 700 Norwegian participants who were randomized to a psychotherapy program (modeled after the UK’s IAPT service) or to treatment as usual. The authors used administrative databases to analyze employment, income, and the economic benefit. “The results support the societal economic benefit of investing in IAPT-like services.” We consider the paper and its implications.

In the second selection, Dr. Calina Ouliaris (of Macquarie University) and her co-authors look at the zero suicide approach. In a Commentary for The British Journal of Psychiatry, they argue that – despite being studied and implemented in several places – it lacks evidence. “The Zero Suicide Framework is an arguably vague framework with a scant evidence base, particularly for application in healthcare settings. Despite this, the concrete goal championed… that of ‘zero suicides’, is appealing and has been widely promulgated in mental health services, ahead of evidence for the same.”

Finally, in the third selection, Dr. Chris Y. Kim (of the University of Toronto) and his co-authors weigh the use of melatonin for children and adolescents. In The Canadian Journal of Psychiatry, they are cautious, in part because of the lack of consistency of over-the-counter melatonin. “Melatonin used as a hypnotic agent for the treatment of insomnia is controversial.”

DG

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Reading of the Week: Lived Experience of Postpartum Depression & Psychosis – the New World Psych Paper; Also, Involuntary Treatment and Family Stress

May 15, 2025 /

From the Editor

“You are normal and then the next thing, you know, you’re crazy.”

So comments a woman about her postpartum depression. Typically, we describe this illness with a list of symptoms. But how do patients experience it? In a new World Psychiatry paper, Dr. Paolo Fusar-Poli (of King’s College London) and his co-authors attempt to answer this question with a “bottom-up” approach, looking at both postpartum depression and psychosis. “To the best of our knowledge, this is the first bottom-up review of the lived experience of postpartum depression and psychosis. Experts by experience co-designed, co-conducted and co-wrote the study, leveraging an established methodological template developed by our group to investigate the lived experience of psychosis [and] depression…” We look at the paper and its implications.

Should people with substance problems be forced into treatment? Across North America, some are proposing this idea, including governments in British Columbia and Alberta. In a new Canadian Journal of Psychiatry paper, Benedikt Fischer (of the University of Toronto) and his co-authors look at the issue and the evidence. “Involuntary treatment for severe SUD is a complex and contentious concept that requires careful in-depth consideration before its adoption.”

In the third selection, a paper written anonymously for The BMJ, the author describes the challenges for families of those with severe mental disorders. He notes his deep frustration with visits to the ward, often leaving him in tears. “Perhaps family support needs to become part of the culture on mental health wards, and we should recognise the need for help in communicating.”

DG


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Reading of the Week: Are the Kids Alright? The New JAMA Paper on Mental Disorders & Children; Also, the Remarkable Life of Dr. Mary Seeman

May 1, 2025 /

From the Editor

Are children experiencing more mental disorders than before, or are we simply getting better at screening for them? Many have opinions and there is debate among psychiatrists and within our society.

In a new JAMA paper, Janet R. Cummings (of Emory University) and her co-authors provide new data shedding light on this issue. Drawing on US government databases covering 22 states and from 2010 to 2019, they looked at diagnoses and demographics among economically disadvantaged children. “This observational study found that the percentage of publicly insured children diagnosed with any mental health or neurodevelopmental disorder increased from 10.7% in 2010 to 16.5% in 2019.” We consider the paper and the accompanying Editorial – and wonder if this reflects better screening or more illness. 

In this week’s other selection, we look at the life and career of Dr. Mary Seeman, who died in 2024. In an obituary for The Canadian Journal of Psychiatry, Dr. Robert B. Zipursky (of the University of Toronto) and his co-authors note her many contributions to psychiatry. “Although Mary was 89 years old at the time of her death, her passion, humour, curiosity, and productivity had not abated. It endures now in the legacy of her scientific work, in her teaching and clinical care and in the many people she inspired to follow her example.”

DG


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Reading of the Week: Student Mental Health – the New CJP Paper; Also, Novel Treatment for Alcohol and Kerman & Stergiopoulos on Encampments

December 19, 2024 /

From the Editor

He walked into our emergency department late one night. He told me that he felt overwhelmed – not just by his university studies, but by everything. Even getting out of bed was challenging. Like many, his depression began in late adolescence, just as he was starting his engineering program.

What are the experiences of university students with mental health problems? And what can be done to improve them? Nathan King (of Queen’s University) and his co-authors try to answer these questions in a new paper published in The Canadian Journal of Psychiatry. They surveyed more than 4 000 Queen’s students over a five-year period, and did both qualitative and quantitative analyses. They found 30% reported a lifetime mental disorder and 23% had a history of self-harm, yet only 15% accessed care. They make several recommendations including: “Student-tailored mental health literacy may be a sustainable approach to address the attitudinal and practical barriers identified.” We consider the paper and its implications.

In the second selection, Dr. Markku Lähteenvuo (of the University of Eastern Finland) and his colleagues discuss semaglutide and sister drugs for alcohol use disorder in a JAMA Psychiatry brief report. Drawing on Swedish databases, they compared individuals who took the glucagon-like peptide-1 receptor (GLP-1) agonists to those who didn’t. “Among patients with AUD and comorbid obesity/type 2 diabetes, the use of semaglutide and liraglutide were associated with a substantially decreased risk of hospitalization due to AUD.”

In the third selection, an op ed published in the Toronto Star, Nick Kerman and Dr. Vicky Stergiopoulos (both of the University of Toronto) consider the Ontario government’s plan to end homeless encampments in Canada’s largest province. They suggest an alternative. “Let’s leverage a housing-first intervention, a proven way to get people the housing and support they need.”

The Reading of the Week is going on holidays for the next weeks (or, at least, I am). The next Reading will be 16 January 2025. All the best in the holiday season.

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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Reading of the Week: Care & Technology – Papers on Virtual Care and an App for Alcohol; Also, Dr. Reisman on ChatGPT & Bedside Manner

October 17, 2024 /

From the Editor

With COVID-19, mental health services were transformed in a matter of weeks when much care shifted to virtual. Today, we are all proficient in our webcams and familiar with terms like Zoom fatigue.

From a system perspective, we have unanswered questions: What’s the right amount of virtual care? When is it appropriate? In the first selection, Matthew Crocker (of the Canadian Institute for Health Information) and his co-authors focus on virtual versus in-person follow-up care after an ED visit in Ontario. Drawing on databases, they analyzed more than 28 000 such visits, wondering if the virtual option led to more adverse psychiatric outcomes. “These results support virtual care as a modality to increase access to follow-up after an acute care psychiatric encounter across a wide range of diagnoses.” We consider the paper and its implications.

Apps for mental health are increasingly popular; the mental health app market may be worth more than $24 billion by 2030, according to one estimate. In the second selection from Internet Interventions, John A. Cunningham (of the University of Toronto) and co-authors describe a new RCT involving participants who were concerned about their drinking. 761 were given either an app with several intervention modules or just educational materials. They were then followed for six months. “The results of this trial provide some supportive evidence that smartphone apps can reduce unhealthy alcohol consumption.”

And in the third selection, Dr. Jonathan Reisman, an ED physician, writes about AI. In a provocative essay for The New York Times, he argues that physicians often rely on scripts to seem compassionate – such as when we deliver bad news. AI, he reasons then, could do that well. “It doesn’t actually matter if doctors feel compassion or empathy toward patients; it only matters if they act like it. In much the same way, it doesn’t matter that A.I. has no idea what we, or it, are even talking about.”

DG

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Reading of the Week: the CANMAT Depression Update – Seven Takeaways & Commentary; Also, Patient Preferences for Televideo Backgrounds

May 23, 2024 /

From the Editor

Much has changed in the past eight years. In 2016, singer Olivia Rodrigo was starting high school. Quarterback Tom Brady seemed ageless. And none of us were talking about pandemics. 2016 was also the year when the last Canadian Network for Mood and Anxiety Treatments (CANMAT) depression guidelines were released. Well, it’s 2024 and the update has just been published in The Canadian Journal of Psychiatry. 

How has depression management changed over these past eight years, and how should you adjust your clinical practice? In the first selection, we look at seven takeaways and a commentary.

Melancholia (from the Wellcome Library)

In this week’s other selection, Dr. Nathan Houchens (of the University of Michigan) and his co-authors consider telemedicine video backgrounds in a new research letter from JAMA Network Open. They asked patients to rate different backgrounds and in various medical circumstances; they report on survey results of more than 1 200 patients. “In this study, two-thirds of participants preferred a traditional health care setting background for video visits with any physician type, with physician office displaying diplomas rated highest.”

DG

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Reading of the Week: Catatonia – the new NEJM Review; CBD for Bipolar and Dr. Samuels on Medical Assistance in Dying

November 23, 2023 /

From the Editor

Catatonia has been well described but is poorly understood.

So write Drs. Stephan Heckers and Sebastian Walther (both of Vanderbilt University) in a new review. We could add: catatonia is often striking. I remember a patient who literally sat for hours in his chair with catatonia secondary to schizophrenia. His family, in some denial, had insisted that his poor eating was related to hospital food and that his lack of activity had to do with the boredom of the ward.

Drs. Heckers and Walther’s review, just published in The New England Journal of Medicine, notes: “Catatonia is common in psychiatric emergency rooms and inpatient units,” with an estimated prevalence of 9% to 30%. They describe the diagnosis and treatment. We consider the paper and its implications.

Waxy flexibility (from catatonia) in an undated photo

Interest in CBD has surged in recent years. Can it help with the tough clinical problem of bipolar depression? In the second selection, Dr. Jairo Vinícius Pinto (of the University of São Paulo) and his co-authors attempt to answer that question in a new Canadian Journal of Psychiatry paper. They describe a pilot study, with 35 patients randomized to CBD or placebo, finding: “cannabidiol did not show significantly higher adverse effects than placebo.”

And in the third selection, Dr. Hannah Samuels (of the University of Toronto) discusses medical assistance in dying in a paper for Academic Psychiatry. This resident of psychiatry describes a patient who, dealing with pain, opted for MAiD. Dr. Samuels considers the decision but her ambivalence in part stemming from her training. “I felt sad, confused, and morally conflicted. Mrs. L never faltered in her confidence that this was the right decision for her, but I could not understand it.”

DG

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