Tag: JAMA Network Open

Reading of the Week: New Tech for Old Problems? An App for Negative Symptoms, Chatbots & Suicidality, Notes in the Age of AI Scribes

October 1, 2026 / / 0 Comments

From the Editor

The voices became quieter, and the paranoia lessened. But my patient continued to complain about his lack of motivation. He left the hospital, but he never rejoined the workforce. Negative symptoms are difficult to treat.

Could an app help? In a new JAMA Network Open paper, Abhishek Pratap (of Boehringer Ingelheim Pharmaceuticals) and his co-authors attempt to answer that question. They describe a randomized clinical trial of 457 individuals with negative symptoms of schizophrenia, comparing those receiving an app (CT-155) intervention featuring evidence-based psychosocial treatments against an active control. “These findings support CT-155 as a potential adjunctive therapy for patients for an indication of negative symptoms of schizophrenia with a high unmet need for FDA-approved pharmacologic treatments specifically targeting negative symptoms.” We discuss the paper and its implications.

As more and more people turn to chatbots for mental health advice, we should ask: how can we make them safer? In a new Comment from npj Digital Medicine, Joanna M. Streck (of Harvard University) and her co-authors describe experimentation with an AI chatbot and the lessons learned. “We describe suicide safety monitoring features for a chatbot implemented in a high-risk clinical setting and make recommendations for chatbot design alongside human-monitoring and triage.”

Finally, in the third selection, Dr. Danilo Rojas-Velasquez (of Harvard University) writes about clinical notes and language in a paper for Academic Psychiatry. He offers suggestions for learners, noting how language affects care – a topic now even more relevant with the growing use of AI scribes. “We watch language do its quiet work, and we write notes that will, in turn, shape how the next team thinks.”

DG

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Reading of the Week: Will the Doctor See You Now? Video vs In-Person Visit Outcomes; Also, Suicide Prevention in India and Barford on Fake Patients

September 24, 2026 / / 0 Comments

From the Editor

This month, Reading of the Week celebrates its 12th anniversary. Over these past years, the program has grown, establishing partnerships in seven countries and promotional arrangements in three more.  

A quick word of thanks for your ongoing interest.

In March 2020, mental health services were transformed by the reality of the pandemic and the webcam became indispensable. Today, many clinical programs offer a mix of video, in-person, and phone visits. But what are the outcomes?

In a new JAMA Network Open paper, Samantha L. Connolly (of Harvard University) and her co-authors attempt to answer that question. Using Veterans Affairs’ data involving 813 699 participants, they compared different modalities of care and looked at outcomes over a year, including inpatient admissions. “In this comparative effectiveness study, receiving mental healthcare via video was associated with improved clinical outcomes compared with receiving care via phone or in-person.” We consider the paper and its implications.

In the second selection, Rakhi Dandona (of the Public Health Foundation of India) and Dr. Rajesh Sagar (of the All India Institute of Medical Sciences) write about suicide prevention in JAMA Psychiatry. They offer lessons from India, where one in five suicides occur. “If most suicides occur in LMICs, then the future of suicide prevention should increasingly be shaped by evidence generated within them.”

And in the third selection from The Globe and Mail, Pat Barford writes about being a “fake patient,” to use her term. She describes her work as a standardized patient for medical students. “I get to watch the highest level of learning happen in real-time.” 

DG


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Reading of the Week: Substance – with New Papers from JAMA Psych, Netw Open & Brookings; Also, the Latest in the News

February 20, 2025 /

From the Editor

For many of our patients, the pull of alcohol can be strong with devastating effects. In recent months, semaglutide, better known for its weight-loss properties, has generated some buzz. Could semaglutide help those with alcohol problems?

In the first selection, Christian S. Hendershot (of the University of Southern California) and his co-authors attempt to answer that question in a new paper for JAMA Psychiatry. They conducted an RCT with 48 participants randomized to semaglutide or placebo over nine weeks, measuring alcohol consumption and craving outcomes, and finding that people taking semaglutide consumed less alcohol by some measures. “These findings provide initial prospective evidence that low-dose semaglutide can reduce craving and some drinking outcomes, justifying larger clinical trials to evaluate GLP-1RAs for alcohol use disorder.” We consider the paper and its implications.

In the second selection, Joshua L. Gowin (of the University of Colorado) and his co-authors explore the impact of heavy lifetime and recent cannabis use on brain function in a new paper for JAMA Network Open. They analyzed data from more than 1 000 young adults, including brain imaging, focusing on tasks administered during fMRIs sessions. “Cannabis use is associated with short- and long-term brain function outcomes, especially during working memory tasks.”

Finally, we explore the latest news with articles from The New York Times and The Free Press, and a new report from the Brookings Institution. The topics: Oregon’s decriminalization, Robert F. Kennedy’s nomination, and decriminalization across North America.

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: Psychological Interventions for Schizophrenia – the New Lancet Psych Study; Also, Service Dogs for PTSD, and the Latest in the News

July 4, 2024 /

From the Editor

She was distressed by the voices and the paranoid thoughts. Many nights, my patient could barely sleep. She had tried several medications without much improvement. Is there a role for psychological interventions? Would CBT help? What is the evidence for this population?

In the first selection, Nurul Husna Salahuddin (of the Technical University of Munich) and co-authors attempt to answer these questions in a new systematic review and network meta-analysis, just published in Lancet Psychiatry. The analyzed 52 RCTs with 5 034 participants. “We provide robust findings that CBTp can reduce the overall symptoms of patients with treatment-resistant schizophrenia, and therefore clinicians can prioritise this intervention in their clinical practice.” We consider the paper and its clinical implications.

In the second selection from JAMA Network Open, Sarah C. Leighton (of the University of Arizona) and her co-authors describe a study involving service dogs for those with PTSD. In a nonrandomized controlled trial involving 156 military members and veterans, they examined outcomes after three months. “[C]ompared with usual care alone, partnership with a trained psychiatric service dog was associated with lower PTSD symptom severity and higher psychosocial functioning in veterans.”

Finally, we explore the latest news with recent articles from The Guardian, the Ottawa Citizen, and The New York Times. Among the topics: “honest” obituaries and the opioid crisis, antidepressants and withdrawal, and care for pregnant women with substance problems.

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: Cannabis & Cardiac Health – the New JAHA Study; Also, Burnout & Outcomes, and Dr. Mary Seeman on Scaling Down

May 9, 2024 /

From the Editor

Our patients increasingly use cannabis, and we worry about the impact on their mental health. But what about the impact on their physical health?

In the first selection, Abra M. Jeffers (of Harvard University) and her co-authors consider cannabis and cardiac health. In a new paper for the Journal of the American Heart Association, they analyzed cardiac outcomes, drawing on survey data and involving more than 400 000 participants, some of whom used cannabis. “Cannabis use is associated with adverse cardiovascular outcomes, with heavier use (more days per month) associated with higher odds of adverse outcomes.” We review the paper and its implications.

In the second selection, Nina A. Sayer (of the University of Minneapolis) and her co-authors look at burnout in a new paper for JAMA Network Open. In a cohort study involving 165 therapists and almost 1 300 patients, they note a connection between provider burnout and PTSD outcomes. “These findings suggest that interventions to reduce therapist burnout might also result in more patients experiencing clinically meaningful improvement…”

Dr. Mary Seeman (of the University of Toronto), who died in late April, had a storied career as a psychiatrist. She had major roles, including the Tapscott Chair in Schizophrenia at the University of Toronto. In a 2003 paper for The American Journal of Psychiatry, she reflects on her work with a patient. This essay – the third selection this week – notes the decades-long connection between doctor and patient. “Her faith in me keeps me coming into work each morning, often tired and achy, sometimes trying unsuccessfully to remember the comforting word I want to be able to say.”

DG

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Reading of the Week: Suicide Attempts in the Healthy – the New JAMA Psych Study; Also, Polypharmacy & Youth, and Coyle on His Sobriety & Mulroney’s

March 7, 2024 /

From the Editor

Overwhelmed by the divorce, she made a serious attempt on her life, saved from certain death by a police officer who was running late for work and drove through an industrial area of Scarborough. After days of observation, I concluded that she had an unfortunate life circumstance, but not a psychiatric disorder.

How commonly do people without mental disorders attempt suicide? What can be done to help them? Dr. Maria A. Oquendo (of the University of Pennsylvania) and her co-authors try to answer these questions in a new JAMA Psychiatry paper. In their study of healthy individuals and suicide attempts, they drew on a US database involving more than 36 000 people who had attempted suicide. “An estimated 19.6% of individuals who attempted suicide did so despite not meeting criteria for an antecedent psychiatric disorder.” We consider the study and its implications.

A healthy individual – at risk for a suicide attempt?

In the second selection, Yueh-Yi Chiang (of the University of Maryland) and her co-authors focus on youth and polypharmacy in a new JAMA Network Open research letter. Concerningly, past work has suggested that polypharmacy is growing more common in the young. Chiang et al. tapped Medicaid data from one US state including almost 127 000 youth. “In this cross-sectional study, we observed a 4% increased odds of psychotropic polypharmacy per year from 2015 to 2020, indicating growing concomitant use of multiple psychotropic classes.”

And in the third selection, reporter Jim Coyle writes about former Prime Minister Brian Mulroney in the Toronto Star. The essay is deeply personal – Coyle discusses his own problems with alcohol and his connection with the former prime minister, who had also struggled with it. “Mulroney knew that alcoholism is no respecter of rank or status, that alcoholics understand each other across any divide, and better than anyone else can.”

There will be no Readings for the next two weeks.

DG

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Reading of the Week: Cannabis-Related Disorders – the new NEJM Paper; Also, Surgeons & Opioid Prescribing and MAiD & Mental Illness

February 8, 2024 /

From the Editor

Cannabis use is increasingly common. Should you be screening for misuse? What’s the role of drug testing? Do short interventions work?

In the first selection, we look at the new paper on cannabis-related disorders, published in The New England Journal of Medicine. Dr. David A. Gorelick (of the University of Maryland) comments on cannabis use disorder, offering practical suggestions, drawing on the latest in the literature (with 76 references). “Cannabis use disorder and heavy or long-term cannabis use have adverse effects on physical and psychological health.” We discuss the paper and its takeaways.

In the second selection, Jason Zhang (of the University of Michigan) and his co-authors consider surgeons and the prescribing of opioids. Given past problems, are surgeons more frugal when they reach for the prescription pad? Drawing on an impressive US database, they analyzed dispensed opioids from 2016 to 2022 in a new JAMA Network Open research letter, finding a step in the right direction – but just a step. “Despite large reductions in opioid prescribing, surgical opioid stewardship initiatives remain important.”

And in the third selection, The Globe and Mail weighs in on the recent decision to delay the expansion of medical assistance in dying, or MAiD, for mental disorders. In an unsigned editorial, the authors recognize the suffering of some, but argue that not enough has been done to define the term irremediable. “A delay is not enough.”

DG

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Reading of the Week: Employee Well-being & Corporate Strategies – the new Industrial Relations Paper; Also, Physician Burnout and Moyles on Suicide

January 25, 2024 /

From the Editor

Mindfulness programs, apps for sleep, resilience training. More and more corporations are offering these types of wellness interventions. Indeed, employee mental health services have become a billion-dollar industry. As reporter Ellen Barry recently observed in The New York Times: “These programs are a point of pride for forward-thinking human resource departments, evidence that employers care about their workers.” But are employees actually feeling better?

In a new paper for Industrial Relations Journal, William J. Fleming (of the University of Oxford) used survey data involving more than 46 000 British employees from 233 organizations, and considered several well-being efforts – including, yes, mindfulness programs, apps for sleep, and resilience training. He looked at several subjective well-being indicators. “Results suggest interventions are not providing additional or appropriate resources in response to job demands.” We look at the study and its implications.

In the second selection, Marcus V. Ortega (of Harvard University) and his co-authors look at physician burnout over time, drawing on US survey data for JAMA Network Open. With the pandemic, not unexpectedly, they found that physicians reported more burnout. “Findings of this survey study suggest that the physician burnout rate in the US is increasing.”

And in the third selection, author Trina Moyles writes about her brother and his suicide in a deeply personal essay for The Globe and Mail. She discusses her grief, the reaction of others, and her attempts at finding closure. She argues that we need to speak more openly about this topic. “Suicide: The word fires like a gunshot, so I’ve found myself whispering it.”

DG

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