Tag: JAMA Pediatrics

Reading of the Week: Trauma & Schizophrenia – the New AJP Study; Also, AI Chatbot & US Teens, and Gunther on the Blessings & Curses of Meds

From the Editor

Can a parent’s trauma influence the development of mental illness in his or her child? Research suggests an intergenerational link for several disorders, including PTSD. But what about schizophrenia? Complicating such research: the complexity of genetics, environment, and trauma – and the limits of data.

In a new American Journal of Psychiatry paper, published last week, Iaroslav Youssim (of the Hebrew University of Jerusalem) and his co-authors attempt to answer these questions by looking at parental exposure to the Holocaust – years before conception – and the associated risk of schizophrenia in their children. They drew data from 92 000 births in West Jerusalem between 1964 and 1976. “Offspring of mothers who were older than age 5 when Nazi persecutions began showed over a twofold increase in schizophrenia risk, underscoring the potential impact of trauma and its timing during the preconception period in the pathogenesis of schizophrenia.” We consider the study and its implications.

How often do adolescents and young adults use AI chatbots for mental health? In the second selection, from JAMA Pediatrics, Ryan K. McBain (of RAND) and his co-authors report on a US survey. They find that one in five youth use AI chatbots for mental health advice. “AI chatbots are already embedded in many youths’ mental health information ecosystem, underscoring the need for parents and clinicians to proactively discuss chatbot use to promote safety, appropriate expectations, and linkages to evidence-based care.”

And in the third selection, Sarah M. Gunther discusses medications and her journey in Psychiatric Services. In her personal essay, she describes trying different meds over time and the problems that they caused. She finally lands on the right combination. “I tell this story so that others won’t give up, and so doctors can see that the medications that they prescribe can make an illness worse.”

DG

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Reading of the Week: Pediatric Self-Injury – the New JAMA Peds Study; Also, Lithium as King, and High-Risk Human-AI Engagement

From the Editor

Recently, I saw an adolescent who described using self-harm as a way to cope. She discussed learning different techniques through social media. “At first, I thought it was strange.”

Presentations of self-injury appear to be becoming more common. How often are healthcare visits for it? How commonly do youth report self-injury? Have these numbers changed over time? In a new study published in JAMA Pediatrics, Dr. Natasha Saunders (of the University of Toronto) and her co-authors attempt to address these questions by drawing on 42 studies with a combined population of 234 million individuals across a dozen nations over a 25-year period. They conducted a systematic review and meta-analysis, finding an average 3.5% relative annual increase. “These findings highlight a consistent rise in health care encounters and self-reported self-injury among children and youth, particularly female individuals, over the past 2 decades.” We consider the study and its implications.

In the second selection from The British Journal of Psychiatry, Dr. Gurubhaskar Shivakumar (of The University of Sydney) and his co-authors write about lithium. They note its declining use and the problems with its safety. Yet they argue that lithium remains the “king” of bipolar disorder treatment. “Ever since its discovery, lithium continues to command authority having repeatedly reclaimed its throne.” 

Finally, in the third selection, Dr. Lena Palaniyappan (of McGill University) and his co-authors discuss high-risk human-AI relationships in a paper for The Canadian Journal of Psychiatry. They offer a framework and constructive suggestions – both highly relevant in the age of AI chatbots. “Risk for problematic AI engagement cuts across diagnostic categories, rooted in distress, isolation, and cognitive style.”

DG

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Reading of the Week: GLP-1 Receptor Agonists for Obesity & Alcohol – the New Lancet Study; Also, Drs. Liao and Fombonne on Autism Overdiagnosis

From the Editor

It could be lifesaving for those with diabetes. And many others are taking GLP-1 receptor agonists, ranging from people with medical conditions such as obesity to those who have cosmetic interests. GLP-1 receptor agonists are having a moment. Could they also be helpful for patients with substance problems? Some small studies suggest yes.

In a major new Lancet study, Dr. Mette Kruse Klausen (of Copenhagen University) and her co-authors attempt to answer that question. They report on a RCT involving patients with both obesity and alcohol use disorder. 108 Danish participants were randomized to the GLP-1 receptor agonist semaglutide or placebo. At six months, adults taking semaglutide reported five heavy drinking days in the previous months (down 41%) compared to nine days in the placebo group. “To our knowledge, this RCT is the first to show that once-weekly semaglutide reduces heavy drinking days and WHO drinking-risk levels in treatment-seeking patients with alcohol use disorder and comorbid obesity.” We consider the paper, the accompanying editorial, and its implications.

In this week’s other selection, a Viewpoint paper from JAMA Pediatrics, Drs. Lester Liao (of McGill University) and Eric Fombonne (of the Oregon Health & Science University) write on autism and overdiagnosis. “Diagnostic practices geared to accessing resources, incorrect diagnostic practices, increased attention, changes to diagnostic criteria and thresholds, and fundamental cultural shifts have contributed.”

DG

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Reading of the Week: Personalized Antidepressant Treatment – the New JAMA Study; Also, Social Media Use & Adolescent Well-Being

From the Editor

Some patients with depression don’t show improvement. Among the reasons why: they may stop treatment too early. For decades, research on improving outcomes has included biomarkers, trying to better pair illness with treatment. But what about following patient preferences in care decisions? Can this help bolster medication compliance and thus improve outcomes?

In a new, compelling paper that was just published in JAMA, Dr. Andrea Cipriani (of the University of Oxford) and his co-authors attempt to answer these questions. They describe a study involving 540 participants in 47 sites. Participants were randomized to receive either the usual care or care using the PETRUSHKA tool, “a web-based clinical decision-support system combining clinical and demographic predictors with patient preferences to personalize antidepressant treatment.” The results are impressive. “Compared with usual care, participants with MDD whose antidepressant was selected using the PETRUSHKA tool had a reduced risk by approximately 40% of discontinuing their antidepressant during the first 8 weeks of treatment.” We consider the paper and its implications, as well as the accompanying Editorial.

The impact of social media on children and adolescents is much discussed; recently, Australia banned youth who are under 16 years of age from using platforms like Instagram. In this week’s other selection, from JAMA Pediatrics, Ben Singh (of the University of South Australia) and his co-authors analyzed social media’s association with well-being. They describe a cohort study of more than 100 000 Australian adolescents who were followed for three years. They found: “a U-shaped association emerged where moderate social media use was associated with the best well-being outcomes, while both no use and highest use were associated with poorer well-being.”

Note: there will be no Readings for the next two weeks.

DG

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Reading of the Week: ECT in Ontario – the New CJP Study; Also, Alcohol & Influencers, and Jayaraman on Chekhov’s Guns

From the Editor

It’s the most effective treatment for those with treatment-resistant depression. Older studies, including one from Quebec, suggest that it’s much less used than in the past. Is ECT going the way of the dodo bird?

In a new Canadian Journal of Psychiatry study, Dr. Tyler S. Kaster (of the University of Toronto) and his co-authors attempt to answer that question. They drew on 17 years of data, tapping several administrative databases from Ontario, covering more than 450 000 treatments. They offer some good news. “We found that while ECT use generally increased over time, there were notable differences between biological sexes, age groups, and geographic regions.” We consider the paper and its implications.

In the second selection, a research letter published in JAMA Pediatrics, Scott I. Donaldson (of Rutgers University) and his co-authors connect social media content with the desire to drink among young people. Drawing on survey data, they analyzed the impact of lifestyle influencers. “This experimental evidence adds to a growing body of research showing that exposure to alcohol-promoting content, particularly on social media, is associated with alcohol-promoting attitudes and behaviors in young adults.” 

Finally, in the third selection, Pranav Jayaraman (of Texas Tech University) writes about diagnoses and patients in Academic Psychiatry. The medical student discusses the temptation to reduce experiences to simple diagnoses. “As I seek to serve patients through psychiatry, a field often facing provider capacity and time constraints, the desire to pinpoint a single cause and address it with a straightforward solution is understandable but can also be limiting.”

DG

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Reading of the Week: Tweets for a Good Cause, But Suicide Prevention? Also, Racism in Mental Health (QT), and Rap & Awareness (JAMA Peds)

From the Editor

It’s an incredible campaign. With each passing year, Bell Let’s Talk Day gains more recognition, with many, including the Prime Minister, tweeting for a good cause.

But does the campaign affect suicide? In the first selection, we look at new paper from The Canadian Journal of Psychiatry. David Côté (of the University of Toronto) and his co-authors study the tweet contents of Bell Let’s Talk Day and suicide completions. “There was no associated change in suicide counts.” We mull the big campaign and the big paper.

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In the second selection, we look at a new podcast that explores race and racism in mental health. In this Quick Takes episode, I’m joined by Drs. Amy Gajaria and Saadia Sediqzadah (both of the University of Toronto). “Racism exists and it exists in the lives of our patients.” The podcast covers some big topics – but it is also practical, with solid clinical advice.

And in the third selection, Alex Kresovich (of the University of North Carolina) and his co-authors wonder about the cultural discussion of mental health. To that end, they review popular rap songs in a JAMA Pediatrics paper. “The findings of this qualitative study suggest that mental health discourse has been increasing during the past 2 decades within the most popular rap music in the US.”

DG

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