Tag: JAMA Psychiatry

Reading of the Week: Suicide-related Reporting – the New BJP Paper; Also, Cannabis Use & Psychosis, and Mental Health & Working from Home

October 16, 2025 / / 0 Comments

From the Editor

The stakes are high: news coverage of suicide can affect suicide rates. So how responsibly do journalists report? How has this changed with time?

In a new paper for The British Journal of Psychiatry, Dr. Mark Sinyor (of the University of Toronto) and his co-authors attempt to answer these questions. Focusing on US network news, they analyzed suicide-related news segments over an 11-year period, including for putatively harmful characteristics. “Coverage of suicide stories by major US cable news networks was often inconsistent with responsible reporting guidelines.” We consider the paper and its implications.

In the second selection from JAMA Psychiatry, Dr. Andrew S. Hyatt (of Harvard University) and his co-authors look at cannabis use after legalization and those individuals with psychosis. In this brief report, they drew from a US database with almost 2 000 participants. “In this study, individuals with psychosis reported a large increase in current cannabis use following legalization and commercialization of cannabis in their state, and by larger amounts than previously reported estimates of the general population.”

Is working from home better for mental health? In the third selection, from Mental Health & Prevention, Jean-Philippe Chaput (of the University of Ottawa) and his co-authors drew on national data to analyze work location and several self-rated measures, including mental health. The dataset is impressive with almost 25 000 participants. “We observed that work location was not related to self-rated mental health, life satisfaction, or life and work stress.”

DG

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Reading of the Week: Antidepressant Discontinuation – the New JAMA Psych Study; Also, Obesity Meds and Nazaryan on His Father’s Depression

July 17, 2025 /

From the Editor

“New Research Questions Severity of Withdrawal From Antidepressants”

– The New York Times

“Antidepressant Pullback Symptoms Fewer Than Thought, Study Shows”

–  Bloomberg

Millions of North Americans take antidepressants – about one in seven Canadians – yet these medications remain controversial. A 2019 Lancet Psychiatry study, which drew heavily from online surveys, found that roughly half of patients who quit these meds experienced severe withdrawal symptoms, sparking much debate – and many, many questions from our patients.

How common are discontinuation symptoms? Which one is most commonly experienced? Michail Kalfas (of King’s College London) and his co-authors attempt to answer these questions with a new JAMA Psychiatry paper. They did a systematic review and meta-analysis by analyzing 50 studies involving almost 18 000 people. “This systematic review and meta-analysis indicated that the mean number of discontinuation symptoms at week 1 after stopping antidepressants was below the threshold for clinically significant discontinuation syndrome.” We consider the paper and its implications.

Celebrities use them; politicians discuss them; our patients ask about them. Are semaglutide and sister drugs game changers for those with mental health problems who struggle with obesity? To explore the opportunities and challenges of these new medications, in a new episode of Quick Takes, I speak with Dr. Mahavir Agarwal (of the University of Toronto), Lisa Schaefer (of Obesity Canada), and Dr. Sanjeev Sockalingam (of the University of Toronto). “Imagine a world where you have all the effects of antipsychotics, but none of the side effects.”

Finally, in the third selection, journalist Alexander Nazaryan discusses his father’s mental illness and its impact on his life. In a deeply personal essay for The New York Times, he notes the long shadow of illness. “My father never got to become a famous physicist or see his son go to M.I.T. Worse, he couldn’t ask for help until it was too late.”

DG

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Reading of the Week: Nudging Sobriety – the New JAMA Psych Paper; Also, Torous & Topol Weigh Generative AI and Wilson on Thick Skin

July 10, 2025 /

From the Editor

Substance work can be lifesaving. But it’s also challenging, as many patients continue to misuse illicit drugs or drop out of care or both. Evidence supports using incentives, including financial ones, to nudge patients toward sobriety. This approach, known as contingency management, includes tools such as vouchers and prizes.

But what forms of nudging work best? And how much of a financial incentive is needed? In a new JAMA Psychiatry paper, Carla J. Rash (of the University of Connecticut) and her co-authors attempt to answer these questions by looking at contingency management. In a systematic review, they drew on 112 protocols from 77 studies, analyzing types of nudges like vouchers (which may be exchangeable for, say, retails items) and prizes (a chance to win things like gift cards) and the amounts of money involved. The authors walk on a familiar path – the literature goes back four decades – but provide a meaningful update. “Based on these findings, weekly incentive magnitude estimates are $128/week for voucher protocols and $55/week for prize-based protocols.” We consider the paper and its implications. 

ChatGPT is the most downloaded app in history with people using it for everything from finding recipes to writing emails. How could generative AI be used for mental health? In a perspectives paper for The Lancet, Drs. John Torous (of Harvard University) and Eric J. Topol (of the Scripps Research Translational Institute) discuss this important and timely topic. “Despite considerable promise, research is still required to establish AI’s benefit and safety for promoting mental health.”

And in the third selection from Academic Psychiatry, Dr. Ariel E. Wilson, a resident of psychiatry at Kaiser Permanente Oakland, writes about patient rights, certifiability, and the weight of making good decisions. The author asks if psychiatrists need to have thick skin. “The challenge in psychiatry lies in finding a balance – creating our own semi-permeable membrane that allows us to protect ourselves from feeling the sting of every emotion we encounter, while also maintaining empathetic and trusting relationships with our patients.”

DG

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Reading of the Week: Glucagon-Like Peptide 1 Receptor Agonists & Mental Health – the New JAMA Psych Study; Also, Innovation and Lee on His Depression

May 29, 2025 /

From the Editor

These medications are widely discussed – and, yes, our patients ask about them. But how do glucagon-like peptide 1 receptor agonists impact mental health and overall wellness? Should we hesitate before reaching for the prescription pad?

Aureliane C. S. Pierret (of King’s College London) and her co-authors attempt to answer these questions in a new paper just published in JAMA Psychiatry. In their systematic review and meta-analysis, they included more than 107 000 patients, comparing treatment with GLP1-RAs to placebo, looking at psychiatric, cognitive, and quality of life outcomes in those who are overweight, obese, or have diabetes. “Our results provide reassurance regarding the psychiatric safety profile of GLP1-RAs and suggest that GLP1-RA treatment is associated with improved mental well-being, in addition to the known physical health improvements.” We consider the paper and its implications.

When we hear innovations in mental healthcare, we tend to think of apps or wearables. In the second selection from Quick Takes, Daisy Singla (of the University of Toronto) discusses her recent study that expanded access to psychotherapy for perinatal women, reducing symptoms of depression and anxiety by drawing a page from work done in low-income countries. The key concept: training up laypeople to deliver therapy (task sharing). “It’s one of the largest psychotherapy trials in the world.”

And in the third selection, from The Globe and Mail, Joe Lee writes about his realization that he has depression and that it has affected his life for years. In a personal essay, he talks about his illness and the impact on his life. “Depression is weird like that. For some people, it sneaks in. For me, it’s always been there – like blood in my body.”

DG

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Reading of the Week: Gone to the Dogs? The New BJP Study on Dog-assisted Interventions; Also, BC Decriminalization & the Latest in the News

April 24, 2025 /

From the Editor

He presented for the appointment with his dog. He told me that getting the chocolate lab – who had been trained by a national, not-for-profit organization – was the best single thing to help him. For the record, the dog was beautiful.

More and more of our patients are turning to animal interventions. But is there evidence to support this trend? In a new The British Journal of Psychiatry paper, Emily Shoesmith (of the University of York) and her co-authors look at dog-assisted interventions (DAIs), describing a review involving 33 papers. “DAIs may show promise for improving mental health and behavioural outcomes for those with mental health or neurodevelopmental conditions, particularly for conditions requiring social skill support. However, the quality of reporting requires improvement.” We discuss the paper and its clinical implications.

In the second selection, John F. Kelly (of Harvard University) reviews the successes of drug decriminalization in Portugal and its failures in British Columbia. In a new Editorial for JAMA Psychiatry, he notes key differences in their approaches. He also mulls the importance of such public-policy experimentation. “As demonstrated in Portugal, persistent, patient, thoughtful analysis, and sensitive, systemic planning is needed to ensure lives are saved and other outcomes improved.”

Finally, we explore the latest news with articles from The New York Times, The Globe and Mail, and NBC News. The topics: one firefighter’s battle with OCD, overdose deaths in North America, and a new mental-health awareness campaign.

DG

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Reading of the Week: ADHD – with Papers from JAMA Psych, PLOS One & Psych Services

April 3, 2025 /

From the Editor

He had struggled for years with mood and ADHD. While we discussed different medication options, my patient was very focused on psychedelics; he explained that his friends had found microdosing to be helpful, especially for their attentional problems.

Psychedelics have entered the mainstream: research is active; patients seem increasingly interested; and, yes, investors offer up billions in the rush to find potential treatments (and profit). But is there evidence for psychedelics for those with ADHD?  Dr. Lorenz Mueller (of the University of Basel) and his colleagues attempt to answer that question with a new paper, just published in JAMA Psychiatry. They describe the first double-blind, placebo-controlled phase 2A randomized clinical trial. 52 participants received repeated doses of LSD (twice weekly) or placebo over six weeks. “In this randomized clinical trial, repeated low-dose LSD administration was safe in an outpatient setting, but it was not more efficacious than placebo in reducing ADHD symptoms.” We consider the paper and its implications.

The molecular structure of LSD – pretty but useful for ADHD?

In the second selection, Vasileia Karasavva (of the University of British Columbia) and her co-authors look at ADHD and social media in a new paper for PLOS One. In a two-part study, they analyzed 100 popular videos on ADHD, finding many views but uneven quality. While they note the “democratizing” of mental health information, they warn: “TikTok’s anecdotal content could lead some viewers to misattribute normal behaviors or those better explained by other conditions to be signs of ADHD…”

In the third selection, Dr. Zilin Cui (of Boston University) writes about ADHD – as a provider and also as a patient. In a personal Psychiatric Services paper, the physician discloses long-standing problems and a diagnosis. She also writes about cultural considerations. “Instead of continuing to dwell on what I cannot do, I now have different tools and strategies to chart my path forward. Now, I can finally tell myself that I am enough.”

DG


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Reading of the Week: Physician Suicide – the New JAMA Psych Paper; Also, Homelessness & Substance (JAMA)

March 6, 2025 /

From the Editor 

It’s a demanding profession that can push us. Not surprisingly, there is some evidence that physicians may be at higher risk of completing suicide than the general population. But are we?

Hirsh Makhija (of the University of California, San Diego) and his co-authors attempt to answer this question in new JAMA Psychiatry study. Drawing on a US national database, they compared suicides among male and female physicians to the nonphysicians, over five years, finding that suicide rates for female physicians were 47% higher than for women in the general population. They also looked at mood, mental health, and other problems. “Comprehensive and multimodal suicide prevention strategies remain warranted for physicians, with proactive consideration for those experiencing mental health issues, job problems, legal issues, and diversion investigations.” We review the paper and its implications, and look at the accompanying Editorial.

In this week’s second selection, Ryan D. Assaf (of the University of California, San Francisco) and his co-authors report on homelessness and substance use. In a new paper for JAMA, they surveyed 3 200 people, finding that 37% reported using any illicit substance regularly (more than three times per week), most commonly crystal methamphetamine. “In a representative study of adults experiencing homelessness in California, there was a high proportion of current drug use, history of overdose, and unmet need for treatment.”

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

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: Psychiatric Care in 21 Countries – The JAMA Psych Study; Also, Industry Payments to Psychiatrists and Batterman on Relating

February 13, 2025 /

From the Editor

Our patients often struggle to access care. But what is the global experience? What percentage of patients in other countries receive care that meets basic standards?

In the first selection, Dr. Daniel V. Vigo (of the University of British Columbia) and his co-authors attempt to answer these questions in a new paper for JAMA Psychiatry. They analyzed effective treatment and its key components for nine mental disorders drawing on the World Mental Health surveys which included structured interviews. Vigo et al. cover familiar ground, but the study stands out due to its unusually robust dataset which includes almost 57 000 people in 21 countries. “The proportion of 12-month person-disorders receiving effective treatment was 6.9%.” We consider the paper and its implications.

In the second selection, Dr. John L. Havlik (of Stanford University) and his co-authors weigh in on industry payment to US psychiatrists. In this Psychiatric Services paper, they analyzed six years of data covering nearly 60 000 physicians, drawing on government databases, finding: “a small number of psychiatrists (<600 psychiatrists per year) received approximately 75% of industry’s compensation to psychiatrists each year.”

And, in the third selection, medical student Alexander I. Batterman (of Rowan University) writes about a patient encounter for Academic Psychiatry. He notes the challenges of connecting with a patient who has psychosis and is dismissive. Batterman persists – and understands. “As a former epilepsy patient who is intimately aware of what it is like to be questioned and observed by clinicians and students in the emergency department, as if I were an animal at the zoo on display, I could relate to the human experience of being judged.”

DG

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Reading of the Week: Alcohol Use Disorder – The NEJM Review; Also, Private Equity & Opioid Treatment and Gee on Refusing Help

January 30, 2025 /

From the Editor

When she was admitted for liver cirrhosis – the last hospitalization in her too-short life – no one visited. In her community, the stigma was great. As she grew more and more ill, I asked if she wanted me to call her family to be at the bedside. She simply smiled and said that they were all busy.

Over the years, I have seen many patients like this woman; we all have. Alcohol misuse is common. What’s the best evidence for screening and treatment? Dr. Paul S. Haber (of the University of Sydney) tries to answer that question with a sparkling review, published in The New England Journal of Medicine. His paper is clearly written and draws from more than sixty references. “Alcohol use disorder is a relapsing and remitting medical and psychological disorder that influences physical health, mental health, and social functioning, and continuing care is recommended.” We consider the review and several key take-aways.

In the second selection, David T. Zhu (of Virginia Commonwealth University) and his co-authors analyze the ownership of opioid treatment programs in the United States, with a particular focus on private equity. The research letter, published in JAMA Psychiatry, drew on government data. “This study found that 29.1% of US opioid treatment programs were owned by private equity firms, exceeding private equity penetration in other sectors of health care (range, 2%-11%).”

And in the third selection, columnist Marcus Gee of The Globe and Mail writes about mental illness and patient rights. He discusses a woman in his neighbourhood who has delusions and refuses shelter in the cold weather, convinced that she will soon be offered keys to a new home. “Surely she deserves better. Surely we can do better.”

DG


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