Tag: JAMA Psychiatry

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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Reading of the Week: More Therapy, More Inequity? The New JAMA Psych Study; Also, Dr. Reimer on Living with Depression and Generative AI & Biases

January 23, 2025 /

From the Editor

What has been the most significant innovation in mental healthcare delivery in recent years? It wasn’t a new medication or therapy, but the widespread adoption of the webcam in 2020. Over the course of a handful of pandemic weeks, psychiatrists and therapists switched to virtual sessions, making it easier for people to receive care, including psychotherapy, unbound by geography, and thus addressing inequity – or, at least, that was the hope. As noted recently in The New York Times: “In the 1990s, teletherapy was championed as a way to reach disadvantaged patients living in remote locations where there were few psychiatrists. A decade later, it was presented as a more accessible alternative to face-to-face sessions, one that could radically lower barriers to care.”

So, are more people receiving psychotherapy? And has this new era of virtual care resulted in better access for all? Dr. Mark Olfson (of Columbia University) and his co-authors attempt to answer these questions in a new paper for JAMA Psychiatry. Drawing on the data of more than 90 000 Americans, they analyzed trends in outpatient psychotherapy in the US, finding more care than ever before. That said, they note greater inequity: “psychotherapy use increased significantly faster among several socioeconomically advantaged groups and that inequalities were evident in teletherapy access.” We consider the study and its implications.

As doctors, we often shy away from discussing our health, especially our mental health – even with our own physicians. This is particularly concerning because doctors have a higher suicide rate than the general population, yet fears of vulnerability, judgment, and stigma keep many of us silent. In this episode of Quick Takes, I sit down with Dr. Joss Reimer, president of the Canadian Medical Association, who openly shares her own experiences with depression, as a doctor and as a patient. “We all need help sometimes.”

And in the third selection, Matthew Flathers (of Harvard University) et al. analyze AI depictions of psychiatric diagnoses in a new paper for BMJ Mental Health. They tested two AI image models with different diagnoses and commented on the results. “Generative AI models acquire biases at every stage of their development – from societal prejudice in online training data, to the optimisation metrics and safety guidelines each developer puts in place. These layered biases persist even when their precise origins remain elusive.”

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: ECT & Maintenance – the New JAMA Psych Paper; Also, Social Contagion & Psychiatry and Dr. Julie Trivedi on Resilience

December 12, 2024 /

From the Editor

He didn’t get better despite several medication trials. Exhausted and feeling suicidal, he chose ECT. The change was incredible. When he returned to the clinic after discharge – bright and energetic – a member of the outpatient team didn’t recognize him. 

But how can we keep people like my patient well and out of hospital? How strong is the evidence supporting maintenance ECT? Dr. Anders Jørgensen (of the University of Copenhagen) and his co-authors attempt to answer these questions in a new JAMA Psychiatry paper. Drawing on a Danish national database and spanning almost two decades of data, they analyzed outcomes for nearly 20 0000 patients who began ECT, including the risk of hospitalizations. “In this cohort study involving patients who had ECT, continuing ECT was associated with a decreased risk of rehospitalization after the acute ECT series and also associated with reduced treatment costs.” We consider the paper and its implications.

Denmark: a land of islands, picturesque cities, and maintenance ECT

In the second selection, Dr. Joel Paris (of McGill University) ponders the societal increase in psychiatric problems, arguing that social contagion may be a factor. In a new BJPsych Bulletin paper, he focuses on non-suicidal self-injurious behaviour. “When clinical symptoms or mental disorders rapidly increase in prevalence, social contagion should be considered as a likely mechanism shaping changes in the form of psychopathology.”

And in the third selection from JAMA, Dr. Julie B. Trivedi (of The University of Texas System) discusses her depression and its treatment. She notes her hospitalization – and her coming to terms with her illness, as a physician, a parent, and a person. “Today, I am focused on bringing light to topics that are stigmatized, talking about topics like mental health and burnout in health care workers that everyone wants to fix but are without an adequate solution, raising awareness of how to recognize mental health challenges among health care professionals, being an advocate for others, and reminding everyone that help is needed.”

DG

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Reading of the Week: Effectiveness of Omega-3 – the New Schiz Bulletin Paper; Also, Weight Loss Meds in Psychiatry & the Latest in the News

December 5, 2024 /

From the Editor

When my patient’s father heard that there is some evidence that omega-3 fatty acids can help in the prevention of psychotic illness, he left my office, walked to the pharmacy down the street, and purchased the largest bottle of the fish oil supplement that he could find. It’s hard to fault his logic: omega-3 fatty acids may be helpful and have few side effects. Clinicians have shared this enthusiasm. No wonder: in 2010, a major study found that patients who took it had a lower transition rate to psychosis for those at ultra-high risk. 

But what does the latest evidence say? Are omega-3 fatty acids helpful? In the first selection, Inge Winter-van Rossum (of the Utrecht University) and her co-authors attempt to answer these questions in a paper for Schizophrenia Bulletin. They report on a double-blind, randomized, placebo-controlled study of ultra-high risk (UHR) patients for psychosis who received either omega-3 supplements or placebo for six months, then followed for 18 months. “The transition rate to psychosis in a sample of subjects at UHR for psychosis was not reduced compared to placebo.” We consider the study and its implications.

Pretty pills – but relevant?

In the second selection, Drs. Sri Mahavir Agarwal and Margaret Hahn (both of the University of Toronto) write about semaglutide in a new Viewpoint for JAMA Psychiatry. They note great opportunities, but caution about challenges, including access to that medication. In a thoughtful paper, they review the relevant literature. “Semaglutide and similar drugs represent the culmination of decades of diabetes and obesity research, and their arrival has already resulted in a paradigm shift in the management of these disorders in the general population.”

Finally, we explore the latest news with articles from The Globe and Mail, Time, and The New York Times. The topics: ADHD and TikTok diagnoses, an app for peer support, and public libraries in a time of homelessness and substance.

DG

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Reading of the Week: ED Visits, Hallucinogens & the Risk of Schizophrenia – the New JAMA Psych Study; Also, Alcohol After COVID and Diab on Being Open

November 21, 2024 /

From the Editor

For my patient who had tried several antidepressants, psilocybin offered hope. He’s not alone; hallucinogens are gaining attention, with many using them for purposes ranging from treating mental disorders to recreation. But how safe are these drugs, especially as their use increasingly occurs outside of clinical settings? What’s the connection with psychosis?

In the first selection, Dr. Daniel T. Myran (of the University of Ottawa) and his co-authors attempt to answer these questions in a new study published in JAMA Psychiatry. The population-based study included over nine million people who had visited an ED in Ontario, Canada over a 13-year period. The researchers compared individuals with an ED visit involving hallucinogen use to the general population and to those with ED visits involving other substances, analyzing the risk of developing a psychotic disorder. “Individuals with an ED visit involving hallucinogen use had a 21-fold greater risk of developing a schizophrenia spectrum disorder compared with the general population…” We consider the study and its implications.

Substance use rose during the early days of the pandemic. Did this trend change after lockdowns and social isolation ended? Dr. Divya Ayyala-Somayajula (of Thomas Jefferson University) and her co-authors analyzed US data related to alcohol use in a research letter for Annals of Internal Medicine. They compared the prevalence of alcohol use and heavy alcohol use before the pandemic, during the pandemic, and in 2020, finding “absolute increases of 2.7% (relative increase, 4.0%) and 1.0% (relative increase, 20.2%) and that the increases were sustained in 2022.”

And in the third selection, writer Saddal Diab discusses her decision to publicly acknowledge her mental disorder. Though people were initially supportive, things changed when she has a manic episode. She considers stigma and acceptance in this Globe and Mail essay. “Whatever gushy feelings had surfaced when I came out did not withstand the reality of mania. This left me feeling ashamed, deserted and questioning the nature of my relationships (which I concluded were flimsier than I had anticipated).”

DG

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Reading of the Week: Culturally-Adapted CBT for Postnatal Depression – the New Lancet Study; Also, ADHD in Adults (JAMA Psych) and the Latest in the News

October 31, 2024 /

From the Editor

She was offered CBT through our outpatient program. Though we encouraged her to come, she didn’t even attend one session. Was the problem partly with the rigidity of our program which wasn’t tailored to her cultural background or language? Can we do better? 

Dr. Nusrat Husain (of the University of Manchester) and his co-authors attempt to answer these questions in a new RCT published in The Lancet. In their study, British south Asian women with postnatal depression were randomized to a culturally-adapted form of CBT or treatment as usual. “Participants in the [intervention] group were estimated to be almost twice as likely to have recovered at 4 months than those in the control group.” We consider the paper, the accompanying Comment, and the implications for clinical care.

In the second selection, Drs. Carlos Blanco (of the National Institutes of Health) and Craig B. H. Surman (of Harvard University) write about ADHD for adults. In a new JAMA Psychiatry Viewpoint, they argue that more needs to be done, especially given the adverse outcomes of untreated ADHD. “A tension exists between undertreatment of adults with ADHD and overuse of addictive treatments for the condition.”

Finally, we explore the latest news with recent articles from The Washington Post, The Globe and Mail, and The New York Times. The topics: ChatGPT for psychotherapy, the generosity of Bruce McKean, and the street psychiatry in LA.

DG

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