Tag: JAMA Psychiatry

Reading of the Week: Do ADHD Meds Reduce Mortality? The New JAMA Psych Study; Also, Dr. Rebecca Lawrence on Her Husband & His Support

April 4, 2024 /

From the Editor

For my patient, ADHD medications transformed his life, helping him focus at school and at work – and even drive better. Many have had similar experiences. Do ADHD medications also reduce mortality? We know that those with ADHD have higher mortality rates and thus it’s reasonable to ask about the possible benefits of methylphenidate and sister drugs.

Lin Li (of the Karolinska Institutet) and her co-authors try to answer that question in a new JAMA Psychiatry paper. Drawing on Swedish databases, they analyzed data from almost 150 000 people with ADHD and looked at two-year mortality, including for those who die by unintentional injuries, suicide, or poisonings, by doing a target trial emulsion – simulating a randomized trial. “Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes.” We consider the paper, the editorial that accompanies it, and the clinical implications.

ADHD meds: life saver?

And in the other selection, Dr. Rebecca Lawrence writes about support in a blog for Doctor and Patient. She is personal – besides working as psychiatrist, Dr. Lawrence has been treated for depression, including with ECT. She notes the incredible help her husband has given her over the years. “I look at myself in the mirror and am appalled, but he still smiles at me.

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: Acupuncture for PTSD – the New JAMA Psych Study; Also, Chronic Homelessness & Hope, and Dr. Suzanne Koven on Mentorship

February 29, 2024 /

From the Editor

He survived a terrible car accident and recalls his worst memory: being pinned for hours in his Honda as rescuers attempted to free him, eventually with the Jaws of Life. The mental recovery proved more complicated than the physical one, with flashbacks and nightmares and the resulting substance misuse. He tried different therapies, but would he have benefitted from alternative treatments?

Dr. Michael Hollifield (of George Washington University) and his co-authors look at acupuncture for PTSD in a new JAMA Psychiatry study. They did an impressive randomized clinical trial involving 93 combat veterans with PTSD who received either verum or sham acupuncture. “[V]erum acupuncture had a large pretreatment to posttreatment effect and was statistically superior to sham needling for reducing PTSD symptoms and enhancing fear extinction.” We consider the paper and its clinical implications.

Across North America, there are more people than ever before who are chronically homeless. Who are they? What psychiatric problems do they have? How can we help them? In the second selection, Dr. Vicky Stergiopoulos (of the University of Toronto) considers those who are chronically homeless in a podcast interview for Quick Takes. “The problem is visible. It’s in our streetcars and buses, our subways, our streets, and it’s hard to ignore.”

And in the third selection, Dr. Suzanne Koven (of Harvard University) writes about mentorship in The New England Journal of Medicine. She discusses how a mentor’s advice transformed her career and then considers what makes for good mentorship. “A mentor is someone who has more imagination about you than you have about yourself.”

DG

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Reading of the Week: MST vs ECT – the new JAMA Psych Study; Also, Dr. Niall Boyce on Frasier and the Latest in the News

December 14, 2023 /

From the Editor

Electroconvulsive therapy, or ECT, is a highly effective treatment for depression. But patients often complain about side effects, including cognitive problems.

Could magnetic seizure therapy, or MST, provide the benefits of ECT without these issues? In a new paper for JAMA Psychiatry, Zhi-De Deng (of Duke University) and co-authors attempt to answer that question. In a study where 73 patients with depression were given ECT or MST, they found similar results. “This randomized clinical trial found that the efficacy of MST was indistinguishable from that of ultrabrief pulse [right unilateral] ECT, the safest form of ECT currently available.” We consider the paper and its implications.

In the second selection, Dr. Niall Boyce (of the Wellcome Trust) mulls the return of Frasier Crane, the “pompous but kind-hearted American psychiatrist.” In a Lancet perspective, he writes about the original TV comedy and the new revival of Frasier – and also notes the change in perception of psychiatry over the years. His assessment of the show: “Is the new Frasier worth watching? On the early evidence, I would say yes.”

And, finally, we explore the latest in the news with consideration of recent articles from The Globe and Mail and other publications. Among the topics: the (over) prescription of antidepressants, safe supply, and hairdressers and psychotherapy in Togo.

DG


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Reading of the Week: Improving Self-Esteem in Youth – the New JAMA Psych Paper; Also, Black Females & Suicide and Dr. Jon Hunter on the End

December 7, 2023 /

From the Editor

Can we help youth before the onset of full disorders to build skills and avoid deeper problems? Several school-based efforts, offering DBT and mindfulness skills, have been tried without much success. Ecological momentary interventions (EMIs) – provided to patients during their everyday lives and in natural settings, giving unstructured recommendations with structured interventions – is a newer therapy that has gained attention.

But does it work? In a new paper for JAMA Psychiatry, Ulrich Reininghaus (of the University of Heidelberg) and his co-authors describe an RCT focused on youth with low self-esteem who have had past adversity, involving 174 Dutch participants. “A transdiagnostic, blended EMI demonstrated efficacy on the primary outcome of self-esteem and signaled beneficial effects on several secondary outcomes.” We consider the paper and its implications.

In the second selection, Victoria A. Joseph (of Columbia University) and her co-authors look at US suicide rates in Black females. In their American Journal of Psychiatry letter, they analyze suicides over two decades, drawing data on age and region from a national database. They conclude that: “increasing trends in suicide death among Black females born in recent years and underscores the need to increase mental health care access among Black girls and women, and to reduce other forms of structural racism.”

And in the third selection, Dr. Jon Hunter (of the University of Toronto) contemplates endings – including his ending – in a personal and moving paper for CMAJ. He notes the need to clean up his possessions. But what about his practice and the many patients that he has followed for years? “I’d rather not shy away from the uncertainty and loss of the ending, and to try to help one more time.”

DG

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Reading of the Week: Running vs SSRIs for Depression – the new JAD Paper; Also, Climate Change & Mental Health, and Understanding My Schizophrenia

October 26, 2023 /

From the Editor

“Go for a Run to Beat Depression – It’s Just As Effective As Taking Medication”

– New York Post

“Running could be just as effective at treating depression as medication, scientists find”

– The Independent

Patients often ask what they can do to get better from their depression. Should we be advising them to put on a pair of runners and go for a jog? A new paper published in the Journal of Affective Disorders seems to suggest as much – and it’s caused a bit of media buzz. In the first selection, Josine E. Verhoeven (of Vrije Universiteit Amsterdam) and her co-authors describe this 16-week study that offered 141 people with depression and/or anxiety either a running intervention or medications, and looked at several mental and physical health outcomes. “We showed that while antidepressant medication and running therapy did not statistically significantly differ on mental health outcomes… the interventions had a significantly different and often contrasting impact on several physical health outcomes, with more favorable outcomes for those in the exercise intervention.” We consider the paper and its implications.

In the second selection, Pim Cuijpers (of Vrije Universiteit Amsterdam) and his co-authors discuss climate change and mental health in a new viewpoint for JAMA Psychiatry. Though they note the lack of high-quality research in the area, they argue that it would disproportionately affect low and middle-income nations. They then point a way forward. “There is no doubt that climate change will have a major impact on mental health in the coming decades.”

And in the third selection which is written anonymously, a person with schizophrenia talks about his experiences in a paper for Schizophrenia Bulletin. He tries to empower himself, working to limit side effects and cope with the voices. “My brain disease is incurable, but it is not an excuse for me to be irresponsible or to give up on life.” 

DG

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Reading of the Week: Fatal Overdoses & Drug Decriminalization – the new JAMA Psych Paper; Also, ChatGPT vs Residents, and Chang on Good Psychiatry

October 5, 2023 /

From the Editor

Does decriminalizing the possession of small amounts of street drugs reduce overdoses? Proponents argue yes because those who use substances can seek care – including in emergency situations – without fear of police involvement and charges. Opponents counter that decriminalization means fewer penalties for drug use, resulting in more misuse and thus more overdoses. The debate can be shrill – but lacking in data.

Spruha Joshi (of New York University) and co-authors bring numbers to the policy discussion with a new JAMA Psychiatry paper. They analyze the impact of decriminalization in two states, Oregon and Washington, contrasting overdoses there and in other US states that didn’t decriminalize. “This study found no evidence of an association between legal changes that removed or substantially reduced criminal penalties for drug possession in Oregon and Washington and fatal drug overdose rates.” We consider the paper and its implications.

In the second selection, Dr. Ashwin Nayak (of Stanford University) and his co-authors look at AI for the writing of patient histories. In a new research letter for JAMA Internal Medicine, they do a head-to-head (head-to-CPU?) comparison with ChatGPT and residents both writing patient histories (specifically, the history of present illness, or HPI). “HPIs generated by a chatbot or written by senior internal medicine residents were graded similarly by internal medicine attending physicians.”

And in the third selection, medical student Howard A. Chang (of Johns Hopkins University) wonders about “good” psychiatry in a paper for Academic Psychiatry. He reflects on the comments of surgeons, pediatricians, and obstetricians, and then mulls the role of our specialty. “I have gleaned that a good psychiatrist fundamentally sees and cares about patients with mental illness as dignified human beings, not broken brains. The good psychiatrist knows and treats the person in order to treat the disease.”

DG

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Reading of the Week: DBT for Youth with Bipolar – the New JAMA Psych Paper; Also, Involuntary Care and Dr. Gibbons on the Truths About Suicide

September 28, 2023 /

From the Editor

Nine! 

This month, the Reading of the Week celebrates a big birthday, its ninth. The first Reading was emailed out in September 2014. Many thanks for your ongoing interest and support. I’m looking forward to the next nine years.

Many young people with bipolar attempt suicide. What can be done to help them? In the first selection, Tina R. Goldstein (of the University of Pittsburgh) and her co-authors attempt to answer that question in a just-published JAMA Psychiatry paper. In their RCT involving youth with bipolar spectrum disorder, participants were enrolled in DBT or they received standard-of-care psychological support. “These findings support DBT as the first psychosocial intervention with demonstrated effects on suicidal behavior for adolescents with bipolar spectrum disorder.” We consider the paper and its clinical implications.

In the second selection, journalist and bestselling author Anna Mehler Paperny discusses coercive care in a new Quick Takes podcast interview. Mehler Paperny’s perspective on involuntary care is informed by her writing on the issue – and her lived experience. She worries that public debate may be driven by a desire to address public disorder rather than genuinely prioritizing the well-being of those with mental illness. “Coercive care is having a moment.”

And in the third selection, Dr. Rachel Gibbons (of the UK Royal College of Psychiatrists) considers suicide in a new BJPsych Bulletin paper. She opens by disclosing that three of her patients died by suicide early in her career. She then reviews “truths” about suicide. “In research we conducted, around two-thirds of psychiatrists and other clinicians felt it was their job to predict suicide. Our fantasy that we can do this, and our fear that we can’t, becomes a constant preoccupation in our work, distracts us from providing therapeutic care and closes our hearts to those in distress.”

DG

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Reading of the Week: Telepsych vs. In-Person Treatment – the new BJP Paper; Also, Rethinking Palliative Care in Psychiatry and Kemp on His Depression

September 21, 2023 /

From the Editor

When the pandemic started in 2020, the webcam sitting on my desk had barely been used. Of course, over the following days, it became an indispensable part of my outpatient practice as terms like “lockdown” and “Zoom fatigue” entered the common lexicon. 

As we move past the pandemic, questions arise. Who benefits from telepsychiatry? And who is better served with in-person visits? Katsuhiko Hagi (of the Sumitomo Pharma Co.) and co-authors attempt to answer these questions with a new systematic review and meta-analysis, just published in The British Journal of Psychiatry. They analyzed 32 papers, involving 3 600 people, across 11 mental illnesses. “Telepsychiatry achieved a symptom improvement effect for various psychiatric disorders similar to that of face-to-face treatment. However, some superiorities/inferiorities were seen across a few specific psychiatric disorders, suggesting that its efficacy may vary according to disease type.” We consider the paper and its implications.

In the second selection, Kwok Ying Chan (of Grantham Hospital) and his co-authors discuss palliative care. In a Viewpoint paper for JAMA Psychiatry, they note that some patients with severe mental illness could benefit from palliative care – yet such care is less available to those with mental disorders than the general population. They highlight challenges and then outline “a more sustainable model for the collaboration between palliative care and psychiatric teams.”

And in the third selection, health care executive Joe Kemp writes about his struggles with suicidal thoughts and substance misuse. In a deeply personal essay for the New York Post, he talks about turning around his life. “I can’t deny my drug-addled past, or that I’m a survivor of two suicide attempts. But I can proudly show the man I am today as someone who has dignity and self-respect; I’ve acquired the most important things to live a happy life. I just followed a different path to get here.”

DG

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Reading of the Week: Written Exposure Therapy for PTSD – the New JAMA Psychiatry Paper; Also, #MedEd & Knowledge Translation

September 14, 2023 /

From the Editor

How to help those with PTSD? Prolonged exposure therapy (PE) and cognitive processing therapy (CPT) are supported by good evidence but both are resource intense and often have high drop-out rates, partly because of the requirement that patients complete homework. Is there an alternative?

In the first selection, we look at a new study considering written exposure therapy (WET), an emerging therapy where patients write about traumatic events – but the therapy doesn’t demand so much from the system (in terms of resources) or patients (in terms of homework assignments). Denise Sloan (of Boston University) and her colleagues conducted a noninferiority trial, comparing this therapy with prolonged exposure therapy for US veterans with PTSD, involving 178 participants from three centres. “We found WET was noninferior to PE, a treatment that includes more treatment sessions, longer sessions, and between-session assignments.” We consider the study, an Editorial responding to it, and mull the clinical implications.

In the last selection, John W. Ayers (of the University of California San Diego, La Jolla) and his co-authors consider social media and medical education in JAMA. They argue that #MedEd is a dynamic platform with the potential to democratize medical education – but also warn of the problems of misinformation. “The potential for #MedEd to improve medical education and the health sciences is considerable, while the risks of dismissing #MedEd is potentially greater.”

DG

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