Tag: JAMA

Reading of the Week: Measurement-based Care – the New Psych Services Paper; Also, Agentic AI, and Dr. Johari on Losing a Patient

August 13, 2026 / / 0 Comments

From the Editor

Studies show that measurement-based care improves patient outcomes, from better functioning to fewer readmissions. Not surprisingly, expert practice guidelines, including the CANMAT clinical guidelines for depression, recommend their use. Yet – despite years of enthusiasm – most of us don’t use scales or questionnaires to monitor symptoms and outcomes.

In a new systematic literature review, Christian Burr (of the Bern University of Applied Sciences) and his co-authors try to identify effective strategies by analyzing recent studies. In their Psychiatric Services paper, they focused on 16 studies in a systematic literature review. “Effective measurement-based care implementation requires context-sensitive strategies, interprofessional collaboration, and active involvement of patients, service users, and caregivers.” We consider the paper and its implications.

In the second selection from The British Journal of Psychiatry, Dr. Scott Monteith (of Michigan State University) and his co-authors write about the evolution of artificial intelligence. They focus on agentic AI (arguably the next big thing), seeing a clear role in education, yes, and in patient care – but they also note problems. “Agentic artificial intelligence systems offer a unique approach to supporting physicians in dealing with the challenges of clinical medicine but also pose validity, privacy, malpractice and security risks.”

And in this week’s final selection, Dr. Paniz Johari, a psychiatrist who works at Northwell Health, writes personally and thoughtfully about the loss of her patient to suicide. In JAMA, she discusses her grief and rumination. “The absence of anything remarkable made it harder to understand and harder to set aside.”

DG

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Reading of the Week: Social Media Likes & Depression – the New JAMA Psych Paper; Also, Dr. Taglienti on Being Noticed

July 30, 2026 /

From the Editor

When you post a cute picture of your baby cousin on social media, you receive many likes and feel encouraged to post more. To speak technically, drawing on reinforcement learning, social rewards reinforce posting. But how do people with depression respond to social media? Would they be less motivated by reinforcement learning (consistent with past work)? Could platforms like Twitter (now X) actually worsen depression?

In a new JAMA Psychiatry study, Dan-Mircea Mirea (of Princeton University) and his colleagues attempt to answer these questions. They analyzed 17 million posts from almost 8 000 Twitter users to test the association between depression and the tendency to be reinforced by likes. “In this cross-sectional study, we found that individuals with depressive psychopathology showed a greater tendency to be reinforced by likes on Twitter.” We consider the paper and its implications; we also look at the accompanying Editorial.

And in this week’s other selection, from JAMA, Dr. Jenna Taglienti (of Hofstra University) writes about a resident who misses a call shift. As the residency program director, she thinks on their conversation – and on being noticed. She recalls the loss of her mother. “I think about my mother labeling photographs and childhood keepsakes long before any of us were ready to imagine needing them.”

DG

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Reading of the Week: Doctors & Suicidality – the New CMAJ Study; Also, GLP-1 RAs & Eating Disorders, and Chin-Yee on the Death of the Consult Note

July 9, 2026 /

From the Editor

His suicidal thoughts were so strong that he had written a suicide note. Yet, during the months before we met in the ED, he had hesitated to seek care. As a doctor, he knew he had severe depression but he told me that he felt he couldn’t get help. 

Such stories are all too common. In a CMAJ study, Dr. An Yi (Annie) Yu (of the University of Toronto) and her co-authors shed light on physicians’ seeking help for suicidality. They drew from the literature (literally): analyzing 52 narratives from academic papers, finding various barriers to seeking care, including aspects of medical culture, and identified facilitators, such as confidential services. “The pressure to achieve in medicine often discourages physicians from acknowledging their need for help, but the value of meaningful work emerged as a positive factor for mental health. The stigma regarding mental health concerns was substantially reduced through role modelling of help-seeking behaviour by colleagues.” We consider the study and its implications.

GLP-1 receptor agonists are having a moment because of the evidence for diabetes and other conditions. In the second selection, Nicholas C. Peiper (of the University of Louisville) and his co-authors focus on those with eating disorders, analyzing data to understand use and misuse in a new JAMA Psychiatry research letter. “This cross-sectional study found that GLP-1 RA use and misuse were common in a targeted sample of people with eating disorders.”

And in the third selection, from JAMA, Dr. Benjamin Chin-Yee (of Western University) writes about consult notes. He wonders what is lost in the “digital transformation” of templates and AI scribes. He worries about the future of the consult note. “The tools may evolve, but the art of pausing, thinking, and telling a story is still ours to preserve.”

DG

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Reading of the Week: Placebo & Practice – the New Lancet Psych Paper; Also, Mortality & Opioids and Mental Health Awareness Campaigns

May 14, 2026 /

From the Editor

The tone of our voice when discussing a treatment. The way we emphasize its benefits. Mention of our hopefulness. As clinicians, we are aware that small things can improve patient outcomes. To speak more technically: we harness placebo effects.

In an impressive new Lancet Psychiatry review, Dr. Matthew J. Burke (of the University of Toronto) and his co-authors examine placebo effects with an eye to the implications for clinical practice. They discuss imaging and physiology; they also mention depression and offer suggestions (including, yes, harnessing placebo effects). “The thoughtful application of placebo and nocebo effects has promise in enhancing patient care and treatment outcomes, but more research is needed to validate specific approaches.” We discuss the paper and its implications.

What is the survival rate after an opioid overdose? In a new research letter just published in JAMA, Dr. Robert A. Kleinman (of the University of Toronto) and his co-authors attempt to answer that question. Though they walk on a well-travelled path, they drew on data in this, the era of fentanyl. “Mortality was higher than estimates from previous research conducted prior to the widespread availability of fentanyl (5.3%-5.5%).”

And in the third selection from The Globe and Mail, Dr. Lester Liao (of McGill University) and his co-authors write about mental health campaigns. They note the unintended consequences, including overdiagnosis of disorders like ADHD and autism. “We started out with the greatest of intentions. Unintended consequences have arisen. That’s okay. We learn along the way. Now it’s time to change course.”

There will be no Reading next week.

DG

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Reading of the Week: MST vs ECT – the New Lancet Psychiatry Paper; Also, the First AI Drug Prescriber and Dr. Taglienti on Her Cancer & Her Career

April 23, 2026 /

From the Editor

He began to respond to ECT and felt less depressed than he had in many years. But as the treatments continued, my patient noticed gaps in his memory including family vacations when his children were young. “Those memories are precious.” He stopped ECT and, soon after, was deeply depressed again. 

Smaller studies suggest that Magnetic Seizure Therapy (MST) – where alternating magnetic fields induce seizures – offers relief to patients without the cognitive problems of ECT. In a new study published by The Lancet Psychiatry, Dr. Daniel M. Blumberger (of the University of Toronto) and his co-authors add to the literature with the largest randomized trial comparing these convulsive therapies conducted and the first non-inferiority clinical trial to address efficacy. The study involved 239 participants with depression. “MST showed non-inferior efficacy relative to… ECT in achieving remission of depression, and a more favourable cognitive safety profile.” We consider the paper and its implications.

Should patients receive prescriptions from an AI prescriber? In the second selection, from JAMA, Dr. Daniel G. Aaron (of the University of Utah) and Christopher Robertson (of Boston University) look at a new Utah program allowing AI to prescribe medications without physician involvement. They are cool to the idea. “Although AI offers the promise of increased efficiency and expanded access, the evasion of legal obligations by early movers raises profound concerns. Incorporating AI into modern health care must be evidence based and responsible.”

And in the third selection, Dr. Jenna Taglienti (of Hofstra University) writes personally about her cancer in JAMA. As a psychiatrist and a residency program director, she finds meaning in her work – but illness helps her gain perspective. “Medicine can have extraordinary meaning. But it cannot substitute for being present in your own life.”

DG

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Reading of the Week: Psychotic Prompts & AI – from JAMA Psych; Also, Lithium Landscape and Dr. Cooke on Growing Up

April 2, 2026 /

From the Editor

Patients, including those with psychosis, may turn to AI chatbots for advice. What are they told? And are they encouraged to seek care?

In a research letter that was recently published in JAMA Psychiatry, Dr. Elaine Shen (of Columbia University) and her co-authors attempt to answer these questions. Using three versions of ChatGPT, they provided 79 statements indicative of positive psychotic symptoms and 79 that were neutral. The responses were then rated by two reviewers. With the free version of ChatGPT – what most people use – psychotic prompts had 43-fold higher cumulative odds of receiving a less appropriate rating than control prompts. We consider the study and its implications.

Lithium has fallen out of fashion; a recent Canadian paper found declining prescriptions in Alberta. In a new American Journal of Psychiatry commentary, Dr. Robert M. Post (of George Washington University) and his co-authors make the case for the old mood stabilizer. They offer several arguments, including that it is a disease-modifying agent. “Clinicians, patients, and the public should be educated about the unique assets of lithium, such that conventional treatment paradigms of bipolar disorder emphasize the greater and earlier use of the drug to achieve a more benign course of illness and less cognitive dysfunction.”

Finally, in the third selection from JAMA, Dr. Emma M. Cooke (of Harvard University) writes about medical school rotations. Now an internist, she remembers the common med school question: “what do you want to do when you grow up?” She mulls her responses – and the simplicity of the question. “For everyone in medicine, not just medical students, our choice of specialty is just a single data point in what makes us who we are.”

DG


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

March 12, 2026 /

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: Coffee & Dementia Risk – the New JAMA Paper; Also, Mental Healthcare and Till on Her Son & His Illness

February 19, 2026 /

From the Editor

Many of us enjoy drinking coffee before a busy afternoon clinic. Is that cup of java actually healthy? Do caffeinated beverages like coffee and tea reduce the risk of dementia?

Smaller studies have suggested that they do reduce risk; a meta-analysis of coffee drinkers had a similar finding. In an impressive, new JAMA paper, Yu Zhang (of Harvard University) and his co-authors attempt to answer these questions. They report on a prospective cohort study involving almost 132 000 people, looking at dementia risk with a follow-up period up to 43 years. They found a reduction of about 18%. “Greater consumption of caffeinated coffee and tea was associated with lower risk of dementia and modestly better cognitive function, with the most pronounced association at moderate intake levels.” We consider the paper and its implications.

A cup (or two) a day keeps the doctor away?

It’s the paradox of modern psychiatry. Our medications and therapies have never been better, yet access remains poor and quality is uneven, in part because there is no mental health “system.” So, what can be done? In the second selection, from the podcast series Quick Takes, I sit down with Dr. Paul Kurdyak. In addition to being the longest serving ED psychiatrist at CAMH, he is the Vice-President, Medical, of Ontario Health’s Mental Health and Addictions Centre of Excellence. “Good systems just work. They don’t need to be navigated.”

And in the third selection, Madeline Till, a psychotherapist, writes about the struggles of her son, who has schizophrenia. In a New York Times essay, she wonders whether it would be easier if he had cancer. “More than anything else I have ever wanted, I want to stop this revolving door. I want schizophrenia to be treated with the same urgency, seriousness and continuity as any other life-threatening illness.”

DG

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Reading of the Week: Cannabinoids for Therapeutic Use – the New JAMA Paper; Also, ECT and Szalavitz on Her Recovery & Substance Use

December 4, 2025 /

From the Editor

Cannabis for chronic pain? What about insomnia or seizures? Patients often ask about the therapeutic use of cannabis. And your patients aren’t the only ones thinking about it; more than one in four Americans have used cannabis for medicinal purposes. But what does the literature actually say?

In an impressive, new review paper just published in JAMA, Dr. Michael Hsu (of the University of California, Los Angeles) and his co-authors seek to answer that question. With 124 citations, they are thorough and thoughtful, drawing on studies, clinical guidelines, and more. They are also clear in their conclusion. “Despite the accumulation of new studies, evidence is insufficient for the use of cannabis or cannabinoids for most medical conditions.” We consider the paper and its implications.

In the second selection from The Lancet Psychiatry, Dr. Richard Braithwaite (of the Sussex Partnership NHS Foundation Trust) and his co-authors comment on ketamine for depression. Though some new studies have reported solid results comparable to ECT, they remain skeptical. “The claim that ketamine is equivalent to ECT is not supported by credible evidence. It is a narrative constructed on a foundation of a small number of inadequately designed trials and flawed meta-analyses.”

Is sobriety required for recovery from substance misuse? In a personal essay for The New York Times, writer Maia Szalavitz argues that it isn’t. She notes her own journey which has spanned 40 years. “In reality, most people who resolve addictions – including me – do not reject all substance use forever.”

DG

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Reading of the Week: Homelessness with Papers from Lancet and JAMA; Also, Kinsella on His Recovery

October 30, 2025 /

From the Editor

The loss of her job. A couple of poorly timed moves, motivated by her need to help care for an ailing parent. Financial woes. These problems converged, and my patient found herself ill and homeless. What were the potential implications for mortality?

In a new paper published by The Lancet Public Health, Sandra Feodor Nilsson (of Copenhagen University) and her co-authors attempt to answer that question. Drawing on Danish data involving more than six million adults, they found that men and women live far fewer years when experiencing homelessness, 15.9 years and 15.3 years, respectively. Though past work has examined the topic, Nilsson et al. offer a more comprehensive look. “Life-years lost exceeded those observed in individuals with schizophrenia, alcohol use disorder (for males), and drug use disorder.” We consider the paper and its implications.

In the second selection, from JAMA, Drs. Kirk B. Fetters and Joshua A. Barocas (both of the University of Colorado) describe recent cuts to Housing First programs in the United States and weigh its impact. They note the evidence for this approach. “Because the health care system is already overburdened and the homelessness crisis is worsening, maintaining and expanding Housing First is not only compassionate but also imperative.”

And in the third selection, Sean Kinsella writes personally about homelessness and addiction. In an essay for the Irish Examiner, he discusses his deep problems – and his recovery. He advocates that we do more for those who are homeless. “I wasn’t seen. I wasn’t heard. I was a file. A risk to be managed.”

DG



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