Tag: Kleinman

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

May 14, 2026 / / 0 Comments

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: ED Visits & Suicide Attempts – the New AJP Study; Also, Smoking Cessation, and Pappas on Her Genes & Her Olympic Drive

August 8, 2024 /

From the Editor

Are ED visits for suicide attempts becoming more frequent? What are the implications for care?

In the first selection from The American Journal of Psychiatry, Dr. Tanner J. Bommersbach (of the Mayo Clinic) and his co-authors attempt to answer these questions by considering US trends in ED visits for suicide attempts and intentional self-harm. Using national survey data collected over a 10-year period, they estimate that the absolute number of suicide attempts tripled to 5.3 million. “A significant national increase in emergency department visits for suicide attempts and intentional self-harm occurred from 2011 to 2020, as a proportion of total emergency department visits and as visits per capita.” We analyze this study.

In the second selection, Drs. Robert A. Kleinman (of the University of Toronto) and Brian S. Barnett (of the Cleveland Clinic) write about smoking cessation and mental illness in a Viewpoint just published in JAMA Psychiatry. They note societal progress – smoking rates are sharply down over the past five decades – yet many with mental illness still use tobacco. They argue that psychiatrists have a significant role to play in addressing this problem. “Patients who stop smoking can limit tobacco-related illness, avoid the distressing effects of nicotine withdrawal and craving, and live longer.”

Later this week, the Olympics conclude in Paris. In the third selection, former Olympian Alexi Pappas discusses her mother’s suicide and her own struggles with depression. In a deeply personal essay from The New York Times, she contemplates genes and destiny and healing. “My future – the universe where my fear lives – was never set in stone, and neither was my mom’s. I’m more than my genes, and I would not reroll the dice if given the option.”

There will be no Readings for the next two weeks.

DG

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Reading of the Week: Can a Phone Intervention Reduce Alcohol? Also, Dr. Goldbloom on His Career & Retirement (QT) and Ending the Term AMA (Annals)

December 15, 2022 /

From the Editor

During the first wave, alone and isolated, he started to drink significantly more. Now, many months later, he continues to struggle with an alcohol use disorder. This patient’s journey – as he told me in the ED last week – is a familiar story that we as clinicians have heard many times in these past few years. What can be done to help? Could we better reach those who are misusing alcohol?

In JAMA Psychiatry, Dan I. Lubman (of Monash University) and his co-authors describe an intervention that is very relevant. In this Australian RCT, some participants received 4-6 sessions of telephone-provided, manualized cognitive and behavioural intervention that included mindfulness. They found that: “this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control.” We discuss the paper and its clinical implications.

Dr. David Goldbloom has had a storied career: senior medical advisor at CAMH, professor at the University of Toronto, former chair of the Mental Health Commission of Canada, former editor of The Canadian Journal of Psychiatry. And tomorrow, he adds another title to that long list: retiree. This week’s second selection is a new Quick Takes podcast interview with him in which he comments on career and retirement and more. “I’m not an entirely gloomy or nihilistic person, either by temperament or based on what I’ve witnessed over the last 40 years.”

Finally, in the third selection, Dr. Robert A. Kleinman (of the University of Toronto) and his co-authors argue that “against medical advice” is a dated term. In Annals of Internal of Medicine, they argue for a new approach: “Shifting away from the ‘AMA’ terminology and toward more collaborative approaches to these discharges would improve the treatment of patients who are too often stigmatized by the clinicians and health systems that are meant to care for them.”

DG

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Reading of the Week: Health Care Workers’ Mental Health – There’s an App for That; Also, Treating Opioids (BMJ) & Dr. Bhushan on Her Bipolar (LA Times)

September 15, 2022 /

From the Editor

With the pandemic dragging on, health care workers report more and more burnout; some complain of depression and anxiety.

What could help? Dr. Sam N. Gnanapragasam (of King’s College London) and his co-authors consider an app designed to provide CBT and mindfulness techniques in a new British Journal of Psychiatry paper. The RCT study involves 16 English sites with over 1000 health care workers. They conclude: “our study suggests that the app was of modest benefit with no adverse effects for a sample of HCWs in England.” We look at the paper.

How to respond to the opioid crisis? In a new analysis paper for BMJ, Dr. Robert A. Kleinman (of the University of Toronto) and his colleagues argue for a different approach to the prescribing of opioid agonist therapy, drawing on the changes made in response to the pandemic. “Embracing a more flexible model of buprenorphine-naloxone dosing would allow better alignment of prescribing practices with the needs and preferences of clients.”

And in the third selection, Dr. Devika Bhushan writes about bipolar disorder for the Los Angeles Times. The essay is very personal: the pediatrician, who serves as California’s acting surgeon general and graduated from Harvard, describes her own experiences. As she notes, during her training, she “had a secret.” Now, however, she speaks openly about her illness. “Today, I live with bipolar disorder as a chronic and manageable health condition.” 

DG

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