Tag: Olfson

Reading of the Week: Health Care Workers & Suicide – the new JAMA Paper; Also, Esketamine vs Quetiapine for Treatment-Resistant Depression (NEJM)

From the Editor

Sure, we are biased – but ours is a different type of job. Working in health care can involve life and death situations and trying to help those who are at their most vulnerable. The stakes can be high. 

But how does such work affect the workers themselves? Dr. Mark Olfson (of Columbia University) and his co-authors try to answer that question in a new paper for JAMA. In it, they analyze suicides among six different types of health care workers, including physicians, by drawing on a US data that offers a nationally representative sample from 2008 to 2019, including 1.84 million people. “Relative to non-health care workers, registered nurses, health technicians, and health care support workers in the US were at increased risk of suicide.” We consider the paper and its implications.

And in the other selection, Dr. Andreas Reif (of the University Hospital Frankfurt) and his co-authors focus on treatment-resistant depression. In this new paper published in The New England Journal of Medicine, they report on the findings from a study where 676 patients were randomized to either esketamine nasal spray or an antipsychotic augmenting agent in addition to an antidepressant. “In patients with treatment-resistant depression, esketamine nasal spray plus an SSRI or SNRI was superior to extended-release quetiapine plus an SSRI or SNRI with respect to remission at week 8.” We also look at the accompanying editorial.


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Reading of the Week: Suicide and Schizophrenia – Across Life Span; Also, Transgender-Inclusive Care (QT), and the NYT on Chatbots

From the Editor

This week, we have three selections.

In the first, we consider suicide and schizophrenia. In a new JAMA Psychiatry paper, Dr. Mark Olfson (of Columbia University) and his co-authors do a cohort study across life-span, tapping a massive database. They find: “the risk of suicide was higher compared with the general US population and was highest among those aged 18 to 34 years and lowest among those 65 years and older.” The authors see clear clinical implications: “These findings suggest that suicide prevention efforts for individuals with schizophrenia should include a focus on younger adults with suicidal symptoms and substance use disorders.”

In the second selection, we consider transgender-inclusive care, looking at a new Quick Takes podcast. Drs. June Lam and Alex Abramovich (both of the University of Toronto) comment on caring for members of this population. “Trans individuals are medically underserved and experience, poor mental health outcomes, high rates of disease burden – compared to cisgender individuals.”


Finally, in our third selection from The New York Times, reporter Karen Brown writes about chatbots for psychotherapy, focusing on Woebot. The writer quotes psychologist Alison Darcy about the potential of these conversational agents: “If we can deliver some of the things that the human can deliver, then we actually can create something that’s truly scalable, that has the capability to reduce the incidence of suffering in the population.”


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Reading of the Week: The Kids are Alright – The New England Journal of Medicine and Childhood Mental Health Disorders

The rate of severe mental illness among children and adolescents has dropped substantially in the past generation, researchers reported Wednesday, in an analysis that defies public perceptions of trends in youngsters’ mental health.

So begins The New York Times’ front-section coverage of a big paper in a big journal with a big result.

This paper, just published by The New England Journal of Medicine, considers the rate and treatment of childhood mental health impairment. In contrast to other surveys, this paper didn’t find a rise in the rate of mental illness. (Contrast this finding with the comment of a former president of the American Psychiatric Association that such illnesses are “an epidemic hidden in plain view” – that is, obviously there but underreported historically.)

Explains the lead author, Dr. Mark Olfson:

The finding is robust and real and challenges the prevailing stereotype that young people are somehow more vulnerable to mental problems.

Dr. Mark Olfson

How common is mental impairment among children and adolescents? How has this changed in recent years? How are patients being treated? Are we prescribing more than in the past? Olfson et al. seek answers to these important questions in “Trends in Mental Health Care among Children and Adolescents” – this week’s Reading. Continue reading