Tag: Post

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

April 2, 2026 / / 0 Comments

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: Something Old & Something New – With Papers from World Psychiatry and Lancet Psychiatry

July 31, 2025 /

From the Editor

He was keen to discuss his new therapist who introduced him to CBT concepts and noted his negative thoughts. The therapist was helpful and thoughtful – but not human. My patient was using an AI chatbot.

More and more patients are looking to AI for information and therapy. What to make of it all? And what is the role of other cutting-edge innovations? In the first selection, Dr. John Torous (of Harvard University) and his co-authors attempt to answer these questions in a new review for World Psychiatry. They focus on, yes, generative AI, as well as apps and virtual reality. The review is sparkling and comprehensive, stretching over 11 000 words and with 269 references. “New tools such as LLMs have rapidly emerged, while relatively older ones such as smartphone apps and virtual reality have quickly expanded. While each tool has offered evidence of clinical impact, broad real-world impact remains aloof for all.” We consider the paper and its implications.

Made with ChatGPT

In this week’s other selection, Dr. Robert M. Post (of The George Washington University) and his co-authors write about lithium in a new Lancet Psychiatry paper. They offer a fresh take on this old medication; they argue that it is a disease-modifying agent, like monoclonal antibodies for multiple sclerosis. “Conceptualisation of lithium as a disease-modifying agent might help to increase clinical use by doctors, especially early in the disease course to better serve our patients.”

DG

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Reading of the Week: rTMS – the New JAMA Psych Paper; Also, Opioid Overdoses (JAMA Net Open) and Green on Peak Mental Health (NYT)

October 13, 2022 /

From the Editor

She’s an accomplished person who had succeeded in business and then writing, all the while raising three children; she also has an amazing smile and lights up the room when talking about her kids. But in my office, sick with depression, she can only focus on her losses and failings; the smile is absent.

Depression is common and disabling. Those who are affected in late-life are particularly challenging to treat. Is there a better way? In the first selection from JAMA Psychiatry, Dr. Daniel Blumberger (of the University of Toronto) and his co-authors consider theta burst stimulation, a newer form of rTMS which has shown promise in earlier work. Their study is a randomized noninferiority trial, directly comparing the two versions of rTMS in elderly patients with depression. The result? “We showed that bilateral TBS was noninferior to standard bilateral rTMS in improving depression, and similarly well tolerated, in a real-world sample of older adults with TRD [treatment resistant depression]…” We review the paper and its clinical implications.

In the second selection, Lori Ann Post (of Northwestern University) and her co-authors draw on CDC data to look at opioid overdoses in the United States with a focus on geography. In a JAMA Network Open research letter, they find: “Overall, opioid-involved overdose deaths rates increased steadily in counties of every urbanicity type, although there were distinct temporal wave patterns by urbanicity.”

And in the third selection, Huw Green (of the University of Cambridge) wonders about mental health and mental illness – and worries that the terms are becoming blurred together. Writing in The New York Times, the psychologist concludes: “When we move away from a focus on psychological problems and toward ‘mental health’ more broadly, clinicians stumble into terrain that extends beyond our expertise. We ought to be appropriately humble.”  

This month, the Reading of the Week enters its ninth year. A quick word of thanks for your ongoing interest.

DG



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