Tag: PTSD

Reading of the Week: Preventing PTSD – the New AJP Study; Also, AI Hallucinations and Dr. Gollapudi on Stethoscopes

November 27, 2025 /

From the Editor

Though years had passed since his peacekeeping service in Bosnia, my patient lucidly described the flashbacks and nightmares that still haunted him. It raises an important question: is it possible to prevent PTSD in the first place?

In a new, important American Journal of Psychiatry paper, Chelsea Dyan Gober Dykan (of Tel Aviv University) and her co-authors attempt to answer that question by drawing on past work showing the effectiveness of response-time-based attention bias modification (RT-based ABM), a cognitive training technique. They describe a three-arm randomized controlled trial involving more than 500 male combat-bound soldiers who, before combat exposure, received one of two cognitive training techniques (RT-based ABM and a variant focused on gaze) or a sham intervention. Participants then reported on PTSD symptoms after it. “Consistent with a previous randomized controlled trial, RT-based ABM reduced risk for PTSD relative to sham ABM when implemented prior to combat exposure.” We consider the paper and its implications.

How common are AI hallucinations? In the second selection, Jake Linardon (of Deakin University) and his co-authors look at hallucinations through the prism of psychiatry, asking ChatGPT to draft writing on several disorders. In their JMIR Mental Health study, hallucinations were frequent. “Citation fabrication and bibliographic errors remain common in GPT-4o outputs, with nearly two-thirds of citations being fabricated or inaccurate.”

Finally, in the third selection from Academic Psychiatry, Dr. Sheba Gollapudi (of the University of Texas) mulls the power of the stethoscope and its psychiatric equivalent. She describes how she developed her listening skills and her use of silence. “Because even though I will not necessarily use a stethoscope in my everyday practice, I know now that the stethoscope is within me.”

DG

Continue reading

Reading of the Week: PTSD Among 9/11 Responders – the New Nature Study; Also, Therapy Isn’t Psychotherapy and Physician Vacations & Burnout

June 19, 2025 /

From the Editor

He survived the car accident that killed his partner. Although he was physically unscathed, he struggled with PTSD, lucidly describing in our sessions the nightmares and fears that dominated his life.

How long do such symptoms last? Does time heal? Frank D. Mann (of Stony Brook University) and his co-authors attempt to answer these questions with a new study, one of the largest and longest on this disorder to date. In the first selection, we examine their Nature Mental Health paper, involving 13 000 responders to the World Trade Center attack, and spanning 20 years of data. “Our findings highlight the enduring impact of PTSD among World Trade Center responders, with substantial variability in individual trajectories. Despite overall modest declines, a subset remained highly symptomatic, underscoring the need for continued treatment.” We consider the paper and its implications.

In the second selection from Psychiatric News, Dr. Steven Reidbord, a psychiatrist based in San Francisco, notes the rising popularity of therapy and how things are changing with AI. But he suggests there is a difference between “corner-cutting” therapy and real psychotherapy, which is meant for personal change. “Psychotherapists must defend quality care against the seductive fictions that pervade social media. Our own message may be less alluring, but it has the advantage of being true…”

And in the third selection, Dr. Christine A. Sinsky (of the American Medical Association) and her co-authors look at physician vacations. Drawing on a national survey of US docs, they analyzed vacations, work during these vacations, and burnout. “These findings suggest that support for taking vacation and efforts to reduce physicians’ obligations to perform patient care-related tasks while on vacation, such as providing full electronic health record inbox coverage, should be considered to prevent physician burnout.”

Note that there will be no Readings for the next two weeks. (The discussion of vacations is inspiring.)

And, on a pivot, to those completing their residency education at the end of this month: all the best in your careers. Enjoy this remarkable moment.

DG

Continue reading

Reading of the Week: Preventing Mental Disorders After Disasters – the New BMJ Ment Health Paper; Also, Healthy Device Use and Dr. Qayyum on Regret

April 17, 2025 /

From the Editor

Floods. Hurricanes. Fire. Extreme weather seems to be more common these days – resulting in some experiencing PTSD and other mental disorders. In an age of climate change, what can mental health services offer? Is it possible to prevent major mental illness with interventions like CBT?

Ahlke Kip (of the University of Münster) and her co-authors attempt to answer these questions in a new meta-analysis and systematic review which assesses the efficacy of psychological and psychosocial interventions after exposure to natural hazards. In the BMJ Mental Health paper, they looked at 10 RCT studies involving more than 5 000 participants, including both civilians and disaster responders, focusing on symptoms of PTSD, depression, and anxiety. They didn’t find superiority to passive control conditions. “The current evidence does not allow for any recommendations regarding prevention programmes in the aftermath of natural hazards.” We consider the paper and its implications.

In the second selection, Joseph Firth (of the University of Manchester) and his co-authors weigh in on youth and digital device usage. In a paper for World Psychiatry, they sought “directly actionable advice” for parents and youth and then drew on the literature to create tips for teenagers. “We sought to produce a set of best-practice approaches, on the basis of available evidence and guidelines, for adolescents and their parents looking to improve their device usage patterns.”

And in this week’s third selection, Dr. Zheala Qayyum (of Harvard University) writes about guilt and time in a paper for Academic Psychiatry. The child and adolescent psychiatrist describes an unkind act in her youth – and an opportunity to make amends decades later. She also notes the tie to training and education. “Only by sharing and reflecting on our own moments, successes, failures, and vulnerabilities, can our trainees recognize and respond to such instances in their own experience.”

DG

Continue reading

Reading of the Week: Psychological Interventions for Schizophrenia – the New Lancet Psych Study; Also, Service Dogs for PTSD, and the Latest in the News

July 4, 2024 /

From the Editor

She was distressed by the voices and the paranoid thoughts. Many nights, my patient could barely sleep. She had tried several medications without much improvement. Is there a role for psychological interventions? Would CBT help? What is the evidence for this population?

In the first selection, Nurul Husna Salahuddin (of the Technical University of Munich) and co-authors attempt to answer these questions in a new systematic review and network meta-analysis, just published in Lancet Psychiatry. The analyzed 52 RCTs with 5 034 participants. “We provide robust findings that CBTp can reduce the overall symptoms of patients with treatment-resistant schizophrenia, and therefore clinicians can prioritise this intervention in their clinical practice.” We consider the paper and its clinical implications.

In the second selection from JAMA Network Open, Sarah C. Leighton (of the University of Arizona) and her co-authors describe a study involving service dogs for those with PTSD. In a nonrandomized controlled trial involving 156 military members and veterans, they examined outcomes after three months. “[C]ompared with usual care alone, partnership with a trained psychiatric service dog was associated with lower PTSD symptom severity and higher psychosocial functioning in veterans.”

Finally, we explore the latest news with recent articles from The Guardian, the Ottawa Citizen, and The New York Times. Among the topics: “honest” obituaries and the opioid crisis, antidepressants and withdrawal, and care for pregnant women with substance problems.

DG

Continue reading

Reading of the Week: Cancer & Suicide & Good News – the New Transl Psychiatry Study; Also, AI & Therapy Dropouts, and Bland on Her Father & His D-Day

June 13, 2024 /

From the Editor

He was so overwhelmed by the cancer diagnosis that he didn’t eat or sleep for days. “It was my worst nightmare.” My patient isn’t alone in that devastating experience, of course – the diagnosis and treatment of cancer is a major life event. Not surprisingly, the suicide rate is roughly double that of the general population in the United States. But with increasing psychosocial interventions, how has this changed over time?

In the first selection, Qiang Liu (of the Chinese Academy of Medical Sciences) and his co-authors attempt to answer that question in a new paper for Translational Psychiatry. Drawing on 40 years of data and a major US database, they analyzed the journeys of five million cancer patients, discovering good news. “We revealed a gradual increase in cancer-related suicide rates from 1975 to 1989, followed by a gradual decrease from 1989 to 2013, and a marked decrease from 2013 to 2017.” Indeed, between 2013 and 2017, the rate dropped by 27%. We consider the paper and its implications.

In the second selection, Sakiko Yasukawa (of the Sony Corporation) and her co-authors aimed to reduce dropouts from psychotherapy using AI. In a new paper for BMJ Mental Health, they describe an RCT involving 149 people. “The results suggest that the personalised messages sent by the chatbot helped participants control their pace in attending lessons and improve programme adherence without human guidance.”

Last week marked the anniversary of D-Day with ceremonies, including in Normandy. What was the toll on those who returned home? In the third selection, an essay published in The Globe and Mail, Normanne Bland describes her father and his time in Europe. She writes about him with mixed feelings, coloured by his mental health problems, including PTSD. “I had a complicated relationship with my father. I was proud of his service but I loathed his drinking.”

There will be no Reading next week.

DG

Continue reading

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

Continue reading

Reading of the Week: PTSD & Healthcare Workers – the New Lancet Psych Paper; Also, Social Media and Youth (Aust Psych) and BMJ’s Xmas Call to Action

December 22, 2022 /

From the Editor

We talk about the virus’ effects on our patients, both in terms of physical and mental health. But what has it done to us?

Health-care workers have been on the front lines of this pandemic and have experienced the psychological toll. While past studies have considered mental disorders of health-care workers, their methodology hasn’t been strong, often relying on online surveys. In the first selection, Hannah Scott (of King’s College London) and her co-authors look at mental disorders and the pandemic in a new Lancet Psychiatry paper. Importantly, they did a two-phase, cross-sectional study comprising of diagnostic interviews. They write: “The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools.” Still, they found that about one in five met threshold for a mental disorder and “thus might benefit from clinical intervention.” We consider the paper and its implications.

In the second selection, Beatrice Webb (of Flinders University) and her co-authors look at social media and young people. In a Point of View paper for Australasian Psychiatry, they note problems with mental health including the rise in psychological distress – something tied to social media. They also observe some benefits to Instagram and other online platforms. The paper is practical and offers advice, including: “We encourage clinicians to explore social media use in the assessment of young people, due to potential impacts on depression, anxiety and self-harm.”

At this time of year, The BMJ runs its Christmas issue, meant to be light-hearted and with liberal use of British humour. In the third selection, Ryan Essex (of the University of Greenwich) considers calls to action in the medical literature. In an Editorial, he opines: “The call to action has several obvious advantages over actually acting. Making that call allows you to salve your conscience, to ‘do something’ without the hard work of actually doing something.”

There will be no Readings for the next two weeks. We will return with force (but a lack of British humour) on 12 January 2023 when we will review the best papers of the year. A quick word of thanks for your continuing interest.

All the best in the holiday season.

DG

Continue reading

Reading of the Week: Better PTSD Symptom Control, Less Diabetes (JAMA Psych)? Also, Buckley on Cannabis (Quick Takes), and the Life of Kajander (Globe)

December 5, 2019 /

From the Editor

Better PTSD symptom control, less diabetes? How do we talk to our patients about cannabis (and cannabis use disorder)? Who was Dr. Ruth Kajander?

This week, there are three selections. The first two deal with timely and relevant topics: the intersection of physical and mental health and the use of cannabis post-legalization. The third reminds us of the youth of our field.

In the first selection, Saint Louis University School of Medicine’s Jeffrey F. Scherrer and his co-authors consider PTSD and diabetes, asking if improvement with the mental health disorder results in a lower risk of type 2 diabetes. Drawing on Veterans Health Affairs data involving nearly 1 600 people, they find that “clinically meaningful reductions in PTSD symptoms are associated with a lower risk of type 2 diabetes.”

treating-ptsd-may-help-reduce-risk-of-type-2-diabetes-696x464

In the second selection, we draw on a podcast interview with the University of Toronto’s Dr. Leslie Buckley, the chief of addictions division at CAMH, on cannabis. What advice would she give clinicians about cannabis use? “Try to have that long conversation with [patients] about their use and make sure that they know the harms – because I feel like most people don’t.”

Finally, with an eye on yesterday and not today, we look at the recent Globe obituary for Dr. Ruth Kajander, a psychiatrist who served in many roles, and was a member of the Order of Canada.

DG

Continue reading

Reading of the Week: PTSD – More Common in High-Income Countries? The New BJP Open Paper; Also, the Trauma of 911 & Torrey on His Sister

September 19, 2019 /

From the Editor

Is there more PTSD in countries like Norway and Canada?

The question seems odd since we typically don’t associate major mental illness with affluence (though, of course, not everyone in an affluent society is affluent). Yet there is a literature suggesting that high-income countries may have more PTSD.

This week, we look at a new paper on the topic. The University of Oslo’s Trond Heir and co-authors consider PTSD in Norway. Drawing on a survey, they find significant rates of PTSD, higher than found in low-income countries. “A possible explanation may be that high expectations for a risk-free life or a happy life can lead to a low threshold for perceiving adverse events as life-threatening or as violating integrity.”

norway-aurlands-fjordenNorway: High incomes, universal health care, many fiords, and more PTSD?

In the next selection and continuing on the topic of PTSD, New York Times reporter James Barron writes about the other victims of September 11 – those who survived, but have struggled with PTSD. As a Long Island clinician notes: “So many suffer in silence. It’s 18 years later, and to some it’s pretty new.”

And in the third selection, Dr. E. Fuller Torrey, a psychiatrist and accomplished researcher, considers his career. He notes that his sister’s psychosis pushed him to choose psychiatry, though he had originally planned to be a family doc.

DG

  Continue reading

Reading of the Week: PTSD & Treatment – What’s Evidence Based? JAMA Psychiatry’s New Network Meta-analysis

August 8, 2019 /

From the Editor

Just over a century ago, Dr. Charles Myers wrote “A Contribution To The Study Of Shell Shock” in The Lancet, the first paper on shell shock. Today, our understanding of PTSD has greatly evolved.

But what’s the most effective treatment for people with PTSD?

This week, we consider the new paper by the University of Basel’s Jasmin Merz and her co-authors. They use a network meta-analysis to determine whether patients do better with medications, psychotherapy, or both; in other words, they attempt to analyze different studies in this area, but not necessarily those that do direct comparisons (that’s my Twitter-length biostatistical summary). They find: “The available evidence is sparse and appears not to support the use of pharmacological therapy as first-line treatment for posttraumatic stress disorder…”

ptsd

We also consider an editorial that runs with the study. Murray B. Stein and Sonya B. Norman, both of University of California San Diego, are critical, commenting that aspects of the study may be “hard to swallow.”

DG

 

Continue reading