Tag: substance

Reading of the Week: Lived Experience of Postpartum Depression & Psychosis – the New World Psych Paper; Also, Involuntary Treatment and Family Stress

May 15, 2025 / / 0 Comments

From the Editor

“You are normal and then the next thing, you know, you’re crazy.”

So comments a woman about her postpartum depression. Typically, we describe this illness with a list of symptoms. But how do patients experience it? In a new World Psychiatry paper, Dr. Paolo Fusar-Poli (of King’s College London) and his co-authors attempt to answer this question with a “bottom-up” approach, looking at both postpartum depression and psychosis. “To the best of our knowledge, this is the first bottom-up review of the lived experience of postpartum depression and psychosis. Experts by experience co-designed, co-conducted and co-wrote the study, leveraging an established methodological template developed by our group to investigate the lived experience of psychosis [and] depression…” We look at the paper and its implications.

Should people with substance problems be forced into treatment? Across North America, some are proposing this idea, including governments in British Columbia and Alberta. In a new Canadian Journal of Psychiatry paper, Benedikt Fischer (of the University of Toronto) and his co-authors look at the issue and the evidence. “Involuntary treatment for severe SUD is a complex and contentious concept that requires careful in-depth consideration before its adoption.”

In the third selection, a paper written anonymously for The BMJ, the author describes the challenges for families of those with severe mental disorders. He notes his deep frustration with visits to the ward, often leaving him in tears. “Perhaps family support needs to become part of the culture on mental health wards, and we should recognise the need for help in communicating.”

DG


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Reading of the Week: Physician Suicide – the New JAMA Psych Paper; Also, Homelessness & Substance (JAMA)

March 6, 2025 /

From the Editor 

It’s a demanding profession that can push us. Not surprisingly, there is some evidence that physicians may be at higher risk of completing suicide than the general population. But are we?

Hirsh Makhija (of the University of California, San Diego) and his co-authors attempt to answer this question in new JAMA Psychiatry study. Drawing on a US national database, they compared suicides among male and female physicians to the nonphysicians, over five years, finding that suicide rates for female physicians were 47% higher than for women in the general population. They also looked at mood, mental health, and other problems. “Comprehensive and multimodal suicide prevention strategies remain warranted for physicians, with proactive consideration for those experiencing mental health issues, job problems, legal issues, and diversion investigations.” We review the paper and its implications, and look at the accompanying Editorial.

In this week’s second selection, Ryan D. Assaf (of the University of California, San Francisco) and his co-authors report on homelessness and substance use. In a new paper for JAMA, they surveyed 3 200 people, finding that 37% reported using any illicit substance regularly (more than three times per week), most commonly crystal methamphetamine. “In a representative study of adults experiencing homelessness in California, there was a high proportion of current drug use, history of overdose, and unmet need for treatment.”

Note that there will be no Readings for the next two weeks.

DG

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Reading of the Week: Substance – with New Papers from JAMA Psych, Netw Open & Brookings; Also, the Latest in the News

February 20, 2025 /

From the Editor

For many of our patients, the pull of alcohol can be strong with devastating effects. In recent months, semaglutide, better known for its weight-loss properties, has generated some buzz. Could semaglutide help those with alcohol problems?

In the first selection, Christian S. Hendershot (of the University of Southern California) and his co-authors attempt to answer that question in a new paper for JAMA Psychiatry. They conducted an RCT with 48 participants randomized to semaglutide or placebo over nine weeks, measuring alcohol consumption and craving outcomes, and finding that people taking semaglutide consumed less alcohol by some measures. “These findings provide initial prospective evidence that low-dose semaglutide can reduce craving and some drinking outcomes, justifying larger clinical trials to evaluate GLP-1RAs for alcohol use disorder.” We consider the paper and its implications.

In the second selection, Joshua L. Gowin (of the University of Colorado) and his co-authors explore the impact of heavy lifetime and recent cannabis use on brain function in a new paper for JAMA Network Open. They analyzed data from more than 1 000 young adults, including brain imaging, focusing on tasks administered during fMRIs sessions. “Cannabis use is associated with short- and long-term brain function outcomes, especially during working memory tasks.”

Finally, we explore the latest news with articles from The New York Times and The Free Press, and a new report from the Brookings Institution. The topics: Oregon’s decriminalization, Robert F. Kennedy’s nomination, and decriminalization across North America.

DG

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Reading of the Week: The Readings at 10; Also, Mentorship and Involuntary Care

September 26, 2024 /

From the Editor

10.

This month, the Reading of the Week celebrates its 10th anniversary. The program has grown and evolved over this past decade but the core idea – timely summaries of the latest in the literature coupled with commentary – hasn’t changed. To mark the anniversary, over the next two weeks, we will look at some important papers that we have covered in the past ten years.

This week: ten papers that I think about often (and helped change my clinical work).

Next week: tens papers that I think about often (and helped change the way I view mental illness).

Of course, the lists of papers are hardly exhaustive. Have a favourite that I missed? Please don’t hesitate to email me.

*      *      *

Many of our colleagues speak enthusiastically about the influence of mentors on their lives – but how can you better incorporate mentorship into your career? What should you look for in a mentor? And what exactly is a mentor? In the second selection, we look at a new Quick Takes podcast interview with Dr. Suzanne Koven (of Harvard University). “Mentorship is especially valuable for people who are aspiring to somewhat unconventional careers, and that was certainly the case with me.”

Finally, in the third selection, a Globe and Mail editorial considers substance misuse and Canadian cities. After an episode of violence in Vancouver, they wonder what could be done and weigh more involuntary care for those with substance problems. “Involuntary care has a role to play in some cases. Getting involuntary care right, however, is difficult.”

DG

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Reading of the Week: In-person vs. Remote CBT – the New CMAJ Study; Also, Treatment & Opioids in the US, and AI & Med School Exams

July 25, 2024 /

From the Editor

In the early days of the pandemic, patients connected with us virtually from their kitchens and bedrooms – and, yes, their closets and washrooms. But as COVID-19 fades, we may wonder: what care should be delivered virtually and what should be done in person?

In the first selection, Sara Zandieh (of McMaster University) and her co-authors examine remote versus in-person CBT in a new CMAJ study. They conducted a systematic review and meta-analysis with 54 randomized controlled trials and almost 5 500 participants, addressing both physical and mental problems. “Moderate-certainty evidence showed little to no difference in the effectiveness of in-person and therapist-guided remote CBT across a range of mental health and somatic disorders, suggesting potential for the use of therapist-guided remote CBT to facilitate greater access to evidence-based care.” We consider the paper and its implications.

In the second selection, Dr. Tae Woo Park (of the University of Pittsburgh) and his co-authors explore opioid use disorder (OUD) treatment. In their JAMA research letter, they compared medication and psychosocial treatments for OUD across the United States, surveying more than 17 000 facilities and analyzing the availability of evidenced-based interventions like buprenorphine and contingency management. “Substance use treatment facilities reported significant gaps in provision of effective treatments for OUD.”

And in the third selection from CNBC, Dr. Scott Gottlieb and Shani Benezra (both of the American Enterprise Institute) describe their experiment: they tasked several large language models with answering questions from the USMLE Step 3. The average resident score is 75%; four of five AI programs surpassed that benchmark. “[These models] may offer a level of precision and consistency that human providers, constrained by fatigue and error, might sometimes struggle to match, and open the way to a future where treatment portals can be powered by machines, rather than doctors.”

There will be no Reading next week.

DG

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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

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Reading of the Week: Preventing Postpartum Depression in Pakistan – the New Nature Med Study; Also, Deaths of Despair and ChatGPT & Abstracts

April 18, 2024 /

From the Editor

Imagine that you are asked to design a program to prevent depression in a population at risk. Would you hire psychiatrists? Look to nurses? Tap the expertise of psychologists? All three?

In the first selection from Nature Medicine, Pamela J. Surkan (of Johns Hopkins University) and her co-authors describe a study that focused on prevention. As they worked in Pakistan – a nation with few mental health providers by Western standards – they chose to train lay people, teaching them to deliver CBT. In their single-blind, randomized controlled trial, 1 200 women who were pregnant and had anxiety (but not depression) were given enhanced usual care or CBT. “We found reductions of 81% and 74% in the odds of postnatal MDE and of moderate-to-severe anxiety…” We discuss the paper and its implications.

In the second selection, Joseph Friedman and Dr. Helena Hansen (both of the University of California, Los Angeles) look at deaths of despair in the United States in a research letter for JAMA Psychiatry. Their work builds on the idea that some deaths are related to the hopelessness of a person’s social or economic circumstance; past publications focused largely on White Americans. Friedman and Hansen drew on more than two decades of data, including ethnicity, from a US database, finding a different pattern and that: “Rising inequalities in deaths of despair among American Indian, Alaska Native and Black individuals were largely attributable to disproportionate early mortality from drug- and alcohol-related causes…”

A recent survey finds that psychiatrists see AI as potentially helpful with paperwork and diagnosing patients. But could AI help you keep up with the literature? In the third selection from Annals of Family Medicine, Dr. Joel Hake (of the University of Kansas) and his co-authors used ChatGPT to produce short summaries of studies, then evaluated their quality, accuracy, and bias. “We suggest that ChatGPT can help family physicians accelerate review of the scientific literature.”

DG

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Reading of the Week: Legal Cannabis at 5 – Considering Nonmedical Legalization with a CMAJ Commentary, Dr. Buckley’s Reflections and Major Papers

October 19, 2023 /

From the Editor

On Oct. 17, 2018, the government of Canada will launch a national, uncontrolled experiment in which the profits of cannabis producers and tax revenues are squarely pitched against the health of Canadians. When Bill C-45 comes into force in mid-October, access to recreational marijuana will be legal, making Canada one of a handful of countries to legalize recreational use of the drug. Given the known and unknown health hazards of cannabis, any increase in use of recreational cannabis after legalization, whether by adults or youth, should be viewed as a failure of this legislation.

 – Dr. Diane Kelsall, Editor-in-Chief, CMAJ, October 2018

On Tuesday, Canada’s experiment with the legalization of cannabis for nonmedical purposes turned five. Did use go up? What about health care utilization? Have there been benefits from justice and social justice perspectives? Is it the failure that Dr. Kelsall feared?

Now is a good time to pause and review the impact of this change. In this Reading, we try to do just that. 

We start with a CMAJ commentary just published. Benedikt Fischer (of Simon Fraser University) and co-authors look at the evidence, including studies on use and ED presentations, as well as statistics on purchases. “A consideration of the evidence 5 years after implementation suggests that success in meeting policy objectives has been mixed, with social justice benefits appearing to be more tangibly substantive than health benefits.”

Dr. Leslie Buckley (of the University of Toronto) mulls this moment with some comments about the CMAJ paper, and the larger discussion. “[T]he legal changes were enacted and resulted in positive outcomes while the preventive changes which would require more financial investment and tight regulation received less attention.”

Finally, we look at three important papers on cannabis that have been featured in this series over the past five years, and another one that we haven’t looked at before.

DG

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Reading of the Week: Fatal Overdoses & Drug Decriminalization – the new JAMA Psych Paper; Also, ChatGPT vs Residents, and Chang on Good Psychiatry

October 5, 2023 /

From the Editor

Does decriminalizing the possession of small amounts of street drugs reduce overdoses? Proponents argue yes because those who use substances can seek care – including in emergency situations – without fear of police involvement and charges. Opponents counter that decriminalization means fewer penalties for drug use, resulting in more misuse and thus more overdoses. The debate can be shrill – but lacking in data.

Spruha Joshi (of New York University) and co-authors bring numbers to the policy discussion with a new JAMA Psychiatry paper. They analyze the impact of decriminalization in two states, Oregon and Washington, contrasting overdoses there and in other US states that didn’t decriminalize. “This study found no evidence of an association between legal changes that removed or substantially reduced criminal penalties for drug possession in Oregon and Washington and fatal drug overdose rates.” We consider the paper and its implications.

In the second selection, Dr. Ashwin Nayak (of Stanford University) and his co-authors look at AI for the writing of patient histories. In a new research letter for JAMA Internal Medicine, they do a head-to-head (head-to-CPU?) comparison with ChatGPT and residents both writing patient histories (specifically, the history of present illness, or HPI). “HPIs generated by a chatbot or written by senior internal medicine residents were graded similarly by internal medicine attending physicians.”

And in the third selection, medical student Howard A. Chang (of Johns Hopkins University) wonders about “good” psychiatry in a paper for Academic Psychiatry. He reflects on the comments of surgeons, pediatricians, and obstetricians, and then mulls the role of our specialty. “I have gleaned that a good psychiatrist fundamentally sees and cares about patients with mental illness as dignified human beings, not broken brains. The good psychiatrist knows and treats the person in order to treat the disease.”

DG

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Reading of the Week: ADHD & Substance Outcomes – the New JAMA Psych Paper; Also, Suicide & the Impact on Psychiatrists and Foulkes on Her Anxiety & Our Times

July 27, 2023 /

From the Editor

Stimulants are commonly prescribed to children with ADHD. Do they protect kids against future substance misuse? Or, having been exposed early to stimulants, are these patients more likely to develop substance problems in adulthood?

Past studies have attempted to answer these questions but have been limited by study design. In a new JAMA Psychiatry paper, Brooke S. G. Molina (of the University of Pittsburgh) and her co-authors take a fresh look. In a cohort study involving 547 students, some of whom were treated with stimulants while others received behavioural therapy during the first period, Molina et al. look at outcomes when these participants are in their mid 20s. “This study found no evidence that stimulant treatment was associated with increased or decreased risk for later frequent use of alcohol, marijuana, cigarette smoking, or other substances used for adolescents and young adults with childhood ADHD.” We consider the study and its implications.

In the second selection, Dr. Juveria Zaheer (of the University of Toronto) discusses patient suicide in a new Quick Takes podcast interview. Focusing on the impact on psychiatrists and residents of psychiatry, she draws from the literature, including a study she recently senior authored for The Canadian Journal of Psychiatry. She notes common reactions by psychiatrists and residents, including guilt and shock. And Dr. Zaheer talks about her own experience. “I’ll never forget when it happened.” 

And in the third selection, Lucy Foulkes (of the University of Oxford) writes about anxiety and current approaches. In a Guardian essay, she notes her own history as an “anxious teen” and wonders if life is better for today’s adolescents, with awareness campaigns but not necessarily meaningful services. “We are now in a situation where many teens know or believe they are anxious but aren’t getting the help they need to manage it.”

The Reading of the Week has formal partnerships with 14 postgraduate programs and, today, we welcome PGY1s who are joining us from across Canada.

DG

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