Tag: The American Journal of Psychiatry

Reading of the Week: Contingency Management for Stimulant Use – the New AJP Paper; Also, LLMs as Mental Health Providers and Kumpf on Her ED Visit

October 9, 2025 / / 0 Comments

From the Editor

Her housing is unstable; major relationships have ended; she is deeply in debt. She presented to the emergency department hoping for help with her crystal methamphetamine addiction. “That drug just grabs you and holds you.” No medications have demonstrated efficacy for stimulant use disorder. But could contingency management be part of a meaningful plan for her recovery?

In the first selection, a paper published last month in The American Journal of Psychiatry, Lara N. Coughlin (of the University of Michigan) and her co-authors attempt to answer that question. They did a retrospective cohort study, comparing those who received contingency management with those who didn’t, looking at outcomes and 12 months of data, and involving 1 481 patients and an equal number of people in the control group. “This study provides the first evidence that contingency management use in real-world health care settings is associated with reduced risk of mortality among patients with stimulant use disorder.” We consider the paper and its implications.

In the second selection, Tony Rousmaniere (of Sentio University) and his co-authors examine large language models as health providers. In a timely paper for The Lancet Psychiatry, they weigh the regulatory and legal contexts. “LLMs have entered everyday use for mental health. Developers who embrace transparency and collaborative research can transform the mental health landscape and define the future of digital care for the better.”

And in the third selection, Emily A. Kumpf (of Johns Hopkins University) writes personally about her first-episode psychosis in Psychiatric Services. While she is grateful for the care she received in the emergency room, she was traumatized by the experience. “When I was restrained, every part of me genuinely believed the medications they were injecting into me were chemicals intended to kill me. My scream pierced through the hospital walls; I thought I was dying. To my surprise, I woke up the next morning.”

DG

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Reading of the Week: Suicide – with Papers from AJP and BJPsych Int; Also, O’Brien on His Brother’s Suicide & His Family

June 12, 2025 /

From the Editor

She came into our ED feeling overwhelmed. After a recent breakup, she felt suicidal; the academic demands of grade 12 further stressed her. As a clinician, this type of adolescent presentation seems to be increasingly common.

But is it? Many people have opinions. Dr. Tanner J. Bommersbach (of the University of Wisconsin) and his co-authors attempt to shed light on the state of teen mental health with a new and important paper focused on suicidal ideation, plans, and attempts. In the first selection, we examine their American Journal of Psychiatry paper, involving almost 120 000 high school students, drawing on US survey data, and covering a decade and a half. “In this nationally representative sample… significant increases occurred in the percentage reporting past-year suicidal thoughts, suicide plans, and suicide attempts from 2007 to 2021.” We consider the paper and its implications.

In the second selection from BJPsych International, Dr. Rachel Gibbons (of the Royal College of Psychiatrists) writes about suicide. In a controversial paper, she argues that we make too many assumptions about suicide, which colour our research and undermine our understanding of patients. “Embracing the complexity of suicide may not only refine prevention but also deepen our understanding of suffering, resilience, and meaning.”

And in the third selection, playwright Dan O’Brien writes about his brother’s suicide for Esquire. In a deeply personal essay, he discusses his brother’s mental health problems and his parents’ desire to hide them. He wonders what could have been. “I would like to be helpful to some who might read this, if only to deny that the suffering of mental illness is a disgrace, and to assert that such suffering is common and survivable.”

DG

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Reading of the Week: AI Chatbots for Mental Healthcare – the New NEJM AI Paper; Also, Neuromodulation for Schizophrenia (AJP)

April 10, 2025 /

From the Editor

Thought logs. Homework. Exposure. Psychotherapy is evidenced for the treatment of many mental disorders – but access is problematic. Can technology help? Is AI a game changer?

In a new NEJM AI paper, Dr. Michael V. Heinz (of Dartmouth College) and his co-authors attempt to answer these questions. In an RCT, they compared 210 participants receiving a chatbot intervention (Therabot) with a control group, analyzing symptoms of mood, anxiety, and disordered eating. “As the first RCT of its kind, our study supports the feasibility, acceptability, and effectiveness of a fine-tuned, fully GenAI–powered chatbot for treating mental health symptoms.” We consider the paper and its implications, and tap the expertise of Dr. John Torous (of Harvard University).

An AI bot for better mental health?

In this week’s other selection, we look at a new review from The American Journal of Psychiatry. Drs. Nicholas H. Neufeld and Daniel M. Blumberger (both of the University of Toronto) provide an update on neuromodulation strategies for schizophrenia, drawing on nearly 140 citations and reviewing different technologies “that span electrical, magnetic, and ultrasound forms of stimulation.” They note: “The evolution of interventions holds the promise of fewer adverse effects and a noninvasive approach, increasing the scale at which these interventions may be offered in hospital and community settings.”

DG

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Reading of the Week: rTMS vs Meds for Antidepressant Non-responders – the New AJP Study; Also, Stea on the Wellness Industry

September 12, 2024 /

From the Editor

He’s had two antidepressant trials, yet he still can’t get out of bed. What’s the next step for my patient with depression? With so many antidepressant options available, the simplest answer is another med. But what could be an alternative? These questions are highly practical – consider that roughly 700 000 Canadians struggle with treatment-refractory depression. 

Iris Dalhuisen (of Radboud University) and her co-authors attempt to shed light on the issue. In a newly published American Journal of Psychiatry study, they describe a randomized comparison involving 89 people with treatment-refractory depression who received either rTMS or another antidepressant. “In a sample of patients with moderately treatment-resistant depression, rTMS was more effective in reducing depressive symptoms than a switch of antidepressant medication.” We analyze the study, the Editorial that accompanies it, and the implications for practice.

In this week’s other selection, Jonathan N. Stea (of the University of Calgary) writes about the wellness industry in an essay for The Globe and Mail. He bemoans the snake-oil salesmen and their big promises. “As a clinical psychologist, I have encountered many patients who received pseudoscientific assessments and treatments for their mental-health concerns. The tidal wave of pseudoscientific mental-health practices originates both within and outside of the mental-health professions.”

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: Cannabis & Cardiac Health – the New JAHA Study; Also, Burnout & Outcomes, and Dr. Mary Seeman on Scaling Down

May 9, 2024 /

From the Editor

Our patients increasingly use cannabis, and we worry about the impact on their mental health. But what about the impact on their physical health?

In the first selection, Abra M. Jeffers (of Harvard University) and her co-authors consider cannabis and cardiac health. In a new paper for the Journal of the American Heart Association, they analyzed cardiac outcomes, drawing on survey data and involving more than 400 000 participants, some of whom used cannabis. “Cannabis use is associated with adverse cardiovascular outcomes, with heavier use (more days per month) associated with higher odds of adverse outcomes.” We review the paper and its implications.

In the second selection, Nina A. Sayer (of the University of Minneapolis) and her co-authors look at burnout in a new paper for JAMA Network Open. In a cohort study involving 165 therapists and almost 1 300 patients, they note a connection between provider burnout and PTSD outcomes. “These findings suggest that interventions to reduce therapist burnout might also result in more patients experiencing clinically meaningful improvement…”

Dr. Mary Seeman (of the University of Toronto), who died in late April, had a storied career as a psychiatrist. She had major roles, including the Tapscott Chair in Schizophrenia at the University of Toronto. In a 2003 paper for The American Journal of Psychiatry, she reflects on her work with a patient. This essay – the third selection this week – notes the decades-long connection between doctor and patient. “Her faith in me keeps me coming into work each morning, often tired and achy, sometimes trying unsuccessfully to remember the comforting word I want to be able to say.”

DG

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Reading of the Week: How Problematic are Benzodiazepines? The New AJP Study; Also, Dickson on His Illness & Humility

March 28, 2024 /

From the Editor

Singer Olivia Rodrigo may have a catchy song about getting a driver’s license and Ariana Grande has a ditty about past relationships, but, in the late 1960s, the Rolling Stones wrote a whole song about diazepam, “Mother’s Little Helper.” The choice of topic isn’t so surprising: between 1968 and 1982, diazepam was the most prescribed medication in the United States and commonly used around the world.

But the pendulum has swung in the other direction. Today, we hesitate on prescribing benzodiazepines like diazepam, in part because of concerns about substance misuse and dose escalation. But how addictive are these meds? How significant is dose escalation over time? Though smaller studies have sought to answer these questions, Dr. Thomas Wolff Rosenqvist (of the University of Copenhagen) and his co-authors drew on Danish databases in an important, new study published in The American Journal of Psychiatry. They looked at two decades of data involving almost a million Danes who have used benzodiazepines. “A limited portion of the population that received benzodiazepines prescriptions were classified as continuous users, and only a small proportion of this group escalated to doses higher than those recommended in clinical guidelines.” We consider the study, the editorial that accompanies it, and the implications for practice.

Denmark: beautiful buildings, rich history, great data on benzodiazepines

In this week’s other selection, Michael Dickson (of the University of South Carolina) writes about the symptoms of schizophrenia. Dickson, who is a professor of philosophy, touches on philosophical concepts but, also, on personal experience – as an individual with the illness. In a paper published by Schizophrenia Bulletin, he recalls a psychotic episode, his ongoing symptoms, and how he came to terms with the disorder. “This attitude has made life better and has made the ‘near-collapses’ much rarer.”

DG

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Reading of the Week: Improving Self-Esteem in Youth – the New JAMA Psych Paper; Also, Black Females & Suicide and Dr. Jon Hunter on the End

December 7, 2023 /

From the Editor

Can we help youth before the onset of full disorders to build skills and avoid deeper problems? Several school-based efforts, offering DBT and mindfulness skills, have been tried without much success. Ecological momentary interventions (EMIs) – provided to patients during their everyday lives and in natural settings, giving unstructured recommendations with structured interventions – is a newer therapy that has gained attention.

But does it work? In a new paper for JAMA Psychiatry, Ulrich Reininghaus (of the University of Heidelberg) and his co-authors describe an RCT focused on youth with low self-esteem who have had past adversity, involving 174 Dutch participants. “A transdiagnostic, blended EMI demonstrated efficacy on the primary outcome of self-esteem and signaled beneficial effects on several secondary outcomes.” We consider the paper and its implications.

In the second selection, Victoria A. Joseph (of Columbia University) and her co-authors look at US suicide rates in Black females. In their American Journal of Psychiatry letter, they analyze suicides over two decades, drawing data on age and region from a national database. They conclude that: “increasing trends in suicide death among Black females born in recent years and underscores the need to increase mental health care access among Black girls and women, and to reduce other forms of structural racism.”

And in the third selection, Dr. Jon Hunter (of the University of Toronto) contemplates endings – including his ending – in a personal and moving paper for CMAJ. He notes the need to clean up his possessions. But what about his practice and the many patients that he has followed for years? “I’d rather not shy away from the uncertainty and loss of the ending, and to try to help one more time.”

DG

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Reading of the Week: Ethnicity, Bias, and Alcohol – the New AJP Paper; Also, Global Mental Health & AI (JAMA Psych) and Halprin on Her Mother (Globe)

May 25, 2023 /

From the Editor

He drinks heavily, but does he have a diagnosed alcohol use disorder?

Does the answer to that question tie to ethnicity and biases? In a new American Journal of Psychiatry paper, Rachel Vickers-Smith (of the University of Kentucky) and her co-authors suggest it does. Drawing on US Veterans Affairs’ data with over 700,000 people, they analyzed the scores of a screening tool and the diagnoses with ethnicity recorded in the EMR. “We identified a large, racialized difference in AUD diagnosis, with Black and Hispanic veterans more likely than White veterans to receive the diagnosis at the same level of alcohol consumption.” We look at the paper and mull its implications.

In the second selection, Alastair C. van Heerden (of the University of the Witwatersrand) and his co-authors consider AI and its potential for global mental health services in a new JAMA Psychiatry Viewpoint. They focus on large language models (think ChatGPT) which could do several things, including helping to train and supervise humans. “Large language models and other forms of AI will fundamentally change how we treat mental disorders, allowing us to move away from the current model in which most of the world’s population does not have access to quality mental health services.”

And, in the third selection, Paula Halprin discusses her mother’s alcohol use in an essay for The Globe and Mail. In a moving piece that touches on anger, trauma, and regret, Halprin writes about her re-examination of her mother’s life. “I now understand my mother drank not because of a weak character, but to cope with a body wearing out before its time from unremitting pregnancy and as a way to swallow her anger and disappointment. It was also a way to mourn a loss of self.”

DG

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Reading of the Week: Polypharmacy & Health – the New AJP Paper; Also, Melatonin Gummies (JAMA) & Mehler Paperny on Involuntary Care (Globe)

May 4, 2023 /

From the Editor

When it comes to antipsychotics, polypharmacy (the use of more than one antipsychotic) has fallen out of fashion – the psychopharmacological equivalent of bell bottoms. Providers worry about side effects and the long-term physical health implications. Are the concerns overstated? In the first selection, Heidi Taipale (of the University of Eastern Finland) and her coauthors analyze Finnish data for The American Journal of Psychiatry. The study includes almost 62,000 patients with schizophrenia with a median follow up period of more than 14 years, and they find that the use of more than one antipsychotic isn’t linked to poorer health outcomes. “The results show that antipsychotic monotherapy is not associated with a lower risk of hospitalization for severe physical health problems when compared with antipsychotic polypharmacy.” We consider the paper and its clinical implications.

Melatonin is a popular recommendation for sleep, but what’s the quality like? In the second selection from JAMA, Dr. Pieter A. Cohen (of Harvard University) and his co-authors try to answer that question with a focus on melatonin gummy products, looking at 30 brands. “The great majority of melatonin gummy products were inaccurately labeled, with most products exceeding the declared amount of melatonin and CBD.”

Gummy melatonin: colourful but what’s the quality?

In the third selection, in an essay for The Globe and Mail, journalist Anna Mehler Paperny writes about the push for more coercive care by different governments. Drawing on her personal experiences, she notes potential problems. “There is a role for coercive care. It’s arguably necessary for some people, sometimes. But used injudiciously, it can sour people on care and set them up for failure.”

There will be no Reading next week.

DG

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