Tag: The British Journal of Psychiatry

Reading of the Week: Suicide-related Reporting – the New BJP Paper; Also, Cannabis Use & Psychosis, and Mental Health & Working from Home

October 16, 2025 /

From the Editor

The stakes are high: news coverage of suicide can affect suicide rates. So how responsibly do journalists report? How has this changed with time?

In a new paper for The British Journal of Psychiatry, Dr. Mark Sinyor (of the University of Toronto) and his co-authors attempt to answer these questions. Focusing on US network news, they analyzed suicide-related news segments over an 11-year period, including for putatively harmful characteristics. “Coverage of suicide stories by major US cable news networks was often inconsistent with responsible reporting guidelines.” We consider the paper and its implications.

In the second selection from JAMA Psychiatry, Dr. Andrew S. Hyatt (of Harvard University) and his co-authors look at cannabis use after legalization and those individuals with psychosis. In this brief report, they drew from a US database with almost 2 000 participants. “In this study, individuals with psychosis reported a large increase in current cannabis use following legalization and commercialization of cannabis in their state, and by larger amounts than previously reported estimates of the general population.”

Is working from home better for mental health? In the third selection, from Mental Health & Prevention, Jean-Philippe Chaput (of the University of Ottawa) and his co-authors drew on national data to analyze work location and several self-rated measures, including mental health. The dataset is impressive with almost 25 000 participants. “We observed that work location was not related to self-rated mental health, life satisfaction, or life and work stress.”

DG

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Reading of the Week: Bipolar Disorder Drug Prescribing – Bad News? The New CJP Paper; Also, An AI Warning and Cannabis & Psychosis

September 11, 2025 /

From the Editor

There are more medication options than ever for the treatment of bipolar disorder. What are physicians prescribing? How often do we use lithium, arguably the best medication?

In the first selection, from The Canadian Journal of Psychiatry, Samreen Shafiq (of the University of Calgary) and her co-authors attempt to answer those questions in a new study. They drew on Alberta government data, including more than 130 000 individuals with bipolar disorder and more than nine million prescriptions. “Overall, we uncovered a concerning trend in the prescribing patterns for bipolar disorder treatment, with antidepressants and second-generation antipsychotics being prescribed frequently and a decline in prescribing of lithium and other mood stabilizers.” We consider the paper and its implications.

What would John Cade think?

In the second selection, Dr. Allen Frances (of Duke University) writes about AI chatbots and psychotherapy in The British Journal of Psychiatry. He notes their “remarkable fluency” and argues that there are clear benefits to AI psychotherapy. He also comments on dangers, and he doesn’t mince his words. “Artificial intelligence is an existential threat to our profession. Already a very tough competitor, it will become ever more imposing with increasing technical power, rapidly expanding clinical experience and widespread public familiarity.”

And in the third section, Sophie Li (of the University of Ottawa) and her co-authors consider psychosis and cannabis in a concise CMAJ paper. They make several points, including: “The tetrahydrocannabinol (THC) content of cannabis has roughly quintupled in the past 2 decades, from around 4% in the 2000s to more than 20% in most legal dried cannabis in Canada by 2023.”

There will be no Reading next week.

DG

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Reading of the Week: Therapy = More Work + Better Income? The New Psych Medicine Study; Also, Zero Suicide & Melatonin for Kids

June 5, 2025 /

From the Editor

After completing a course of psychotherapy, he felt better and began a part-time job. The employment gave him a sense of purpose. As a physician, I could both sympathize and empathize; for many, work is a meaningful part of life, after all.

But does psychotherapy necessarily result in employment? Does therapy pay for itself with economic benefits? Otto R. F. Smith (of NLA University College) and his co-authors attempt to answer these questions in an impressive new paper in Psychological Medicine. They report on an RCT involving more than 700 Norwegian participants who were randomized to a psychotherapy program (modeled after the UK’s IAPT service) or to treatment as usual. The authors used administrative databases to analyze employment, income, and the economic benefit. “The results support the societal economic benefit of investing in IAPT-like services.” We consider the paper and its implications.

In the second selection, Dr. Calina Ouliaris (of Macquarie University) and her co-authors look at the zero suicide approach. In a Commentary for The British Journal of Psychiatry, they argue that – despite being studied and implemented in several places – it lacks evidence. “The Zero Suicide Framework is an arguably vague framework with a scant evidence base, particularly for application in healthcare settings. Despite this, the concrete goal championed… that of ‘zero suicides’, is appealing and has been widely promulgated in mental health services, ahead of evidence for the same.”

Finally, in the third selection, Dr. Chris Y. Kim (of the University of Toronto) and his co-authors weigh the use of melatonin for children and adolescents. In The Canadian Journal of Psychiatry, they are cautious, in part because of the lack of consistency of over-the-counter melatonin. “Melatonin used as a hypnotic agent for the treatment of insomnia is controversial.”

DG

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Reading of the Week: Gone to the Dogs? The New BJP Study on Dog-assisted Interventions; Also, BC Decriminalization & the Latest in the News

April 24, 2025 /

From the Editor

He presented for the appointment with his dog. He told me that getting the chocolate lab – who had been trained by a national, not-for-profit organization – was the best single thing to help him. For the record, the dog was beautiful.

More and more of our patients are turning to animal interventions. But is there evidence to support this trend? In a new The British Journal of Psychiatry paper, Emily Shoesmith (of the University of York) and her co-authors look at dog-assisted interventions (DAIs), describing a review involving 33 papers. “DAIs may show promise for improving mental health and behavioural outcomes for those with mental health or neurodevelopmental conditions, particularly for conditions requiring social skill support. However, the quality of reporting requires improvement.” We discuss the paper and its clinical implications.

In the second selection, John F. Kelly (of Harvard University) reviews the successes of drug decriminalization in Portugal and its failures in British Columbia. In a new Editorial for JAMA Psychiatry, he notes key differences in their approaches. He also mulls the importance of such public-policy experimentation. “As demonstrated in Portugal, persistent, patient, thoughtful analysis, and sensitive, systemic planning is needed to ensure lives are saved and other outcomes improved.”

Finally, we explore the latest news with articles from The New York Times, The Globe and Mail, and NBC News. The topics: one firefighter’s battle with OCD, overdose deaths in North America, and a new mental-health awareness campaign.

DG

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Reading of the Week: Psychiatry & Daily Life with Papers on Mood Variation, Loneliness, and the Fear of Miscarriage

February 27, 2025 /

From the Editor 

In recent months, we have covered topics such as emerging evidence for a new medication treatment for alcohol use disorder, a new, short therapy for PTSD, and recommendations for managing insomnia. But what about psychiatry and daily life? This week, we make a bit of a pivot and ask: Should we have more morning meetings? How do we understand loneliness? And is the fear of miscarriage in need of its own (Greek-based) medical term? 

How does mood and anxiety vary over the course of the day, the week, and the season? In the first selection, Feifei Bu (of University College London) and her co-authors try answer that question in a new paper for BMJ Mental Health. Drawing on nearly a million observations, they assess time-of-day association with depression, anxiety, well-being, and loneliness. “Generally, things do indeed seem better in the morning.” We consider the paper and its implications – including whether morning meetings are, in fact, ideal.

Early morning, better mood?

Loneliness is increasingly recognized as a societal problem. A few years ago, the UK government created a Cabinet position to focus on the issue; Time magazine applauded “the World’s First Loneliness Minister.” In a new review for Nature Mental Health, Brendan E. Walsh (of the University of South Florida) and his co-authors push past the rhetoric and focus on the concept – or, rather, a couple of them. Walsh et al. then analyze demographics and propose treatments. “This Review is intended to be heuristic and to inspire future inquiry research across disciplines, including public health, psychology, healthcare, and social work/community health.”

And in the third selection, nurse Ruth Oshikanlu and Dr. Babatunde A. Gbolade (of the University of Leeds) discuss the fear of miscarriage. In a British Journal of Psychiatry letter, they argue that pregnant women worry about it, and a formal medical term (and more research) is needed. “We believe that apotychiaphobia, our proposed label for the fear of miscarriage experienced by pregnant women, goes beyond semantics. It entails appreciation for the emotional turmoil that many pregnant women face in silence.”

DG

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Reading of the Week: Social Media – with Papers from Digital Health & BJP, and Dr. Vivek Murthy on Warning Labels

February 6, 2025 /

From the Editor

“I know all about antidepressants,” the young patient told me in the ED. “I’ve seen TikTok videos.” Social media isn’t just a source of great cat videos, many individuals – especially younger patients – turn to it for health information.

But how reliable is the mental-health information? In a new Digital Health paper, Roxanne Turuba (of the University of British Columbia) and her co-authors report on a summative content analysis of the 1 000 most popular mental health TikTok videos. They found that many featured personal stories and confessionals; less than 4% referenced scientific evidence; about a third offering advice was misleading. “Healthcare practitioners and researchers may consider increasing their presence on the platform to promote the dissemination of evidence-based information to a wider and more youth-targeted population.” We examine the paper and its implications.

Social media: more than cat videos?

In the second selection, Harriet Battle (of the South London and Maudsley NHS Foundation Trust) and her co-authors consider attitudes toward mental health providers in social media. In a new British Journal of Psychiatry study, they analyzed more than 300 000 tweets spanning over a 16-year period, finding: “positive perceptions of mental health and mental health professionals increased over time. However, ‘psychiatrist’ had a consistently higher proportion of negative perceptions.”

And in the third selection, Dr. Vivek H. Murthy (the former US Surgeon General) writes about social media and adolescents in a New York Times essay. He notes the potential harms of social media for youth. He advocates changes, including warning labels. “We have the expertise, resources and tools to make social media safe for our kids. Now is the time to summon the will to act.”

DG

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Reading of the Week: Antipsychotics – the New, the Old & the Patient Experience, with Papers from JAMA Psych, BJP and Schiz Bulletin

October 10, 2024 /

From the Editor

“FDA approves a novel drug for schizophrenia, a potential ‘game changer’”

– The Washington Post

“Will ‘Game Changer’ Antipsychotic Live Up to the Hype?”

– Medscape

Two weeks ago, for the first time in decades, the FDA approved an antipsychotic for schizophrenia with a novel mode of action. What does the data show for this medication, xanomeline-trospium chloride? Is it a “game changer” as some headlines suggest? 

In the first selection, Dr. Inder Kaul (of Karuna Therapeutics) and his co-authors report on a double-blind, randomized, placebo-controlled trial that was published in JAMA Psychiatry. 256 people with schizophrenia were given the antipsychotic or the placebo and followed for five weeks. “Xanomeline-trospium was efficacious and well tolerated in people with schizophrenia experiencing acute psychosis.” We consider the study and its implications.

In contrast to this week’s first selection, the second selection looks at an older antipsychotic: clozapine. Drawing on Canadian databases, Lloyd Balbuena (of the University of Saskatchewan) and his co-authors put the risks and benefits of this medication in a new light in a paper for The British Journal of Psychiatry. They analyzed data on admissions and adverse events, with almost 50 000 participants. “Clozapine was associated with lower relapse overall, but this was accompanied by higher adverse events for adults. For children/youth, clozapine was associated with lower relapse all throughout and had no difference in adverse events compared with other antipsychotics.”

And in the third selection, Susan Weiner writes about antipsychotics for Schizophrenia Bulletin. She discusses her first psychotic break, her long journey, and her ultimate recovery. In a personal essay, she also describes the connection she made with her psychiatrist and the medication that transformed her life. “The right medicine for the right person can produce sanity like a miracle drug, and all is once again bright.”

DG

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Reading of the Week: MAiD, Suicide & the Patient-Family Perspective – the new CJP Paper; Also, AI & Misinformation, and Palus on Mental Health Merch 

November 9, 2023 /

From the Editor

In March, medical assistance in dying will be expanded in Canada to include those with mental illness. Not surprisingly, many people feel strongly about it, with some seeing the change as a natural extension of basic rights and others arguing that it will be a profound mistake. 

What do patients and family members think? How does it relate to their views of suicide in general? Lisa Hawke (of the University of Toronto) and her co-authors attempt to answer these questions in a new Canadian Journal of Psychiatry paper. They do a qualitative analysis, interviewing 30 people with mental illness and 25 family members on medical assistance in dying when the sole underlying medical condition is mental illness (or MAiD MI-SUMC). “Participants acknowledge the intersections between MAiD MI-SUMC and suicidality and the benefits of MAiD MI-SUMC as a more dignified way of ending suffering, but also the inherent complexity of considering [such] requests in the context of suicidality.” We consider the paper and its implications.

In the second selection, Dr. Scott Monteith (of Michigan State University) and his co-authors write about artificial intelligence and misinformation in a new British Journal of Psychiatry paper. They note the shift in AI – from predictive models to generative AI – and its implications for patients. “Misinformation created by generative AI about mental illness may include factual errors, nonsense, fabricated sources and dangerous advice.”

And in the third selection, writer Shannon Palus discusses the rise of “mental health merch” – clothing items and other merchandise that tout mental health problems, including a pricey sweatshirt with “Lexapro” written on the front (the US brand name for escitalopram). In Slate, Palus discusses her coolness to such things. “As a person who struggles with her own mental health, as a Lexapro taker – well, I hate this trend, honestly! I find it cloying and infantilizing.”

Note that there will be no Reading next week.

DG

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Reading of the Week: Clozapine Monitoring – the New BJP Paper; Also, Suicide Trends Among Adolescents (CJP) and Van Gogh’s Ear & Iconography (ANZJP)

June 15, 2023 /

From the Editor

“Despite its strong evidence base, clozapine remains grossly under-prescribed in clinical practice. Although reasons for this are multifaceted, a commonly cited influence is the need for mandatory haematological monitoring.” So notes Ebenezer Oloyede (of the University of Oxford) and his co-authors in a new British Journal of Psychiatry paper. Could the requirements be simplified? 

In the first selection, Oloyede et al. look at outcomes of 569 patients on clozapine when, during the pandemic, routine blood monitoring was changed. In this mirror-image cohort study, they find: “[E]xtending the haematological monitoring interval from 4-weekly to 12-weekly did not increase the incidence of life-threatening agranulocytosis in people taking clozapine.” We consider the paper and its implications.

In the second selection, Dr. Rachel H. B. Mitchell (of the University of Toronto) and her co-authors analyze Canadian data on suicide and sex differences. In this Canadian Journal of Psychiatry research article, they find that suicide rates among female adolescents aged 10 to 14 years surpassed similarly aged males in 2011. “The marked and consistent trend of rising suicide rates among adolescent females aged 10 to 14 years in Canada signals increased distress and/or maladaptive coping in this segment of the population.” 

And in the third selection, Alexander Smith (of the University of Bern) and his co-authors write about Vincent van Gogh. In an Editorial for the Australian and New Zealand Journal of Psychiatry, they describe his mental health struggles but also their commercialization. “Vincent van Gogh’s ear has generated an intrinsic cultural currency. Yet, the psychiatric vulnerabilities encompassed by his act of self-harm are not always sensitively considered or acknowledged.”

DG

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Reading of the Week: Health Care Workers’ Mental Health – There’s an App for That; Also, Treating Opioids (BMJ) & Dr. Bhushan on Her Bipolar (LA Times)

September 15, 2022 /

From the Editor

With the pandemic dragging on, health care workers report more and more burnout; some complain of depression and anxiety.

What could help? Dr. Sam N. Gnanapragasam (of King’s College London) and his co-authors consider an app designed to provide CBT and mindfulness techniques in a new British Journal of Psychiatry paper. The RCT study involves 16 English sites with over 1000 health care workers. They conclude: “our study suggests that the app was of modest benefit with no adverse effects for a sample of HCWs in England.” We look at the paper.

How to respond to the opioid crisis? In a new analysis paper for BMJ, Dr. Robert A. Kleinman (of the University of Toronto) and his colleagues argue for a different approach to the prescribing of opioid agonist therapy, drawing on the changes made in response to the pandemic. “Embracing a more flexible model of buprenorphine-naloxone dosing would allow better alignment of prescribing practices with the needs and preferences of clients.”

And in the third selection, Dr. Devika Bhushan writes about bipolar disorder for the Los Angeles Times. The essay is very personal: the pediatrician, who serves as California’s acting surgeon general and graduated from Harvard, describes her own experiences. As she notes, during her training, she “had a secret.” Now, however, she speaks openly about her illness. “Today, I live with bipolar disorder as a chronic and manageable health condition.” 

DG

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