Tag: therapy

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: How Many Steps A Day to Avoid Depression? The New Lancet Study; Also, TikTok & Med Records and Lieberman on ChatGPT Therapy

August 14, 2025 /

From the Editor

How much exercise is enough to prevent illness?

In the first selection, Ding Ding (of The University of Sydney) and her co-authors attempt to answer that question in a new, clever study for The Lancet Public Health. They did a systematic review and meta-analysis involving 57 studies that looked at daily step count and health outcomes, including depression. “Although 10 000 steps per day can still be a viable target for those who are more active, 7 000 steps per day is associated with clinically meaningful improvements in health outcomes and might be a more realistic and achievable target for some.” We consider the paper and its implications.

5 787 more steps needed?

In the second selection, Isabelle Toler and Lindsey Grubbs (both of Case Western Reserve University) look at medical records and language in a paper for The New England Journal of Medicine. In a unique approach, they observe themes in the TikTok videos of patients who are frustrated by what their physicians have written about them. “In the context of a system of medical documentation in which patients have little power to shape their own narratives, clinicians should respect the channels they have chosen to use to share their stories and listen to the messages they convey.”

And in the third selection, psychologist Harvey Lieberman reflects on therapy and ChatGPT in an essay for The New York Times. As a therapist and an octogenarian, he is skeptical of the therapeutic aspects of ChatGPT – but, with use, he partly changes his mind. “I concluded that ChatGPT wasn’t a therapist, although it sometimes was therapeutic. But it wasn’t just a reflection, either.”

Note: there will be no Reading next week.

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: Suicide Prevention in the Acute Care Setting (JAMA Psychiatry); Also, Gottlieb on Racism (Wash Post)

June 25, 2020 /

From the Editor

In the year before they suicide, more than 90% of people have had contact with some type of acute care – an ED visit, a trip to the family doctor, or an appointment at an outpatient specialty clinic. So how can we help people better? Given the contact, what can we do to reduce suicides?

This week, we have two selections; the first focuses on this question. In a new JAMA Psychiatry paper, Dr. Stephanie K. Doupnik (of the University of Pennsylvania) and her co-authors do a systematic review and meta-analysis of 14 studies that used brief suicide prevention interventions in acute care settings (think brief contact interventions like a phone call after an ED visit). They find an encouraging result: “In this meta-analysis, brief suicide prevention interventions were associated with reduced subsequent suicide attempts.” We consider the big paper, and the editorial that accompanies it.

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In the other selection, therapist Lori Gottlieb discusses race and therapy in a Washington Post essay. She examines her own biases, and the way they play out in her therapy session. “Here’s what we didn’t talk about [in school]: the racism that might take place inside the supposedly ‘safe space’ of our therapy rooms – our patients’ racism and our own.”

Please note that there will be no Reading next week. Happy Canada Day.

DG

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