Reading of the Week: Doctors & Suicidality – the New CMAJ Study; Also, GLP-1 RAs & Eating Disorders, and Chin-Yee on the Death of the Consult Note

July 9, 2026 / / 0 Comments

From the Editor

His suicidal thoughts were so strong that he had written a suicide note. Yet, during the months before we met in the ED, he had hesitated to seek care. As a doctor, he knew he had severe depression but he told me that he felt he couldn’t get help. 

Such stories are all too common. In a CMAJ study, Dr. An Yi (Annie) Yu (of the University of Toronto) and her co-authors shed light on physicians’ seeking help for suicidality. They drew from the literature (literally): analyzing 52 narratives from academic papers, finding various barriers to seeking care, including aspects of medical culture, and identified facilitators, such as confidential services. “The pressure to achieve in medicine often discourages physicians from acknowledging their need for help, but the value of meaningful work emerged as a positive factor for mental health. The stigma regarding mental health concerns was substantially reduced through role modelling of help-seeking behaviour by colleagues.” We consider the study and its implications.

GLP-1 receptor agonists are having a moment because of the evidence for diabetes and other conditions. In the second selection, Nicholas C. Peiper (of the University of Louisville) and his co-authors focus on those with eating disorders, analyzing data to understand use and misuse in a new JAMA Psychiatry research letter. “This cross-sectional study found that GLP-1 RA use and misuse were common in a targeted sample of people with eating disorders.”

And in the third selection, from JAMA, Dr. Benjamin Chin-Yee (of Western University) writes about consult notes. He wonders what is lost in the “digital transformation” of templates and AI scribes. He worries about the future of the consult note. “The tools may evolve, but the art of pausing, thinking, and telling a story is still ours to preserve.”

DG

Continue reading

Reading of the Week: Controversies & Kids – Papers on Social Media Bans and Smartphone Restrictions; Also, Sexsomnia for Psychiatrists

July 2, 2026 / / 0 Comments

From the Editor

Canada’s Parliament is debating a ban. Government officials are discussing similar measures in the UK, Poland, Denmark, and Malaysia. As more and more countries think about restricting kids from access to social media, the Australian experiment is interesting and important. In 2024, Australia passed legislation banning youth under the age of 16 years. 

But has the Australian law had an effect on use? In The BMJ, Courtney Barnes (of the University of Newcastle) and her co-authors attempt to answer that question with a prospective observational study. They analyzed survey data collected just before implementation and again three months after it, involving 408 youth. “Despite the intent of the Social Media Minimum Age Act 2024 to delay access to social media platforms and reduce the potential for online harms, little evidence was found of immediate substantive reductions in reported social media use by adolescents under 16 years.” We consider the study and its implications.

In the second selection, Maiara da Silva Martins (of Pontifical Catholic University of Rio Grande do Sul) and her co-authors focus on cellphone restriction in Brazil during the school day. In a letter published in Journal of the American Academy of Child & Adolescent Psychiatry, they report on a longitudinal study involving 1 643 students. “Our findings suggest that school-hour restrictions alone are insufficient to alter the trajectory of internalizing problems like anxiety and withdrawal.”

And in the third selection, from The Canadian Journal of Psychiatry, Dr. Colin M. Shapiro (of the University of Toronto) and his colleagues write about sexsomnia. They note that the condition is more common than previously believed and offer some clinical tips. “For clinicians, the key point is that sexual behaviours during sleep can occur without conscious awareness and should be considered within the broader spectrum of parasomnias during clinical assessment.”

DG

Continue reading

Reading of the Week: Suicide – Papers from BJPsych & Lancet Psychiatry, and Dr. Mark Sinyor on Prevention

June 25, 2026 /

From the Editor

“Media reports about suicide have the potential to influence suicide rates. Most research in this area has focused on increased rates of suicide that follow widely reported stories of suicide death, often in celebrities, the so-called Werther effect. However, a small and growing literature has investigated the Papageno effect in which widely disseminated stories of mastery of suicide crises and survival are followed by fewer suicides.”

So opens a fascinating paper recently published in The British Journal of Psychiatry. In it, Sangsoo Shin (of the University of Melbourne) and her co-authors look at a highly publicized news story: the singer Jon Bon Jovi intervening to stop a woman’s suicide attempt in 2024. Was there a Papageno effect? The authors analyzed suicide mortality data spanning a decade in Tennessee and 19 other states with 60 subgroups. “This study provides the first evidence of a Papageno effect following a widely publicised, real-life survival story.” We consider the paper and its implications.

Suicide prevention has come a long way since the SAD PERSONS mnemonic that many of us learned in medical school. And the research continues to evolve. What to make of it all, and how should the latest research inform practice? In the second selection, an episode of Quick Takes, I speak with Dr. Mark Sinyor, professor at the University of Toronto and staff psychiatrist at Sunnybrook Health Sciences Centre. We discuss the efficacy of suicide-prevention barriers (think the Bloor Viaduct here in Toronto) and restricting highly lethal pesticides. “You don’t actually need billions of dollars to prevent suicide. You just need really good coordination.”

In the third selection, from Lancet Psychiatry, a medical student discusses her suicidal thoughts. The paper – which is written anonymously – argues that many providers take the wrong approach when speaking to patients who are suicidal. “All I am saying is, if medicine placed the same emphasis on healing as it does on survival, I believe our approaches would change and perhaps our outcomes would improve as well.”

DG

Continue reading

Reading of the Week: Help-seeking & Gambling – the New CMAJ Study; Also, Women With Schizophrenia, and Dr. Campo on Patients & Faith

June 18, 2026 /

From the Editor

Can Argentina repeat? Could England end its six-decade drought? Roughly five billion people will watch this year’s World Cup. The tournament can be understood in different ways: a great sporting event, a giant party, and, yes, a huge draw for gamblers. In Ontario – and across North America – recent laws have dramatically expanded gambling options. How have such changes affected problem gambling and the need for help? 

In a new CMAJ study, Ryan Forrest (of the University of Toronto) and his co-authors attempt to answer that question. They drew on Ontario data to quantify the increase in help-seeking following the launch of a government-operated online gambling platform in January 2015 and the subsequent expansion of private online gambling. They analyzed almost 750 000 contacts to a helpline over 13 years, finding that the mean monthly rate of gambling-related contacts nearly doubled. “The rapid expansion and privatization of online gambling, including single-event sports betting, in Ontario were respectively associated with marked increases in gambling-related helpline contacts, specifically among adolescent boys and young men.” We consider the paper and its implications.

In the second selection, from JAMA Psychiatry, Laura M. Rowland (of the University of Maryland) and Dr. Ellen E. Lee (of the University of California San Diego) write about schizophrenia and women. “The lack of focused health research on women in general is well recognized, and mental health research remains no exception. Surprisingly, there is also a lack of mental health research on older people with schizophrenia with less than 5% of scientific publications on schizophrenia dedicated to this older group.”

Finally, in the third selection, Dr. John V. Campo (of Johns Hopkins University) discusses faith and psychiatry. In a personal essay for The Washington Post, he notes his own religious experience and declining health. “Taking our patients seriously requires physicians to explore issues of ultimate concern, suggesting that a spiritual history should be an expected component of any comprehensive clinical evaluation.”

DG

Continue reading

Reading of the Week: Trauma & Schizophrenia – the New AJP Study; Also, AI Chatbot & US Teens, and Gunther on the Blessings & Curses of Meds

June 11, 2026 /

From the Editor

Can a parent’s trauma influence the development of mental illness in his or her child? Research suggests an intergenerational link for several disorders, including PTSD. But what about schizophrenia? Complicating such research: the complexity of genetics, environment, and trauma – and the limits of data.

In a new American Journal of Psychiatry paper, published last week, Iaroslav Youssim (of the Hebrew University of Jerusalem) and his co-authors attempt to answer these questions by looking at parental exposure to the Holocaust – years before conception – and the associated risk of schizophrenia in their children. They drew data from 92 000 births in West Jerusalem between 1964 and 1976. “Offspring of mothers who were older than age 5 when Nazi persecutions began showed over a twofold increase in schizophrenia risk, underscoring the potential impact of trauma and its timing during the preconception period in the pathogenesis of schizophrenia.” We consider the study and its implications.

How often do adolescents and young adults use AI chatbots for mental health? In the second selection, from JAMA Pediatrics, Ryan K. McBain (of RAND) and his co-authors report on a US survey. They find that one in five youth use AI chatbots for mental health advice. “AI chatbots are already embedded in many youths’ mental health information ecosystem, underscoring the need for parents and clinicians to proactively discuss chatbot use to promote safety, appropriate expectations, and linkages to evidence-based care.”

And in the third selection, Sarah M. Gunther discusses medications and her journey in Psychiatric Services. In her personal essay, she describes trying different meds over time and the problems that they caused. She finally lands on the right combination. “I tell this story so that others won’t give up, and so doctors can see that the medications that they prescribe can make an illness worse.”

DG

Continue reading

Reading of the Week: Pediatric Self-Injury – the New JAMA Peds Study; Also, Lithium as King, and High-Risk Human-AI Engagement

June 4, 2026 /

From the Editor

Recently, I saw an adolescent who described using self-harm as a way to cope. She discussed learning different techniques through social media. “At first, I thought it was strange.”

Presentations of self-injury appear to be becoming more common. How often are healthcare visits for it? How commonly do youth report self-injury? Have these numbers changed over time? In a new study published in JAMA Pediatrics, Dr. Natasha Saunders (of the University of Toronto) and her co-authors attempt to address these questions by drawing on 42 studies with a combined population of 234 million individuals across a dozen nations over a 25-year period. They conducted a systematic review and meta-analysis, finding an average 3.5% relative annual increase. “These findings highlight a consistent rise in health care encounters and self-reported self-injury among children and youth, particularly female individuals, over the past 2 decades.” We consider the study and its implications.

In the second selection from The British Journal of Psychiatry, Dr. Gurubhaskar Shivakumar (of The University of Sydney) and his co-authors write about lithium. They note its declining use and the problems with its safety. Yet they argue that lithium remains the “king” of bipolar disorder treatment. “Ever since its discovery, lithium continues to command authority having repeatedly reclaimed its throne.” 

Finally, in the third selection, Dr. Lena Palaniyappan (of McGill University) and his co-authors discuss high-risk human-AI relationships in a paper for The Canadian Journal of Psychiatry. They offer a framework and constructive suggestions – both highly relevant in the age of AI chatbots. “Risk for problematic AI engagement cuts across diagnostic categories, rooted in distress, isolation, and cognitive style.”

DG

Continue reading

Reading of the Week: Concealing Problems & TikTok – the New JMIR Study; Also, Cannabis in Canada, and Antidepressants & the 2-4 Week Myth

May 28, 2026 /

From the Editor

He spoke about depression and its impact on his life but held back on certain details. Only when his family showed me the texts did I fully understand how ill he really was. 

Patients often conceal some aspects of their problems. In a new paper published in the Journal of Medical Internet Research, Chloe Roske (of the Albert Einstein College of Medicine) and her co-authors shed light on this concealment with a creative approach: by analyzing social media. Drawing on nearly 100 TikTok videos with more than 73 million views, they conducted a qualitative analysis. “TikTok creators frequently described concealment as a strategy to avoid perceived punitive consequences, manage interpersonal dynamics, or cope with emotional distress.” We consider the paper and its implications.

In the second selection, Benedikt Fischer (of Simon Fraser University) and his co-authors discuss Canada’s legalization of cannabis, noting a decline in crime but an increase in problematic use. “Nonmedical cannabis legalization in Canada was a milestone policy reform when implemented almost a decade ago. However, complacency about its presently main outcomes would be misplaced, also since its original objectives have been at best partially achieved.”

And, in the third selection, Dr. Stefani Mihilli (of the University of Toronto) and her co-authors discuss antidepressants in a paper for The Canadian Journal of Psychiatry. They focus on the commonly made claim that antidepressants take several weeks to start working. “Telling patients that antidepressants ‘kick in’ after 2–4 weeks is not only potentially inaccurate but also may cause unnecessary distress or even reduce positive outcomes.”

DG

Continue reading

Reading of the Week: Placebo & Practice – the New Lancet Psych Paper; Also, Mortality & Opioids and Mental Health Awareness Campaigns

May 14, 2026 /

From the Editor

The tone of our voice when discussing a treatment. The way we emphasize its benefits. Mention of our hopefulness. As clinicians, we are aware that small things can improve patient outcomes. To speak more technically: we harness placebo effects.

In an impressive new Lancet Psychiatry review, Dr. Matthew J. Burke (of the University of Toronto) and his co-authors examine placebo effects with an eye to the implications for clinical practice. They discuss imaging and physiology; they also mention depression and offer suggestions (including, yes, harnessing placebo effects). “The thoughtful application of placebo and nocebo effects has promise in enhancing patient care and treatment outcomes, but more research is needed to validate specific approaches.” We discuss the paper and its implications.

What is the survival rate after an opioid overdose? In a new research letter just published in JAMA, Dr. Robert A. Kleinman (of the University of Toronto) and his co-authors attempt to answer that question. Though they walk on a well-travelled path, they drew on data in this, the era of fentanyl. “Mortality was higher than estimates from previous research conducted prior to the widespread availability of fentanyl (5.3%-5.5%).”

And in the third selection from The Globe and Mail, Dr. Lester Liao (of McGill University) and his co-authors write about mental health campaigns. They note the unintended consequences, including overdiagnosis of disorders like ADHD and autism. “We started out with the greatest of intentions. Unintended consequences have arisen. That’s okay. We learn along the way. Now it’s time to change course.”

There will be no Reading next week.

DG

Continue reading

Reading of the Week: GLP-1 Receptor Agonists for Obesity & Alcohol – the New Lancet Study; Also, Drs. Liao and Fombonne on Autism Overdiagnosis

May 7, 2026 /

From the Editor

It could be lifesaving for those with diabetes. And many others are taking GLP-1 receptor agonists, ranging from people with medical conditions such as obesity to those who have cosmetic interests. GLP-1 receptor agonists are having a moment. Could they also be helpful for patients with substance problems? Some small studies suggest yes.

In a major new Lancet study, Dr. Mette Kruse Klausen (of Copenhagen University) and her co-authors attempt to answer that question. They report on a RCT involving patients with both obesity and alcohol use disorder. 108 Danish participants were randomized to the GLP-1 receptor agonist semaglutide or placebo. At six months, adults taking semaglutide reported five heavy drinking days in the previous months (down 41%) compared to nine days in the placebo group. “To our knowledge, this RCT is the first to show that once-weekly semaglutide reduces heavy drinking days and WHO drinking-risk levels in treatment-seeking patients with alcohol use disorder and comorbid obesity.” We consider the paper, the accompanying editorial, and its implications.

In this week’s other selection, a Viewpoint paper from JAMA Pediatrics, Drs. Lester Liao (of McGill University) and Eric Fombonne (of the Oregon Health & Science University) write on autism and overdiagnosis. “Diagnostic practices geared to accessing resources, incorrect diagnostic practices, increased attention, changes to diagnostic criteria and thresholds, and fundamental cultural shifts have contributed.”

DG

Continue reading

Reading of the Week: Psychedelics vs Antidepressants – the New JAMA Psych Paper; Also, US Psilocybin Use and Hahn on the Work of Mental Illness

April 30, 2026 /

From the Editor

“Trump signs order to accelerate access to psychedelic drug treatments”

– Reuters, 18 April 2026

Last week, the U.S. president signed an executive order easing the way for more research on psychedelics for mental illness. It’s another example of the enthusiasm that many – policymakers, politicians, patients, families, members of the public – have for these drugs. Past work has indicated some effectiveness in treating depression. But how much of it can be explained by placebo? Psychedelics are, after all, challenging to study, in part because of difficulties with blinding (people can figure out whether they receive a psychedelic or placebo).

Dr. Zachary J. Williams (of the University of California, Los Angeles) and his co-authors attempt to shed light on this issue with a new, smart study published in JAMA Psychiatry. In it, they did a meta-analysis, comparing the effectiveness of psychedelic-assisted therapy (PAT) and open-label traditional antidepressants (TADs) for the treatment of major depression, drawing on 24 studies. “These findings suggest that PAT is no more effective than TADs under equal-unblinding conditions for the treatment of depression and highlight the potential role of blinding integrity.” We consider the paper and its implications.

And, on the topic of psychedelics, Dr. Kevin H. Yang (of the University of California, San Diego) and his co-authors look to quantify the number of people using psilocybin in the United States. In a priority data letter for The American Journal of Psychiatry, they used data from the National Survey on Drug Use and Health, a survey with more than 59 000 respondents. “With approximately 8 million individuals estimated as having used in the past year, naturalistic psilocybin use is sufficiently prevalent that psychiatrists are likely to encounter patients who use it outside of clinical settings.”

And in the third selection, an essay from The Globe and Mail, Brandon Hahn writes personally about his experiences with mental illness, noting public intolerance and tolerance – and meaningful gestures. “Sometimes support looks like red tape and a pile of forms. Sometimes it looks like a chair that faces the window while holding a hand.”

DG

Continue reading