The use of CAMS and DBT to effectively treat patients who are suicidal

Jobes, D. A., & Rizvi, S. L. (2024).

Frontiers in psychiatry, 15, 1354430.

https://doi.org/10.3389/fpsyt.2024.1354430

Abstract

Around the world, suicide ideation, attempts, and deaths pose a major public and mental health challenge for patients (and their loved ones). Accordingly, there is a clear need for effective clinical treatments that reliably reduce suicidal thoughts and behaviors. In this article, we review the Collaborative Assessment and Management of Suicidality (CAMS) and Dialectical Behavior Therapy (DBT), two clinical treatments that rise to the highest levels of empirical rigor. Both CAMS and DBT are now supported by randomized controlled trials (RCTs), with independent replications, and meta-analyses. There are also supportive data related to training clinical providers to use CAMS and DBT with adherence. RCTs that investigate the use of both interventions within clinical trial research designs and the increasing use of these complementary approaches within routine clinical practice are discussed. Future directions for research and clinical use of CAMS and DBT are explored as means to effectively treat suicidal risk.

Here are some thoughts:

This review's real value is putting CAMS and DBT side by side on equal empirical footing, showing them as complementary rather than competing: CAMS for acute, driver-focused ideation in 4-12 sessions, DBT for chronic, multi-attempt presentations tied to emotion dysregulation over 6+ months. The evidence patterns mirror this division nicely. The Swift et al. meta-analysis found CAMS significantly reduces suicidal ideation and hopelessness but had no significant effect on attempts specifically, while DeCou et al.'s DBT meta-analysis found the reverse, reduced self-directed violence but no significant ideation effect. The Pistorello SMART trial adds a useful clinical heuristic: patients with no attempt history did better with CAMS, while those with multiple attempts and borderline features responded better to treatment as usual than to CAMS, consistent with DBT's stronger footing for that chronic population.

A couple of things worth flagging. Several CAMS trials were genuinely mixed, underpowered, or favored treatment as usual early in follow-up, and Jobes discloses a financial interest as founder of CAMS-care, LLC, which doesn't invalidate the independently replicated RCTs but is worth naming given how the mixed findings are framed. The Hope Institute section is the most practically interesting piece for service delivery: a next-day-appointment outpatient model achieving stabilization in 5-6 weeks, positioned against the paper's opening point that inpatient hospitalization itself lacks strong evidence outside the immediate post-attempt window.

From Clinical Judgment to Machine Learning: Rethinking Psychotherapeutic Decision-Making with Artificial Intelligence

Onah, C., & Gwar, N. (2025).

Psychotherapy Bulletin, 60(4), 45-54.

According to the World Health Organization (WHO; n.d.) mental health disorders, such as anxiety disorder, bipolar disorder, schizophrenia and post-traumatic stress disorder (PTSD), are some of the most significant public health challenges in the WHO European Region. Within this region (which includes 53 countries across Europe and parts of Central Asia), mental health disorders are the leading cause of disability and the third leading cause of overall disease burden. Among these disorders, depression remains one of the most common mental illnesses globally, yet a staggering 66% of affected individuals continue to live with unmet treatment needs (Eilert et al., 2021; World Health Organization, 2023).

Empirically supported psychotherapeutic treatments have demonstrated strong efficacy, are endorsed by clinical guidelines, and are widely used in mental health care as a preferred first-line treatment option (Lorimer et al., 2021). A substantial body of research and numerous clinical trials have affirmed their effectiveness across a wide spectrum of mental and behavioral health disorders (Eilert et al., 2021), applicable to diverse settings (e.g., primary care medicine, community health, specialty treatment services), and across the lifespan (Nathan & Gorman, 2007). In addition, psychotherapy research has identified both specific and non-specific factors that contribute to treatment outcomes (Norcross & Lambert, 2019). Beyond core techniques and strategies, broader factors, such as the quality of the therapeutic relationship, therapist competence, and adherence to protocols, significantly shape psychotherapy’s clinical effectiveness. As such, psychotherapy is a fundamentally human-centered practice, dependent on the dynamic interplay of targeted interventions delivered within a professional, relational framework to effect meaningful clinical change (Aafjes-van Doorn et al., 2020).

At the same time, artificial intelligence (AI) and machine learning are rapidly advancing and are increasingly applied to the field of mental health, including psychotherapy (Burr & Floridi, 2020; Torous et al., 2020). These technologies aim to assist individuals in learning and applying therapeutic skills, identifying behavioral patterns, and integrating interventions into daily life and by drawing on well-established approaches, such as cognitive behavioral therapy (CBT), positive psychology, and mindfulness (Prescott & Barnes, 2024). Some AI-based conversational agents and chatbots are even designed to simulate emotional intelligence with the goal of forming therapeutic alliances with users, clients, or patients (Darcy et al., 2021; Ghandeharioun et al., 2019).

Link to the article is here.

Here are some thoughts:

A central insight from the article is the critical distinction between "simulated" empathy and the genuine therapeutic alliance. The authors argue that while chatbots can be programmed to mimic emotional intelligence, they fundamentally lack the capacity for a true relational bond—a factor that research consistently identifies as the primary driver of healing in psychotherapy. This reinforces the view that a machine mirroring words back to a patient is functionally different from a human truly understanding them, and that removing the human from the loop risks stripping therapy of its most effective component.

Furthermore, the article raises significant alarms about the dangers of "datafication" and the potential for bias when human judgment is removed. The authors warn that reducing complex human experiences—such as trauma and personal history—into quantifiable data points for an algorithm can strip away the very humanity that therapy seeks to address. They explicitly caution against "blind reliance" on these tools, noting that AI models are often trained on limited or skewed datasets. Without a skilled clinician to interpret these suggestions with cultural humility and nuance, an automated system could actively harm vulnerable patients by misinterpreting their symptoms or reinforcing existing stereotypes.

Finally, the article touches on deep ethical questions that support my prior articles on this topic. It questions whether it is even ethically permissible for chatbots to feign empathy when they cannot actually feel it, suggesting that such deception undermines the core values of the profession. While the article admits that automation offers 24/7 accessibility, it concedes that AI lacks the adaptability and emotional support necessary for complex cases. Ultimately, the authors conclude that AI should be viewed strictly as an "adjunct"—a helper tool—rather than a replacement, confirming that the human professional remains the essential safeguard against the hollowness and risks of automated mental healthcare.

Suicide Prevention Among People of Different Races and Ethnicities in Large Health Systems: Implications for Practice

Coleman, K. J., Stewart, C., et al. (2025).

Psychiatric services (Washington, D.C.), 

Advance online publication.

https://doi.org/10.1176/appi.ps.20240477

Abstract

Objective: This study examined receipt of three components (screening, risk assessment, and intervention) of the national Zero Suicide model among patients of various races-ethnicities who were treated in six large health systems.

Methods: The data included outpatient psychiatry and addiction medicine visits (N=4,682,918) during 2019 for patients age 13 and older. Documentation in the electronic health record of administration of the nine-item Patient Health Questionnaire, the Columbia-Suicide Severity Rating Scale, and lethal means counseling and provision of crisis resources (with or without a full Stanley-Brown Safety Plan) were used to define having received suicide screening, risk assessment, and intervention, respectively.

Results: After adjustment for age, sex, and health system, analyses indicated that Black patients were 12%-20% less likely (odds ratio [OR] range 1.12-1.20), and Asian patients were 5%-15% more likely (OR range 1.05-1.15), to be screened for suicidal ideation compared with patients of other races-ethnicities. Compared with White patients, patients of other races-ethnicities were found to be more likely (OR range 1.08-1.24) to receive risk assessment, and Asian and Black patients were found to be 17% (95% CI=1.02-1.35) and 15% (95% CI=1.01-1.32) more likely, respectively, to receive an evidence-based intervention for suicide prevention. American Indian/Alaska Native (AI/AN) patients had the lowest unadjusted rates of receiving an intervention (65.8%).

Conclusions: The adjusted analyses suggested that more focus is needed on population-based screening for suicidal ideation and to improve delivery of evidence-based interventions for suicide prevention among White patients. The descriptive findings suggest that more research is needed to improve intervention delivery to AI/AN patients at risk of suicide.

Highlights

• Black patients were less likely, and Asian patients were more likely, to be screened for suicidal ideation compared with patients of other races-ethnicities.
• White patients were less likely than patients of other races-ethnicities to have risk for suicide assessed after a positive screen for ideation and were less likely than Asian or Black patients to receive an evidence-based intervention for suicide prevention.
• The descriptive findings suggested that improvement is needed on intervention delivery to American Indian/Alaska Native patients at risk of suicide.
• Better strategies are needed for population-based screening and delivery of evidence-based interventions
• for suicide prevention in health systems.

Integrating moral injury into forensic psychiatry

Brisco, G. et al. (2025)

The Lancet Psychiatry, 

Volume 12, Issue 12, 874 - 876

Moral injury has garnered increasing attention in contemporary research, expanding from its initial association with military veterans to encompass a broader range of populations exposed to trauma and adversity. Potentially morally injurious events involve perceived transgressions of one's own moral code (perpetration) or betrayals by trusted authorities who have exposed the person to unnecessary danger or harm. The betrayal dimension was first highlighted by Shay in Vietnam veterans, by Freyd in people who have experienced child abuse, and more recently in ethnic, sexual, and gender minorities following perceived breaches of trust by family, friends, and public services, with adverse outcomes.

The article is paywalled here. Please contact the author for a copy of the article.

Here are some thoughts:

The article's most novel contribution is the proposed two-axis conceptual framework (Figure 1) to guide assessment and intervention. The axes—degree of illness attribution (how much the individual attributes their actions to their illness) and current severity of illness—provide a practical clinical tool. This framework helps clinicians determine the appropriate timing and type of intervention, whether it's immediate treatment for moral injury, stabilization of the mental illness first, or a focus on restorative processes. By advocating for targeted therapies like Compassion-Focused Therapy, Acceptance and Commitment Therapy, and restorative justice, the authors make a compelling ethical and clinical case for formally recognizing and addressing moral injury to alleviate distress and improve outcomes in some of the most complex and vulnerable patient populations in both forensic and acute psychiatric settings.

Understanding and Combating Human Trafficking: A Psychological Perspective

Sidun, N. M. (2025).

American Psychologist.

https://doi.org/10.1037/amp0001516

Abstract

Human trafficking is a global crisis that represents one of the gravest violations of human rights and dignity in modern times. Defined by international and U.S. frameworks, trafficking involves the exploitation of individuals through fraud, force, or coercion for purposes such as labor, sexual exploitation, or organ harvesting. Psychology provides a unique lens to understand, prevent, and address this issue by examining the underlying psychological mechanisms used by traffickers and the profound effects on survivors. Traffickers leverage psychological manipulation—grooming, coercion, and trauma bonding—to control victims, while survivors endure severe mental health consequences, including posttraumatic stress disorder, complex trauma, depression, and anxiety.

Psychologists play a pivotal role in combating trafficking through research, education, advocacy, and clinical practice. Research informs prevention by identifying vulnerabilities and effective interventions. Education raises public awareness and equips professionals to recognize and support victims.Advocacy shapes policies that uphold human rights and strengthen antitrafficking laws. Clinicians provide essential trauma-and trafficking-informed care tailored to survivors, utilizing evidence-based practices and adjunctive psychological interventions that foster healing and resilience while addressing immediate and long-term impacts. In conclusion, psychology is integral to eradicating human trafficking. By bridging research, practice, and policy, psychology contributes significantly to global antitrafficking efforts, ensuring a lasting impact on addressing this pervasive human rights violation.

Public Significance Statement

This article presents an overview of human trafficking and how psychology can assist in understanding various aspects of trafficking. It describes how psychology is well-positioned to help prevent, recognize, and support the elimination of human trafficking.

Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis

Jia, Y., Ye, Z., et al. (2025).

Therapeutic advances in psychopharmacology,

15, 20451253251342628.

https://doi.org/10.1177/20451253251342628

Abstract

Background: Post-traumatic stress disorder (PTSD) is a prevalent mental illness with a high disability rate. The neurobiological abnormalities in PTSD suggest that drug therapy may have certain therapeutic effects. According to the recommendations of clinical guidelines for PTSD, the current clinical preference is for selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Nevertheless, the efficacy of other types of drugs remains uncertain, which impacts the selection of personalized treatment for patients.

Objectives: The aim of this meta-analysis was to assess the efficacy and acceptability of drugs with different pharmacological mechanisms in alleviating PTSD symptoms by comparing the response rates and dropout rates of different drug treatment groups in randomized clinical trials.

Design: Systematic review and meta-analysis.

Methods: We searched and analyzed 52 reports that described the efficacy and acceptability of medication for PTSD. Among these, 49 trials used the dropout rate as an acceptability indicator, and 52 trials used the response rate as an efficacy indicator.

Results: In the 49 trials with the dropout rate as the indicator, the dropout rate was 29% (95% confidence interval, 0.26-0.33; n = 3870). In the 52 trials with the response rate as the indicator, the response rate was 39% (95% confidence interval, 0.33-0.45; n = 3808). After drug treatment, the core symptoms of PTSD were significantly improved. This meta-analysis indicated that there was no significant difference between antidepressants and antipsychotics in improving clinical symptoms and acceptability. However, antidepressants may have a slight advantage in efficacy, although with a higher dropout rate.

Conclusion: Drug treatment is an effective rehabilitation method for PTSD patients, and individualized drug management should be considered.

Plain language summary

The purpose of this study was to assess the acceptability and efficacy of all types of pharmacotherapeutic agents in reducing the symptoms of PTSD. In this systematic meta-analysis, the dropout and response rates of various pharmacotherapy groups reported by randomized clinical trials were compared. A total of 52 reports that described the acceptability and efficacy of PTSD pharmacotherapies were retrieved and analyzed. This meta-analysis supports antidepressants and antipsychotics have no significant difference

in improving clinical symptoms and acceptabity, however, AAs may has a slight advantage tendency in efficacy, albeit with a higher dropout rate, so individualized drug management should be considered.

Management of Suicidal Thoughts and Behaviors in Youth. Systematic Review

Sim L, Wang Z, et al (2025).

Prepared by the Mayo Clinic Evidence-based 

Practice Center under

The information is here.

Abstract

Background: Suicide is a leading cause of death in young people and an escalating public health crisis. We aimed to assess the effectiveness and harms of available treatments for suicidal thoughts and behaviors in youths at heightened risk for suicide. We also aimed to examine how social determinants of health, racism, disparities, care delivery methods, and patient demographics affect outcomes.

Methods: We conducted a systematic review and searched several databases including MEDLINE®, Embase®, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and others from January 2000 to September 2024. We included randomized clinical trials (RCTs), comparative observational studies, and before-after studies of psychosocial interventions, pharmacological interventions, neurotherapeutics, emerging therapies, and combinations therapies. Eligible patients were youths (aged 5 to 24 years) who had a heightened risk for suicide, including youths who have experienced suicidal ideation, prior attempts, hospital discharge for mental health treatment, or command hallucinations; were identified as high risk on validated questionnaires; or were from other at-risk groups. Pairs of independent reviewers selected and appraised studies. Findings were synthesized narratively.

Results: We included 65 studies reporting on 14,534 patients (33 RCTs, 13 comparative observational studies, and 19 before-after studies). Psychosocial interventions identified from the studies comprised psychotherapy interventions (33 studies, Cognitive Behavior Therapy, Dialectical Behavior Therapy, Collaborative Assessment and Management of Suicidality, Dynamic Deconstructive Psychotherapy, Attachment-Based Family Therapy, and Family-Focused Therapy), acute (i.e., 1 to 4 sessions/contacts) psychosocial interventions (19 studies, acute safety planning, family-based crisis management, motivational interviewing crisis interventions, continuity of care following crisis, and brief adjunctive treatments), and school/community-based psychosocial interventions (13 studies, social network interventions, school-based skills interventions, suicide awareness/gatekeeper programs, and community-based, culturally tailored adjunct programs). For most categories of psychotherapies (except DBT), acute interventions, or school/community-based interventions, there was insufficient strength of evidence and uncertainty about suicidal thoughts or attempts. None of the studies evaluated adverse events associated with the interventions. The evidence base on pharmacological treatment for suicidal youths was largely nonexistent at the present time. No eligible study evaluated neurotherapeutics or emerging therapies.

Conclusion: The current evidence on available interventions intended for youths at heightened risk of suicide is uncertain. Medication, neurotherapeutics, and emerging therapies remain unstudied in this population. Given that most treatments were adapted from adult protocols that may not fit the developmental and contextual experience of adolescents or younger children, this limited evidence base calls for the development of novel, developmentally and trauma-informed treatments, as well as multilevel interventions to address the rising suicide risk in youths.

Evidence-Based Care for Suicidality as an Ethical and Professional Imperative: How to Decrease Suicidal Suffering and Save Lives

Jobes, D. A., & Barnett, J. E. (2024).

American Psychologist.

https://doi.org/10.1037/amp0001325

Abstract

Suicide is a major public and mental health problem in the United States and around the world. According to recent survey research, there were 16,600,000 American adults and adolescents in 2022 who reported having serious thoughts of suicide (Substance Abuse and Mental Health Services Administration, 2023), which underscores a profound need for effective clinical care for people who are suicidal. Yet there is evidence that clinical providers may avoid patients who are suicidal (out of fear and perceived concerns about malpractice liability) and that too many rely on interventions (i.e., inpatient hospitalization and medications) that have little to no evidence for decreasing suicidal ideation and behavior (and may even increase risk). Fortunately, there is an emerging and robust evidence-based clinical literature on suicide-related assessment, acute clinical stabilization, and the actual treatment of suicide risk through psychological interventions supported by replicated randomized controlled trials. Considering the pervasiveness of suicidality, the life versus death implications, and the availability of proven approaches, it is argued that providers should embrace evidence-based practices for suicidal risk as their best possible risk management strategy. Such an embrace is entirely consistent with expert recommendations as well as professional and ethical standards. Finally, a call to action is made with a series of specific recommendations to help psychologists (and other disciplines) use evidence-based, suicide-specific, approaches to help decrease suicide-related suffering and deaths. It is argued that doing so has now become both an ethical and professional imperative. Given the challenge of this issue, it is also simply the right thing to do.

Public Significance Statement

Suicide is a major public and mental health problem in the United States and around the world. There are now proven clinical approaches that need to be increasingly used by mental health providers to help decrease suicidal suffering and save lives.

Here are some thoughts:

The article discusses the prevalence of suicidality in the United States and the importance of evidence-based care for suicidal patients. It highlights that many clinicians avoid working with suicidal patients or use interventions that lack empirical support, often due to fear and concerns about liability.  The authors emphasize the availability of evidence-based psychological interventions and urge psychologists to adopt these practices.  It is argued that utilizing evidence-based approaches is both an ethical and professional responsibility.

Advancements in AI-driven Healthcare: A Comprehensive Review of Diagnostics, Treatment, and Patient Care Integration

Kasula, B. Y. (2024, January 18).

International Journal of Machine Learning

for Sustainable Development.

Volume 6 (1).

Abstract

This research paper presents a comprehensive review of the recent advancements in AI-

driven healthcare, focusing on diagnostics, treatment, and the integration of AI technologies in

patient care. The study explores the evolution of artificial intelligence applications in medical

imaging, diagnosis accuracy, personalized treatment plans, and the overall enhancement of

healthcare delivery. Ethical considerations and challenges associated with AI adoption in

healthcare are also discussed. The paper concludes with insights into the potential future

developments and the transformative impact of AI on the healthcare landscape.

A pdf of the research is here.

Here are some thoughts:

This research paper provides a comprehensive review of recent advancements in AI-driven healthcare, focusing on diagnostics, treatment, and the integration of AI technologies in patient care. The study explores the evolution of artificial intelligence applications in medical imaging, diagnosis accuracy, personalized treatment plans, and the overall enhancement of healthcare delivery. It discusses the transformative impact of AI on healthcare, highlighting key achievements, challenges, and ethical considerations associated with its widespread adoption.

The paper examines AI's role in improving diagnostic accuracy, particularly in medical imaging, and its contribution to developing personalized treatment plans. It also addresses the ethical dimensions of AI in healthcare, including patient privacy, data security, and equitable distribution of AI-driven healthcare benefits. The research emphasizes the need for a holistic approach to AI integration in healthcare, calling for collaboration between healthcare professionals, technologists, and policymakers to navigate the evolving landscape successfully.

It is important for psychologists to understand the content of this article for several reasons. Firstly, AI is increasingly being applied in mental health diagnosis and treatment, as mentioned in the paper's references. Psychologists need to be aware of these advancements to stay current in their field and potentially incorporate AI-driven tools into their practice. Secondly, the ethical considerations discussed in the paper, such as patient privacy and data security, are equally relevant to psychological practice. Understanding these issues can help psychologists navigate the ethical challenges that may arise with the integration of AI in mental health care.

Moreover, the paper's emphasis on personalized medicine and treatment plans is particularly relevant to psychology, where individualized approaches are often crucial. By understanding AI's potential in this area, psychologists can explore ways to enhance their treatment strategies and improve patient outcomes. Lastly, as healthcare becomes increasingly interdisciplinary, psychologists need to be aware of technological advancements in other medical fields to collaborate effectively with other healthcare professionals and provide comprehensive care to their patients.

Virtual Mental Health Care and Suicide-Related Events

Tenso, K., Strombotne, K., et al. (2024).

JAMA Network Open, 7(11), e2443054.

https://doi.org/10.1001/jamanetworkopen.2024.43054

Key Points

Question  Is the shift from face-to-face to virtual mental health service delivery associated with the risk of suicide-related events?

Findings  In this cohort study assessing 66 387 data points from 16 236 unique veterans, a 1% increase in the percentage of virtual mental health visits relative to the total visits was associated with a statistically significant 2.5% decrease in suicide-related events.

Meaning  The results of this cohort study suggest that offering virtual mental health care in addition to in-person care may reduce suicide-related events.

Abstract

Importance  The rising suicide rates in the US emphasize the need for effective prevention. While telehealth has transformed access to mental health care, the impact of telehealth on suicide outcomes is unknown.

Objective  To evaluate the association of virtual mental health services with individual-level suicide-related events (SREs).

Conclusions and Relevance  Findings from this cohort study using a retrospective quasi-experimental design found that an increase in virtual mental health visits relative to total visits was associated with a statistically significant decrease in SREs, suggesting that providing virtual mental health services may reduce suicide-related outcomes.

------------------------

Here are some thoughts:

This research investigates the connection between virtual mental health care and suicide-related events among veterans. Using data from the Veterans Health Administration, the study found a statistically significant decrease in suicide-related events associated with an increase in virtual mental health visits, suggesting that providing virtual mental health services may reduce suicide-related outcomes. The study controls for various factors that could influence both virtual care utilization and suicidal behaviors, employing an instrumental variable (IV) probit model to address potential confounders and reverse causality. The study concludes that virtual mental health care may be protective in terms of suicide-related outcomes, supporting the expansion of telehealth services within the VHA.

Moving Beyond Statements to Protect Transgender Youth

Santos, M., Zempsky, W. T., & Shmerling, J. (2024).

JAMA.

https://doi.org/10.1001/jama.2024.10196

The care of transgender and nonbinary youth (aged 18 years or younger) has been scrutinized and politicized, heightening stress for lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) youth. These external forces have led to increased mental health concerns for this group. The statistics for LGBTQ+ youth from the Trevor Project’s 2023 US National Survey on the Mental Health of LGBTQ Young People,1 which included more than 28 000 respondents, is startling: more than 40% of respondents considered attempting suicide over the past year, less than 40% reported their homes to be LGBTQ+ affirming, and 53% reported verbal harassment at school. In addition, 67% and 54% of respondents reported symptoms of anxiety and depression, respectively. The statistics focused specifically on transgender and nonbinary youth are even more disheartening: more than 50% of respondents considered suicide over the past year and 75% and 60% reported increased symptoms of anxiety and depression, respectively. Notably, more than half of LGBTQ+ youth who wanted counseling from a mental health professional did not receive it.

The article is paywalled here.

Here is my summary:

The care of transgender and nonbinary youth has become a highly politicized and scrutinized issue, leading to increased stress and mental health concerns for this vulnerable population. Recent statistics from the Trevor Project's 2023 US National Survey on the Mental Health of LGBTQ Young People reveal alarming rates of suicide ideation, anxiety, and depression among LGBTQ+ youth, with even higher rates among transgender and nonbinary individuals. Despite the controversy surrounding gender-affirming care, major medical organizations and research confirm its lifesaving necessity.

Children's hospitals are uniquely positioned to make a positive impact on the lives of transgender and nonbinary youth and their families. However, simply offering statements of support is no longer sufficient. Families are fearful about accessing care, particularly in states that have banned gender-affirming services. Children's hospitals must take action to counteract the harm caused by this cultural war. This includes establishing resource centers to connect families with care, providing evidence-based education to counter misinformation, increasing care capacity to reduce waiting lists, ensuring safety and support for LGBTQ+ healthcare workers, and convening legal experts to protect staff and maintain care access.

By taking these steps, children's hospitals can help address the medical and psychological needs of transgender and nonbinary youth, ultimately saving lives. The article concludes with a call to action, emphasizing the need for collaborative efforts to support vulnerable families and healthcare workers. As the situation remains critical, with a transgender youth attempting suicide every few minutes, it is imperative that children's hospitals take immediate action to provide comprehensive support and care.

Doctors’ union will ‘critique’ Cass Review after criticising puberty blocker ban

Aine Fox

Independent

Originally posted 1August 24

The doctors’ union is to “critique” the Cass Review into children’s gender services and make recommendations to improve a healthcare system which it said has “failed transgender patients”.

The British Medical Association (BMA) said its evaluation of the review will “pay particular attention” to the methodology used to underpin the report’s recommendations.

Published in April and first commissioned in 2020, the report concluded that gender care is currently an area of “remarkably weak evidence” and young people have been caught up in a “stormy social discourse”.

Research by the University of York, carried out alongside the report, found evidence to be severely lacking on the impact of puberty blockers and hormone treatments, while the majority of clinical guidelines were found not to have followed international standards.

The review made 32 recommendations on how to ensure young people get a high standard of care which meets their needs in a way that is “safe, holistic and effective”.

The info is here.

Here is a summary:

The British Medical Association (BMA) has announced plans to "critique" the Cass Review, a report on children's gender services, and make recommendations to improve healthcare for transgender patients. The BMA has expressed concerns about the report's methodology and is calling for the implementation of its recommendations to be paused while the union carries out its evaluation, which is expected to take the rest of the year to complete. However, the NHS has rejected this suggestion, stating that it has "full confidence" in the report and will soon publish a plan to bring in its recommendations.

The BMA's evaluation will focus on several key areas, including the methodology used to underpin the report's recommendations, the impact of puberty blockers and hormone treatments (which was found to have severely lacking evidence), and clinical guidelines (most of which were found not to follow international standards). The union is also advocating for transgender patients to continue receiving specialist healthcare regardless of age and is calling for more research to form a solid evidence base for children's care. The BMA's critique will be shared with its UK council in January 2025.

The decision to evaluate the Cass Review comes after the report concluded that gender care is currently an area of "remarkably weak evidence" and that young people have been caught up in a "stormy social discourse". The report made 32 recommendations on how to ensure young people get a high standard of care that meets their needs in a way that is "safe, holistic and effective". The BMA's chairman of council, Professor Philip Banfield, emphasized the importance of getting this work right, stating that it is a highly specialized area of healthcare for children and young adults with complex needs.

Evidence-Based Care for Suicidality as an Ethical & Professional Imperative: How to Decrease Suicidal Suffering & Save Lives

Jobes, D. A., & Barnett, J. E. (2024).

The American Psychologist

10.1037/amp0001325.

Advance online publication.

https://doi.org/10.1037/amp0001325

Abstract

Suicide is a major public and mental health problem in the United States and around the world. According to recent survey research, there were 16,600,000 American adults and adolescents in 2022 who reported having serious thoughts of suicide (Substance Abuse and Mental Health Services Administration, 2023), which underscores a profound need for effective clinical care for people who are suicidal. Yet there is evidence that clinical providers may avoid patients who are suicidal (out of fear and perceived concerns about malpractice liability) and that too many rely on interventions (i.e., inpatient hospitalization and medications) that have little to no evidence for decreasing suicidal ideation and behavior (and may even increase risk). Fortunately, there is an emerging and robust evidence-based clinical literature on suicide-related assessment, acute clinical stabilization, and the actual treatment of suicide risk through psychological interventions supported by replicated randomized controlled trials. Considering the pervasiveness of suicidality, the life versus death implications, and the availability of proven approaches, it is argued that providers should embrace evidence-based practices for suicidal risk as their best possible risk management strategy. Such an embrace is entirely consistent with expert recommendations as well as professional and ethical standards. Finally, a call to action is made with a series of specific recommendations to help psychologists (and other disciplines) use evidence-based, suicide-specific, approaches to help decrease suicide-related suffering and deaths. It is argued that doing so has now become both an ethical and professional imperative. Given the challenge of this issue, it is also simply the right thing to do. 

Note: I really wish the APA would make these article available for every mental health provider.

Here is my best summary:

1. Use evidence-based suicide risk assessments like the Ask Suicide Questionnaire, Columbia Suicide Severity Rating Scale, and Patient Health Questionnaire-9 to identify suicide risk, but do not rely solely on them.
2. Implement acute stabilization interventions for highly suicidal patients, such as the Safety Plan Intervention, Crisis Response Plan, reducing access to lethal means, crisis hotlines/text lines, and caring contact follow-ups.
3. Utilize evidence-based psychological treatments focused specifically on suicidal thoughts and behaviors, rather than solely treating underlying mental disorders. Examples are Cognitive Therapy for Suicide Prevention, Dialectical Behavior Therapy, and the Collaborative Assessment and Management of Suicidality.
4. Receive comprehensive training in evidence-based suicide assessment and treatment during education and through continuing education to increase competence and reduce fear of working with suicidal patients.
5. Integrate significant others into treatment with patient consent for support, monitoring, and reducing hospitalization need, while addressing confidentiality.
6. Follow risk management strategies like thorough informed consent, documentation, and consulting colleagues, which align with ethical principles and reduce liability concerns.

New California Court for the Mentally Ill Tests a State’s Liberal Values

Tim Arango

The New York Times

Originally posted 21 March 24

Here is an excerpt:

The new initiative, called CARE Court — for Community Assistance, Recovery and Empowerment — is a cornerstone of California’s latest campaign to address the intertwined crises of mental illness and homelessness on the streets of communities up and down the state.

Another piece of the effort is Proposition 1, a ballot measure championed by Gov. Gavin Newsom and narrowly approved by California voters this month. It authorizes $6.4 billion in bonds to pay for thousands of treatment beds and for more housing for the homeless — resources that could help pay for treatment plans put in place by CARE Court judges.

And Mr. Newsom, a Democrat in his second term, has not only promised more resources for treatment but has pledged to make it easier to compel treatment, arguing that civil liberties concerns have left far too many people without the care they need.

So when Ms. Collette went to court, she was surprised, and disappointed, to learn that the judge would not be able to mandate treatment for Tamra.

Instead, it is the treatment providers who would be under court order — to ensure that medication, therapy and housing are available in a system that has long struggled to reliably provide such services.

“I was hoping it would have a little more punch to it,” Ms. Collette said. “I thought it would have a little more power to order them into some kind of care.”

The info is here.

Here is a summary:

California's new CARE Court (Community Assistance, Recovery and Empowerment) is a court system designed to address the issues of mental illness and homelessness. It aims to provide court-ordered care plans for individuals struggling with severe mental illness who are unable to care for themselves. This initiative tests the state's liberal values by balancing individual liberty with the need for intervention to help those in crisis.

Ethical Considerations When Confronted by Racist Patients

Charles Dike

Psychiatric News

Originally published 26 Feb 24

Here is an excerpt:

Abuse of psychiatrists, mostly verbal but sometimes physical, is common in psychiatric treatment, especially on inpatient units. For psychiatrists trained decades ago, experiencing verbal abuse and name calling from patients—and even senior colleagues and teachers—was the norm. The abuse began in medical school, with unconscionable work hours followed by callous disregard of students’ concerns and disparaging statements suggesting the students were too weak or unfit to be doctors.

This abuse continued into specialty training and practice. It was largely seen as a necessary evil of attaining the privilege of becoming a doctor and treating patients whose uncivil behaviors can be excused on account of their ill health. Doctors were supposed to rise above those indignities, focus on the task at hand, and get the patients better in line with our core ethical principles that place caring for the patient above all else. There was no room for discussion or acknowledgement of the doctors’ underlying life experiences, including past trauma, and how patients’ behavior would affect doctors.

Moreover, even in recent times, racial slurs or attacks against physicians of color were not recognized as abuse by the dominant group of doctors; the affected physicians who complained were dismissed as being too sensitive or worse. Some physicians, often not of color, have explained a manic patient’s racist comments as understandable in the context of disinhibition and poor judgment, which are cardinal symptoms of mania, and they are surprised that physicians of color are not so understanding.

The info is here.

Here is a summary:

This article explores the ethical dilemma healthcare providers face when treating patients who express racist views. It acknowledges the provider's obligation to care for the patient's medical needs, while also considering the emotional toll of racist remarks on both the provider and other staff members.

The article discusses the importance of assessing the urgency of the patient's medical condition and their mental capacity. It explores the option of setting boundaries or termination of treatment in extreme cases, while also acknowledging the potential benefits of attempting a dialogue about the impact of prejudice.

FDA Clears the First Digital Therapeutic for Depression, But Will Payers Cover It?

Frank Vinluan

MedCityNews.com

Originally posted 1 April 24

A software app that modifies behavior through a series of lessons and exercises has received FDA clearance for treating patients with major depressive disorder, making it the first prescription digital therapeutic for this indication.

The product, known as CT-152 during its development by partners Otsuka Pharmaceutical and Click Therapeutics, will be commercialized under the brand name Rejoyn.

Rejoyn is an alternative way to offer cognitive behavioral therapy, a type of talk therapy in which a patient works with a clinician in a series of in-person sessions. In Rejoyn, the cognitive behavioral therapy lessons, exercises, and reminders are digitized. The treatment is intended for use three times weekly for six weeks, though lessons may be revisited for an additional four weeks. The app was initially developed by Click Therapeutics, a startup that develops apps that use exercises and tasks to retrain and rewire the brain. In 2019, Otsuka and Click announced a collaboration in which the Japanese pharma company would fully fund development of the depression app.

The information is here.

Here is a quick summary:

Rejoyn is the first prescription digital therapeutic (PDT) authorized by the FDA for the adjunctive treatment of major depressive disorder (MDD) symptoms in adults. 

Rejoyn is a 6-week remote treatment program that combines clinically-validated cognitive emotional training exercises and brief therapeutic lessons to help enhance cognitive control of emotions. The app aims to improve connections in the brain regions affected by depression, allowing the areas responsible for processing and regulating emotions to work better together and reduce MDD symptoms. 

The FDA clearance for Rejoyn was based on data from a 13-week pivotal clinical trial that compared the app to a sham control app in 386 participants aged 22-64 with MDD who were taking antidepressants. The study found that Rejoyn users showed a statistically significant improvement in depression symptom severity compared to the control group, as measured by clinician-reported and patient-reported scales. No adverse effects were observed during the trial. 

Rejoyn is expected to be available for download on iOS and Android devices in the second half of 2024. It represents a novel, clinically-validated digital therapeutic option that can be used as an adjunct to traditional MDD treatments under the guidance of healthcare providers.

LSD-Based Medication for GAD Receives FDA Breakthrough Status

Megan Brooks

Medscape.com

Originally posted March 08, 2024

The US Food and Drug Administration (FDA) has granted breakthrough designation to an LSD-based treatment for generalized anxiety disorder (GAD) based on promising topline data from a phase 2b clinical trial. Mind Medicine (MindMed) Inc is developing the treatment — MM120 (lysergide d-tartrate).

In a news release the company reports that a single oral dose of MM120 met its key secondary endpoint, maintaining "clinically and statistically significant" reductions in Hamilton Anxiety Scale (HAM-A) score, compared with placebo, at 12 weeks with a 65% clinical response rate and 48% clinical remission rate.

The company previously announced statistically significant improvements on the HAM-A compared with placebo at 4 weeks, which was the trial's primary endpoint.

"I've conducted clinical research studies in psychiatry for over two decades and have seen studies of many drugs under development for the treatment of anxiety. That MM120 exhibited rapid and robust efficacy, solidly sustained for 12 weeks after a single dose, is truly remarkable," study investigator David Feifel, MD, PhD, professor emeritus of psychiatry at the University of California, San Diego, and director of the Kadima Neuropsychiatry Institute in La Jolla, California, said in the news release.

The info is here.

Here is some information from the Press Release from Mind Medicine.

About MM120

Lysergide is a synthetic ergotamine belonging to the group of classic, or serotonergic, psychedelics, which acts as a partial agonist at human serotonin-2A (5-hydroxytryptamine-2A [5-HT2A]) receptors. MindMed is developing MM120 (lysergide D-tartrate), the tartrate salt form of lysergide, for GAD and is exploring its potential applications in other serious brain health disorders.

About MindMed

MindMed is a clinical stage biopharmaceutical company developing novel product candidates to treat brain health disorders. Our mission is to be the global leader in the development and delivery of treatments that unlock new opportunities to improve patient outcomes. We are developing a pipeline of innovative product candidates, with and without acute perceptual effects, targeting neurotransmitter pathways that play key roles in brain health disorders.

MindMed trades on NASDAQ under the symbol MNMD and on the Cboe Canada (formerly known as the NEO Exchange, Inc.) under the symbol MMED.

Should Patients Be Allowed to Die From Anorexia? Is a 'Palliative' Approach to Mental Illness Ethical?

Katie Engelhart

New York Times Magazine

Originally posted 3 Jan 24

Here is an excerpt:

He came to think that he had been impelled by a kind of professional hubris — a hubris particular to psychiatrists, who never seemed to acknowledge that some patients just could not get better. That psychiatry had actual therapeutic limits. Yager wanted to find a different path. In academic journals, he came across a small body of literature, mostly theoretical, on the idea of palliative psychiatry. The approach offered a way for him to be with patients without trying to make them better: to not abandon the people who couldn’t seem to be fixed. “I developed this phrase of ‘compassionate witnessing,’” he told me. “That’s what priests did. That’s what physicians did 150 years ago when they didn’t have any tools. They would just sit at the bedside and be with somebody.”

Yager believed that a certain kind of patient — maybe 1 or 2 percent of them — would benefit from entirely letting go of standard recovery-oriented care. Yager would want to know that such a patient had insight into her condition and her options. He would want to know that she had been in treatment in the past, not just once but several times. Still, he would not require her to have tried anything and everything before he brought her into palliative care. Even a very mentally ill person, he thought, was allowed to have ideas about what she could and could not tolerate.

If the patient had a comorbidity, like depression, Yager would want to know that it was being treated. Maybe, for some patients, treating their depression would be enough to let them keep fighting. But he wouldn’t insist that a person be depression-free before she left standard treatment. Not all depression can be cured, and many people are depressed and make decisions for themselves every day. It would be Yager’s job to tease out whether what the patient said she wanted was what she authentically desired, or was instead an expression of pathological despair. Or more: a suicidal yearning. Or something different: a cry for help. That was always part of the job: to root around for authenticity in the morass of a disease.

The info is here.

Some thoughts:

The question of whether patients with anorexia nervosa should be allowed to die from their illness or receive palliative care is a complex and emotionally charged one, lacking easy answers. It delves into the profound depths of autonomy, mental health, and the very meaning of life itself.

The Anorexic's Dilemma:

Anorexia nervosa is a severe eating disorder characterized by a relentless pursuit of thinness and an intense fear of weight gain. It often manifests in severe food restriction, excessive exercise, and distorted body image. This relentless control, however, comes at a devastating cost. Organ failure, malnutrition, and even death can be the tragic consequences of the disease's progression.

Palliative Care: Comfort Not Cure:

Palliative care focuses on symptom management and improving quality of life for individuals with life-threatening illnesses. In the context of anorexia, it would involve addressing physical discomfort, emotional distress, and spiritual concerns, but without actively aiming for weight gain or cure. This raises numerous ethical and practical questions:

• Respecting Autonomy: Does respecting a patient's autonomy mean allowing them to choose a path that may lead to death, even if their decision is influenced by a mental illness?
• The Line Between Choice and Coercion: How do we differentiate between a genuine desire for death and succumbing to the distorted thinking patterns of anorexia?
• Futility vs. Hope: When is treatment considered futile, and when should hope for recovery, however slim, be prioritized?

Finding the Middle Ground:

There's no one-size-fits-all answer to this intricate dilemma. Each case demands individual consideration, taking into account the patient's mental capacity, level of understanding, and potential for recovery. Open communication, involving the patient, their family, and a multidisciplinary team of healthcare professionals, is crucial in navigating this sensitive terrain.

Potential Approaches:

• Enhanced Supportive Care: Focusing on improving the patient's quality of life through pain management, emotional support, and addressing underlying psychological issues.
• Conditional Palliative Care: Providing palliative care while continuing to offer and encourage life-sustaining treatment, with the possibility of transitioning back to active recovery if the patient shows signs of willingness.
• Advance Directives: Encouraging patients to discuss their wishes and preferences beforehand, allowing for informed decision-making when faced with difficult choices.

How to Navigate the Pitfalls of AI Hype in Health Care

Suran M, Hswen Y.

JAMA.

Published online January 03, 2024.

doi:10.1001/jama.2023.23330

What is AI snake oil, and how might it hinder progress within the medical field? What are the inherent risks in AI-driven automation for patient care, and how can we ensure the protection of sensitive patient information while maximizing its benefits?

When it comes to using AI in medicine, progress is important—but so is proceeding with caution, says Arvind Narayanan, PhD, a professor of computer science at Princeton University, where he directs the Center for Information Technology Policy.

The interview and the video is here.

Here is my summary:

• AI has the potential to revolutionize healthcare, but it is important to be aware of the hype and potential pitfalls.
• One of the biggest concerns is bias. AI algorithms can be biased based on the data they are trained on, which can lead to unfair or inaccurate results. For example, an AI algorithm that is trained on data from mostly white patients may be less accurate at diagnosing diseases in black patients.
• Another concern is privacy. AI algorithms require large amounts of data to work, and this data can be very sensitive. It is important to make sure that patient data is protected and that patients have control over how their data is used.
• It is also important to remember that AI is not a magic bullet. AI can be a valuable tool, but it is not a replacement for human judgment. Doctors and other healthcare professionals need to be able to critically evaluate the output of AI algorithms and make sure that it is being used in a safe and ethical way.

Overall, the interview is a cautionary tale about the potential dangers of AI in healthcare. It is important to be aware of the risks and to take steps to mitigate them. But it is also important to remember that AI has the potential to do a lot of good in healthcare. If we develop and use AI responsibly, it can help us to improve the quality of care for everyone.

Here are some additional points that were made in the interview:

• AI can be used to help with a variety of tasks in healthcare, such as diagnosing diseases, developing new treatments, and managing chronic conditions.
• There are a number of different types of AI, each with its own strengths and weaknesses.
• It is important to choose the right type of AI for the task at hand.
• AI should always be used in conjunction with human judgment.

How does marijuana affect the brain?

Heather Stringer

Monitor on Psychology

Vol. 54, No. 5, p. 20

Here is an excerpt:

Mixing marijuana with mental health issues

Psychologists also share a sense of urgency to clarify how cannabis affects people who suffer from preexisting mental health conditions. Many veterans who suffer from PTSD view cannabis as a safe alternative to other drugs to alleviate their symptoms (Wilkinson, S. T., et al., Psychiatric Quarterly, Vol. 87. No. 1, 2016). To investigate whether marijuana does in fact provide relief for PTSD symptoms, Jane Metrik, PhD, a professor of behavioral and social sciences at the Brown University School of Public Health and a core faculty member at the university’s Center for Alcohol and Addiction Studies, and colleagues followed more than 350 veterans for a year. They found that more frequent cannabis use worsened trauma-related intrusion symptoms—such as upsetting memories and nightmares—over time (Psychological Medicine, Vol. 52, No. 3, 2022). A PTSD diagnosis was also strongly linked with cannabis use disorder a year later. “Cannabis may give temporary relief from PTSD because there is a numbing feeling, but this fades and then people want to use again,” Metrik said. “Cannabis seems to worsen PTSD and lead to greater dependence on the drug.”

Metrik, who also works as a psychologist at the Providence VA Medical Center, has also been studying the effects of using cannabis and alcohol at the same time. “We need to understand whether cannabis can act as a substitute for alcohol or if it leads to heavier drinking,” she said. “What should we tell patients who are in treatment for problem drinking but are unwilling to stop using cannabis? Is some mild cannabis use OK? What types of cannabis formulations are helpful or harmful for people who have alcohol use disorder?”

Though there are still many unanswered questions, Metrik has seen cases that suggest adding cannabis to heavy drinking behavior is risky. Sometimes people can successfully quit drinking but are unable to stop using cannabis, which can also intensify depression and lead to cannabis hyperemesis syndrome—repeated and severe bouts of vomiting that can occur in heavy cannabis users, she said. Cannabis withdrawal symptoms such as irritability, anxiety, increased cravings, aggression, and restlessness usually subside after 1 to 2 weeks of abstinence, but insomnia tends to persist longer than the other symptoms, she said.

Cannabis may also interfere with pharmaceutical medications patients are taking to treat mental health issues. Cannabidiol (CBD) can inhibit the liver enzymes that metabolize medications such as antidepressants and antipsychotics, said Ryan Vandrey, PhD, a professor of psychiatry and behavioral sciences at Johns Hopkins University and president of APA’s Division 28 (Psychopharmacology and Substance Abuse). “This could lead to side effects because the medication is in the body longer and at higher concentrations,” he said. In a recent study, he found that a high dose of oral CBD also inhibited the metabolism of THC, so the impairment and the subjective “high” was significantly stronger and lasted for a longer time (JAMA Network Open, Vol. 6, No. 2, 2023). This contradicts the common conception that high levels of CBD reduce the effects of THC, he said. “This interaction could lead to more adverse events, such as people feeling sedated, dizzy, [or] nervous, or experiencing low blood pressure for longer periods of time,” Vandrey said.

The interactions between CBD, THC, and pharmaceutical medications also depend on the dosing and the route of administration (oral, topical, or inhalation). Vandrey is advocating for more accurate labeling to inform the public about the health risks and benefits of different products. “Cannabis is the only drug approved for therapeutic use through legislative measures rather than clinical trials,” he said. “It’s really challenging for patients and medical providers to know what dose and frequency will be effective for a specific condition.”

The info is here.