Yeah, No Journal Club

In this episode, we explore a recent clinical trial of deep brain stimulation (DBS) for the management of severe, treatment refractory obsessive compulsive disorder (OCD). While this study is very small, the authors explore not only which stimulant sites are most effective in OCD, they also studied what stimulation at each site does on a cognitive level and what neural circuits are altered by the stimulation. Along the way, we think about cognitive flexibility (the ability to change the rules that govern decisions) and whether or not enhancing cognitive flexibility is necessary to effectively treat OCD. We also bask in the glory of this example of translational neuroscience and think about what we know about circuits in other psychiatric illnesses.

In this episode we work through a paper that attempts to estimate the benefit of attending AA for patients with alcohol use disorder. AA promises that "it works if you work it"--is this true? Precisely how true is it? And how do you figure that out, given that patients are free to choose to attend AA (or not), and typically have deeply individual reasons for attending (or not). We revisit our past discussion about "unobserved confounders" and work through some confusing wording choices made by the authors (the words "randomization" and "group assignment" mean different things). This paper is part of the ABPN MOC. As always, the podcast authors have no knowledge of the ABPN MOC content.

In this episode, we look at a large, prominent trial that found no effect of prazosin on PTSD symptoms or sleep quality in veterans with a history of combat trauma. Why didn't this study find benefit from prazosin treatment, when many others had? And if so many other trials found benefit, why do this study anyway? . We get excited talking about inclusion criteria, and we say equipoise many, many times. The article we discuss is part of the ABPN MOC; none of the podcast authors are associated with the MOC, and we have no knowledge of the questions.

In this episode, we discuss the primary outcomes of the ED-SAFE study, which assessed the efficacy of universal screening for suicidal ideation and brief intervention for SI among patients seen in medical emergency departments. Although these interventions (screening alone vs screening + brief intervention) were assessed in a multi-site trial, the authors do not perform a randomized clinical trial. Why not? How can we effectively assess systems-levels interventions? Can we trust the authors' conclusion that brief intervention is truly effective for decreasing suicide attempts in the year following the initial ED visit? We think so--listen in and see if you agree.

In this episode, we discuss a difficult article that uses large sets of data to (try to) identify gene polymorphisms associated with bipolar disorder. The study authors, members of the Psychiatric Genomics Consortium, utilize a technique knowns as genome-wide association study (GWAS). Understanding the technique requires having a sense of what a gene is, which turns out to be more complicated than we were taught back in high school. If you've forgotten what a SNP is or what "linkage disequilibrium" means, don't worry--we talk about those, too. We end with leaning into the uncertainty.

In this episode, we dive into a recent paper that found that antipsychotics were not effective in treating delirium . . . . at least, not effective in decreasing the number of days with delirium among intubated patients in the ICU, which is a finding that may or may not be relevant to psychiatrists. We spend time examining what the authors mean when they say that "the odds ratio included unity" in the "adjusted and unadjusted analyses" with a review of what exactly an odds ratio is.

In this episode, we discuss how the B-SNIP project is working to utilize biomarkers to redefine categories of psychosis across schizophrenia, schizoaffective disorder, and bipolar disorder. We do our best to break down complicated math into digestible chunks to figure out how the authors go from collecting things like eye movements and EEG responses to sound in order to create a new way of classifying patients with psychosis. We end on the most important question--why should a practicing psychiatrist care about this anyway?

Join us on a wild ride through the "registration trial" for intranasal esketamine. We work on understanding why this phase 3 trial was done in 3 phases. We focus in on placebo responding in antidepressant trials and why this is such an important piece of new medication development and FDA approval. Along the way, we rant a bit about the difference between "active control" and "augmentation."

In this episode, we look at data trying to get at which parts of DBT are necessary and sufficient to decrease suicide attempts and non-suicidal self injury in patients with borderline personality disorder. Is less more or is more more? In working to understand how to approach this question, we consider non-inferiority designs and one of our hosts gets worked up about the use of a one-sided p value. Not sure what a one-sided p value is? Now is your chance to learn!

The article we discuss in this episode is part of the ABPN Psychiatry MOC self-study. The podcasts hosts have no knowledge of the questions or assessments used as part of MOC.

(Adriane dela Cruz, M.D., Ph.D., is an Assistant Professor of Psychiatry at UT Southwestern Medical Center and with the Peter O’Donnell Jr. Brain Institute who focuses on treating patients with drug and alcohol addictions. The opinions expressed are her own and do not reflect those of UT Southwestern, the O’Donnell Brain Institute, the UT System, or the state.)

If you're like us, at some point in your psychiatry training you learned that lithium treatment decreases the incidence of suicide in people with bipolar disorder, but you might also have been taught that this assertion has been disproven. In the second episode on of the Yeah No Journal Club, we take a hard look at a recent attempt to answer the question of whether or not lithium decreases suicide. Along the way, we dig in to the concept of confounding by indication and the ways in which confounding by indication plagues popular press reports about effects of psychiatric medications.

(Adriane dela Cruz, M.D., Ph.D., is an Assistant Professor of Psychiatry at UT Southwestern Medical Center and with the Peter O’Donnell Jr. Brain Institute who focuses on treating patients with drug and alcohol addictions. The opinions expressed are her own and do not reflect those of UT Southwestern, the O’Donnell Brain Institute, the UT System, or the state.)