Yeah, No Journal Club Adriane dela Cruz

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.