The edition · Psychiatry
Talking therapies for voices help a little, and avatar therapy helps most
A meta-analysis of 23 trials finds a small benefit from psychological treatment aimed at auditory hallucinations, while US data show benzodiazepine dispensing falling and gambling legalisation linked to more mental health care.
The edition in brief
Today's psychiatry edition opens on prescribing. US dispensing data covering 1.1 billion fills show benzodiazepine prevalence fell from 7.5% to 5.5% between 2013 and 2024, with the steepest drop in young adults, while fills by nurse practitioners and physician assistants doubled. A difference-in-differences study of 62 million enrollee-years found that state legalisation of online sports betting was associated with small rises in antidepressant and anxiolytic prescribing and in outpatient depression and anxiety diagnoses. A secondary analysis of a trial in high-risk US service members found that brief cognitive behavioural therapy shifted the separate dimensions of suicidal thinking faster and more evenly than present-centred therapy. The FDA recorded a supplement to a generic olanzapine application, an administrative step rather than a new indication or safety finding. The pearl covers how to ask about voices in a way that opens the door to targeted therapy. The edition closes on a JAMA Psychiatry meta-analysis of 23 randomised trials (2,016 adults with schizophrenia-spectrum disorders): psychological interventions aimed at auditory hallucinations reduced their severity by a small margin (SMD −0.18, NNT 16, low certainty), with avatar therapy showing the largest effect (SMD −0.37).
Benzodiazepine dispensing fell by a quarter in a decade, but not among all prescribers
Benzodiazepine use is falling, so review the prescriptions that remain and make sure every prescriber group shares the same tapering and co-sedative checks.
Online sports betting legalisation linked to more depression and anxiety care
Add a question about online betting, the patient's own or a family member's, to the assessment of new depression or anxiety.
Brief CBT moves the strands of suicidal thinking faster and together
When monitoring suicidal ideation, watch its separate parts, because an improving total can hide a wish to die that has not moved.
FDA records a supplement to a generic olanzapine application
This is an administrative generic-licence supplement; olanzapine prescribing and metabolic monitoring stay the same.
Asking about voices so the answer helps treatment
Go beyond 'do you hear voices' to their content, power, commands and distress, which is what voice-focused therapy works on.
Psychological treatment for voices: a small benefit, largest with avatar therapy
For persistent, distressing voices despite medication, consider adding a voice-focused psychological therapy, with avatar therapy the most promising where available.
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