The AI Psych Brief

National Trends in Benzodiazepine Dispensing

Cruz N, Samples H, Crystal S, Olfson M, Xie F, Bushnell G · American Journal of Psychiatry · September 2026

Rutgers and Columbia investigators used the IQVIA Longitudinal Prescription dataset — more than 1.1 billion benzodiazepine fills — to track US dispensing from 2013 to 2024 by patient age and prescriber type. The annual share of Americans filling a benzodiazepine fell 26.7 percent, from 7.5% to 5.5%, with the steepest relative drop in adults aged 18 to 29 (−44.8%).

The decline was not uniform across prescribers. Fills fell sharply from pain specialists (−62.5%), primary care physicians (−44.3%) and psychiatrists and other mental health specialists (−38.3%), while fills written by advanced practice providers roughly doubled (+101.5%). Mean total dose per prescription fell across every age group and prescriber type. Primary care still writes the most benzodiazepine prescriptions overall.

Read the paper →  doi:10.1176/appi.ajp.20251346

Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study

Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF · American Journal of Psychiatry · June 2007

This landmark Cornell trial randomized 90 outpatients with borderline personality disorder to a year of transference-focused psychotherapy (TFP), dialectical behavior therapy (DBT), or a manualized dynamic supportive treatment, with medication as indicated. Blind raters assessed suicidality, aggression, impulsivity, anxiety, depression and social adjustment every four months, and the investigators used individual growth-curve modeling to capture the shape of change rather than only endpoints.

All three groups improved in depression, anxiety, global functioning and social adjustment. TFP and DBT were both associated with reduced suicidality; TFP and supportive treatment with reduced anger and facets of impulsivity; and only TFP predicted change in irritability and in verbal and direct assault. The authors concluded that patients with BPD respond to structured outpatient treatment across multiple domains, with TFP associated with change in the broadest set of constructs.

Read the paper →  doi:10.1176/ajp.2007.164.6.922

Fluvoxamine can make clozapine cheaper on the metabolic budget — if you cut the clozapine first

Clozapine is cleared mainly by CYP1A2 to norclozapine, and fluvoxamine is the most potent CYP1A2 inhibitor in the psychiatric formulary. Added carelessly, it can multiply a clozapine level several-fold and produce sedation, hypotension, seizures or ileus. Added deliberately, the same interaction has been studied as a strategy: in Lu and colleagues' 12-week randomized trial (J Clin Psychiatry 2004), 68 treatment-resistant inpatients received either clozapine up to 600 mg/day or fluvoxamine 50 mg plus clozapine capped at 250 mg/day. Steady-state clozapine concentrations were similar, but only the monotherapy group gained significant weight and developed higher glucose and triglycerides — and those metabolic changes tracked the norclozapine level, not the clozapine level.

The practical rule: never start fluvoxamine in a patient on a stable clozapine dose without first reducing the clozapine and rechecking a trough level, and treat any later fluvoxamine discontinuation as a cue to recheck too, because levels will fall.

A patient's gift is an association — receive it before you decide what to do with it

Trainees usually meet the gift as a boundary question with two scripted answers: accept graciously or decline per policy. Both skip the clinical step. A gift is an enacted communication about the relationship, often of something not yet sayable in words — gratitude, yes, but also an attempt to repair imagined damage, to balance a debt that feels humiliating, to bind the therapist before a separation, or to test whether the therapist can be moved. The technical move is to delay the disposition decision just long enough to get curious, then explore timing and meaning with the patient, ideally in the same session. Timing is the richest clue: a gift before a break, after an angry session, or on the anniversary of a loss tells you more than its price. Small, ordinary gifts can usually be accepted once explored; refusing reflexively can land as a rejection that becomes the session's real event.