The AI Psych Brief

Online Sports Betting Legalization and Behavioral Health Care Use

Benjamin Westermeyer, Matthew D. Eisenberg, Mark K. Meiselbach · JAMA Psychiatry · October 2026

Since 2018 the number of US states with legal online sports betting has grown from 1 to 31. This Johns Hopkins team used a staggered difference-in-differences design on employer-sponsored insurance claims from 2016 to 2023 (about 62 million enrollee-years, ages 18 to 64), comparing states that legalized online betting between 2018 and 2022 with states that had not.

After legalization, the share of enrollees filling an antidepressant rose by 0.57 percentage points in men and 1.08 in women, and antianxiety fills rose by 0.32 and 0.64 points. Outpatient diagnoses of depression and anxiety rose as well, with outpatient anxiety up 0.67 points in men and 1.15 in women. There was no detectable change in substance use disorder medications or diagnoses, and no change in emergency or inpatient behavioral health diagnoses.

Read the paper →  doi:10.1001/jamapsychiatry.2026.3175

Revascularization of Asymptomatic Carotid Artery Stenosis: Cognitive Results of the CREST-2 Randomized Trials

Ronald M. Lazar, James F. Meschia, Lloyd J. Edwards, et al. · JAMA · September 2026

Asymptomatic carotid stenosis is associated with poorer cognition, and revascularization has long been hoped to protect the brain beyond preventing stroke. CREST-2 comprised two parallel trials in patients with 70% or greater asymptomatic stenosis: carotid stenting plus intensive medical management versus intensive medical management alone, and endarterectomy plus intensive medical management versus medical management alone.

In this prespecified secondary analysis, 2,165 patients (mean age 70) completed blinded, centrally administered telephone cognitive batteries yearly for up to four years. Composite cognitive scores at four years were essentially identical between arms, with between-group differences of 0.03 standard deviations for stenting and 0.02 for endarterectomy, and confidence intervals spanning zero. No individual test favored revascularization.

Read the paper →  doi:10.1001/jama.2026.14703

Infection can double a clozapine level without a single dose change

Clozapine is cleared mainly by CYP1A2, and systemic inflammation suppresses that enzyme: cytokines such as interleukin-6 downregulate its transcription. A patient stable for years on the same dose can develop a pneumonia, urinary infection or COVID and see the level climb two-fold or more within days, presenting as new sedation, hypersalivation, myoclonus, ileus or seizures, which are easy to misread as delirium from the infection itself. Smoking cessation on admission (no more polycyclic hydrocarbon induction) compounds this, since inpatients often stop smoking at the same time. The practical move is to check a clozapine level when a patient on clozapine is febrile or has raised inflammatory markers, and to consider holding or reducing the dose by about half until the infection resolves, then retitrating against levels. Do not assume fever on clozapine is always the drug: clozapine can cause fever too, so treat the infection and measure the level rather than guessing which came first.

Interpret shame from beside the patient, not from above

Guilt is about something one has done; shame is about who one is, and its core experience is being seen. That makes the act of interpretation itself risky with shame-prone patients, because an accurate observation delivered from the stance of the one who sees can reproduce the very exposure being defended against. The patient then withdraws, turns contemptuous, or agrees compliantly while the work goes dead. The technical adjustment is not to soften the content but to change the position of the speaker: name the experience of being looked at before the thing that was seen, use "we" to place the therapist alongside the patient, and frame the defense as having a sensible protective purpose. Shame also tends to show up as a sudden shift in the process (gaze aversion, a joke, a change of topic) rather than as reported feeling, so the move often starts with noticing that shift aloud and gently.