Journal of General Internal Medicine
April 1, 2026
Katherine Drabiak
2 citations
Ketamine has become a multibillion-dollar industry for mental health treatment in the USA, with three delivery models: in-person clinics offering off-label racemic ketamine, clinic visits for esketamine (Spravato), and telehealth services prescribing off-label racemic ketamine, the latter accounting for about half the market. The article describes legal changes enabling telehealth-only providers, differences in patient monitoring requirements, and implications for patient safety. Providers should evaluate whether sound evidence exists for off-label prescribing, whether benefits outweigh risks, and whether it serves the patient's best interests, noting that ketamine's dissociative properties raise concerns about appropriate prescribing under controlled substance laws.
Journal of General Internal Medicine
May 19, 2025
Marieke Arts-De Jong, Dirk E. M. Geurts, Philip Spinhoven et al.
2 citations
A 4-week therapist-assisted mindfulness-based stress reduction (MBSR) program was not superior to a minimal self-guided mindfulness-based intervention (MBI) for improving mental health among frontline healthcare workers during the COVID-19 pandemic. In a randomized trial with 201 participants, both interventions led to similar, significant reductions in depressive, anxiety, and somatic symptoms from baseline to 6-month follow-up (Cohen's d -0.78 for MBSR, -0.72 for self-guided MBI). The therapist-assisted MBSR showed a greater reduction in symptoms immediately after the intervention and exclusively increased posttraumatic growth at that point. Both approaches improved posttraumatic symptoms, insomnia, repetitive negative thinking, mental well-being, mindfulness, and self-compassion.
Journal of General Internal Medicine
June 4, 2026
Serena Wong, Sanjay Saint, Jessica Ameling et al.
Sacred moments—brief periods of transcendence, boundlessness, ultimacy, deep interconnectedness, and spiritual emotions—appear to protect clinicians against burnout while promoting meaning in work, well-being, and prosocial engagement. For patients, these moments function as a buffer against stress and are associated with well-being, purpose in life, greater satisfaction with care, stronger alliance with clinicians, and mental health improvements. The term sacred is grounded in the psychological theory of sanctification. The paper reviews predisposing, precipitating, process-based, and prohibitive factors, and maps related phenomena such as glimmers, peak experiences, flow states, mystical experiences, and quantum change. Recommendations include conducting Sacred Moment Rounds, partnering with spiritual care, and creating conditions conducive to sacred moments in healthcare. Future research directions are suggested.
Journal of General Internal Medicine
December 1, 2023
Evan A Balmuth, Thomas E Scammell
Harriet Tubman, a hero of the abolitionist movement, suffered a childhood head injury that led to sleep attacks and visions documented in historical accounts. Her contemporaries viewed these episodes as expressions of her faith, not illness. The authors propose that her sleep attacks, often attributed to temporal lobe epilepsy, actually represent post-traumatic narcolepsy. Using historical analysis and modern sleep medicine, they examine the long-term effects of severe traumatic brain injury, consider differential diagnoses for excessive daytime sleepiness and hypnagogic hallucinations, and review narcolepsy's pathophysiology, diagnosis, and treatment. Tubman persevered despite intrusive sleep episodes to work for the betterment of others.