Treatment resistance is a major challenge in the treatment of schizophrenia, and there are a growing number of studies in this field. Samara and colleagues carried out simple pairwise analyses and a network meta-analysis of 40 randomized clinical trials involving 5172 subjects and found no large differences in efficacy between antipsychotics including clozapine, the current gold standard treatment in this population. In an editorial, Kane and Correll discuss the implications of these findings for clinical practice and advocate for retaining the privileged status of clozapine in this field.
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Brief psychotic disorders have been operationalized repeatedly, without an accepted standard nosology. Fusar-Poli and colleagues present a meta-analysis of 82 studies to assess the differential prognostic significance of 4 competing constructs. There was no prognostic difference in risk of psychotic recurrence between acute and transient psychotic disorder, brief psychotic disorder, brief intermittent psychotic symptoms, and brief limited intermittent psychotic symptoms, but risk was higher in patients with remitted first-episode schizophrenia. McGorry and Nelson discuss the relevance of the findings for the staging of psychotic disorders.
High prevalence of child abuse exposure might explain the higher likelihood of suicide in modern US veterans relative to civilians. Afifi and colleagues examined 2 nationally representative data sets from Canadian military personnel and civilians. Child abuse exposure was more prevalent in military personnel compared with the general population and was associated with an increased likelihood of suicidal ideation, suicide plans, and suicide attempts. In an editorial, Blosnich and Bossarte discuss the importance of these findings.
Depression is associated with significant disability, but the link between parental depression and long-term outcomes in children is not fully understood. Shen and colleagues examined the relationship between school grades at age 16 years (the end of compulsory education in Sweden) and the incidence of parental depression in more than 1 million children. Both maternal and paternal depression any time before the final school year were significantly associated with worse school performance. In an editorial, Weissman discusses the implications of these findings for research in intergenerational effects of mood disorders.
Antipsychotics are increasingly used in youth, but risk for type 2 diabetes mellitus (T2DM) has caused concern. Galling and colleagues conducted a meta-analysis of 13 longitudinal studies reporting on T2DM in youth 2 to 24 years old who were exposed to antipsychotics for at least 3 months. In antipsychotic-exposed youth, T2DM incidence rate was 3.09 cases per 1000 patient years. The T2DM risk was higher in antipsychotic-exposed youth compared with healthy youth and psychiatric controls.
Highlights. JAMA Psychiatry. 2016;73(3):185. doi:10.1001/jamapsychiatry.2015.1612