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In This Issue of JAMA Psychiatry
June 2016


JAMA Psychiatry. 2016;73(6):541. doi:10.1001/jamapsychiatry.2015.1630

Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression, but response prediction has been elusive. Redlich and colleagues used structural magnetic resonance imaging to predict ECT response in acutely depressed patients. Response was predicted correctly in 18 of 23 patients treated with ECT and in 13 of 13 patients who responded to ECT. In an editorial, Abbott and colleagues discuss the value of machine-learning approaches for the prediction of ECT response.


Continuing Medical Education

Relapse prevention in recurrent depression is a significant public health problem. Kuyken and colleagues examined individual patient data from 9 studies comprising 1329 participants in a meta-analysis and found that patients receiving mindfulness-based cognitive therapy were associated with significantly reduced risk of depressive relapse compared with those not receiving this therapy, including in comparisons with active therapy. In an editorial, Davidson discusses the implications of these findings for psychiatric applications of mindfulness-based cognitive therapy.


Excess alcohol consumption and alcohol use disorders (AUD) are associated with substantially increased mortality. Kendler and colleagues studied all individuals born in Sweden between 1940 and 1965 to determine whether the excess mortality in individuals with AUD arises from the predisposition of the person or is a direct result of AUD. The effect of predisposition is more prominent early in life, whereas the direct effect of AUD becomes progressively more important later in life and with longer duration of AUD. In an editorial, Heinz and colleagues discuss alcohol as an environmental mortality hazard.


Goes and colleagues performed whole-exome sequencing of 36 affected members with bipolar disorder, followed by association testing in a large meta-analysis. They found rare variants in 82 genes, enriched for sets identified in de novo studies of autism and schizophrenia and for targets of the fragile X mental retardation protein pathway. This association with bipolar disorder provides support for an overlap of potential autism and schizophrenia risk genes with rare, segregating variants in bipolar disorder. In an editorial, Kember and Bućan discuss the value of whole-exome sequencing in the study of psychiatric disorders.


Self-harm, unintentional injury, and suicide are major causes of morbidity and mortality in patients with bipolar disorder, but the effect of maintenance mood stabilizer treatment on these outcomes is not known. Hayes and colleagues used electronic health record data from a nationally representative United Kingdom sample of 2148 patients prescribed lithium, 1670 patients prescribed valproate, 1477 patients prescribed olanzapine, and 1376 patients prescribed quetiapine as maintenance treatment. Patients taking lithium had significantly reduced self-harm and unintentional injury rates compared with others, but the rate of suicide was too low to allow accurate estimates.

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