Psychiatric admissions against the will of the patient can be traumatic and should be prevented. de Jong and colleagues conducted a systematic review and meta-analysis of 13 randomized clinical trials of 4 interventions to reduce compulsory psychiatric admissions: advance statements, community treatment orders, compliance enhancement, and integrated treatment. Advance statements showed a 23% risk reduction in compulsory admissions, but the other 3 treatments did not show a significant risk reduction. In an editorial, Thornicroft and Henderson discuss the importance of reducing compulsory psychiatric admissions.
Alterations in glutamatergic neurotransmission have been implicated in the pathophysiology of schizophrenia, but these alterations are not well understood. In a meta-analysis, Merritt and colleagues examined 59 magnetic resonance spectroscopy studies including 1686 patients and 1451 control individuals and identified significant elevations in glutamate in the basal ganglia and glutamine in the thalamus; no region showed a reduction in glutamate metabolites. These findings support the hypothesis that schizophrenia is associated with excess glutamatergic neurotransmission. In an editorial, Coyle and Konopaske discuss the meaning of glutamate measures using magnetic resonance spectroscopy.
Genetic variation contributes to the risk for posttraumatic stress disorder (PTSD). Stein and colleagues report a genome-wide association study in 3167 new US Army soldiers with PTSD and a replication sample of 947 soldiers with PTSD. They found significant loci in ANKRD55 on chromosome 5 and in ZNF626 on chromosome 19 in the cohort of new soldiers but not in the replication sample. Further efforts are needed to replicate the association of PTSD with ANKRD55, which is associated with autoimmune and inflammatory disorder. Ressler discusses the findings in an editorial.
Attention-deficit/hyperactivity disorder has been defined as a neurodevelopmental disorder. Caye and colleagues report prevalence in childhood and adulthood from a prospective, longitudinal study of a representative birth cohort in Brazil. At 11 years of age, the disorder was present in 8.9% of children and at age 18 to 19 years it was present in 12.2%. Only 12.6% of young adults with the disorder had the diagnosis in childhood. In an editorial, Faraone and Biederman discuss whether youth- and adult-onset disorders are distinct syndromes.
Targeted complicated grief treatment is efficacious for complicated grief, but the role for antidepressant medications is not clear. Shear and coauthors carried out a 20-week placebo-controlled randomized trial with 395 adults with complicated grief and found that complicated grief treatment was efficacious on its own, citalopram was not, but that depressive symptoms decreased significantly more when citalopram was added to complicated grief treatment. These results suggest that complicated grief treatment is the treatment of choice for complicated grief, and the addition of citalopram optimizes the treatment of co-occurring depressive symptoms.
In This Issue. JAMA Psychiatry. 2016;73(7):645. doi:10.1001/jamapsychiatry.2015.1636