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Combined pharmacotherapy for major depressive disorder with psychotic features includes antidepressant and antipsychotic medications, but it is unclear whether patients in remission should discontinue antipsychotic treatment to avoid serious adverse drug-related events. Flint and colleagues for the STOP-PD II Study Group randomized 126 patients in remission for an episode of psychotic depression treated with sertraline plus olanzapine and found that continuing combined therapy vs treatment with sertraline alone reduced the risk of relapse over 36 weeks. In an Editorial, Coryell discusses the long-term clinical management of patients with psychotic depression.
Visual Abstract and CME
Overt hypothyroidism and Graves hyperthyroidism during pregnancy are established risk factors for preterm birth, but it is uncertain whether thyroid function test abnormalities in the absence of overt disease are also associated with an increased risk of prematurity. The Consortium on Thyroid and Pregnancy and Study Group on Preterm Birth analyzed data for 47 045 pregnant women and found that subclinical hypothyroidism, isolated hypothyroxinemia, and detection of thyroid peroxidase antibodies were associated with a higher risk of preterm birth. In an Editorial, Cappola and Casey discuss the lack of evidence to support screening or treatment for subclinical hypothyroidism.
Estimates vary for the length of time after smoking cessation that the risk of cardiovascular disease diminishes to the level of a never smoker. Duncan and colleagues conducted a retrospective study of 8770 individuals and found that smoking cessation was associated with a lower risk of cardiovascular disease within 5 years but remained elevated for 10 to 15 years.
Pathogenic mutations in breast cancer susceptibility genes 1 and 2 (BRCA1/2) are associated with increased risks for breast, ovarian, fallopian tube, and peritoneal cancer in women. The US Preventive Services Task Force recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1 and BRCA2 gene mutations using a valid risk assessment tool. In an Editorial, Domchek and Robson recommend targeted screening of high-risk groups.
Editorial, Related Article, and JAMA Patient Page
Author Audio Interview and CME
Recommendations for risk assessment, genetic counseling, and genetic testing of women with unknown BRCA1/2 mutation status should be based on scientific evidence. Nelson and colleagues reviewed 103 studies with 92 712 participants and found that the benefits and harms of risk assessment, genetic counseling, and genetic testing to reduce cancer incidence and mortality associated with BRCA1 and BRCA2 have not been directly evaluated by current research.
Author Audio Interview
Catheter ablation is effective for maintaining sinus rhythm and relieving symptoms of atrial fibrillation. This JAMA Insights article by Upadhyay and Alenghat discusses therapeutic options for patients with atrial fibrillation.
This JAMA Clinical Challenge by Soliman and colleagues presents a 65-year-old man with increasing fatigue, dizziness, and palpitations. What would you do next?
Highlights. JAMA. 2019;322(7):589–591. doi:10.1001/jama.2018.15465
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