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In This Issue of JAMA Psychiatry
May 2014


JAMA Psychiatry. 2014;71(5):461. doi:10.1001/jamapsychiatry.2013.2727


Nock and colleagues examined lifetime suicidal behavior in nondeployed soldiers in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Prevalence of suicide ideation, plans, and attempts was 13.9%, 5.3%, and 2.4%, respectively, with most cases having pre-enlistment onsets. More than one-third of post-enlistment first suicide attempts were associated with pre-enlistment mental disorders. Major depression and intermittent explosive disorder were especially important predictors, highlighting the importance of screening for those disorders.

Editorial, Related Article 1, Related Article 2

Lerman and colleagues used resting-state functional magnetic resonance imaging to examine strength of coupling between 3 large-scale brain networks in 37 smokers. They report reduced internetwork connectivity during abstinence vs smoking, suggesting weaker inhibition of the default mode network by the salience network. Weaker internetwork connectivity predicted increases in cravings to smoke and less suppression of default mode network activity during performance of a working memory task.


Attenuated ventral striatal response during reward anticipation has been found consistently in schizophrenia, but the relationship to genetic risk was unknown. Grimm and colleagues used functional magnetic resonance imaging to demonstrate that healthy first-degree relatives of schizophrenic patients, as well, show striatal hypoactivation during reward anticipation. This neuroimaging phenotype was reliable, independent from striatal structure, and influenced by a schizophrenia risk variant in NRG1, suggesting a functional neural mechanism related to genetic risk.


Byers and colleagues examined the association between posttraumatic stress disorder (PTSD) and disability among older adults (≥55 years) in the Collaborative Psychiatric Epidemiology Surveys data. Of the 3.7% of older adults with a history of PTSD, approximately half had persistent PTSD in later life (age at onset <55 years as well as a recent diagnosis). Disability in older Americans was strongly associated with PTSD; in particular, persistent PTSD highly compromised function.

Gustafson and colleagues conducted an 8-month randomized trial of the Addiction–Comprehensive Health Enhancement Support System (A-CHESS), a smartphone application for the continuing care of alcohol use disorders. Patients with A-CHESS reported significantly fewer risky drinking days and greater likelihood of abstinence than those in the control group; no significant differences were found between groups for negative consequences of drinking. The results suggest that a smartphone app may provide effective continuing care for alcohol use disorders.