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In This Issue of JAMA Psychiatry
February 2016


JAMA Psychiatry. 2016;73(2):97. doi:10.1001/jamapsychiatry.2015.1606


Clinical services for individuals at high risk for the development of a psychotic disorder require inclusion criteria. Fusar-Poli and colleagues review 33 studies with up to 4227 patients for a meta-analysis of risk-stratification strategies. Eighty-five percent of patients were included because of attenuated psychotic symptoms, 10% with brief limited intermittent psychotic symptoms, and 5% owing to genetic risk and deterioration. There was a significantly higher risk of psychosis in the brief limited intermittent psychotic symptoms group. In an editorial, Cornblatt discusses the relevance of this meta-analysis for psychosis prevention programs.


Weight gain is a common adverse effect of antipsychotic medication. Nielsen and colleagues investigate striatal activity with functional magnetic resonance imaging in antipsychotic-naive patients during a monetary reward task. After 6 weeks of treatment with the D2 antagonist amisulpride, 39 patients underwent a second functional magnetic resonance imaging study, and weight change was recorded. Patients gained a mean of 2.3 kg in body weight. Weight gain was predicted by low baseline reward-related activity in the putamen and associated with an increase in the same region after treatment. In an editorial, Kapur and Marques discuss the study.


Continuing Medical Education

Estrogens have known antidepressive effects; yet, association between endogenous estrogen exposure and risk for postmenopausal depression has not been studied. In a meta-analysis, Georgakis and colleagues examine the relationship of depression to age at menopause and duration of reproductive period. Increasing age at menopause (odds ratio for 2-year increment: 0.98, [95% CI, 0.96-0.99], n = 67 406; 13 studies) and reproductive period (odds ratio for 2-year increment: 0.98 [95% CI, 0.96-0.99], n = 54 686; 5 studies) were inversely associated with depression in postmenopausal women. In an editorial, Joffe and Bromberger discuss the implications of exposure to endogeneous estrogens for mood disorders.


Persons treated for a mental disorder often present with physical conditions, but the details of this association are unclear. Scott and colleagues study 16 DSM-IV mental disorders and the subsequent diagnosis of 10 chronic physical conditions in 18 community surveys from 17 countries. Most of the 16 mental disorders were associated with subsequent physical conditions, with odds ratios ranging from 1.2 to 3.6. The odds ratios for a single mental disorder ranged from 1.3 to 1.8, whereas the odds ratios for 5 mental disorders ranged from 1.9 to 4.0.