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In This Issue of JAMA Psychiatry
August 2017


JAMA Psychiatry. 2017;74(8):769. doi:10.1001/jamapsychiatry.2016.2531


Maternal depression disproportionately affects low-income and minority women. Silverstein and coauthors compared the effect of problem-solving education with usual care in 230 depressed mothers at 6 Head Start agencies. Problem-solving education resulted in an incident rate ratio of 60% compared with usual care, with a greater effect in women with low-level baseline depressive symptoms and no difference in those with higher-level baseline depressive symptoms. In an Editorial, Ammerman discusses the treatment of maternal depression in community settings.


Continuing Medical Education

Electroconvulsive therapy is a highly efficacious therapy, but there is little information about its population effects. Using population-based data and an instrumental variable model, Slade and coauthors examined the effect of electroconvulsive therapy administration on 30-day hospital readmission rates for more than 162 000 psychiatric inpatients and showed that administration of electroconvulsive therapy was associated with a highly significant reduction in readmissions. In an Invited Commentary, Lo Sasso discusses the statistical approach used in the analysis, and in an Editorial, Sackeim discusses the role of electroconvulsive therapy in clinical care.

Editorial and Invited Commentary

Attention-deficit/hyperactivity disorder (ADHD) is associated with lower standardized test scores, but it is not clear whether treatment of ADHD with stimulants translates into better academic performance. Lu and coauthors studied 930 individuals who had taken multiple entrance examinations and used stimulants intermittently. Using a within-individual design, they found test scores to be 4.8 points higher (on a scale from 0 to 200) during periods when individuals were medicated vs nonmedicated. In an Invited Commentary, Rohde discusses the relevance of this finding for the treatment of ADHD.

Invited Commentary

Autoimmune pathology has been proposed as a pathophysiological process for some individuals with obsessive-compulsive disorder (OCD). In a case-control positron emission tomography study with 20 individuals with OCD and 20 age-matched healthy volunteers using a radioligand for translocator protein (TSPO), Attwells and coauthors show that TSPO density was significantly higher among individuals with OCD in multiple brain regions, including subcortical structures. Individuals with the greatest TSPO volume in the orbitofrontal cortex reported the highest distress ratings when preventing compulsive behaviors.

Early identification of people at risk for bipolar spectrum disorder is critical, but we currently cannot predict whether any given individual will be diagnosed with the disorder in the future. As part of the Pittsburgh Bipolar Offspring Study, Hafeman and coauthors studied 412 at-risk youth for more than 9 years and developed a risk calculator, which discriminated those who subsequently converted to bipolar spectrum disorder from those who did not. In an Invited Commentary, Mesman and Hillegers discuss the implications for prediction in at-risk youth.

Invited Commentary