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In This Issue of JAMA Psychiatry
October 2018


JAMA Psychiatry. 2018;75(10):983. doi:10.1001/jamapsychiatry.2017.3002


The US Food and Drug Administration is considering limiting cigarettes to very low nicotine levels, but it is not known how such a change would affect nondaily smokers’ behavior. Shiffman and colleagues randomized 238 such participants to their own brand of cigarettes or very low-nicotine-content ones and found that the latter was associated with a significant reduction of 1.6 cigarettes per day consumed without a change in abstinence rates. Thus, very low-nicotine-content cigarettes reduce consumption without increasing quitting. In an Editorial, Hatsukami discusses implications for the field.


Off-label prescriptions of psychiatric medication can be associated with significant adverse consequences, eg, about 75% of quetiapine prescriptions are off label. Sacarny and colleagues conducted a randomized clinical trial using peer comparison message randomized across the 5055 highest Medicare prescribers of the antipsychotic quetiapine and showed subsequently reduced prescribing for at least 2 years. These results indicate that peer messaging can modify prescriber behavior. In an accompanying Editorial, Liao and Navathe highlight the intricacies that need to be considered when conducting peer messaging.


Continuing Medical Education

Although soldiers with prior mental health diagnoses are at risk for suicide attempts, little is known about those with no diagnosis. Ursano and colleagues found that among 9650 soldiers with documented suicide attempt, 36.3% did not have a previous mental health diagnosis; risk factors for suicide attempt were broadly similar among those with and without a diagnosis. Thus, suicide attempt risk among soldiers without mental health diagnoses is a significant challenge. Reger and colleagues discuss implications of this research in an Editorial.


Psychoticlike experiences are common and may reflect increased vulnerability to psychotic disorders. Papanastasiou and colleagues conducted a multicenter functional magnetic resonance imaging study assessing 1434 adolescents and found that those with high psychoticlike experiences showed significantly greater right frontal activation emerging between ages 14 and 19 years and decreased activation of the head of the caudate at age 19 years, all during reward processing. These findings suggest individuals with high psychotic-like experiences may show aberrant salience.

Anorexia nervosa is among the deadliest diseases in psychiatry, yet its underlying neurobiology is still poorly understood. In this case-control imaging study, Frank and colleagues examined 56 adolescents with anorexia nervosa and 52 matched control individuals and showed increased activation in reward-learning circuits that was directly associated with harm avoidance and weight gain in treatment. These results emphasize the importance of reward circuit dysfunction in this disorder. In an Editorial, Steinglass and Foerde point out that there is still a long road ahead in meaningfully connecting brain imaging findings with clinical psychopathology.