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In This Issue of JAMA Psychiatry
May 2019


JAMA Psychiatry. 2019;76(5):459. doi:10.1001/jamapsychiatry.2018.2980


Suicide is one of the most devasting problems among military personnel. Comtois and colleagues conducted a randomized clinical trial using Caring Contacts, an intervention of brief letters expressing care, concern, and interest for 1 or more years, in 658 soldiers. Although there was no significant reduction in severity of suicidal ideation or likelihood of suicide risk, soldiers experienced fewer suicidal ideations. In 2 Editorials, Stein et al raise the issue that we need novel interventions preventing suicide, and Hoge discusses the importance of weighing risks and benefits of interventions targeted to reduce suicide.

Editorial Editorial

Author Audio Interview

Despite its high prevalence, evidence-based treatments for abuse-related posttraumatic stress disorder (PTSD) in adolescents have rarely been studied. In this randomized clinical trial, Rosner and colleagues randomized 88 participants with abuse-related PTSD to developmentally adapted cognitive processing therapy or a wait-list condition and found that those in the intervention arm had significantly greater improvement in PTSD symptom severity after treatment and 3-month follow-up. These results indicate that cognitive processing therapy may be an option for adolescents with abuse-related PTSD.

Continuing Medical Education

The effectiveness of antipsychotic polypharmacy in schizophrenia is controversial. Tiihonen and colleagues conducted a nationwide cohort study of 62 250 patients with schizophrenia in Finland and found that any antipsychotic polypharmacy was associated with a significant 7% to 13% lower risk of psychiatric rehospitalization compared with any monotherapy. These results suggest that certain types of polypharmacy may be feasible and useful in the treatment of schizophrenia. In an Editorial, Goff discusses the implications of this and the companion Stroup article.

Editorial Related Article

There is little evidence in the literature about the comparative effectiveness of using psychotropic medications in addition to antipsychotics in schizophrenia. Stroup and colleagues used US national Medicaid data to examine outcomes of initiating adjunctive treatment and found that antidepressant initiation was associated with significantly lower risk and benzodiazepine initiation with significantly higher risk of psychiatric hospitalization and emergency department visits. These results indicate initiation of adjunctive treatments has differential effects in schizophrenia. In an Editorial, Goff discusses implications of this and the companion Tiihonen article.

Editorial Related Article

The usefulness of polygenic risk scores as a measure of genetic liability for depression is not well established in the general population. Using Danish cohort data from 34 573 individuals, Musliner and colleagues studied the association of polygenic risk scores for major depression, bipolar disorder, and schizophrenia with incident first depression in the general population and found that all 3 scores were associated with increased hazard of first depression. These findings suggest that psychiatric disorders share some genetic overlap.