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In This Issue of JAMA Psychiatry
December 2019


JAMA Psychiatry. 2019;76(12):1217. doi:10.1001/jamapsychiatry.2018.3015


Individual placement and support (IPS) is an effective vocational intervention, but the effect of enhancing IPS with cognitive remediation and work-focused social skills training is not known. In a randomized clinical trial, Christensen and colleagues randomized 720 participants with severe mental illness to service as usual, IPS, or IPS with enhancements and found that IPS and IPS with enhancements were both associated with significantly increased employment and education rates over 18 months of follow-up. Thus, IPS and IPS with enhancements are effective, but enhancing IPS does not offer additional effects.

Continuing Medical Education

Uncertainty exists as to the adverse health outcomes associated with antidepressants. Dragioti and colleagues reviewed 45 meta-analyses of observational studies and found that only a few of the 74 statistically significant associations between antidepressants and adverse health outcomes were supported by empirical scrutiny. In an accompanying Editorial, Flores et al emphasize that systematic reviews and umbrella reviews cannot control for systematic bias or confounding present in the underlying studies; thus, caution is still warranted.


Psychotic experiences are reported by 5% to 10% of the general population, but the genetic basis of this phenomenon and its association with other disorders is not clear. Using UK Biobank data from 127 966 individuals, Legge and colleagues showed that psychotic experiences were associated with genetic liability for major depression, schizophrenia, autism spectrum disorder, and attention-deficit/hyperactivity disorder. These results identify shared genetic liability between psychotic experiences in the general population and major psychiatric disorders. In an Editorial, Powers discusses the significance of psychotic experiences in the general population.


Evidence for bipolar disorder suggests that the stress-diathesis hypothesis includes exposure to infectious agents and the associated immune activation resulting in a multisystem inflammatory disease of the brain and the body. Frye and colleagues show that cytomegalovirus IgG was significantly increased and toxoplasma IgG was significantly decreased in bipolar cases compared with control individuals. The authors conclude that more work is needed to better understand the genetic and environmental disease risk contribution to the pathogenesis of bipolar disorder.

Iron plays a role in neurodevelopment, but prenatal iron deficiency in neurodevelopmental disorders has not been examined. Using longitudinal data from 532 232 individuals in the Stockholm Youth Cohort, Wiegersma and colleagues found that the prevalence of neurodevelopmental disorders was significantly higher among children born to mothers diagnosed as having anemia in the first 30 weeks of pregnancy compared with mothers diagnosed later in pregnancy or not at all. These results emphasize the importance of early screening for iron status and nutritional counseling in pregnancy.