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In This Issue of JAMA Psychiatry
February 2020


JAMA Psychiatry. 2020;77(2):109. doi:10.1001/jamapsychiatry.2019.2784


Negative symptoms represent a substantial burden in schizophrenia without an available effective treatment. Valiengo and colleagues conducted a double-blind sham-controlled randomized clinical trial of add-on transcranial direct current stimulation for negative symptoms in 100 stable patients with schizophrenia and found that 10 sessions over the left prefrontal cortex over 5 days led to significantly greater improvement in negative symptom scores at weeks 6 and 12 when compared with the sham procedure. Thus, transcranial direct current stimulation is effective and safe in ameliorating negative symptoms in patients with schizophrenia.

Author Audio Interview

Stellate ganglion block treatment has been proposed but not adequately studied for treating posttraumatic stress disorder. Rae Olmsted and colleagues conducted a blinded sham-controlled randomized clinical trial with 113 active-duty service members with posttraumatic stress disorder symptoms and found that right-sided stellate ganglion block at weeks 0 and 2 was significantly more effective for reducing these symptoms from baseline to 8 weeks than sham procedure was. These findings indicate that stellate ganglion block merits further study as a posttraumatic stress disorder treatment.

Continuing Medical Education

Psychiatry needs scalable models for training clinicians in implementing evidence-based treatments. Wilfley and colleagues conducted a cluster-randomized clinical trial in 24 college counseling centers and trained 184 college counseling center therapists in using interpersonal psychotherapy with either a train-the-trainer or an expert condition model. Both condition groups showed significant within-group improvement for adherence to the model, but the train-the-trainer model showed significantly greater improvement in competence. Given its potential capability to train more therapists over time, train-the-trainer has the potential to facilitate widespread dissemination of evidence-based treatments.

Certain personality phenotypes are associated with subsequent dementia in older adults, but these may be reflections of preexisting disease. Chapman and coauthors used personality trait data from a national sample of 82 232 high school students with a mean age 15.8 years collected in 1960 and found that higher levels of vigor were associated with lower risk of dementia at a follow-up mean age of 69.5 years; calm and maturity are protective, increasing with socioeconomic status. Thus, adolescent personality traits may be a true independent risk factor for dementia, preceding it by almost 5 decades.

Knowledge about mental disorders in children and adolescents is essential for research and planning of health services, and population-based registers can provide precise estimates of incidence rates. Dalsgaard and colleagues studied all 1.3 million individuals born in Denmark from 1995 to 2016 and found 15% of all individuals were diagnosed as having a mental disorder at younger than 18 years, with anxiety disorder being the most common diagnosis in girls and attention-deficit/hyperactivity disorder in boys. The distinct signatures of different mental disorders have important implications for service planning and etiologic research.