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In This Issue of JAMA Psychiatry |

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JAMA Psychiatry. 2015;72(12):1157. doi:10.1001/jamapsychiatry.2014.1924.
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Adults with schizophrenia are at a markedly increased risk for premature death. Olfson and coauthors study mortality ratios in a large, longitudinal schizophrenia cohort of patients aged 20 to 64 years old. Adults with schizophrenia were more than 3.5 times as likely to die in the follow-up period as adults in the general population. Cardiovascular disease had the highest mortality rate. In an editorial, Suetani and colleagues discuss the importance of physical health for the mentally ill.

Physicians are at high risk for suicide, particularly during internship, with suicidal ideation increasing 4-fold. Guille and colleagues conduct a randomized clinical trial of web-based cognitive behavioral therapy (wCBT) in 199 interns from multiple specialties. During at least 1 point in the internship, 12% of interns in the wCBT group and 21.2% of interns in the control group endorsed suicidal ideation. The relative risk to endorse suicidal ideation in the wCBT group was 0.40. In an editorial, Reynolds reviews the importance of addressing mental health needs in training physicians.

Treatment of adult attention-deficit hyperactivity disorder with medication combined with psychotherapy has demonstrated benefits over medication treatment alone. Philipsen and colleagues conduct a multicenter, randomized clinical trial to compare 2 forms of psychotherapy, cognitive behavioral group psychotherapy and individual clinical management , when added to methylphenidate compared with placebo. Cognitive behavioral group psychotherapy was not found to be more effective then the control clinical management condition, except in secondary outcomes. Methylphenidate was superior to placebo in nearly all outcome domains.

Late-life depression and anxiety are under treated, particularly among low-income community-dwelling individuals. Mavandadi and colleagues conduct a pseudo randomized clinical trial comparing a feasible and scalable telephone-based data collection plus care management and brief therapy program with data collection alone for 1018 community-dwelling, elderly patients with new onset of depression or anxiety. Individuals assigned to the intervention arm showed significantly greater improvements in mental health functioning, depressive symptoms, and anxiety symptoms over time.

Psychiatric disorders are complex, dynamic systems of mutually interacting symptoms, where more densely connected symptoms may indicate poorer prognosis. However, it is unknown whether the baseline network structure of depression symptoms predicts the longitudinal course of major depressive disorder (MDD). Van Borkulo and colleagues prospectively studied 515 patients with past-year MDD for 2 years and classified them as remittent or persistent. Persisters had a more densely connected network structure at baseline than remitters, suggesting that more pronounced associations between symptoms may be an important determinant of longitudinal course in MDD.





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