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Use of Genetically Informed Methods to Clarify the Nature of the Association Between Cannabis Use and Risk for Schizophrenia
Nathan A. Gillespie, PhD; Kenneth S. Kendler, MD
doi : 10.1001/jamapsychiatry.2020.3564
JAMA Psychiatry. 2021;78(5):467-468
Cohort studies and meta-analyses have documented a robust association between cannabis use, heavy use, and misuse with future risk of schizophrenia.1-3 Despite adjusting for covariates, including current psychotic symptoms, other psychopathology, and social integration,1 the ability of these models to determine the degree to which cannabis causes schizophrenia is limited and dependent on their ability to capture all relevant confounders. When evaluating efforts to reduce cannabis use as a means of preventing schizophrenia, the proportion of this association that is causal is critical.
Psychedelics in Psychiatry—Keeping the Renaissance From Going Off the Rails
David B. Yaden, PhD; Mary E. Yaden, MD; Roland R. Griffiths, PhD
doi : 10.1001/jamapsychiatry.2020.3672
JAMA Psychiatry. 2021;78(5):469-470
There is a resurgence, some say renaissance, of clinical research on psychedelic substances after decades of dormancy. Recent studies have produced findings suggesting psychedelics may demonstrate substantial efficacy for serious psychiatric conditions such as mood and substance use disorders. As a result, ongoing clinical trials with the psychedelic psilocybin have been given the Breakthrough Therapy designation by the US Food and Drug Administration that could result in medical approval for major depressive disorder and/or treatment-resistant depression.
The Healthy Brain and Child Development Study—Shedding Light on Opioid Exposure, COVID-19, and Health Disparities
Nora D. Volkow, MD; Joshua A. Gordon, MD, PhD; Michelle P. Freund, PhD
doi : 10.1001/jamapsychiatry.2020.3803
JAMA Psychiatry. 2021;78(5):471-472
The coronavirus disease 2019 (COVID-19) pandemic highlights longstanding health disparities in the United States. African American individuals contract the disease at much higher rates than White individuals and are nearly twice as likely to die of it. Hispanic/Latinx people and American Indian and Alaska Native people are also overrepresented among confirmed cases.1 Structural racism fosters vast inequalities among individuals of color, including economic disadvantage as a result of low-paying jobs, discrimination in education and the workforce, underrepresentation in research,2 and lack of access to adequate health care and healthy foods. These and other associated factors, including the higher prevalence of comorbid conditions, such as obesity, type 2 diabetes, and cardiovascular disease, contribute to the greater morbidity and mortality associated with COVID-19 infection in Black, Latinx, and American Indian and Alaska Native populations.
Toward a Paradigm for Youth Mental Health
Peter J. Uhlhaas, PhD; Patrick D. McGorry, PhD, MD; Stephen J. Wood, PhD
doi : 10.1001/jamapsychiatry.2020.3905
JAMA Psychiatry. 2021;78(5):473-474
The current paradigm for understanding and treating mental disorders is in crisis. The limited availability of existing treatments is exacerbated by their lack of efficacy for some of the most disabling features of major syndromes, such as impairments in cognitive and functional domains. Despite the promises of genetics and translational neuroscience, causal mechanisms of major syndromes remain to be clearly identified. As a result, development of novel pharmacological therapies has also largely stalled.
JAMA Psychiatry—The Year in Review, 2020
Dost ?ngür, MD, PhD
doi : 10.1001/jamapsychiatry.2021.0099
JAMA Psychiatry. 2021;78(5):475-476
Psilocybin-Assisted Supportive Psychotherapy in the Treatment of Major Depression—Quo Vadis?
Charles F. Reynolds III, MD
doi : 10.1001/jamapsychiatry.2020.2901
JAMA Psychiatry. 2021;78(5):476-478
In this issue of JAMA Psychiatry, Davis and colleagues1 at the Johns Hopkins Center for Psychedelic and Consciousness Research have contributed a timely and important proof-of-concept randomized clinical trial on the effects of psilocybin-assisted supportive psychotherapy for the treatment of major depression. The authors reported rapid relief of depressive symptoms and high rates of response and remission that were sustained for more than 4 weeks in a sample of 24 midlife adults, many of whom had chronic depression. The research, supported by crowd-sourced funding, was carried out rigorously, with attention to experimental bias through the use of both immediate and delayed treatment conditions, single-blind and self-reported outcome assessments across many domains, and urn randomization to yield comparable groups of participants in both immediate and delayed treatment conditions. In addition to assessing efficacy, the investigators carefully documented potentially adverse (medical and psychological) effects of psilocybin use. Because of this attention to efficacy and tolerability as well as high rates of retention, treatment completion, and follow-up, the data from this trial are clinically informative and have heuristic value for further research.
New Directions in Research on Heterogeneity of Treatment Effects for Major Depression
Alex Luedtke, PhD; Ronald C. Kessler, PhD
doi : 10.1001/jamapsychiatry.2020.4489
JAMA Psychiatry. 2021;78(5):478-480
In this issue of JAMA Psychiatry, Maslej et al1 carried out a meta-analysis of placebo-controlled trials to investigate whether systematic individual differences exist in antidepressant medication (ADM) response. To our knowledge, this is the fifth meta-analysis of the same data set.2-5 All 5 have compared outcome score variances, since larger variance in the treatment group than control group cannot occur in the absence of heterogeneity of treatment effects (HTE). The 5 studies differed in effect size measures. Basing a comparison on a simple variance ratio in the earliest reports led to the conclusion that no meaningful HTE exists.2,3 Correcting for between-group outcome mean differences in a subsequent report4 led to the conclusion that HTE may exist, but that article was retracted based on the finding that evidence for HTE disappears when the association between the outcome mean and variance is estimated rather than assumed to be either 0 (the implicit assumption when making the simple variance comparison) or 1 (the implicit assumption when adjusting for mean differences).5 The Maslej et al report1 updates the data set with more recent trials and again finds a negative result based on this regression-based estimation method.
Effects of Psilocybin-Assisted Therapy on Major Depressive DisorderA Randomized Clinical Trial
Alan K. Davis, PhD; Frederick S. Barrett, PhD; Darrick G. May, MD; et al.
doi : 10.1001/jamapsychiatry.2020.3285
JAMA Psychiatry. 2021;78(5):481-489
Importance Major depressive disorder (MDD) is a substantial public health burden, but current treatments have limited effectiveness and adherence. Recent evidence suggests that 1 or 2 administrations of psilocybin with psychological support produces antidepressant effects in patients with cancer and in those with treatment-resistant depression.
Individual Differences in Response to AntidepressantsA Meta-analysis of Placebo-Controlled Randomized Clinical Trials
Marta M. Maslej, PhD; Toshiaki A. Furukawa, MD, PhD; Andrea Cipriani, MD, PhD; et al.
doi : 10.1001/jamapsychiatry.2020.4564
JAMA Psychiatry. 2021;78(5):490-497
Importance Antidepressants are commonly used to treat major depressive disorder (MDD). Antidepressant outcomes can vary based on individual differences; however, it is unclear whether specific factors determine this variability or whether it is at random.
Implementation and Effectiveness of Nonspecialist-Delivered Interventions for Perinatal Mental Health in High-Income CountriesA Systematic Review and Meta-analysis
Daisy R. Singla, PhD; Andrea Lawson, PhD; Brandon A. Kohrt, MD; et al.
doi : 10.1001/jamapsychiatry.2020.4556
JAMA Psychiatry. 2021;78(5):498-509.
Importance Task sharing—or training of nonspecialist providers with no formal training in counseling—is an effective strategy to improve access to evidence-based counseling interventions and has the potential to address the burden of perinatal depression and anxiety.
Association Between Cardiovascular Risk Factors and Cognitive Impairment in People With SchizophreniaA Systematic Review and Meta-analysis
Katsuhiko Hagi, PhD; Tadashi Nosaka, BSc; Dwight Dickinson, PhD; et al.
doi : 10.1001/jamapsychiatry.2021.0015
JAMA Psychiatry. 2021;78(5):510-518
Importance Schizophrenia is associated with cognitive dysfunction and cardiovascular risk factors, including metabolic syndrome (MetS) and its constituent criteria. Cognitive dysfunction and cardiovascular risk factors can worsen cognition in the general population and may contribute to cognitive impairment in schizophrenia.
Association of Attention-Deficit/Hyperactivity Disorder in Childhood and Adolescence With the Risk of Subsequent Psychotic DisorderA Systematic Review and Meta-analysis
Mikaïl Nourredine, MD, MSc; Adrien Gering, MD; Pierre Fourneret, MD, PhD; et al.
doi : 10.1001/jamapsychiatry.2020.4799
JAMA Psychiatry. 2021;78(5):519-529
Importance Growing evidence supports an association between attention-deficit/hyperactivity disorder (ADHD) in childhood and subsequent psychotic disorders. Both disorders share physiopathological features such as attention deficits, dopaminergic imbalance, and genetic susceptibility. However, the results of epidemiologic studies have been conflicting.
Association of History of Psychopathology With Accelerated Aging at Midlife
Jasmin Wertz, PhD; Avshalom Caspi, PhD; Antony Ambler, MSc; et al.
doi : 10.1001/jamapsychiatry.2020.4626
JAMA Psychiatry. 2021;78(5):530-539
Importance Individuals with mental disorders are at an elevated risk of developing chronic age-related physical diseases. However, it is not clear whether psychopathology is also associated with processes of accelerated aging that precede the onset of age-related disease.
Prospective Development and Validation of the Computerized Adaptive Screen for Suicidal Youth
Cheryl A. King, PhD; David Brent, MD; Jacqueline Grupp-Phelan, MD, MPH; et al.
doi : 10.1001/jamapsychiatry.2020.4576
JAMA Psychiatry. 2021;78(5):540-549
Importance The rate of suicide among adolescents is rising in the US, yet many adolescents at risk are unidentified and receive no mental health services.
Factors Associated With Real-Life Functioning in Persons With Schizophrenia in a 4-Year Follow-up Study of the Italian Network for Research on Psychoses
Armida Mucci, MD; Silvana Galderisi, MD; Dino Gibertoni, PhD; et al.
doi : 10.1001/jamapsychiatry.2020.4614
JAMA Psychiatry. 2021;78(5):550-559
Importance The goal of schizophrenia treatment has shifted from symptom reduction and relapse prevention to functional recovery; however, recovery rates remain low. Prospective identification of variables associated with real-life functioning domains is essential for personalized and integrated treatment programs.
Caring for the Patient With Catatonia
Stephan Heckers, MD; Sebastian Walther, MD
doi : 10.1001/jamapsychiatry.2021.0096
JAMA Psychiatry. 2021;78(5):560-561
Catatonia has been known for more than 150 years, but it still confuses clinicians.1 Here, we review 3 aspects of psychiatric practice that are crucial for the optimal care of a patient with catatonia: identification, treatment, and prevention. Catatonia, a psychomotor syndrome, reminds us that the mind engages with the world through the body. Being in the world is always a bodily experience. Mental health is the internal equilibrium that assures a harmonious relationship between body and mind.2 Clinicians make inferences about this relationship through conversation and via observation and examination of the body. Whenever a person does not engage with the world, catatonia needs to be considered.
Overdose-Related Cardiac Arrests Observed by Emergency Medical Services During the US COVID-19 Epidemic
Joseph Friedman, MPH; Leo Beletsky, JD, MPH; David L. Schriger, MD, MPH
doi : 10.1001/jamapsychiatry.2020.4218
JAMA Psychiatry. 2021;78(5):562-564
Methamphetamine Overdose Deaths in the US by Sex and Race and Ethnicity
Beth Han, MD, PhD, MPH; Jessica Cotto, MPH; Kathleen Etz, PhD; et al.
doi : 10.1001/jamapsychiatry.2020.4321
JAMA Psychiatry. 2021;78(5):564-567
US age-adjusted rates of drug overdose deaths involving methamphetamine increased nearly 5-fold during 2012-2018.1 Although addiction outcomes can be improved with sex-specific and culturally tailored prevention and treatment interventions, the extent to which fatalities differ as functions of sex and race and ethnicity has not been analyzed, to our knowledge.
Posttraumatic Stress Disorder in Patients After Severe COVID-19 Infection
Delfina Janiri, MD; Angelo Carf?, MD; Georgios D. Kotzalidis, MD, PhD; et al.
doi : 10.1001/jamapsychiatry.2021.0109
JAMA Psychiatry. 2021;78(5):567-569
Errors in a Response Rate and in Effect Sizes in Study of Psilocybin-Assisted Therapy for Major Depressive Disorder
Alan K. Davis, PhD; Roland R. Griffiths, PhD
doi : 10.1001/jamapsychiatry.2020.4638
JAMA Psychiatry. 2021;78(5):569
To the Editor On behalf of our coauthors, we regret to report that we have discovered calculation errors in some of the reported effects in our Original Investigation, “Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial,”1 that was published in JAMA Psychiatry on November 4, 2020.
Errors in Response Rate, Effect Sizes, and Confidence Intervals
doi : 10.1001/jamapsychiatry.2020.4714
JAMA Psychiatry. 2021;78(5):569
JAMA Psychiatry Peer Reviewers in 2020
doi : 10.1001/jamapsychiatry.2021.0054
JAMA Psychiatry. 2021;78(5):e210054.
