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In This Issue of JAMA |

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JAMA. 2013;310(5):451-453. doi:10.1001/jama.2013.5234.
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Alcohol dependence and posttraumatic stress disorder (PTSD) are highly comorbid; however, how to best treat individuals with this combination of conditions is not clear. In a single-blind, randomized controlled trial that enrolled 165 individuals with alcohol dependence and PTSD, Foa and colleagues compared the efficacy of 2 evidence-based treatments—naltrexone for alcohol dependence and prolonged exposure treatment for PTSD—separately and in combination along with supportive counseling focused on medication management. Among the authors’ findings were that naltrexone treatment resulted in a greater decrease in the percentage of days drinking than placebo and that prolonged exposure therapy for PTSD was not associated with increased drinking or alcohol craving. In an Editorial, Mills discusses the treatment of comorbid alcohol dependence and PTSD.

Related Editorial

Suicide has emerged as a leading cause of death among US military personnel. To assess factors associated with suicide in current and former members of the military, LeardMann and colleagues analyzed linked data from the Millennium Cohort Study—a prospective study that commenced in 2001 and has enrolled 151 560 participants from all branches of the armed services—the National Death Index, and the Department of Defense Medical Mortality Registry. The authors report that 83 suicides occurred between July 2001 and December 2008. Factors associated with an increased risk of suicide included male sex and mental disorders (depression, bipolar disorder, and alcohol-related problems) but not deployment-related variables (combat experience, days deployed, and number of deployments). In an Editorial, Engel discusses the need to address modifiable mental health antecedents of suicide among individuals with a history of military service.

Related Editorial

Clinical Review & Education

It is estimated that much of the US population will experience exposure to a natural disaster, technological accident, or intentional act of human terrorism, and a significant number of these individuals may develop posttraumatic stress disorder or other adverse mental health consequences. Based on a review of 222 articles on disaster and emergency mental health response interventions and services, North and Pfefferbaum summarize the evidence relating to identification and appropriate triage of individuals in need of services and discuss the provision of mental health interventions as part of the emergency medical response to disasters.

Ms P, a 48-year-old woman who was born and raised in Somalia, experienced multiple severe traumas during the civil war there. She has lived in the United States since 2003. Ms P reports chronic and worsening extremity pain and weakness, although comprehensive evaluations have revealed only mild knee osteoarthritis; she has had no formal education and she speaks only Somali. In this Clinical Crossroads article, Crosby discusses primary care management of refugees who have experienced trauma, including the importance of and methods for obtaining a trauma history; recognition of psychological and physical manifestations of trauma; and potential effects of cultural differences on the patient-physician relationship.

A man was shot in the face. Examination revealed an entrance wound over the right mandible with no visible exit wound. Breath sounds were clear and equal in all lung fields. The patient had a persistent, dry cough. Chest radiography showed a foreign body in the right side of his chest. What would you do next?



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