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In This Issue of JAMA Psychiatry
March 2014


JAMA Psychiatry. 2014;71(3):217-219. doi:10.1001/jamapsychiatry.2013.2715

Schizophrenia has been consistently associated with abnormalities of hippocampal function. By studying a large sample of patients with schizophrenia and their healthy siblings, Rasetti and colleagues now show that this abnormality is also related to increased genetic risk for schizophrenia, suggesting that genes that influence schizophrenia risk do so at least in part by affecting hippocampal function.

Recent assessments of substance use in individuals with mental illness are based on population surveys that do not include individuals with severe psychotic illness. Using the Genomic Psychiatry Cohort, a multiethnic sample consisting of 9142 individuals with a severe psychotic disorder and 10 195 controls, Hartz et al found the odds of smoking and alcohol and other substance use to be dramatically higher than recent estimates of substance use in mild mental illness.

Aberg and colleagues performed one of the first large-scale methylome-wide association studies, including approximately 27 million CpG sites, in 1497 schizophrenic case-control subjects. Critical findings were replicated in an independent cohort using a different technology. Replicated findings could be linked to hypoxia and infection, suggesting that a record of pathogenic events may be preserved in the methylome. This study suggests new avenues to increase disease understanding and identify biomarkers that may potentially improve disease management.

Bustillo and colleagues used proton magnetic resonance spectroscopy to measure glutamine, a metabolite of synaptic glutamate, in the dorsal cingulate cortex, a region involved in salience detection. Glutamine, but no glutamate, was increased in treated schizophrenic patients and it directly related to severity of positive symptoms. Choline, a glial marker, was also increased in the schizophrenia group.

Takayanagi and colleagues examined the lifetime prevalence of mental and physical disorders at mid- to late life using both 1-time retrospective and prospective (cumulative) evaluations in a community sample. Retrospective evaluations substantially underestimated the lifetime prevalence of mental disorders as compared with cumulative evaluations. In contrast, the lifetime prevalence estimates of common physical disorders did not differ meaningfully between the 2 ascertainment methods.

Related Editorial

Allsop and colleagues administered a cannabis extract (Nabiximols/Sativex) or placebo to manage inpatient cannabis withdrawal. Sativex reduced overall and DSM-5–subset cannabis withdrawal symptoms. Sativex retained patients in treatment longer than placebo and was not associated with detectable adverse events, intoxication, or rebound withdrawal on cessation of medication. Inpatient Sativex treatment for acute cannabis withdrawal did not, however, reduce cannabis use or cannabis dependence during the month after discharge from the hospital.

Maenner and colleagues applied the DSM-5 autism spectrum disorder (ASD) criteria to the Autism and Developmental Disabilities Monitoring Network surveillance system. For surveillance years 2006 and 2008, they found that ASD prevalence estimates would likely be lower under the DSM-5 than the DSM-IV-TR criteria. Changes to diagnostic practices for ASD could temper the effects of the DSM-5 criteria on ASD prevalence in the future.

McGrath and colleagues examined the association between parental age at the time of conception vs risk of psychiatric disorder in the offspring. While recent research has focused on advanced paternal age and schizophrenia, this study reports a more complex pattern of association. The offspring of teenage mothers are also at increased risk of various mental health disorders.

Ginsburg and colleagues conducted a naturalistic follow-up of 288 anxious children and adolescents an average of 6 years after they were randomized in the Child/Adolescent Anxiety Multimodal Extended Long-term Study. Remission rates at the follow-up were higher in responders during the acute treatment phase compared with nonresponders (odds ratio, 1.83). Treatment condition (cognitive behavioral therapy, medication, or their combination) did not predict long-term outcomes. Relapse occurred in almost half (48%) of the treatment responders.

In a large population-based study, Chang and colleagues explored the association between attention-deficit/hyperactivity disorder (ADHD) and the risk of serious transport accidents and the extent to which ADHD medication influences this risk among patients with ADHD. Results showed that ADHD is associated with an increased risk of serious transport accidents, and this risk seems to be reduced by ADHD medication, at least among male patients with ADHD.

Continuing Medical Education

Fazel and colleagues tracked premature mortality in individuals diagnosed with traumatic brain injury in the entire Swedish population and investigated the role of psychiatric comorbidity. The study found that the odds of all-cause mortality, suicide, and accidental death compared with the general population and unaffected siblings were substantially elevated in persons with head injury and comorbid psychiatric illness or substance abuse. These risks remained elevated many years after the head injury.