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In This Issue of JAMA Psychiatry
November 2015


JAMA Psychiatry. 2015;72(11):1065. doi:10.1001/jamapsychiatry.2014.1918

Disturbed interoception might contribute to the emotional dysregulation in borderline personality disorder (BPD). Müller and coauthors studied heartbeat evoked potentials (HEPs) in medication-free patients with BPD, patients with BPD in remission, and matched healthy control subjects. Heartbeat evoked potentials indicate the cortical representation of signals from the cardiovascular system. Patients with BPD had significantly reduced HEP amplitudes, which were correlated with emotional dysregulation and positively associated with insula and anterior cortex gray matter volume. Garfinkel and coauthors discuss the importance of the findings for a theory of perturbed interoception in BPD.


High placebo responses pose a significant challenge for clinical trials of major depressive disorder (MDD). Pecina and coauthors explored neurochemical mechanisms of the placebo effect in the treatment of 35 medication-free patients with MDD with positron emission tomography of the μ-opioid receptor. Higher baseline μ-opioid receptor binding in the nucleus accumbens was associated with better treatment response. Placebo-induced endogenous opioid release predicted 43% of the variance in symptom improvement. Fava discusses the implications of the findings for treatment studies of patients with MDD.


Baseline depression severity is related to treatment outcomes, and current guidelines recommend treating severe depression with pharmacotherapy and mild and moderate depression with either psychotherapy or pharmacotherapy even though it is not known whether baseline severity is related to treatment outcomes. Weitz and coauthors carried out an individual patient–level meta-analysis of studies of cognitive behavioral therapy (CBT) and antidepressant medication (ADM) including 1700 patients. There was a main effect of ADM superior to CBT but baseline severity did not moderate differences between CBT and ADM for several depression outcomes.

Adolescents whose parents have a history of depression are at risk of depression and functional impairment but the long-term effects of prevention programs for these adolescents are not known. Brent and coauthors carried out a 6-year follow-up for 316 at-risk adolescents aged 13 to 17 years who underwent either a 6-month cognitive behavioral prevention program or usual care (any treatment initiated by family). The significant protective effect of the intervention on new onsets of depression persisted at 6 years in youth whose index parent was not depressed at time of intake.

Continuing Medical Education

Posttraumatic stress disorder (PTSD) has been studied in male Vietnam veterans but a major epidemiological study in female veterans had been lacking. Magruder and coauthors report lifetime and current PTSD symptoms in more than 4000 female Vietnam veterans. The prevalence of lifetime PTSD was 20.1% and the prevalence of current PTSD was 15.9%. This indicates that the prevalence of PTSD in female Vietnam veterans is higher than previously demonstrated.