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In This Issue of JAMA Psychiatry
May 2016


JAMA Psychiatry. 2016;73(5):427. doi:10.1001/jamapsychiatry.2015.1624

Treatment of long-term opioid use disorder with injectable diacetylmorphine hydrochloride (the active ingredient of heroin) is effective in the treatment of chronic injection street opioid users, but the treatment is not available in many countries. Oviedo-Joekes and colleagues tested whether injectable hydromorphone is noninferior to injectable diacetylmorphine for long-term opioid use disorder. In a 6-month randomized trial, noninferiority was demonstrated in the per-protocol analysis but not the intent-to-treat analysis. In an editorial, Schottenfeld and O’Malley discuss the importance of the study for the treatment of heroin addiction.


Continuing Medical Education

Deep brain stimulation is a promising therapeutic option for patients with treatment-resistant depression. Bergfeld and colleagues assessed the efficacy and tolerability of deep brain stimulation targeting the ventral anterior limb of the internal capsule. While 40% of treatment-resistant depression patients responded to deep brain stimulation in the initial open-label study, patients experienced significantly more depressive symptoms during a subsequent double-blind, randomized crossover trial comparing sham with active stimulation. In an editorial, Mayberg and coauthors interpret the results of study in light of recent dialectical behavior therapy trials of treatment-resistant depression .


Cognitive deficits are present in schizophrenia before psychosis emerges. Kendler and colleagues studied a large Swedish cohort to assess cognitive performance in adolescence and the deviation of that performance from the individual’s familial cognitive aptitude. The risk for schizophrenia was predicted by the deviation of the individual’s school achievement and IQ from the familial cognitive aptitude but not by the observed school achievement and IQ. In an editorial, Keefe and Reichenberg discuss the importance of this finding for our efforts to predict schizophrenia.


Cannabis dependence (as defined in DSM-IV) is a common disorder; genetics contributes to risk but no genetic factors have been established. Gelernter and colleagues analyzed data from 3 studies of substance use disorder genetics involving 14 754 participants and identified 3 novel independent regions with genome-wide significant single-nucleotide polymorphism association with cannabis dependence. They also found shared genetic risks between cannabis dependence and major depressive disorder and schizophrenia. In an editorial, Walters and Owen discuss implications of these findings for psychiatric genetics.


Author Audio Interview

Excoriation (skin-picking) disorder is a disabling condition with no clearly effective treatment. Grant and colleagues carried out a 12-week, randomized, placebo-controlled, double-blind clinical trial of N-acetylcysteine (dose range 1200-3000 mg/d) with 66 adults with the condition. Compared with the placebo, N-acetylcysteine was well tolerated and associated with significant improvements in a modified Yale-Brown Obsessive Compulsive Scale and in the Clinical Global Impression–Severity scale, suggesting that N-acetylcysteine may be beneficial in treating excoriation disorder.