Cognitive behavioral therapy of obsessive-compulsive disorder is effective, but many youths with obsessive-compulsive disorder remain symptomatic. Storch and colleagues tested the efficacy of augmenting 10 weekly treatments of cognitive behavioral therapy with either d-cycloserine (25 mg or 50 mg) or placebo in a randomized clinical trial of 142 youths with obsessive-compulsive disorder. Both groups showed significant reduction of Yale-Brown Obsessive Compulsive Scale scores with no added benefit of d-cycloserine. In an editorial, Hofmann discusses the value of d-cycloserine for augmentation of behavioral therapies.
Limitations of depression treatment highlight the need for novel approaches. Janssen and colleagues conducted a randomized, double-blind study of whole-body hyperthermia in 30 adult patients with major depressive disorder. Compared with the sham group, the whole-body hyperthermia group showed significantly reduced Hamilton Depression Rating Scale scores across the 6-week postintervention study period. The study suggests whole-body hyperthermia as a safe, rapidly acting antidepressant.
It is not known what life events trigger committing of violent crimes among patients with psychotic disorders. Using a patient register drawn from all individuals born in Sweden over a 30-year period, Sariaslan and colleagues found that exposure to violence, traumatic brain injuries, unintentional injuries, self-harm, substance intoxication, and parental bereavement significantly contribute to risk for engagement in violent crime in the subsequent week compared with earlier periods within the same individuals. In an editorial, Volavka discusses the implications of these findings for research into violence in psychotic disorders.
Continuing Medical Education
Despite the prevalence of antenatal depression, the effect of untreated depression on neonatal outcomes is not well understood. In this systematic review and meta-analysis, Jarde and colleagues examined neonatal outcomes in women with untreated depression compared with women without depression in 23 studies including a total of 25 663 women and found that untreated depression was associated with significantly increased risks of preterm birth and low birth weight. These results suggest that pregnant women and their clinicians should consider the risks of untreated depression when making decisions about depression treatment.
Marijuana is the most commonly used illicit substance in the United States, but its long-term effects on brain function are poorly understood. Martz and colleagues studied 108 young adult marijuana users over the course of 4 years with 3 functional magnetic resonance imaging scans. Greater marijuana use was associated with later blunted activation of the nucleus accumbens during a monetary incentive delay task. The result indicates that marijuana modulates reward anticipation, which may increase risk for later addiction. In an editorial, Filbey interprets the findings of the study.
In This Issue. JAMA Psychiatry. 2016;73(8):765. doi:10.1001/jamapsychiatry.2015.1642