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In This Issue of JAMA Psychiatry
April 2019


JAMA Psychiatry. 2019;76(4):347. doi:10.1001/jamapsychiatry.2018.2975


About 2 of 100 individuals are affected by body dysmorphic disorder, which is associated with substantial disability and for which few treatment options are available. In this randomized clinical trial conducted at 2 sites, Wilhelm and colleagues enrolled 120 adults and compared supportive psychotherapy with cognitive behavioral therapy. Cognitive behavioral therapy worked in both sites, but supportive psychotherapy only worked in 1 site. In an Editorial, Mennin highlights the importance of examining what the patient actually adopts when engaged in therapy, which may contribute to the success for a particular disorder.


Continuing Medical Education

Drug repurposing is potentially useful, but the benefit of currently used medications for people with mental illness has not been studied. Using a population-wide registry in Sweden, Hayes and colleagues examined rates of psychiatric hospitalization and self-harm in 142 691 individuals with bipolar disorder, schizophrenia, and associated conditions and found that patients exposed to HMG-CoA reductase inhibitors, L-type calcium channel antagonists, and biguanides were significantly less likely to experience psychiatric hospitalization and self-harm. Thus, exposure to 3 classes of nonpsychotropic medications may lead to improved outcomes in serious mental illness.

Folic acid supplementation has been associated with reduced risk of autism spectrum disorder in the child, but recurrence of autism spectrum disorder in high-risk families has not been examined. Schmidt and colleagues analyzed prospective data from more than 300 families who already had a child with autism spectrum disorder and found that the prevalence of autism spectrum disorder in the younger sibling was significantly lower in children whose mothers took prenatal vitamins in the 6 months before pregnancy. Thus, maternal prenatal vitamin intake may reduce autism recurrence in high-risk families.

The causal direction between exercise and depression is a vexing conundrum in psychiatry. Choi and colleagues used a mendelian randomization approach, a form of instrumental variable analysis, in 611 583 individuals to help arbitrate the link between exercise and depression. Whereas genetic variants that favor objective measures of exercise had a protective effect on depression, those genetic variants that favored depression did not exert an effect on exercise. In an Editorial, Chekroud emphasizes examining confounders in mendelian randomization approaches and suggests the need for prospective studies targeting depression prevention.


A large number of individuals had been exposed as children to lead in the latter part of the last century. Reuben and colleagues examined 579 individuals who participated in the Dunedin Multidisciplinary Health and Development Study between 1972 and 2012. Those individuals who were exposed to lead also had a higher level of general psychopathology, internalizing symptoms, and thought disorder. Thus, lead exposure may have long-term consequences by increasing different aspects of psychopathology.