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In This Issue of JAMA Psychiatry
September 2013


JAMA Psychiatry. 2013;70(9):890-891. doi:10.1001/jamapsychiatry.2013.2003


Schmidt and colleagues investigated whether dysfunctional brain connectivity during working memory processing predates the onset of psychosis and whether connectivity parameters were related to antipsychotic treatment. This study suggests that abnormalities in working memory–induced modulation of connectivity may separate healthy controls from people with an at-risk mental state and patients with first-episode psychosis.

Wunderink and colleagues followed up patients with remitted first-episode psychosis who 7 years ago participated in an 18-month dose-reduction/discontinuation trial. They compared the long-term recovery rates in patients who at the time received dose-reduction strategy with patients who were in maintenance treatment strategy. They found a recovery rate twice as high (40%) in patients who received the dose-reduction strategy compared with patients who were in the maintenance treatment strategy (18%), while relapse rates were equal in the long term.

Related Editorial, Related Article

Blasi and colleagues investigated the association of a single-nucleotide polymorphism in the serotonin receptor 2a gene—HTR2A rs6314—with schizophrenia-related phenotypes and response to olanzapine treatment. Consistent with in silico predictions, they found that the rs6314 T allele predicts reduced prefrontal postmortem and in vitro HTR2A expression, inefficient prefrontal functional magnetic resonance imaging response, and lower accuracy during cognitive processing in healthy subjects as well as worse response after olanzapine treatment in patients with schizophrenia.

Crump and colleagues examined the physical health effects of bipolar disorder in a national cohort of 6 587 036 Swedish adults, including 6618 with bipolar disorder. Women and men with bipolar disorder died 9.0 and 8.5 years earlier than the rest of the population. Multiple causes were identified, including increased mortality from cardiovascular disease, diabetes, chronic obstructive pulmonary disease, influenza/pneumonia, accidents, and suicide (both women and men) and cancer (women only).

Kelleher and colleagues show in a longitudinal report that psychotic symptoms act as a marker of clinical high risk for suicidal behavior. Among young people with baseline psychopathology who reported psychotic symptoms, 14% had a suicide attempt by the 3-month follow-up and 34% had a suicide attempt by the 12-month follow-up, highlighting the importance of renewed clinical focus on assessing for psychotic symptoms in nonpsychotic patients.

Continuing Medical Education

Eftekhari and colleagues evaluated the effectiveness of prolonged exposure therapy as implemented with a large number of veterans with posttraumatic stress disorder. Clinically significant reductions in posttraumatic stress disorder and depressive symptoms were achieved among male and female veterans of all war eras and for combat- and non–combat-related traumas.

Gaysina and colleagues used 3 independent genetically sensitive research designs to examine the association between maternal smoking during pregnancy and child conduct problems, where children were reared by genetically related and genetically unrelated mothers. By uniquely disentangling common genetic factors from postnatal environmental influences (eg, parenting practices), the results across the 3 studies highlight the role of smoking in pregnancy as a prenatal risk factor for offspring conduct problems, when specific perinatal and postnatal factors are controlled.

Related Editorial

Corrigan and colleagues longitudinally evaluated brain chemistry between 3 and 10 years of age in children with autism spectrum disorder (ASD) and idiopathic developmental delay (DD) in comparison with children with typical development. Patterns of chemical changes in the ASD group, most notably a reversal of early N-acetylaspartate reductions, were not similarly observed in the DD group. The findings suggest that a dynamic brain developmental process underlies ASD, whereas a different, more static, developmental process underlies DD.

Cardinale and colleagues examined the asymmetry of functional brain networks in adolescents with autism spectrum disorder (ASD). They found atypical asymmetry for 10 of 17 networks identified from independent component analysis of resting-state functional magnetic resonance imaging data. Without exception, these networks (visual, auditory, motor, executive, language, and attentional) showed shifts toward the right hemisphere in the ASD group, suggesting that atypical rightward asymmetry may be a pervasive feature of functional brain organization in ASD.

Clinical Review & Education

Based on recent findings that antidepressant drugs reactivate a juvenile-like plastic state in the adult brain, Castrén proposes that antidepressants do not directly influence mood, but by reactivating network plasticity, they promote the effects of rehabilitation and psychological therapy to bring about mood recovery. This hypothesis explains the enhanced effect of combining antidepressant treatment with psychotherapy and suggests that antidepressants might be useful in many other disorders where neuronal network plasticity would expedite clinical recovery.