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In This Issue of JAMA Psychiatry
May 2015


JAMA Psychiatry. 2015;72(5):409. doi:10.1001/jamapsychiatry.2014.1882


The etiology of autism spectrum disorder is complex. Colvert and colleagues used data from a population-based twin sample that included the full clinical spectrum of autism spectrum disorder to study the relative contribution of genetic and environmental factors. For 4 different clinical measures of autism spectrum disorder, they found evidence for substantial genetic influences, with heritability estimates ranging from 56% to 95%, and moderate nonshared environmental influences.

The effectiveness of treating alcohol use disorder with the opioid antagonist naltrexone has been linked to a functional polymorphism (Asn40Asp) of the µ-opioid receptor gene. Oslin and colleagues conducted a 12-week double-blind randomized clinical trial of naltrexone versus placebo, which revealed a significant reduction in heavy drinking across all groups and no evidence of an Asn40Asp genotype × treatment interaction. The Asn40Asp polymorphism is not a biomarker to predict the response to naltrexone treatment of alcohol dependence.

Antipsychotic medications are associated with increased mortality in older adults with dementia. In a retrospective case-control study of 46 008 medication users with dementia who were 65 years or older, Maust and colleagues found an increased mortality risk for individuals receiving antipsychotic medication, ranging from 3.8% for haloperidol to 2.0% for quetiapine. As a group, atypical antipsychotics showed a dose-response increase in mortality risk, with 3.5% greater mortality in the high-dose group.

Many individuals in the general population have psychotic experiences but it is not clear if they show the neural abnormalities seen in psychotic disorders. Wolf and colleagues used functional magnetic resonance imaging to examine brain activation patterns during a working memory and emotion identification task in a population-based sample of 260 youth individuals with psychosis spectrum features and 220 matched typically developing youth individuals (11-22 years of age). Functional abnormalities observed in the psychosis spectrum group were similar to those seen in individuals with or at risk for schizophrenia.

Dialectical behavior therapy (DBT) is a multicomponent evidenced-based treatment for individuals with borderline personality disorder; however, it remains unknown which of the components is most important for treatment success. Linehan and colleagues compared standard DBT treatment with treatment with either DBT skills training or individual DBT therapy in 99 women with borderline personality disorder. While all treatments were equally effective at reducing suicidal ideation and suicide attempts, treatments that contained skills training were superior for treatment adherence and reducing depression and anxiety.