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In This Issue of JAMA Psychiatry
April 2017

In This Issue

JAMA Psychiatry. 2017;74(4):309. doi:10.1001/jamapsychiatry.2016.2511


Several psychotherapies were developed specifically for borderline personality disorder. Cristea and colleagues conducted a systematic review and meta-analysis of 33 randomized psychotherapy trials to assess their efficacy. Dialectical behavior therapy and psychodynamic approaches were more effective for outcomes at follow-up. Fonagy and colleagues review the implications for psychotherapy of borderline personality disorder.



Autism spectrum disorder (ASD) is more common in men, but the neurobiological mechanisms for this observation remain elusive. Ecker and colleagues developed a predictive model of biological sex based on cortical thickness in 98 adults with ASD and 98 control individuals and found that probability of ASD increased significantly with male neuroanatomical brain phenotype. These findings suggest normative sex-related phenotypic diversity is related to an individual’s risk of ASD. In an Editorial, Cahill discusses the implications.


Self-guided internet-based cognitive behavioral therapy (iCBT) would increase access and availability of evidence-based therapy and reduce the cost of depression treatment, but its efficacy has not been well established. Karyotaki and colleagues carried out an individual patient-level meta-analysis and found that self-guided iCBT was significantly more effective than controls on depressive symptoms severity and treatment response. This result indicates that self-guided iCBT is effective in treating depressive symptoms and can be considered an evidence-based first step approach.

Disrupted reward processing is characteristic of addictive behaviors, but the exact nature of striatal dysfunction in this process is not understood. Luijten and colleagues performed a meta-analysis of 25 functional magnetic resonance imaging studies. Addicted individuals showed significantly decreased striatal activation during reward anticipation and significantly increased striatal activation during reward outcome. This combination of abnormalities in the striatum of substance-addicted individuals suggests an inability to respond appropriately to rewarding stimuli and may provide insights into addiction using learning-deficit theory.

Clinical Review and Education

Ketamine appears to produce rapid and robust antidepressant effects in patients with treatment-resistant mood disorders, and this has led to dramatically increased use of ketamine as an “off-label” treatment in psychiatry. In a review and consensus statement, Sanacora and colleagues provide clinicians with a general overview of the safe use of ketamine for the treatment of mood disorders. They also highlight the limitations of existing knowledge. In an Invited Commentary, Zorumski and Conway place the review and recommendations in context and suggest directions for future research.

Invited Commentary