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In This Issue of JAMA Psychiatry
September 2017


JAMA Psychiatry. 2017;74(9):861. doi:10.1001/jamapsychiatry.2016.2536


Different manuals have been developed for evidence-based psychotherapies of mood and anxiety disorders. Barlow and colleagues studied a unified protocol for the transdiagnostic treatment in a randomized equivalence trial of 233 adult patients with various anxiety disorders. Reduction in symptom severity with the unified protocol was statistically equivalent to reductions with single-disorder protocols after 16 to 21 weeks of treatment and at the 6-month follow-up. In an Editorial, Roy-Byrne discusses the importance of the study for the dissemination of psychotherapy for anxiety disorders.


Buprenorphine is a well-known treatment for opiate use disorder but carries significant abuse liability. This multisite, double-blind, randomized clinical trial investigated the use of a weekly subcutaneous depot buprenorphine injection for the treatment of opiate use disorder. The treatment completely blocked opiate drug liking, suppressed drug withdrawal, and was well tolerated. Thus, depot buprenorphine is an efficacious treatment for opiate use disorder and minimizes diversion or misuse liability.

Alcohol use is among the most significant modifiable risk factors for global burden of disease. In this investigation of 2 nationally representative samples of US adults, Grant and colleagues show a significant increase of drinking between 2001-2002 and 2012-2013. Drinking patterns increased across intensity, ie, from high-risk drinking to alcohol use disorder, and across various sociodemographic groups. These increases were substantial and point toward potentially mounting alcohol crisis. In an accompanying Editorial, Schuckit focuses on identifying alcohol use disorder and the need for comprehensive treatment.


Rates of mental illness in the US criminal justice system are high, and individuals with mental illness are more likely to be reincarcerated. Skeem and colleagues tested whether specialty probation in 1 urban agency yielded better public safety outcomes than traditional probation in another agency. Specialty probation had no significant effect on violence, but odds of rearrest were significantly higher for traditional probationers during the 2-year longitudinal study. Specialty probation appears to be effective in reducing recidivism in individuals with mental illness.

Borderline personality disorder is characterized by interpersonal difficulties, but the neurobiological mechanisms of social interaction are poorly understood. Using functional magnetic resonance imaging, Bilek and colleagues studied cross-brain information flow in pairs of patients, including a healthy control individual and a current or remitted patient with borderline personality disorder or healthy control individual during a joint attention task, and found that the control–current borderline pair showed significantly lower neural coupling than the control–control and control-remitted borderline pairs. In an Editorial, Minzenberg discusses the implications of this research for our understanding of borderline personality disorder.