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In This Issue of JAMA Psychiatry
December 2017


JAMA Psychiatry. 2017;74(12):1181. doi:10.1001/jamapsychiatry.2016.2551


Although opioid medication treatment is an effective way of reducing illicit opioid use and mortality, it still maintains a dependency state. Alternative treatments are still needed to effectively reduce opioid dependence. In this 12-week, open-label randomized clinical trial of 159 opioid users, Tanum and coauthors found that treatment with extended-release naltrexone was as effective as buprenorphine-naloxone in reducing the use of heroin, opioids, and other illicit substances. Thus, naltrexone may help to transition individuals with opioid use disorder to abstinence.

Continuing Medical Education

Dopamine abnormalities may underlie psychosis irrespective of diagnosis, but this has not been directly examined in bipolar disorder with psychosis. Jauhar and coauthors used positron emission tomography to show significant and comparable elevations in dopamine synthesis capacity in 22 individuals with bipolar psychosis and 16 with schizophrenia compared with 22 matched controls; these elevations were positively associated with psychotic symptom severity. These findings suggest a transdiagnostic role for dopamine dysfunction in psychotic disorders. In an Editorial, Öngür discusses the implications for psychosis research.


The biological relationship between major depressive disorder and obesity is not well understood. Milaneschi and coauthors stratified 11 837 participants with depression as having decreased or increased appetite and/or weight and found that common genetic correlation with body mass index explained approximately 10% of the heritability in the 2 subgroups; the increased subgroup also carried a higher polygenic risk for body mass index. These results suggest that phenotypic interrelationships between atypical depressive symptoms and obesity-related traits may arise from shared pathophysiological mechanisms in a subset of major depressive disorder. Editorial perspective is provided by Peterson.


Comorbidity between alcohol use disorder and other psychiatric disorders is the rule rather than the exception. Zhou and coauthors identified a genome-wide significant association of semaphorin 3A, a membrane protein involved in axonal guidance and connectivity, with comorbid alcohol dependence and major depression in a sample of 4653 African American individuals but not in European American individuals. This finding highlights the importance of genetic risk factors that are specific to subpopulations and extend to more than one psychiatric condition. Editorial perspective is provided by Edwards.


There are no real-world trials of stepped care available in a disaster context, which would provide important evidence for the appropriate provision of mental health care under extraordinary circumstances. In a modeling study that simulated treatment scenarios starting 4 weeks after a major hurricane, Cohen and coauthors show that stepped care for posttraumatic stress disorder (PTSD) is more effective than usual care in the aftermath of disaster. Therefore, stepped care after a disaster may help to reduce adverse mental health consequences.