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In This Issue of JAMA Psychiatry
August 2018


JAMA Psychiatry. 2018;75(8):765. doi:10.1001/jamapsychiatry.2017.2992


The social motivation hypothesis posits that individuals with autism find social stimuli less rewarding, but functional magnetic resonance imaging studies of reward processing have yielded mixed results. In this meta-analysis, Clements and colleagues evaluated 13 studies and found that autism was associated with aberrant decreased striatal activation to both social and nonsocial rewards. These findings suggest that in autism, there is a general reward-processing abnormality and not one specific to social rewards. In an Editorial, Dichter discusses implications for the field.


Research has suggested an association between hypertensive disorders of pregnancy and neurodevelopmental disorders in offspring, but consensus is lacking. Maher and colleagues conducted a meta-analysis of more than 700 000 individuals and reported a significantly elevated risk of autism and attention-deficit/hyperactivity disorder in offspring but inconsistent results for other neurodevelopmental disorders. These results indicate that exposure to hypertensive disorders during pregnancy may be associated with an increased risk of autism and attention-deficit/hyperactivity disorder.

The repercussions of abortion for mental health have not been adequately studied. Steinberg and colleagues examined a cohort of 396 397 women from Danish population registries and found that first-time antidepressant prescription redemptions were elevated among women who had an abortion, but the rate of prescription redemption was not significantly different between the year prior and the year following abortion. Thus, increased use of antidepressants is not attributable to having had an abortion but to differences in risk factors for depression. In an Editorial, Stotland and Shrestha discuss implications for research and policy.


Trajectories of depression in autism have not been studied adequately. Rai and colleagues followed a sample of 6091 children from the Avon Longitudinal Study and reported that children with autism or autistic traits had significantly higher than average depressive symptom scores by age 10 years, and these remained elevated in an upward trajectory until age 18 years, with bullying explaining a substantial proportion of risk. These findings suggest that children with autism and autistic traits have persistently higher depression scores.

Children at high familial risk for schizophrenia and bipolar disorder have previously not been studied in conjunction and at a young age. Hemager and colleagues analyzed data on 514 participants aged 7 years from the Danish High Risk and Resilience study and found that children at familial high risk for schizophrenia were significantly impaired compared with control children on multiple congitive domains. These results point to distinct neurodevelopmental manifestations for schizophrenia and bipolar disorder at this young age.