BACKGROUND: Autism spectrum disorder (ASD) is increasingly recognized as a public health issue. Irritability and aggression (IA) often negatively affect the lives of people with ASD and their families. Although many medications have been tested for IA in ASDs in randomized controlled trials (RCTs), critical quantitative analyses of these trials are lacking in the literature. OBJECTIVES:To systematically review and quantitatively analyze the efficacy and safety of pharmacologic treatments for IA in youth with ASD.DATA SOURCES: Studies were identified from Medline, PsycINFO, Embase, and review articles. METHODS:Original articles on placebo-controlled RCTs of pharmacologic treatments of IA in youth age 2 to 17 years with ASD were included. Data items included study design, study goals, details of study participants, details of intervention, study results, statistical methods, side effects, and risks of bias. The primary study outcome measure was the effect size of reduction in the Aberrant Behavioral Checklist-Irritability (ABC-I) scores in the medication group, as compared with placebo, in RCTs using parallel groups design. RESULTS:Forty-six RCTs were identified. Compared with placebo, 3 compounds resulted in significant improvement in ABC-I at the end of treatment. Risperidone and aripiprazole were found to be the most effective, with the largest effect sizes. Sedation, extrapyramidal sides effects, and weight gain were assessed quantitatively. CONCLUSIONS:Although risperidone and aripiprazole have the strongest evidence in reducing ABC-I in youth with ASD, a few other compounds also showed significant efficacy with fewer potential side effects and adverse reactions in single studies.

Objectives:Dysbindin (DTNBP1) has been identified as a susceptibility gene for schizophrenia (SZ) through a positional approach. However, a variety of single nucleotide polymorphisms (SNPs) and haplotypes, in different parts of the gene, have been reported to be associated in different samples, and a precise molecular mechanism of disease remains to be defined. We have performed an association study with two well-characterized family samples not previously investigated at the DTNBP1 locus. Methods: We examined 646 subjects in 136 families with SZ, largely of European ancestry (EA), genotyping 26 SNPs in DTNBP1. Results: Three correlated markers (rs875462, rs760666, and rs7758659) at the 3′ region of DTNBP1 showed evidence for association to SZ (p = 0.004), observed in both the EA (p = 0.031) and the African American (AA) subset (p = 0.045) with the same over-transmitted allele. The most significant haplotype in our study was rs7758659-rs3213207 (global p = 0.0015), with rs3213207 being the most frequently reported associated marker in previous studies. A non-conservative missense variant (Pro272Ser) in the 3′ region of DTNBP1 that may impair DTNBP1 function was more common in SZ probands (8.2%) than in founders (5%) and in dbSNP (2.1%), but did not reach statistical significance. Conclusion: Our results provide evidence for an association of SZ with SNPs at the 3′ end of DTNBP1 in the samples studied.

Our failure to find an association between NRG1 and schizophrenia might reflect different linkage disequilibrium (LD) patterns found in different populations, disease allelic heterogeneity, clinical heterogeneity of schizophrenia, or inadequate statistical power deriving from moderate sample size. NRG1, if a true gene for schizophrenia, accounts for a small fraction of the disease in most populations. The confirmation of NRG1 as a schizophrenia susceptibility gene will require studies with a comprehensive set of markers and in larger samples. The possibility remains that reports of NRG1 association might reflect false positives.

Discipline-specific guidelines for psychiatrists' interactions with social media and electronic communications are needed. Informed by the survey described here, a review of the literature, and consensus opinion, a framework for developing such a set of guidelines is proposed. The model integrates four key areas: treatment frame, patient privacy, medico-legal concerns, and professionalism. This conceptual model, applicable to many psychiatric settings, including clinical practice, residency training, and continuing medical education, will be helpful in developing discipline-wide guidelines for psychiatry and can be applied to a decision-making process by individual psychiatrists in day-to-day practice.

Objective This study’s objective is to differentiate possible ADHD syndromes on the basis of symptom trajectories, prognosis, and associated clinical features in a high-risk cohort. Method Latent class analysis of inattentive (IA) and hyperactive–impulsive (HI) symptoms in 387 non-disabled members of a regional low birthweight/preterm birth cohort who were evaluated for ADHD at 6, 9, and 16 years. Adolescent functional outcomes and other clinical features were examined across the classes. Results Three latent classes were identified: unaffected (modest IA and HI symptom prevalences at six, remitting by nine), school age limited (relatively high IA and HI symptom prevalences at six and nine, declining by 16), and persistent inattentive (high IA and HI prevalences at six and nine, with high IA levels persisting to 16). The persistent inattentive class was distinctively associated with poor functioning, motor problems, other psychiatric disorders, and social difficulties as indexed by a positive screen for autism spectrum disorder at 16. Conclusion These findings differentiate a potential persistent inattentive syndrome relevant to ADHD evaluation and treatment.

The topic of "e-therapy" is of great research and clinical interest in 2012. This article presents a case study that examines several elements of psychotherapy, as administered in the "Second Life" virtual environment. In this case, psychotherapy took place primarily via text messaging between two avatars (client and therapist) who "sat" in a virtual office. The therapist resided in the United States and provided therapy to an individual from a developing nation who was currently residing in another more developed Middle Eastern country for work and to escape political atrocities being committed in his home country. This case example raises many issues that could be explored, including the ethics of providing such therapy, cultural competence, technological details, and providing therapy across national lines. However, due to the complicated and multifaceted nature of providing therapy in a virtual environment, this case presentation focuses on technical issues, such as the basics of providing therapy in Second Life. Given that the patient in this case used multiple avatars (cartoon-like representations of himself) in therapy, the topic of the avatar as the expression of internal representations and conflicts is also examined. This case report also discusses the patient's presenting problems and elements of the therapeutic alliance such as transference and countertransference. Finally, suggestions for future research are made. The author posits that mental health professionals can now reach at-risk patients (e.g., refugees residing in other countries) whom they were not previously able to treat and suggests that mental health practitioners may have an ethical duty to research and provide these kinds of services so that certain underserved populations may be treated. (Journal of Psychiatric Practice 2012;18:451-459).

I n this issue we introduce a new feature called Journal Watch. Much of the new research relevant to psychoanalytic constructs of mental function and the clinical situation is published in journals that are not routinely read by most clinicians. In fact, there are so many journals that it is not really possible for even the dedicated academic to keep up. We have therefore recruited members of the editorial board and assigned them each a group of journals to review searching for articles of interest to JAPA readers. The journals are the leading publications in the fields of psychology, psychiatry, neuroscience, social science, and medicine. As you will see, once an article is selected, a brief synopsis is prepared and full reference provided. Even with our best efforts we anticipate that there will be much we will miss. We welcome the help of JAPA readers and ask them, should they come across an article they think appropriate for Journal Watch, to contact Bret Rutherford, the editorial associate in charge of this section, at e-mail

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