Monday, December 31, 2018

AJP Editors Highlight Favorite Articles of 2018

Improving outcomes in patients with depression and posttraumatic stress disorder, drug development, and psychotherapy were among the topics of the seven articles selected as favorites of 2018 by the editors of the American Journal of Psychiatry. The articles are listed below in the order they appeared in the print issue of the Journal:

Adjunctive Bright Light Therapy for Bipolar Depression: A Randomized Double-blind Placebo-controlled Trial: Dorothy Sit, M.D., and colleagues randomly assigned adults with bipolar I or II disorder with symptoms of major depression who were on stable concomitant medications to either a 7,000-lux bright white light or 50-lux dim red light (placebo) for six weeks. Compared with the dim light group, the group treated with bright white light experienced a significantly higher remission rate (68.2% compared with 22.2%) after four weeks and significantly lower depression scores by the end of the study. No mood polarity switches were observed.

Role of Complex Epigenetic Switching in Tumor Necrosis Factor-α Upregulation in the Prefrontal Cortex of Suicide Subjects: Qingzhong Wang, Ph.D., and colleagues examined the expression of the pro-inflammatory cytokine gene tumor necrosis factor–alpha (TNF-α) in the postmortem brains of people with and without major depressive disorder who died by suicide and of people with major depressive disorder who died of causes other than suicide. They found TNF-α expression was significantly higher in the dorsolateral prefrontal cortex of people in both groups. However, among the microRNAs that regulate TNF-α levels, only miR-19a-3p was upregulated in the prefrontal cortexes of those who died by suicide and was unaltered in individuals with major depressive disorder who died by other means.

Association Between Insight and Outcome of Psychotherapy: Systematic Review and Meta-analysis: Simone Jennissen, M.Sc., and colleagues conducted a meta-analysis to examine the association between patient insight and psychotherapy outcome across a range of treatment modalities. They found that across studies, more insight is moderately associated with better psychotherapy outcome.

Reduction of PTSD Symptoms With Pre-reactivation Propranolol Therapy: A Randomized Controlled Trial: Alain Brunet, Ph.D., and colleagues randomly assigned patients who had experienced PTSD for at least six months to receive propranolol (a noradrenergic beta-receptor blocker) or placebo 90 minutes before sessions where they actively recalled their traumatic event. Those who participated in the sessions under the influence of propranolol once a week for up to six weeks showed a substantial decrease in symptom ratings compared with those in the placebo group.

Revisiting Antipsychotic Drug Actions Through Gene Networks Associated With Schizophrenia: Karolina Kauppi, Ph.D., and colleagues merged genetic data on schizophrenia risk genes with a database of the known gene targets of 64 antipsychotics to look for interactions between these genes. They found that most of the genes were connected in different biological networks. However, there were also several schizophrenia risk genes that had no genetic links to current antipsychotic drugs, representing potentially novel drug targets.

Epigenetic Aging in Major Depressive Disorder: DNA methylation—a process by which cells regulate gene expression—is considered a good biological clock since methylation normally occurs at a regular rate. Laura K.M. Han, M.Sc., and colleagues found that people with major depression have accelerated methylation activity, especially those who experienced childhood trauma.

Improving Depression Outcome by Patient-Centered Medical Management: As part of an article series that celebrated the 175th year of the Journal, John Rush, M.D., and Michael Thase, M.D., explored the fundamental issue of how doctors work collaboratively with their patients. They noted that while adjunct psychotherapy can boost the effectiveness of pharmacotherapy/neuromodulation for patients with mood disorders, the two treatments are often not well-coordinated. To overcome this challenge, Rush and Thase proposed a new system in which patient care is divided into four clinical tasks: 1) engaging and retaining the patient in treatment; 2) optimizing symptom control; 3) restoring daily functioning and quality of life; and 4) mitigating the long-term risk of relapse. Psychiatrists then work with patients to systematically address each task, tailoring the treatment strategies to the strengths and needs of each patient.

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