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“As always, we looked for high clinical relevance, balanced with solid methodology, and every study we chose focused on improving clinicians' abilities to treat patients, whether by identifying the best options or highlighting the weaknesses of some once-touted approaches,” wrote Peter Roy-Byrne, M.D., editor-in-chief of NEJM Journal Watch Psychiatry, in a post announcing the selection of top journal articles of the year. These are the AJP studies:
| • | Olanzapine Versus Placebo in Adult Outpatients With Anorexia Nervosa: A Randomized Clinical Trial: Evelyn Attia, M.D., and colleagues found that while the antipsychotic olanzapine may help adults with anorexia nervosa gain some weight, the medication does not appear to reduce obsessionality—a characteristic psychological feature of anorexia nervosa. The findings were based on a trial of 152 adults aged 18 to 65 with anorexia, who were assigned to olanzapine or placebo for 16 weeks. The researchers, who saw the patients weekly, used the Yale-Brown Obsessive Compulsive Scale (YBOCS) interview and several other assessments to determine participants’ obsessionality, eating disorder severity, and other factors over the course of the trial. They found that olanzapine was associated with a significantly greater rate of weight gain than placebo (approximately 1 lb per month for a woman of average height, or 5 feet 5 inches), but there was no significant difference between treatment groups in the rate of change in YBOCS total score or YBOCS subscale scores. |
| • | General Predictors and Moderators of Depression Remission: A VAST-D Report: Sidney Zisook, M.D., and colleagues reported that a patient’s age and hypomanic symptoms may be key indicators for those most likely to benefit from specific, targeted interventions. The researchers studied data from the VA Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) study—a trial that examined outcomes in 1,522 Veterans Health Administration patients who received one of three next-step treatments after failing to respond to at least one antidepressant treatment: a switch to sustained-release bupropion, a combination of the current medication with sustained-release bupropion, or augmentation of the current medication with the antipsychotic aripiprazole. The analysis revealed that augmentation with aripiprazole was more effective for patients aged 65 years and older compared with the bupropion regimens. In contrast, for patients with severe mixed hypomanic symptoms, augmentation with aripiprazole or the current treatment combined with bupropion was more effective than switching to bupropion. |
For related information, see the American Journal of Psychiatry article “2019 Articles of Import and Impact.”