AJP Articles Named ‘Top Stories of 2019’ By NEJM Journal Watch Psychiatry

Two articles published last year in the American Journal of Psychiatry have been named “top stories of 2019” by the editorial board of NEJM Journal Watch Psychiatry.

“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:

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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.

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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.”

AJP Articles Make NEJM Journal Watch Psychiatry, BBRF’s Top 10 for 2017

The American Journal of Psychiatry has once again received recognition from New England Journal of Medicine (NEJM) Journal Watch Psychiatry and the Brain and Behavior Research Foundation (BBRF) for the publication of outstanding research in the past year that advances the clinical practice of psychiatry. Two AJP articles were named “top stories of 2017” by NEJM Journal Watch Psychiatry, and four were listed as representing “top advances and breakthroughs” by the Brain and Behavior Research Foundation.

One article—“Adjunctive Bright Light Therapy for Bipolar Depression: A Randomized Double-Blind Placebo-Controlled Trial,” by Dorothy K. Sit, M.D., et al.—appeared on both lists. As Sit and colleagues explained in the AJP article, there is a growing interest in nonpharmacological approaches to treat bipolar depression, after many medications used to treat the disorder have proven ineffective and/or produce adverse effects, including mood switching. The researchers discovered that exposing patients with bipolar depression on stable antimanic medications to midday bright white light led to reductions in their depression scores after six weeks compared with those in the control group. Importantly, no hypomania, dramatic mood switching, or serious side effects were observed during the study.

The other study named on NEJM Journal Watch Psychiatry’s Top 10 list was “KINECT 3: A Phase 3 Randomized, Double-Blind, Placebo-Controlled Trial of Valbenazine for Tardive Dyskinesia,” by Robert A. Hauser, M.D., M.B.A., et al. This study found that once-daily treatment with valbenazine at 80 mg/day significantly improved the symptoms of tardive dyskinesia compared with placebo in a population of patients with schizophrenia, schizoaffective disorder, or a mood disorder. The medication was generally well tolerated, even among patients taking concomitant antipsychotics, and the psychiatric status of the patients remained stable throughout the trial.

In addition to the article by Sit and colleagues referenced above, the following studies were selected by BBRF in its list of the top advancements and breakthroughs by Foundation grantees in 2017 (in chronological order):

• “Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder,” by Jennifer A.Y. Johnston, M.A., et al. Relying on multiple MRI techniques, the authors of this study compared brain images of 68 participants aged 14 to 25 with bipolar disorder who did or did not have a prior suicide attempt. Their analysis revealed significant differences in brain structure and connectivity between these two groups. Intriguingly, among suicide attempters, reduced connections to the left or right prefrontal cortex were correlated with more serious suicidal ideation or suicide attempts, respectively.

• “Effect of a Novel NMDA Receptor Modulator, Rapastinel (Formerly GLYX-13), in OCD: Proof of Concept,” by Carolyn I. Rodriguez, M.D., Ph.D., et al. In this small, open-label trial, Rodriguez and colleagues found that unmedicated patients with obsessive-compulsive disorder who received a single intravenous dose of rapastinel reported a drop in obsessive-compulsive, depression, and anxiety severity scores within 90 minutes of the infusion. The effects were short-lived, however, with no significant effects on symptoms seen one week later.

• “The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis,” by Samuel T. Wilkinson, M.D., et al. A single infusion of ketamine appears to significantly reduce suicidal thoughts in depressed patients in as little as one day, with benefits lasting for up to one week, according to this meta-analysis. Notably, after controlling for improvement in severity of depressive symptoms, ketamine’s effects on suicidal ideation remained significant. This suggests that ketamine has a specific effect on suicidal ideation that depends only partly on change in overall severity of depressive symptoms.

To see a list of the AJP articles that were recognized last year, click here.

AJP Recognized for Outstanding Publication of Research That Informs Clinical Practice

Two prestigious institutions have recognized the American Journal of Psychiatry (AJP) for publication of outstanding research that informs and improves clinicians’ practice of psychiatry by enhancing assessment of patients or improving treatment options.

New England Journal of Medicine (NEJM) Journal Watch Psychiatry and the Brain and Behavior Research Foundation have each recognized its top 10 choices for research studies published in 2016. Two AJP articles were selected by NEJM Journal Watch Psychiatry, and three were selected by the Brain and Behavior Research Foundation. For both lists, AJP had the most number of listed publications.

“Providing reliable, up-to-date information for clinicians and their patients is the most important role of the American Journal of Psychiatry,” said AJP Editor Robert Freedman, M.D. “Therefore, the Editorial Board, our authors, and I take special pride in receiving top recognition this year from both NEJM Journal Watch Psychiatry and the Brain and Behavior Research Foundation for bringing our readers the highest quality information that can guide their practice now and in the future.”

These are the two reports selected by NEJM Journal Watch Psychiatry:

• The Risk of Treatment-Emergent Mania With Methylphenidate in Bipolar Disorder" by Alexander Viktorin, Ph.D., and colleagues. This study found no evidence of a positive association between methylphenidate and treatment-emergent mania among patients with bipolar disorder who were concomitantly receiving a mood-stabilizing medication. This is clinically important given that up to 20% of people with bipolar disorder suffer from comorbid ADHD.
• “Efficacy and Safety of Antidepressants Added to Antipsychotics for Schizophrenia: A Systematic Review and Meta-Analysis” by Bartosz Helfer, M.Sc., and colleagues. This study showed that adding an antidepressant to the antipsychotic regimen of a  patient with schizophrenia can alleviate depression without risking exacerbation of psychosis.
  

The Brain and Behavior Research Foundation selected these reports:

• Opioid Modulation With Buprenorphine/Samidorphan as Adjunctive Treatment for Inadequate Response to Antidepressants by Maurizio Fava, M.D., et al. The researchers found that buprenorphine/samidorphan in combination is a novel and promising candidate for treatment of major depressive disorder for patients who have an inadequate response to standard antidepressants.
• An Individualized Risk Calculator for Research in Prodromal Psychosis by Tyrone D. Cannon, Ph.D., et al., and its companion article, Personalized Prediction of Psychosis: External Validation of the NAPLS-2 Psychosis Risk Calculator With the EDIPPP Project by Ricardo E. Carrión, et al. The researchers described a risk calculator, comparable in accuracy to those for cardiovascular disease and cancer, for predicting individualized risk for conversion to psychosis in newly ascertained clinical high-risk cases.
• Neurometabolic Disorders: Potentially Treatable Abnormalities in Patients With Treatment-Refractory Depression and Suicidal Behavior by Lisa A. Pan, M.D., et al. This study found that examination of metabolic disorders in patients with treatment-refractory depression identified an unexpectedly large proportion of patients with potentially treatable abnormalities.

More information about these studies will appear in a future issue of Psychiatric News.

(Image: American Journal of Psychiatry)

American Journal of Psychiatry Shines in NEJM Journal Watch Psychiatry's Top 10 List of Psychiatry Articles for 2015

Four of the articles chosen as the NEJM Journal Watch Psychiatry’s top 10 most clinically important psychiatry research articles of 2015 appeared in the American Journal of Psychiatry (AJP). No other journal in the list had more than one publication.

“The predominance of AJP in this top 10 list reinforces our emphasis on choosing landmark studies that will advance the clinical practice of psychiatry, as well as those that will provide direction for future research,” AJP Editor-in-Chief Robert Freedman, M.D., told Psychiatric News.

Two of the AJP studies selected for inclusion focused on promising new treatments for psychiatric disorders: Helen Lavretsky, M.D., and colleagues found that combining the antidepressant citalopram with methylphenidate, a stimulant, appears to improve outcomes in geriatric patients with depression; and an article by John Kane, M.D., and colleagues outlined a multifaceted treatment approach to first-episode psychosis that improves functional and clinical outcomes.

The other two AJP studies named in the top 10 list aim to improve clinical assessment: A study by Terrie Moffitt, M.D., and colleagues revealed that adults with attention-deficit/hyperactivity disorder (ADHD) do not share all the characteristics of childhood ADHD and that many adults with ADHD do not have a history of the childhood disorder; and Richard Wesseloo, M.D., and colleagues found patients with bipolar disorder were significantly less likely to experience severe episodes postpartum than patients with a history of postpartum psychosis.

Among other articles in the top 10 list were reports on the use of omega-3 fatty acids in the prevention of psychosis, bilateral transcranial magnetic stimulation for treatment of schizophrenia, the deleterious effects of marijuana use on symptoms of posttraumatic stress disorder, and the safety of SSRIs in pregnancy.

For more information, see the Psychiatric News articles “Psychosocial Treatments Found Effective for Early Psychosis” and “Study Suggests ADHD in Adults May Be Distinct Disorder.”