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NEJM Journal Watch Psychiatry Top Stories of 2014
Peter Roy-Byrne, MD
A perspective on the clinically most important research from the past year
On behalf of the editors of NEJM Journal Watch Psychiatry, I am pleased to present the Psychiatry Top Stories of 2014. NEJM Journal Watch Psychiatry covers many different aspects of the field, but this year we have sharpened our focus on studies and reviews that can inform and improve the clinician's practice of psychiatry.
The task of choosing the best stories was difficult. In an initial step, we editors looked at the more than 200 summaries published between mid-November 2013 and mid-November 2014. Each editor chose his or her favorite 20 stories (which were assigned one point) and then, from these, named their top 10 (and each of these was given an extra point). Seven stories received at least 5 points; another nine stories received 4 points. The group of editors voted one more time to select the final three stories from the “second-tier” stories.
In keeping with our emphasis on clinical concerns, this year's top stories all have high relevance for improving clinical psychiatric practice, not only to help our patients but also “to do no harm.” Three stories provide important new information on how to minimize adverse effects (the management of weight and metabolic effects of antipsychotics) and on understanding drug interactions (knowledge of P450 effects may not be sufficient to predict drug interactions).
The pipeline for new medications is disappointingly slow, and research efforts continue to concentrate on more basic than clinical neuroscience issues. Thus, psychiatrists need to be creative regarding possible off-label uses of already available medications, better ways to use common medications, and the best ways to employ older, still powerfully effective modalities such as electroconvulsive therapy (ECT). Five stories fit into this category: One discusses a melatonin agonist for minimizing circadian disruptions in elderly demented patients prone to delirium; another one documents potential efficacy of amantadine for irritability in brain-injured patients; a third encourages early use of lithium in bipolar patients to improve long-term outcomes; and two focus on the possible advantages, but also limitations, of ECT in patients with refractory bipolar depression or refractory schizophrenia.
Two other stories are reflective of concerns raised in the consumer literature. Many of our patients have shown interest in dietary approaches to improve their well-being, but only a few of these have been demonstrated to be beneficial for psychiatric syndromes. One of our top stories highlights the complicated effects of B vitamins in enhancing antidepressant response. And, our final story provides important guidance on avoiding excess exposure to media coverage of traumatic events that can further traumatize our patients.
Of the many valuable psychotherapy stories published this year, a few just missed making the cut in our board's voting. Examples are papers revealing newer psychotherapeutic approaches to common conditions and documenting the effective application of time-honored psychotherapies to new conditions (e.g., psychodynamic psychotherapy for social anxiety) [PubMed® abstract].
We are always interested in hearing from our readers, and we are curious as to which articles from 2014 that you thought were most important. Please let us know by adding a reader comment.
The board and I wish you all a great 2015.
Start Lithium Early in the Course of Bipolar Illness?
[Kessing LV et al. Starting lithium prophylaxis early v. late in bipolar disorder. Br J Psychiatry 2014 Jul 10. PubMed® abstract]
Can a Sleeping Pill Prevent Delirium?
[Hatta K et al. Preventive effects of ramelteon on delirium: A randomized placebo-controlled trial. JAMA Psychiatry 2014 Feb 19. PubMed® abstract]
Weight Loss and Lifestyle Interventions for Patients Taking Antipsychotics
[Green CA et al. The STRIDE weight loss and lifestyle intervention for individuals taking antipsychotic medications: A randomized trial. Am J Psychiatry 2014 Sep 15. PubMed® abstract]
Can B Vitamins Enhance Antidepressant Response?
[Almeida OP et al. B vitamins to enhance treatment response to antidepressants in middle-aged and older adults: Results from the B-VITAGE randomised, double-blind, placebo-controlled trial. Br J Psychiatry 2014 Sep 25. PubMed® abstract]
Melatonin for Drug-Induced Metabolic Syndrome
[Romo-Nava F et al. Melatonin attenuates antipsychotic metabolic effects: An eight-week randomized, double-blind, parallel-group, placebo-controlled clinical trial. Bipolar Disord 2014 Mar 17. PubMed® abstract]
Stop Replaying the Tragedy
[Holman EA et al. Media's role in broadcasting acute stress following the Boston Marathon bombings. Proc Natl Acad Sci U S A 2014 Jan 7; 111:93. Full-text Proc Natl Acad Sci U S A article PDF in PubMed® Central | PubMed® abstract]
When Clozapine Is Insufficient for Schizophrenia, Then What?
[Petrides G et al. Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: A prospective, randomized study. Am J Psychiatry 2014 Aug 26. PubMed® abstract]
Do Cytochrome P450 Effects Predict Drug Interactions in Real Life?
[Sager JE et al. Fluoxetine- and norfluoxetine-mediated complex drug–drug interactions: In vitro to in vivo correlation of effects on CYP2D6, CYP2C19, and CYP3A4. Clin Pharmacol Ther 2014 Jun; 95:653. PubMed® abstract]
ECT or Pharmacotherapy for Treatment-Resistant Bipolar Depression?
[Schoeyen HK et al. Treatment-resistant bipolar depression: A randomized controlled trial of electroconvulsive therapy versus algorithm-based pharmacological treatment. Am J Psychiatry 2014 Sep 15. PubMed® abstract]
Amantadine for Irritability After Traumatic Brain Injury
[Hammond FM et al. Effectiveness of amantadine hydrochloride in the reduction of chronic traumatic brain injury irritability and aggression. J Head Trauma Rehabil 2013 Nov 20. PubMed® abstract]
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