NEJM Journal Watch Psychiatry Top Stories of 2015

Letter to Readers |
December 28, 2015

NEJM Journal Watch Psychiatry Top Stories of 2015

  1. Peter Roy-Byrne, MD

A perspective on the clinically most important research from the past year

  1. Peter Roy-Byrne, MD

On behalf of the editors of NEJM Journal Watch Psychiatry, I am pleased to present the Psychiatry Top Stories of 2015. Although NEJM Journal Watch Psychiatry covers many different aspects of the field, we continue to prioritize studies and reviews that can inform and improve the clinician's practice of psychiatry.

As always, the task of choosing the best stories was difficult. Our six editors choose the top 10 stories from the more than 200 summaries published in the past year.

Stories about promising new treatments for our patients have always been high on our list, and 4 of our top 10 provide information that could change a clinician's practice. Omega-3 fatty acids may help prevent the development of psychosis in people at risk for this condition. Adding methylphenidate to antidepressants in older depressed patients appears to improve depression outcomes. A special integrated program of medication and family, psychosocial, and occupational treatment greatly improves outcomes for individuals suffering a first episode of schizophrenia. Transcranial magnetic stimulation, traditionally thought of as a treatment for refractory depression, may also reduce negative symptoms in schizophrenia, the symptom cluster most associated with disability and more difficult than positive symptoms to treat pharmacologically.

Two stories alert us to potential harmful effects of chronic marijuana use, which is associated with changes in brain structure and connectivity and which appears to worsen the course and outcome of post-traumatic stress disorder (PTSD), in contrast to assertions that “medical marijuana” helps PTSD sufferers. These findings remind us that occasional marijuana use likely differs greatly from the regular, daily use associated with both cannabis dependence and “medical” use in most cases. Currently, no proof exists that marijuana use improves any mental health condition; emerging evidence suggests that chronic use, as in our story about PTSD, may aggravate depressive and anxious symptoms.

Four stories may help us fine-tune our abilities to diagnose and assess risks in our patients. A very novel take on adult attention-deficit/hyperactivity disorder (ADHD) might help the clinician facing an adult complaining of this syndrome but having no childhood history. The symptoms may well be accounted for by another comorbidity; if not, these might need to be managed similarly to childhood ADHD, despite the absence of a childhood history. Although risks of all selective serotonin reuptake inhibitors are small in pregnancy, sertraline is apparently the safest one. For women with prior histories of postpartum bipolar depression or psychosis, medication during a future pregnancy may decrease risk of recurrence. Finally, an important study shows that the symptoms often relied upon in making a diagnosis of postconcussion syndrome in high school athletes are extremely common in this age group, which warns us to be cautious in attributing these symptoms to brain injury in teens who might suffer a concussion.

In 2016, the editorial board and I join you as we strive to use the best evidence in the service of providing the best care for our patients. Best wishes in the New Year.

Omega-3 Prevents Conversion to Psychosis

Augmenting Antidepressants with Methylphenidate for Patients with Geriatric Depression

NAVIGATING the Management of First-Episode Psychosis

Bilateral Repetitive Transcranial Magnetic Stimulation for Schizophrenia

Would You Use Marijuana if You Knew This?

Medical Marijuana for Post-Traumatic Stress Disorder? No Way!

How Related Are Adult and Childhood ADHD?

Which SSRIs Are Safest in Pregnancy?

Postpartum Relapse Risks in Bipolar Disorder and Postpartum Psychosis

Sounds like a Concussion, but It's Not

Editor Disclosures at Time of Publication

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / Research support NIH-NIDA; NIH-NIMH Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (President)

Reader Comments (1)

Jane Schwarting, MS, MSN, PMHNP-BC Nurse/NP/PA, Psychiatry, NC

Excellent information, will use in my practice

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