AJP Editors Select 2018 Favorites

The end of 2018 marked a big year for the American Journal of Psychiatry (AJP), with the completion of the journal’s 175th volume and the tenure of editor-in-chief Robert Freedman, M.D.

As is tradition, the editors of AJP used an editorial in the December issue to offer their personal selections for the articles they found particularly interesting or relevant in the past year. Eight articles covering a range of topics were highlighted as top picks in 2018; a selection of these is included below.

Daniel Pine, M.D., selected as his favorite article a clinical trial that showed that propranolol—a beta-blocker used to treat high blood pressure—can improve the effectiveness of memory reactivation therapy in patients with posttraumatic stress disorder (PTSD). Pine wrote that he enjoyed this article by Alain Brunet, Ph.D., of McGill University in Montreal and colleagues because the clinical potential of propranolol was discovered through both basic and clinical research into the role of memories in PTSD. “Thus, clinical observations on traumatic memories inspired basic science researchers, who generated the idea of using propranolol to inhibit retrieval of traumatic memories.”

The top pick of Carol Tamminga, M.D., was a study that combined genetics and computational biology in search of antipsychotic drug targets. Karolina Kauppi, Ph.D., of Umea University in Sweden and colleagues looked for gene-gene interactions between 108 schizophrenia risk loci uncovered by the Psychiatric Genomics Consortium and the known gene targets of 64 antipsychotics. They found that most of the genes in the two groups overlapped and were part of the same biological pathways. But Kauppi and colleagues also identified several genes among the schizophrenia risk loci that had no connections to any current antipsychotic targets. “The article represents a novel alternative strategy for drug discovery,” Tamminga wrote. “The availability of large datasets makes this approach an early example of new computational strategies for drug discovery.”

A study on how depression may affect aging was a favorite of Susan Schultz, M.D. Laura K.M. Han, M.Sc., of VU Medical Center in the Netherlands and colleagues found that people with depression had accelerated DNA methylation activity, especially those who had experienced childhood trauma. DNA methylation is a process by which cells regulate gene expression; it normally occurs at a regular rate, making it a good biological clock. “This finding offers perspective into how we miss opportunities to understand aging by focusing only on middle to later adulthood,” Schultz wrote.

Oliver Glass, M.D., editor-in-chief of the AJP Residents’ Journal, selected an article by Somya Abubucker, M.D., a resident at Johns Hopkins University, on the deaths by suicide of celebrities Anthony Bourdain and Kate Spade. “Although some may argue that progress has been made, mental health stigma continues to linger deep in our culture,” Glass wrote. “As trainees, psychiatrists, and health professionals, we must lead the effort to dismantle this stigma so that individuals who struggle with psychiatric crises can obtain immediate support.”

Freedman picked a fitting article for his final editor’s selection: a review from John Rush, M.D., and Michael Thase, M.D., titled “Improving Depression Outcome by Patient-Centered Medical Management.” This piece was part of a series of articles that looked at the past and considered the future as a nod to AJP’s 175th year. The article also discussed findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study, the first major clinical trial published in AJP during Freedman’s tenure.

“The Rush and Thase article struck me because it re-examines the fundamental issue in patient care, how doctors work collaboratively with patients,” Freedman wrote. As described in the editorial, STAR*D showed that many patients with depression become frustrated and display poor medication adherence when they don’t experience immediate symptom improvements. Psychotherapy can be an effective adjunct treatment, but it is often not well coordinated with pharmacotherapy.

To overcome this challenge, Rush and Thase proposed a new system called patient-centered medical management. Under this system, patient care is divided into four clinical tasks: (1) engaging and retaining the patient in treatment; (2) optimizing symptom control; (3) restoring functioning and quality of life; and 4) mitigating the risk of relapse. Psychiatrists work with patients to systematically address each task, tailoring the behavioral strategies used to the strengths and limitations of each patient.

“The Journal is a vast collaboration, with thousands of colleagues interested in mental disorders, from genes to the community, and infants to the aged,” wrote Freedman in an accompanying farewell letter in which he thanked the Journal’s editors, authors, reviewers, and APA staff for working tirelessly and usually anonymously to keep AJP running smoothly. “I look forward to reading this coming year’s issues and the next phase in the progress of the Journal.” ■