NEJM Journal Watch Psychiatry Top Stories of 2016

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 2016.

The selection of the 10 best stories was, as always, difficult, with more than 200 summaries published in the past year that inform and improve the clinician's practice of psychiatry, whether by enhancing assessment or improving treatment options.

Our six Editorial Board members of NEJM Journal Watch Psychiatry have always prioritized stories about promising new treatments for our patients. Seven of our top 10 this year provide information that could change a clinician's practice:

Two stories document the effectiveness of light manipulations for mood disorder — either providing phototherapy for patients with nonseasonal depression (you don't have to have “winter depression” to benefit) or restricting light with the use of blue-blocking glasses to attenuate mania.
Use of methylphenidate in bipolar patients with attention-deficit/hyperactivity disorder (ADHD) is likely safe, provided the patient is already taking a mood stabilizer, but will likely cause mood dysregulation in patients not using a stabilizer.
Adding an antidepressant to the antipsychotic regimen of a schizophrenic patient can improve depression without risking exacerbation of psychosis.
Discontinuing an antipsychotic after 6 months of antimania treatment in a bipolar patient likely is safe and does not risk manic relapse.
A novel psychosocial treatment for suicidality helps clinicians construct plans that directly address triggers for suicidal ideation. This study provides useful direction for clinicians looking to improve their office management of this troubling problem.
Finally, a comprehensive review documents the absence of any benefit for neurofeedback in ADHD and reminds us that we can't believe everything we read on the Internet.

This caveat about the importance of evidence-based information also applies to genetic tests in psychiatry. Another selected study tells us that, despite significant advances in psychiatric genetics, such tests are not ready for prime time and do not provide benefits to our patients eager to “personalize” their pharmacotherapy.

Two other selected articles help improve our ability to assess critical issues in our patients. Understanding the characteristics of suicidal children is crucial; this article highlights demographic and diagnostic correlates as well as the frequent absence of any warning signs. Finally, psychiatrists are concerned about the effects of traumatic brain injury but too often forget the important neurological-exam components that need to be considered when assessing any of our patients with recent head trauma.

In 2017, 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. The democratization of information makes it increasingly hard to determine which tests and treatments are supported by the best scientific evidence. We hope to fill the gap for our readers so that they can guide their patients toward those treatments and tests that are evidence-based.

Best wishes in the New Year.