AJP Editors Select Best of Journal’s 2019 Studies

As one of the leading voices in psychiatric research, the American Journal of Psychiatry (AJP) prides itself on regularly publishing important articles every month. But before a new year begins, the AJP editors take a moment to reflect on articles from the passing year that they feel rose above the rest. This year’s selections—which were named in an editorial in January—were the first under the leadership of AJP’s new editor-in-chief, Ned Kalin, M.D.

In discussing his vision for AJP in an editor’s note in January 2019, Kalin, the Hedberg Professor and Chair of Psychiatry at the University of Wisconsin, stated a desire to broaden the scope of the journal to include more basic and translational studies in emerging fields including neuroimaging and computational neuroscience. Such studies, he said, would complement the outstanding clinical papers AJP is already known for.

“It is not just about integrating clinical and basic research,” Kalin said of his vision for the journal during a recent interview with Psychiatric News. While other journals in psychiatry are emphasizing studies with larger and larger sample sizes, “AJP wants to publish studies that will stimulate people to look at psychiatric disorders from a new perspective,” he said.

Kalin’s inaugural editor’s selection—“Cerebellar-Prefrontal Network Connectivity and Negative Symptoms in Schizophrenia” by Roscoe Brady, M.D., Ph.D., and colleagues—provides an example of how technologies can be combined to further the understanding of psychiatric illness and test new treatments.

Brady and colleagues demonstrated that the amount of disruption in a neural circuit that connects the cerebellum and the right dorsolateral prefrontal cortex correlated with the severity of negative symptoms such as depression and social withdrawal in schizophrenia patients. When the researchers targeted this circuit with transcranial magnetic stimulation in a sample of 11 patients with schizophrenia, they found that the patients experienced a reduction in negative symptoms.

“This study provides a new way of thinking about the most disabling symptoms of schizophrenia, which are the negative symptoms,” Kalin said.

The top pick from 2019 that Deputy Editor Elisabeth Binder, M.D., Ph.D., chose to highlight encourages readers to think about the role that a long-overlooked brain region known as the choroid plexus might play in psychosis. This small cluster of cells and blood vessels both manufactures cerebrospinal fluid and forms the barrier between the brain and spinal column.

Nearly 100 years ago, researchers in Japan proposed that the choroid plexus might be involved in schizophrenia, but since then almost no additional research has been done.

Paulo Lizano, M.D., Ph.D., and colleagues used brain imaging to quantify the volumes of the choroid plexus in over 1,400 individuals, which included patients with schizophrenia, their relatives without psychosis, and unrelated healthy controls. The imaging data revealed that the choroid plexus is significantly larger in patients with psychosis compared with their relatives or healthy people without psychosis. Additional tests revealed that greater choroid plexus volume correlated with worse performance on cognitive tests in these patients.

“This carefully executed study encourages further investigations in the burgeoning field of choroid plexus research in psychiatry and inspires a series of clinical and basic research follow-up experiments,” Binder wrote.

Two other articles highlighted this year focus on novel strategies to address substance use disorders.

Deputy Editor Kathleen Brady, M.D., Ph.D., selected a study by Elias Dakwar, M.D., and colleagues at Columbia University Medical Center that explored ketamine as an adjunct to behavioral therapy for cocaine use disorder. Dakwar and colleagues found that participants who received a single infusion of ketamine at the start of a five-week course on mindfulness-based relapse prevention had significantly more abstinence, fewer cravings, and less risk of relapse than those given an infusion of the sedative midazolam (See story).

Brady noted the need for caution given ketamine’s risk of abuse, but she added that she found these findings provocative. “[T[he fact that this study showed robustly positive results in decreasing cocaine use and craving across a number of different outcomes is reason for optimism in the treatment of a disorder for which hundreds of agents have been tested, yet no treatments have been approved by the U.S. Food and Drug Administration,” she wrote.

Deputy Editor Carolyn Rodriguez, M.D., Ph.D., is no stranger to the therapeutic promise of novel compounds (Rodriguez has studied ways ketamine might be used to reduce symptoms of obsessive-compulsive disorder), so it may not be surprising that she selected a study from Yasmin Hurd, Ph.D., and colleagues at the Icahn School of Medicine at Mount Sinai looking at cannabidiol (CBD) as an opioid treatment. “The devastating consequences of the opioid crisis underscore the urgent need for novel therapeutics to break the cycle of addiction,” Rodriguez wrote.

Building on their preclinical research in mice and humans, Hurd and colleagues tested the effects of acute and protracted CBD administration on craving and anxiety among individuals with heroin use disorder. Participants who got a dose of either 400 mg or 800 mg oral CBD showed significantly lower cue-induced cravings and anxiety within one to two hours after ingestion compared with those who took placebo. The effects of a single dose diminished after 24 hours, but after receiving three daily CBD doses, participants had lower cravings for up to seven days.

The studies highlighted above, as well as the selections from deputy editors David Lewis, M.D., Daniel Pine, M.D., and Madhukar Trivedi, M.D. (see box above) represent the breadth and creativity of research published in AJP, Kalin said. He emphasized, however, that all the editors had a difficult time making their personal choices from the list of outstanding papers published this past year.

“I have been extremely impressed with both the quality of papers I have seen so far and in the great team I work with,” Kalin said. That includes his deputy editors as well as Executive Editor Michael Roy and the APA editorial staff, who Kalin noted are critical to the journal’s success.

“I am looking forward to year two, and though it will be difficult, I hope I can raise the bar for AJP even more.” ■