It’s been a really interesting year for psychiatry, to say the least. Because of that we decided to poll our editorial board and some of our most widely read contributors and their colleagues to get a very unscientific survey of this year’s most meaningful issues. I have a few of my own that I’ll save till the end, but here are some of our contributors’ responses.
Drs. Ronald Pies, Barbara Schildkrout, and Paul Summergrad all nominated the genomics and proteomics research that has given rise to incredible advances in our understanding of major psychiatric disorders like schizophrenia, bipolar disorder, and major depression. One study, cited by Ron Pies, identified genes that seem to commonly affect all 3 of these disorders and among other things relate to control of brain cell communication and immune responsiveness.1 Another report, mentioned by both Schildkrout and Summergrad, focuses on the role of the C4A gene in the development of schizophrenia and discusses the implication of the genetic findings and potential approaches this suggested disease mechanism has for treatment.2,3
One compelling aspect of these examples is the fact that the results come from exceptionally large groups of subjects. I recently heard a talk by one of the researchers describing a study with 40,000 patients. He noted that the state of the art level of expectation of significance in current genomic research now is 5 × 10-8. That’s an incredible change from commonly used research standards of 10-2.
Psychotomimetic agents for treatment
Drs. James Knoll, Steve Koh, and Michael First all mentioned work being done with ketamine for rapid-onset antidepressant effect, and its possible use in quickly ameliorating suicidal ideation. Ketamine, which got its very negative reputation in the 1960s, seems to work by an as-yet unknown mechanism. This research is important not only in the study of ketamine itself, but because, as James Knoll wrote, it offers an opening into studying other psychotomimetic agents, which have gone unexplored in recent decades.
Neuromodulation, imaging, biomarkers
Dr. Helen Lavretsky’s vote goes to the rapidly expanding field of neuromodulation research, and she refers us to 2 important books on the subject.4,5 The field offers a promise of mood and cognitive benefits for treatment of a variety of disorders. I can personally vouch for the importance of further work in this area, since in my own lab, we have used both rTMS and neurofeedback training in several studies that found benefits in the treatment of ADHD or autism.6,7
Other important areas of neuroscience research were mentioned by Dr. Jerald Kay. One study he notes from Nature, relates to the Human Connectome Project.8 Several hundred healthy young adults were studied, and 97 previously unidentified new specific areas in the cortex were found. He also highlights a study in which the relationship between early life stress and amygdala hyper-reactivity is investigated.9 While the lasting biological effects of early life stress have been known for decades, this study predicts with more than 80% accuracy the likely response to antidepressants in this population. It emphasizes the rapidly intensifying area of research aimed at identifying biomarkers associated with either specific diseases or treatment interventions. The study also suggests the potential utility of combining biological markers with other historical and/or psychological information to predict treatment response.
Several contributors voted for the long overdue attention to the epidemic of opiate addiction. I had written about this in an editorial earlier this year. In that column, I said that I was glad this issue was finally being addressed but chastised both the government and large medical organizations like the AMA that ignored the problem, about which psychiatrists had been long aware, which had spiraled out of control years ago.10 Dr. Thomas Kosten cites an article by Nora Volkow and colleagues11 that offers convincing evidence to a broad medical readership that standard prescribing practices for opiates are not tenable. They also highlight both prescribing practice changes and policy changes, including much better education starting at the medical school level and research aimed at developing new potent, but nonaddictive pain medications and nonpharmacological pain-treatment strategies. Nearly all her recommendations are embodied in the FDA and CDC guidelines for opiate prescribing.12
1. Darby MM, Yolken RH, Sabunciyan S. Consistently altered expression of gene sets in postmortem brains of individuals with major psychiatric disorders. Transl Psychiatry. September 2016. http://www.nature.com/tp/journal/v6/n9/full/tp2016173a.html. Accessed November 10, 2016.
2. Sekar A, Bialas AR, de Rivera H, et al. Schizophrenia risk from complex variation of complement component 4. Nature. 2016;530:177-183.
3. Mukherjee S. Runs in the family. New Yorker. March 2016. http://www.newyorker.com/magazine/2016/03/28/the-genetics-of-schizophrenia. Accessed November 10, 2016.
4. Hamami C, Holtzheimer P, Lozano AM, Mayberg H, eds. Neuromodulation in Psychiatry. 1st ed. London, UK: Wiley-Blackwell; 2016.
5. Siegel DJ. Mind: A Journey to the Heart of Being Human. 1st ed. New York: WW Norton; 2016.
6. Sokhadze EM, El-Baz A, Tasman A, et al. Neuromodulation integrating rTMS and neurofeedback for the treatment of autism spectrum disorder: an exploratory study. Appl Psychophysiol Biofeedback. 2014;39:3-4.
7. Hillard B, El-Baz A, Sears L, et al. Neurofeedback training aimed to improve focused attention and alertness in children with ADHD: a study of relative power of EEG rhythms using custom-made software application. Clin EEG Neurosci. 2013;44:193-202.
8. Glasser MF, Coalson TS, Robinson EC, et al. A multi-modal parcellation of human cerebral cortex. Nature. 2016;536:171-178.
9. Goldstein-Piekarski AN, Korgaonkar MS, Green E, et al. Human amygdala engagement moderated by early life stress exposure is a biobehavioral target for predicting recovery on antidepressants. Proc Natl Acad Sci. 2016;113:11955-11960.
10. Tasman A. At last . . . I hope. Psychiatric Times. May 2016. http://www.psychiatrictimes.com/psychopharmacology/last-i-hope. Accessed November 10, 2016.
11. Volkow ND, McLellan T. Opioid abuse in chronic pain: misconceptions and mitigation strategies. N Engl J Med. 2016;374:1253-1263.
12. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain: United States, 2016. http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm. Accessed November 10, 2016.
13. Pies RW. Physician-assisted dying for adolescents with intractable mental illness? Psychiatric Times. May 2016. http://www.psychiatrictimes.com/blogs/physician-assisted-dying-adolescents-intractable-mental-illness. Accessed November 10, 2016.
14. Barnard A. How Omran Daqneesh, 5, became a symbol of Aleppo’s suffering. August 2016. http://www.nytimes.com/2016/08/19/world/middleeast/omran-daqneesh-syria-aleppo.html. Accessed November 10, 2016.
15. US Department of Health and Human Services. Mental Health and Substance Use Disorder Parity Task Force: Final Report. http://www.hhs.gov/about/agencies/advisory-committees/parity/index.html#report. Accessed November 10, 2016.
16. Tasman A. Whistle while you work, Stevenson’s a jerk. Psychiatric Times. September 2016. http://www.psychiatrictimes.com/cultural-psychiatry/whistle-while-you-work-stevensons-jerk. Accessed November 10, 2016.
17. Estes MK, McAllister AK. Maternal Th17 cells take a toll on baby’s brain. Science. 2016;351:919-920.