Fifty-Fifty

Alongside a special 2017 celebratory series of articles (Retrospectives – see below), we begin this commemorative year with a number of interesting opinion pieces to get your neurons firing.

The debate by Hatcher (this issue) draws attention to the importance of implementing guidelines. In recent years, under the auspices of The Royal Australian and New Zealand College of Psychiatrists, the Australian & New Zealand Journal of Psychiatry (ANZJP) has published a series of guidelines for managing psychiatric disorders. Beginning with eating disorders in 2014, and then mood disorders in 2015, last year featured two sets of guidelines for dealing with schizophrenia and deliberate self-harm. These are now in the process of being ‘translated’ into digestible documents for patients, which will be called Community Guides. Interestingly, the mood disorders guideline will serve as the foundation for two community guides: one for depression and another for bipolar disorder. This is good news but, as pointed out by Simon Hatcher, their broader implementation and, more importantly, the impact they have on practice, is yet to be determined. The key problem facing guidelines when attempting to implement them in practice is how to measure what difference they make. This requires some baseline knowledge of clinical practice and remarkably in most instances this is not already known and not easily mapped with sufficient detail or accuracy, and so identifying a change effected by implementing guidelines is all the more challenging.

An equally incisive debate by Murray (this issue) questions the validity of the seasonal affective disorder construct. The article draws attention to the varied and interesting research that is taking place in this field and attempts to shed light on the complex interactions that occur between nature’s seasons and circadian rhythms that perhaps play a role in the aetiopathogenesis and treatment of mood disorders. Being a fellow musician, a drummer to be precise, Murray is licensed to use the term ostinato, when referring to the repetitive rhythm that underpins almost all of our basic behaviours. In an equally provocative Viewpoint, Hegerl and Hensch (this issue) revitalize the debate concerning the therapeutic use of stimulants for the treatment of mood disorders. They question their specificity and ask, ‘Why do stimulants not work in typical depression?’ Their percipient article points out that there are no randomized controlled trials supporting the belief that stimulants have specific antidepressant effects. Indeed, recent trials have failed to show benefits even with adjunctive use of stimulants alongside antidepressants. Intriguingly, they identify the fog of psychopathology as one possible cause for the persistence of the myth that stimulants have antidepressant effects. However, they also suggest that greater discrimination of mood disorder subtypes may identify patients more likely to benefit from the effects of stimulants, and argue for separation of patients that have upregulated versus downregulated arousal. Together these absorbing pieces underscore an important ongoing mission of the ANZJP, namely to question the Zeitgeist and maintain a curious perspective on clinical and research developments in psychiatry.

The Key Review in this issue of the ANZJP by Andrews and colleagues discusses the role of inflammatory cytokines in major depressive disorder and reports the findings of a rigorous case control study. Similar ideas have been posited in relation to bipolar disorder and schizophrenia suggesting that neuroinflammation may be a common pathway leading to the manifestation of a whole spectrum of psychiatric disorders. In addition to these thought-provoking excursions into mood disorders, the Editor’s Choice this month highlights an article on occipital bending in schizophrenia that is juxtaposed to an article in a similar vein that reports on an examination of schizoaffective disorder using surface-based brain morphometry and diffusion tensor imaging. The imaging theme is continued in the article by da Silveira and colleagues (this issue) who examine the neurochemical changes in the hippocampus in bipolar disorder using proton spectroscopy.

Emphasizing the importance of research that informs practice, Ionescu and colleagues (this issue) report on the findings from a study that investigates the use of ketamine in treatment-resistant depression. Such evidence is welcome given the use of ketamine remains contentious. Further controversy is featured in the correspondence section of the Journal, which then concludes with an Erudite Encounter that is not to be missed.

To mark 50 years of publication, a number of celebratory initiatives introduced in this issue will feature throughout the year. These include a new set of articles, a call to poets and a change to the cover and logo that will be used on articles in 2017.

Retrospectives (see Pursuing melancholia, this issue) are articles written by key opinion leaders who have been invited to provide an eclectic, but personal, account of a field within psychiatry, noting where relevant the specific contributions of the ANZJP during the last 50 years. They are intended to provide interesting insights and perspectives but, given their brevity, are not intended to be exhaustive. These pieces will showcase how psychiatry, as featured in the ANZJP, has made a significant impact on the world stage and facilitated understanding.

Another commemorative initiative is an invitation to readers to contribute poems of 50 words or less. These pieces, called ‘Fifty-Fifty’, can be on any aspect of psychiatry, but must be original poems that have not been published elsewhere. I encourage all readers, especially those with a flair for verse, to consider this invitation. If you have a poem you would like to submit, please send it directly to me at the Editorial Office address.

The ANZJP logo has been modified for this 50th commemorative year so as to identify those articles published this year and as a reminder of this achievement. This logo will also be used to identify key papers throughout the year, especially the Retrospectives, and will feature on the cover of the Journal. The latter will also take on a different look for the year as the brain is replaced by images from publications within the Journal over the past 50 years.

It is a pleasure and a privilege to be Editor of the ANZJP, but especially so in this coming year, during which I hope you will join the Editorial team and myself in honouring the Journal’s many achievements and the work of all those who have contributed to its success over the past half a century.