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Castro Martínez JC, Santamaría-García H. Understanding mental health through computers: An introduction to computational psychiatry. Front Psychiatry 2023; 14:1092471. [PMID: 36824671 PMCID: PMC9941647 DOI: 10.3389/fpsyt.2023.1092471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Computational psychiatry recently established itself as a new tool in the study of mental disorders and problems. Integration of different levels of analysis is creating computational phenotypes with clinical and research values, and constructing a way to arrive at precision psychiatry are part of this new branch. It conceptualizes the brain as a computational organ that receives from the environment parameters to respond to challenges through calculations and algorithms in continuous feedback and feedforward loops with a permanent degree of uncertainty. Through this conception, one can seize an understanding of the cerebral and mental processes in the form of theories or hypotheses based on data. Using these approximations, a better understanding of the disorder and its different determinant factors facilitates the diagnostics and treatment by having an individual, ecologic, and holistic approach. It is a tool that can be used to homologate and integrate multiple sources of information given by several theoretical models. In conclusion, it helps psychiatry achieve precision and reproducibility, which can help the mental health field achieve significant advancement. This article is a narrative review of the basis of the functioning of computational psychiatry with a critical analysis of its concepts.
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Affiliation(s)
- Juan Camilo Castro Martínez
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Hernando Santamaría-García
- Ph.D. Programa de Neurociencias, Departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana, Bogotá, Colombia
- Centro de Memoria y Cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
- Global Brain Health Institute, University of California, San Francisco – Trinity College Dublin, San Francisco, CA, United States
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2
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Nussbaum AM. Questionable Agreement: The Experience of Depression and DSM-5 Major Depressive Disorder Criteria. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2020; 45:623-643. [PMID: 33206179 DOI: 10.1093/jmp/jhaa025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Immediately before the release of DSM-5, a group of psychiatric thought leaders published the results of field tests of DSM-5 diagnostic criteria. They characterized the interrater reliability for diagnosing major depressive disorder by two trained mental health practitioners as of "questionable agreement." These field tests confirmed an open secret among psychiatrists that our current diagnostic criteria for diagnosing major depressive disorder are unreliable and neglect essential experiences of persons in depressive episodes. Alternative diagnostic criteria exist, but psychiatrists rarely encounter them, forestalling the discipline's epistemological crisis. In Alsadair MacIntyre's classic essay, such crises occur in science when a person encounters a rival schemata that is incompatible with their current schemata and subsequently constructs a narrative that allows them to reconstruct their own tradition. In search of rival schemata that are in conversation with their own tradition, psychiatric practitioners can utilize alternative diagnostic criteria like the Cultural Formulation Interview, embrace an epistemologically humble psychiatry, and attend to the narrative experience of a person experiencing a depressive episode.
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Carrier F. Réduction diagnostique en psychiatrie : enjeux éthiques et implications pour la clinique. CANADIAN JOURNAL OF BIOETHICS 2020. [DOI: 10.7202/1073548ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cet article aborde le thème de la réduction diagnostique en psychiatrie, un processus par lequel des situations forcément complexes et multifactorielles sont réduites à des conditions médicales. Ce processus présente des écueils évidents, mais aussi certaines fonctions, notamment celle de circonscrire ce sur quoi porte légitimement ou non le jugement psychiatrique. Nous discuterons parallèlement des distinctions entre souffrance narrative et pathologique, ainsi que des jugements moraux et médicaux qui peuvent leur être associés. Ceci mènera à argumenter en faveur d’une attitude pragmatique par rapport à la classification diagnostique psychiatrique, c’est-à-dire par rapport au vocable standardisé servant à catégoriser et identifier les troubles dits de santé mentale. Nous dégagerons par la suite des implications pour la pratique clinique, notamment qu’une discussion transparente de ces aspects avec certains patients peut bénéficier à la relation thérapeutique et permettre aux personnes atteintes de troubles mentaux d’envisager un narratif qui n’ait pas à se limiter à une condition psychiatrique ni à se constituer par le rejet de cette dernière, mais puisse lui laisser une place légitime. Ultimement, nous souhaitons que la sensibilisation des cliniciens aux enjeux éthiques inhérents au diagnostic psychiatrique permette de limiter le caractère potentiellement péjoratif et déshumanisant de la réduction diagnostique, en leur permettant d’adopter des attitudes réflexives et transparentes sur ces questions.
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Affiliation(s)
- Félix Carrier
- Département de psychiatrie et de neurosciences, Université Laval, Laval, Québec, Canada
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Szechtman H, Harvey BH, Woody EZ, Hoffman KL. The Psychopharmacology of Obsessive-Compulsive Disorder: A Preclinical Roadmap. Pharmacol Rev 2020; 72:80-151. [PMID: 31826934 DOI: 10.1124/pr.119.017772] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This review evaluates current knowledge about obsessive-compulsive disorder (OCD), with the goal of providing a roadmap for future directions in research on the psychopharmacology of the disorder. It first addresses issues in the description and diagnosis of OCD, including the structure, measurement, and appropriate description of the disorder and issues of differential diagnosis. Current pharmacotherapies for OCD are then reviewed, including monotherapy with serotonin reuptake inhibitors and augmentation with antipsychotic medication and with psychologic treatment. Neuromodulatory therapies for OCD are also described, including psychosurgery, deep brain stimulation, and noninvasive brain stimulation. Psychotherapies for OCD are then reviewed, focusing on behavior therapy, including exposure and response prevention and cognitive therapy, and the efficacy of these interventions is discussed, touching on issues such as the timing of sessions, the adjunctive role of pharmacotherapy, and the underlying mechanisms. Next, current research on the neurobiology of OCD is examined, including work probing the role of various neurotransmitters and other endogenous processes and etiology as clues to the neurobiological fault that may underlie OCD. A new perspective on preclinical research is advanced, using the Research Domain Criteria to propose an adaptationist viewpoint that regards OCD as the dysfunction of a normal motivational system. A systems-design approach introduces the security motivation system (SMS) theory of OCD as a framework for research. Finally, a new perspective on psychopharmacological research for OCD is advanced, exploring three approaches: boosting infrastructure facilities of the brain, facilitating psychotherapeutic relearning, and targeting specific pathways of the SMS network to fix deficient SMS shut-down processes. SIGNIFICANCE STATEMENT: A significant proportion of patients with obsessive-compulsive disorder (OCD) do not achieve remission with current treatments, indicating the need for innovations in psychopharmacology for the disorder. OCD may be conceptualized as the dysfunction of a normal, special motivation system that evolved to manage the prospect of potential danger. This perspective, together with a wide-ranging review of the literature, suggests novel directions for psychopharmacological research, including boosting support systems of the brain, facilitating relearning that occurs in psychotherapy, and targeting specific pathways in the brain that provide deficient stopping processes in OCD.
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Affiliation(s)
- Henry Szechtman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Brian H Harvey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Erik Z Woody
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Kurt Leroy Hoffman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
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5
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Gozé T, Moskalewicz M, Schwartz MA, Naudin J, Micoulaud-Franchi JA, Cermolacce M. Reassessing "Praecox Feeling" in Diagnostic Decision Making in Schizophrenia: A Critical Review. Schizophr Bull 2019; 45:966-970. [PMID: 30476340 PMCID: PMC6737542 DOI: 10.1093/schbul/sby172] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The "Praecox Feeling" (PF) is a classical concept referring to a characteristic feeling of bizarreness experienced by a psychiatrist while encountering a person with schizophrenia. Although the PF used to be considered a core symptom of the schizophrenia spectrum, it fell into disuse since the spread of operationalized diagnostic methods (Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases systems). In contemporary research on schizophrenia, it remains largely unaddressed. This critical review investigates the evolution of the PF in historical and contemporary literature and presents an exhaustive overview of empirical evidence on its prevalence in clinical decision making, its reliability and validity. The review demonstrates that the PF is a real determinant of medical decision making in schizophrenia, although, without further research, there is not enough evidence to sustain its rehabilitation as a reliable and valid clinical criterion. PF-like experiences should not be opposed to any criteriological attitude in diagnosis and would be clinically useful if the conditions of descriptive precaution and rigorous epistemology are maintained. The aim of teaching clinical expertise is to transform this basic experience into a well-founded clinical judgment. Finally, the article discusses the possible relevance of the PF for basic science and clinical research according to a translational approach inspired by phenomenology.
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Affiliation(s)
- Tudi Gozé
- Department of Psychiatry, Psychotherapies, Art Therapy, Toulouse University Hospital, Toulouse, France,Equipe de Recherche sur les Rationalités Philosophiques et les Savoirs (ERRaPhiS-EA 3051), Toulouse University–Jean Jaurès, Toulouse, France,To whom correspondence should be addressed; CHU Purpan–Pavillon SENAC–Place Baylac, TSA 40031-31059, Toulouse Cedex 9, France; tel: 33-(0)-668-386-674, fax: 33-(0)-561-772-282, e-mail:
| | - Marcin Moskalewicz
- The Oxford Research Centre in the Humanities (TORCH), University of Oxford, Oxford, UK,Department of Social Sciences, Poznan University of Medical Sciences, Poznan, Poland
| | - Michael A Schwartz
- Department of Psychiatry and Behavioral Sciences, Texas A&M Health Science Center, Texas A&M College of Medicine, Round Rock, TX,Department of Humanities in Medicine, Texas A&M Health Science Center, Texas A&M College of Medicine, Round Rock, TX
| | - Jean Naudin
- Department of Psychiatry, Hôpital Sainte-Marguerite, Aix-Marseilles University, Marseilles, France,Laboratory of Public Health (Health, Chronic Diseases and Quality of Life, EA 3279), Aix-Marseilles University, Marseilles, France
| | | | - Michel Cermolacce
- Department of Psychiatry, Hôpital Sainte-Marguerite, Aix-Marseilles University, Marseilles, France,Institut de Neurosciences des Systèmes (INS, INSERM UMR 1106), Aix-Marseille University, Marseilles, France
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5-Methoxy-N,N-dimethyltryptamine: An Ego-Dissolving Endogenous Neurochemical Catalyst of Creativity. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s41470-019-00063-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Woody EZ, Hoffman KL, Szechtman H. Obsessive compulsive disorder (OCD): Current treatments and a framework for neurotherapeutic research. ADVANCES IN PHARMACOLOGY 2019; 86:237-271. [PMID: 31378254 DOI: 10.1016/bs.apha.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
We briefly review current approaches to the diagnosis and treatment of OCD, noting their lack of a strong theoretical foundation. In keeping with the Research Domain Criteria project (RDoC) calls for reconceptualizing psychopathology in ways that better link up with normal brain systems, we advance an adaptationist, brain-network perspective on OCD and propose that OCD represents a dysfunction in the stopping dynamics of a normal brain network that evolved to handle potential danger. We then illustrate how this theoretical perspective can be used to organize possibilities for research on neurotherapeutics for OCD and suggest novel directions for future work.
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Affiliation(s)
- Erik Z Woody
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Kurt Leroy Hoffman
- Centro de Investigación en Reproducción Animal (CIRA), Universidad Autónoma de Tlaxcala-CINVESTAV, Tlaxcala, Mexico
| | - Henry Szechtman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
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Gozé T, Moskalewicz M, Schwartz MA, Naudin J, Micoulaud-Franchi JA, Cermolacce M. Is "praecox feeling" a phenomenological fossil? A preliminary study on diagnostic decision making in schizophrenia. Schizophr Res 2019; 204:413-414. [PMID: 30072280 DOI: 10.1016/j.schres.2018.07.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/21/2018] [Accepted: 07/27/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Tudi Gozé
- Department of Psychiatry, Psychotherapies, Art-therapy, Toulouse University Hospital, France.
| | - Marcin Moskalewicz
- Department of Social Sciences, Poznan University of Medical Sciences, Poland; The Oxford Research Centre in the Humanities (TORCH), University of Oxford, UK
| | - Michael A Schwartz
- Department of Psychiatry and Behavioral Sciences, Department of Humanities in Medicine, Texas A&M Health Science Center, Texas A&M School of Medicine, USA
| | - Jean Naudin
- Department of Psychiatry, Hôpital Sainte-Marguerite, Aix-Marseilles University, Marseilles, France; Laboratory of Public Health (Health, Chronic Diseases and Quality of Life, EA 3279), Aix-Marseilles University, Marseilles, France
| | - Jean-Arthur Micoulaud-Franchi
- Clinique du sommeil, Services d'explorations fonctionnelles du système nerveux, Bordeaux University Hospital, France
| | - Michel Cermolacce
- Department of Psychiatry, Hôpital Sainte-Marguerite, Aix-Marseilles University, Marseilles, France; Laboratory of Cognitive Neurosciences (LNC, Centre National de la Recherche Scientifique 7291), Aix-Marseilles University, Marseilles, France
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9
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Fingelkurts AA, Fingelkurts AA. Brain space and time in mental disorders: Paradigm shift in biological psychiatry. Int J Psychiatry Med 2019; 54:53-63. [PMID: 30073888 DOI: 10.1177/0091217418791438] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Contemporary psychiatry faces serious challenges because it has failed to incorporate accumulated knowledge from basic neuroscience, neurophilosophy, and brain-mind relation studies. As a consequence, it has limited explanatory power, and effective treatment options are hard to come by. A new conceptual framework for understanding mental health based on underlying neurobiological spatial-temporal mechanisms of mental disorders (already gained by the experimental studies) is beginning to emerge.
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Cratsley K. The Ethical and Empirical Status of Dimensional Diagnosis: Implications for Public Mental Health? NEUROETHICS-NETH 2018. [DOI: 10.1007/s12152-018-9390-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Singh Sen M, Sahoo S, Aggarwal S, Singh SM. Reply to: Myalgic Encephalomyelitis, chronic fatigue syndrome or systemic exercise intolerance disease: What's in a name? Asian J Psychiatr 2016; 24:69-70. [PMID: 27931912 DOI: 10.1016/j.ajp.2016.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 08/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Mahadev Singh Sen
- Department of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Shivali Aggarwal
- Department of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Shubh Mohan Singh
- Department of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
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Martin MS, Hynes K, Hatcher S, Colman I. Diagnostic Error in Correctional Mental Health. JOURNAL OF CORRECTIONAL HEALTH CARE 2016; 22:109-17. [DOI: 10.1177/1078345816634327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michael S. Martin
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Katie Hynes
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian Colman
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Möller-Leimkühler AM, Möller HJ, Maier W, Gaebel W, Falkai P. EPA guidance on improving the image of psychiatry. Eur Arch Psychiatry Clin Neurosci 2016; 266:139-54. [PMID: 26874959 DOI: 10.1007/s00406-016-0678-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
This paper explores causes, explanations and consequences of the negative image of psychiatry and develops recommendations for improvement. It is primarily based on a WPA guidance paper on how to combat the stigmatization of psychiatry and psychiatrists and a Medline search on related publications since 2010. Furthermore, focussing on potential causes and explanations, the authors performed a selective literature search regarding additional image-related issues such as mental health literacy and diagnostic and treatment issues. Underestimation of psychiatry results from both unjustified prejudices of the general public, mass media and healthcare professionals and psychiatry's own unfavourable coping with external and internal concerns. Issues related to unjustified devaluation of psychiatry include overestimation of coercion, associative stigma, lack of public knowledge, need to simplify complex mental issues, problem of the continuum between normality and psychopathology, competition with medical and non-medical disciplines and psychopharmacological treatment. Issues related to psychiatry's own contribution to being underestimated include lack of a clear professional identity, lack of biomarkers supporting clinical diagnoses, limited consensus about best treatment options, lack of collaboration with other medical disciplines and low recruitment rates among medical students. Recommendations are proposed for creating and representing a positive self-concept with different components. The negative image of psychiatry is not only due to unfavourable communication with the media, but is basically a problem of self-conceptualization. Much can be improved. However, psychiatry will remain a profession with an exceptional position among the medical disciplines, which should be seen as its specific strength.
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Affiliation(s)
- A M Möller-Leimkühler
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, 80336, Munich, Germany.
| | - H-J Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, 80336, Munich, Germany.
| | - W Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine-University Düsseldorf, Bergische Landstraße 2, 40629, Düsseldorf, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, 80336, Munich, Germany
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Sulzer SH, Muenchow E, Potvin A, Harris J, Gigot G. Improving patient-centered communication of the borderline personality disorder diagnosis. J Ment Health 2015; 25:5-9. [PMID: 26360788 PMCID: PMC4937878 DOI: 10.3109/09638237.2015.1022253] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) has historically been difficult to diagnose, and laden with stigma, leading to a variety of clinical responses to patients who present with symptoms. AIMS (1) To understand how clinicians communicate the diagnosis of BPD with patients. (2) To compare these practices with patient communication preferences. (3) To use patient preferences to evaluate clinician practices. METHODS Semi-structured interviews with mental health care providers and experts (n = 32) were compared with patients (n = 10) and primary patient-written accounts (n = 22). Grounded theory was used to explore causal pathways between clinical practice and patient responses. RESULTS The majority of clinicians sampled did not actively share the BPD diagnosis with their patients, even when they felt it was the most appropriate diagnosis. The majority of patients wanted to be told that they had the disorder, as well as have their providers discuss the stigma they would face. Patients who later discovered that their diagnosis had been withheld consistently left treatment. CONCLUSIONS Clinicians believed that by not using the BPD label they were acknowledging or sidestepping the stigma of the condition. However, from the perspective of patients, open communication was essential for maintaining a therapeutic relationship.
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Affiliation(s)
- Sandra H Sulzer
- a Department of Family Medicine , University of Wisconsin-Madison , Madison , WI , USA
| | | | - Annabelle Potvin
- b National Alliance on Mental Illness , Minneapolis , MN , USA , and
| | - Jessica Harris
- c University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research , Chapel Hill , NC , USA
| | - Grant Gigot
- a Department of Family Medicine , University of Wisconsin-Madison , Madison , WI , USA
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Ross DA, Alpert MD, Edens EL. A narrative-based approach to teaching diagnostic criteria. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2014; 38:706-708. [PMID: 25501344 DOI: 10.1007/s40596-014-0131-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 04/03/2014] [Indexed: 06/04/2023]
Affiliation(s)
- David A Ross
- School of Medicine, Yale University, New Haven, CT, USA,
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Abstract
BACKGROUND Current diagnostic systems for mental disorders rely upon presenting signs and symptoms, with the result that current definitions do not adequately reflect relevant neurobiological and behavioral systems--impeding not only research on etiology and pathophysiology but also the development of new treatments. DISCUSSION The National Institute of Mental Health began the Research Domain Criteria (RDoC) project in 2009 to develop a research classification system for mental disorders based upon dimensions of neurobiology and observable behavior. RDoC supports research to explicate fundamental biobehavioral dimensions that cut across current heterogeneous disorder categories. We summarize the rationale, status and long-term goals of RDoC, outline challenges in developing a research classification system (such as construct validity and a suitable process for updating the framework) and discuss seven distinct differences in conception and emphasis from current psychiatric nosologies. SUMMARY Future diagnostic systems cannot reflect ongoing advances in genetics, neuroscience and cognitive science until a literature organized around these disciplines is available to inform the revision efforts. The goal of the RDoC project is to provide a framework for research to transform the approach to the nosology of mental disorders.
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Cosgrove VE, Suppes T. Informing DSM-5: biological boundaries between bipolar I disorder, schizoaffective disorder, and schizophrenia. BMC Med 2013; 11:127. [PMID: 23672587 PMCID: PMC3653750 DOI: 10.1186/1741-7015-11-127] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 04/19/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) opted to retain existing diagnostic boundaries between bipolar I disorder, schizoaffective disorder, and schizophrenia. The debate preceding this decision focused on understanding the biologic basis of these major mental illnesses. Evidence from genetics, neuroscience, and pharmacotherapeutics informed the DSM-5 development process. The following discussion will emphasize some of the key factors at the forefront of the debate. DISCUSSION Family studies suggest a clear genetic link between bipolar I disorder, schizoaffective disorder, and schizophrenia. However, large-scale genome-wide association studies have not been successful in identifying susceptibility genes that make substantial etiological contributions. Boundaries between psychotic disorders are not further clarified by looking at brain morphology. The fact that symptoms of bipolar I disorder, but not schizophrenia, are often responsive to medications such as lithium and other anticonvulsants must be interpreted within a larger framework of biological research. SUMMARY For DSM-5, existing nosological boundaries between bipolar I disorder and schizophrenia were retained and schizoaffective disorder preserved as an independent diagnosis since the biological data are not yet compelling enough to justify a move to a more neurodevelopmentally continuous model of psychosis.
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Affiliation(s)
- Victoria E Cosgrove
- Bipolar and Depression Research Program, VA Palo Alto Health Care System, 3801 Miranda Avenue (151T), Palo Alto, CA 94304, USA
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Abstract
PURPOSE OF REVIEW To provide an update on the conceptual status of attenuated psychosis syndrome (APS) as a psychiatric disorder. RECENT FINDINGS In May 2012, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Task Force announced that the planned introduction of APS as a new diagnosis in DSM-5 was cancelled and that APS was being moved to 'Section III' of the manual as a diagnostic construct requiring more work. Recent studies of APS have reflected this uncertainty and debate over its validity. SUMMARY Before and after the decision in May 2012 to remove APS as a new diagnosis in DSM-5, scientific work has proceeded in a robust manner to shore up the validity of APS as a diagnostic construct. Recent work on APS has revolved around a series of unresolved questions: the actual incidence of conversion of APS to full-blown psychosis, the identification of the subgroup that will convert, the appropriate treatment for APS, the ability of treatment to prevent conversion to psychosis, the wide range of long-term outcomes of APS and finally the decision whether to include APS as a formal psychiatric diagnosis. Although the debate continues, a substantial number of the major researchers have argued that APS does not yet enjoy a degree of validity that warrants inclusion as a formal diagnosis.
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Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue. Part 4: general conclusion. Philos Ethics Humanit Med 2012; 7:14. [PMID: 23249629 PMCID: PMC3563521 DOI: 10.1186/1747-5341-7-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 11/20/2012] [Indexed: 06/01/2023] Open
Abstract
In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis - the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances' responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first - what is the nature of psychiatric illness - and that in some manner all further questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders - and future nosologies - as far more complex and uncertain than we have imagined.
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Affiliation(s)
- James Phillips
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Allen Frances
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St, Durham, NC, 27710, USA
| | - Michael A Cerullo
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH, 45219, USA
| | - John Chardavoyne
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Hannah S Decker
- Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA
| | - Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Nassir Ghaemi
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Gary Greenberg
- Human Relations Counseling Service, 400 Bayonet Street Suite #202, New London, CT, 06320, USA
| | - Andrew C Hinderliter
- Department of Linguistics, University of Illinois, Urbana-Champaign, 4080 Foreign Languages Building, 707 S Mathews Ave, Urbana, IL, 61801, USA
| | - Warren A Kinghorn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St, Durham, NC, 27710, USA
- Duke Divinity School, Box 90968, Durham, NC, 27708, USA
| | - Steven G LoBello
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
| | - Elliott B Martin
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Aaron L Mishara
- Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL, 60654, USA
| | - Joel Paris
- Department of Psychiatry, Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, McGill University, 4333 cote Ste. Catherine, Montreal, QC, H3T1E4, Canada
| | - Joseph M Pierre
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Ronald W Pies
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY, 13210, USA
| | - Harold A Pincus
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA
- New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY, 10032, USA
- Rand Corporation, 1776 Main St Santa Monica, California, 90401, USA
| | - Douglas Porter
- Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA, 70113, USA
| | - Claire Pouncey
- Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA
| | - Michael A Schwartz
- Department of Psychiatry, Texas A & M College of Medicine, 4110 Guadalupe Street, Austin, TX, 78751, USA
| | - Thomas Szasz
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY, 13210, USA
| | - Jerome C Wakefield
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
- Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY, 10016, USA
| | - G Scott Waterman
- Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, VT, 05405, USA
| | - Owen Whooley
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St, New Brunswick, NJ, 08901, USA
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
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