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Johansson Å, Andreassen OA, Brunak S, Franks PW, Hedman H, Loos RJ, Meder B, Melén E, Wheelock CE, Jacobsson B. Precision medicine in complex diseases-Molecular subgrouping for improved prediction and treatment stratification. J Intern Med 2023; 294:378-396. [PMID: 37093654 PMCID: PMC10523928 DOI: 10.1111/joim.13640] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Complex diseases are caused by a combination of genetic, lifestyle, and environmental factors and comprise common noncommunicable diseases, including allergies, cardiovascular disease, and psychiatric and metabolic disorders. More than 25% of Europeans suffer from a complex disease, and together these diseases account for 70% of all deaths. The use of genomic, molecular, or imaging data to develop accurate diagnostic tools for treatment recommendations and preventive strategies, and for disease prognosis and prediction, is an important step toward precision medicine. However, for complex diseases, precision medicine is associated with several challenges. There is a significant heterogeneity between patients of a specific disease-both with regards to symptoms and underlying causal mechanisms-and the number of underlying genetic and nongenetic risk factors is often high. Here, we summarize precision medicine approaches for complex diseases and highlight the current breakthroughs as well as the challenges. We conclude that genomic-based precision medicine has been used mainly for patients with highly penetrant monogenic disease forms, such as cardiomyopathies. However, for most complex diseases-including psychiatric disorders and allergies-available polygenic risk scores are more probabilistic than deterministic and have not yet been validated for clinical utility. However, subclassifying patients of a specific disease into discrete homogenous subtypes based on molecular or phenotypic data is a promising strategy for improving diagnosis, prediction, treatment, prevention, and prognosis. The availability of high-throughput molecular technologies, together with large collections of health data and novel data-driven approaches, offers promise toward improved individual health through precision medicine.
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Affiliation(s)
- Åsa Johansson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala university, Sweden
| | - Ole A. Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopment Research, University of Oslo, Oslo, Norway
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
- Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2200 Copenhagen, Denmark
| | - Paul W. Franks
- Genetic and Molecular Epidemiology Unit, Lund University Diabetes Centre, Department of Clinical Science, Lund University, Sweden
- Novo Nordisk Foundation, Denmark
| | - Harald Hedman
- Department of Medical Biosciences, Umeå University, Umeå, Sweden
| | - Ruth J.F. Loos
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Charles Bronfman Institute for Personalized Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Meder
- Precision Digital Health, Cardiogenetics Center Heidelberg, Department of Cardiology, University Of Heidelberg, Germany
| | - Erik Melén
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm
- Sachś Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Craig E Wheelock
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Göteborg, Sweden
- Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway
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2
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Acklin MW. Excursions in Rorschachlandia: Surveying the scientific and philosophical landscape of Hermann Rorschach's Psychodiagnostics. JOURNAL OF THE HISTORY OF THE BEHAVIORAL SCIENCES 2023; 59:148-170. [PMID: 36511395 DOI: 10.1002/jhbs.22235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 06/17/2023]
Abstract
This article examines the milieu of Hermann Rorschach's Psychodiagnostics (1921/2021) under development between 1911 and his death in 1922 and explores new evidence about the direction Rorschach's test might have taken after publication of Psychodiagnostics. This includes direct and indirect influences from turn of the century continental philosophy and science and innovative colleagues in the Swiss psychiatric and psychoanalytic societies. The availability of newly translated scholarship, including the correspondence between Ludwig Binswanger and Hermann Rorschach following the 1921 publication of Psychodiagnostics, Binswanger's posthumous 1923 commentary in the International Journal of Psychoanalysis, and recent new translation of Psychodiagnostics, permits a fresh appraisal of the milieu and foundations of Rorschach's development. Understanding these sources and influences opens new vistas in reappraising the nature of Rorschach's "test theory" which Rorschach considered undeveloped at the time of his death. This paper presents new evidence that, under the influence of Rorschach's close colleague, Ludwig Binswanger, the Geisteswissenschaften and phenomenology might have figured prominently in future developments. The paper concludes that Rorschach, preoccupied with considerations of kinesthetic subjectivity in his innovative conceptualization of human movement responses, was a nascent phenomenologist whose untimely death cut short further developments in his theory of the test.
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Affiliation(s)
- Marvin W Acklin
- Department of Psychiatry, John A. Burns Medical School & Independent Practice, Honolulu, Hawaii, USA
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3
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Chee KT, Ng QX. Case reports are valuable for psychiatry. Bipolar Disord 2022; 24:758-759. [PMID: 36064203 DOI: 10.1111/bdi.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fusar-Poli P, Manchia M, Koutsouleris N, Leslie D, Woopen C, Calkins ME, Dunn M, Tourneau CL, Mannikko M, Mollema T, Oliver D, Rietschel M, Reininghaus EZ, Squassina A, Valmaggia L, Kessing LV, Vieta E, Correll CU, Arango C, Andreassen OA. Ethical considerations for precision psychiatry: A roadmap for research and clinical practice. Eur Neuropsychopharmacol 2022; 63:17-34. [PMID: 36041245 DOI: 10.1016/j.euroneuro.2022.08.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/04/2022] [Accepted: 08/05/2022] [Indexed: 12/14/2022]
Abstract
Precision psychiatry is an emerging field with transformative opportunities for mental health. However, the use of clinical prediction models carries unprecedented ethical challenges, which must be addressed before accessing the potential benefits of precision psychiatry. This critical review covers multidisciplinary areas, including psychiatry, ethics, statistics and machine-learning, healthcare and academia, as well as input from people with lived experience of mental disorders, their family, and carers. We aimed to identify core ethical considerations for precision psychiatry and mitigate concerns by designing a roadmap for research and clinical practice. We identified priorities: learning from somatic medicine; identifying precision psychiatry use cases; enhancing transparency and generalizability; fostering implementation; promoting mental health literacy; communicating risk estimates; data protection and privacy; and fostering the equitable distribution of mental health care. We hope this blueprint will advance research and practice and enable people with mental health problems to benefit from precision psychiatry.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | - Monica E Calkins
- Neurodevelopment and Psychosis Section and Lifespan Brain Institute of Penn/CHOP, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | - Michael Dunn
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore
| | - Christophe Le Tourneau
- Institut Curie, Department of Drug Development and Innovation (D3i), INSERM U900 Research unit, Paris-Saclay University, France
| | - Miia Mannikko
- European Federation of Associations of Families of People with Mental Illness (EUFAMI), Leuven, Belgium
| | - Tineke Mollema
- Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN), Brussels, Belgium
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Alessio Squassina
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Italy
| | - Lucia Valmaggia
- South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry, KU Leuven, Belgium
| | - Lars Vedel Kessing
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Center Copenhagen, Denmark; Department of clinical Medicine, University of Copenhagen, Denmark
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Center for Psychiatric Neuroscience; The Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Gregorio Marañón; Health Research Institute (IiGSM), School of Medicine, Universidad Complutense de Madrid; Biomedical Research Center for Mental Health (CIBERSAM), Madrid, Spain
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Kurtz MM. Kraepelin, schizophrenia and the first biological era in psychiatry. Schizophr Res 2022; 244:69-70. [PMID: 35640354 DOI: 10.1016/j.schres.2022.05.007] [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: 05/05/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Matthew M Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Judd Hall, 207 High Street, Middletown, CT 06459, United States.
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Smith GC. Why is formulation daunting? A response to Bagster et al.'s 'instructions' for developing skills in formulation. Australas Psychiatry 2022; 30:266-268. [PMID: 34748710 DOI: 10.1177/10398562211054038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the theme identified by Bagster et al.1 in their selective psychiatric literature review that formulation can appear daunting. CONCLUSION Formulation is understandably daunting, even though it occurs in all human encounters. The plural nature of mental symptoms is such that anxiety-provoking intuitive judgement is required at all points in both the process and explication of formulation, a type of instinctive guessing. There are no rules for this, because the laws of vertical integration of systems are not established. Guidelines are more appropriate than 'instructions'. Much of the wider mental health and clinical reasoning literature addresses intuitive judgement, but the current psychiatric literature tends to focus on pattern recognition as a deliberative cognitive act of Type 2 processes. Arguably this reductionism adds to the dauntingness. Anxiety detected about the intuitive judgement involved can be addressed in supervision, taking into account the psychological mindedness of the trainee.
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Affiliation(s)
- Graeme C Smith
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
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7
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Tell Me About It: The Historical Development of the Psychiatric Interview. Harv Rev Psychiatry 2021; 29:438-443. [PMID: 34767330 DOI: 10.1097/hrp.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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de Leon J. Reflections on US Psychiatry: How the Baton Was Passed From European Psychiatry and the Contributions of US Psychiatry. J Nerv Ment Dis 2021; 209:403-408. [PMID: 34037550 DOI: 10.1097/nmd.0000000000001324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The medical model in psychiatry and descriptive psychopathology were established in Germany by Krapelin's textbook and Jaspers' General Psychopathology. In the United Kingdom, Mayer-Gross' textbook synthesized both books, influencing US psychiatry. US psychiatrists from the World War II generation defeated the US academic psychoanalytic establishment by building three pillars: biological psychiatry (brought by Wortis), the psychopharmacology revolution, and the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III). The psychopharmacology revolution included immigrants (e.g., Gershon), Cole's marketing, and textbooks by Klein and Fink. The "neo-Kraepelinians" introduced the medical model in US psychiatry and defined 15 valid psychiatric disorders. Spitzer supervised DSM-III's development. Its 1980 publication started the world dominance of US psychiatry and the multiplication of diagnoses. Major contributions by US psychiatrists include a) McHugh's update of the Jaspersian approach, b) Fink's inclusion of catatonia as a syndrome in DSM-5 (following Abrams and Taylor's studies), and c) DSM-III's departure from the Jaspersian hierarchy of schizophrenia and affective symptoms.
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Affiliation(s)
- Jose de Leon
- University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, Kentucky; Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada; and Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
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9
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Sanches M. Mood and Affect in the COVID-19 Era. J Nerv Ment Dis 2021; 209:228. [PMID: 33620915 DOI: 10.1097/nmd.0000000000001280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marsal Sanches
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth); and UTHealth Center of Excellence on Mood Disorders, Houston, Texas
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10
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Manchia M, Pisanu C, Squassina A, Carpiniello B. Challenges and Future Prospects of Precision Medicine in Psychiatry. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2020; 13:127-140. [PMID: 32425581 PMCID: PMC7186890 DOI: 10.2147/pgpm.s198225] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/14/2020] [Indexed: 12/21/2022]
Abstract
Precision medicine is increasingly recognized as a promising approach to improve disease treatment, taking into consideration the individual clinical and biological characteristics shared by specific subgroups of patients. In specific fields such as oncology and hematology, precision medicine has already started to be implemented in the clinical setting and molecular testing is routinely used to select treatments with higher efficacy and reduced adverse effects. The application of precision medicine in psychiatry is still in its early phases. However, there are already examples of predictive models based on clinical data or combinations of clinical, neuroimaging and biological data. While the power of single clinical predictors would remain inadequate if analyzed only with traditional statistical approaches, these predictors are now increasingly used to impute machine learning models that can have adequate accuracy even in the presence of relatively small sample size. These models have started to be applied to disentangle relevant clinical questions that could lead to a more effective management of psychiatric disorders, such as prediction of response to the mood stabilizer lithium, resistance to antidepressants in major depressive disorder or stratification of the risk and outcome prediction in schizophrenia. In this narrative review, we summarized the most important findings in precision medicine in psychiatry based on studies that constructed machine learning models using clinical, neuroimaging and/or biological data. Limitations and barriers to the implementation of precision psychiatry in the clinical setting, as well as possible solutions and future perspectives, will be presented.
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Affiliation(s)
- Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Claudia Pisanu
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Alessio Squassina
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
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11
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Foucher JR, Gawlik M, Roth JN, de Crespin de Billy C, Jeanjean LC, Obrecht A, Mainberger O, Clauss JME, Elowe J, Weibel S, Schorr B, Cetkovich M, Morra C, Rebok F, Ban TA, Bollmann B, Roser MM, Hanke MS, Jabs BE, Franzek EJ, Berna F, Pfuhlmann B. Wernicke-Kleist-Leonhard phenotypes
of endogenous psychoses: a review of their validity
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 22:37-49. [PMID: 32699504 PMCID: PMC7365293 DOI: 10.31887/dcns.2020.22.1/jfoucher] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
While the ICD-DSM paradigm has been a major advance in clinical psychiatry, its usefulness for biological psychiatry is debated. By defining consensus-based disorders rather than empirically driven phenotypes, consensus classifications were not an implementation of the biomedical paradigm. In the field of endogenous psychoses, the Wernicke-Kleist-Leonhard (WKL) pathway has optimized the descriptions of 35 major phenotypes using common medical heuristics on lifelong diachronic observations. Regarding their construct validity, WKL phenotypes have good reliability and predictive and face validity. WKL phenotypes come with remarkable evidence for differential validity on age of onset, familiality, pregnancy complications, precipitating factors, and treatment response. Most impressive is the replicated separation of high- and low-familiality phenotypes. Created in the purest tradition of the biomedical paradigm, the WKL phenotypes deserve to be contrasted as credible alternatives with other approaches currently under discussion.
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Affiliation(s)
- Jack R Foucher
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France ; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Micha Gawlik
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Julian N Roth
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Clément de Crespin de Billy
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Ludovic C Jeanjean
- IICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Alexandre Obrecht
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France; Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France
| | - Olivier Mainberger
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France. CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Julie M E Clauss
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France. SAGE - CNRS UMR 7363, FMTS, University of Strasbourg, France
| | - Julien Elowe
- Department of Psychiatry, Prangins Psychiatric Hospital (CHUV), Route de Benex, Prangins, Switzerland
| | - Sébastien Weibel
- IPôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France; Physiopathologie et Psychopathologie Cognitive de la Schizophrénie - INSERM 1114, FMTS, University of Strasbourg, France
| | - Benoit Schorr
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France; Physiopathologie et Psychopathologie Cognitive de la Schizophrénie - INSERM 1114, FMTS, University of Strasbourg, France
| | - Marcelo Cetkovich
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Carlos Morra
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of StInstitute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Sanatorio Morra, Córdoba, Argentina
| | - Federico Rebok
- "Servicio de Emergencia", Acute Inpatient Unit, Moyano Neuropsychiatric Hospital, Buenos Aires, Argentina
| | - Thomas A Ban
- International Network for the History of Neuropsychopharmacology (INHN), Córdoba, Argentina
| | - Barbara Bollmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Germany
| | - Mathilde M Roser
- Department of Psychiatry, Mondor Hospital France, Creteil, France
| | - Markus S Hanke
- Universitäre psychiatrische Dienste Bern, Spiez, Switzerland
| | - Burkhard E Jabs
- Klinik für Psychiatrie and Psychotherapie, Städtisches Klinikum Dresden, Dresden, Germany
| | - Ernst J Franzek
- Yes We Can Clinics, Department of Research and Development, Eindhoven, The Netherlands
| | - Fabrice Berna
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany; Department of Psychiatry, Prangins Psychiatric Hospital (CHUV), Route de Benex, Prangins, Switzerland
| | - Bruno Pfuhlmann
- IKlinik für Psychiatrie and Psychotherapie, Städtisches Klinikum Dresden, Dresden, Germany
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Rocha Neto HG, Estellita-Lins CE, Lessa JLM, Cavalcanti MT. Mental State Examination and Its Procedures-Narrative Review of Brazilian Descriptive Psychopathology. Front Psychiatry 2019; 10:77. [PMID: 30890969 PMCID: PMC6413621 DOI: 10.3389/fpsyt.2019.00077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 02/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Mental State Examination (MSE) is compared with physical examination as a reliable method of objective data investigation. There is a growing concern with psychiatric clinics, nosology, and the reliability of diagnostic interview methods as a source of valid diagnostic strategy. Efforts to achieve an international diagnosis protocol have been unsuccessful or polemical. This paper focuses on psychopathology, MSE, and mental function development within Brazilian psychiatry over the last few decades. Methods: Searches, interviews, and narrative reviews were done to look for systematic ways in which to conduct MSE, mental functions, symptom clusters, orientations about data observation and records. Brazilian psychopathology textbooks were examined, if they provided access to consolidated knowledge on psychopathology examination. Results: Sixteen textbooks were selected from a 49 year span. Descriptive psychopathology with phenomenological orientation was the primary trend in the MSE. Concepts derived from different traditions, most lacking common terminology, suggested some divergence among authors. Recommendations for patient observation and how to collect objective data was clear, but MSE standardization efforts were missing. A detailed description of mental function abnormalities was the main MSE record strategy, without consensus about ways to summarize and record this data. In an examination summary, mental strata was divided into "mental functions," and MSE subsets were frequent. All authors considered the following mental functions: consciousness, perception, thought, memory, attention, orientation, and volition. Discussion: Psychiatric competence demands MSE proficiency. Official documents are not clear about performance and recording standards. MSE data was usually recorded through descriptive psychopathology. A shift from detailed descriptive findings, to an array of observed pathological elements, described through a mental function checklist was observed over time. Clinical practice and research guidelines should consider the development of reliable MSE practices; however, it has been neglected by modern psychiatry/neuroscience through the excessive emphasis on interview protocols. Better MSE practices, and the improvement of bedside skill in psychiatry are necessary and depend on the recovery of psychopathological debates and semiological reasoning, which will allow the return of phenomenology-oriented "observational" techniques.
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Big Data and Discovery Sciences in Psychiatry. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1192:3-15. [PMID: 31705487 DOI: 10.1007/978-981-32-9721-0_1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The modern society is a so-called era of big data. Whereas nearly everybody recognizes the "era of big data", no one can exactly define how big the data is a "big data". The reason for the ambiguity of the term big data mainly arises from the widespread of using that term. Along the widespread application of the digital technology in the everyday life, a large amount of data is generated every second in relation with every human behavior (i.e., measuring body movements through sensors, texts sent and received via social networking services). In addition, nonhuman data such as weather and Global Positioning System signals has been cumulated and analyzed in perspectives of big data (Kan et al. in Int J Environ Res Public Health 15(4), 2018 [1]). The big data has also influenced the medical science, which includes the field of psychiatry (Monteith et al. in Int J Bipolar Disord 3(1):21, 2015 [2]). In this chapter, we first introduce the definition of the term "big data". Then, we discuss researches which apply big data to solve problems in the clinical practice of psychiatry.
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14
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Fluyau D. Integrating DSM/ICD, Research Domain Criteria, and Descriptive Psychopathology in Teaching and Practice of Psychiatry. Front Psychiatry 2018; 9:484. [PMID: 30344498 PMCID: PMC6183547 DOI: 10.3389/fpsyt.2018.00484] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 09/17/2018] [Indexed: 01/13/2023] Open
Abstract
Background: Some believe that Psychiatry relies solely on the Diagnostic and Statistical Manual of Mental Disorders (DSM). Some are not aware of the effort initiated by the Research Domain Criteria (RDoC) to propel the field to a new era of Medicine. Others are not acquainted with studies of Descriptive Psychopathology that can dissect symptoms and signs of mental illness and convert them into reliable clinical data for diagnosis and treatment purpose. This document is to bring keenness of the advances in research, translational or clinical, made in Psychiatry, and to encourage students, psychiatric residents, as well as psychiatric practitioners to integrate DSM/ICD, RDoC, and Descriptive Psychopathology into teaching and practice. Methods: A search of the literature originated from 1985 to 2018 on two central databases: Google Scholar and Pubmed by free-texting: "comparison, strengths and weaknesses, Diagnostic and Statistical Manual of Mental Disorders, Research Domain Criteria, and Descriptive Psychopathology." Results: The DSM and ICD possess algorithms for psychiatric diagnosis, but they are limited to determine psychobiological causes of mental illnesses. Descriptive Psychopathology aims to dissect the mind to understand better "signs and symptoms," their psychological, neurological, or neuropsychological origins but has been criticized for being non-reliable to practically explain the meaning of signs and symptoms that it attempts to describe. The RDoC claims to be a data-driven system of biological and psychological research for an evidence-based approach to Psychiatry. It is said that RDoC utilizes translational research that has been very slow to move to human experimentation. Discussion and conclusion: Despite incommensurable translational research and human trials, the integration of translational research (neurosciences, experimental psychology, and genomics) as available human research data into teaching and practice is lacking. The author believes that the integration will enhance scientific and well-founded communication with our peers, advance psychopharmacologic treatments and improve our patient's mental well-being.
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Affiliation(s)
- Dimy Fluyau
- Brain Health, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
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Schütz CG, Ramírez-Vizcaya S, Froese T. The Clinical Concept of Opioid Addiction Since 1877: Still Wanting After All These Years. Front Psychiatry 2018; 9:508. [PMID: 30386269 PMCID: PMC6198080 DOI: 10.3389/fpsyt.2018.00508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 09/26/2018] [Indexed: 02/02/2023] Open
Abstract
In 1877, the psychiatrist Edward Levinstein authored the first monograph on opioid addiction. The prevalence of opioid addiction prior to his publication had risen in several countries including England, France and Germany. He was the first to call it an illness, but doubted that it was a mental illness because the impairment of volition appeared to be restricted to opioid use: it was not pervasive, since it did not extend to other aspects of the individuals' life. While there has been huge progress in understanding the underlying neurobiological mechanisms, there has been little progress in the clinical psychopathology of addiction and in understanding how it relates to these neurobiological mechanisms. A focus on cravings has limited the exploration of other important aspects such as anosognosia and addiction-related behaviors like smuggling opioids into treatment and supporting the continued provision of co-patients. These behaviors are usually considered secondary reactions, but in clinical practice they appear to be central to addiction, indicating that an improved understanding of the complexity of the disorder is needed. We propose to consider an approach that takes into account the embodied, situated, dynamic, and phenomenological aspects of mental processes. Addiction in this context can be conceptualized as a habit, understood as a distributed network of mental, behavioral, and social processes, which not only shapes the addict's perceptions and actions, but also has a tendency to self-maintain. Such an approach may help to develop and integrate psychopathological and neurobiological research and practice of addictions.
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Affiliation(s)
- Christian G Schütz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Susana Ramírez-Vizcaya
- Philosophy of Science Graduate Program, National Autonomous University of Mexico, Mexico City, Mexico
| | - Tom Froese
- Institute for Applied Mathematics and Systems Research, National Autonomous University of Mexico, Mexico City, Mexico
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