Approach In Psychiatry Research Articles

Therapeutic drug monitoring of sertraline in children and adolescents: A naturalistic study with insights into the clinical response and treatment of obsessive-compulsive disorder

BackgroundSertraline is a selective serotonin reuptake inhibitor with specific indications in child and adolescent psychiatry. Notwithstanding its frequent use and clinical benefits, the relationship between pharmacokinetics, pharmacodynamics, efficacy, and tolerability of sertraline across indications, particularly in non-adult patients, is not fully understood. MethodThis naturalistic therapeutic drug monitoring (TDM) study was conducted in a transdiagnostic sample of children and adolescents treated with sertraline (n = 78; mean age, 14.22 ± 2.39; range, 7–18 years) within the prospective multicenter “TDM-VIGIL” project. Associations between dose, serum concentration, and medication-specific therapeutic and side effects based on the Clinical Global Impression scale were examined. Tolerability was measured qualitatively with the 56-item Pediatric Adverse Event Rating Scale. ResultsA strong linear positive dose–serum concentration relationship (with dose explaining 45% of the variance in concentration) and significant effects of weight and co-medication were found. Neither dose nor serum concentration were associated with side effects. An overall mild-to-moderate tolerability profile of sertraline was observed. In contrast with the transdiagnostic analysis that did not indicate an effect of concentration, when split into depression (MDD) and obsessive-compulsive disorder (OCD) diagnoses, the probability of clinical improvement significantly increased as both dose and concentration increased for OCD, but not for MDD. ConclusionsThis TDM–flexible-dose study revealed a significant diagnosis-specific effect between sertraline serum concentration and clinical efficacy for pediatric OCD. While TDM already guides clinical decision-making regarding compliance, dose calibration, and drug–drug interactions, combining TDM with other methods, such as pharmacogenetics, may facilitate a personalized medicine approach in psychiatry.

Computational mechanisms underlying illusion of control in delusional individuals

Humans navigate complex situations that require the accurate estimation of the controllability of the environment. Aberrant controllability computation might lead to maladaptive behaviors and poor mental health outcomes. Illusion of control, which refers to a heightened sense of control while the environment is uncontrollable, is one such manifestation and has been conceptually associated with delusional ideation. Nevertheless, this association has not yet been formally characterized in a computational framework. To address this, we used a computational psychiatry approach to quantify illusion of control in human participants with high (n = 125) or low (n = 126) trait delusion. Participants played a two-party exchange game in which their choices either did (“Controllable condition”) or did not (“Uncontrollable condition”) influence the future monetary offers made by simulated partners. We found that the two groups behaved similarly in model-agnostic measures (i.e., offer size, rejection rate). However, computational modeling revealed that compared to the low trait delusion group, the high delusion group overestimated their influence (“expected influence” parameter) over the offers made by their partners under the Uncontrollable condition. Highly delusional individuals also reported a stronger sense of control than those with low trait delusion in the Uncontrollable condition. Furthermore, the expected influence parameter and self-reported beliefs about controllability were significantly correlated in the Controllable condition in individuals with low trait delusion, whereas this relationship was diminished in those with high trait delusion. Collectively, these findings demonstrate that delusional ideation is associated with aberrant computation of and belief about environmental controllability, as well as a belief-behavior disconnect.

Sind Psychedelika schnell wirksame Antidepressiva?

Psychedelics, such as psilocybin represent one of the most promising current therapeutic approaches in psychiatry. Psychedelics seem to have not only potent antidepressant effects. Do they also work particularly quickly, i.e. within one day? The available literature on clinical studies of psychedelics in depressive syndromes is presented both from the period up to the prohibition of these substances in the late 1960s as well as after the resumption of research in the 2000s. One focus is the speed of onset of antidepressant action. Only the clinical studies published since 2016 that meet modern methodological standards have also systematically examined the speed of the antidepressant onset of action. The published studies, which were almost exclusively carried out with psilocybin, so far show small sample sizes (the total number of patients with depression treated in published clinical studies is < 200) and some of them have methodological weaknesses; however, they suggest apronounced and very rapid onset of action within one day for depression, treatment-resistant depression and depression in the context of life-threatening cancer. The available studies indicate apotent, rapid onset and in many cases long-lasting antidepressant effect over several months. The currently conducted studies with three-digit patient numbers will provide final information about the potential of psilocybin for depression.

Vers une psychiatrie énactive et computationnelle

IntroductionPsychiatry is challenged by a plurality of complementary approaches. These challenges stem from the existence of multiple levels of understanding, i.e. systems of representations, tools, methodologies and objectives in psychiatry–ranging from computational approaches and systems dynamics to the multiplicity of emerging nosographies, such as the NIMH Research Domain Criteria project or staging models. In this plurality, a significant number of clinicians have adopted the biopsychosocial model. However, such a model has been widely criticized for more than twenty years. In parallel, science has declined a set of different pluralistic frameworks. Thus, through the challenges of computational modeling in psychiatry, we will see how the enactive approach of psychiatry could respond to this multiplicity. Indeed, such an enactive approach considers that perception is a (predictive) activity, which gives sense to the environment (i.e., sense making). Perception and, by extension, cognitive processes are not internal representations of the outside world, but they are deployed according to the 5E approach, i.e., an embodied, embedded, enacted, emotive and extended approach. MethodsIn this article, we first study the pluralist framework in psychiatry, in order to show its contributions in the clinical practice. Secondly, we analyze the contributions of the enactive approach for clinical practice in psychiatry. ResultsTwo forms of pluralisms can be described: a non-integrative pluralism and an integrative pluralism. The first examines the coexistence of different potentially incompatible or untranslatable systems in the scientific or clinical landscape. The second proposes the development of a general framework, bringing together the different levels of understanding and systems of representations. However, pluralism has many pitfalls and limitations. Especially by allowing computational modeling, the enactive framework, anchored both in cognitive sciences, theory of dynamic systems, systems biology and phenomenology, has recently been proposed as an answer to the challenge of integrative psychiatry. ConclusionsA significant number of mental health professionals are already working accepting such a variety of clinical and scientific approaches. We show that the enactive approach allows psychiatry: (1) to consider the subjectivity and the patient's experience, (2) to articulate different “granularities” within the clinical consultation, (3) to explain the benefits the creation of meaning for the patient, (4) to provide concrete models, (5) to support pedagogy in psychiatry. The enactive approach provides a conception for understanding psychiatric disorders as embodied, embedded, enacted, emotional and extended. In that way, the manifestations experienced by the patients are sense making experiences and can be conceived according to various levels of granularity.

The Proposition for Bipolar Depression Forecasting Based on Wearable Data Collection.

Bipolar depression is treated wrongly as unipolar depression, on average, for 8 years. It is shown that this mismedication affects the occurrence of a manic episode and aggravates the overall condition of patients with bipolar depression. Significant effort was invested in early detection of depression and forecasting of responses to certain therapeutic approaches using a combination of features extracted from standard and online testing, wearables monitoring, and machine learning. In the case of unipolar depression, this approach yielded evidence that this data-based computational psychiatry approach would be helpful in clinical practice. Following a similar pipeline, we examined the usefulness of this approach to foresee a manic episode in bipolar depression, so that clinicians and family of the patient can help patient navigate through the time of crisis. Our projects combined the results from self-reported daily questionnaires, the data obtained from smart watches, and the data from regular reports from standard psychiatric interviews to feed various machine learning models to predict a crisis in bipolar depression. Contrary to satisfactory predictions in unipolar depression, we found that bipolar depression, having more complex dynamics, requires personalized approach. A previous work on physiological complexity (complex variability) suggests that an inclusion of electrophysiological data, properly quantified, might lead to better solutions, as shown in other projects of our group concerning unipolar depression. Here, we make a comparison of previously performed research in a methodological sense, revisiting and additionally interpreting our own results showing that the methodological approach to mania forecasting may be modified to provide an accurate prediction in bipolar depression.

Phenomenological interviews in learning and teaching phenomenological approach in psychiatry

Phenomenological interviews in learning and teaching phenomenological approach in psychiatry

TRADITIONAL CONCEPTS AND APPROACHES IN PSYCHIATRY AS PRECONDITIONS FOR PSYCHOSOMATIC CONCEPT: THE NEUROBIOLOGICAL ASPECT

In the current article, conceptual approaches in psychiatry (considered as backgrounds in revising of psychosomatic conception) are discussed. The increasing development of neuroscience demonstrated the limitation of psychopathological methods. Significant differences and discrepancies in assessing the type, degree, course of psychopathological disorders at the nozological level are revealed. The widespread use of the new classification systems led to dissolving boundaries between mental and behavioral norms and pathology led to rejection of the classical approaches. It made transition from monothetic to polythetic categorization. Nozological psychiatry transformed into syndromological one. The phenomenological approach in psychiatry is considered as an alternative to the nozological principle. However, despite some advantages, they are not without disadvantages, which cover diagnostic, terminological, theoretical, pedagogical and other aspects. The phenomenological approach still leads to a disagreement among psychiatrists regarding the terminological definitions, the theoretical basis. The current classifications of mental and behavioral disorders lead to a blurring of the boundaries between the mental and behavioral norm and pathology and enormously expand the boundaries of mental abnormality, narrowing the boundaries of norm and health. Analysis of pathogenetic mechanisms of mental disorders demonstrated the failure of all the concepts, and approaches (primarily neurobiological) due to the lack of specificity for certain pathology. It is indicated that both endogenous disorders and psychosomatic ones are based on neurotransmitter processes. In this case the discrepancy in the diagnosis of mental disorders by different specialists is observed. There is no specific etiology, pathogenetic mechanisms, and environmental factors for a particular mental disorder.

Neurodiversity and Opportunities in Psychiatry

Neurodiversity and Opportunities in Psychiatry

A camp approach of community psychiatry in India: Past, present, and the future.

Camps are a popular approach to deliver medical care in India. While it is usually a one-off event for physical ailments, it is a long-term affair in Psychiatry. One of the first camps in psychiatry was rolled out as early as in 1967 at Mandar, Ranchi, followed by Raipur Rani (Haryana) in 1976 and at Gunjur, Karnataka in 1977. This camp approach became extremely popular and got expanded across India as they were thought to be synonymous with community-based outreach for mental illnesses. In the past 5 years, however, newer models of community care have emerged, necessitating a relook at this traditional approach. In this paper, the authors trace the origin, utility and future directions of these camps, taking data from community psychiatry camps conducted by the National Institute of Mental Health and Neurosciences, Bengaluru, a premier neuropsychiatric tertiary care institute in India. Data have been collated from the annual reports of the Institute, database from the District Mental health Program, Government of Karnataka, India, and compared with published literature on the same field. While camps remain as one of the important avenues to reach the unreached, there is a need to change the approach of their functioning by incorporating training (primary care providers) aspects and collaborative care. The latter may make the initiative more meaningful and sustainable.

Mental health and validity of the psycho-neurobiological stress model

Background and objectives: The public costs of self-reported mental stress and distress are enormous. And both the advance of neurobiology and the modern more biological approach of psychiatry as a whole are considerable. This work intends to provide an essential, updated and objective panoramic view on the neurobiology of all kinds of stress in relation to people’s mental health and pathologies. Method: Bibliographic indexes such as Pubmed, Psycinfo Journal and Índices CSIC, were consulted, among others. The matter being tackled is extremely profuse, varied and complex, therefore the found literature has been as numerous as heterogeneous. It is also so dispersed that we have conducted a narrative non-systematic review that is intended to be impartial and balanced. Results: This article will concisely discuss the available, prominent and reliable scientific information regarding the main cerebral structures involved in the experience of stress, such as the hippocampus, prefrontal cortex, amygdala and hypothalamus. It will also comment on stress physiology, neuroendocrinology and associated psychopathology, as well as specifically certain genetic variations and linked molecular and immune activities. Conclusion: We have synthesised the relevant and current scientific knowledge of the correlations among stress, mental health and neurobiology as well as of their reciprocal interactions. There is increasing knowledge of these correlations and interactions, but it remains limited. Accordingly, further research is required.

Symposium

Covid-19 pandemic has been an unprecedented crisis seen by the humanity in the last two years with a magnitude no less than the two world wars. Globally, more than 260 million cases have been reported and more than 5 million deaths have been attributed to Covid-19 till the end of November 2021. Despite introduction of the vaccine nearly a year ago, though there has been a big hope of controlling the pandemic, there have been repeated rises in infections due to the mutations in virus, like the coming of Delta, Delta plus and Omicron variants, which are increasingly infectious. There have already been two waves of the pandemic with the second wave being very lethal in India. The pandemic had both direct as well as indirect effects on mental health of the population across allover the world. Many countries had to resort to lockdowns to control the spread of infection, which had serious economic consequences, adding to the mental and social distress. Other infection control measures like quarantine and social isolation, and inability of the persons with existing mental illnesses to access treatment further added to the problem. Introduction of vaccine brought some hope, but it has been a great challenge to cover such a huge population with vaccine alongwith dealing with vaccine hesitancy.This symposium being proposed by the World Association of Social Psychiatry. The symposium will assess the current situation with focus on psychosocial aspects, social psychiatry approach used to deal with the mental health issues, challenges ahead and the lessons learnt to deal with any future challenges of similar nature.Chair: Rachid Bennegadi, President, WASP; Gautam Saha, President, IPSProposer: Rakesh K ChaddaCurrent situation - Roy Abraham Kallivayalil Social psychiatry approach - Debasish Basu Challenges ahead- Ramarao GogineniLessons learnt - Rakesh K Chadda

Cognitive [Computational] Neuroscience Test Reliability and Clinical Applications for Serious Mental Illness (CNTRaCS) Consortium: Progress and Future Directions.

The development of treatments for impaired cognition in schizophrenia has been characterized as the most important challenge facing psychiatry at the beginning of the twenty-first century. The Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) project was designed to build on the potential benefits of using tasks and tools from cognitive neuroscience to better understanding and treat cognitive impairments in psychosis. These benefits include: (1) the use of fine-grained tasks that measure discrete cognitive processes; (2) the ability to design tasks that distinguish between specific cognitive domain deficits and poor performance due to generalized deficits resulting from sedation, low motivation, poor test taking skills, etc.; and (3) the ability to link cognitive deficits to specific neural systems, using animal models, neuropsychology, and functional imaging. CNTRICS convened a series of meetings to identify paradigms from cognitive neuroscience that maximize these benefits and identified the steps need for translation into use in clinical populations. The Cognitive Neuroscience Test Reliability and Clinical Applications for Schizophrenia (CNTRaCS) Consortium was developed to help carry out these steps. CNTRaCS consists of investigators at five different sites across the country with diverse expertise relevant to a wide range of the cognitive systems identified as critical as part of CNTRICs. This work reports on the progress and current directions in the evaluation and optimization carried out by CNTRaCS of the tasks identified as part of the original CNTRICs process, as well as subsequent extensions into the Positive Valence systems domain of Research Domain Criteria (RDoC). We also describe the current focus of CNTRaCS, which involves taking a computational psychiatry approach to measuring cognitive and motivational function across the spectrum of psychosis. Specifically, the current iteration of CNTRaCS is using computational modeling to isolate parameters reflecting potentially more specific cognitive and visual processes that may provide greater interpretability in understanding shared and distinct impairments across psychiatric disorders.

From Personalized Medicine to Precision Psychiatry?

Personalised medicine aims to find an individualized approach for each particular patient. Most factors used in current psychiatry, however, depend on the assessment made by the individual clinician and lack a higher degree of reliability. Precision medicine bases decisions on quantifiable indicators available thanks to the tremendous progress in science and technology facilitating the acquisition, processing and analysis of huge amounts of data. So far, psychiatry has not been benefiting enough from the advanced diagnostic technologies; nevertheless, we are witnessing the dawn of the era of precision psychiatry, starting with the gathering of sufficient amounts of data and its analysis by the means of artificial intelligence and machine learning. First results of this approach in psychiatry are available, which facilitate diagnosis assessment, course prediction, and appropriate treatment choice. These processes are often so complex and difficult to understand that they may resemble a “black box”, which can slow down the acceptance of the results of this approach in clinical practice. Still, bringing precision medicine including psychiatry to standard clinical practice is a big challenge that can result in a completely new and transformative concept of health care. Such extensive changes naturally have both their supporters and opponents. This paper aims to familiarize clinically oriented physicians with precision psychiatry and to attract their attention to its recent developments. We cover the theoretical basis of precision medicine, its specifics in psychiatry, and provide examples of its use in the field of diagnostic assessment, course prediction, and appropriate treatment planning.

The Readiness of Psychiatrists to Implement Psychedelic-Assisted Psychotherapy.

Introduction: Psychedelic-assisted psychotherapy is a promising approach in psychiatry; evidence is growing and it may not be long before mainstream services are expected to offer it to selected patients. This pilot study examined the attitudes and knowledge of NHS psychiatrists of all levels towards psychedelic-assisted psychotherapy and explored potential barriers and facilitators to its implementation.Methods: A mixed-methods approach was adopted, using a cross-sectional survey and focus groups. All psychiatrists in one NHS mental health trust were approached by email to participate. The survey was analysed using a simple descriptive approach and thematic analysis was used for the focus groups.Results: Eighty-three (25.7%) psychiatrists participated in the survey. All psychiatrists were familiar with one or more psychedelic substances. Although 77.2% felt that there should be a role for controlled or therapeutic use of psychedelics, trainees appeared better informed than non-training grade psychiatrists. Psychiatrists of all grades did not feel prepared to participate in the delivery of psychedelic-assisted psychotherapy. Thematic analysis of the focus groups identified three main themes in relation to psychedelic-assisted psychotherapy: “need for knowledge,” “openness to change,” and “uncertainty.”Discussion: NHS psychiatrists are positive about the potential for psychedelic-assisted therapy to advance psychiatric practise. However, psychiatrists are lacking in confidence or preparedness to implement this treatment should it become a mainstream option and significant training needs were identified. Thematic analysis highlighted the need for societal shifts as well as professional ones.

TRADITIONAL CONCEPTS AND APPROACHES IN PSYCHIATRY AS PRECONDITIONS FOR PSYCHOSOMATIC CONCEPT: THE NEUROBIOLOGICAL ASPECT

In the current article, conceptual approaches in psychiatry (considered as backgrounds in revising of psychosomatic conception) are discussed. The increasing development of neuroscience demonstrated the limitation of psychopathological methods. Significant differences and discrepancies in assessing the type, degree, course of psychopathological disorders at the nozological level are revealed. The widespread use of the new classification systems led to dissolving boundaries between mental and behavioral norms and pathology led to rejection of the classical approaches. It made transition from monothetic to polythetic categorization. Nozological psychiatry transformed into syndromological one. The phenomenological approach in psychiatry is considered as an alternative to the nozological principle. However, despite some advantages, they are not without disadvantages, which cover diagnostic, terminological, theoretical, pedagogical and other aspects. The phenomenological approach still leads to a disagreement among psychiatrists regarding the terminological definitions, the theoretical basis. The current classifications of mental and behavioral disorders lead to a blurring of the boundaries between the mental and behavioral norm and pathology and enormously expand the boundaries of mental abnormality, narrowing the boundaries of norm and health. Analysis of pathogenetic mechanisms of mental disorders demonstrated the failure of all the concepts, and approaches (primarily neurobiological) due to the lack of specificity for certain pathology. It is indicated that both endogenous disorders and psychosomatic ones are based on neurotransmitter processes. In this case the discrepancy in the diagnosis of mental disorders by different specialists is observed. There is no specific etiology, pathogenetic mechanisms, and environmental factors for a particular mental disorder.

MHealth and technology innovations for anxiety and OC spectrum disorders.

Interdisciplinary mobile health (mHealth) technologies and intervention approaches are changing the nature of health research, providing the opportunity to shift from more reactive approaches for patient care to a more proactive stance. As with the larger field of medicine, mHealth and technology-enhanced approaches in psychiatry and clinical psychology are opening an unparalleled number of avenues to help reduce the risk for psychiatric disease, treat psychological disorders, and increase well-being of our patients. While promising, this research is characterized by complex challenges across the domains of concept development, initial design and testing, and downstream implementation and scaled-up dissemination. This Special Issue in the British Journal of Clinical Psychology was designed to highlight the development and implementation of mHealth research in the anxiety and obsessive-compulsive spectrum disorders. In addition to informing readers about important advances that have been made, the present special issue also draws attention to the myriad challenges that will need to be considered in future research. Three domains relevant for mHealth research are addressed, including a careful consideration of where the research currently stands and what challenges we should prepare for, the adaptation of traditional and adjunctive treatments to mobile or online platforms, and the ability for technology and associated methodological approaches to provide further insight into aetiological investigations.

Autism Spectrum Disorder in Infancy and Early Childhood: The Model of the Centro de Estudos do Bebé e da Criança for Diagnosis and Therapeutic Intervention

The Centro de Estudos do Bebé e da Criança in Hospital Dona Estefânia has organized a multidisciplinary model for children under three with suspected autism spectrum disorder, thus implementing the recent guidelines established by the Directorate General for Health. The aim of this study is to describe this model and case series. A retrospective descriptive study of observed children with suspected ASD. They were observed according to the model of the Centro de Estudos do Bebé e da Criança and DC:0-5TM classification, between January 2018 and September 2019. The study included 178 children. The average age at the initial assessment was 27 months. From the total sample, 116 children concluded the diagnostic sessions (axis I): Autism Spectrum Disorder/Early Atypical (36%), Developmental Language Disorder (18%), Other (19%). Factors of axes II, III, IV and V of DC:0-5TM were determinant for clinical diagnosis in 26%. Of 116 children, 36% were diagnosed with Autism Spectrum Disorder. This highlights the diagnostic challenge posed by neurodevelopmental disorders in early infancy. The sample shows that the characteristics of the relationship with the caregiver (axis II), presence of physical conditions (axis III), psycho-social stressors (axis IV) and developmental trajectory (axis V) have a significant clinical impact. In the future, the initial assessment should take place well before the age of 27 months because of the impact on prognosis. This model is a pioneering approach in Portugal. It promotes a common approach of Child and Adolescent Psychiatry and Neuropediatrics/Developmental Pediatrics in early infancy. Moreover, it increases the diagnostic acuity of Autism Spectrum Disorders and early therapeutic intervention.

Critical phenomenology and psychiatry

Whereas classical Critical Theory has tended to view phenomenology as inherently uncritical, the recent upsurge of what has become known as critical phenomenology has attempted to show that phenomenological concepts and methods can be used in critical analyses of social and political issues. A recent landmark publication, 50 Concepts for Critical Phenomenology, contains no reference to psychiatry and psychopathology, however. This is an unfortunate omission, since the tradition of phenomenological psychiatry—as we will demonstrate in the present article by surveying and discussing the contribution of Jaspers, Minkowski, Laing, Basaglia, and Fanon—from the outset has practiced critical thinking, be it at the theoretical, interpersonal, institutional, or political level. Fanon is today a recognized figure in critical phenomenology, even if his role in psychiatry might not yet have been appreciated as thoroughly as his anticolonial and antiracist contributions. But as we show, he is part of a long history of critical approaches in psychopathology and psychiatry, which has firm roots in the phenomenological tradition, and which keeps up its critical work today.

The Establishment of a Clinic for Personality Modulation in Iran: A Novel Approach in Personality Psychiatry with a Dimensional Approach

The Establishment of a Clinic for Personality Modulation in Iran: A Novel Approach in Personality Psychiatry with a Dimensional Approach

Uncertainty Promotes Neuroreductionism: A Behavioral Online Study on Folk Psychological Causal Inference from Neuroimaging Data

Introduction: Increased efforts in neuroscience try to understand mental disorders as brain disorders. In the present study, we investigate how common a neuroreductionist inclination is among highly educated people. In particular, we shed light on implicit presuppositions of mental disorders little is known about in the public, exemplified here by the case of body integrity dysphoria (BID) that is considered a mental disorder for the first time in ICD-11. Methods: Identically graphed, simulated data of mind-brain correlations were shown in 3 contexts with presumably different presumptions about causality. 738 highly educated lay people rated plausibility of causality attribution from the brain to mind and from mind to the brain for correlations between brain structural properties and mental phenomena. We contrasted participants’ plausibility ratings of causality in the contexts of commonly perceived brain lesion-induced behavior (aphasia), behavior-induced training effects (piano playing), and a newly described mental disorder (BID). Results: The findings reveal the expected context-dependent modulation of causality attributions in the contexts of aphasia and piano playing. Furthermore, we observed a significant tendency to more readily attribute causal inference from the brain to mind than vice versa with respect to BID. Conclusion: In some contexts, exemplified here by aphasia and piano playing, unidirectional causality attributions may be justified. However, with respect to BID, we critically discuss presumably unjustified neuroreductionist inclinations under causal uncertainty. Finally, we emphasize the need for a presupposition-free approach in psychiatry.