History Of Psychiatry Research Articles

P199: Cluster analysis dissecting cognitive deficits in older adults with major depressive disorder and the association between neurofilament light chain

Objectives:Cognitive impairment is a growing problem with increasing burden in ageing global population. Older adults with major depressive disorder (MDD) have higher risk of dementia during ageing. Neurofilament light chain (NfL) has been proven as a potential biomarker related to dementia. The present study aims to assess the cognitive deficits in older adults with MDD and investigate their association with peripheral blood levels of NfL.Design:We enrolled 39 individuals with MDD and 15 individuals with mild neurocognitive disorder or major neurocognitive disorder, Alzheimer’s type. Both groups were over age 65 and with restricted Mini-Mental State Examination (MMSE) score. Demographic data, clinical variables, and plasma NfL levels were obtained. We used cluster analysis according to their cognitive profile and estimated the correlation between plasma NfL levels and cognitive impairment in each domain.Result:In the MDD group, participants have higher rate of family psychiatry history and higher rate of current alcohol use habit compared with patients with neurocognitive disorders. In the neurocognitive disorders group, participants showed significantly lower score in total MMSE and higher plasma NfL levels. Part of the MDD patients presented cognitive deficits similar to that of neurocognitive disorders (cluster A). In cluster A, the total MMSE score (r=-0.58277, p=0.0287) and the comprehension domain (r=-0.71717, p=0.0039) were negatively correlated to NfL levels after adjusting for age, while the associations had not been observed in the other cluster.Conclusion:We noted the negative correlation between NfL levels and cognitive performance in MDD patients whose cognitive manifestation were more similar to that of degenerative neurocognitive disorders. NfL might be a potential marker to predict patients with MDD to develop cognitive decline especially in domains typically found in Alzheimer’s disease. Further longitudinal studies are required to validate our findings for clinical implications.

Sickle Cell Disease and Comorbid Psychiatric Conditions: A Single-Center Retrospective Study

Introduction: It is established that patients with various chronic disease states are predisposed to psychiatric comorbidities. However, in the sickle cell disease (SCD) patient population, psychiatric comorbidities have been uniquely shown to exacerbate disease through a psychosomatic component. A co-existing diagnosis of depression is found in 1 of 3 patients with SCD, and they are more than 5 times as likely to suffer from a mood disorder than the general population. SCD patients with psychiatric illnesses have significantly worse physical and mental health outcomes. Additionally, healthcare costs are more than double for SCD patients with depression than for those without. Thus, SCD patients with psychiatric comorbidities have unique challenges and are an important population to study. Methods: This was a retrospective single-center study of patients with SCD, all genotyped and ≥16 years old, who were treated at UT Physicians Comprehensive Sickle Cell Center during the study period (March-July 2023). The demographics, clinical characteristics, psychiatry history, initial and recent PHQ-9 results, and laboratory findings were collected and analyzed. Descriptive statistics were obtained and analyzed between SCD patients with and without psychiatric disorders and are presented in percentages, medians, and interquartile ranges. Data analysis was completed using a p value < 0.05 to indicate statistical significance, using an independent group unpaired t-test for continuous variables and Chi-square and Fisher's exact tests for categorical data, respectively. Data was analyzed using GraphPad Prism version 9.0.2. Results: Patient sex was 45% male and 55% female; 73% of patients had the HbSS genotype. Of the studied cohort, 33% were affected by at least one psychiatric disorder. The most common psychiatric disorder was depression, which occurred in 26% of patients, followed by anxiety (21%). The most common pharmacotherapy for psychiatric conditions was tricyclic antidepressants (TCAs), followed by SSRIs and SNRIs. There was no significant difference in ED visits or hospitalization rates between patients with known psychiatric disorders versus those without. Common laboratory markers used to assess SCD (LDH, total bilirubin, reticulocyte count) were overall higher in the subset with psychiatric illnesses, but only LDH was statistically significantly higher. Surprisingly, SCD patients with psychiatric disorders used fewer opioids than those without with a lower Morphine Equivalent Daily Dose (although this was not statistically significant). Conclusion: Although it is known that psychiatric illnesses in SCD patients are prevalent, exacerbate disease, and pose a cost burden, in our study there was nosignificant increase in hospitalizations or ED visits. However, it is notable that our study patient population was an outpatient population that is compliant and generally has access to resources including a robust behavioral health team and regular psychotherapy sessions. Due to these factors, ourdata may not be generalizable to the entire SCD patient population. Additionally, althoughlaboratorymarkers were overall poorer in the psychiatric population, they were not statistically significant, perhaps owing to the small sample size. Our study calls for a broader look at SCD patients with psychiatric illness, perhaps also to review these variables in SCD patients in the inpatient setting. A future direction could also be to evaluate the efficacy of psychiatric pharmacotherapy versus cognitive behavioral therapy in this patient population. Word count: 518 words

Dr José Rizal (1861-1896) and the sociocultural aspects of mental health in the Philippines in the late 19th century - Psychiatry in history.

Dr José Rizal (1861-1896) and the sociocultural aspects of mental health in the Philippines in the late 19th century - Psychiatry in history.

Problems of diagnostic psychiatry—and the search for a way forward

The recent history of psychiatry is one of diagnostic expansion. Since the etiological model of mental illness was superseded by the symptom model around 1980, new diagnoses have continuously been added to the reigning manuals of psychopathology, most recently with DSM-5 and ICD-11. This article unfolds some of the criticism that has recently been directed at diagnostic psychiatry with a focus on two quite different lines of critical thought: One represented by a neuroscientific approach known as RDoC, which argues that psychiatry must move beyond symptoms and find the causes of mental illness in the brain (Insel et al., 2010), and another represented by a contextual approach known as PTMF, which argues that mental distress is by and large understandable in light of what happens to people (Boyle & Johnstone, 2020). These oppositional perspectives stand out as prototypical, and each contain valuable insights but also limitations. The article ends by arguing that the limitations can be overcome if the perspectives are united by a hybrid theory stating that mental illness is always a property of a relation between a person and an environment. Two such theories are introduced and discussed (Gannik, 2002; Wakefield, 1992).

The psychopathic hospital.

A new psychiatric institution emerged in the late nineteenth and early twentieth centuries: the psychopathic hospital. This institution represented a significant development in the history of psychiatry, as it marked the profession's reorientation from asylum-based to hospital-based care, and in this way presaged the deinstitutionalization movement that would begin half a century later. Psychopathic hospitals were also an important marker of psychiatry's efforts to redefine its professional boundaries and respond to its vociferous critics. This entailed both a rapprochement with general medicine in an effort to assert its scientific bona fides and a redefinition of its scope of practice to absorb non-certifiable 'borderland' cases in order both to emphasize non-coercive treatment and to enlarge the profession's boundaries.

History of child psychiatry in Spain

History of child psychiatry in Spain

S’agenrer avec la trans-psychiatrie : de Dorchen Richter à Paul B. Preciado

GoalsIn this article we establish the history of transpsychiatry from the debate with Sigmund Freud to the present day. The objective of this epistemology is to show how gender choice, or a-gendering, has always been part of psychiatrists’ clinical practice with trans patients. MethodsWe use archival sources and the history of psychiatry since 1830 in order to establish the stages of clinical work around gender: firstly, by finding in German and American sources the first consultations and the innovative techniques that made treatment possible; secondly, by situating the different discourses against binary categorization; and finally, by situating the speech and action of trans people in the production of new experiential knowledge. ResultsThe results demonstrate how the notion of gender within clinical psychiatry has moved from binary categorization to a participatory transpsychiatry that includes trans people and professional psychiatrists. Going from Dorchen Richet to Paul B. Preciado, the results of surgical and hormonal techniques are compared with the modifications of institutions, associations, and psychiatric journals. DiscussionThe discussion between psychiatrists and trans people is highlighted here through the themes of identity, subjective speech, and clinical support protocols. ConclusionTranspsychiatry is the recognition of both transgendering and the transformation of gender, as a clinical entity, by psychiatry.

La spécialité de la psychiatrie de l’enfant et de l’adolescent en Espagne. La route longue et sinueuse

ObjectivesAugust 3, 2021 marks an important milestone in the history of psychiatry in Spain with the establishment of the title of specialist in child and adolescent psychiatry. Until then, Spain remained one of the few European countries where this measure had not been implemented. This article aims to examine the development of child and adolescent psychiatry, highlighting the various contributions that have made it possible. MethodA literature review was conducted to trace the historical evolution of child and adolescent psychiatry. ResultsThe advancements in child and adolescent psychiatry worldwide are first presented, followed by an examination of the specific case of Spain. It is evident that the development of child and adolescent psychiatry in Spain has been slower compared to neighboring countries. Additionally, there is concerning heterogeneity in its implementation within the Spanish state. DiscussionThe findings suggest the emergence of new challenges, including the need to develop training programs and clinical guidelines based on scientific evidence. Ensuring effective, quality, and equitable mental healthcare services for children within the national health system is essential, with particular attention to patients with severe mental disorders. ConclusionThe introduction of the specialist title in child and adolescent psychiatry in Spain represents a significant advancement. However, new challenges need to be addressed, such as the formulation of evidence-based training plans and clinical guidelines. It is crucial to establish measures that ensure appropriate and equitable care for children and adolescents with mental disorders.

Commissioned Book Review: Matthew Smith, The First Resort: A History of Social Psychiatry in the United States

Commissioned Book Review: Matthew Smith, <i>The First Resort: A History of Social Psychiatry in the United States</i>

Paternal and maternal psychiatric history and risk of preterm and early term birth: A nationwide study using Swedish registers.

Women with psychiatric diagnoses are at increased risk of preterm birth (PTB), with potential life-long impact on offspring health. Less is known about the risk of PTB in offspring of fathers with psychiatric diagnoses, and for couples where both parents were diagnosed. In a nationwide birth cohort, we examined the association between psychiatric history in fathers, mothers, and both parents and gestational age. We included all infants live-born to Nordic parents in 1997 to 2016 in Sweden. Psychiatric diagnoses were obtained from the National Patient Register. Data on gestational age were retrieved from the Medical Birth Register. Associations between parental psychiatric history and PTB were quantified by relative risk (RR) and two-sided 95% confidence intervals (CIs) from log-binomial regressions, by psychiatric disorders overall and by diagnostic categories. We extended the analysis beyond PTB by calculating risks over the whole distribution of gestational age, including "early term" (37 to 38 weeks). Among the 1,488,920 infants born throughout the study period, 1,268,507 were born to parents without a psychiatric diagnosis, of whom 73,094 (5.8%) were born preterm. 4,597 of 73,500 (6.3%) infants were born preterm to fathers with a psychiatric diagnosis, 8,917 of 122,611 (7.3%) infants were born preterm to mothers with a pscyhiatric diagnosis, and 2,026 of 24,302 (8.3%) infants were born preterm to both parents with a pscyhiatric diagnosis. We observed a shift towards earlier gestational age in offspring of parents with psychiatric history. The risks of PTB associated with paternal and maternal psychiatric diagnoses were similar for different psychiatric disorders. The risks for PTB were estimated at RR 1.12 (95% CI [1.08, 1.15] p < 0.001) for paternal diagnoses, at RR 1.31 (95% CI [1.28, 1.34] p < 0.001) for maternal diagnoses, and at RR 1.52 (95% CI [1.46, 1.59] p < 0.001) when both parents were diagnosed with any psychiatric disorder, compared to when neither parent had a psychiatric diagnosis. Stress-related disorders were associated with the highest risks of PTB with corresponding RRs estimated at 1.23 (95% CI [1.16, 1.31] p < 0.001) for a psychiatry history in fathers, at 1.47 (95% CI [1.42, 1.53] p < 0.001) for mothers, and at 1.90 (95% CI [1.64, 2.20] p < 0.001) for both parents. The risks for early term were similar to PTB. Co-occurring diagnoses from different diagnostic categories increased risk; for fathers: RR 1.10 (95% CI [1.07, 1.13] p < 0.001), 1.15 (95% CI [1.09, 1.21] p < 0.001), and 1.33 (95% CI [1.23, 1.43] p < 0.001), for diagnoses in 1, 2, and ≥3 categories; for mothers: RR 1.25 (95% CI [1.22, 1.28] p < 0.001), 1.39 (95% CI [1.34, 1.44] p < 0.001) and 1.65 (95% CI [1.56, 1.74] p < 0.001). Despite the large sample size, statistical precision was limited in subgroups, mainly where both parents had specific psychiatric subtypes. Pathophysiology and genetics underlying different psychiatric diagnoses can be heterogeneous. Paternal and maternal psychiatric history were associated with a shift to earlier gestational age and increased risk of births before full term. The risk consistently increased when fathers had a positive history of different psychiatric disorders, increased further when mothers were diagnosed and was highest when both parents were diagnosed.

"On Suggestion" by John Bostock, 1923: A comparison with twenty-first century understandings of the placebo effect.

This paper describes Australian psychiatrist John Bostock's 1923 concept of suggestion and compares it to our understandings, in 2023, of the placebo effect. Bostock's 1923 article on "suggestion" gives us a glimpse of the history of Australian psychiatry. It also stimulates thought about the current understandings of the placebo effect. Now, as then, placebo effects can play a critical role in patient outcomes. However, careful consideration is required to ensure contemporary ethical standards are met and harm is not done.

Blame or discovery? Walter Benjamin's Jetztzeit, Purdue Pharma LP and 'our values and our historical understanding of psychiatrists'.

This commentary explores issues of professional identity, fairness and discovery in the history of psychiatry in the light of Walter Benjamin's (1892-1940) philosophy of history, especially his concept of Jetztzeit (now-time) and the profession's relationship with the founder and owners of Purdue Pharma LP.

H. Yumi Kim, Madness in the Family: Women, Care, and Illness in Japan

One might expect that themes involving Japanese family, mental illness and women would tend to fall into certain stereotypes associated with exotism, Orientalism or Japonism. In this book, however, most of these ‘expectations’ are betrayed. It describes with great accuracy the history of psychiatry in modern Japan based on many Japanese-language sources. This history is written from the viewpoint of patients and their families, focusing on issues related to women’s domestic labour and caregiving, and women’s bodies and physiology, a significant improvement on what has previously been lacking in research by Japanese scholars. But the book is not only about the weakness and perseverance of Japanese women who suffer and endure in the face of social inequality, as it also depicts their toughness and strengths that go beyond simply following such a society. This is such an important contribution to the field that it will be difficult to discuss the history of Japanese psychiatry from now on without Kim’s book.

Masturbatory insanity: the history of an idea, revisited.

In the eighteenth century, masturbation was extended from the moral to the medical sphere and conceptualized as being the cause of various deteriorative physical illnesses. In the nineteenth century, psychiatrists accepted that difficult to control masturbation was a feature of many mental disorders. They also believed that masturbation could play a casual role in a specific type of insanity with a distinctive natural history. In 1962, E.H. Hare published an article on the concept of masturbatory insanity that became an important explication of the masturbation and mental illness relationship in the history of psychiatry. Historical research published subsequent to Hare's article suggests several updates to his analysis. Hare did not note that the masturbation and mental illness relationship was promoted to the general public by quacks peddling quick cures. Hare emphasized psychiatrists' condemnatory language only, neglecting the aspiration of psychiatrists to treat disorders caused by excessive masturbation, not punish the sin of masturbation. Hare recognized the importance of hebephrenia and neurasthenia to this history but attributed the decline of masturbation related mental illness in part to the rejection of an irrational, unscientific hypotheses about masturbation's causal role. As an alternative, we suggest that before the causal role of masturbation was widely abandoned, the concepts of hebephrenia and neurasthenia gained a competitive advantage and became primary diagnoses for cases that once would have been conceptualized as masturbatory insanity.

Moving From Traumatic Events to Traumatic Experiences in the Study of Traumatic Psychopathology.

Trauma is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as an event that includes "actual or threatened death, serious injury, or sexual violence" (p. 271). The list of traumatic events included in the DSM-5 represents a long history of psychiatry and psychology's attempts to define trauma and differentiate these events from less severe stressors. In this commentary, we suggest that this strict distinction between traumatic events and stressful events is not useful for public health. The current DSM-5 list of traumatic events may work well for identifying people with the most severe experiences and highest conditional probability of distress who need clinical care. However, the public health field has different priorities. If we think about posttraumatic psychological distress on a population scale, it is not only helping those with the most severe experiences that is needed; rather, public health requires paying attention to all people experiencing distressing stress and trauma reactions. We propose that context is crucial to the development of a population-relevant definition of trauma and provide examples of situations in which stressors have resulted in posttraumatic psychological distress and in which traumatic event reactions have been mitigated by the context in which they occur. We discuss trauma context from an epidemiologic perspective and conclude with recommendations for the field. This article is part of a Special Collection on Mental Health.

La psychiatrie et les disciplines extrinsèques. Ouvertures et compositions

ObjectivesPsychiatry as a discipline is oriented towards the other and towards otherness; not only that of the patient and of their psychological issues, but also for the alterity of external knowledge. Recognizing its own limitations and its inability to think alone, psychiatry, whose specific knowledge is undoubtedly quite limited, has since the beginning turned to other disciplines. This article does not try to propose a new model likely to articulate this conceptual heterogeneity, but tries to understand how this movement of opening towards other disciplines is carried out. Psychiatry undeniably finds a richness in this, but does not its subservience to currents that are external to it risk accentuating its dissolution and making its identity disappear? MethodBased on the distinction proposed by G. Lantéri-Laura between intrinsic disciplines (i.e. clinical disciplines such as neurology, psychoanalysis) and extrinsic disciplines, which use a theoretical elaboration that owes nothing to clinical engagement with subjects (such as anthropology, history, or linguistics), this article will endeavor to show the contribution of extrinsic disciplines throughout the history of psychiatry, using a number of specific cases. ResultsThis article describes several ways in which psychiatry is linked to extrinsic knowledge, focusing more specifically on the human and social sciences and on history. Firstly, we study the movement by which psychiatry seeks support for its practice, an ethic of care, and even a critical ‘third eye’ that can offer it this perspective on a practice that is often decried. Secondly, this study proposes to examine the extent to which psychiatry, through the knowledge that it isolates concerning the question of madness, opens up by itself to a questioning of humanity that can be taken into account by other disciplines. Sociology shows, in particular, how clinical categories can be linked to the prejudices and ideals of a culture and an era. History shows how an event such as Pinel's liberation from chains can benefit from historical interpretations, the meanings of which are never exhausted. DiscussionPsychiatry is inspired by other knowledges, but this borrowing is often based on displacements that reflect the need to adapt to clinical issues. This extrinsic knowledge is never imported without transformation and without some infidelity. ConclusionRe-examining what is most obvious, questioning what seems most customary, these are the benefits that psychiatry can obtain by choosing to decentralize and to call upon disciplines extrinsic to the clinical. The inclusion of the human and social sciences in the understanding of psychological disorders is now well established. The dialogue that results from the meeting of heterogeneous disciplines is not intended to lead to a consensus. The clinical practice of psychiatry retains strong specificities linked to the exercise of the encounter with mental disorder. The resulting knowledge is irreducible to other disciplines. The psychiatric act is based on a responsibility incumbent on the clinician alone, irremediably divided by the issues he or she must face.

Reflections on the use of patient records: Privacy, ethics, and reparations in the history of psychiatry.

One of the most common questions we get asked as historians of psychiatry is "do you have access to patient records?" Why are people so fascinated with the psychiatric patient record? Do people assume they are or should be available? Does access to the patient record actually tell us anything new about the history of psychiatry? And if we did have them, what can, or should we do with them? In the push to both decolonize and personalize the history of psychiatry, as well as make some kind of account or reparation for past mistakes, how can we proceed in an ethical manner that respects the privacy of people in the past who never imagined their intensely personal psychiatric encounter as subject for future historians? In this paper, we want to think through some of the issues that we deal with as white historians of psychiatry especially at the intersection of privacy, ethics, and racism. We present our thoughts as a conversation, structured around questions we have posed for ourselves, and building on discussions we have had together over the past few years. We hope that they act as a catalyst for further discussion in the field.

PLAID-Care : une recherche sur le moindre recours à la coercition en France

The use of coercion is a common practice in psychiatry despite its deleterious effects and insufficient evidence of benefits. It is so deeply rooted that the mention of establishments that make little use of it arouses a form of incredulity. However, the history of psychiatry and the international literature provide numerous examples of a psychiatry that is hardly coercive and numerous experiences of a reduction in the use of seclusion and/or restraint in psychiatric facilities. Today, in France, there are also less coercive establishments, which, for example, do not use mechanical restraint, have all their units open, or have reduced their use of seclusion and restraint. With regard to the stated policy objectives of reducing the use of coercion, it is surprising that most of these facilities receive little attention. PLAID-Care research aims to contribute to the visibility and analysis of these institutions and the factors involved in the reduced use of coercion. While these factors have already been identified in the international literature, the research is based on the multiplication of disciplinary perspectives (nursing, sociology, anthropology, geography) and the mobilization of a multi-level analytical framework that allows us to embrace their multiplicity and better understand their articulation. The originality of the research also lies in its historical dimension, which allows us to understand, on the scale of an institution, how a policy and practices aiming at the least recourse emerge and are consolidated. The project timeline is divided in three tasks: firstly, an inventory of “low-coercion” facilities in France; secondly, we will select and research four traditionally “low-coercion” facilities in France; thirdly we will focus on recently emerged “low-coercion” practices. PLAID-Care aims to revitalize French research on this theme which to date has been relatively lagging behind the numerous international studies. It will bring together and articulate the knowledge, tools and forms of organization and collaboration that contribute to making a policy of lesser use of coercion operational.

The Fairy Tale King and his royal psychiatrist: the contribution to neuroscience of Dr Johann Bernhard Aloys von Gudden, psychiatrist to King Ludwig II – Psychiatry in history

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An Essential Therapeutic: Occupational Therapy in GDR Psychiatric Institutions as Seen by Contemporary Witnesses

The aim of this survey of professionals working in the GDR and former patients was to help determine the role and function of occupational therapy in psychiatric institutions. 74 contemporary witnesses were interviewed who had worked professionally in psychiatric institutions in the GDR or had been treated there in adulthood. The interviews were evaluated qualitatively. The eyewitnesses interviewed described the organisation and goals of occupational therapy as well as changes that took place over time. Occupational therapy was rated highly, as it represented an important additional therapy offering. Uniform activities and the misuse of patients' labor while neglecting their therapeutic requirements were subjected to critical assessment. In future, the interviews with contemporary witnesses should be included to a greater extent in investigations into the history of psychiatry. The view of the development of occupational therapy can provide valuable insights for further historical reappraisal, and contribute to our current understanding of these forms of therapy.