Implications For Psychiatry Research Articles

Measuring neuroplasticity in human development: the potential to inform the type and timing of mental health interventions.

Neuroplasticity during sensitive periods, the molecular and cellular process of enduring neural change in response to external stimuli during windows of high environmental sensitivity, is crucial for adaptation to expected environments and has implications for psychiatry. Animal research has characterized the developmental sequence and neurobiological mechanisms that govern neuroplasticity, yet gaps in our ability to measure neuroplasticity in humans limit the clinical translation of these principles. Here, we present a roadmap for the development and validation of neuroimaging and electrophysiology measures that index neuroplasticity to begin to address these gaps. We argue that validation of measures to track neuroplasticity in humans will elucidate the etiology of mental illness and inform the type and timing of mental health interventions to optimize effectiveness. We outline criteria for evaluating putative neuroimaging measures of plasticity in humans including links to neurobiological mechanisms shown to govern plasticity in animal models, developmental change that reflects heightened early life plasticity, and prediction of neural and/or behavior change. These criteria are applied to three putative measures of neuroplasticity using electroencephalography (gamma oscillations, aperiodic exponent of power/frequency) or functional magnetic resonance imaging (amplitude of low frequency fluctuations). We discuss the use of these markers in psychiatry, envision future uses for clinical and developmental translation, and suggest steps to address the limitations of the current putative neuroimaging measures of plasticity. With additional work, we expect these markers will significantly impact mental health and be used to characterize mechanisms, devise new interventions, and optimize developmental trajectories to reduce psychopathology risk.

The Evolving Landscape of Social Neuroscience and Its Implications for Psychiatry

The Evolving Landscape of Social Neuroscience and Its Implications for Psychiatry

Exploring the Philosophy of Mind and Its Implications for Psychiatry

IntroductionPhilosophy of mind grapples with fundamental questions concerning the Consciousness, the Mind-body problem, the Identity, and Free will (as opposed to Determinism). In the context of psychiatry, this philosophical groundwork provides a conceptual framework for comprehending the intricate workings of the human psyche.ObjectivesWe aim to discuss how the philosophical investigation of the mind influence and enhance psychiatrists understanding of psychiatric disorders and patient-centered care.MethodsReview of the literature.ResultsPhilosophy of mind explores what it means to be conscious and the nature of subjective experience. This includes questions about the “hard problem” of consciousness, that refers to the difficulty of explaining why and how physical processes in the brain give rise to subjective, first-person experiences (or qualia). The “hard problem” posits that even if we knew everything about the brain’s physical processes and how they relate to cognitive functions, we would still lack an explanation for why these processes give rise to subjective consciousness. Psychiatry often deals with individuals who experience disturbances in their subjective conscious experiences, so the “hard problem” perspective allows psychiatrists to appreciate the diversity of conscious experiences and to empathize with their patients’ unique mental worlds.Related with the previous topic is the mind-body problem. The elucidation of this problem highlights the challenge of reconciling mental phenomena with neurobiological processes. Integrating philosophical notions of dualism, materialism, and emergentism into psychiatric practice is essential for addressing the holistic nature of mental health.Concerning to philosophical perspectives on personal identity, questions about the continuity of identity, selfhood, and the role of narrative in shaping one’s sense of self contribute to a deeper understanding of disorders like dissociative identity disorder, borderline personality disorder and even psychosis.Furthermore, philosophical discussions on free will and determinism are pertinent to psychiatric ethics and the treatment of individuals with behavioral disorders, informing the ethical considerations surrounding involuntary psychiatric hospitalization, medication administration, and the delicate balance between autonomy and paternalism in psychiatric care.ConclusionsPhilosophy of mind provides psychiatry with a rich conceptual landscape, offering insights into the nature of mental phenomena. As our understanding of the brain and consciousness continues to evolve, the philosophy of mind remains an evolving area of philosophical inquiry.Disclosure of InterestNone Declared

Bradykinin actions in the central nervous system: historical overview and psychiatric implications.

Bradykinin (BK), a well-studied mediator of physiological and pathological processes in the peripheral system, has garnered less attention regarding its function in the central nervous system, particularly in behavioural regulation. This review delves into the historical progression of research focused on the behavioural effects of BK and other drugs that act via similar mechanisms to provide new insights into the pathophysiology and pharmacotherapy of psychiatric disorders. Evidence from experiments with animal models indicates that BK modulates defensive reactions associated with panic symptoms and the response to acute stressors. The mechanisms are not entirely understood but point to complex interactions with other neurotransmitter systems, such as opioids, and intracellular signalling cascades. By addressing the existing research gaps in this field, we present new proposals for future research endeavours to foster a new era of investigation regarding BK's role in emotional regulation. Implications for psychiatry, chiefly for panic and depressive disorders are also discussed.

A conversation analytic approach to schizophrenic interaction: methodological reflections on disruptions of the common-sense world.

Certain schools of phenomenological psychiatry conceive of schizophrenia as a pathology of common-sense. Ethnomethodological enquiry, with its roots in Schutzian social phenomenology, takes as its domain, topic, and substance of study the ongoing achievement of a common-sense world between social members. Yet, dialogue between psychiatry and ethnomethodological approaches is thin. In this article, we discuss a conversation analytic approach to schizophrenic interaction which has generated and utilized a model of a five-world manifold to frame analyses of talk-in-interaction. 'Worlds' are conceived, after Schutz, as finite domains of meaning, and the model operates as a breach of natural attitude assumptions to examine mechanisms of the constitution of the one-world-in-common of common-sense. It is suggested that certain aspects of schizophrenic talk might receive account in terms of a loss of integration between these five domains of meaning. Conversation Analytic methods were applied to transcripts of audio recordings of psychiatric interviews but encountered hurdles that motivated the broadening of methodological scope. Such hurdles included a weakening of the next turn proof procedure, implicit reification of the schizophrenia construct, and problems of translation presented by the analyst's normative membership encountering non-normative life-worlds of schizophrenic experience. Strategic responses to these hurdles included exploring linkages between phenomenological psychiatry and ethnomethodological approaches, as well as an engagement of ethnomethodological self-reflection and conceptual clarification of the schizophrenia construct in line with Garfinkel's unique adequacy requirement. The manifold model is glossed, and interaction between two of its worlds - a world of concrete, situational immediacies and another of abstract organizations - is explored in more detail via analysis of conversational data. It is suggested that the five-world model, along with further micro-analysis of talk-in-interaction, might have implications in psychiatry for topics such as autism, double bookkeeping, concretism, theories of disturbed indexicality, and insight attribution. We conclude that the consideration of atypical interaction obliges the interaction analyst to take account of their own implicit normative world-frames and that the use of domain-specific top-down models in conjunction with the inductive approach of Conversation Analysis may extend the reach of CA to facilitate productive dialogue with other disciplines.

Artificial intelligence in psychiatry research, diagnosis, and therapy.

Psychiatric disorders are now responsible for the largest proportion of the global burden of disease, and even more challenges have been seen during the COVID-19 pandemic. Artificial intelligence (AI) is commonly used to facilitate the early detection of disease, understand disease progression, and discover new treatments in the fields of both physical and mental health. The present review provides a broad overview of AI methodology and its applications in data acquisition and processing, feature extraction and characterization, psychiatric disorder classification, potential biomarker detection, real-time monitoring, and interventions in psychiatric disorders. We also comprehensively summarize AI applications with regard to the early warning, diagnosis, prognosis, and treatment of specific psychiatric disorders, including depression, schizophrenia, autism spectrum disorder, attention-deficit/hyperactivity disorder, addiction, sleep disorders, and Alzheimer's disease. The advantages and disadvantages of AI in psychiatry are clarified. We foresee a new wave of research opportunities to facilitate and improve AI technology and its long-term implications in psychiatry during and after the COVID-19 era.

Palliating in Avoidable Death: Reconciling Psychiatrists' Roles as Treaters on Death Row With Participation in a System of Overt Harm

Abstract Although nations across the globe have eliminated capital punishment, the United States remains one of the few countries in the Americas and Europe that still uses execution. There has been little discussion around the implications of psychiatry's involvement in providing care to incarcerated individuals awaiting death. The following perspective examines the United States as an example of a democratic and highly developed country where the death penalty remains an undeniable reality; the piece provides a brief discussion on psychiatry's relationship with end-of-life care to provide context for subsequent discussion on the role of the psychiatrist on death row in the United States. Medicolegal and ethical considerations are further outlined to identify specific concessions that might be made by the US criminal justice system to truly allow death row psychiatrists to practice to the highest standard of compassionate care.

Banging the drum: evolutionary and cultural origins of music and its implications for psychiatry.

There is growing interest in music-based therapies for mental/behavioural disorders. We begin by reviewing the evolutionary and cultural origins of music, proceeding then to discuss the principles of evolutionary psychiatry, itself a growing a field, and how it may apply to music. Finally we offer some implications for the role of music and music-based therapies in clinical practice.

Is It Cheating to Use Chat GPT-4 in the Clinical Practice of Psychiatry?

Back to table of contents Previous article Next article ViewpointsFull AccessIs It Cheating to Use Chat GPT-4 in the Clinical Practice of Psychiatry?Steven Hyler, M.D.Steven HylerSearch for more papers by this author, M.D.Published Online:8 Jun 2023https://doi.org/10.1176/appi.pn.2023.07.7.27As an enthusiastic admirer of technological advancements, I have always been fascinated by novel innovations, especially their potential implications in psychiatry. OpenAI's latest offering, Chat GPT-4, intrigued me due to its exceptional ability to provide a wealth of both personal and professional information. However, it's noteworthy to mention that this technology occasionally produces fictitious answers, or as known in AI parlance, "hallucinates," prompting questions about its reliability in patient care.In an endeavor to assess its applicability in psychiatry, my team at Columbia University Medical Center and I embarked on a project to compare Chat GPT-4's responses to a “gold standard” of psychiatric questions and answers readily available online. Our findings indicated that Chat GPT-4 delivered accurate responses about 70% to 80% of the time, a success rate parallel to studies conducted using the MCAT and USMLE. This outcome implies that Chat GPT-4 holds potential as a valuable asset in psychiatric practice.Nevertheless, the specter of “cheating” looms large when contemplating the deployment of AI technology in a professional setting. It's pivotal to distinguish between academic testing—where outside assistance is traditionally prohibited—and real-life medical practice, where physicians might significantly profit from harnessing all accessible resources for their patients' welfare. In 1983, Robert Spitzer, M.D., proposed the LEAD standard, which is an acronym for Longitudinal Evaluation conducted by expert clinicians, leveraging All Data available—family members' inputs, hospital records, psychological evaluations, and laboratory results included. Therefore, it begs the question: Why insist that our trainees rely solely on memory? Why not empower them with all available tools, teaching them how to optimally use these resources during their training?Consider a hypothetical study utilizing exam questions from the PRITE or ABPN. One group is instructed to refrain from using technology while answering the questions, under the threat of severe repercussions. In contrast, the other group is informed of no such limitations. Who would score higher? Which group would eventually morph into better physicians? It might be worth seeking the patients' perspective. Would they prefer their physicians to base their assessments, diagnoses, and treatment plans on memory alone? Or would they favor their physicians using all tech aids at their disposal for better patient care?In the realm of clinical psychiatry, I contend that using Chat GPT-4 should not be stigmatized as "cheating." Rather, it should be perceived as an additional instrument in the ever-growing arsenal of technology available to health care professionals. As physicians, we are tasked with the responsibility of setting boundaries when assimilating AI technology into patient care. It goes without saying that physicians should maintain accountability for their patients' care, not solely relying on AI-generated responses.Endorsing this viewpoint, I argue for the enablement and encouragement of trainees to harness all accessible resources, including Chat GPT-4, during their education. This approach could potentially enhance their clinical acumen and proficiency in integrating technology into patient care. I eagerly anticipate engaging in further discussions on this subject with other professionals who might hold divergent views. ■Steven Hyler, M.D., is professor emeritus of psychiatry at Columbia University Medical Center. He has a longstanding interest in education and technology. ISSUES NewArchived

Love’s place in the spectrum of affect, one of 24 secondary emotions: implications for psychiatry

Love is defined and examined as an emotion, using the psychoevolutionary theory of emotions developed by Robert Plutchik and extended to social psychiatry by Henry Kellerman. This theory posits a fourfold ethogram, representing the valanced adaptive reactions to problems of life which define the eight primary emotions. The problem of identity is addressed by acceptance and disgust; temporality, by joy–happiness and sadness. Using a hierarchical classification system, love is defined as a secondary-level emotion, a mixture of joy and acceptance. Examination of the brain infrastructure of these emotions supports their interpretation as basic emotions. In romantic and other forms of love, there is a global acceptance–incorporation, of the other, together with the joy of sexual pair-bonding. This can rise to the level of a clinical disposition that is both histrionic and manic, akin to a Durkheimian collective effervescence. The emotions of acceptance and joy are in everyday life constrained by ego-defense mechanisms: acceptance is constrained by a more critical, less idealised, view of a potential love object; uninhibited joy of sexuality is defended against by sublimation, in which libidinal energy is deflected into an emphasis on correct and proper behaviour, and purposive and productive activities.

Regulation of DNA Methylation by Cannabidiol and Its Implications for Psychiatry: New Insights from In Vivo and In Silico Models.

Cannabidiol (CBD) is a non-psychotomimetic compound present in cannabis sativa. Many recent studies have indicated that CBD has a promising therapeutic profile for stress-related psychiatric disorders, such as anxiety, schizophrenia and depression. Such a diverse profile has been associated with its complex pharmacology, since CBD can target different neurotransmitter receptors, enzymes, transporters and ion channels. However, the precise contribution of each of those mechanisms for CBD effects is still not yet completely understood. Considering that epigenetic changes make the bridge between gene expression and environment interactions, we review and discuss herein how CBD affects one of the main epigenetic mechanisms associated with the development of stress-related psychiatric disorders: DNA methylation (DNAm). Evidence from in vivo and in silico studies indicate that CBD can regulate the activity of the enzymes responsible for DNAm, due to directly binding to the enzymes and/or by indirectly regulating their activities as a consequence of neurotransmitter-mediated signaling. The implications of this new potential pharmacological target for CBD are discussed in light of its therapeutic and neurodevelopmental effects.

Is the pursuit of happiness the pursuit of homeostasis? A review on the modulatory functions of endorphins on human behavior

IntroductionEndorphins have been associated with analgesia and pleasurable activities. However, the so-called “happy chemicals” are far more complex than initially thought. Research shows that their impact on human behavior is modulatory, with the main goal not being “happiness” but a “return to the most desirable state” – which can be highly context-dependent.ObjectivesReview of the modulatory functions of endorphins on human behavior and their possible implications in psychiatric conditions.MethodsPubmed search consisting of the MeSH terms “Endorphins”, “Opioid Peptides”, “Behavior”, and “Psychiatry”.ResultsEndorphins elicit pleasure via stimulation of the release of dopamine from the ventral tegmental area to the nucleus accumbens. They are known to be involved in analgesia and stress response and social interaction. Endorphins can be released in a multitude of circumstances that may seem contradictory – having both inhibitory and stimulating roles in appetite, sexual response, and memory– but are modulatory effects depending on what constitutes homeostasis in each context. Peripheral levels of endorphins have been found low in depression and post-traumatic stress disorder. In schizophrenia, studies suggest that peripheral levels are high during psychosis, low in chronic disease and that naltrexone seems to improve auditory hallucinations. Endorphins may also have a role as markers of treatment response.ConclusionsEndorphins have a complex role in behavior and homeostasis. These molecules could have implications in psychiatry- given that they are part of our stress response and are released to promote a more “desirable state”. Their role as a marker of illness or response to treatment needs further investigation.DisclosureNo significant relationships.

Personalized values in life as point of interaction with the world: Developmental/neurobehavioral basis and implications for psychiatry.

Behavioral neuroscience has dealt with short-term decision making but has not defined either daily or longer-term life actions. The individual brain interacts with the society/world, but where that point of action is and how it interacts has never been an explicit scientific question. Here, we redefine value as an intrapersonal driver of medium- and long-term life actions. Value has the following three aspects. The first is value as a driving force of action, a factor that commits people to take default-mode or intrinsic actions daily and longer term. It consists of value memories based on past experiences, and a sense of values, the source of choosing actions under uncertain circumstances. It is also a multilayered structure of unconscious/automatic and conscious/self-controlled. The second is personalized value, which focuses not only on the value of human beings in general, but on the aspect that is individualized and personalized, which is the foundation of diversity in society. Third, the value is developed through the life course. It is necessary to clarify how values are personalized through the internalization of parent-child, peer, and social experiences through adolescence, a life stage almost neglected in neuroscience. This viewpoint describes the brain and the behavioral basis of adolescence in which the value and its personalization occur, and the importance of this personalized value as a point of interaction between the individual brain and the world. Then the significance of personalized values in psychiatry is discussed, and the concept of values-informed psychiatry is proposed.

Commercial Use of Emotion Artificial Intelligence (AI): Implications for Psychiatry.

Emotion artificial intelligence (AI) is technology for emotion detection and recognition. Emotion AI is expanding rapidly in commercial and government settings outside of medicine, and will increasingly become a routine part of daily life. The goal of this narrative review is to increase awareness both of the widespread use of emotion AI, and of the concerns with commercial use of emotion AI in relation to people with mental illness. This paper discusses emotion AI fundamentals, a general overview of commercial emotion AI outside of medicine, and examples of the use of emotion AI in employee hiring and workplace monitoring. The successful re-integration of patients with mental illness into society must recognize the increasing commercial use of emotion AI. There are concerns that commercial use of emotion AI will increase stigma and discrimination, and have negative consequences in daily life for people with mental illness. Commercial emotion AI algorithm predictions about mental illness should not be treated as medical fact.

Gut microbiota and its implications for psychiatry

IntroductionIn recent years there has been increasing interest in knowing the function of the microbiota, especially its role in the gut-brain axis. The microbiota is the set of millions of microorganisms that coexist in a symbiotic way in our body and are located in the digestive tract mainly. Numerous evidences show that the microbiota could modulate the information directed to the brain and therefore the pathogenic basis of numerous psychiatric and neurological disorders.ObjectivesA better understanding of the microbiota and its interaction with the brain and mental health.MethodsReview of recent literature about the implications of the gut microbiota in psychiatry.ResultsThe connection between the microbiota and the central nervous system (gut-brain axis) occurs through the vagus nerve, the systemic pathway (through the release of hormones, metabolites and neurotransmitters) and the immune system (through the action of cytokines). Changes in the microbiota are associated not only with gastrointestinal diseases, but also with disorders such as depression, anxiety, autism, anorexia, attention deficit and hyperactivity, Alzheimer’s disease and Parkinson’s disease. As some research indicates, changes in diet and composition of the microbiota can reduce the risk of suffering these diseases or reduce their symptoms. Other therapeutic alternatives postulated are the use of probiotics or fecal microbiota transplantation.ConclusionsDespite growing interest in the microbiota in the last few years, little is known about the mechanisms underlying this communication. More research is expected to contribute to the design of strategies that modulate the gut microbiota and its functions in order to improve mental health.

Mental health and biological evolution: implications for psychiatry and psychosomatic medicine

Abstract Psychiatric disorders are common and seem to increase in prevalence worldwide. Most scientific approaches for this phenomenon fail to explain why the majority of mental disorders, unlike most somatic diseases, manifest in early adulthood, why individuals are not more resilient, and why some genes increasing the risk for mental disorders have not been selected against. In this article, an evolutionary perspective on mental health and disorder is taken. This perspective suggests that mismatches between ancestral and contemporary environments contribute to the risk for mental disorders. In addition, predictions from attachment theory and life history theory can explain individual differences with regard to the risk of developing a psychiatric or psychosomatic disorder. Insights from evolutionary approaches to psychiatric and psychosomatic disorders may contribute to improve the prevention and treatment of mental disorders.

Ways of Debating Assisted Suicide and Euthanasia: Implications for Psychiatry

Euthanasia or assisted suicide (EAS) is permitted in a handful of jurisdictions. But its scope (ranging from being restricted to the end of life to no restrictions save those of autonomy) and its legal basis (ranging from a necessary prerogative of physicians to a human right) vary greatly. The debate over psychiatric EAS (pEAS) needs to be understood within this complex context. This essay addresses one specific aspect: can pEAS be grounded on a basic human right? The author argues against pEAS as grounded on a basic human right by showing that such a view has several implications we ought not accept.

Modulation of Slow-Wave Sleep: Implications for Psychiatry.

The objectives of this review are to examine and integrate existing empirical evidence regarding the impact of slow-wave sleep (SWS) modulation on memory and executive function performance in individuals with psychiatric disorders, and to examine the feasibility of integrating SWS modulation into psychiatric care. SWS modulation in individuals with psychiatric disorders resulted in changes to SWS across multiple psychiatric disorders, using all stimulation methods. SWS stimulation was associated with improved cognitive performance. SWS modulation using acoustic stimulation resulted in improved cognitive performance in children with ADHD, and the use of transcranial stimulation was associated with improved cognitive performance in individuals with mild cognitive impairment. Significant relationships between changes in SWS and cognitive improvement were found for individual with mild cognitive impairment following the use of acoustic or transcranial stimulation night. Our review reveals partial support to the potential efficacy of SWS modulation as a transdiagnostic intervention that uses sleep to improve cognitive functions of individuals diagnosed with psychiatric disorders and cognitive deficits. It further highlights multiple barriers pertaining to the feasibility of integrating SWS modulation into clinical practice and proposes ways to improve it.

Fetal alcohol spectrum disorders awareness in health professionals: implications for psychiatry.

Fetal Alcohol Spectrum Disorders (FASD) are a plethora of malformative conditions leading to mental retardation that affect newborns and children who have been exposed to alcohol during pregnancy or breastfeeding. FASD is a relevant topic for public health in Europe: European area is first in ranking for alcohol use during pregnancy with a prevalence of 25.2%. Italy ranked third among European countries with higher prevalence of FASD (45.0 per 1000 population). Furthermore, FASD could still be underestimated because of numerous undiagnosed and misdiagnosed cases. Aims of the study were to briefly summarize existing evidences about FASD and its psychiatric aspects to assess knowledge, attitudes and practice towards alcohol drinking during pregnancy in an Italian sample of health care professionals in order to provide information about FASD prevention. An anonymous online questionnaire containing the AUDIT-C, T-ACE model and the Drinking Motive Questionnaire was sent to 400 Italian healthcare professionals and students. The survey included socio-demographic information, questions about drinking habits and about knowledge, attitude and practice towards alcohol assumption during pregnancy. Among 320 respondents, 96.3% were women. AUDIT-C revealed that 52.4% were low risk drinkers but 27.6% were hazardous drinkers. The 90.6% of participants denied to ever attended a course about the fetus damage induced by alcohol consumption during pregnancy but 91.3% were willing to participate to professional update initiatives on the topic. Only 19.1% of participants talk regularly about the deleterious effects for the fetus of prenatal alcohol drinking to women and only 51.1% advise the 'zero alcohol' policy. Around 41% of participants tolerates the assumption of low-alcohol beverages. No differences were found between no drinkers and low and hazardous drinkers. In conclusion, data show that only specific and continuing updating for health care professionals about drinking habits may have impactful actions to prevent gestational alcohol intake in order to prevent the main cause of mental retardation in western countries.

Epigenetic mechanisms in schizophrenia and other psychotic disorders: a systematic review of empirical human findings.

Schizophrenia and other psychotic disorders are highly debilitating psychiatric conditions that lack a clear etiology and exhibit polygenic inheritance underlain by pleiotropic genes. The prevailing explanation points to the interplay between predisposing genes and environmental exposure. Accumulated evidence suggests that epigenetic regulation of the genome may mediate dynamic gene-environment interactionsat the molecular level by modulating the expression of psychiatric phenotypes through transcription factors. This systematic review summarizes thecurrent knowledge linking schizophrenia and other psychotic disorders to epigenetics, based on PubMed and Web of Science database searches conducted according to the PRISMA guidelines. Three groups of mechanisms in case-control studies of human tissue (i.e., postmortem brain and bio-fluids) were considered: DNA methylation, histone modifications, and non-coding miRNAs. From the initial pool of 3,204 records, 152 studies met our inclusion criteria (11,815/11,528, 233/219, and 2,091/1,827 cases/controls for each group, respectively). Many of the findings revealed associations with epigenetic modulations of genes regulating neurotransmission, neurodevelopment, and immune function, as well as differential miRNA expression (e.g., upregulated miR-34a, miR-7, and miR-181b). Overall, actual evidence moderately supports an association between epigenetics and schizophrenia and other psychotic disorders. However, heterogeneous results and cross-tissue extrapolations call for future work. Integrating epigenetics into systems biology may critically enhance research on psychosis and thus our understanding of the disorder. This may have implications for psychiatry in risk stratification, early recognition, diagnostics, precision medicine, and other interventional approaches targeting epigenetic fingerprints.