Paradigm In Psychiatry Research Articles

Antipsychotic Treatment in People at Clinical High Risk for Psychosis: A Narrative Review of Suggestions for Clinical Practice.

The "early intervention" paradigm in psychiatry holds significant promise for preventing psychosis. Recent evidence showed that individuals at clinical high risk for psychosis (CHR-P) with antipsychotic (AP) prescription at baseline have higher psychosis transition rates compared with those without AP, although the underlying cause remains unclear. In this article, we reviewed international guidelines on early intervention in CHR-P people, paying specific attention to clinical recommendations on AP treatment. Then, we comment on these suggestions in the light of recent empirical evidence examining AP prescription in CHR-P populations within "real-world" clinical settings. This search was conducted on PubMed/MEDLINE, PsycINFO, EMBASE, and Google, looking for both "Guidelines AND CHR-P OR UHR OR Early Psychosis." International guidelines generally recommend not using AP as first-line treatment, but only when psychosocial interventions have failed. CHR-P people with AP drug showed high prevalence rates and had more severe clinical picture at entry. Is this a "warning signal" for potentially higher psychosis transition risk? Is it a direct AP iatrogenic effect? Is it possible to detect specific CHR-P subgroup that may benefit from AP? These are the questions that this article seeks to explore. The current framework for identifying CHR-P subjects has defined psychometric criteria mainly based on positive symptoms. In our opinion, this is reductive, especially for evaluating therapeutic outcomes and prognosis. A more comprehensive assessment considering quality of life, psychiatric comorbidity, persistent negative symptoms, subjective experience of CHR-P psychopathology, and social/personal recovery is thus needed.

The operational paradigm in psychiatry: How valid is it?

One of the criticisms of the operational/diagnostic criteria, generalised since DSM-III, has been that they were shaped solely to achieve the best inter-peer reliability with no considerations for validity. This does not fully reflect reality since throughout the development of the criteria, there was an effort to define and fulfil some validity requirements. However, despite several attempts to create alternative diagnostic systems, there is still a widespread misunderstanding of the epistemological foundations that support this paradigm. In this article, we intend to analyse the epistemological context in which the operational criteria (OC) emerged and some of the validation processes they have undergone since their conception. On the epistemological basis of these operational criteria (OC) the influence of Hempel has been widely discussed. However, the group from St. Louis and, also the DSM-III editors, never openly acknowledged his role and his contribution and revealed other influences such as other medical specialties (that used and validated several OC in the diagnosis of their diseases). On the other hand, contrary to what has often been mentioned there has been a continuous attempt to validate the OC since their conception. In the implementation and development of the operational paradigm, a more instrumental trend was followed, focused on utility, but with successive attempts to achieve realistic validity by searching for biological or psychological causality. The methodologies were initially expert-driven and gradually more data-driven and included some variables external to the construct itself, such as familial aggregation, diagnostic consistency over time, prognostic and other psychometric measures.

Complementary perspectives in subclinical psychosis: From clinical high-risk and personality organization to ordinary psychosis

ABSTRACT In this paper, I try to bring the Lacanian psychoanalytic concept of ‘ordinary psychosis’ (OP) into dialogue with the prevailing paradigms in psychiatry and psychodynamic theory regarding subclinical psychosis: respectively, the model of clinical-high-risk for psychosis and that of personality organization/disorder. OP is a bottom-up clinical approach applicable to both atypical/subclinical psychoses and disordered personality that identifies both the main psychological difficulties encountered and the compensatory mechanisms employed by the individual. Its diagnosis relies on subtle indices or markers of a ‘disturbance of the sense of life’ and of a failure of knotting together the elements of the subjective structure. Many patients typically diagnosed with a personality disorder may be treated as cases of OP. This clinical concept is not limited to a descriptive approach and it offers insights into both subtle psychological deficits and mechanisms contributing to resilience. It avoids the risk of unjustified preventive treatments and stigmatization carried by a model of attenuated psychosis. It facilitates the direction of the psychotherapeutic treatment offering more than support to the individual’s adaptive attitudes. It offers insights into the communication between the medical and the psychodynamic models. OP is therefore a category of clinical utility, psychological validity, and ethical value.

Botulinum Toxin Treatment for Depression: A New Paradigm for Psychiatry.

Multiple randomized double-blind placebo-controlled trials have shown that botulinum toxin A (BoNT/A), when injected into the frown musculature, is an antidepressant. This review outlines the conceptual narrative behind this treatment modality, starting with theory developed by Charles Darwin. We develop the concept of emotional proprioception and discuss how the muscles of facial expression play an important role in relaying valenced information to the brain's emotional neuroanatomical circuit. We review the role of facial frown musculature as the brain's barometer and transmitter of negatively valanced emotional information. The direct connections between the corrugator muscles and the amygdala are reviewed, and these provide a neuroanatomical circuit that is a logical target for treatment with BoNT/A. The centrality of amygdala dysfunction in the pathogenesis of many psychiatric disorders, and the evidence that BoNT/A modulates amygdala activity, provides the mechanistic link between BoNT/A and its antidepressant activity. Animal models of BoNT/A's antidepressant effects confirm the evolutionary conservation of this emotional circuit. The clinical and theoretical implications of this evidence, as it relates to the potential treatment of a broad range of psychiatric disorders by BoNT/A, is discussed. The ease of administration, long duration, and favorable side effect profile of this therapy is reviewed in the context of existing antidepressant treatments.

Inequality and barriers in psychosis prevention: A systematic review on clinical high-risk for psychosis studies from developing countries.

The clinical high-risk for psychosis (CHR) paradigm is one of the best studied preventive paradigms in psychiatry. However, most studies have been conducted in high-income countries. It is unclear if knowledge from such countries applies to low and middle-income countries (LAMIC), and if there are specific limitations hindering CHR research there. Our aim is to systematically review studies on CHR from LAMIC. A multistep PRISMA-compliant literature search was performed in PubMed and Web of Science for articles published until 1/03/2022, conducted in LAMIC, addressing the concept and correlates of CHR. Study characteristics as well as limitations were reported. Corresponding authors of the included studies were invited to answer an online poll. Quality assessment was done with the MMAT. A total of 109 studies were included in the review: none from low-income countries, 8 from lower middle-income countries, and 101 from upper middle-income countries. The most frequent limitations were small sample size (47.9%), cross-sectional design (27.1%), and follow-up issues (20.8%). Mean quality of included studies was of 4.4. Out of the 43 corresponding authors, 12 (27.9%) completed the online poll. They cited further limitations as few financial resources (66.7%), no involvement of population (58.2%) and cultural barriers (41.7%). Seventy five percent researchers reported that CHR research should be conducted differently in LAMIC compared to high-income countries, due to structural and cultural issues. Stigma was mentioned in three out of five sections of the poll. Results show the discrepancy of available evidence on CHR in LAMIC, given the shortage of resources in such countries. Future directions should aim to increase the knowledge on individuals at CHR in such settings, and to address stigma and cultural factors that may play a role in the pathways toward care in psychosis. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=316816, CRD42022316816.

Implications of postmaterialist theories of consciousness for psychiatry: towards an integral paradigm

Abstract Mental health professionals can help patients understand exceptional and paranormal experiences, integrate them into day-to-day life, and cope with confusion and anxiety that sometimes accompany them. However, a broader clinical perspective and specialized training in clinical parapsychology is needed. In the first part of the paper I argue that psychiatry as currently practiced is limited because it embraces a strictly materialist paradigm, emphasizes treatment over prevention, and relies principally on pharmaceuticals that are often ineffective and/or unsafe. A paradigm shift in psychiatry is taking place that will soon lead to novel concepts of energy and innovations in therapeutic approaches. In the second part of the paper I review the ongoing debate over consciousness, implications of novel understandings of energy for psychiatry, and research findings in physics, neuroscience and parapsychology that are contributing to a postmaterialist paradigm in psychiatry. I comment on an important problem in the philosophy of science called Hempel’s dilemma and argue that future scientific theories of consciousness will probably encounter similar conceptual limits to those faced by current theories. Following Beauregard, Trent and Schwartz (2018) I argue that different categories of theories may be needed to adequately explain the variety of human experiences and I propose an integral paradigm that acknowledges the validity of both conventional scientific explanations and postmaterialist theories of consciousness. Finally, I discuss implications of postmaterialism for research, education and training in psychiatry.

Psychedelic medicine at a crossroads: Advancing an integrative approach to research and practice.

Psychedelics have been already used by human societies for more than 3000 years, mostly in religious and healing context. The renewed interest in the potential application of psychedelic compounds as novel therapeutics has led to promising preliminary evidence of clinical benefit in some psychiatric disorders. Despite these promising results, the potential for large-scale clinical application of these profoundly consciousness-altering substances, in isolation from the sociocultural contexts in which they were traditionally used, raises important concerns. These concerns stem from the recognition that the mechanisms of therapeutic action of psychedelics are not entirely dependent on neurobiology, but also on the psychological, social and spiritual processes for their efficacy. For these reasons, physicians or psychotherapists involved in psychedelic-assisted psychotherapy need training in ways to accompany patients through this experience to promote positive outcomes and address potential side effects. Psychedelic therapies may foster the emergence of a novel paradigm in psychiatry that integrates psychopharmacological, psychotherapeutic, and cultural interventions for patients with mental health issues.

Debate: Conduct disorder, like all psychiatric diagnoses, is not a diagnosis.

Like all psychiatric diagnoses, conduct disorder (CD) relies on entirely subjective foundations. Without empirical anchors, we are left with descriptors that cannot help us identify cases that share universalisable commonalities beyond those imposed on them by the subjectivity of the diagnoser. This article highlights how mistaking a descriptive category for a diagnosis has resulted in, including for CD, a failure to improve scientific knowledge or clinical outcomes. For progress to occur the dominance of a technical diagnostic paradigm in psychiatry must be over-turned and CD will then lie on the slag heap of history alongside the other consumable brands mis-labelled as a psychiatric diagnosis.

«A lot of quotes, a lot of grief, but little scientific» A few comments on the discussion (questions to the authors of the review and article) «The crisis of natural science and humanitarian approaches in psychiatry»

The discourse is based on a review (article) by I.M.Zislin on an article by N.G. Neznanov et al. (Review of Psychiatry and Medical Psychology. 2019;1: 8-15). Based on the methodology and philosophy of science, the key words of the review are discussed. The subject of psychiatry as a medical (clinical) science is analyzed — the same for all its sections, taking into account the principle of demarcation. The humanitarian approach is reduced to the humanitarian (axiological, pragmatic) paradigm of psychiatry, in particular, the crisis of psychology. The importance of including spirituality in the biopsychosocial model (BPS model), mainly through psychotherapy, is pointed out.

Empirical support for the use and further study of the countertransference construct in the clinical care of patients with bipolar disorder.

We thank Andrew Shaw and colleagues for their recent paper1 inBipolar Disorders, highlightingthat theeffectivetreatment of patients with bipolar disorder requires a good therapeutic alliance,which is related to the clinicians' countertransference reactions and their management. The authorssuggestthat the integration of a psychodynamic approach into the biological paradigm in psychiatry might be helpful to increase countertransference awareness in clinicians, andpotentially improvingdyadic communication,resolution ofalliance ruptures, and treatment adherence. Theyalsomention that although the theoretical literature on countertransference is well developed, no good empirical studies exist that investigate the countertransferential responses experienced by mental health clinicians involved in the care of individualsduring acute phases of bipolar disorder. We would, however, like to add some examples of empirical evidence for the use (and further study) of the countertransference in the clinical care of these patients.

Psychedelics: A New Treatment Paradigm in Psychiatry?

The renaissance of psychedelics has accelerated further over the past year. At least that's true if you follow the public press. The New York Times recently titled "The Psychedelic Revolution Is Coming. Psychiatry May Never Be the Same." on its front page 1.

Spór o depresję. Czy fenomenologicznie zorientowana filozofia psychiatrii rozwiąże problemy psychiatrii redukcjonistycznej?

Celem artykułu jest zarysowanie sporu dotyczącego trudności w diagnozowaniu, definiowaniu i leczeniu depresji toczącego się w ramach redukcjonistycznej psychiatrii biologicznej, a także odpowiedź na pytanie, czy nowe podejście do zaburzeń psychicznych oferowane przez filozofów psychiatrii wywodzących się z nurtu fenomenologicznego i paradygmatu ucieleśnionego poznania rozwiązuje owe trudności. Problematyczne zagadnienia związane ściśle z depresją przedstawiam w kontekście głównych wskazywanych obecnie problemów psychiatrii redukcjonistycznej. Po tym wprowadzeniu prezentuję enaktywistyczne, fenomenologiczne i ucieleśnione koncepcje dotyczące depresji, w tym terapii depresji. Na koniec rozważam, na ile owe koncepcje istotnie wykraczają poza nurty już obecne w psychiatrii. Wskazuję również, pod jakimi względami omawiane koncepcje w filozofii psychiatrii mogą okazać się pożyteczne, nawet jeśli z różnych względów nie rozwiązują wielu ze wskazanych problemów psychiatrii redukcjonistycznej.

The «System 3+3» in a Problem of Searching of a New Paradigm in Psychiatry

In article are presented possibilities of a unique method of diagnosis of mental diseases - the dispersion of amplitude-frequency characteristics of an alpha rhythm (DAFCAR) from positions of paradigm shift of the psychiatry based on the dimensions research techniques.

Fear Processing, Psychophysiology, and PTSD.

The processing and regulation of fear is one of the key components of posttraumatic stress disorder (PTSD). Fear can involve both acute and potential threats that can manifest in different behaviors and result from activity within different neural nodes and networks. Fear circuits have been studied extensively in animal models for several decades and in human neuroimaging research for almost 20 years. Therefore, the centrality of fear processing to PTSD lends the disorder to be more tractable to investigation at the level of brain and behavior, and provides several observable phenotypes that can be linked to PTSD symptoms. Moreover, psychophysiological metrics of fear conditioning offer tools that can be used to shift diagnostic paradigms in psychiatry toward neurobiology-consistent with a Research Domain Criteria approach to PTSD. In general, mammalian fear processing can be divided into fear learning (or acquisition), during which an association develops between previously neutral stimuli and aversive outcomes, and fear extinction, in which the latter associations are suppressed by a new form of learning. This review describes translational research in both fear acquisition and extinction, along with their relevance to PTSD and PTSD treatment, focusing specifically on the empirical value and potential clinical utility of psychophysiological methods.

Depression in the Context of Search of a New Paradigm in Psychiatry

Depression in the Context of Search of a New Paradigm in Psychiatry

The Role of Cardiology in Search of a Paradigm of Psychiatry

The Role of Cardiology in Search of a Paradigm of Psychiatry

Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective.

Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally stressful events in childhood, including abuse, emotional neglect, disturbed attachment, and boundary violations are central and typical etiological factors. Familial, societal, and cultural factors may give rise to the trauma and/or they may influence the expression of DID. Memory and the construction of self-identity are cognitive processes that appear markedly and centrally disrupted in DID and are related to its etiology. Enduring decoupling of psychological modes may create separate senses of self, and metamemory processes may be involved in interidentity amnesia. Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied. Comparison of well-selected samples of DID patients with non-dissociative subjects who have other psychiatric disorders would further delineate the neurobiological and cognitive features of the disorder, whereas genetic research on DID would further illuminate the interaction of the individual with environmental stress. As such, DID may be seen as an exemplary disease model of the biopsychosocial paradigm in psychiatry.

Biomarkers in DSM-5 Sleep-Wake Disorders: A Useful Paradigm for Psychiatry?

The biomarkers and nosology of sleep-wake disorder medicine, as represented in the DSM-5, furnish an informative paradigm for the use of biomarkers in psychiatric practice. This article presents a case study that illustrates the relevance of sleep-related biomarkers to diagnosis, treatment monitoring, and prognosis. The biomarkers discussed in the DSM-5 sleep-wake disorders chapter have reliability as well as antecedent, concurrent, and predictive validity, making them clinically useful for personalized medicine. The optimal clinical context for the use of such biomarkers is care that is measurement based, longitudinal, team based, patient focused, and (as often as not) family centered. In addition, such biomarkers also provide important clues to etiopathogenesis.

A social paradigm in psychiatry - themes and perspectives.

Psychiatry as science is underpinned by paradigms. Considering whether a social paradigm may help to advance the current state of psychiatry, the review provides a reference to the rich, but fragmented past of related initiatives in the history of psychiatry and a personal view of themes, challenges and perspectives of using a social paradigm in psychiatry. Major themes are the evidence on social determinants of mental health; the value-based importance of integrating people with mental disorders in society; options to overcome the social isolation and improve the networks of psychiatric patients; utilising a systemic approach for interventions in families and communities; and understanding group and one-to-one treatments in psychiatry primarily as social interactions. Whilst all these themes open up perspectives for future action and/or research, there are also conceptual challenges through the limitations of the current construct of mental disorders and the dominating terminology. Initiatives for using a social paradigm in psychiatry may refer to important achievements in the past, but need to go beyond this and consider on-going societal changes. Innovation may benefit from close collaboration with social sciences and humanities.

The two-process model of sleep regulation: a reappraisal.

In the last three decades the two-process model of sleep regulation has served as a major conceptual framework in sleep research. It has been applied widely in studies on fatigue and performance and to dissect individual differences in sleep regulation. The model posits that a homeostatic process (Process S) interacts with a process controlled by the circadian pacemaker (Process C), with time-courses derived from physiological and behavioural variables. The model simulates successfully the timing and intensity of sleep in diverse experimental protocols. Electrophysiological recordings from the suprachiasmatic nuclei (SCN) suggest that S and C interact continuously. Oscillators outside the SCN that are linked to energy metabolism are evident in SCN-lesioned arrhythmic animals subjected to restricted feeding or methamphetamine administration, as well as in human subjects during internal desynchronization. In intact animals these peripheral oscillators may dissociate from the central pacemaker rhythm. A sleep/fast and wake/feed phase segregate antagonistic anabolic and catabolic metabolic processes in peripheral tissues. A deficiency of Process S was proposed to account for both depressive sleep disturbances and the antidepressant effect of sleep deprivation. The model supported the development of novel non-pharmacological treatment paradigms in psychiatry, based on manipulating circadian phase, sleep and light exposure. In conclusion, the model remains conceptually useful for promoting the integration of sleep and circadian rhythm research. Sleep appears to have not only a short-term, use-dependent function; it also serves to enforce rest and fasting, thereby supporting the optimization of metabolic processes at the appropriate phase of the 24-h cycle.