Psychiatry Science Research Articles

Deconstructing the Language of Psychotherapy Documentation

In this paper, the author examines the role that psychotherapy documentation plays in community mental health: documentation’s bureaucratic/administrative functions, its foundation in the science of psychiatry, and the impact it has on the clinical situation. His critique of documentation language uses ideas drawn from Samuel Beckett’s 1951 novel Molloy, which deals with the weakness and absurdity of language as a means to express what is often unnamable. Likewise, he draws on Hanna Segal’s idea of symbol formation to offer a psychodynamic explanation for the way language is employed in documenting treatment in community settings, especially the treatment of those with severe mental illness. The author argues that the essence of psychotherapy and what it addresses cannot be captured by the style of documentation imposed on medical/agency settings. He uses his own personal story and a case study to show how the documentation requirements became a source of distress and negatively impacted the treatment.

The Vast and Diverse World of the Science of Paranoid Schizophrenia, Scientific Vision of Cognitive Science and a Biomedical Science Perspective

The world of challenges in the field of medical science, biomedical science, health sciences and engineering are in the path of newer scientific and technological regeneration. In the similar vision, the science of psychology and psychiatry are also in the avenues of deep scientific ingenuity and scientific prowess. This is a case study of the author who is suffering from schizophrenia from November, 1993. Since October, 2012, he is diagnosed with glaucoma in his both eyes. Long years of agony, ardor, trials and tribulations have passed since then. This treatise deeply elucidates the strong ardor and mental health challenges faced by the author since November, 1993. Medical science, health science and technology needs to be revamped and re-envisioned as regards treatment and cure of this difficult mental health illness. The author deeply pronounces the needs of psychotherapy and counselling in the treatment and well-being of the patient. This article reiterates the revamping of the science of paranoid schizophrenia since this is an incurable ailment. Scientific rejuvenation and deep technological vision are the utmost needs of the hour. The field of biomedical sciences and biological engineering will truly open newer windows of scientific innovation and scientific triumph in decades to come. This article is a message to all sufferers of the ailment of schizophrenia and other bi-polar disorders. Surely a newer day and a newer dawn in medical science will emerge if discoveries and innovations moves towards positive directions in treatment and cure. Civilization and science will surely usher in a newer dawn in the science of psychiatry if there is an effective support system from doctors and psychologists across the globe. In the similar vision the domain of healthcare system across the world will witness newer scientific regeneration if researchers, scientists, students and policy makers takes affirmative steps and affirmative vision in the scientific research pursuit in psychological science in decades to come. Recent breakthroughs in cognitive science and neuroscience will surely usher in newer dimensions in treatment and cure of schizophrenia.

Monitoring and treatment in patients with bipolar disorder using smartphones—New perspectives for improved quality in patient care

The rapid international growth in access to and capabilities of mobile and wireless technologies (mHealth) presents a feasible route towards augmenting traditional mental health care. The interest in mHealth science in psychiatry has been further heightened by the acknowledged potential for these tools to improve individual risk prediction and diagnostic precision, as well as improved treatment options. We have conducted research within smartphone-based monitoring and treatment in patients with bipolar disorder through the last decade. We conclude that the technological capabilities of smartphones are already changing mental health care and is accompanied by an early but promising evidence base. However, further efforts towards strengthening the evidence and implementation must be addressed for digital mental health technologies to truly improve mental health research and treatment in the future.

The Simple Science of Psychiatry, Psychodrugs and of WAR—Friendless Childhoods Foment Warring Adults

The Simple Science of Psychiatry, Psychodrugs and of WAR—Friendless Childhoods Foment Warring Adults

Reframing Psychiatry for Precision Medicine

The art of observing and describing behaviors has driven diagnosis and informed basic science in psychiatry. In recent times, studies of mental illness are focused on understanding the brain’s neurobiology but there is a paucity of information on the potential contributions from peripheral activity to mental health. In precision medicine, this common practice leaves a gap between bodily behaviors and genomics that we here propose to address with a new layer of inquiry that includes gene expression on tissues inclusive of brain, heart, muscle-skeletal and organs for vital bodily functions. We interrogate gene expression on human tissue as a function of disease-associated genes. By removing genes linked to disease from the typical human set, and recomputing gene expression on the tissues, we can compare the outcomes across mental illnesses, well-known neurological conditions, and non-neurological conditions. We find that major neuropsychiatric conditions that are behaviorally defined today (e.g., autism, schizophrenia, and depression) through DSM-observation criteria have strong convergence with well-known neurological conditions (e.g., ataxias and Parkinson’s disease), but less overlap with non-neurological conditions. Surprisingly, tissues majorly involved in the central control, coordination, adaptation and learning of movements, emotion and memory are maximally affected in psychiatric diagnoses along with peripheral heart and muscle-skeletal tissues. Our results underscore the importance of considering both the brain–body connection and the contributions of the peripheral nervous systems to mental health.

Ritual healing and mental health in India

Ritual healing is very widespread in the Indian state of Uttarakhand, and is by far the most common option for those with serious behavioral disturbances. Although ritual healing thus accounts for a very large part of the actual health care system, the state and its regulatory agencies have, for the most part, been structurally blind to its existence. A decade of research on in this region, along with a number of shorter research trips to healing shrines and specialists elsewhere in the subcontinent, and a thorough study of the literature, suggest that such techniques are often therapeutically effective. However, several considerations suggest that ritual healing may not be usefully combined with mainstream "Western" psychiatry: (a) psychiatry is deeply influenced by the ideology of individualism, which is incompatible with South Asian understandings of the person; (b) social asymmetries between religious healers and health professionals are too great to allow a truly respectful relationship between them; and (c) neither the science of psychiatry nor the regulatory apparatus of the state can or will acknowledge the validity of "ritual therapy"--and even if they did so, regulation would most likely destroy what is most valuable about ritual healing. This suggests that it is best if the state maintain its structural blindness to ritual healing.

Resident Honors Department Chair Who Led Through Katrina

Resident Honors Department Chair Who Led Through Katrina

Schizophrenia and yogic concepts

Background: There is a great deal of overlap between the symptoms of schizophrenia and the nature of yogic experiences described in various societies and religions. Aim: This study aims to separate the symptoms of psychotic disorders from the experiences described by various yogic systems. Materials and Methods: A review of various scriptures like Shrimad Bhagvad Gita, Vedas, and other spiritual literature was done and was compared with the various scientific studies regarding yogic experiences. Results: The result shows that, there exist the abnormal behaviors, which need to be controlled by taking help from psychiatry, but there are also the genuine yogic experiences, that are often confused with the symptoms of a psychotic disorder like schizophrenia. Conclusions: The science of psychiatry is playing an important role in classifying the behavioral patterns and thus helping us to control the abnormal behavior patterns. Still, we cannot deny the fact that, the budding science in a developmental stage is unable to unravel the complete mysteries of human mind and because of that; some genuine yogic experiences are often confused with psychotic disorders.

Schizophrenia and yogic concepts

Background: There is a great deal of overlap between the symptoms of schizophrenia and the nature of yogic experiences described in various societies and religions. Aim: This study aims to separate the symptoms of psychotic disorders from the experiences described by various yogic systems. Materials and Methods: A review of various scriptures like Shrimad Bhagvad Gita, Vedas, and other spiritual literature was done and was compared with the various scientific studies regarding yogic experiences. Results: The result shows that, there exist the abnormal behaviors, which need to be controlled by taking help from psychiatry, but there are also the genuine yogic experiences, that are often confused with the symptoms of a psychotic disorder like schizophrenia. Conclusions: The science of psychiatry is playing an important role in classifying the behavioral patterns and thus helping us to control the abnormal behavior patterns. Still, we cannot deny the fact that, the budding science in a developmental stage is unable to unravel the complete mysteries of human mind and because of that; some genuine yogic experiences are often confused with psychotic disorders.

The Fate of the Generalist: Edward L. Walker (1914−1997) as a Case Study

Psychology has become a field for specialists. I explore the fate of a generalist who did not fit this image, Edward L. Walker. Walker was president of both a regional society and a division of the American Psychological Association, author of 11 books, counselor to many graduate students, and a mainstay in a top psychology department. He received a Career Research Award from the National Institute of Mental Health. He contributed to the study of learning and motivation, aesthetics, the science of psychiatry, social psychology, and more. Yet, on his death, there appeared no obituaries in the psychology national media. One reason may be the very breadth of his interests.

The NKI-Rockland Sample: A Model for Accelerating the Pace of Discovery Science in Psychiatry

The National Institute of Mental Health strategic plan for advancing psychiatric neuroscience calls for an acceleration of discovery and the delineation of developmental trajectories for risk and resilience across the lifespan. To attain these objectives, sufficiently powered datasets with broad and deep phenotypic characterization, state-of-the-art neuroimaging, and genetic samples must be generated and made openly available to the scientific community. The enhanced Nathan Kline Institute-Rockland Sample (NKI-RS) is a response to this need. NKI-RS is an ongoing, institutionally centered endeavor aimed at creating a large-scale (N > 1000), deeply phenotyped, community-ascertained, lifespan sample (ages 6–85 years old) with advanced neuroimaging and genetics. These data will be publically shared, openly, and prospectively (i.e., on a weekly basis). Herein, we describe the conceptual basis of the NKI-RS, including study design, sampling considerations, and steps to synchronize phenotypic and neuroimaging assessment. Additionally, we describe our process for sharing the data with the scientific community while protecting participant confidentiality, maintaining an adequate database, and certifying data integrity. The pilot phase of the NKI-RS, including challenges in recruiting, characterizing, imaging, and sharing data, is discussed while also explaining how this experience informed the final design of the enhanced NKI-RS. It is our hope that familiarity with the conceptual underpinnings of the enhanced NKI-RS will facilitate harmonization with future data collection efforts aimed at advancing psychiatric neuroscience and nosology.

Neuroscience, Clinical Evidence, and the Future of Psychiatric Classification in DSM-5

Neuroscience, Clinical Evidence, and the Future of Psychiatric Classification in DSM-5

Lee N Robins

On 25 September 2009, Lee Nelken Robins, PhD, lost her long bout with colon cancer. She was 87. She was professor emeritus of social science in psychiatry at Washington University School of Medicine in St Louis. She was also a highly esteemed psychiatric researcher with a long and influential career. Robins was elected to the ACNP in 1967 and was a life fellow at the time of her death. Robins was born in New Orleans on 29 August 1922, and earned her doctoral degree in 1951, from Harvard University/Radcliffe College. She began her career at Washington University School of Medicine as a research assistant in the Department of Psychiatry, and was promoted to full professor in 1968. She founded and directed the unique Master's Program in Psychiatric Epidemiology, still in existence at the School of Medicine. She was also active on the undergraduate campus, where she held several positions through the years: lecturer and adjunct associate professor of sociology from 1957 to 1963, professor of sociology from 1969 to 1991, and professor in the Program for Social Thought and Analysis, beginning in 1991 until she retired in 2001. Her research placed her at the forefront of psychiatric epidemiology research, with a career spanning five decades. Her early work focused on the effect of psychiatric disorders occurring in childhood on later adult life, spawning her seminal work, Deviant Children Grown Up, published by Williams & Wilkins in 1966. Later NIH-funded studies looked at other populations, such as Vietnam veterans and disaster survivors, but it is the pioneering Epidemiologic Catchment Area study conducted in the 1980s with which she is perhaps most associated. She and principal investigators at other sites led this monumental study investigating the prevalence of psychiatric illness among the general population, for which 20 000 people were interviewed. Robins wrote the Diagnostic Interview Schedule and, indeed, was a leader in the development of psychiatric assessments, training researchers from throughout the world in interview administration. Robins achieved numerous distinctions in her career, including fellow of the American Academy of Arts and Sciences, fellow of the Society for the Study of Addiction to Alcohol and Other Drugs, member of the Institute of Medicine, the Paul Hoch Award from the American Psychopathological Association, the Nathan B Eddy Award from the College on Problems of Drug Dependence, the Lifetime Achievement Award from the Alcohol, Tobacco and Other Drugs section of the American Public Health Association, honorary fellow of the Royal Society of Psychiatrists and of the American Society of Psychiatrists, and the 2005 honorary grand marshal at the university's commencement. In addition to her prolific and significant work, she and her husband Eli had four sons, eight grandchildren, and two great grandchildren. Robins was widowed in 1994, but she remarried in 1998, to Hugh Chaplin, Jr, MD, emeritus professor in Washington University School of Medicine's Departments of Medicine and Pathology and former head of the Irene Walter Johnson Institute of Rehabilitation.

Als Clinicus over de Grenzen van de Psychiatrie. De verwantschap tussen literatuur en wetenschap in het werk van de psychiater H.C. Rümke (1893-1967)

As a clincian beyond the boundaries of psychiatry. The congeniality of literature and psychiatry in the work of psychiatrist H.C. Rumke (1893-1967) One of the most important Dutch psychiatrists in the interwar period was H.C. Rumke (1893-1967). With his eclectic interest in psychiatric approaches such as both psychoanalysis and phenomenology, Rumke is most well known for his remarkable diagnostic and therapeutic skills. The life and work of Rumke has been studied in detail, most notably by the Dutch historian Jacob Van Belzen. Despite this extensive research, in this paper it is stated that a relevant aspect of Rumke’s work has been largely disregarded – namely his profound interest in and use of poetry and literature. Not only did Rumke write poems himself under the pseudonym of H. Cornelius, in his scholarly work he frequently refers to fictional literature and at the end of his career he wrote a comprehensive analysis of Frederik van Eeden’s novel Van de Koele Meeren des Doods. For the eclectic clinician Rumke literature and poetry are a source of knowledge to gain insight into the human psyche. Furthermore, according to Rumke, often literature succeeds better at expressing the human condition than the science of psychiatry can. In this article it is argued that for a coherent interpretation of the life and work of Rumke this literal and poetic aspect of his work cannot be disregarded. It is precisely Rumke’s profound interest in literature and poetry that reflects his two main theses about the science of psychiatry. These are on the one hand the centrality of clinical practice and on the other hand the boundaries of psychiatry. As a clinical practitioner Rumke’s aim was to be able to understand the suffering of the patient – literature and poetry could help him do that. Rumke’s use of literature and poetry can be understood by taking into account the context of the clinic, but the intertwinement between psychiatry, literature and poetry in Rumke’s work also reflects a broader issue. Namely that the science of psychiatry is not omnipotent and that sometimes the arts are better equipped to grasp the human condition.

Book Review: The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry

Book Review: The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry

The rise and fall of the biopsychosocial model: reconciling art and science in psychiatry

This is the first book-length historical critique of psychiatry's mainstream ideology, the biopsychosocial (BPS) model. Developed in the twentieth century as an outgrowth of psychosomatic medicine, the biopsychosocial model is seen as an antidote to the constraints of the medical model of psychiatry. Nassir Ghaemi details the origins and evolution of the BPS model and explains how, where, and why it fails to live up to its promises. He analyzes the works of its founders, George Engel and Roy Grinker Sr., traces its rise in acceptance, and discusses its relation to the thought of William Osler and Karl Jaspers. In assessing the biopsychosocial model, Ghaemi provides a philosophically grounded evaluation of the concept of mental illness and the relation between evidence-based medicine and psychiatry. He argues that psychiatry's conceptual core is eclecticism, which in the face of too much freedom paradoxically leads many of its adherents to enact their own dogmas. Throughout, he makes the case for a new paradigm of medical humanism and method-based psychiatry that is consistent with modern science while incorporating humanistic aspects of the art of medicine. Ghaemi shows how the historical role of the BPS model as a reaction to biomedical reductionism is coming to an end and urges colleagues in the field to embrace other, less-eclectic perspectives.

Mental Illness Prevention Finally Gets Support From Science

Mental Illness Prevention Finally Gets Support From Science

The "Father of modern psychiatry". Philippe Pinel's "release from chains" of 1793 and the beginning of the "science of psychiatry"

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Commentary: Stigma, Conscience, and Science in Psychiatry: Past, Present, and Future

In his response to Reynolds and colleagues' "The Future of Psychiatry as Clinical Neuroscience," the author considers three themes prominent in the history of psychiatry: stigma, conscience, and science, considering each in the past, present, and into the future. A series of conclusions follow these historical perspectives. One, unraveling the web of stigma in the future depends more on moral, educational, and political achievements than neuroscientific ones. Two, psychiatry's future depends upon the public trust, which has fluctuated over its history and into the present era, during which legacies of undue influence and failed regulation have damaged this trust. While explaining the mechanisms for mental disorders is crucial, the returns from these scientific investments are decades away, and failures of conscience today undermine the vital public trust and impede psychiatry's abilities to immediately address the plight of the mentally ill. Three, the researcher-entrepreneur in perennial search of funding has replaced the old model of the curious researcher-practitioner. This drive for funding promotes hubris and failures of conscience in psychiatric science. Moreover, the information explosion and superspecialization of contemporary academic medicine has led to an intellectual fragmentation analogous to the service fragmentation at the beginnings of psychiatry. Attention to integrative synthesis of research information, as well as conscientious moral reflection on scientific advances, will promote humility over hubris: enhancing the public trust, assuring public confidence in psychiatric science, and empowering patients.

Mania: a short history of bipolar disorder

Mania: A Short History of Bipolar Disorder By David Healy (Baltimore, Md.: Johns Hopkins University Press, 2008) (296 pages; $24.95 cloth) This well-written and compelling book goes well beyond historical analysis of a single illness, bipolar disorder, once called manic depression, to fundamentally question relationship between science of psychiatry and business of psychopharmacology. The author, David Healy, is a professor of psychiatry whose previous works, The Antidepressant Era (1998) and Let Them Eat Prozac (2004), raised serious concerns about increased risk of suicide with certain medications. Mania draws from both primary historical sources and interviews to build on these previous accounts by arguing that pharmaceuticals have become less about breakthrough commodities, like penicillin and insulin, and more about marketing and manipulation of public views on health and illness. In book's first chapters, Healy takes on claims that bipolar disorder can be traced to ancient Greeks. He points out that Greek physicians relied on publicly visible signs to make diagnoses-the swelling, heat, and redness of a tumor, smell of urine, mute rigidity of stupor, frenzy of delirium (p. 12). In contrast, modern-day psychiatrists base diagnoses on words of patients or even third parties, such as parents or teachers. Even famous story of woman from Thasos, frequently cited as an early case of bipolar disorder, apparently a condition of nausea, fever, and spasms. Mania during this period more likely delirium, according to Healy. Melancholia stupor or lethargy. Against a background of lethal epidemics of antiquity, Healy concludes, bipolar disorder was almost an irrelevance (p. 8). A similar approach to debunking idea that bipolar disorder a widespread condition in past societies takes reader through subsequent chapters on evolution of medical science. During Renaissance, for instance, attention within European scientific community shifted from observable behavior to internal mental states. This typified in Willis's anatomical work that revealed brain as a solid organ, a new vision that in turn laid groundwork for fields of neurology and psychology. Sydenham's study of hysteria likewise contributed to emphasis on mind rather than body in explaining psychiatric conditions. In threading these developments together, Healy moves on to consider the brain in asylum, noting how building of asylums in nineteenth century gave physicians unprecedented access to persons with various forms of mental illness. The first clear descriptions of bipolar disorder by French psychiatrists soon followed. However, this disorder remained quite rare, according to Healy. Reviewing nearly 3,500 admissions to asylum in North Wales between 1875 and 1924, he found only 123 individuals who were admitted for what we would now call bipolar disorder. …