New diagnosis in psychiatry: beyond heuristics

Psychological Medicine, Год журнала: 2025, Номер 55

Опубликована: Янв. 1, 2025

Abstract Background Diagnosis in psychiatry faces familiar challenges. Validity and utility remain elusive, confusion regarding the fluid arbitrary border between mental health illness is increasing. The mainstream strategy has been conservative iterative, retaining current nosology until something better emerges. However, this led to stagnation. New conceptual frameworks are urgently required catalyze a genuine paradigm shift. Methods We outline candidate strategies that could pave way for such These include Research Domain Criteria (RDoC), Hierarchical Taxonomy of Psychopathology (HiTOP), Clinical Staging, which all promote blend dimensional categorical approaches. Results alternative still heuristic transdiagnostic models provide varying levels clinical research utility. RDoC was intended framework reorient beyond constraints DSM. HiTOP began as derived from statistical methods now pursuing Staging aims both expand scope refine diagnosis by inclusion dimension timing. None yet fit purpose. Yet they relatively complementary, it may be possible them operate an ecosystem. Time will tell whether have capacity singly or jointly deliver Conclusions Several developed separately synergistically build infrastructure enable new define structure, development, mechanisms disorders, guide treatment meet needs patients, policymakers, society.

Язык: Английский

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The paradox of the biopsychological and sociocultural levels in post‐traumatic stress disorder

World Psychiatry, Год журнала: 2025, Номер 24(1), С. 87 - 88

Опубликована: Янв. 15, 2025

It is fascinating to see how the field of post-traumatic stress disorder (PTSD) has evolved over past 50 years. The team authors led by C. Brewin1 – comprising psychologists, epidemiologists, psychiatrists, and intervention researchers provides a comprehensive analysis significant developments in this underlying empirical evidence. I would like enumerate few points on which am complete agreement with authors. First, there now an accepted set different phenotypes PTSD, includes "classic" PTSD known for several decades, complex severe dissociative condition, other that have been linked childhood trauma. Second, diagnosis should rely pattern symptoms resulting disabilities rather than definitions trauma criterion, as still often case when diagnosing day. Third, delayed essentially based altered sensitivity, patients display isolated prior full development condition. On all these points, authors' thorough presentation deserves gratitude dissemination professional community. Brewin et al's extension core psychopathology theory from disturbed memory identity changes also noteworthy. However, phenomenon trauma-related disorders be highlighted, we refer biopsychological-sociocultural paradox (in brief, fact traumatic experiences mostly disrupt biopsychological processes, while sociocultural processes usually foster recovery). In biology, numerous studies documented existence deficits vulnerabilities related multitude regulatory systems circuits. psychological research initially focused then impairments. clinical setting, evidenced focus patients' suffering, including re-experiencing, avoidance persistent (physiological) sense threat. most effective antidote disturbances social support those affected2. There sufficient evidence multiple confirm appropriate victims or survivors can effectively reduce impact disorders3. This observed clinically shorter recovery times socially well-connected culturally integrated treatment facilities4. worth noting not various factors areas are exclusively pathogenic. To give examples, protective such larger hippocampal volume or, realm, range less avoidant coping strategies. Nevertheless, seeking others friends, family members one's cultural community consistently yields greater effects biological areas. apparent contradiction between predominance social-interpersonal-cultural antidotes may ontological status PTSD. could said "silent suffering" individuals: after traumatization, do complain about their suffering. Those who experienced distress might find it normal inevitable5, 6. Some suggested one reason why mental was "discovered" so late compared depression, psychosis anxiety disorders. possible that, conditions, behaviors, facial expressions body postures signal partners "ill". philosophical basis embodiment recently described journal7 therefore comparatively pronounced psychology its admittedly yet very advanced program, suggests primarily "social disease". This, course, does undermine suffering afflicted disorder. assertion consistent findings prevention research, discussed paper al. According this, current preventive programs place strong emphasis dyadic group cohesion aspects. What pressing transcultural issues reducing future? my view, beneficial first consider low utilization services cultures European-North American (Global North) ones. Even Global North cultures, differences. large groups affected people, no perception needing help. For example, 9/11 attacks New York, quickly established outpatient health emergency help centers had only requests people Could scripts go far beyond symptom descriptions DSM ICD? Many individuals self-perception being "broken" having "a kink lifeline"8. provision lists syndromes idioms consequences trauma, mentioned al, improved scientific standpoint. A key question divergent arise, they into overarching, systematic context. light above, seems reasonable suggest takes account global matrices values, norms traditions logical choice. instance, study conducted Rwanda traumatized individuals, many whom were genocide against Tutsis 1990s, indicated values showing maintaining self- reputation, well Ubuntu short, humanity towards others), apparently mediate expression suffering9. After examination influencing specialized assistance, more nuanced foundation. correctly emphasizes potential community-based interventions, particularly addressing disparities.

Язык: Английский

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Breaking Barriers: Contemporary Challenges and Solutions in Male Mental Health

Опубликована: Янв. 1, 2025

Язык: Английский

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The history of psychiatric classification and mental health statistics

Significance, Год журнала: 2025, Номер 22(2), С. 12 - 17

Опубликована: Фев. 4, 2025

Abstract The official collection of mental health data began in the nineteenth-century asylums England, and debate around classification still rages today. Kevin Matthew Jones shares a fascinating exploration historical links between diagnosis statistics

Язык: Английский

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Severity of anhedonia is associated with hyper-synchronization of the salience-default mode network in non-clinical individuals: a resting state EEG connectivity study

Journal of Neural Transmission, Год журнала: 2025, Номер unknown

Опубликована: Фев. 15, 2025

Anhedonia is a core transnosographic symptom in several neuropsychiatric disorders. Recently, the Triple Network (TN) model has been proposed as useful neurophysiological paradigm for conceptualizing anhedonia, providing new insights to clinicians and researchers. Despite this, relationship between functional dynamics of TN severity anhedonia relatively understudied non-clinical samples, especially resting state (RS) condition. Therefore, current study, we investigated this using electroencephalography (EEG) connectivity. Eighty-two participants (36 males; mean age: 24.28 ± 7.35 years) underwent RS EEG recording with eyes-closed completed Beck Depression Inventory-derived 4-item scale (BDI-Anh4) Brief Symptoms Inventory (BSI). data on connectivity were analyzed exact low-resolution electromagnetic tomography (eLORETA). A significant positive correlation was observed BDI-Anh4 total score salience-default mode network beta frequency band (r = 0.409; p 0.010). The results hierarchical linear regression analysis also showed that pattern positively independently associated (β 0.358; < 0.001) explained an additional 11% variability. association increased synchronization detected study may reflect difficulty disengaging from internal/self-related mental contents, which consequently impairs processing other stimuli, including rewarding stimuli.

Язык: Английский

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The mind-brain problem: Ethical and clinical implications for psychiatry

International Review of Psychiatry, Год журнала: 2025, Номер unknown, С. 1 - 13

Опубликована: Март 7, 2025

The mind-brain problem, which explores the relationship between mind and brain nature of consciousness, remains a scientific challenge. It is not purely theoretical issue; it profoundly shapes our understanding human nature. This paper reviews evidence on problem views impacting ethical, clinical, academic domains. Evidence shows that dualism prevalent, even among mental health professionals. belief declines with age, likely due to generational shifts rather than maturation. Prevalent metaphysical assumptions embedded in training (e.g., physicalist reductive emphasizing biological causes – gene expression neurologic alterations) may influence this shift. Regarding ethics, radical determinism—aligned view mind—can diminish perceptions responsibility, agency, free will, affecting individual sense autonomy legal systems by portraying individuals as less responsive rehabilitation seen more prone repeat behaviors. In health, influences four key areas: origins disorders, treatment approaches, patient self-agency, stigma. Deterministic reduce adherence outcomes, while control enhances responsibility positive results. Biogenetic models blame but lower self-control increase unpredictability behavior.

Язык: Английский

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Equity in eating disorders: a dialectical approach to stigma, expertise, and the coproduction of knowledge

Journal of Eating Disorders, Год журнала: 2025, Номер 13(1)

Опубликована: Фев. 17, 2025

Within mental health research, there has been a growing recognition of the importance knowledge obtained through lived experiences illness, treatment, recovery, and health. In recent years, field eating disorders seen an emergence co-produced knowledge, in particular co-design patient-facing materials for use clinical settings, body rich qualitative research by those who may straddle identities clinician, researcher person with lived/living experience. However, are significant variations how expertise experience is defined utilised within practice, persisting inequities extent to which people afforded agency define their illnesses treatment. This paper's authorship collaboration between personal professional relationships subject disorders, bringing life concept sharing power decision-making across multiple viewpoints identities. Situating about stigma wider historical philosophical context, authors argue that practice rooted stigmas. To address this, 'dialectical' stance proposed, draws upon Dialectical Behaviour Therapy broader principles coproduction offer practical approach operationalising epistemic justice dismantling field.

Язык: Английский

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My Week of Denial and Disorientation: A Lived Experience Narrative of a Stay in a Psychiatric Emergency Department

Journal of Psychiatric and Mental Health Nursing, Год журнала: 2025, Номер unknown

Опубликована: Март 13, 2025

ABSTRACT Background Psychiatric emergency departments (EDs) are common settings in which patients receive crisis care, yet their experiences these environments remain understudied. Aim This lived experience narrative recounts the first author's week‐long stay a psychiatric ED, providing insight into and challenges of inpatient care. Methods The author used approach to develop series vignettes that captured significant moments her experience. Both authors reflected on experiences, drawing professional expertise existing literature. Findings reveals lack communication unit, power imbalances between staff dismissal patients' concerns, identities. It illustrates how behaviours often misinterpreted, contributing further distress disempowerment. Discussion examine systemic problems mental health such as epistemic injustice, dominance biomedical model restrictive control over patient autonomy. They argue for need shift more compassionate, pluralistic trauma‐informed Conclusion highlights reforms By centring voices, services can foster respectful healing environment people crisis.

Язык: Английский

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Enactive Approaches to Disability

Опубликована: Янв. 1, 2025

Язык: Английский

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Reflections on philosophy of psychiatry

World Psychiatry, Год журнала: 2024, Номер 23(2), С. 174 - 175

Опубликована: Май 10, 2024

In this issue of the journal, Stein et al1 summarize current status philosophy psychiatry, focusing on several issues in areas nosology, psychiatric science and mind-body problem. I agree with their favorable view "soft naturalism" as an appropriate conceptualization diagnostic categories. "Hard" naturalism, expecting clear boundaries essences, which applies to some entities (e.g., elements periodic table) is clearly inappropriate for disorders. Our disorders are "fuzzy" do not have essences. Do exist world be "discovered" or we "create" them? Although favor former position, historical work suggests skepticism. If Kraepelin went into zoology, like his older brother, would someone else described dementia praecox manic-depressive illness same terms? Many clinicians were working, over 19th century, sort out space mood psychotic disorders2. Something resembling our views likely evolved without Kraepelin, but how similar it been? Psychiatry has long believed that next scientific revolution – brain pathology, Mendelian genes monoamine neurotransmitters solve problem by discovering mono-causal "essentialist" explanations. This a regrettable, recurrent pipe-dream profession. Ironically, near beginning evolution psychiatry (early century), confronted general paresis insane. been greatest success story science, left us unrealistic expectational set cannot repeat remaining syndromes. With rare exceptions, highly multi-causal "all way down". It therefore express impatience DSM yet produced etiology-based system. Despite all advances imaging molecular genetics, still remain ignorant at basic level about causes change anytime soon. Indeed, genetics pointing hard will be, aptly called "the curse polygenicity". My role values nosology more restricted than advocated al. The most important value enters review process prioritization potential validators. We broadly now should, so far possible, empirically based. Revised sets criteria disorder perform better predecessors real-world data. But decide what kind performance should prioritized? Once you know want your diagnoses do, becomes possible least approximate full-bore data-driven approach. system, many different validators uncertain weights, problematic3. Review Committees much difficult job those who evaluate randomized controlled trials US Food Drug Administration, drug response only relevant variable. also al's emphasis importance pluralism psychiatry. As field, multiple legitimate perspectives disorders, etiology, treatment. need results from nature these However, concern "undisciplined" pluralism: risk degenerating anti-scientific "let 1,000 flowers bloom" perspective. To sit pluralist table, empirical needed. Correlations enough. Designs allow causal inference critical. thresholds high, because field mental health attracts wide variety theorists, whom little constrained problems evidence. advocate "hard-nosed" pluralism. concerned often people enter research agenda influenced strong priori ideological commitments. is, thought, partly immaturity touch core assumptions being human. appreciate concerns put together too easy specialized researchers dig deeply own corner etiologic entire career never look up. fact, funding system encourages such specialization. brand "pluralism" discussed al: "integrative pluralism"4. that, every once while, incumbent scientist come his/her hole spend energy trying integrate findings adjacent perspectives. A comment reduction warranted here. consider dirty word. increasing merger neuroscience uncover pathways genetic variants among exciting field. More power (and funding) them advisable. objection reductionists argue approach way. "Reductive hubris" harmful phases discipline. Certainly, equal. psychological social interventions proved number bringing me back arguments above multi-causality. contrast questions largely within fundamentally metaphysical one. While innately fascinating, insights gained compared effort needed wend one's through thickets area have, me, disappointing years. make few brief personal comments. Philosophers ponder Psychiatrists live it. best metaphor heard describe psychiatrist-patient encounters, where good clinician switch forth between seeing patients minded brained, "binocularity"5. can see depth two eyes, lens brained minded. am non-reductive materialist. sure coherent up with. means roughly not, my work, assume mind independent brain. instantiated mind-brain interactive one although explain works. Mind central concept mind-less oxymoronic me. suggest tensions mind-based brain-based definitional history6. And believe top-down causation. Important things "happen" sometimes great significance7. conclusion, heart-warming prominent journal give wide-ranging thoughtful essay. bring range philosophical assumptions. question whether, point career, they take time examine whether any might revision.

Язык: Английский

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