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Jun 01, 2011, 10:17 AM
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Quote:
Psychiatry as a Clinical Neuroscience Discipline
Training in Clinical Neuroscience
The recognition that mental disorders are brain disorders suggests that psychiatrists of the future will need to be educated as brain scientists. Indeed, psychiatrists and neurologists may be best considered clinical neuroscientists, applying the revolutionary insights from neuroscience to the care of those with brain disorders.33 The study of unconscious processes, motivation, or defenses, while at one time the sole province of psychoanalytic therapies, is now also in the domain of cognitive neuroscience.34-35 Systems neuroscience will be reformulating our notions of attention and emotion in the next decade just as it reformulated our understanding of language and perception in the last decade.
Will a deep understanding of the psyche remain a central focus of psychiatry? The need for a sophisticated understanding of interpersonal relationships along with the use of evidence-based, nonpharmacological treatments (from psychoeducation to cognitive behavioral treatments) will be the tools of the effective healer in the future as much as in the past. Just as the need for rehabilitation following acute care for any serious injury or medical illness has been recognized, ideally the psychiatrist will increasingly be part of a team that provides culturally valid psychosocial rehabilitation along with medications to help those with mental disorders recover and return to a productive and satisfying life. What will be different is having the ability to target these treatments to specific aspects of the disease process.
Redefining the foundation of psychiatry as clinical neuroscience also accelerates the integration of psychiatry with the rest of medicine. The separation of psychiatry from other medical specialties has contributed to the stigma of those who treat mental disorders as well as those who have them. Even beyond stigma, this separation has led to inadequate care. The recent scientific recognition of the importance of effective treatments of mental illnesses in cardiovascular disease and diabetes36-37 mandates the incorporation of psychiatry into truly integrated and effective treatment teams.
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http://www.nimh.nih.gov/about/direct...scipline.shtml
The National Institute of Mental Health seems to be addressing concerns of those who find the medical model inadequate. A more eclectic approach that merges treatments of mental and physical manifestations of illnesses having both biological and environmental components certainly seems reasonable.
Quote:
New Findings Reveal New Worlds In Neuroscience
Thomas Insel
“The purpose of science is not to open the door to an infinitude of wisdom but to set some limit to the infinitude of error.”
Brecht, Galileo
This quote comes to mind with a couple of recent clinical research reports that suggest some of the broadly accepted wisdom of our field may be wrong. For instance, lack of adherence to oral medication has been widely considered the most common reason for treatment failure in schizophrenia. However, in a recent random assignment study with a two year follow-up, an injectable, long-acting medication was no better than oral medication, as measured by re-hospitalization or quality of life measures.
In another example, PTSD has been assumed to be a leading cause of the increased suicides in soldiers and veterans. Yet a recent VA study of more than 7,000 suicides found that bipolar disorder was the most prevalent diagnosis. PTSD only increased the risk for suicide when complicated by substance abuse.
Nonetheless, windows to completely new areas of research have been opened recently by research efforts in basic science. These reports may not offer “an infinitude of wisdom,” but they force us to consider factors that have not previously been thought to have any role in mental health or illness.
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http://www.nimh.nih.gov/about/direct...oscience.shtml
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