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The Psychiatric Body
Published in Roger Cooter, John Pickstone, Medicine in the Twentieth Century, 2020
At present, a new somatic style dominates. Biological psychiatry has altered almost beyond recognition the science and therapeutics of mental illness. It sustains an international research enterprise, and it consumes immense intellectual, professional, and governmental resources. Some participants believe it represents the definitive and presumably unchanging model of the human mind. The biopsychiatric program appears to be realizing the neophrenological dream of linking mental behaviors with events that are localizable in the brain; in its grander moments, it claims to have answered formidable metaphysical quandaries, like the mind-body problem, that have eluded the foremost thinkers of the past. Only time will test these assertions. This much, however, is certain: at the outset of the twenty-first century, the power, promise, and problems of modern psychiatry are great. For precisely this reason it is imperative to have an historically informed psychiatric profession and a biomedically enlightened public.
Clinical indications for ECT: adults
Published in Alan Weiss, The Electroconvulsive Therapy Workbook, 2018
The World Federation of Societies of Biological Psychiatry (WFSBP) provides two comprehensive reviews on the use of ECT in guidelines for the biological treatment of unipolar depressive disorders; Part 1, update 2013, on the acute and continuation treatment of unipolar depressive disorders, and Part 2 on the maintenance treatment of major depressive disorder - update 2015 (Bauer et al., 2013; Bauer et al., 2015).
Psychiatric Diagnosis: The State of the Art
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Robert Moreines, Irl Extein, Mark S. Gold
A major goal of research in biological psychiatry has been to identify measurable biological abnormalities that would reliably confirm a psychiatric diagnosis, identify the major psychiatric disorders, and aid in differential diagnosis and choice of treatment. One strategy for augmenting clinical diagnosis is to measure neuroendocrine and other biological correlates that, in addition to helping to elucidate the biological mechanisms of psychiatric disorders, may define more homogeneous groups of psychiatric patients and guide the choice of pharmacotherapy. The development in the past 25 years of effective and specific pharmacotherapies for major depression, manic-depressive illness, and schizophrenia has underlined the importance of diagnosing these disorders accurately. The efficacy of tricyclics and monoamine oxidase inhibitors in depression, lithium in manic-depression, and antipsychotic (neuroleptics) in schizophrenia, as well as the demonstration of a strong genetic component in the etiology of affective disorders and schizophrenia, have given credibility to the working assumption that neurobiological abnormalities underlie many of the major psychiatric disorders. Despite the advances of clinical nosology that DSM III offers,49 the use of biological markers may define more clearly homogeneous groups of psychiatric patients and guide choice of treatment.
BNC210: an investigational α7-nicotinic acetylcholine receptor modulator for the treatment of anxiety disorders
Published in Expert Opinion on Investigational Drugs, 2023
Elliot Hampsey, Adam Perkins, Allan H. Young
The National Institute for Care Excellence (NICE) stepped-care model recommends SSRIs such as sertraline, and then either an SNRI or alternative SSRI, in those who do not respond to low-intensity psychotherapies [31]. Benzodiazepines are not recommended for the treatment of anxiety by NICE in primary or secondary care [31], albeit benzodiazepines are oftentimes used acutely as an augmentation to serotonergic treatments during the 4–8 week period it takes for them to take effect. Recent guidelines from the World Federation of Societies of Biological Psychiatry (WFSBP) concerning various anxiety disorders, including GAD, SAD, and PTSD [32,33] confirmed SSRIs and venlafaxine as first-line treatments, in addition to recommending benzodiazepines as augmentation for SSRIs in the early weeks of treatment for SAD & GAD. Taken together, roughly 50% of patients show a response to the above treatments, with only a third achieving remission [34]. Reasons for insufficient response in many patients varies, although intolerable side-effects such as sedation, and inadequate (i.e. length of trial) or inappropriate use (contrary to evidence-based guidelines) of the treatments are certainly key factors [35]. Clearly, a need exists to develop novel pharmacological compounds that ameliorate anxiety symptoms faster than serotonergic treatments with less severe side effect profiles than benzodiazepines.
Who is blind in psychedelic research? Letter to the editor regarding: blinding and expectancy confounds in psychedelic randomized controlled trials
Published in Expert Review of Clinical Pharmacology, 2021
As Muthukumaraswamy et al. rightly reference, the standardization of the double-blind RCT as the gold-standard pharmaceutical practice and regulatory demand occurred concomitantly with the first wave of psychiatric research with psychedelics in the 1950’s and 60’s. These two fields were not, however, “parallel histories’’. Some of the very pioneers in psychedelic research, Osmond and Hoffer, discussed limitations of the new blinding methodology in 1961 [9] and also conducted one of the first blind trials in psychiatry [10]. These convergences matter because the difficulty to blind psychedelic trials was the main reason for distrust regarding clinical results obtained with LSD in alcoholics. At the time, the role of compassionate psychotherapeutic or psychoanalytically oriented approaches were criticized as not objective enough, and some patients were abusively restrained in the name of ‘scientific objectivity’ [9]. Thus it was the epistemic debate which ultimately led psychedelics to be prematurely discarded from psychiatry [9,11]. Furthermore, inspired by psychedelics, Osmond and Hoffer elaborated one of the earliest hypotheses centering on the role of neurochemicals in the etiology and possible treatment of psychiatric illnesses, during the early days of biological psychiatry [9,10]. What then were unconventional ideas in a predominantly psychodynamic field became the prevailing biological psychiatry messaging half a century later, which propagates a misleading narrative that “mental disorders are brain diseases cured by scientifically designed medications’’, which may be detrimental to patients [12].
Clinical evolution of patients treated with aripiprazole long-acting injectable: a preliminary, prospective, observational study
Published in International Journal of Psychiatry in Clinical Practice, 2020
Juan Carlos García Álvarez, Luz González Sánchez, Eloy García Resa, José María Bonete Llácer, Ana Román Rodríguez, Beatriz Pecino Esquerdo, Enrique Pérez Martínez
Since aripiprazole LAI initiation was associated with an improvement in symptomatology and related outcomes and control of metabolic parameters, we next examined whether the number of co-administered antipsychotic drugs was reduced upon switch to this injectable agent. The change to aripiprazole LAI resulted in a significant decrease in antipsychotic polypharmacy, defined as the concomitant prescription of more than one antipsychotic drug. Patients with schizophrenia are commonly in complex treatment regimens, and the NICE or the World Federation of Societies of Biological Psychiatry guidelines strongly recommend to simplify the therapy as much as possible to avoid dose-related adverse events that could also jeopardise treatment adherence (Fleischhacker and Uchida 2014). The reduction of co-administered antipsychotic drugs is of particular relevance in a chronic disease such as schizophrenia, and could positively influence other interconnected variables (treatment adherence, health care costs or incidence adverse events).