Relevance of Ethology to Psychiatry

Abstract: The interactions between ethology and psychiatry were reviewed. The ethological methods have provided more objective and theory-free observation techniques than the traditional psychiatric methods. The evolution-based ethological viewpoints afford some fundamentally new and more comprehensive approaches in understanding psychiatric conditions. The ethological theory has many concepts in common with various other schools of psychiatry, and thus is expected to act as a bridge to integrate them to lead to a more comprehensive psychiatric theory system. Ethology has not explored its potential in therapy, but may be useful, especially in terms of prevention and social psychiatry.     

La santé du sommeil en psychiatrie : à la croisée de la physiologie et de la santé publique

The concept, and analysis, of sleep can often open the door to new health studies and strategies in psychiatry. Sleep is indeed a physiological and behavioral function essential to mental health. First, we need to screen and treat comorbid sleep disorders in persons with mental disorders. A sleep disorder is a pathological condition related to a sleep dysfunction that interferes with an individual's health. Scales can be used to help screen for sleep disorders in persons with a mental disorder. In return, psychiatry, through its attention to mental symptomatology, can provide important elements to better detect, delineate, and define sleep disorders. Second, we need to assess sleep alterations and a person's sleep health related to mental disorders. Indeed, the absence of a comorbid sleep disorder is not necessarily associated with good sleep health in persons with a mental disorder. The mental disorder may indeed impact sleep through a common pathophysiology, but also through non-optimal sleep behaviors for health. Scales can be used to assess sleep health in persons with a mental disorder. The implementation of preventive measures targeting sleep as a modifiable behavior in psychiatry is also necessary. In return, psychiatry, with its attention to behavior, can provide important elements for the development of integrative models to predict the relationship between sleep health and mental health, and propose an iterative approach between behavioral change models and pathophysiological models of mental disorders and sleep disorders, and can also design prevention strategies that improve sleep health that will have a real impact on mental health.     

新型冠状病毒肺炎防控期间认知障碍患者及其照护者精神卫生与心理社会支持专家建议

新型冠状病毒肺炎疫情给公众,尤其是老年人身体和心理都造成了巨大影响。老年认知障碍患者不仅是易感人群,也容易出现心理应激反应,甚至有诱发和加重精神行为症状的风险。其照护者在疫情期间面临更大的照护负担,可能心理应激反应更明显。国内多个老年精神医学与认知障碍相关学术团体联合制定专家建议,针对疫情期间认知障碍患者和照护者可能出现的心理应激反应以及患者已有精神行为问题的波动特点,提出多学科团队进行精神卫生和心理社会干预的策略,指导疫情期间为认知障碍患者提供诊疗及照护的相关人员开展全程管理。     

An evolutionary perspective on psychiatry

Recent progress in the evolutionary understanding of behavior may greatly assist psychiatry. Although explanations of psychopathology have traditionally emphasized proximate causes of individual differences, consideration of the evolutionary functions of human behavior is essential for psychiatry, just as biology, ethology, and medicine routinely consider both proximate and evolutionary explanations for a variety of phenomena. The methods and data for testing evolutionary hypotheses are reviewed, and the ways in which evolutionary principles can help to explain maladaptive behaviors are considered. Some psychiatric symptoms that seem maladaptive may, in fact, serve specific survival functions. Hypotheses are proposed about the possible evolutionary significance of overeating, anorexia nervosa, panic attacks, and sexual disorders, and tests of these hypotheses are considered. By incorporating an evolutionary perspective on psychopathology, psychiatry may share the foundation that evolution provides for the rest of natural science.     

Treatment of offenders with mental disorders: focusing on prison psychiatry

Forensic mental health services exist in a nebulous space at the intersection of two different systems-criminal justice and mental health-and the entanglement of these systems poses intricate problems for psychiatrists. This article discusses the present circumstances of forensic mental health services in Japan, focusing on trends in prison psychiatry. In the traditional Japanese system, offenders with mental disorders were treated within general psychiatry as involuntarily admitted patients, or within the prison system as mentally ill inmates. As a consequence of recent legal reform, however, this situation has radically changed. The Medical Treatment and Supervision Act of 2005 aimed to provide intensive psychiatric treatment to offenders with mental disorders, attaching great importance to their reintegration into society. Under the new system, a person who commits a serious criminal offense in a state of insanity or diminished capacity shall be referred by the public prosecutor to the district court; following a treatment order of the court, the person shall be treated in psychiatric facilities established by the law. While the new system is expected to play a role in the context of specialist forensic psychiatry, its distinction from general psychiatry remains unclear. For example, persons who commit serious crimes, such as assault, in an acute psychotic state are occasionally admitted to general psychiatric hospitals, even if they meet the criteria for a treatment order under the Medical Treatment and Supervision Act. The relationship between prison psychiatry and specialist forensic psychiatry is still more problematic. Compared to the intensive, rehabilitation-oriented care provided under the Medical Treatment and Supervision Act, mental health services in penal institutions have a number of disadvantages, and it is unlikely that mentally ill prisoners have benefited from the recent progress in forensic psychiatry. Statistics show that the number of sentenced prisoners with mental disorders has steadily increased during the last decade. Although a majority of these individuals are substance abusers, the number of patients with schizophrenia who are unable to serve a sentence due to severe illness is not insignificant. Although patients are sometimes transferred to medical prisons, a substantial number of inmates with mental disorders remain in general prisons, most of which lack adequate medical staff. Accordingly, the growing number of mentally ill inmates is imposing a heavy burden on the penal administration system. Provisions of the Mental Health and Welfare Act pertaining to general psychiatry are not applicable to patients in penal institutions. The Psychiatric Review Board established in each prefecture does not intervene in the management of these facilities. As a result, legal safeguards against the violation of patients' rights are not sufficiently guaranteed in penal institutions. There are no legal provisions for transferring patients with severe mental disorders from prisons to psychiatric hospitals. Once sentenced to imprisonment, offenders with mental disorders are treated almost exclusively within the prison system. This situation is particularly serious in the case of patients with long-term sentences. In addition, the continued availability of psychiatric care after discharge from prison, which is crucial for preventing relapse of illness and recidivism, is not assured. When a mentally ill inmate is discharged, the head of the institution is required to report the discharge to the prefectural governor, in accordance with the Mental Health and Welfare Act. Recently, although the number of such reports has sharply increased, in actuality many of the persons reported are not admitted to hospitals because they do not meet the criteria for involuntary admission, and the provisions of the Medical Treatment and Supervision Act do not apply to them. In conclusion, more attention should be paid to the reform of prison psychiatry. Coordination of the separate functions of general psychiatry, specialist forensic psychiatry, and prison psychiatry is also important.     

L’addictologie est-elle une spécialisation de la psychiatrie ?

The addictive behavior is defined as “a strong, long-lasting and excessive trend to make a commitment in behavior of production of pleasure or avoidance of negative affects” (A. Goodman). Epidemiological data show that patients receiving psychiatric care frequently have, besides the mental pathology for which they are followed, substance use disorders. It is thus particularly important to detect and to take care of the consumptions of psychoactive substances by the patients followed in psychiatry, not only to improve the forecast of the substance use disorder, prevent or handle the somatic complications, but also to improve the forecast of the associated psychiatric disorder. The integrated care seems the best adapted. We try to show it through a clinical illustration. In the discussion part, we try to highlight that addictology corresponds to a common, clinical, scientific and political approach of all the substance disorders and that this discipline becomes completely integrated into the field of psychiatry.     

Mental illness--problems with definition, diagnosis and legal regulations

The analysis of literature and events in psychiatry in the course of past centurie show that the term mental illness even though it had played a positive role in the development of knowledge of psychic disorders and the place of psychiatry as part of clinical medicine has become an anachronic term in time. Because its content and form were never precisely defined, it began to serve as a means of hiding the lack of knowledge of the causes of mental disorders It was abused against its initial aim, e.g. used to 'label' persons whose behaviour did not fit socially accepted conventions. At times it caused a permanent exclusion of those persons. These circumstanc es were a means of giving up on the term mental illness in the modern diagnostic-classification systems of psychic disorders (DSM-IV, ICD-10). Retaining of the term mental illness, and its derivatives menatlly ill, a mentally ill person are anchronisms in the Polish legislation, which can be a cause of serious misunderstanings and abuse. The author believes that these terms should disappear from the Polish legislation and the mental health act. They should be replaced by terms adequate for legal regulations but also be compliant with modern psychiatric terminology.     

Computational neuroscience approach to biomarkers and treatments for mental disorders

Psychiatry research has long experienced a stagnation stemming from a lack of understanding of the neurobiological underpinnings of phenomenologically defined mental disorders. Recently, the application of computational neuroscience to psychiatry research has shown great promise in establishing a link between phenomenological and pathophysiological aspects of mental disorders, thereby recasting current nosology in more biologically meaningful dimensions. In this review, we highlight recent investigations into computational neuroscience that have undertaken either theory‐ or data‐driven approaches to quantitatively delineate the mechanisms of mental disorders. The theory‐driven approach, including reinforcement learning models, plays an integrative role in this process by enabling correspondence between behavior and disorder‐specific alterations at multiple levels of brain organization, ranging from molecules to cells to circuits. Previous studies have explicated a plethora of defining symptoms of mental disorders, including anhedonia, inattention, and poor executive function. The data‐driven approach, on the other hand, is an emerging field in computational neuroscience seeking to identify disorder‐specific features among high‐dimensional big data. Remarkably, various machine‐learning techniques have been applied to neuroimaging data, and the extracted disorder‐specific features have been used for automatic case–control classification. For many disorders, the reported accuracies have reached 90% or more. However, we note that rigorous tests on independent cohorts are critically required to translate this research into clinical applications. Finally, we discuss the utility of the disorder‐specific features found by the data‐driven approach to psychiatric therapies, including neurofeedback. Such developments will allow simultaneous diagnosis and treatment of mental disorders using neuroimaging, thereby establishing ‘theranostics’ for the first time in clinical psychiatry.     

Psychiatry in Former Socialist Countries: Implications for North Korean Psychiatry

Very little information is available regarding psychiatry in North Korea, which is based on the legacy of Soviet psychiatry. This paper reviews the characteristics of psychiatry in former socialist countries and discusses its implications for North Korean psychiatry. Under socialism, psychiatric disorders were attributed primarily to neurophysiologic or neurobiological origins. Psychosocial or psychodynamic etiology was denied or distorted in line with the political ideology of the Communist Party. Psychiatry was primarily concerned with psychotic disorders, and this diagnostic category was sometimes applied based on political considerations. Neurotic disorders were ignored by psychiatry or were regarded as the remnants of capitalism. Several neurotic disorders characterized by high levels of somatization were considered to be neurological or physical in nature. The majority of "mental patients" were institutionalized for a long periods in large-scale psychiatric hospitals. Treatment of psychiatric disorders depended largely on a few outdated biological therapies. In former socialist countries, psychodynamic psychotherapy was not common, and psychiatric patients were likely to experience social stigma. According to North Korean doctors living in South Korea, North Korean psychiatry is heavily influenced by the aforementioned traditions of psychiatry. During the post-socialist transition, the suicide rate in many of these countries dramatically increased. Given such mental health crises in post-socialist transitional societies, the field of psychiatry may face major challenges in a future unified Korea.     

Culture and history in psychiatric diagnosis and practice.

A brief review of the history of Western psychiatry underscores how happenings in Anglo European societies during the early modern and modern era impacted on regional populations in the midst of profound demographic, social and political economic change. Such factors along with cultural conventions created an amalgam of behavior problems: social responses to these under the aegis administrative bodies gave rise to the discipline and profession of psychiatry. Central tenets that we take for granted as facts about psychiatric disorders (e.g., their manifestations, natural history, diagnosis) were shaped by historical and cultural influences. Psychiatry may outline a science of the psyche and its disturbances but it also reflects a cultural interpretation about personal experience, responsibility, social behavior, and the requirements for social order. The cultural character of the psychiatric enterprise itself, just as much as the characteristics of its disorders, constitute the subject matter of cultural psychiatry. Events during the late eighteenth and nineteenth centuries in Anglo European societies gave rise to psychiatry. First, there took place the differentiation of psychiatric disorders from the pool of human social and behavior problems. Second, and in relation to this, a segment of the medical profession was accorded (or appropriated) a social mandate and acquired an obligation to treat victims of mental disorders. The historical sociology of psychiatry constitutes one aspect of cultural psychiatry. The second covers developments during the latter part of the twentieth century. At this juncture, psychiatry became the target of labeling theorists in sociology, cultural relativists in anthropology, antipsychiatrists from within the discipline itself, and revisionist and critical historians of psychiatry. An outgrowth of this is the perspective that underscores the important role played by values, ideas, and world-views in how individuals experience and carry out their lives, phenomena that are critical to the expression, interpretation, diagnosis, and treatment of psychiatric disorders. That the science and practice of modern psychiatry incorporate an ethnocentric, Anglo European bias or slant on psychopathology is an integral assumption of cultural psychiatry. By describing how other non-Western systems of psychiatry have operated, for example, their theories and practices, one gains a further appreciation of the important role of culture in shaping Western psychiatry. This is taken up in an article by Fàbrega elsewhere in this issue where concepts and practices of traditional Chinese and Indian medicine that pertain to mental health and illness are reviewed.     

Training psychiatrists to diagnose and treat substance abuse disorders

Addiction training in psychiatric residency programs needs expansion. Epidemiology research has shown that patients with substance use disorders and co-occurring mental health disorders are the norm in nearly all clinical settings. Unfortunately, traditional training approaches built around brief rotations on detoxification or intensive substance abuse rehabilitation units do not adequately train psychiatrists in long-term management skills, and may reinforce misperceptions that these patients do not respond to treatment. An enhanced addiction curriculum coupled with an extended outpatient clinic rotation is an ideal model for teaching the skills needed to successfully care for these patients. Training must include an adequate knowledge base, an opportunity to cultivate positive attitudes toward these patients, and recognition that psychiatrists must take responsibility for treating the addiction problem and any co-occurring psychiatric disorders. The program developed at Boston University Medical Center successfully integrates expanded addiction psychiatry training into the general psychiatry residency.     

Contextual aspects of mental disorders: a proposal for axis III of the ICD-10 multiaxial system

After several years of development and testing, the World Health Organization (WHO) has recently completed work on the multiaxial presentation of ICD-10 for use in adult psychiatry. Axis III of the ICD-10 multiaxial system is intended for clinicians’ reporting of contextual factors which may influence the diagnosis, treatment or prognosis of mental disorders that are recorded on Axis I. It was tested in two WHO-coordinated international field trials and found to be user-friendly, reasonably reliable and useful in routine clinical work, in the training of mental health professionals and in research on mental disorders.     

Forensische Psychiatrie

A basic task of psychiatry is to identify and treat mentally disordered persons at risk of committing crimes. Psychiatry has an important function in preserving social peace, law, and order. How the psychiatric world handles this duty has changed with time. There have been very important changes from asylums to mental hospitals and from voluntary or involuntary inpatient treatment to outpatient care; but clinical psychiatry cannot give up forensic psychiatry. As a result of developments, inpatient care in mental hospitals often concentrates on crisis management, risk assessment, and risk management. On the other hand, forensic psychiatry has made great efforts in recent decades with special therapies for mentally disturbed criminals and collaborated closely with criminologists in developing instruments for risk assessment and prognosis of repeat offenses.     

The integrative approach to psychiatry

From the early days of psychiatry as a distinct field of knowledge and clinical practice two competing approaches to the etiology and treatment of mental disorders have vied for dominance: the somatic and the psychic ("moral"). We are witnessing the same struggle today. To speak metaphorically, we can opt for either brainless or mindless psychiatry, as Szasz proposed. He failed to consider a third option, however, one that may be called an integrative approach. The latter is neither mindless nor brainless but rather encompasses both the mind and the brain in its theoretical and practical consideration. I will formulate the integrative approach in this paper and argue that it has a distinct advantage for both the study and treatment of mental disorders.     

Personality disorders and forensic psychiatry

Personality problems of various kinds make a significant impact on the practice of forensic psychiatry. Clusters of personality problems that amount to clinical syndromes should be treated as such and not discriminated against. ‘Psychopathic’ is a confusing term and currently in the UK may be best reserved for legal purposes. Treatment for personality disorders is akin to treatment for other chronic disabling disease such as schizophrenia. Patients with severe personality disorders should have just as much access to inpatient services as patients with other diseases. Such access should include access to compulsory care as well as to voluntary care. British mental health law allows, indeed encourages, such an approach. Prison care for personality disordered patients has an important role to play in their management, but prison management should not be the mainstay of treatment for personality disorders any more than it is for any other disease. The task for forensic psychiatry is to conduct research into personality disorders and to reduce the negativity associated with this term.     

Myths and facts in contemporary psychopharmacotherapy: evidence-based vs. evidence-biased treatment algorithms practice

Evidence based psychiatry and treatment guidelines have a significant role in raising the quality of mental health care and treatment, as well as in providing order where chaos reigns. The purpose of treatment guidelines and algorithms is to provide psychiatrists, health authorities, patients and their families with best evidence for making treatment decisions. However, adherence to some guidelines may do more harm than good if they are not flexible enough to take into account individual patient preferences and circumstances. The paradox at the heart of algorithms-based practice is that gold standard treatments are predicated on statistical generalizations about patients, mental disorders and treatments. In contrast, the effectiveness of a treatment is based on the art and practice of learning organization, the uniqueness of the patient, the doctor-patient relationship and the willingness of the patient to change her/his mental model, life philosophy and the relationships in his family. Treatment guidelines are the lifelines of medical psychiatry and clinical psychopharmacology, without which psychiatry will never reach professional maturity and become fully accepted in medical circles.     

Microbes and mental health: Can the microbiome help explain clinical heterogeneity in psychiatry?

Trillions of microbes cover the surfaces of our bodies and inhabit our gastrointestinal tract. In the past decade, research efforts examining the role of the microbiome in mental health have moved to the forefront of neuroscience and psychiatry. Based on a foundation of animal studies demonstrating the vital role for microbiota-brain communication in brain development, behavior, and brain function over the life span, clinical studies have started to consider the microbiome in psychiatric disorders. The composition, diversity and function of commensal microbes is influenced by genetic, lifestyle, and environmental factors. This review provides an overview of the factors contributing to individual differences in the microbiome, reviews recent work in psychiatric disorders, and considers what is needed to advance a better understanding of how the microbiome impacts mental health which may help us understand the heterogeneity observed in clinical psychiatric populations.     

Mad scenes in early 19th-century opera

OBJECTIVE: It is our objective to examine the phenomenon of mad scenes in bel canto opera from a modern perspective. METHOD: The development of psychiatry and music at the beginning of the 19th century is described. Common elements of romantic music and mental disorders are discussed. It is shown how bel canto composers represent psychiatric illness by musical means. The psychopathology depicted in a prototypical mad scene is evaluated. RESULTS: Early romantic music is characterized by imagination, illusion and loss of structure; characteristics which can be well expressed in mad scenes. While madness (withdrawal into a utopian world) gained a certain attraction in society, clinical psychiatry increasingly focused on emotional causes of illness and on drug-induction of mental disorders. CONCLUSION: Mad scenes in bel canto opera can be understood as expression of an increasing interest in emotional aspects in music and society as well as in clinical psychiatry.     

Putting "rural" into psychiatry residency training programs.

OBJECTIVE: Evidence indicates disparities in the number of psychiatrists practicing in rural America compared to urban areas suggesting the need for a greater emphasis on rural psychiatry in residency training programs. The authors offer suggestions for integrating a rural focus in psychiatry residency training to foster greater competency and interest in rural psychiatry. METHODS: The authors surveyed the limited rural psychiatry training and the more extensive family medicine rural residency literature to review efforts to develop rural focused training curricula. RESULTS: Many factors in the rural environment influence mental health care, including overlapping professional-patient relationships, caregiver isolation and stress, limited availability and access to mental health resources, disease stigma, and economic and health status. To enhance both an interest in and the quality of the training for a rural practice, the authors suggest three levels of training for integrating rural factors into psychiatry programs from a basic didactic understanding of the contextual issues affecting rural psychiatry, to creating rural clinical experiences and preceptors, to developing a rural psychiatry fellowship. CONCLUSIONS: Providing trainees with an understanding of the rural mental health issues and experiences might contribute to trainees' selecting rural practices and enhance the rural competency of psychiatrists.     

Neuroendocrine mechanisms of stress and social interaction: implications for mental disorders

PURPOSE OF REVIEW: The purpose of the present review is to consider further evidence for the role of neuroendocrine mechanisms in mental disorders by focusing on recent trends and advances in the field of psychoneuroendocrinology. RECENT FINDINGS: Recent studies confirm the importance of the hypothalamic-pituitary-adrenal axis for the development and course of mental disorders. Notably, the neuropeptide oxytocin has been shown to reduce the responsiveness of the hypothalamic-pituitary-adrenal axis to social stress and to improve social approach behavior. A better understanding of the neuroendocrine mechanisms of action underlying normal behavior has recently been translated to studies investigating novel therapeutic approaches using hormone administration. SUMMARY: Neuroendocrine systems relevant to behavior clearly demonstrate their impact for the field of psychiatry. Further neuroendocrine research provides insight into the origins of mental disorders both from an etiological perspective and an interventional perspective.