A major theme of our postings on Demystifying Psychiatry has been the importance of psychiatrists understanding brain structure and function, and becoming more conversant in modern neuroscience.
As explained in an earlier post, the training of psychiatrists is much more like that of neurologists than psychologists. Psychiatric research is advancing rapidly, and understanding many of these advances requires neuroscience expertise.
Two of psychiatry's most read and respected journals are the American Journal of Psychiatry and the Archives of General Psychiatry. To demonstrate the increasing importance of neuroscience to psychiatry, we will quote from abstracts of several articles from the June 2011 issues of these two journals:
1. (from American Journal of Psychiatry) "Brain Structure Abnormalities in Early-Onset and Adolescent-Onset Conduct Disorder" by Fairchild and colleagues. A sentence from the Results section of the abstract reads: "The combined conduct disorder group displayed gray matter volume reductions in the bilateral amygdala, extending into the insula, relative to healthy comparison subjects."
2. (from American Journal of Psychiatry) "Resting-State Functional Connectivity in Treatment-Resistant Depression" by Lui and colleagues. A sentence from the Results section of the abstract reads: "However, the nonrefractory group showed a more distributed decrease in connectivity than the refractory group, especially in the anterior cingulate cortex and in the amygdala, hippocampus, and insula bilaterally; in contrast, the refractory group showed disrupted functional connectivity mainly in prefrontal areas and in thalamus areas bilaterally."
3. (from Archives of General Psychiatry) "In Vivo Imaging of Cerebral Serotonin Transporter and Serotonin 2A Receptor Binding in 3,4-Methylenedioxymethamphetamine (MDMA or "Ecstasy") and Hallucinogen Users" by Erritzoe and colleagues. A sentence from the Results section of the abstract reads: "Compared with nonusers, MDMA-preferring users showed significant decreases in SERT nondisplaceable binding potential (neocortex, -56%; pallidostriatum, -19%; and amygdala, -32%)..."
4. (from Archives of General Psychiatry) "Functional Magnetic Resonance Imaging Investigation of the Amphetamine Sensitization Model of Schizophrenia in Healthy Male Volunteers" by O'Daly and colleagues. A sentence from the Results section of the abstract reads: "During a high-load cognitive challenge, sensitization did not produce performance deficits, but functional magnetic resonance imaging showed hyperactivity of the dorsolateral prefrontal cortex and aberrant recruitment of the superior temporal gyrus, caudate nucleus, and thalamus."
These four articles are typical of those published in the most highly read psychiatry journals. These journals are not basic science journals; they are aimed at practicing psychiatrists and psychiatric scientists.
The reason that research studies with substantial emphasis on brain structure and function are being published in our best journals is that we are beginning to better define illnesses in terms of abnormalities in brain systems. Elucidating these abnormalities has the potential to lead to improved pharmacological, psychological, electrical, and surgical treatments, and, hopefully, to break down some of the stigma associated with psychiatric illnesses.
To many clinicians, the articles we have cited may seem to be written in a foreign language. Certainly, many people would be surprised that the language in these articles is part of the language of psychiatry. In order for tomorrow's psychiatrists to provide the best possible care with the most innovative treatments, they will need to understand current and future research and be able to translate such research into messages that other medical and mental health colleagues can understand. They also must translate the concepts into terms that can be understood by patients and their families.
Currently, some (perhaps many) psychiatry residency programs are lagging behind in teaching this type of clinical science to their trainees. Psychiatric educators are increasingly trying to upgrade educational programs so that medical students and residents who are training to become psychiatrists have the scientific background in systems neuroscience and molecular neuroscience to understand the current and future research that will be leading to diagnostic and therapeutic advances.
Of course, training in neurosciences must proceed in addition to, not instead of, mastering communication skills and understanding complex human behavior at more descriptive levels. The future of psychiatry requires integration of biology and psychology - neither alone is adequate for developing improved and more effective treatment of our most devastating illnesses.
This column was written by Eugene Rubin MD, PhD and Charles Zorumski MD.
