When answers are hard to find, change the question: Asking different causal questions can enable progress

2020 ◽  
pp. 46-59
Author(s):  
Rachel Cooper
Keyword(s):  
Mental Disorders ◽  
Causal Explanation ◽  
Psychiatric Research ◽  
Question Asking ◽  
Research Programmes ◽  
Concepts Of Disease ◽  
Empirical Progress

This chapter argues that changing the causal questions asked by psychiatric research programmes might facilitate progress in finding the causes of mental disorders. K. Codell Carter’s (2003) The Rise of Causal Concepts of Disease shows that empirical progress sometimes requires a change in the causal questions that researchers ask. The philosophical claim that causal explanation is contrastive implies that projects that seek ‘the causes of disorder’ might pursue this aim in multiple ways. Some causal questions will turn out to be easier to address than others. This means that when research programmes stall, it is worth trying to restart progress through switching the causal questions asked. The chapter considers one type of causal question, ‘Why do some people with condition X find it harmful and others harmless?’, that might plausibly be fruitfully addressed more often than at present.

Suicidality and Treatment Experience Among Young People Who Inject Drugs

2020 ◽  
Author(s):  
Mary Ellen Mackesy-Amiti ◽  
Lawrence J. Ouellet
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Young People ◽  
Mental Disorders ◽  
Mental Health Treatment ◽  
People Who Inject Drugs ◽  
Multivariable Analysis ◽  
Psychiatric Research ◽  
Health Treatment ◽  
The Past

Background. We examined correlates of past year suicidal thoughts and behavior (STB) and described past year treatment experiences among young people who inject drugs (PWID). Methods. Participants were 570 adults (18-25 years) who injected primarily heroin. Interviews were conducted at field stations operated by Community Outreach Intervention Projects in Chicago, Illinois (USA). Interviewers administered the Psychiatric Research Instrument for Substance and Mental Disorders. Substance use and mental disorders were based on DSM-IV diagnostic criteria. Past year STB was based on multiple questions. Results. Sixteen percent of men and 25% of women reported STB in the past year. In multivariable analysis, STB was associated with non-heterosexual orientation, foster care, and being raised by two parents. Primary major depression, post-traumatic stress disorder, other anxiety disorders, and borderline personality disorder had independent effects on suicidality. Among those reporting past year STB (n=111), 83% ever received mental health treatment, while 44% did so in the past year. While 24% of respondents indicated that at least one treatment matched their needs very well, 30% reported treatment that did not match their needs at all. The most common reason for ending treatment was program completion (about 50%) while getting better was endorsed by about 25%. Nearly half reported ending treatment due to a bad experience, logistical issues, or expense. Conclusions. Young PWID are at high risk for suicidal behavior and their mental health treatment experiences often do not meet their needs. There is a pressing need for more integrated substance use and mental health treatment.

Validación de la versión española de la psychiatric research interview for substance and mental disorders (PRISM)

2001 ◽  
Vol 3 (4) ◽  
pp. 293
Author(s):  
D. Serrano ◽  
G. Pérez ◽  
M. Astals ◽  
R. Martín-Santos ◽  
C. Castillo ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Psychiatric Research ◽  
Research Interview

scholarly journals Early systematic communication between physician, patient and employer to promote return to work

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P Nordling ◽  
L Nordeman ◽  
I M Skoglund ◽  
C Björkelund ◽  
G Hensing
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Return To Work ◽  
Usual Care ◽  
Common Mental Disorders ◽  
Pragmatic Trial ◽  
Organizational Factors ◽  
Psychiatric Research ◽  
Related Factors ◽  
Physician Patient

Abstract Background In the sickness absence and return-to-work process communication between stakeholders is beneficial but difficult to achieve. Addressing work-related issues early in the process could support decision making. The aim of this study was to test if early systematic communication about work and health between physician, patient/employee and employer facilitated by a communication tool, the Capacity Note, was feasible for patients with common mental disorders (CMD) in primary care. Methods In a pragmatic trial, physicians at primary health care centers (PHCCs) were randomized to control/intervention physician and were responsible for identifying eligible patients. In addition to usual care, intervention patients used the Capacity Note with their physician and were then instructed to use it with their employer and return it to the physician. Control patients received usual care. A study log book and sick leave data for each PHCC were used for process evaluation purposes. Results Eighteen of 24 PHCCs in the region were contacted; eight participated. At study start, 434 patients filled the basic inclusion criteria. Of these, 93 were identified as eligible by the physicians and were asked to participate. Around 40% declined participation, most commonly due to lack of energy or hesitation to talk to the employer. The final sample included 56 patients. Of the 28 intervention patients nine (32%) completed the intervention. Conclusions The study was negatively affected by suboptimal research conditions in primary care (e.g. severe time constraints). Also, the patients' hesitation to participate highlights the sensitivity of the topic and the difficulties in doing research in this vulnerable patient group. Thus, the feasibility was hampered by both organizational and patient related factors. It is of utmost importance to improve possibilities for social psychiatric research in primary care given the high prevalence of CMD and associated reduced capacity to work. Key messages Discussing health-related issues with the employer was seen as a sensitive matter among patients with common mental disorders. Research on best practices for sickness certification and return-to-work was difficult to achieve due to both personal and organizational factors.

Psychiatric Research Interview for Substance and Mental disorders (PRISM): Validation of the Spanish version

1999 ◽  
Vol 9 ◽  
pp. 337
Author(s):  
D. Serrano ◽  
G. Pérez ◽  
A. Ortells ◽  
R. Martin-Santos ◽  
C. Castillo ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Spanish Version ◽  
Psychiatric Research ◽  
Research Interview

Psychiatry 2017: Acknowledging Complexity While Avoiding Defeatism

2017 ◽  
Vol 41 (S1) ◽  
pp. S1-S1
Author(s):  
M. Maj
Keyword(s):  
Bipolar Disorder ◽  
Mental Disorders ◽  
Psychiatric Research ◽  
Psychiatric Diagnoses ◽  
The Past ◽  
Current Period ◽  
Competing Interest ◽  
Main Components

In the past few years, it has become a sort of cliché to state that psychiatry is in a crisis. In particular, it has been repeatedly argued that: (a) psychiatric diagnoses are invalid; (b) psychiatric research has not progressed significantly (in particular, it has not been able to identify “the cause” of schizophrenia, depression or bipolar disorder); (c) psychiatric treatments are of limited value, and their widespread use has not been able to reduce the incidence of mental disorders. This perception of crisis has been at least in part generated by an identification of mainstream psychiatry with the neo-kraepelinian paradigm, so that the crisis of confidence in that paradigm has expanded into a crisis of confidence in the psychiatric discipline. According to Kuhn, the crisis of confidence in a paradigm is accompanied by a period of “extraordinary science”, marked by a proliferation of competing methodologies, the proposition of a variety of divergent solutions for the problem defining the crisis, and the recourse to philosophy and to debate over fundamentals of the discipline. The crisis of confidence in the neo-kraepelinian paradigm has generated such a period, in which we are all now immersed. In this presentation, I will summarize the main components of the neo-kraepelinian paradigm; I will illustrate why that paradigm has failed, or at least has lost people's confidence; and will summarize the main elements which are emerging in the current period of “extraordinary science”.Disclosure of interestThe author has not supplied his declaration of competing interest.

There Is No Cure for Existence: On the Medicalization of Psychological Distress

2015 ◽  
Vol 17 (3) ◽  
pp. 149-158 ◽  
Author(s):  
Dolores Albarracin ◽  
Alain Ducousso-Lacaze ◽  
David Cohen ◽  
François Gonon ◽  
Pascal-Henri Keller ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Current Model ◽  
Biological Psychiatry ◽  
Psychiatric Research ◽  
Institutional Discourse ◽  
The Public ◽  
Ethical Commitment ◽  
Diagnostic Thresholds ◽  
And Control ◽  
Positive Effect

The current model of biological psychiatry assumes that mental suffering results from cerebral/neuronal disturbances yet to be identified. Under this model, the lowering of diagnostic thresholds or the invention of new disorders are surprising given that there have been no major etiological findings for decades. No clinical or epidemiological research demonstrates biological causes for problems defined as mental disorders, no more than research validates the numerous categories that supposedly describe them.The diagnostic spiral leads to the increasing prescription of drugs, sometimes for life, even if they have not been shown to have any substantial positive effect on any measure of “morbidity” for mental disorders. Today, the lives of children and adults are punctuated by the consumption of psychotropic drugs prescribed by physicians who are pushed to diagnose, treat, and control their symptoms.We aimed at showing that, despite these inarguable failures, the scientific and media discourse gives the public a warped view of reality where progress in biological psychiatric research is unceasing. Therefore we call for a paradigm shift in mental health: critical thinking, openness of mind, and analysis of the scientific and institutional discourse must be encouraged among all practitioners because their ethical commitment to their patients demands it.

scholarly journals A Theoretical Framework for Evaluating Psychiatric Research Strategies

2017 ◽  
Vol 1 ◽  
pp. 184-207 ◽  
Author(s):  
Kentaro Katahira ◽  
Yuichi Yamashita
Keyword(s):  
Mental Disorders ◽  
Statistical Power ◽  
Computational Models ◽  
Diagnostic Category ◽  
Theoretical Framework ◽  
Research Strategy ◽  
Psychiatric Research ◽  
Research Strategies ◽  
Advantages And Disadvantages ◽  
Diagnostic Categories

One of the major goals of basic studies in psychiatry is to find etiological mechanisms or biomarkers of mental disorders. A standard research strategy to pursue this goal is to compare observations of potential factors from patients with those from healthy controls. Classifications of individuals into patient and control groups are generally based on a diagnostic system, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases ( ICD). Several flaws in these conventional diagnostic-based approaches have been recognized. The flaws are primarily due to the complexity in the relation between the pathogenetic factors (causes) and disorders: The current diagnostic categories may not reflect the underlying etiological mechanisms. To overcome this difficulty, the National Institute of Mental Health initiated a novel research strategy called Research Domain Criteria (RDoC), which encourages studies to focus on the neurobiological mechanisms and core aspects of behavior rather than to rely on traditional diagnostic categories. However, how RDoC can improve research in psychiatry remains a matter of debate. In this article, we propose a theoretical framework for evaluating psychiatric research strategies, including the conventional diagnostic category-based approaches and the RDoC approach. The proposed framework is based on the statistical modeling of the processes of how the disorder arises from pathogenetic factors. This framework provides the statistical power to quantify how likely relevant pathogenetic factors are to be detected under various research strategies. On the basis of the proposed framework, we can discuss which approach performs better in different types of situations. We present several theoretical and numerical results that highlight the advantages and disadvantages of the strategies. We also demonstrate how a computational model is incorporated into the proposed framework as a generative model of behavioral observations. This demonstration highlights how the computational models contribute to designing psychiatric studies.

scholarly journals The network approach to psychopathology: a review of the literature 2008–2018 and an agenda for future research

2019 ◽  
Vol 50 (3) ◽  
pp. 353-366 ◽  
Author(s):  
Donald J. Robinaugh ◽  
Ria H. A. Hoekstra ◽  
Emma R. Toner ◽  
Denny Borsboom
Keyword(s):  
Mental Disorders ◽  
Research Program ◽  
Critical Analysis ◽  
Psychiatric Research ◽  
Future Research ◽  
Network Approach ◽  
Review Of The Literature ◽  
The Past ◽  
Body Of Knowledge ◽  
Broad Framework

AbstractThe network approach to psychopathology posits that mental disorders can be conceptualized and studied as causal systems of mutually reinforcing symptoms. This approach, first posited in 2008, has grown substantially over the past decade and is now a full-fledged area of psychiatric research. In this article, we provide an overview and critical analysis of 363 articles produced in the first decade of this research program, with a focus on key theoretical, methodological, and empirical contributions. In addition, we turn our attention to the next decade of the network approach and propose critical avenues for future research in each of these domains. We argue that this program of research will be best served by working toward two overarching aims: (a) the identification of robust empirical phenomena and (b) the development of formal theories that can explain those phenomena. We recommend specific steps forward within this broad framework and argue that these steps are necessary if the network approach is to develop into a progressive program of research capable of producing a cumulative body of knowledge about how specific mental disorders operate as causal systems.

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