scholarly journals Meaning and Matter in Psychiatry: A Historical View and New Approach

2020 ◽  
Vol 8 (3) ◽  
pp. 376
Author(s):  
Ketil Slagstad
Keyword(s):  
Mental Illness ◽  
Network Model ◽  
Biopsychosocial Model ◽  
Cultural Factors ◽  
Mental Illnesses ◽  
Social Psychological ◽  
New Approach ◽  
Historical View ◽  
Medical Network ◽  
Person Centered Approach

In this article, I argue that a person-centered approach in psychiatry needs to pay attention to how mental illnesses are historically constituted and products of biological, social, psychological and cultural factors. Even if the ambition of the biopsychosocial model and the medical network model was to break with reductionist understandings of (mental) illness, I argue that these models risk stabilising, rather than deconstructing dichotomies between nature versus culture, brain versus mind, somatic versus mental or hard facts versus soft sciences. I rather propose to re-orient psychiatry as a form of “relational medicine” in which causes and reasons are treated as inseparable and where matter and meaning are entangled. A person-centered approach in psychiatry must start with the person including the embodied production of meaning in Society.

Medicine

Mind-Society ◽  
2019 ◽  
pp. 259-291
Author(s):  
Paul Thagard
Keyword(s):  
Mental Illness ◽  
Molecular Mechanisms ◽  
Social Cognitive ◽  
Neural Mechanisms ◽  
Mental Illnesses ◽  
New Approach ◽  
Treatment Of Depression ◽  
Repair Mechanisms ◽  
Multiple Levels ◽  
Simple Reduction

All mental illnesses involve breakdowns in neural mechanisms for emotions that do not simply reduce to isolated mental, social, or chemical causes. The case of depression shows how illness results from the interaction of many causes that can be social, cognitive, neural, and molecular. Depression emerges from the interactions of mechanisms at all of these levels in a way that exemplifies emergence rather than simple reduction. Accordingly, treatment of depression often benefits from trying to repair mechanisms at multiple levels, most commonly by employing psychotherapy to make changes in mental representations and by employing antidepressants to change neurochemistry. Social cognitivism, the approach that integrates social, mental, neural, and molecular mechanisms, provides a new approach to explaining mental illness thanks to semantic pointer theories of cognition and communication.

How to adopt the biopsychosocial model

2020 ◽  
pp. 363-380
Author(s):  
Rebecca Roache
Keyword(s):  
Mental Illness ◽  
Biopsychosocial Model ◽  
A Priori ◽  
Mental Illnesses ◽  
The Other ◽  
Social Aspects ◽  
Social Approach ◽  
Biopsychosocial Approach ◽  
Social Explanations ◽  
Social Causes

This chapter focuses on how the biopsychosocial psychiatrist can most appropriately take account of the fact that mental illness has biological, psychological, and social aspects. Commitment to the biopsychosocial model should not involve an a priori acceptance of the view that mental illness always has biological, psychological, and social causes. Adopting the biopsychosocial model should involve recognizing that the understanding of any given mental illness may best be advanced by considering explanations at each of the biological, psychological, and social levels. Often, explanation at one of these levels may be more elucidating than explanations at the other levels, but considering all of them combined is likely to maximize one's understanding. Psychological and social explanations are not eliminable in favour of biological ones, largely because of the way that mental illnesses are conceived and diagnosed. Moreover, commitment to a biopsychosocial approach should not involve commitment to the view that treatment of mental illness should always involve interventions at every level. Which treatment is most effective in any given case—that is, whether a biological, a psychological, or a social approach—can best be decided empirically.

scholarly journals What neuroscience has already done for us

2020 ◽  
Vol 44 (3) ◽  
pp. 110-112
Author(s):  
Lindsey Isla Sinclair
Keyword(s):  
Mental Illness ◽  
Life Events ◽  
Biopsychosocial Model ◽  
Mental Illnesses ◽  
Genetic Abnormalities

SummaryEach of the components of the biopsychosocial model of mental illness is important for understanding mental illness. Biological and genetic abnormalities have been demonstrated in major mental illnesses. These are leading to changes in our understanding of these conditions, as well as our understanding of the link between life events and mental illness.

Mental and Physical Health Consequences of the Stigma Associated with Mental Illnesses

2017 ◽  
Author(s):  
Bruce G. Link ◽  
Jo C. Phelan ◽  
Greer Sullivan
Keyword(s):  
Mental Illness ◽  
Physical Health ◽  
Health Disparity ◽  
Premature Mortality ◽  
Labeling Theory ◽  
Mental Illnesses ◽  
Mental Illness Stigma ◽  
Social Psychological ◽  
Stigma Of Mental Illness ◽  
Mental And Physical Health

People with mental illnesses experience physical illness and premature mortality at much higher rates compared to people without such illnesses. This chapter proposes that the stigma of mental illness comprises an important set of causes of this physical health disparity. It draws on classical and modified labeling theory from sociology for insights and propositions as to why mental illness stigma might affect physical health. The chapter proposes that the stigma of mental illness might affect not only the future experience of mental illness but also a broad range of physical illnesses, thereby contributing to the substantial physical health disparity that people with mental illnesses experience. The chapter develops a conceptual model that places at its center stigma processes including structural, interpersonal, social psychological, and internalized processes. Stigma processes at these levels induce stress and reduce resources, which in turn compromise physical health to produce large physical health disparities.

Sati

Crisis ◽  
2005 ◽  
Vol 26 (2) ◽  
pp. 73-77 ◽  
Author(s):  
Dinesh Bhugra
Keyword(s):  
Mental Illness ◽  
Psychiatric Disorders ◽  
Indian Subcontinent ◽  
Cultural Factors ◽  
Role Expectations ◽  
Prevention Strategies ◽  
Social Causation ◽  
Gender Role Expectations ◽  
Good Wife ◽  
And Gender

Abstract. Sati as an act of ritual suicide has been reported from the Indian subcontinent, especially among the Hindus, for several centuries. Although legally proscribed, these acts occur even now in modern India. The principle behind such acts has been put forward as the principle of good wife. There is little evidence to suggest that women who commit this act suffer from a formal mental illness. Cultural factors and gender role expectations play a significant role in the act and its consequences. Using recent examples, this paper illustrates the cultural factors, which may be seen as contributing to the act of suicide. Other factors embedded in the act also emphasize that not all suicides have underlying psychiatric disorders and clinicians must take social causation into account while preparing any prevention strategies.

Prescriptive Power: Biologism, Biopsychiatry and Drug-centred Psychopharmacology

Somatechnics ◽  
2019 ◽  
Vol 9 (2-3) ◽  
pp. 291-309
Author(s):  
Francis Russell
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Social Justice ◽  
Cultural Theory ◽  
Human Experience ◽  
Mental Illnesses ◽  
False Consciousness ◽  
The Subject ◽  
Biological Ontology ◽  
Health Discourse

This paper looks to make a contribution to the critical project of psychiatrist Joanna Moncrieff, by elucidating her account of ‘drug-centred’ psychiatry, and its relation to critical and cultural theory. Moncrieff's ‘drug-centred’ approach to psychiatry challenges the dominant view of mental illness, and psychopharmacology, as necessitating a strictly biological ontology. Against the mainstream view that mental illnesses have biological causes, and that medications like ‘anti-depressants’ target specific biological abnormalities, Moncrieff looks to connect pharmacotherapy for mental illness to human experience, and to issues of social justice and emancipation. However, Moncrieff's project is complicated by her framing of psychopharmacological politics in classical Marxist notions of ideology and false consciousness. Accordingly, she articulates a political project that would open up psychiatry to the subjugated knowledge of mental health sufferers, whilst also characterising those sufferers as beholden to ideology, and as being effectively without knowledge. Accordingly, in order to contribute to Moncrieff's project, and to help introduce her work to a broader humanities readership, this paper elucidates her account of ‘drug-centred psychiatry’, whilst also connecting her critique of biopsychiatry to notions of biologism, biopolitics, and bio-citizenship. This is done in order to re-describe the subject of mental health discourse, so as to better reveal their capacities and agency. As a result, this paper contends that, once reframed, Moncrieff's work helps us to see value in attending to human experience when considering pharmacotherapy for mental illness.

Effective e-health design for those with, and without, mental health disorders: shallow navigation, concentrated contents, modest number of links, one screen area for links. (Preprint)

2018 ◽  
Author(s):  
Armando Rotondi ◽  
Jonathan Grady ◽  
Barbara H. Hanusa ◽  
Michael R. Spring ◽  
Kaleab Z. Abebe ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Success Rate ◽  
Fractional Factorial ◽  
Mental Illnesses ◽  
Schizophrenia Spectrum Disorders ◽  
Design Elements ◽  
Website Usability ◽  
Schizophrenia Spectrum ◽  
Health Applications

BACKGROUND E-health applications are an avenue to improve service responsiveness, convenience, and appeal, and tailor treatments to improve relevance, engagement, and use. It is critical to user engagement that the designs of e-health applications are intuitive to navigate. Limited research exists on designs that work for those with a severe mental illness, many of whom infrequently seek treatment, and tend to discontinuation medications and psychosocial treatments. OBJECTIVE The purpose of this study was to evaluate the influence of 12 design elements (e.g., website depth, reading level, use of navigational lists) on the usability of e-health application websites for those with, and without, mental health disorders (including severe mental illness). METHODS A 212-4 fractional factorial experimental design was used to specify the designs of 256 e-health websites, which systematically varied the 12 design elements. The final destination contents of all websites were identical, only the navigational pages varied. Three subgroups of participants comprising 226 individuals, were used to test these websites (those with schizophrenia-spectrum disorders, other mental illnesses, and no mental illness). Unique to this study was that the 12 design elements were manipulated systematically to allow assessment of combinations of design elements rather than only one element at a time. RESULTS The best and worst designs were identified for each of the three subgroups, and the sample overall. The depth of a website’s navigation, that is, the number of screens/pages users needed to navigate to find desired content, had the strongest influence on usability (ability to find information). The worst performing design for those with schizophrenia-spectrum disorders had an 8.6% success rate (ability to find information), the best had a 53.2% success rate. The navigational design made a 45% difference in usability. For the subgroup with other mental illnesses the design made a 52% difference, and for those with no mental illness a 50% difference in success rate. The websites with the highest usability all had several key similarities, as did the websites with the poorest usability. A unique finding is that the influences on usability of some design elements are variable. For these design elements, whether they had a positive or negative effect, and the size of its effect, could be influenced by the rest of the design environment, that is, the other elements in the design. This was not the case for navigational depth, a shallower hierarchy is better than a deeper hierarchy. CONCLUSIONS It is possible to identify evidence-based strategies for designing e-health applications that result in a high level of usability. Even for those with schizophrenia, or other severe mental illnesses, there are designs that are highly effective. The best designs have key similarities, but can also vary in some respects. Key words: schizophrenia, severe mental illness, e-health, design, website, usability, website design, website usability, fractional factorial design.

scholarly journals Use of a Consultation Service Following Pharmacogenomic Testing in Psychiatry

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 179-180
Author(s):  
Daniel Dowd ◽  
David S. Krause
Keyword(s):  
Mental Illness ◽  
Drug Interactions ◽  
Metabolic Pathways ◽  
Patient Characteristics ◽  
Healthcare Resource Utilization ◽  
Machine Learning Algorithms ◽  
Mental Illnesses ◽  
Variable Response ◽  
Drug Induced ◽  
Commercial Laboratory

AbstractBackgroundThere is a plethora of drugs available to psychiatrists for treatment of mental illness, which can vary in efficacy, tolerability, metabolic pathways and drug-drug interactions. Psychotropics are the second most commonly listed therapeutic class mentioned in the FDA’s Table of Pharmacogenomic Biomarkers in Drug Labeling. Pharmacogenomic (PGx) assays are increasingly used in psychiatry to help select safe and appropriate medication for a variety of mental illnesses. Our commercial laboratory offers PGx expert consultations by PharmDs and PhDs to clinician-users. Our database contains valuable information regarding the treatment of a diverse and challenging population.MethodsGenomind offers a PGx assay currently measuring variants of 24 genes relevant for selection of drugs with a mental illness indication. Since 2012 we have analyzed > 250,000 DNA samples. Between 10/18 - 8/20 6,401 reports received a consult. The data contained herein are derived from those consults. Consultants record information on prior meds, reason for failure or intolerability, potential risk-associated or useful drugs based on the genetic variants. Consultants only recommend specific drugs and doses consistent with a published PGx guideline.ResultsThe 5 most commonly discussed genes were SLC6A4, MTHFR, CACNA1C, COMT and BDNF. The 3 most commonly discussed drugs were fluoxetine, lithium and duloxetine. The most common reasons for drug failure were inefficacy and drug induced “agitation, irritability and/or anxiety”. SSRIs were the most common class of discontinued drug; sertraline, escitalopram and fluoxetine were the three most commonly reported discontinuations and were also the 3 most likely to be associated with “no improvement”. Aripiprazole was the most commonly reported discontinued atypical antipsychotic. The providers rated 94% of consultations as extremely or very helpful at the time of consult. An independent validation survey of 128 providers confirmed these ratings, with 96% reporting a rating of “very helpful” or “extremely helpful”. In addition, 94% reported that these consults were superior to PGx consults provided through other laboratories. Patient characteristics captured during consults via a Clinical Global Impressions-Severity (CGI-S) scale revealed that the majority of patients were moderately (54%) or markedly ill (23%). The most frequent symptoms reported were depression, anxiety, insomnia and inattentiveness.DiscussionThe large variety of psychotropic drugs available to providers, and their highly variable response rates, tolerability, capacity for drug-drug interactions and metabolic pathways present a challenge for even expert psychopharmacologists. Consultation with experts in PGx provides additional useful information that may improve outcomes and decrease healthcare resource utilization. This database may provide future opportunities for machine learning algorithms to further inform implications of included gene variants.FundingGenomind, Inc.

scholarly journals Priority vaccination for mental illness, developmental or intellectual disability

2021 ◽  
pp. medethics-2021-107247
Author(s):  
Nina Shevzov-Zebrun ◽  
Arthur L Caplan
Keyword(s):  
Mental Illness ◽  
Living Arrangement ◽  
State Level ◽  
Elevated Risk ◽  
Mental Illnesses ◽  
Healthcare Personnel ◽  
Diverse Populations ◽  
Federal Level ◽  
Control And Prevention ◽  
Prevention Guidelines

Coronavirus vaccines have made their debut. Now, allocation practices have stepped into the spotlight. Following Centers for Disease Control and Prevention guidelines, states and healthcare institutions initially prioritised healthcare personnel and elderly residents of congregant facilities; other groups at elevated risk for severe complications are now becoming eligible through locally administered programmes. The question remains, however: who else should be prioritised for immunisation? Here, we call attention to individuals institutionalised with severe mental illnesses and/or developmental or intellectual disabilities—a group highly susceptible to the damages of COVID-19, recent research shows, and critical to consider for priority vaccination. The language describing both federal-level and state-level intentions for this population remains largely vague, despite the population’s diversity across age, diagnosis, functional status and living arrangement. Such absence of specificity, in turn, leaves room for confusion and even neglect of various subgroups. We review data stressing this group’s vulnerability, as well as select state plans for priority vaccination, highlighting the importance of clarity when describing intentions to vaccinate, or even generally care for, diverse populations composed of distinct subgroups in need.

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