Understanding how Psychiatric Disorders develop(Neuroscience)
1.Psychiatric comorbidities in neurodevelopmental disorders(PubMed)
Author : Bryan H King
Abstract : Purpose of review: Recent changes in the diagnostic criteria for psychiatric and neurodevelopmental disorders as well as increases in the prevalence of both have elevated the focus on these areas of medicine and their clinical overlap.
Recent findings: Several recent studies have examined psychiatric comorbidities in neurodevelopmental disorders including autism and specific genetic syndromes. A growing number of reports underscore the genetic overlap between previously distinct clinical disorders. Behavioral and psychiatric features are increasingly identified in association with intellectual developmental disorders.
Summary: As there have been advances in our collective understanding of the genetic underpinnings of certain disorders and the downstream physiological consequences of those genetic alterations, challenges to the way boundaries have been drawn around psychiatric disorders, and by extension, the concept of comorbidity, warrant review
2. Psychiatric Disorders: Grounded in Human Biology but Not Natural Kinds(PubMed)
Author : Steven E Hyman
Abstract : The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and its descriptive psychiatry-based intellectual antecedents imagined psychiatric disorders as discontinuous categories, presumably natural kinds, that would be empirically validated based on future scientific studies. Validation would emerge from a predicted convergence of clinical descriptions (symptom clusters that could be shown to be stable over the lifespan), laboratory results, and family studies. That future science is now arriving, but rather than validating the categorical DSM approach, large-scale genetics along with modern neurobiology and epidemiology have emphatically undercut it. Clinical description, laboratory studies, and family (now genetic) studies do not converge at all on distinct categories. Rather, modern studies are consistent with psychiatric disorders as heterogeneous quantitative deviations from health. The characteristics of these disorders have proven to be discoverable rather than invented and thus are grounded in nature. However, scientific results demonstrate that psychiatric disorders cannot reasonably be understood as discrete categories-and certainly not as natural kinds.
3.Addressing Suffering in Patients With Psychiatric Disorders (PubMed)
Author : Joel Yager
Abstract : Background: Patients with psychiatric disorders (as well as general medical conditions) often describe their lives in terms of suffering. Although suffering is honored as a central focus of physicians’ concerns, it is not even indexed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Generally connoting severe, prolonged distress, suffering can be distinguished from pain, depression, and anxiety. The aims of this article are to consider whether attending to suffering per se in psychiatric patients merits attention independent of other commonly assessed psychiatric symptoms such as anxiety, depression, and conventional distress, and how targeting suffering per se might add value to psychiatric patient care.
Methods: Sources for this article were obtained via a selective literature search in PubMed using the terms “suffering” in the title and the terms “psychiatric disorder,” “mental illness,” “assessment,” “measurement,” “scale,” “existential suffering,” and “unbearable suffering.” Articles of interest were followed up using a snowball technique to examine “similar articles” and “cited by” titles to find additional pertinent articles.
Results: Definitions of suffering in the medical literature stress its subjectivity, particularity, complexity, and connection to a wide variety of noxious sensations, as well as real and anticipated deficits, losses, and thwarted motivations. These can affect the entire spectrum of universal human needs, from basic biological issues through intrapsychic, interpersonal, and social issues, encompassing existential concerns of meaning, purpose, and transcendence. Based on these factors, a definition of suffering in patients with psychiatric disorders is proposed. Although efforts to measure suffering have been limited and numerous gaps in the literature are evident, several scales may offer suitable bases for the study of suffering in patients with psychiatric disorders.
Conclusions and implications: Ascertaining sources of suffering may require new types of inquiry and additional time. Well-described, evidence-informed strategies and time-honored psychotherapy techniques are available for addressing the numerous concerns that contribute to suffering. Patients with psychiatric disorders whose distinct, multidimensional sources of suffering are identified, acknowledged, and addressed may experience better treatment quality, greater treatment satisfaction, and possibly better outcomes than those whose clinicians’ attention is limited to conventional psychiatric signs and symptoms.
4. Psychiatric disorders in the elderly(PubMed)
Author : Ingmar Skoog
Abstract : Recent research has shown that depression, anxiety disorders, and psychosis are more common than previously supposed in elderly populations without dementia. It is unclear whether the frequency of these disorders increases or decreases with age. Clinical expression of psychiatric disorders in old age may be different from that seen in younger age groups, with less and often milder symptoms. Concurrently, comorbidity between different psychiatric disorders is immense, as well as comorbidity with somatic disorders. Cognitive function is often decreased in people with depression, anxiety disorders, and psychosis, but whether these disorders are risk factors for dementia is unclear. Psychiatric disorders in the elderly are often related to cerebral neurodegeneration and cerebrovascular disease, although psychosocial risk factors are also important. Psychiatric disorders, common among the elderly, have consequences that include social deprivation, poor quality of life, cognitive decline, disability, increased risk for somatic disorders, suicide, and increased nonsuicidal mortality.
