Biological psychiatry

Biological psychiatry, or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics and physiology to form theories about the biological bases of behaviour and psychopathology.cite web
url = http://cancerweb.ncl.ac.uk/cgi-bin/omd?query=biological+psychiatry
title = On-Line Medical Dictionary
publisher = Dept. of Medical Oncology, University of Newcastle upon Tyne] cite web
url = http://www.websters-online-dictionary.org/Bi/Biological_Psychiatry.html
title = Webster's Dictionary definition of biological psychiatry
publisher = Webster's Dictionary] cite web
url = http://www.sobp.org/purpose.asp
title = Purpose of Society of Biological Psychiatry
publisher = Society of Biological Psychiatry] cite web
url = http://www.infoplease.com/ipd/A0342210.html
title = Infoplease dictionary definition of Biological Psychiatry
publisher = Infoplease dictionary]

While there is some overlap between biological psychiatry and neurology, the latter generally focuses on disorders where gross or visible pathology of the nervous system is apparent, such as epilepsy, cerebral palsy, encephalitis, neuritis, Parkinson's disease and multiple sclerosis. There is some overlap with neuropsychiatry, which typically deals with behavioural disturbance in the context of apparent brain disorder.

Biological psychiatry and other approaches to mental illness are not mutually exclusive, but may simply attempt to deal with the phenomena at different levels of explanation. Because of the focus on the biological function of the nervous system, however, biological psychiatry has been particularly important in developing and prescribing drug-based treatments for mental disorder.

In practice, however, psychiatrists may advocate both medication and psychological therapies when treating mental illness. The therapy is more likely to be conducted by clinical psychologists, psychotherapists, occupational therapists or other mental health workers who are more specialised and trained in non-drug approaches.cite web
url = http://medapps.med.harvard.edu/psych/education-residency.htm
title = Harvard/Cambridge psychiatric training syllabus
publisher = Dept. of Psychiatry Harvard Medical School] cite journal
author = Vetulani, J.
year = 2001
month = November
title = Biological basis of psychiatry
journal = Psychiatry Pol
pmid = 11877886]

The history of the field extends back to the ancient Greek physician Hippocrates,cite web
url = http://www.delano.com/ReferenceArticles/Depression-Historical.html
title = Historical treatment of depression
author = Payk, T.R.
publisher = The Delano Report] but the term "biological psychiatry" was first used in peer-reviewed scientific literature in 1953. The term is more commonly used in the US than in some other countries such as the UK.cite journal
author = Bennett, A.E.
year = 1953
month = October
title = Biological Psychiatry
journal = American Journal of Psychiatry
volume = 4
issue = 110
pages = 244–52
pmid = 13092281] The field, however, is not without its critics and the phrase "biological psychiatry" is sometimes used by those critics as a term of disparagement.

cope and detailed definition

Biological Psychiatry is a branch of Psychiatry where the focus is chiefly on researching & understanding the biological basis of major mental disorders such as Unipolar and Bipolar Affective (Mood) Disorders, Schizophrenia and Organic Mental Disorders such as Alzheimers Disease. This knowledge has been gained using imaging techniques, psychopharmacology, neuroimmunochemistry and so on. Discovering the detailed interplay between neurotransmitters and the understanding of the neurotransmitter fingerprint of psychiatric drugs such as Clozapine has been a helpful result of the research. On a research level, it includes all possible biological bases of behavior - biochemical, genetic, physiological, neurological and anatomical. On a clinical level, it includes various therapies, such as drugs, diet, avoidance of environmental contaminants, exercise, and alleviation of the adverse effects of life stress,cite journal
author = McEwen, B.S.
year = 2005
month = September
title = Stressed or stressed out: what is the difference?
journal = Journal of Psychiatry and Neuroscience
pmid = 16151535] all of which can cause measurable biochemical changes.cite journal
author = Hendricks H., "et al."
year = 2005
title = Metabolism, mood and cognition in aging: the importance of lifestyle and dietary intervention
journal = Neurobiology Aging
pmid = 16290269
doi = 10.1016/j.neurobiolaging.2005.10.005
volume = 26
pages = 1] The biological psychiatrist views all of these as possible etiologies of or remedies for mental health disorders.

However, the biological psychiatrist typically does not discount psychoanalytic approaches (talk therapies). Medical psychiatric training generally includes both psychodynamic and biological approaches.cite web
url = http://medapps.med.harvard.edu/psych/education-residency.htm
title = Harvard/Cambridge psychiatric training syllabus
publisher = Dept. of Psychiatry Harvard Medical School] Accordingly, psychiatrists are usually comfortable with a dual approach: "psychotherapeutic methods...are as indispensable as psychopharmacotherapy in a modern psychiatric clinic",cite journal
author = Vetulani, J.
year = 2001
month = November
title = Biological basis of psychiatry
journal = Psychiatry Pol
pmid = 11877886]

Basis for biological psychiatry

Sigmund Freud developed psychotherapy in the early 1900s, and through the 1950s this technique was prominent in treating mental health disorders.

However in the late 1950s, the first modern antipsychotic and antidepressant drugs were developed: Chlorpromazine (also known as Thorazine), the first widely-used antipsychotic, was synthesized in 1950, and iproniazid, one of the first antidepressants, was first synthesized in 1957. In 1959 imipramine, the first tricyclic antidepressant, was developed.

Based significantly on clinical observations of the above drug results, in 1965 the seminal paper "The catecholamine hypothesis of affective disorders" was published.cite journal
author = Schildkraut J J, "et al."
year = 1965
month = November
title = British psychiatry in the 20th century--observations from a psychiatric journal
journal = The American Journal of Psychiatry
pmid = 5319766] It articulated the "chemical imbalance" hypothesis of mental health disorders, especially depression. It formed much of the conceptual basis for the modern era in biological psychiatry.cite web
url = http://www.massmentalhealthcenter.org/research/programs-programpages-majoraffective.htm
title = Psychobiology Of Major Affective Disorders
publisher = Massachusetts General Mental Health Center]

Although the "chemical imbalance" hypothesis has been significantly revised since 1965, many newer medications (such as fluoxetine and other SSRIs) were developed based on the underlying theories of the hypothesis. More recent research points to deeper underlying biological mechansisms as the possible basis for several mental health disorders.cite journal
author = Duman, R.S.
year = 2004
title = Depression: a case of neuronal life and death?
journal = Biological Psychiatry
pmid = 15271581
doi = 10.1016/j.biopsych.2004.02.033
volume = 56
pages = 140] cite web
url = http://www.psychologytoday.com/articles/pto-19990301-000031.html
title = Depression: Beyond Serotonin
publisher = Psychology Today Magazine]

Modern brain imaging techniques allow noninvasive examination of neural function in patients with mental health disorders, however this is currently experimental. With some disorders it appears the proper imaging equipment can reliably detect certain neurobiological problems associated with a specific disorder.cite journal
author = Johnson, M.R.
year = 2006
title = A Functional Magnetic Resonance Imaging Study of Working Memory Abnormalities in Schizophrenia
journal = Biological Psychiatry
pmid = 16503328
doi = 10.1016/j.biopsych.2005.11.012
volume = 60
pages = 11] cite journal
author = Whalley H.C., "et al."
year = 2006
title = Functional Imaging as a Predictor of Schizophrenia
journal = Biological Psychiatry
pmid = 16460690
doi = 10.1016/j.biopsych.2005.11.013
volume = 60
pages = 454] If further studies corroborate these experimental results, future diagnosis of certain mental health disorders could be expedited using such methods.

Another source of data indicating a significant biological aspect of some mental health disorders is twin studies. Identical twins have the same nuclear DNA, so carefully constructed studies may indicate the relative importance of environmental and genetic factors on the development of a particular mental health disorder.

The results from this research and the associated hypotheses form the basis for biological psychiatry and the treatment approaches in a clinical setting.

Scope of clinical biological psychiatric treatment

While psychiatrists often combine both psychodynamic ("talk therapy") and biological approaches, this discussion covers mainly the biological aspects.

Since various biological factors can affect mood and behavior, psychiatrists often evaluate these before initiating further treatment. Such factors include hormone levels (especially thyroid), diet (especially alcohol and caffeine), and amount/quality of regular sleep and exercise.

Biological treatment of mental health disorders is not limited to drugs. Non-drug treatments include diet and exercise modifications, and in some severe cases treatments such as transcranial magnetic stimulation or electroconvulsive therapy may be indicated.

Diagnostic process

Correct diagnosis is important for mental health disorders, otherwise the condition could worsen, resulting in a negative impact on both the patient and the healthcare system.cite journal
author = Pini S., "et al."
year = 1999
month = April-June
title = Detection and management of mental distress and psychiatric disorders in primary care settings
journal = Epidemiologia e psichiatria sociale
pmid = 10540512] Another problem with misdiagnosis is that a treatment for one condition might exacerbate other conditions.cite journal
author = Goldberg JF
year = 2003
month = May
title = When do antidepressants worsen the course of bipolar disorder?
journal = Journal of Psychiatric Practice
pmid = 15985931
doi = 10.1097/00131746-200305000-00002
volume = 9
pages = 181] cite web
url = http://www.psych.org/psych_pract/treatg/pg/bipolar_revisebook_index.cfm
title = Practice Guideline for the Treatment of Patients with Bipolar Disorder
publisher = American Psychiatric Association
accessmonthday = April 20
accessyear = 2006] In other cases apparent mental health disorders could be a side effect of a serious biological problem such as concussion,cite journal
author = Ryan LM, "et al."
year = 2003
month = November
title = Post concussion syndrome
journal = International Review of Psychiatry
pmid = 15276952
doi = 10.1080/09540260310001606692
volume = 15
pages = 310] brain tumor,cite journal
author = Weitzner, M.
year = 1998
title = Neuropsychiatry and pituitary disease: an overview
journal = Psychotherapy and Psychosomatics
pmid = 9667059
doi = 10.1159/000012272
volume = 67
pages = 125] cite journal
author = Sobrinho LG
year = 1998
title = Emotional aspects of hyperprolactinemia
journal = Journal of Psychiatric Practice
pmid = 15985931] or hormonal abnormality,cite journal
author = Sonino N
year = 1998
title = Psychosomatic aspects of Cushing's disease
journal = Psychotherapy and Psychosomatics
pmid = 9667061
doi = 10.1159/000012274
volume = 67
pages = 140] cite journal
author = Larisch R, "et al."
year = 2004
month = September
title = Depression and anxiety in different thyroid function states
journal = Hormone and Metabolic Research
pmid = 15486818
doi = 10.1055/s-2004-825925
volume = 36
pages = 650] cite journal
author = Fink G, "et al."
year = 1999
month = November
title = Androgen actions on central serotonin neurotransmission: relevance for mood, mental state and memory
journal = Behavioural Brain Research
pmid = 10553690
doi = 10.1016/S0166-4328(99)00082-0
volume = 105
pages = 53] which could require medical or surgical intervention.

Disorders and biologic treatment

*Seasonal affective disorder: Light box, SSRIs
*Clinical depression: SSRIs [(Prozac)] , SNRIs Effexor, atypical antidepressants: (Wellbutrin, Remeron), electroconvulsive therapy, transcranial magnetic stimulation
*Bipolar disorder: Lithium Carbonate, valproic acid, Lamictal, Carbamazepine
*Schizophrenia: Includes haloperidol, clozapine, olanzapine, risperidone, Quetiapine, Ziprasidone and other Antipsychotics
*Generalized anxiety disorder: SSRIs, benzodiazepines, buspirone
*Obsessive-compulsive disorder: Clomipramine, SSRIs citalopram

History

Early 20th century

Sigmund Freud was originally focused on the biological causes of mental illness. Freud's professor and mentor, Ernst Wilhelm von Brücke, strongly believed that thought and behavior were determined by purely biological factors. Freud initially accepted this and was convinced that certain drugs (particularly cocaine) functioned as antidepressants. He spent many years trying to "reduce" personality to neurology, a cause he later gave up on before developing his now well-known psychoanalytic theories.cite web
url = http://www.ship.edu/~cgboeree/freud.html
title = Sigmund Freud
author = Boeree, George C.
publisher = Shippensburg University]

Nearly 100 years ago, Harvey Cushing, the father of neurosurgery, noted that pituitary gland problems often cause mental health disorders. He wondered whether the depression and anxiety he observed in patients with pituitary disorders were caused by hormonal abnormalities, the physical tumor itself, or both.

Mid 20th century

An important point in modern history of biological psychiatry was discovery of modern antipsychotic and antidepressant drugs. Chlorpromazine (also known as Thorazine), an antipsychotic, was first synthesized in 1950, and iproniazid, one of the first antidepressants, was first synthesized in 1957. In 1959 imipramine, the first tricyclic antidepressant, was developed. Research into the action of these drugs led to the first modern biological theory of mental health disorders called the catecholamine theory, later broadened to the monoamine theory, which included serotonin. These were popularly called the "chemical imbalance" theory of mental health disorders.

Late 20th century

Starting with fluoxetine (marketed as Prozac) in 1988, a series of monoamine-based antidepressant medications belonging to the class of selective serotonin reuptake inhibitors were approved. These were no more effective than earlier antidepressants, but generally had fewer side effects.cite journal
author = Hotopf M., "et al."
year = 1996
title = Are SSRIs a cost-effective alternative to tricyclics?
journal = British Journal of Psychiatry
pmid = 8730935] Most operate on the same principle, which is modulation of monoamines (neurotransmitters) in the neuronal synapse. Some drugs modulate a single neurotransmitter (typically serotonin). Others affect multiple neurotransmitters, called dual action or multiple action drugs. They are no more effective clinically than single action versions. That most antidepressants invoke the same biochemical method of action may explain why they are each similarly effective in rough terms. Recent research indicates antidepressants often work but are somewhat less effective than earlier thought.cite journal
author = Ban, T.A.
year = 2001
title = Pharmacotherapy of depression: a historical analysis
journal = Journal of Neural Transmission
pmid = 11478422
doi = 10.1007/s007020170047
volume = 108
pages = 707]

Problems with catecholamine/monoamine hypotheses

The monoamine hypothesis was compelling, especially based on apparently successful clinical results with early antidepressant drugs, but even at the time there were discrepant findings. Only a minority of patients given the serotonin-depleting drug reserpine became depressed; in fact reserpine even acted as an antidepressant in many cases. This was inconsistent with the initial monoamine theory which said depression was caused by neurotransmitter deficiency.

Another problem was the time lag between antidepressant biological action and therapeutic benefit. Studies showed the neurotransmitter changes occurred within hours, yet therapeutic benefit took weeks.

To explain these behaviors, more recent modifications of the monoamine theory describe a synaptic adaptation process which takes place over several weeks. Yet this alone does not appear to explain all of the therapeutic effects.cite web
url = http://www.medscape.com/viewarticle/436395
title = Serotonin and Norepinephrine Antidepressant Effects
author = Korn, Martin L.
publisher = Medscape]

Latest biological hypotheses of mental health disorders

New research indicates different biological mechanisms may underlie some mental health disorders, only indirectly related to neurotransmitters and the monoamine "chemical imbalance theory."

Recent research indicates a biological "final common pathway" may exist which both electroconvulsive therapycite journal
author = Ongür D., "et al."
year = 2004
title = A role for glia in the action of electroconvulsive therapy
journal = Harvard Review of Psychiatry
pmid = 15590574] and most current antidepressant drugs have in common. These investigations show recurrent depression may be a neurodegenerative disorder, disrupting the structure and function of brain cells, destroying nerve cell connections, even killing certain brain cells, and precipitating a decline in overall cognitive function.

In this new biological psychiatry viewpoint, neuronal plasticity is a key element. Increasing evidence points to various mental health disorders as a neurophysiological problem which inhibits neuronal plasticity.cite journal
author = Duman C.H., "et al."
year = 2005
title = Neurobiology and treatment of anxiety: signal transduction and neural plasticity
journal = Handb Exp Pharmacol
pmid = 16594263
doi = 10.1007/3-540-28082-0_11
volume = 169
pages = 305] cite journal
author = Warner-Schmidt J.L., "et al."
year = 2006
title = Hippocampal neurogenesis: opposing effects of stress and antidepressant treatment
journal = Hippocampus
pmid = 16425236
doi = 10.1002/hipo.20156
volume = 16
pages = 239] cite journal
author = Perera, T.D.
year = 2000
title = Neurogenesis and depression
journal = Journal of Psychiatric Practice
pmid = 15990493
doi = 10.1097/00131746-200011000-00003
volume = 6
pages = 322–333]

This is called the neurogenic hypothesis of depression. It promises to explain pharmacological antidepressant action,cite journal
author = Duman, R.S.
year = 2004
title = Depression: a case of neuronal life and death?
journal = Biological Psychiatry
pmid = 15271581
doi = 10.1016/j.biopsych.2004.02.033
volume = 56
pages = 140] cite journal
author = Kodama M., "et al."
year = 2004
title = Chronic olanzapine or fluoxetine administration increases cell proliferation in hippocampus and prefrontal cortex of adult rat
journal = Biological Psychiatry
pmid = 15476686
doi = 10.1016/j.biopsych.2004.07.008
volume = 56
pages = 570] including the time lag from taking the drug to therapeutic onset, why downregulation (not just upregulation) of neurotransmitters can help depression, why stress often precipitates mood disorders,cite journal
author = Duman, R.S.
year = 2004
title = Role of neurotrophic factors in the etiology and treatment of mood disorders
journal = Neuromolecular Medicine
pmid = 15001809
doi = 10.1385/NMM:5:1:011
volume = 5
pages = 011] and why selective modulation of different neurotransmitters can help depression. It may also explain the neurobiological mechanism of other non-drug effects on mood, including exercise, diet and metabolism.cite journal
author = Newton, S.S.
year = 2005
title = Regulation of neurogenesis and angiogenesis in depression
journal = Curr Neurovasc Res
pmid = 16181076] Lastly, by identifying the neurobiological "final common pathway" into which most antidepressants funnel, it may allow rational design of new medications which target only that pathway. This could yield drugs which have fewer side effects, are more effective and have quicker therapeutic onset.

Criticism

A vocal minority of patients, activists, and psychiatrists dispute biological psychiatry as a scientific concept or as having a proper empirical basis, for example arguing that there are no known biomarkers for recognised psychiatric conditions. This position has been represented in niche academic journals such as "The Journal of Mind and Behavior" [ [http://www.umaine.edu/JMB/archives/volume11/11_3-4_1990summerautumn.html Journal of Mind and Behavior ] ] and "Ethical Human Psychology and Psychiatry", which publishes material specifically countering "the idea that emotional distress is due to an underlying organic disease."cite web
url = http://www.springerpub.com/journal.aspx?jid=1559-4343
title = "Ethical Human Psychology and Psychiatry"
author = Breggin, Peter R
publisher = Springer Publishing] Alternative theories and models instead view mental disorder as non-biomedical and might explain it in terms of, for example, emotional reactions to negative life circumstances or to acute trauma. [ cite book
last = Arieti
first = Silvano
title = Interpretation of Schizophrenia
publisher = Aronson
date = 1994]

Fields such as social psychiatry, clinical psychology, and sociology may offer non-biomedical accounts of mental distress and disorder for certain aliments and are sometimes critical of biopsychiatry. Social critics believe biopsychiatry fails to satisfy the scientific method because they believe there is no testable biological evidence of mental disorders. Thus, these critics view biological psychiatry as a pseudoscience attempting to portray psychiatry as a biological science.

R.D. Laing argued that attributing mental disorders to biophysical factors was often flawed due to the diagnostic procedure. The "complaint" is often made by a family member, not the patient, the "history" provided by someone other than patient, and the "examination" consists of observing strange, incomprehensible behavior. Ancillary tests (EEG, PET) are often done after diagnosis, when treatment has begun, which makes the tests non-blind and incurs possible confirmation bias.

References

ee also

* Biological psychology
* Psychiatry

External links

* [http://www.nytimes.com/2006/04/20/health/20psych.html?ex=1146196800&en=f315a6be44ef7a9b&ei=5070&emc=eta1 NYTimes.com] - 'Study Finds a Link of Drug Makers to Psychiatrists', Benedict Carey, "New York Times" (April 20, 2006)
* [http://www.psychologytoday.com/articles/pto-19990301-000031.html PsychologyToday.com] - 'Depression: Beyond Serotonin: Much more than a chemical imbalance, depression is a disorder of mind, brain, and body', Hara Estroff Marano, "Psychology Today" (March, 1999)