[Mind the gap: towards integrative perspectives of psychiatry].

In this century, marked advances in human genetics and brain imaging technology have finally allowed us to approach fundamental questions in psychiatry, even those in clinical psychiatry, by utilizing biological science. As of 2014, discussion on the advantages and limitations in operational diagnostic criteria, such as DSM (Diagnostic and Statistical Manual of Mental Disorders), in clinical psychiatry is becoming even more important. In contrast to most of the medical areas in which multi-disciplinal approaches are successful, factionalism augmented by mind-brain problem or mind-body problem has hampered the progress of psychiatry. Here I discuss the importance of building integrative perspectives of psychiatry.

Neuroscience, power and culture: an introduction.

In line with their vast expansion over the last few decades, the brain sciences -- including neurobiology, psychopharmacology, biological psychiatry, and brain imaging -- are becoming increasingly prominent in a variety of cultural formations, from self-help guides and the arts to advertising and public health programmes. This article, which introduces the special issue of "History of the Human Science" on "Neuroscience, Power and Culture," considers the ways that social and historical research can, through empirical investigations grounded in the observation of what is actually happening and has already happened in the sciences of mind and brain, complement speculative discussions of the possible social implications of neuroscience that now appear regularly in the media and in philosophical bioethics. It suggests that the neurosciences are best understood in terms of their lineage within the "psy"-disciplines, and that, accordingly, our analyses of them will be strengthened by drawing on existing literatures on the history and politics of psychology -- particularly those that analyze formations of knowledge, power and subjectivity associated with the discipline and its practical applications. Additionally, it argues against taking today's neuroscientific facts and brain-targetting technologies as starting points for analysis, and for greater recognition of the ways that these are shaped by historical, cultural and political-economic forces.

Brainhood, anthropological figure of modernity.

If personhood is the quality or condition of being an individual person, "brainhood" could name the quality or condition of being a brain. This ontological quality would define the "cerebral subject" that has, at least in industrialized and highly medicalized societies, gained numerous social inscriptions since the mid-20th century. This article explores the historical development of brainhood. It suggests that the brain is necessarily the location of the "modern self," and that, consequently, the cerebral subject is the anthropological figure inherent to modernity (at least insofar as modernity gives supreme value to the individual as autonomous agent of choice and initiative). It further argues that the ideology of brainhood impelled neuroscientific investigation much more than it resulted from it, and sketches how an expanding constellation of neurocultural discourses and practices embodies and sustains that ideology.

Neurobiological formulations: integrating clinical and biological psychiatry.

OBJECTIVE: The authors describe a pilot program allowing psychiatric residents to participate in neurobiological evaluations of patients with Axis I disorders. The program aimed to familiarize residents with available tools for assessing cognitive and neuroanatomical abnormalities in psychiatric patients and to foster greater interest among residents in correlating psychiatric symptoms with abnormalities in neural structures and pathways. METHODS: Residents meet weekly with a faculty mentor to plan and construct a neurobiological formulation. Residents review the salient literature on the Axis I condition present in a patient of their choosing. The patient undergoes neuroanatomical, physiological, and cognitive testing relevant to his disorder. The resident then integrates the findings from this testing with the patient's clinical presentation. Using a questionnaire, the authors obtain feedback from residents based on residents' experiences with this didactic program. RESULTS: Residents felt they obtained a greater appreciation and understanding of the relevance of neuroanatomical and neurophysiological abnormalities and testing in clinical psychiatry. The project was well received and residents rated it highly for its educational value. CONCLUSION: Neurobiological formulations offer a new educational method to foster knowledge and interest among psychiatric residents about the importance of neuroscience in clinical practice.

Psychotherapy in psychiatry.

The relationship between psychotherapy and psychiatry has become a beleagured one in recent years. The swing of the pendulum in the direction of biological psychiatry has led to a marginalization of psychotherapy within the discipline of psychiatry as a whole. However, psychotherapy continues to be a basic science of psychiatry with application in all clinical settings. It must be regarded as a biological treatment that works by changing the brain and is therefore just as important as pharmacotherapy in terms of overall treatment planning. The combined treatment of medication and psychotherapy has become the most common mode of psychiatric treatment planning in current practice. Both the two-treater model and the single-treater model have a set of advantages and disadvantages that are explicated. Further research is needed to identify clinical situations in which psychotherapy is essential, whether alone or in combination with medication. Moreover, as greater insights are gained into the brain mechanisms responsible for therapeutic changes, more specifically targeted psychotherapies can be developed.

[An integrative research model for child and adolescent psychiatry bringing together biological, psychological and social research approaches]. / Ein integratives Forschungsmodell für die Kinder- und Jugendpsychiatrie: die Zusammenführung von biologischen, psychologischen und sozialen Untersuchungsansätzen.

After some general remarks on the current situation of child and adolescent psychiatric research in Germany, a research concept is presented which in the course of 30 years of testing and further development has proven to be successful both in the inauguration of scientific projects, as well as in the qualification of trainees and co-workers. The nucleus of this concept is a research unit that is to a large extent independent of the daily health care routine. Some of the unit staff members are natural scientists holding permanent positions, complemented by a secondary labour force of young doctors and psychologists aspiring to a scientific career. This research unit provides supply for scientific projects and basic research, as well as for the development of new methods. The unit was endorsed by a Clinical Research Group funded by the German Research Foundation (DFG) that proved of value as power supply for research (e.g. by raising substantial third-party funds) and as an instrument for the qualification of young scientists. The article describes some results of four research projects derived from this approach (schizophrenia research, dyslexia research, research on Asperger syndrome, quality assurance, and therapy evaluation research).

The use of standardized patients for mock oral board exams in neurology: a pilot study.

BACKGROUND: Mock oral board exams, fashioned after the live patient hour of the American Board of Psychiatry and Neurology exam, are commonly part of resident assessment during residency training. Exams using real patients selected from clinics or hospitals are not standardized and do not allow comparisons of resident performance across the residency program. We sought to create a standardized patient mock oral board exam that would allow comparison of residents' clinical performance. METHODS: Three cases were created and then used for this mock oral boards exercise utilizing trained standardized patients. Residents from the University of Cincinnati and Indiana University participated in the exam. Residents were scored by attending physician examiners who directly observed the encounter with the standardized patient. The standardized patient also assessed each resident. A post-test survey was administered to ascertain participant's satisfaction with the examination process. RESULTS: Resident scores were grouped within one standard deviation of the mean, with the exception of one resident who was also subjectively felt to "fail" the exam. In exams with two faculty "evaluators", scores were highly correlated. The survey showed satisfaction with the examination process in general. CONCLUSION: Standardized patients can be used for mock oral boards in the live patient format. Our initial experience with this examination process was positive. Further testing is needed to determine if this examination format is more reliable and valid than traditional methods of assessing resident competency.

Genetic susceptibility to psychiatric disorders.

Genetics contributes susceptibility to most psychiatric conditions and the understanding of these genetic factors is increasing rapidly. Because of such breakthroughs and their implications for patient care, professional nursing organizations support the incorporation of genetics into nursing curricula and the attainment of a working knowledge of genetics by all nurses. In this article, the basics of psychiatric genetics are presented to provide a foundation for the understanding of current and future findings in the field as well as information about family history assessment and appropriate references that the practitioner may find helpful.

A new intellectual framework for psychiatry.

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.

[Body-mediated therapies in geriatric psychiatry]. / Thérapies à médiation corporelle en psychiatrie gériatrique.

The use of body mediated therapies at the Clinical geriatric psychiatry became possible due to the convergence between multi, inter and transdisciplinary approaches and the clinical experience in this application of various therapeutic technics. This approach at the aged clinic must take into consideration the specificity of the correlation to the body of the aged person beside the advantages and the needs that resent this approaches to both the patient and his therapist.