Quo Vadis Psychiatry? Why It Is Time to Endorse Evolutionary Theory.

ABSTRACT: In recent decades, psychiatry and the neurosciences have made little progress in terms of preventing, diagnosing, classifying, or treating mental disorders. Here we argue that the dilemma of psychiatry and the neurosciences is, in part, based on fundamental misconceptions about the human mind, including misdirected nature-nurture debates, the lack of definitional concepts of "normalcy," distinguishing defense from defect, disregarding life history theory, evolutionarily uninformed genetic and epigenetic research, the "disconnection" of the brain from the rest of the body, and lack of attention to actual behavior in real-world interactions. All these conceptual difficulties could potentially benefit from an approach that uses evolutionary theory to improve the understanding of causal mechanisms, gene-environment interaction, individual differences in behavioral ecology, interaction between the gut (and other organs) and the brain, as well as cross-cultural and across-species comparison. To foster this development would require reform of the curricula of medical schools.

Women amid the COVID-19 pandemic: Self-protection through the behavioral immune system.

Studies of the activation of the behavioral immune system triggered by the coronavirus disease-2019 pandemic have demonstrated that evolutionary explanations of individual differences in self-protection should not be based only on parental investment and sexual selection theory. An evolutionary model must also incorporate individual differences that arise within each sex as a result of life history strategies and attachment patterns.

Non-verbal social communication in individuals with eating disorders: an ethological analysis in experimental setting.

PURPOSE: Evidence that social difficulties promote the development and the maintenance of eating disorders (EDs) derive from self-reported data and only partially from experimental tasks. This study objectively assessed non-verbal behaviors of individuals with EDs in a psycho-social stress scenario. METHODS: Thirty-one women suffering from EDs (13 with anorexia nervosa and 18 with bulimia nervosa) and 15 healthy women underwent the Trier Social Stress Test (TSST), the paradigm of psycho-social stress, and were videotaped. Throughout the procedure, anxiety feelings were measured by the State-Trait Anxiety Inventory state subscale and saliva samples were collected to evaluate cortisol levels. Non-verbal behaviors were analyzed through the Ethological Coding System for Interviews and were compared between study samples through multivariate analysis of variance. Multivariate regression analyses were performed to assess the association between anxiety, cortisol and behavioral responses to TSST. RESULTS: Women with EDs showed reduced submissiveness, flight (cutoff from social stimuli) and gesture compared to healthy peers during TSST. Submissiveness and flight behaviors were negatively associated with stress-induced anxiety, while TSST-induced anxiety and cortisol increases were positively associated with looking at the other's face behavior in participants with EDs. In this population, cortisol reactivity was also positively associated with submissiveness and negatively with gesture. CONCLUSION: Women with EDs showed a hostile and freezing response to acute psycho-social stress: reduced submissiveness and flight may represent strategies to manage social anxiety. These findings confirm that the non-verbal behavior assessment provides complementary information to those derived from traditional measurements and suggests research and clinical implications. LEVEL OF EVIDENCE I: Evidence obtained from experimental study.

Psychotraumatology: What researchers and clinicians can learn from an evolutionary perspective.

This review outlines the contribution of evolutionary science to experimental and clinical psychotraumatology. From an evolutionary perspective, traumatic and psychosocial stressors are conceived of as events or circumstances that thwart the achievement of biological goals. The more important is the adaptive value of the goal, the more painful is the emotional impact of the life event that endangers goal achievement. Life history theory and sexual selection theory help to explain why goal priorities differ between the sexes and across age groups. Cultural values and social learning interact with evolved inclinations in determining the hierarchy of goals for a specific person in a specific phase of his or her life. To illustrate the applicability of the evolutionary model, epidemiological and clinical data concerning individual differences in stress sensitivity and stress generation are reviewed and discussed. The final part of the review summarizes new hypotheses that explain how early and current psychosocial stressors can activate a series of adaptive mechanisms including developmental plasticity, predictive adaptive responses and differential susceptibility. Ultimately, the contribution of evolutionary science to psychotraumatology is the idea that experimental and clinical studies should shift the focus of research from the external environment (defined as all stressful factors external to the subjects under investigation) to the ecological environment (defined as those stressful factors of the external environment that have a greater potential to threaten the adaptive equilibrium of the subjects under investigation because of their evolved inclinations).

The biology of mental disorders: What are we talking about?

After the Darwinian revolution, biology is not only the study of the operation of structural elements (functional biology), but also the study of adaption and phylogenetic history (evolutionary biology). From an evolutionary perspective, the biology of mental disorders is not just "neurobiology and genetic constitution" but also adaptive reactions to adverse situations. Evolutionary explanations of mental disorders are biological and non-reductionist.

An evolutionary analysis of the applicability and utility of the clinico-pathological method in psychiatry.

Unlike other medical specialties, psychiatry has not been involved in the theoretical shift that replaced the syndromal approach with the clinico-pathological method, which consists in explaining clinical manifestations by reference to morbid anatomical and physiological changes. Past and present discussions on the applicability of the clinico-pathological method in psychiatry are based on a pre-Darwinian concept of biology as the study of proximate causation. Distinguishing between mediating mechanisms and evolved functions, an evolutionary perspective offers an original contribution to the debate by overcoming the opposite views of dualism (i.e., the clinico-pathological method is not applicable to disorders of the mind) and neuroessentialism (i.e., the definitive way of explaining psychiatric disorders is by reference to the brain and its activity). An evolutionary perspective offers original insights on the utility of the clinico-pathological method to solve critical questions of psychiatric research and clinical practice, including the distinction between mental health and illness, a better understanding of the etiology and pathophysiology, the classification and differential diagnosis of psychiatric disorders, and the development of more efficacious psychiatric treatments.

Drug development in psychopharmacology: Insights from evolutionary psychiatry.

In the last decade, no other branch of clinical pharmacology has been subject to as much criticism of failed innovation and unsatisfactory effectiveness as psychopharmacology. Evolutionary psychiatry can offer original insights on the problems that complicate pharmacological research. Considering that invalid phenotyping is a major obstacle to drug development, an evolutionary perspective suggests targeting clinical phenotypes related to evolved behavior systems because they are more likely to map onto the underlying biology than constructs based on predetermined diagnostic criteria. Because of their emphasis on symptom remission, pharmacological studies of psychiatric populations rarely include functional capacities as the primary outcome measure and neglect the impact of social context on the effects of psychiatric drugs. Evolutionary psychiatry explains why it is appropriate to replace symptoms with functional capacities as the primary target of psychiatric therapies and why social context should be a major focus of studies assessing the effectiveness of drugs currently used and new drugs under development. When the focus of research shifts to those questions that go beyond the "disease-based" concept of drug action, evolutionary psychiatry clearly emerges as a reference framework to assess drug effectiveness and to optimize clinicians' decisions about prescribing, deprescribing, and non-prescribing.

Mental Health Challenges during the COVID-19 Pandemic.

The impact of the COVID-19 pandemic on mental health has unveiled the complexity of the relationship between psychiatry and the rest of medicine, as clearly shown by the collection of studies published in this Special Issue entitled "Mental Health Challenges during the COVID-19 Pandemic" [...].

I Got it. Perceived Infectability and Germ Aversion after Covid-19 Infection.

Objective: The COVID-19 pandemic has offered a unique opportunity to test evolutionary hypotheses on the functionality of the behavioral immune system. The aim of the present study was to ascertain if a previous infection with COVID-19 was associated with increased levels of perceived infectability and germ aversion. Based on the calibration hypothesis, we predicted that the activation of the behavioral immune system was greater in those participants who had been infected compared to those who reported no previous COVID-19 infection. Method: The sample included 2072 participants who completed an online survey between March 1 and April 10, 2022 when the Italian population was facing the third wave of the COVID-19 pandemic. To measure the activation of the behavioral immune system, we used the Perceived Vulnerability to Disease (PVD) scale. Results: Perceived infectability was significantly greater in those participants who had been infected compared to those who reported no previous COVID-19 infection but there was no significant difference between the two groups in terms of germ aversion.Conclusions Overall, our findings suggest that individual differences in the activation of the behavioral immune system were marginally affected by a personal history of COVID-19 infection. A possible explanation is that the environmental sensitivity of the behavioral immune system is tuned more on chronic disease threat (i.e., ecologies with higher pathogen load) than on situational disease threat (e.g., a pandemic or disease outbreak like the COVID-19 pandemic).

COVID-19 vaccination and the behavioral immune system: The newcomer and the old friend get along in preventing infection.

Despite its old evolutionary history and emotional relevance, the behavioral immune system is one of the less studied individual predictors of vaccine uptake. To fill the gap, we conducted a large online study (2072 participants) during the spring 2022 when the great majority of the Italian population had already received at least one dose of the COVID-19 vaccine. Hierarchical binary logistic regression showed that, after controlling for the confounding effects of demographic and personality factors, there was a significant and positive association between pathogen disgust sensitivity and COVID-19 vaccine uptake (OR, 1.68; 95% CI, 1.42-1.99). The likelihood of being vaccinated for a participant with the highest possible score on the PVD Germ Aversion scale was approximately 12 times higher than the likelihood for a participant with the lowest possible score. Public health messaging could leverage the activation of the behavioral immune system as an emotional driver of vaccine uptake.

The long-term impact of early adverse experience on adaptive functioning: a pilot study integrating measures of mental status, nonverbal communication, and heart rate variability.

Background: Childhood maltreatment (CM) can disrupt the development of behavioural and physiological systems, increasing the risk of physical and psychological adverse outcomes across the lifespan. CM may cause interpersonal dysfunctions that impair social communication and lead to dysfunctional activation of the autonomic nervous system. The present exploratory study analyzed the long-term impact of CM from an integrated perspective through the simultaneous assessment of psychological symptoms, social and behavioural communication, and physiological regulation.Methods: Participants were 55 healthy university students (9 males and 46 females; mean age ± SD = 25.26 ± 2.83 years), who filled out a battery of questionnaires to assess the presence of CM (Childhood Trauma Questionnaire) and psychopathological symptoms (Symptom Check-List-90 Item Revised). Participants were then subjected to a videotaped interview for the assessment of non-verbal behaviour (Ethological Coding System for Interviews) and measurement of tonic heart rate variability (HRV), a measure of physiological adaptability to the environment. We performed Pearson's correlation analysis to evaluate the associations between non-verbal behaviour, HRV, and CM variables. Multiple regression analysis was used to evaluate the independent associations between CM variables on HRV and nonverbal behaviour.Results: We found an association between more severe CM, increased symptoms-related distress (ps < .001), less submissive behaviour (ps < .018), and decreased tonic HRV (ps < .028). As a result of multiple regression analysis, participants with a history of emotional abuse (R² = .18, p = .002) and neglect (R² = .10, p = .03) were more likely to display decreased submissive behaviour during the dyadic interview. Moreover, early experience of emotional (R² = .21, p = .005) and sexual abuse (R² = .14, p = .04) was associated with decreased tonic HRV.Conclusion: Our preliminary findings show the utility of analyzing the long-term effects of adverse early experiences at different levels of 'adaptive functioning' (the capabilities needed to respond effectively to environmental demands).

Substantial traumatic experiences during childhood, such as emotional abuse, emotional neglect, and sexual abuse were associated with lower heart rate variability levels in a sample of young adults.Young adults with a history of emotional abuse and neglect were more likely to display decreased submissive behaviour (ethological behaviour) during the dyadic interview.Severe childhood maltreatment was associated with increased symptoms-related distress, less submissive behaviour (ethological behaviour), and decreased tonic heart rate variability in young adults.

Emergence of bariatric psychiatry as a new subspecialty.

Bariatric surgery is the branch of surgery aimed at helping a person with obesity lose weight. The implementation of surgical treatment of obesity is growing at an impressive rate. As expected, the expanding implementation of bariatric procedures has progressively revealed critical issues that were not evident when the number of obese patients treated with surgery was relatively small. One critical issue is the importance of mental health assessment and care of bariatric patients. The aim of this review is to provide readers with an up-to-date summary of the goals, methods, and clinical strategies of bariatric psychiatry. The aims can be grouped into three distinct categories. First, to ascertain that there are no psychiatric contraindications to safe bariatric surgery. Second, to diagnose and treat pre-surgery mental conditions that could predict poor weight loss. Third, to diagnose and treat post-surgery mental conditions associated with poor quality of life. Although bariatric psychiatry has gained the status of a new subspecialty within the field of mental health and psychopathology, many clinical questions remain unsolved. We need more long-term data on outcome measures such as quality of life, adherence to behavioral guidelines, risk of suicide, and post-surgery prevalence of psychological disturbances and mental disorders.

Genetics of adult attachment and the endogenous opioid system.

Since the pioneering work by Panksepp et al, the neurobiological bases of attachment behavior have been closely linked with opioid neurotransmission. Candidate gene studies of adult individuals have shown that variation in the mu-opioid receptor gene (OPRM1) influences attachment behavior. Early maternal care and the A/A genotype of the A118G polymorphism interact in modulating levels of fearful attachment. Compared to their counterparts carrying the A/A genotype, individuals expressing the minor 118G allele show lower levels of avoidant attachment and experience more pleasure in social situations. Brain imaging research has strengthened the biological plausibility of candidate gene studies. The avoidance dimension of attachment correlates negatively with mu-opioid receptor availability in the thalamus and anterior cingulate cortex, as well as the frontal cortex, amygdala, and insula. Overall, findings from human studies combined with those from animal models suggest that research on the genetic bases of attachment should include the endogenous opioid system among the investigated variables.

Biological Psychiatry is Dead, Long Live Biological Psychiatry!

The failure of biological psychiatry to deliver on its promises of enlightening the origin of psychiatric disorders and optimizing their treatment is due to invalid theoretical postulates that derive from an outdated conceptualization of human biology. The crisis of biological psychiatry depends on its identification with functional biology. A major contribution of evolutionary biology (the other current of biological thought) is to integrate the study of environmental variables (developmental, interpersonal, and ecological) with those mechanisms that are the field of study of functional biology (genetics, anatomy, and physiology). A new theoretical framework based on the integration of functional and evolutionary explanations can revitalize the crippled field of biological psychiatry.

Etiology of Psychiatric Disorders: Lay Beliefs and the Role of Gender, Field of Study and Personality Traits.

In the present study, we recruited a large sample (N = 595) of highly educated participants to assess which causal variables they considered as more important in the etiology of two diagnostically unlabeled cases of psychiatric disorders. The first clinical case described a patient with early schizophrenia whereas the second clinical case described a patient with conversion disorder. We aimed at ascertaining if participants' gender, field of study (scientific vs. humanistic), and personality traits influenced their causal beliefs. Based on the scores assigned to both the clinical cases, participants believed that current life stressors were the most important etiological variable and that adverse early experiences were not an important causal factor in anyone of the two clinical cases. Regardless of their field of study, women perceived the loss of a loved one as a relevant variable in the etiology of conversion disorder. Participants' beliefs about the etiology of early schizophrenia varied with their field of study. Compared to participants studying humanities, those studying scientific disciplines attributed more importance to organic causes and less importance to unconscious conflict and early traumatic experiences. Overall, the role of personality traits in influencing causal beliefs was negligible. Public education about the causes of psychopathology is necessary to optimize actual usage of mental health services and treatment choice for psychiatric disorders.

The behavioral immune system in action: Psychological correlates of pathogen disgust sensitivity in healthcare professionals working in a COVID-19 hospital.

The behavioral immune system includes a set of proactive mechanisms that inhibit contact with pathogens in the first place. These mechanisms offer a sort of psychological and behavioral prophylaxis against infection. The aim of this study was to assess the functionality of the behavioral immune system under conditions of strong ecological validity. Our hypothesis was that the emotional and more primitive component of the behavioral immune system (i.e. pathogen disgust sensitivity) acts as a powerful predictor of fear of infection. The sample was made up of 101 healthcare professionals working in a COVID-19 hospital when vaccination was not yet available. We conducted a hierarchical regression analysis to assess the role of germ-related disgust in modulating levels of fear. After controlling for the significant effects of depressive symptoms and exposure to people with a confirmed diagnosis of COVID-19, we found that fear of infection was more intense in those healthcare workers who reported higher levels of germ-related disgust. Fear of infection was not related to perceived infectability, an individual variable informed by more rational cognitive appraisals. These findings show that, even in healthcare workers who can take advantage of their professional knowledge and acquired skills for rational appraisals, the most primitive component of the behavioral immune system still plays a major role in eliciting fear of COVID-19. It is likely that the psychological reactions elicited by the behavioral immune system promote preventive health behaviors in modern environments as well.

Exploring the Link between ADHD and Obesity: A Focus on Temperament.

Multiple studies support the relationship between ADHD and overweight/obesity in youth. Different mechanisms may be involved, such as temperamental and psychopathological factors. The aim of this study was to test the hypothesis that specific temperamental and psychopathological dimensions could mediate the relationship between ADHD and obesity. The sample included 100 children and adolescents (78 males and 22 females; age range 6 to 18 years; mean age 9.90 ± 2.5 years). The assessment procedure included Conners' Parent Rating Scale-Long (CPRS-R:L) as the inclusion criterion for ADHD diagnosis, the Child Behavior Checklist (CBCL), a dimensional measure for psychopathology, and the Junior Temperament and Character Inventory, which describes four temperamental dimensions: novelty seeking (NS), harm avoidance (HA), reward dependence (RD), and persistence (P). While in the whole ADHD sample, the highest scores were found in NS and the lowest in P, ADHD with overweight/obesity, compared to ADHD with normal weight, showed higher HA and RD, lower NS, and higher CBCL Internalizing scores. These findings suggest that ADHD youth with overweight/obesity present specific temperamental and psychopathological features compared to those without overweight/obesity. If confirmed in larger samples, using a control group without ADHD, these temperamental and psychological features may be helpful for an earlier recognition of ADHD patients at higher risk for obesity, and may represent possible targets for temperament-based preventive interventions and tailored treatment programs. These features should be included in the routine assessment of children and adolescents with ADHD and/or are overweight/obese.

Low cholesterol is a risk factor for attentional impulsivity in patients with mood symptoms.

This study examined the relationship between cholesterol levels and impulsivity in a large sample of patients with mood symptoms. Three hundred and one patients with mood, anxiety, and personality disorders completed a battery of psychometric scales including the Barratt Impulsiveness Scale-Version 11 (BIS-11) and the Profile of Mood States (POMS). On the same day of psychometric assessment, blood samples were analyzed for total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C). Statistical analysis controlling for the confounding effects of age, gender, diagnosis, and current mood symptoms showed that lower TC levels were associated with increased attentional impulsivity. There was a weak linear correlation between TC and attentional impulsivity across the entire range of TC levels (110-295mg/dL) but a highly significant difference between participants with TC levels lower than 165mg/dL and the rest of the sample. The current study adds to the growing body of evidence pointing to the association between serum cholesterol and mental health. Considering that attentional impulsivity is a demonstrated risk factor for suicide, patients presenting with low cholesterol and mood symptoms may warrant increased clinical attention and surveillance.

Psychoactive drug use: Expand the scope of outcome assessment.

The "hijacking" and "drug instrumentalization" models of psychoactive drug use predict opposite outcomes in terms of adaptive behavior and fitness benefits. Which is the range of applicability of each model? To answer this question, we need more data than those reported by studies focusing on medical, psychiatric, and legal problems in addicted users. An evolutionary analysis requires a much wider focus.