This week's article, A New Intellectual Framework for Psychiatry, by Eric R. Kandel, M.D, was published two months after I finished my med school Psychiatry clerkship. The 1990s had been declared "The Decade of the Brain" by the NIH--and it was a time of rapid discovery, with the advent of functional brain imaging, the start of the Human Genome Project, and new applications of molecular biology to neuroscience. There were a lot of heady claims about what clinical applications might result "any day now" from this research. I'll leave it as an exercise for the readers to deliberate what, if anything, has changed since that time frame.
Dr. Kandel is one of the true renaissance thinkers of psychiatry--Nobel-winning basic scientist, core textbook editor, art historian (some of us heard him speak at the Minneapolis Institute of Arts a couple of years ago), and analytically-trained psychiatrist. This article addresses the false dichotomy between psychological and biological paradigms of psychiatry, and offers, I think, insights in how to reconcile the two viewpoints. I think you might enjoy his reflections on the history of how this developed, as well as his survey of how five basic principles of neuroscience apply to Psychiatry. Given that this article is now pushing 20 years of age--do you think that any more recent knowledge has changed that framework? Can you think of any specific finding of the last 18 years that would make Kandel's 1998 perspective obsolete? How does basic neuroscience knowledge inform or alter your approach to clinical needs of the patient?
[Google drive link: Kandel]
I enjoyed this article. I completely agree that much is still to be learned about the molecular basis of mental disorders. Since the advent of psychopharmacology in the 1970s, I feel that we are at a plateau again in understanding the biology of mental processes. Pharmaceutical industries have decreased funding research to treat psychiatric disorders and shifted to invest in other disease areas (e.g., cancer, cardiovascular, etc.). Despite the recent advances in neuroscience, animal models of human depression, schizophrenia, and other psychiatric disorders have been inadequate representations of "real" human diseases. However, the technological advances in the recent years are promising. Easily accessible growing databases of information provides unprecedented opportunities for exploration, descriptive observation, and research. New neuroimaging techniques, biochemical and genetic assays, and laboratory instruments allow for broader methodologies. For instance, fMRI demonstrated that antidepressants correct abnormal brain function by reducing limbic over-activation and prefrontal cortex under-activation in depressed patients. Epigenetics demonstrated that environmental risk factors impact genetic expression to cause major depression. These neuroscience knowledge remind me to be a vigilant provider as I "remodel" and "correct" the brain of mentally ill patients.
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