Moving Ahead Yet Falling Behind

Abstract

The progress of psychiatry over the past few years is impressive. That process, however, is nonlinear and in this paper three developments in depression research are discussed and thought to be counterproductive. First, the depression classification as institutionalized by the DSM-III is an unfocused and confusing one. The regular revisions, moreover, largely based on the opinions of experts rather than on the research by experts, add to the confusion. Second, the preoccupation of biological psychiatry with nosology is seen as a growth-inhibiting factor. The functional/dimensional approach searching for correlations between biological and psychological dysfunctions, an approach we have been advocating for many years, seems to have great potential and deserves to be included in mainstream biological psychiatry. Finally, the ‘biologization’ of depression research went too far. The conception of depression as a brain disease is a ‘terrible simplification’, even for the syndrome considered to be the most ‘biological’ of all: major depression, melancholic type. Psychological determinants of the brain dysfunctions underlying depressive disorders deserve as much scientific scrutiny as their biological counterparts. Te mind should not be the soft belly of (biological) psychiatry.

Risk Factors for Adult Depression: Adverse Childhood Experiences and Personality Functioning

“…From a clinical perspective, it is relevant to achieve knowledge both of the vulnerabilities that underlies symptomatology (in this case, personality functioning) and of the risk factors, especially the ACE. This, in order to be able to make an approach that not only addresses the current symptomatic manifestation of the patient, but also takes a complete look at its complexity and heterogeneity, including interventions that are conducive to the patient's profile, enriching an idiosyncratic and patient-centered treatment (Van Praag, 1989;Gabbard and Simonsen, 2007;Dagnino et al, 2017).…”

Mechanisms of drug-induced driving impairment: a dimensional approach

“…Data from animal experiments have demonstrated the involvement of the histaminergic system in maintaining wakefulness and arousal (Lin et al, 1996;Schwartz et al, 1995). DISCUSSION AND CONCLUSION In the above section, a rather optimistic vision of dimensional psychopharmacology (Van Praag, 1989) was presented. The aim of such psychopharmacological frameworks is to provide a method of predicting drug eects from a consideration of the basic neuropharmacology of the drug and the known psychological/behavioural eects associated with particular neurotransmitters.…”

“…Dimensional psychopharmacology is the study of the association between pharmacological dimensions expressed by neurotransmitter systems and independent behavioural dimensions as expressed by speci®c psychological functions or processes (Van Praag, 1989). The eects of medicinal psychoactive drugs on actual driving, studied here using the standard measure of weaving (O'Hanlon, 1984), are analyzed in terms of their pharmacological and behavioural dimensions.…”

Brauchen wir die Psychiatrie noch als eigenständiges Fach?

“…Kaum 15 Jahre ist es her, dass weite Kreise innerhalb unserer ¹Biologischen Psychi− atrie" den Ankündigungen gewisser US−amerikanischer ¹Opini− on Leaders" vertrauten, dass es möglich geworden sei, durch Pa− rametrisierung einer einminütigen mehrkanaligen EEG−Ablei− tung zu DSM−III−R−konformen Diagnosen zu gelangen [16,17]. Einwände grundsätzlicher Art gegen eine derartige Eulenspiege− lei blieben ebenso unbeachtet wie van Praag [18], der als Rufer in der Wüste seit Jahrzehnten auf das triviale Faktum hinweist, dass die ¹biologische" Validierung eines bloßen Namens, wie eben einer DSM−III−Diagnose, einem Wunder gleichkäme. So platzte dann auch besagtes Projekt in zeitlichem Zusammen− hang mit der ¹EEG−Mapping ± Blase" noch ehe es begonnen hatte [19].…”