The Future of Psychiatry as Clinical Neuroscience

Abstract

In 2012, Thomas Insel, 1 director of the National Institute of Mental Health, wrote an essay entitled The Future of Psychiatry (= Clinical Neuroscience), echoing a familiar trope in our field. 2 The themes he described then are even more relevant today. Technologic advances have enhanced our ability to study the brain, and new findings have reshaped the fundamental way in which we understand psychiatric illness. For example, although depression was once characterized as simply a monoaminergic deficit, new research is expanding our understanding of depression across multiple levels of analysis-from circuits, to neurotransmitters, to synaptic plasticity, to second messenger systems, to epigenetic and genetic differences. 3 To date, however, these advances seem largely limited to the pages of our leading research journals. We have not yet experienced a paradigm shift in the way most physicians approach patient care or in the way we communicate about our field with each other and with the lay public. Given how much progress has already been made, why does this transition remain a thing of the future? What barriers prevent our field from embracing a new identity today? Barriers to Integrating a Neuroscience Perspective Into PsychiatryThe largest barrier may be the pervasive belief that neuroscience is not relevant to patient care. It is true that current scientific models leave many questions unanswered. Although we are starting to see the introduction of new, hypothesis-driven treatments, much of this research has not translated into routine clinical interventions.Resistance to embracing neuroscience may also reflect the complexity of research and the challenge of keeping up with a rapidly developing field. Consider, for example, the

The WPA- Lancet Psychiatry Commission on the Future of Psychiatry

“…In response, collaborations such as the National Neuroscience Curriculum Initiative are extending across programmes to develop shared open resources for teaching. 303 Additional examples of open access resources for medical education include FOAM (Free Open Access Meducation), SlideShare, MedEdPORTAL, Khan Academy, and TED (Technology, Education and Design) Talks.…”

Frontal alpha asymmetry as a pathway to behavioural withdrawal in depression: Research findings and issues

“…These data reflect a need to investigate models of depression that encompass a wider range of factors than simply the neurochemical explanations upon which pharmacological treatments are based. As recently commented by Ross et al [10], depression is a disease of the brain and requires neurological models to understand and treat it successfully.…”

Integrating neuroscience in clinical psychiatry: a paradigm shift

“…These techniques include anatomical techniques (e.g., computed tomography and magnetic imaging resonance), functional techniques (e.g., electroencephalography, magnetoencephalography, positron emission tomography, and near-infrared spectroscopy), and other related techniques (e.g., optical brain imaging such as event-related optical signal technique). However, despite identifying the potential advantages of neuroscientific approaches in classifying psychiatric conditions, a comprehensive and systematic methodology to achieve this still remains elusive [6,7].…”