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Challenges and opportunities in (neuro)psychiatry

Published online by Cambridge University Press:  02 January 2018

Ketan D. Jethwa*
Affiliation:
University of Warwick, and CT1 medicine (clinical haematology), Nottingham University Hospitals, Nottingham, UK, email: ketan.jethwa@nuh.nhs.uk
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Abstract

Type
Columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2014

It would appear that British psychiatry is retreating to a neurophobic position. Reference Bullmore, Fletcher and Jones1 The disconnect between psychiatry and its medical foundations is further exacerbated by the lack of medical experience in specialties relevant to psychiatry such as neurology, endocrinology and geriatric medicine. This is related to the constraints placed on training by service provision and the separation of psychiatric and medical services. The Future of Mental Health Services Report, 2 headed by Prof. Dinesh Bhugra in collaboration with the Mental Health Foundation, called for greater collaboration between psychiatric and general medical services.

Elucidating the nature of mental illness and developing effective treatments requires enthusiastic and talented academics and clinicians. Instead of ideological turf wars, collaboration between disciplines is required to appreciate the nuanced interactions between genetics, biochemistry and the environment.

For example, the classical distinction between affective and psychotic experiences is becoming increasingly blurred. The formation of delusions is associated with a ‘jumping to conclusions’ cognitive bias. Reference Broome, Johns, Valli, Woolley, Tabraham and Brett3 This can result in an intolerance of uncertainty and anomalous interpretations of internal or external stimuli. There is renewed focus on the ways in which affective processes can contribute to the formation of delusions and how these mechanisms can be modified using cognitive-behavioural techniques. Reference Garety and Freeman4 These insights from cognitive neuropsychology are substantiated by neuroimaging studies. The salience network, an intrinsic large-scale cerebral network, shows strong connectivity between the anterior cingulate gyrus and insular cortex. This network enables switching between different dynamic brain states. Dysfunction in this network has been implicated in the formation of the key symptoms of psychosis: inappropriate salience attached to ambiguous stimuli can predispose to and perpetuate unusual beliefs or delusions. Reference Palaniyappan and Liddle5 There is hope that research such as this will begin to have an impact on clinical practice by highlighting these brain-mind links.

As a specialty we need to be far more proactive in promoting psychiatry as clinical neuroscience at both the undergraduate and postgraduate level. We must make sure that the scientific underpinnings of psychiatry are explicit within mental health services and in our interactions with patients and the public in general.

References

1 Bullmore, E, Fletcher, P, Jones, PB. Why psychiatry can't afford to be neurophobic. Br J Psychiatry 2009; 194: 293–5.Google Scholar
2 Mental Health Foundation. Starting Today: The Future of Mental Health Services, Final Inquiry Report. Mental Health Foundation, 2013.Google Scholar
3 Broome, MR, Johns, LC, Valli, I, Woolley, JB, Tabraham, P, Brett, C, et al Delusion formation and reasoning biases in those at clinical high risk for psychosis. Br J Psychiatry 2007; 191 (suppl 51): s3842.CrossRefGoogle Scholar
4 Garety, PA, Freeman, D. The past and future of delusions research: from the inexplicable to the treatable. Br J Psychiatry 2013; 203: 327–33.Google Scholar
5 Palaniyappan, L, Liddle, PF. Does the salience network play a cardinal role in psychosis? An emerging hypothesis of insular dysfunction. J Psychiatry Neurosci 2012; 37: 1727.Google Scholar
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