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Brains of people with schizophrenia-related disorders aren't all the same: New study supports the use of a data-driven approach to identify novel biomarkers -- ScienceDaily
"We know that, on average, people with schizophrenia have more social impairment than people in the general population," says senior author Dr. Aristotle Voineskos in the Campbell Family Mental Health Research Institute at the Centre for Addiction and Mental Health (CAMH) in Toronto. "But we needed to take an agnostic approach and let the data tell us what the brain-behavioural profiles of our study participants looked like. It turned out that the relationship between brain function and social behaviour had nothing to do with conventional diagnostic categories in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)."
Most brain research in the mental health field compares a disease group to a non-disease or "healthy" group to search for biomarkers, a biological measure of mental health symptoms. This search for biomarkers has been elusive. This multi-site research study -- which included 179 participants recruited at CAMH in Toronto, Zucker Hillside Hospital in New York and the Maryland Psychiatric Research Center in Baltimore -- calls that paradigm into question because people with the same mental illness may not show the same biological patterns.
The study, which involved participants completing a facial imitation task while undergoing functional MRI brain scans, found three "activation profiles," says first author Dr. Colin Hawco, also of CAMH. These can be described as typical, over-activated and de-activated profiles.
Diagnosing and treating personality disorders needs a dynamic approach -- ScienceDaily
"Personality researchers are on the verge of marrying technological advances and psychological theories to generate novel insights about why people are different and how that can go wrong," he said.
Hopwood acknowledges that there is value in clinical descriptions of personality disorders focusing on traits -- which he describes as abstract concepts, averaged across situations. For instance, neuroticism includes features such as anger, impulsivity, anxiety and self-consciousness, but those traits are over-generalized and could apply to various psychopathologies.
They are poorly suited to answer specific questions about particular moments in daily life and environmental changes over time, Hopwood said.
"By analogy," Hopwood said, "although it would be more useful for a musician to understand chords (personality factors) and notes (personality facets) than to learn a few songs (personality disorder categories), this does not mean that she would not ultimately prefer a model of rhythm, melody, and key signatures (dynamics) through which she can better understand and even generate her own music."
What's in a name? Researchers track PTSD's many identities during war -- ScienceDaily
The paper revealed that PTSD symptoms were known as shell shock during World War I, and irritable heart or soldier's heart during World War II. The term gross stress reaction was introduced in the first edition of the Diagnostic and Statistical Manual in 1952, but was omitted in a second edition in 1968 during the Vietnam War.
It wasn't until 1980, with the publication of the manual's third edition, that the term PTSD was introduced to describe military trauma and non-war related factors, such as sexual abuse. "PTSD has existed forever," Chekroud said. "It's just a question of what we've been calling it."
Chadi Abdallah, MD, Assistant Professor of Psychiatry at Yale and the editor of Chronic Stress, said the history of disjointed terminology resulted in a 60-year delay in understanding traumatic symptoms experienced by veterans and others.
National Institute Of Mental Health Forsakes the DSM, the Bible Of Psychiatry
NIMH's move away from the DSM is a necessary paradigm shift that will, in the long run, enable researchers to find new ways to improve psychiatric diagnosis, and heal a society which is simultaneously under-treated for mental illness and over-medicated in all of the wrong ways.
Dr. Thomas Insel, the director of the NIMH, explained that while the DSM manual has improved reliability and helped to standardize mental health treatment across different health care providers, the diagnostic categories still lack underlying scientific validity. He wrote:
"Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever."
Why Are There No Biological Tests in Psychiatry? - Scientific American Blog Network
we must also not minimize the grave practical problems and limitations associated with not having biological tests to identify psychiatric disorders. Most troubling is the fact that the overwhelming majority of prescriptions for psychotropic medicines are written by primary care physicians who often have little training in psychiatry; little time to perform an adequate diagnostic evaluation; a tendency to depend on tests rather than talking to patients; and too great a susceptibility to quick trigger diagnosis and poorly chosen pill solutions (fostered by aggressive and misleading drug company marketing). The lack of precise and easily available biological tests in psychiatry permits much loose diagnosing and cowboy prescribing.
DSM versus neuroscience
Compared with the psychiatric diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), which can be vague and flawed, brain-based research holds out the promise of a precise and truly scientific understanding of mental illness.
