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Psychiatry is evolving as a profession. The number of patients with mental disorders in all life-cycle phases, from childhood to old age, is increasing all over the world and is responsible for enormous social and economic loss. The expectations for psychiatry as a profession are getting higher.
However, such complex and heterogeneous psychiatric disorders still cannot be classified and diagnosed precisely by diagnostic criteria such as DSM and ICD. Professor Yamawaki encourages us to establish objective diagnosis by utilizing findings of recent brain science research, and develop innovative treatments. If not, the expectation towards psychiatry may turn into disappointment.
The field of psychiatry is developing in a number of areas. Development of contemporary cognitive, affective and social neuroscience using neuroimaging are especially prominent. Molecular target data are being accumulated using genome and epigenome research and proteomics; however, issues such as reproducibility have arisen. In order to elucidate the pathophysiology of complex psychiatric disorders with variant, heterogeneous conditions, and to establish objective diagnosis, we need large cohort studies which have incorporated brain function and biomarker measurements, as well as clinical evaluation.
While there are many hurdles to achieving breakthroughs in our field, the theme of the 30th CINP congress is one to strive for - Innovation Integrated with Neuroscience for Mental Health.
The CINP have made active efforts to accelerate the development of biomarker and objective diagnosis by precompetitive collaboration of public and private institutions - a collaboration of basic and clinical academia, pharmaceutical companies and regulatory agencies.
By applying every brain science approach such as genomics, proteomics and neuroimaging and data analysis techniques, he is confident that we will see breakthroughs in the future.
The full video interview with Professor Yamawaki will be posted on www.progress.im soon. Also, look out for our interview with Professor John Krystal, CINP President Elect, in which we hear about future plans for the CINP as he takes the position of CINP president
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At the 30th international CINP congress in Seoul, Korea, we were privileged to speak with Professor Shigeto Yamawaki, President of the CINP, about changes and developments in the field and the valu
The depth of depression in some of our patients is not well captured by MADRS and HAM-D. Even when the scores are high. Though we do use them, they do not necessarily capture the full depth of depression of emotion in some patients. Lots of emotional information is lost. Perhaps this is too much to ask of a questionnaire! But you can get the information by talking and, above all, listening. It’s about empathy.
And that’s what I try and do. Of course, it’s time consuming. But if I am on call and not too busy, I go to the acute unit and sit and talk to patients. We talk about anything – what they’re watching on TV, politics, religion, football. What they think about the world. What they think about their therapies. Anything that moves them.
I use both drugs and psychotherapy – Acceptance and Commitment Therapy (ACT). If you are anxious or depressed, most of the time you hide. You avoid things. And if you do that, slowly but inevitably, your life becomes empty. And if your life is empty it is impossible to recover from depression.
The therapy is about accepting the fact that you may not be able to control your thoughts and the feelings that come with them. But you can control your actions and the values and direction of your life. The commitment is to act according to your values to rebuild your life. To approach once again your family, your health.
I use this therapy in combination with antidepressant drugs. Ours is a private hospital, so patients are paying. And part of our job is to make sure they get the most effective combination of treatment that is possible.
Dr Jose Antonio Aguado of the Hospital Benito Menni, Valladolid, Spain, talks about his approach to the management of depression and the importance of combined treatment.
Access to a small number of data packages for candidate agents has already been attained and interest in some of the 9 drugs so far collected is already apparent.
Over the past three years, The Medicine Chests Initiative has been taking shape, the purpose of which is to gain access to ‘failed’ compounds and facilitate their reinvestigation, ideally in clinical experimental studies. Indeed, should it be necessary, resynthesis of interesting compounds is being and could be considered (albeit via. research grants) should an agent no longer be physically available. As these agents have already been administered in patients, toxicological studies are unlikely to be needed, as toxicology reports are included in the Medicines Chest repository.
As Dr Ann Hayes, UK, explained, access to a small number of data packages for candidate agents has already been attained and interest in some of the 9 drugs so far collected is already apparent.
Dr Trevor Robbins, UK, outlined how he has applied for a research grant to investigate whether a D1 receptor antagonist previously developed in Alzheimer’s disease might be used both to further investigate the basic science underlying D1 receptor antagonism and also the effect of this drug on cognition – an area of research in which it has not previously been investigated in clinical patients but one now considered worth of pursuit.
To find out more about the Medicines Chest and the agents available go to https://www.ecnp.eu/projects-initiatives/ECNP-medicines-chest.aspx
What does a pharmaceutical company do with a psychotherapeutic drug once it fails in clinical trials? As often as not, it bins it.
A: Cognitive deficits are really important to patients and this is often what they come in to the office to report – particularly when they have seen an improvement in their mood. Many of my patients think that these residual effects are actually related to their antidepressant treatment.
These can be residual symptoms that interfere with functional activity. In daily life, this may be seen at work and at home, where memory is affected, with patients not remembering what tasks they have to do.
A: My strategies for dealing with cognitive symptoms in patients with depression include trying to use an antidepressant with wider aspects – or I may use addition drug therapies or cognitive remedial strategies. Not all patients are the same and it needs an individual approach.
An interview with Dr Narcis Cardoner, Psychiatrist, Bellvitge Hospital, Barcelona, ES about cognitive symptoms of depression