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Controversies in psychiatry

Felix Neumaier, Mario Paterno, Serdar Alpdogan, Etienne E Tevoufouet, Toni Schneider, Jürgen Hescheler, Walid Albanna
Brain surgery to promote behavioural or affective changes in men remains one of the most controversial topics at the interface of medicine, psychiatry, neuroscience and bioethics. Rapid expansion of neuropsychiatric deep brain stimulation has recently revived the field and warrants a careful appraisal of its two sides, namely the promise to help severely devastated patients on the one hand and the dangers of premature application without appropriate justification on the other. Here, we reconstruct the vivid history of the field and examine its present status to delineate the progression from crude free-hand operations into a multi-disciplinary treatment of last resort...
October 13, 2016: World Neurosurgery
Himanshu Sharma
Background-The Placebo is defined as an inert substance with a potent therapeutic effect. Its effect is attributed to its psychological and neurobiological effect. Its use in Psychiatric drug practice in drug trials and clinical practice is common, especially in India .Currently there is a debate whether to use it or not as there are ethical, moral and legal issues. Also, its mechanism of action is not known. Discussion-The Indian Psychiatry scenario is muddled in relation to use of placebo in Randomized Controlled Trials or Psychiatric clinical practice...
August 10, 2016: Central Nervous System Agents in Medicinal Chemistry
E P Bello, R Casas-Cordero, G L Galiñanes, E Casey, M A Belluscio, V Rodríguez, D Noaín, M G Murer, M Rubinstein
Motor execution and planning are tightly regulated by dopamine D1 and D2 receptors present in basal ganglia circuits. Although stimulation of D1 receptors is known to enhance motor function, the global effect of D2 receptor (D2R) stimulation or blockade remains highly controversial, with studies showing increasing, decreasing or no changes in motor activity. Moreover, pharmacological and genetic attempts to block or eliminate D2R have led to controversial results that questioned the importance of D2R in motor function...
July 19, 2016: Molecular Psychiatry
Otto F Kernberg, Robert Michels
This paper originated in a series of dialogues between the authors over a period of approximately one year, focused on present problems (and possible solutions) in psychoanalytic education, internationally but particularly in the U.S. Both authors have been involved in psychoanalytic education and governance over many years and share a concern with where psychoanalysis presently stands and where it is going. They share the experience of being part of what today is a significant minority of psychoanalysts involved in academic pursuits, thus being situated at the boundary between psychoanalysis and university-based psychiatry as professions...
June 2016: Journal of the American Psychoanalytic Association
Tsutomu Kumazaki
Theory of mind is a prominent, but highly controversial, field in psychology, psychiatry, and philosophy of mind. Simulation theory, theory-theory and other views have been presented in recent decades, none of which are monolithic. In this article, various views on theory of mind are reviewed, and methodological problems within each view are investigated. The relationship between simulation theory and Verstehen (understanding) methodology in traditional human sciences is an intriguing issue, although the latter is not a direct ancestor of the former...
September 2016: History of Psychiatry
Feng-Rong An, Sha Sha, Qing-E Zhang, Gabor S Ungvari, Chee H Ng, Helen F K Chiu, Ping-Ping Wu, Xin Jin, Jian-Song Zhou, Yi-Lang Tang, Yu-Tao Xiang
Physical restraint (PR) for patients is an ongoing controversial topic in psychiatry. This study examined the percentage of PR and its associations with clinical characteristics and the implementation of the National Mental Health Law (NMHL) in China. The study consecutively assessed a sample of 1364 psychiatric inpatients. Socio-demographic and clinical data including use of PR were collected from the medical records using a form designed for this study and confirmed via interview. Psychopathology and insight were measured using standardized instruments...
July 30, 2016: Psychiatry Research
Viara R Mileva-Seitz, Marian J Bakermans-Kranenburg, Chiara Battaini, Maartje P C M Luijk
The practice of parent and child sharing a sleeping surface, or 'bed-sharing', is one of the most controversial topics in parenting research. The lay literature has popularized and polarized this debate, offering on one hand claims of dangers, and on the other, of benefits - both physical and psychological - associated with bed-sharing. To address the scientific evidence behind such claims, we systematically reviewed 659 published papers (peer-reviewed, editorial pieces, and commentaries) on the topic of parent-child bed-sharing...
March 15, 2016: Sleep Medicine Reviews
Tahir Rahman, Phillip J Resnick, Bruce Harry
The case of Anders Breivik, who committed mass murder in Norway in 2011, stirred controversy among forensic mental health experts. His bizarrely composed compendium and references to himself as the "Knights Templar" raised concerns that he had a psychotic mental illness. Beliefs such as Mr. Breivik's that precede odd, unusual, or extremely violent behavior present a unique challenge to the forensic evaluator, who sometimes struggles to understand those beliefs. Psychotic disorder frequently is invoked to characterize odd, unusual, or extreme beliefs, with a classification that has evolved over time...
March 2016: Journal of the American Academy of Psychiatry and the Law
D Bichescu-Burian, C Cerisier, A Czekaj, J Grempler, S Hund, S Jaeger, P Schmid, G Weithmann, T Steinert
BACKGROUND: In Germany, in-patient treatment of patients with depressive, neurotic, anxiety, and somatoform disorders (ICD-10 F3, F4) is carried out in different settings in psychiatry and psychosomatics. Which patient characteristics determine referral to one or the other specialty is a crucial question in mental health policy and is a matter of ongoing controversy. However, comparative data on patient populations are widely lacking. METHODS: In the study of Treatment Pathways of Patients with Anxiety and Depression (PfAD study), a total of 320 patients with ICD-10 F3/F4 clinical diagnoses were consecutively recruited from four treatment settings (psychiatric depression ward, psychiatric crisis intervention ward, psychiatric day hospitals, or psychosomatic hospital units; 80 participants per setting) and investigated...
February 3, 2016: Der Nervenarzt
Régis Marion-Veyron, Michaël Saraga, Friedrich Stiefel
Despite intensive efforts in neurobiology and epidemiology, depression remains a diagnosis with blurred b. We illustrate this point by examining the controversial issue of systematic screening by GPs, which highlights tensions between psychiatry and general medicine. We suggest a broader perspective on depression, taking into account the patient's individuality, as well as potentially pathogenic social determinants. In the era of operational diagnostic criteria, clinical intuition and the wider sociological context of the doctor-patient relationship are relevant...
October 21, 2015: Revue Médicale Suisse
Saumil Y Dholakia, Chandramouleeswaran Susmita, Krishna Das Ranjit, Yogendra Singh, Deepa Braganza
The utility of the terms psychosis and neurosis in psychiatry have maintained their dichotomous stance since ages. Clinical observations and etiological hypothesis of psychiatric disorders have kept this polarity intact since the times of Freud and Jung. This case series attempts to revisit this perennial psychiatric controversy.
July 2015: Indian Journal of Psychological Medicine
Elena Levy Yeyati
This paper reviews the principal critiques and reactions stated regarding the launching of DSM-5 up to the present days in Anglo-Saxon's mental health domain. The arguments are gathered as follows: current diagnoses systems; validity of psychiatric diagnoses; limits of the efficacy of psychiatric treatments (especially medications and conflict of interests); the image of psychiatry in user's networks. In the end controversies get polarized between medicalization of ordinary life and antipsychiatry. However, if acknowledged impasses and benevolent distrust are tolerated, it is possible to make a clinical use of the critiques and reactions...
May 2015: Vertex: Revista Argentina de Psiquiatriá
A Del Rey, M Verdenhalven, A C Lörwald, C Meyer, M Hernangómez, A Randolf, E Roggero, A M König, J T Heverhagen, C Guaza, H O Besedovsky
It is still controversial which mediators regulate energy provision to activated neural cells, as insulin does in peripheral tissues. Interleukin-1β (IL-1β) may mediate this effect as it can affect glucoregulation, it is overexpressed in the 'healthy' brain during increased neuronal activity, and it supports high-energy demanding processes such as long-term potentiation, memory and learning. Furthermore, the absence of sustained neuroendocrine and behavioral counterregulation suggests that brain glucose-sensing neurons do not perceive IL-1β-induced hypoglycemia...
September 2016: Molecular Psychiatry
Wuroh Timbo, Aishwarya Sriram, Elizabeth K Reynolds, Renee DeBoard-Lucas, Matthew Specht, Carolyn Howell, Colleen McSweeney, Marco A Grados
The use of seclusion and restraints (SR) in acute hospital settings remains a controversial practice. Despite the focus on SR in the psychiatric services literature, data on SR use in pediatric day hospital settings is lacking. A case-control retrospective analysis for children admitted into a pediatric psychiatry day hospital in a 2-year span examined predictors of SR use. Demographic and clinical descriptors were examined in relation to SR events using univariate and multivariate regression models. Significant univariate risk factors for SR use were psychiatric morbidity, history of physical abuse, post-traumatic stress disorder, having any anxiety disorder, and younger age...
October 2016: Child Psychiatry and Human Development
Yoji Nakatani, Suguru Hasuzawa
This article describes the background and recent changes in French forensic mental health. The literature suggests that three law reforms have been crucial to changes in the mental health system. First, the Penal Code of 1992 redefined the provisions of criminal responsibility and introduced the category of diminished responsibility. Second, a controversial law for preventive detention (rétention de sûretê) was enacted in 2008, according to which criminals with severe personality disorders are subject to incarceration even after the completion of their prison sentences if they are still considered to pose a danger to the public...
2015: Seishin Shinkeigaku Zasshi, Psychiatria et Neurologia Japonica
Motoaki Nakamura
Therapeutic applications of repetitive transcranial magnetic stimulation (rTMS) have long been awaited for not only neurological but also psychiatric disorders as a low-invasive transcranial brain stimulation. In 2008, the Food and Drug Administration (FDA) of the United States finally approved repetitive transcranial magnetic stimulation (rTMS) for medication-resistant patients with major depression. More recently, at the beginning of 2013, a deep TMS device with the H-coil received FDA approval as the second TMS device for major depression...
2015: Seishin Shinkeigaku Zasshi, Psychiatria et Neurologia Japonica
P Hoff
Delusion is a central but difficult and controversial term in psychiatry. Similar to the term schizophrenia at the nosological level, the basic questions in the specialty are linked in the debate on delusion at the clinical psychopathological level, beginning with epistemological and methodological aspects up to concrete embodiment of the physician-patient relationship. The text of this article reflects this development from the nineteenth century up to the present day and makes reference to the lively discussion on the future directions of psychiatric research triggered by the research domain criteria (RDoC)...
January 2016: Der Nervenarzt
Jan Jarab
Persons with psychosocial disabilities (mental health problems) are under the protection of the new United Nations Convention on Rights of Persons with Disabilities (CRPD). The CRPD brings a human rights-based approach to disability: it challenges paternalistic views by emphasizing the person as a rights-holder, an active subject, and not just a passive object of care. It also represents a challenge to mainstream human rights movements and mechanisms who have long paid insufficient attention to human rights of persons with (psychosocial) disabilities...
2015: Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation
Eran Elhaik, Peter Zandi
A century of investigations enhanced our understanding of bipolar disorder although it remains a complex multifactorial disorder with a mostly unknown pathophysiology and etiology. The role of the immune system in this disorder is one of the most controversial topics in genetic psychiatry. Though inflammation has been consistently reported in bipolar patients, it remains unclear how the immunologic process influences the disorder. One of the core components of the immune system is the NF-κB pathway, which plays an essential role in the development of innate and adaptive immunity...
November 2015: Journal of Psychiatric Research
A S G Ralston, J A Swinkels
BACKGROUND: Professional journals in the Dutch language have played hardly any part in the recent controversies relating to DSM-5. So far, there has been no philosophical analysis of these discussions. AIM: To discuss the current philosophical and psychiatric literature pertaining to the current debate on psychiatric classification. Our main focus will be on a scientific and realistic approach to classification. METHOD: We discuss the literature from historical, scientific and philosophical perspectives...
2015: Tijdschrift Voor Psychiatrie
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