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While there is some overlap between biological psychiatry and Neurology , the latter generally focuses on disorders where gross or visible pathology of the nervous system is apparent, such as Epilepsy , Cerebral Palsy , Encephalitis , Neuritis , Parkinson's Disease and Multiple Sclerosis . There is some overlap with Neuropsychiatry , which typically deals with behavioural disturbance in the context of apparent brain disorder. Biological psychiatry and other approaches to mental illness are not mutually exclusive, but may simply attempt to deal with the phenomena at different levels of explanation. Because of the focus on the biological function of the nervous system, however, biological psychiatry has been particularly important in developing drug-based treatments for mental disorder. In practice, however, psychiatrists may apply both medication and psychological therapies when treating mental illness, often in co-operation with Clinical Psychologist s, Psychotherapist s, Occupational Therapist s or other mental health workers who may be more specialised in non-drug treatments. The history of the field extends back to the ancient Greek physician Hippocrates , SCOPE AND DETAILED DEFINITION Biological psychiatry is a broader field than commonly-mentioned disorders (e.g, depression, schizophrenia) and associated drug treatments. On a research level, it includes all possible biological bases of behavior - biochemical, genetic, physiological, neurological and anatomical. On a clinical level, it includes various therapies, such as drugs, diet, avoidance of environmental contaminants, exercise, and alleviation of the adverse effects of life stress However, the biological psychiatrist typically does not discount psychoanalytic approaches (talk therapies). Medical psychiatric training generally includes both Psychodynamic and biological approaches. BASIS FOR BIOLOGICAL PSYCHIATRY Sigmund Freud developed psychotherapy in the early 1900s, and through the 1950s this technique was prominent in treating mental health disorders. However in the late 1950s, the first modern (also known as Thorazine), the first widely-used antipsychotic, was synthesized in 1950, and Iproniazid , one of the first antidepressants, was first synthesized in 1957. In 1959 Imipramine , the first Tricyclic Antidepressant , was developed. Based significantly on clinical observations of the above drug results, in 1965 the seminal paper "The catecholamine hypothesis of affective disorders" was published. Although the "chemical imbalance" hypothesis has been significantly revised since 1965, many newer medications (such as Fluoxetine and other SSRI s) were developed based on the underlying theories of the hypothesis. More recent research points to deeper underlying biological mechansisms as the possible basis for several mental health disorders. Modern brain imaging techniques allow noninvasive examination of neural function in patients with mental health disorders. With some disorders it appears the proper imaging equipment can reliably detect neurobiological problems which correlate with a specific disorder. Another source of data indicating a significant biological aspect of some mental health disorders is Twin Studies . Identical twins have the same nuclear DNA, so carefully constructed studies may indicate the relative importance of environmental and genetic factors on the development of a particular mental health disorder. The results from this research and the associated hypotheses form the basis for biological psychiatry and the treatment approaches in a clinical setting. SCOPE OF CLINICAL BIOLOGICAL PSYCHIATRIC TREATMENT While psychiatrists often combine both psychodynamic ("talk therapy") and biological approaches, this discussion covers mainly the biological aspects. Since various biological factors can affect mood and behavior, psychiatrists often evaluate these before initiating further treatment. Such factors include hormone levels (especially thyroid), diet (especially alcohol and caffeine), and amount/quality of regular sleep and exercise. Biological treatment of mental health disorders is not limited to drugs. Non-drug treatments include diet and exercise modifications, and in some severe cases treatments such as Transcranial Magnetic Stimulation or Electroconvulsive Therapy may be indicated. DIAGNOSTIC PROCESSS Correct diagnosis is important for mental health disorders, otherwise the condition could worsen, resulting in a negative impact on both the patient and the healthcare system. DISORDERS AND BIOLOGIC TREATMENT
HISTORY Early 20th century Sigmund Freud was originally focused on the biological causes of mental illness. Freud's professor and mentor, Ernst Wilhelm Von Brücke , strongly believed that thought and behavior were determined by purely biological factors. Freud initially accepted this and was convinced that certain drugs (particularly Cocaine ) functioned as antidepressants. He spent many years trying to "reduce" personality to neurology, a cause he later gave up on before developing his now well-known Psychoanalytic theories. Nearly 100 years ago, Harvey Cushing , the father of Neurosurgery , noted that Pituitary Gland problems often cause mental health disorders. He wondered whether the depression and anxiety he observed in patients with pituitary disorders were caused by hormonal abnormalities, the physical tumor itself, or both. Mid 20th century An important point in modern history of biological psychiatry was discovery of modern Antipsychotic and Antidepressant drugs. Chlorpromazine (also known as Thorazine), an antipsychotic, was first synthesized in 1950, and Iproniazid , one of the first antidepressants, was first synthesized in 1957. In 1959 Imipramine , the first Tricyclic Antidepressant , was developed. Research into the action of these drugs led to the first modern biological theory of mental health disorders called the Catecholamine theory, later broadened to the Monoamine theory, which included serotonin. These were popularly called the "chemical imbalance" theory of mental health disorders. Late 20th century Starting with Fluoxetine (marketed as Prozac) in 1988, a series of monoamine-based Antidepressant medications belonging to the class of Selective Serotonin Reuptake Inhibitors were approved. These were no more effective than earlier antidepressants, but generally had fewer side effects. Problems with catecholamine/monoamine hypotheses The monoamine hypothesis was compelling, especially based on apparently successful clinical results with early antidepressant drugs, but even at the time there were discrepant findings. Only a minority of patients given the serotonin-depleting drug Reserpine became depressed; in fact reserpine even acted as an antidepressant in many cases. This was inconsistent with the initial monoamine theory which said depression was cased by neurotransmitter deficiency. Another problem was the time lag between antidepressant biological action and therapeutic benefit. Studies showed the neurotransmitter changes occurred within hours, yet therapeutic benefit took weeks. To explain these behaviors, more recent modifications of the monoamine theory describe a synaptic adaptation process which takes place over several weeks. Yet this alone does not appear to explain all of the therapeutic effects. LATEST BIOLOGICAL HYPOTHESES OF MENTAL HEALTH DISORDERS New research indicates different biological mechanisms may underlie some mental health disorders, only indirectly related to neurotransmitters and the monoamine "chemical imbalance theory." Recent research indicates a biological "final common pathway" may exist which both Electroconvulsive Therapy In this new biological psychiatry viewpoint, Neuronal Plasticity is a key element. Increasing evidence points to various mental health disorders as a neurophysiological problem which inhibits neuronal plasticity. This is called the neurogenic hypothesis of depression. It promises to explain pharmacological antidepressant action CRITICISM See Also: Anti-psychiatry A vocal minority of patients, activists and mental health care professionals, including some psychiatrists, dispute biological psychiatry as a scientific concept, arguing that there are no known biological markers for recognised psychiatric conditions. This position is often represented in a scholarly journal, ''Ethical Human Psychology and Psychiatry'', that publishes material specifically countering "the idea that emotional distress is due to an underlying organic disease." |
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