EDITORIAL URRENT C OPINION
Editorial: Psychiatry, medicine and the behavioural sciences Mohan Isaac and Winfried Rief
The articles compiled in this year’s section on Psychiatry, Medicine and Behavioural Sciences cover a wide range of topics which are of relevance to routine clinical practice in primary care, mental health and various medical speciality settings. The reviews of evidence presented in this section include issues related to classification of somatoform syndromes, mental health consequences of violence against women and girls, psychiatric aspects of organ donation and transplantation, neurobiology of childhood socioeconomic disadvantage, psychological interventions in cardiovascular disease, expectancies as core features of mental disorders, pet ownership and physical health and the role of spirituality in medicine. Various forms of somatoform disorders are widely prevalent in routine clinical settings as well as in the general community, across the world. The assessment, diagnosis, classification and management of persons presenting with medically unexplained bodily symptoms continue to pose major problems for primary care and mental health clinicians. The existing classifications of these disorders are controversial and have overlapping boundaries, poor reliability and clinical validity. The WHO is currently working on the Eleventh Revision of the International Classification of Diseases (ICD-11), including the chapter on Mental and Behavioural Disorders which is likely to become available in 2017. In this issue, Gureje [1], Chair of the WHO Working Group on Somatic Distress and Dissociative Disorder, reviews the numerous criticisms of the classification of Somatoform Disorders in ICD-10. In the light of recent and existing evidence, Gureje discusses the major changes to the somatoform disorders that are being considered and their justification. The proposed new single disorder that will subsume most of the existing ICD-10 categories, namely Bodily Distress Disorder, is described. We will have to wait to see what kind of advantages this new name will offer to patients, their families and clinicians and its potential clinical utility. There are millions of women and girls all over the world who experience various forms of abuse
and violence on a regular basis. This abuse may take many forms such as physical and sexual abuse, intimate partner violence, abuse at the work place, child sexual abuse, under age and forced marriage, rape and sex trafficking. Their health (physical and mental) and wellbeing can be immensely affected by this violence. According to a recent WHO report [2], violence against women and girls is now a ‘global health problem of epidemic proportions’. Although women in general are vulnerable, the review in this section by Chandra et al. [3] identifies specific vulnerabilities of certain high-risk groups such as adolescents, migrants and homeless women and women in the perinatal period. With the steady increase in the number of conflict zones in different parts of the world, health consequences of conflictrelated violence against women and girls become increasingly important. The authors note that sexual violence is used in most conflict zones across the world as a ‘weapon of war’. An emerging area that needs increased research attention is interpersonal violence and mental health in same-sex relationships. The article highlights the need for prospective, longitudinal research in this area using mixed method designs. The role of psychiatrists and mental health professionals in solid-organ transplantation programmes, particularly in pretransplant selection and long-term posttransplant management is being better understood. Transplant programmes are increasingly more willing to accept persons with substance use related and mental health problems for transplants. DiMartini’s review [4] of psychiatric aspects of organ transplantation and donation note that interventions targeting known-risk factors which contribute to poorer mental health and transplant outcomes are urgently needed. Pretransplant Fremantle Hospital, University of Western Australia, Crawley, WA, Australia Correspondence to Mohan Isaac, Fremantle Hospital, University of Western Australia (M704), 35 Stirling Highway, Crawley, WA, 6009, Australia. Tel: +61 8 9431 3474; e-mail: [email protected] Curr Opin Psychiatry 2015, 28:343–344 DOI:10.1097/YCO.0000000000000187
0951-7367 Copyright ß 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.co-psychiatry.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Psychiatry, medicine and the behavioural sciences
studies could contribute to better preparation for transplants. Greater attention needs to be paid to a variety of mental health-related issues in living donor selection and education and posttransplant regimen adherence. The latest developments in what is being referred to as a new field of ‘environmental imaging’ – study of neural alterations through compromised brain structure and function of environmental adversity and socioeconomic disadvantage which might subsequently result in psychopathology and behavioural problems – are reviewed by Meyer-Lindenberg [5]. Brain effects of social inequality and ‘social defeat’ – experience of being excluded characterized by a subordinate position, stress and isolation – ethnic minority background, poverty, other childhood adverse psychosocial experiences and mother’s smoking during pregnancy have been reviewed. Recent research regarding neural mechanisms of socioeconomic disadvantage provides convincing evidence of the detrimental effects of early childhood adversities on brain structure and function. Well defined longitudinal studies addressing cause-effect relationships are needed in this emerging area of ‘environmental neuroimaging’. Authors point out the need to move beyond examination of structure and volume differences to task-based fMRI studies. Greater understanding of the association between adversity and brain changes may open up possibilities of primary prevention and early intervention since environmental-risk factors are potentially modifiable. Tan [6] reviews recent literature on psychological interventions in cardiovascular disease. Although it is known that psychological conditions increase cardiovascular risk and complicate cardiovascular disease, what sorts of psychological interventions are useful is unclear. Owing to a variety of methodological issues such as the specific and individualized nature of the interventions, poor descriptions of the actual interventions and the complex nature of some of them, the multiplicity of outcome measures employed and the heterogeneity of published reports, reviewers observe that evaluating the benefits of psychological interventions is difficult and the results are mixed. Rief [7] reviews recent research on the development, persistence and modification of expectancies in mental disorders and proposes a new model for expectation persistence and expectation change. The importance of modifications of expectations as a core mechanism of treatment in psychiatry is identified. The need to better address persistence of expectancies to reduce treatment failures and enhance the efficacy of psychological therapies is highlighted. Does pet ownership offer any beneficial effects to one’s physical and mental health? Is there any 344
www.co-psychiatry.com
evidence for the efficacy of Animal Assisted Therapy? Matchock [8] critically reviews the steadily growing literature on pet-health connection and finds out that pet ownership correlates with numerous aspects of positive health outcomes. However, most of the reported studies are cross-sectional, involving small sample sizes and have methodological flaws. Are there risks associated with pet ownership? It is well known that grief and bereavement are experienced by some pet owners in response to loss of their pets. Increased risk of a road traffic accident while driving with a pet inside a motor vehicle, zoonotic infections, and allergies have been reported. Authors point out that more and methodologically better designed research is needed on numerous issues such as what types of pets are most effective and with what types of health conditions and clinical outcomes. There is a growing body of literature on the role of spirituality in health, well being and disease. It is usually the fields of traditional, complementary and alternate medical systems that deal with spirituality. Ramakrishnan [9] discusses the implications and pitfalls of mainstream medicine and religion/spirituality coming together. Reviewing clinical work at the intersection of religion/spirituality, theology and medicine, the author makes a case for the incorporation of clinical pastoral education into medical education and residency training curriculum/programme. Acknowledgements None. Financial support and sponsorship None. Conflicts of interest There are no conflicts of interest.
REFERENCES 1. 2.
3. 4. 5.
6. 7. 8. 9.
Gureje O. Classification of somatic syndromes in ICD-11. Curr Opin Psychiatry 2015; 28:345–349. World Health Organization. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and nonpartner sexual violence. WHO, 2013. Satyanarayana VA, Chandra PS, Vaddiparti K. Mental health consequences of violence against women and girls. Curr Opin Psychiatry 2015; 28:350–356. Faeder S, Moschenross D, Rosenberger E, et al. Psychiatric aspects of organ transplantation and donation. Curr Opin Psychiatry 2015; 28:357–364. Holz NE, Laucht M, Meyer-Lindenberg A. Recent advances in understanding the neurobiology of childhood socioeconomic disadvantage. Curr Opin Psychiatry 2015; 28:365–370. Tan MP, Morgan K. Psychological interventions in cardiovascular disease: an update. Curr Opin Psychiatry 2015; 28:371–377. Rief W, Glombiewski JA, Gollwitzer M, et al. Expectancies as core features of mental disorders. Curr Opin Psychiatry 2015; 28:378–385. Matchock RL. Pet ownership and physical health. Curr Opin Psychiatry 2015; 28:386–392. Ramakrishnan P. ‘You are here’: locating ‘spirituality’ on the map of the current medical world. Curr Opin Psychiatry 2015; 28:393–401.
Volume 28 Number 5 September 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Editorial: Psychiatry, medicine and the behavioural sciences Mohan Isaac and Winfried Rief
The articles compiled in this year’s section on Psychiatry, Medicine and Behavioural Sciences cover a wide range of topics which are of relevance to routine clinical practice in primary care, mental health and various medical speciality settings. The reviews of evidence presented in this section include issues related to classification of somatoform syndromes, mental health consequences of violence against women and girls, psychiatric aspects of organ donation and transplantation, neurobiology of childhood socioeconomic disadvantage, psychological interventions in cardiovascular disease, expectancies as core features of mental disorders, pet ownership and physical health and the role of spirituality in medicine. Various forms of somatoform disorders are widely prevalent in routine clinical settings as well as in the general community, across the world. The assessment, diagnosis, classification and management of persons presenting with medically unexplained bodily symptoms continue to pose major problems for primary care and mental health clinicians. The existing classifications of these disorders are controversial and have overlapping boundaries, poor reliability and clinical validity. The WHO is currently working on the Eleventh Revision of the International Classification of Diseases (ICD-11), including the chapter on Mental and Behavioural Disorders which is likely to become available in 2017. In this issue, Gureje [1], Chair of the WHO Working Group on Somatic Distress and Dissociative Disorder, reviews the numerous criticisms of the classification of Somatoform Disorders in ICD-10. In the light of recent and existing evidence, Gureje discusses the major changes to the somatoform disorders that are being considered and their justification. The proposed new single disorder that will subsume most of the existing ICD-10 categories, namely Bodily Distress Disorder, is described. We will have to wait to see what kind of advantages this new name will offer to patients, their families and clinicians and its potential clinical utility. There are millions of women and girls all over the world who experience various forms of abuse
and violence on a regular basis. This abuse may take many forms such as physical and sexual abuse, intimate partner violence, abuse at the work place, child sexual abuse, under age and forced marriage, rape and sex trafficking. Their health (physical and mental) and wellbeing can be immensely affected by this violence. According to a recent WHO report [2], violence against women and girls is now a ‘global health problem of epidemic proportions’. Although women in general are vulnerable, the review in this section by Chandra et al. [3] identifies specific vulnerabilities of certain high-risk groups such as adolescents, migrants and homeless women and women in the perinatal period. With the steady increase in the number of conflict zones in different parts of the world, health consequences of conflictrelated violence against women and girls become increasingly important. The authors note that sexual violence is used in most conflict zones across the world as a ‘weapon of war’. An emerging area that needs increased research attention is interpersonal violence and mental health in same-sex relationships. The article highlights the need for prospective, longitudinal research in this area using mixed method designs. The role of psychiatrists and mental health professionals in solid-organ transplantation programmes, particularly in pretransplant selection and long-term posttransplant management is being better understood. Transplant programmes are increasingly more willing to accept persons with substance use related and mental health problems for transplants. DiMartini’s review [4] of psychiatric aspects of organ transplantation and donation note that interventions targeting known-risk factors which contribute to poorer mental health and transplant outcomes are urgently needed. Pretransplant Fremantle Hospital, University of Western Australia, Crawley, WA, Australia Correspondence to Mohan Isaac, Fremantle Hospital, University of Western Australia (M704), 35 Stirling Highway, Crawley, WA, 6009, Australia. Tel: +61 8 9431 3474; e-mail: [email protected] Curr Opin Psychiatry 2015, 28:343–344 DOI:10.1097/YCO.0000000000000187
0951-7367 Copyright ß 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.co-psychiatry.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Psychiatry, medicine and the behavioural sciences
studies could contribute to better preparation for transplants. Greater attention needs to be paid to a variety of mental health-related issues in living donor selection and education and posttransplant regimen adherence. The latest developments in what is being referred to as a new field of ‘environmental imaging’ – study of neural alterations through compromised brain structure and function of environmental adversity and socioeconomic disadvantage which might subsequently result in psychopathology and behavioural problems – are reviewed by Meyer-Lindenberg [5]. Brain effects of social inequality and ‘social defeat’ – experience of being excluded characterized by a subordinate position, stress and isolation – ethnic minority background, poverty, other childhood adverse psychosocial experiences and mother’s smoking during pregnancy have been reviewed. Recent research regarding neural mechanisms of socioeconomic disadvantage provides convincing evidence of the detrimental effects of early childhood adversities on brain structure and function. Well defined longitudinal studies addressing cause-effect relationships are needed in this emerging area of ‘environmental neuroimaging’. Authors point out the need to move beyond examination of structure and volume differences to task-based fMRI studies. Greater understanding of the association between adversity and brain changes may open up possibilities of primary prevention and early intervention since environmental-risk factors are potentially modifiable. Tan [6] reviews recent literature on psychological interventions in cardiovascular disease. Although it is known that psychological conditions increase cardiovascular risk and complicate cardiovascular disease, what sorts of psychological interventions are useful is unclear. Owing to a variety of methodological issues such as the specific and individualized nature of the interventions, poor descriptions of the actual interventions and the complex nature of some of them, the multiplicity of outcome measures employed and the heterogeneity of published reports, reviewers observe that evaluating the benefits of psychological interventions is difficult and the results are mixed. Rief [7] reviews recent research on the development, persistence and modification of expectancies in mental disorders and proposes a new model for expectation persistence and expectation change. The importance of modifications of expectations as a core mechanism of treatment in psychiatry is identified. The need to better address persistence of expectancies to reduce treatment failures and enhance the efficacy of psychological therapies is highlighted. Does pet ownership offer any beneficial effects to one’s physical and mental health? Is there any 344
www.co-psychiatry.com
evidence for the efficacy of Animal Assisted Therapy? Matchock [8] critically reviews the steadily growing literature on pet-health connection and finds out that pet ownership correlates with numerous aspects of positive health outcomes. However, most of the reported studies are cross-sectional, involving small sample sizes and have methodological flaws. Are there risks associated with pet ownership? It is well known that grief and bereavement are experienced by some pet owners in response to loss of their pets. Increased risk of a road traffic accident while driving with a pet inside a motor vehicle, zoonotic infections, and allergies have been reported. Authors point out that more and methodologically better designed research is needed on numerous issues such as what types of pets are most effective and with what types of health conditions and clinical outcomes. There is a growing body of literature on the role of spirituality in health, well being and disease. It is usually the fields of traditional, complementary and alternate medical systems that deal with spirituality. Ramakrishnan [9] discusses the implications and pitfalls of mainstream medicine and religion/spirituality coming together. Reviewing clinical work at the intersection of religion/spirituality, theology and medicine, the author makes a case for the incorporation of clinical pastoral education into medical education and residency training curriculum/programme. Acknowledgements None. Financial support and sponsorship None. Conflicts of interest There are no conflicts of interest.
REFERENCES 1. 2.
3. 4. 5.
6. 7. 8. 9.
Gureje O. Classification of somatic syndromes in ICD-11. Curr Opin Psychiatry 2015; 28:345–349. World Health Organization. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and nonpartner sexual violence. WHO, 2013. Satyanarayana VA, Chandra PS, Vaddiparti K. Mental health consequences of violence against women and girls. Curr Opin Psychiatry 2015; 28:350–356. Faeder S, Moschenross D, Rosenberger E, et al. Psychiatric aspects of organ transplantation and donation. Curr Opin Psychiatry 2015; 28:357–364. Holz NE, Laucht M, Meyer-Lindenberg A. Recent advances in understanding the neurobiology of childhood socioeconomic disadvantage. Curr Opin Psychiatry 2015; 28:365–370. Tan MP, Morgan K. Psychological interventions in cardiovascular disease: an update. Curr Opin Psychiatry 2015; 28:371–377. Rief W, Glombiewski JA, Gollwitzer M, et al. Expectancies as core features of mental disorders. Curr Opin Psychiatry 2015; 28:378–385. Matchock RL. Pet ownership and physical health. Curr Opin Psychiatry 2015; 28:386–392. Ramakrishnan P. ‘You are here’: locating ‘spirituality’ on the map of the current medical world. Curr Opin Psychiatry 2015; 28:393–401.
Volume 28 Number 5 September 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
