Damian Sendler: Psychiatrists are often tasked with dealing with patients who have really difficult medical conditions. Cases may be approached from a variety of viewpoints, including psychological and social ones, each with its own advantages and disadvantages. We may thank these viewpoints for helping to influence our field’s growth and helping to set the bar for future practice.
Damian Jacob Sendler: In the last 20 years, groundbreaking advances in neuroscience have allowed us to get a better understanding of the basic causes of mental disorders. Rather than competing with our rich cultural heritage, this work enhances it. Since all successful therapies (whether psychotherapy or pharmacologic medicines) modify key brain networks and so are biological in character, the divide between “psychological” and “biological” is gradually eroding. 2 Psychodynamic notions such as self-awareness, defenses and drives, and unconsciously held beliefs are all better understood using the cutting-edge brain system models provided by cognitive neuroscience. 1 Understanding epigenetics, on the other hand, provides new insights into how social context and environmental variables influence the expression of genes. 3
Together, these developments provide a novel paradigm for integrating the apparently disparate viewpoints of a standard biopsychosocial formulation.
Dr. Sendler: Our patients, their families, and other health care providers may benefit from having a fresh conversation regarding the underlying causes and implications of their mental health symptoms thanks to these initiatives. People who suffer from mental health concerns are typically stigmatized because they are seen as having moral flaws and are blamed for their conduct because of their mental illness, rather than because of their character or morality. Despite the fact that many of these results have yet to be converted into innovative therapeutic techniques, they may nonetheless serve to guide and educate our treatment decisions.. It is easier to treat PTSD when we grasp the role that fear conditioning and learning play in the disease. 5,6
It is still difficult to incorporate neuroscience with psychiatry, despite its importance to the practice of medicine.
Damian Sendler
For a long time, even before we had the ability to study the brain in depth or create complex molecular explanations for mental disease, psychiatry was an established clinical field. A wide practice gap should not be surprising, as mental illness has been increasingly recognized as a result of genetics, neurobiological development and the underlying neuronal circuitry; nonetheless, these key views are usually omitted from therapeutic treatment. Program directors in psychiatry are unanimous in their belief that neuroscience instruction should be included in their curriculum, although few schools have been able to do so comprehensively for a variety of reasons.
Damian Jacob Markiewicz Sendler: The National Neuroscience Curriculum Initiative (NNCI) was created in response to these obstacles in order to enhance the teaching of neuroscience in psychiatry, with an initial concentration on residency programs. There are many ways to incorporate current neuroscience into the practice of psychiatry, and the NNCI has worked with educators and neuroscientists to develop and distribute an extensive collection of tools based on the principles of adult learning. This project has received more attention than expected. A total of more than 127 thousand page views and more than 15,000 unique visitors from 130 countries were recorded on the NNCI website (http://www.NNCIonline.org) between March 2015 and November 2016. Over 75 psychiatric residency programs have acknowledged using NNCI teaching resources.
These initiatives are improving neuroscience education in the classroom, but if these improvements are not maintained in clinical settings, they will have little impact. There is an implicit assumption that if residents spend the majority of their time training in clinical services without a neuroscience viewpoint, it does not matter. That said, we must address the issue of “translational teaching,” which asks how to bring neuroscience education into clinical practice.
Taking on this project is a huge undertaking in itself. In today’s increasingly complicated medical world, each of us has carved out our own specialties. Teachers and psychiatrists alike are naturally preoccupied with the day-to-day responsibilities of their jobs in the clinic. As such, neuroscientists are engrossed in cutting-edge research that may appear removed from the day-to-day treatment of patients due to its concentration on molecular studies or animal models. It’s been shown in numerous social circumstances that each group may live in its own echo chamber and connect mostly with others who share similar ideas (if not entirely). Dialogue between researchers and doctors is difficult due to the fact that each group has an own lingo. Because of this, a big part of the difficulty is to promote communication across this wide cultural barrier.
We are thrilled to be able to publish the first Educational Review in JAMA Psychiatry with these concerns in mind. Many of the concepts and principles that we have discussed here are included in this article6. A group of clinician-educators and neuroscientists worked together to create the Educational Review. With this essay, we intend to reach a wide audience: the main text concentrates on the most important ideas and principles, while the figures provide more in-depth information on particular themes. In addition to the major sources cited, we also provide a number of secondary sources.
Ptsd is a common clinical problem, therefore we’ll concentrate on five key areas of neuroscience to better understand this condition (presented separately as a Clinical Challenge in this issue).
Damien Sendler: The importance of each issue to clinical practice is examined both now and in the future. We also talk about the connections between the various themes and psychological and societal viewpoints. What we’re trying to do is a kind of “neuroscience literacy”: what are the kinds of things a professional psychiatrist might consider when talking to a patient about their PTSD symptoms? On what fundamental ideas may he or she rely? How would we expect him or her to communicate this information to a patient or a family member?
If professionals utilize these tools for their own education and to help guide patient treatment, we’d want to hear from you! They should be easily available and serve as a starting point for clinician-educators in their educational endeavors. With the use of these tools, we seek to raise awareness of the therapeutic importance of current neuroscience among scientists and give narrative examples to help spread new results.
Damian Jacob Sendler
In the realm of mental hygiene, closed-circuit television (CCTV) has been established as a medium for the widespread distribution of treatment. Evidence suggests that watching this form of programming may help find new and better ways to treat people with mental illnesses. 1 At the beginning of a peer-reviewed study published in 1957, this optimistic remark occurred. Telepsychiatry “as a means of extending mental health services to areas that are remote from psychiatric centers”2 was outlined four years later.2 Where are we now, more than half a century later?
A study by Serhal and colleagues3 in this edition of the journal examines how and where telepsychiatry is delivered in Ontario from the standpoint of health care usage. By examining how telepsychiatry in Ontario is faring and giving statistics on whether or not it has succeeded in overcoming access hurdles, particularly for the most vulnerable people, they provide a unique Canadian viewpoint. According to Serhal et al., this is not the case. More than 48,000 patients who needed mental health treatment (defined by the authors as those who had been hospitalized for more than one year) were only seen by one psychiatrist through telepsychiatrists—and 39 percent were not seen by a psychiatrist at all. Although telepsychiatry is becoming more common in the United States, it is still in its infancy here. 4
What are the obstacles to using this well-established, scientifically-proven way of diagnosing and treating mental illness? Psychiatrists are the first to become involved. A research by Serhal et al.3 found that only 7% of Ontario psychiatrists provided treatment through televideo and that the average age of the psychiatrists was about 50 years. The irony is that younger psychiatrists are more comfortable with video conferencing tools like Skype and Facetime than older psychiatrists are with these same technologies.
Telemedicine is used by 24% of Ontario doctors, according to the 2014 National Physician Survey.
5 When it comes to the clinical specialities, psychiatry is the least physical of them all. Psychiatrists are geographically dispersed, yet there are perceived and actual obstacles that must be addressed if access to care is to be improved.
Some psychiatrists are concerned that telepsychiatry may have an unfavorable effect on the therapeutic alliance because of the lack of face-to-face contact. One of the first controlled studies of telepsychiatry in Canada was place at the Centre for Addiction and Mental Health over two decades ago, comparing it to an in-person assessment6. 7 However, doctors were less happy with telepsychiatry evaluation, although they were still favorable about the therapeutic partnership and patient satisfaction.
Another issue may be compensation for high-quality labor. It’s worth noting that additional telepsychiatry billing codes beyond those that are currently available for consultation exist in Ontario and may serve to encourage psychiatrists to perform this type of work; in addition, Ontario provides sessional funding for telepsychiatry consultations to family health teams, which allows for indirect consultation and education and compensates psychiatrists accordingly.
Concerns concerning risk management for “new” technologies may also be raised. Telepsychiatry is a reality in clinical practice, and the Canadian Medical Protective Association accepts this and gives its own recommendations. 8 When it comes to protecting electronic communications, we feel that permission is more vital than anything else. There is always the possibility that someone at home is listening in on the upstairs extension while we are on the phone with patients! There is already a permission form that acknowledges the limitations of technological secrecy for email communication since patients in need are considerably more worried about access to treatment than electronic security.
