Happy Birthday Psychiatry!

The 200th Anniversary of Psychiatry is upon us. The term 'psychiatry' was first created by Johann Reil, a german professor of medicine in 1808. There is an editorial on this by Andreas Marneros, in the latest British Journal of Psychiatry (Marneros, 2008). Reil wanted psychiatry to be recognised along with 2 other branches of medicine - surgery and general medicine. Even at the very inception of psychiatry, Reil saw many of the thematic problems in psychiatry. He requested measures to counter discrimination against those with a mental illness, identified the possibility of diminished responsibility and recgonised the importance of psychological therapies in treatment. Its a pity we can't travel back in time to see that historic moment in 1808. Thanks Johann Reil for giving us psychiatry.


References

Marneros, A. Psychiatry's 200th birthday. Editorial. The British Journal of Psychiatry. 2008. 193. No 1. pp1-3.

The Benefits of Exercise

The by-now common sense view that exercise delays the onset of many diseases including Alzheimer's has been supported by a study in the latest edition of Neurology (1). 64 people without dementia were compared with 57 people with early onset Alzheimer's disease. The exercise capacity of subjects was assessed (using a measure of their use of oxygen) as were the brain volumes of the subjects. Essentially the results showed that if a person had Alzheimer's and didn't do very much exercise, their brain volumes were smaller than someone with Alzheimer's who did a lot of exercise. In the people without dementia this didn't seem to hold true i.e. exercise didn't seem to be related to brain volume. The conclusion was that if your going to get Alzheimer's, you'll probably have a better prognosis if you do more exercise. Why? - because having a larger brain volume gives you a better prognosis. So the evidence piles up in favour of us doing exercise!

References
(1) Neurology. Cardiorespiratory fitness and brain atrophy in early Alzheimer Disease. Burns J et al. 2008. 71. 210-216.

Pharmaceutical Industry Relation to Psychiatry

A big story emerging in the United States at the moment is the request of Senator Charles Grassley to the American Psychiatric Association to reveal a breakdown of its sources of funding - http://blogs.wsj.com/health/2008/07/14/grassley-targets-psychiatric-association-for-industry-ties/. The relationship between psychiatrists (indeed nearly all doctors) and pharmaceutical companies is persistently debated across the world. The relationship is not straightforward as it covers a multitude of different companies, doctors, drugs and regulations. The simplest argument runs as follows. If a doctor receives funding from a company that produces drug A, then the doctor may be more likely to prescribe drug A to a patient. If this were the case it would reduce the doctor's prescribing autonomy and is therefore a conflict of interest. This basic argument is then refined and adapted to various situations. The counterarguments run along the lines that the pharmaceutical industry have provided drugs which have saved lives and improved quality of life, have pushed forwards medical science and as a necessity must operate in a commercial environment where marketing is essential to survival. Of course, all of this is a gross oversimplification and this debate will no doubt continue indefinitely. Big stories like this always help to focus attention on this important issue and I for one have spent a bit more time thinking about this subject (which usually lingers at the very back of my mind) as a result.

The Amazing World of Psychiatry

Welcome to the Amazing World of Psychiatry. I believe that Psychiatry has the ability to make the world a better place. In this blog, I will write about psychiatry as it is currently practiced as well as exciting new developments in the field. The following definition - http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=302# - describes psychiatry as treating 'mental health conditions'. It is no easy task to define this term as it covers so many different conditions. Some, such as depression are easier to describe whilst others such as personality disorders can be closely intertwined with culture. Still other conditions are only just emerging and their inclusion amongst the ranks of mental health conditions are being debated. However, they all have one thing in common which is that they all affect this mysterious thing we refer to as the mind. The mind has itself become a cultural phenomenon, shaped according to the various belief systems that contribute to society. Secular humanists will identify the mind as the brain whereas some with a spiritual perspective will see the mind as the receptacle for the soul. The nature of mental health conditions is such that people's thoughts, feelings and behaviours over a reasonable period of time - weeks, months or even years should be taken into account in their assessment. The diagnosis and treatment involves not just the psychiatrist but other mental health professionals as well - nurses, social workers, occupational therapists, psychologists, art therapists, support workers to name just a few. Treatment can be thought of according to a biopsychosocial model - a biological or medical approach (e.g. medication and ECT), a psychological approach (e.g psychotherapy) and a social approach (e.g. supporting people in the community with carers). All the while as an understanding of the roles of genes improves, as imaging techniques and knowledge of drug actions become more sophisticated so too does society and culture become ever more fluid and complex. These provide psychiatry with many challenges on the quest to relieve the suffering and distress caused by mental illness.