Challenges and opportunities in (neuro)psychiatry

It would appear that British psychiatry is retreating to a neurophobic position. ¹ The disconnect between psychiatry and its medical foundations is further exacerbated by the lack of medical experience in specialties relevant to psychiatry such as neurology, endocrinology and geriatric medicine. This is related to the constraints placed on training by service provision and the separation of psychiatric and medical services. The Future of Mental Health Services Report, ² headed by Prof. Dinesh Bhugra in collaboration with the Mental Health Foundation, called for greater collaboration between psychiatric and general medical services.

Elucidating the nature of mental illness and developing effective treatments requires enthusiastic and talented academics and clinicians. Instead of ideological turf wars, collaboration between disciplines is required to appreciate the nuanced interactions between genetics, biochemistry and the environment.

For example, the classical distinction between affective and psychotic experiences is becoming increasingly blurred. The formation of delusions is associated with a ‘jumping to conclusions’ cognitive bias. ³ This can result in an intolerance of uncertainty and anomalous interpretations of internal or external stimuli. There is renewed focus on the ways in which affective processes can contribute to the formation of delusions and how these mechanisms can be modified using cognitive-behavioural techniques. ⁴ These insights from cognitive neuropsychology are substantiated by neuroimaging studies. The salience network, an intrinsic large-scale cerebral network, shows strong connectivity between the anterior cingulate gyrus and insular cortex. This network enables switching between different dynamic brain states. Dysfunction in this network has been implicated in the formation of the key symptoms of psychosis: inappropriate salience attached to ambiguous stimuli can predispose to and perpetuate unusual beliefs or delusions. ⁵ There is hope that research such as this will begin to have an impact on clinical practice by highlighting these brain-mind links.

As a specialty we need to be far more proactive in promoting psychiatry as clinical neuroscience at both the undergraduate and postgraduate level. We must make sure that the scientific underpinnings of psychiatry are explicit within mental health services and in our interactions with patients and the public in general.