Essays
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Deep Brain Stimulation for Psychiatric Disorders - Widge, Alik S.
In this monograph, we briefly review the rationale for deep brain stimulation (DBS) for psychiatric illness, beginning with current noninvasive treatment options and progressing to the evolution and success of DBS as a therapy. This discussion will focus on obsessive‐compulsive disorder (OCD) and major depressive disorder (MDD) particularly, as these are the only two diagnoses that have been subjected to adequately controlled DBS trials to date. The majority of the essay then describes the significant limitations that DBS is currently facing and emerging approaches to address them. This will lead into a discussion of new technologies such as patient‐specific modeling of electric fields and closed‐loop DBS systems and how we can best utilize these to increase our understanding of DBS and the overall efficacy of this novel therapy. -
Mechanisms of Fear Reduction - Lancaster, Cynthia L.
Over the past century, numerous theories have been advanced toward a unified account of fear reduction and have achieved various degrees of empirical support. Here, we first provide a brief overview of the basic models that account for fear acquisition, then we provide a review of several of the most prominent theories of fear reduction, and finally, we describe important cutting‐edge directions for future research. -
Normal Negative Emotions and Mental Disorders - Horwitz, Allan V.
The basic goal of psychiatric diagnosis is to distinguish genuine mental dysfunctions from normal, albeit distressing, emotions. This task is especially difficult because, unlike other medical specialties, psychiatry does not have biological markers that can validate diagnoses of mental disorders. Therefore, diagnostic criteria have an outsized role in psychiatry compared to other medical fields. Until the development of the DSM‐III in 1980, psychiatric diagnoses were general, continuous, and causal. In contrast, the diagnostic system that emerged in the DSM‐III and that has remained basically intact until the present has been specific, categorical, and a causal. This type of classification, however, is prone to mistake contextually appropriate symptoms as indicators of mental disorders. Cutting‐edge research incorporates the context in which symptoms emerge and persist to separate normal, distressing emotions from mental illnesses. It also develops alternatives to the DSM's categorical diagnoses. Other valuable studies try to differentiate conditions that stem from evolutionarily normal genes that no longer fit modern environments rather than from genetic or psychological dysfunctions within individuals. Going forward, research must attempt to use biological, psychological, and social factors to develop definitions that adequately distinguish normal responses to stressful environments, evolutionary mismatches, and mental disorders. It will also try to find biomarkers that can set appropriate boundaries between natural and pathological conditions. Finally, it will consider the best ways to optimize the balance between under‐ and over‐diagnosing mental illnesses. -
Problems Attract Problems: A Network Perspective on Mental Disorders - Cramer, AngéLique O. J.
What is the nature of mental disorders such as major depression and panic disorder? Are mental disorders analogous to tumors, in that they exist as separate entities somewhere in people's minds? Do mental disorders cause symptoms such as insomnia and fatigue? Until very recently, it was exactly this sort of thinking that (implicitly) permeated many, if not all, research paradigms in clinical psychology and psychiatry. However, in recent years, a novel approach has been advocated (i.e., the network perspective), in which mental disorders are not conceived of as entities that have a separate existence from their respective symptoms. Instead, mental disorders are hypothesized to be networks of symptoms that directly influence one another. So, for example, from a network perspective, insomnia and fatigue are not caused by the same underlying disorder (i.e., major depression) but causally influence one another (i.e., insomnia → fatigue). A disorder, then, develops because of such direct relations between symptoms in which positive feedback mechanisms (i.e., vicious circles) are present: for example, insomnia → fatigue → feelings of guilt → insomnia. These feedback mechanisms may propel the aggravation of one's condition and make a person end up in, for example, a full‐fledged depressive episode. In this contribution, we elaborate on network perspectives on the nature of mental disorders as well as their implications for our outlook on diagnosis and comorbidity.