Psychiatry is a clinical neuroscience, but how do we move the field?

Attitudes of Psychiatry Residents in Canadian Universities toward Neuroscience and Its Implication in Psychiatric Practice

OBJECTIVE

Despite recent advances in neuroscience highlighting its potential applications in the assessment and treatment of psychiatric disorders, the training of psychiatrists in neuroscience is lacking. However, it is not clear to what extent Canadian trainees are interested in further learning and using neuroscience in their daily clinical practice. This study explored the attitudes of Canadian psychiatry trainees with regard to neuroscience education and training by asking them to assess their own understanding of neuroscience and the perceived relevance of neuroscience knowledge to effective psychiatric practice.

METHODS

An online questionnaire was sent to psychiatry residents at Canadian universities. This questionnaire consisted of self-assessments of neuroscience knowledge, attitudes toward neuroscience education, preferences in learning modalities, and interest in specific neuroscience topics.

RESULTS

One hundred and eleven psychiatry residents from psychiatry residency programs at Canadian universities responded to this survey. Participants represented trainees from all 5 years of residency. Almost half of all trainees (49.0%) reported their knowledge of neuroscience to be either "inadequate" or "less than adequate," and only 14.7% of trainees reported that they feel "comfortable" or "very comfortable" discussing neuroscience findings with their patients. 63.7% of Canadian trainees rated the quantity of neuroscience education in their residency program as either less than adequate or inadequate, and 46.1% rated the quality of their neuroscience education as "poor" or "very poor." The vast majority of participants (>70%) felt that additional neuroscience education would be moderately-to-hugely helpful in finding personalized treatments, discovering future treatments, destigmatizing patients with psychiatric illness, and understanding mental illness.

CONCLUSIONS

Canadian trainees generally feel that their neuroscience knowledge and the neuroscience education they receive during their psychiatry residencies is inadequate. However, as the first step for any change, the majority of future Canadian psychiatrists are very motivated and have a positive attitude toward neuroscience learning.

The psychobiology of using automated driving systems: A systematic review and integrative model

Using vehicles with engaged automated driving systems (ADS) ('highly automated driving', HAD) will substantially impact on future society's mobility, yet the current understanding of human psychobiology related to HAD is still limited. Hence, we synthesized evidence on the psychobiology of subjects using HAD, informing an integrative model of the psychobiology of HAD, and providing guidance for reporting future research on this topic. We included (non-)randomized studies assessing human peripheral biology markers of in-vehicle-users in real or simulated driving environments, using vehicles with vs. without engaged ADS, published in English until April 2018. We systematically searched Web of Science, SCOPUS, and PubMed. The search consisted of a combination of terms describing HAD and psychobiological parameters. Risk of bias was assessed regarding randomization, blinding, incomplete outcome data, selective outcome reporting, and other potential causes. We extracted data using predefined data fields. Four out of five studies included in this review (N = 194 subjects) reported associations of use of vehicles with vs. without engaged ADS with various psychobiological parameters, including heart rate, respiratory sinus arrhythmia (RSA), indicators of electrodermal activity (EDA), and masseter electromyography (EMG). Heart rate tended to be reduced during HAD along with increased EDA and EMG, with no clear indication for changes in RSA. We cannot exclude substantial risk of bias, among others because the status of engagement of ADS was mostly non-randomized. Yet, findings suggest that HAD goes along with tractable changes in peripheral biology. Informed by the conceptual endophenotype approach (Hellhammer et al., 2018, Psychoneuroendocrinology), we propose the Embodied Driving (EMBODD) model that describes how HAD reshapes vehicle use experience, and highlight how to make future ADS equipped vehicles successful regarding user's health. Based on the review, we suggest reporting guidelines for future research on the psychobiology of HAD.

Precuneus and psychiatric manifestations: Novel neurobiological formulations through lesion based connectivity mapping of psychopathology

Lesion-based investigations of psychopathology have preceded contemporary network-neuroscience initiatives. However, brain-lesions detected in routine psychiatric practice are often considered incidental and therefore ignored. Here, we illustrate a strategy to combine individual subject-level lesion information with open-source normative functional-connectomics data to make putative, neuroscience-informed symptom interpretation. Specifically, we report a patient with left precuneus granulomatous lesion and seizures followed by two distinct symptoms - kinetopsia and delusions of nihilism and guilt - which had a differential treatment response. The lesion-based brain-mapping approach could identify correlated (default-mode) and anti-correlated (temporo-parieto-occipital) networks, which enabled a neurobiological formulation of these diverse clinical manifestations.

Conceptual endophenotypes: A strategy to advance the impact of psychoneuroendocrinology in precision medicine

Psychobiological research has generated a tremendous amount of findings on the psychological, neuroendocrine, molecular and environmental processes that are directly relevant for mental and physical health, but have overwhelmed our capacity to meaningfully absorb, integrate, and utilize this knowledge base. Here, we reflect about suitable strategies to improve the translational success of psychoneuroendocrinological research in the era of precision medicine. Following a strategy advocated by the National Research Council and the tradition of endophenotype-based research, we advance here a new approach, termed "conceptual endophenotypes". We define the contextual and formal criteria of conceptual endophenotypes, outline criteria for filtering and selecting information, and describe how conceptual endophenotypes can be validated and implemented at the bedside. As proof-of-concept, we describe some of our findings from research that has adopted this approach in the context of stress-related disorders. We argue that conceptual endophenotypes engineer a bridge between the bench and the bedside. This approach readily lends itself to being continuously developed and implemented. Recent methodological advances, including digital phenotyping, machine learning, grassroots collaboration, and a learning healthcare system, may accelerate the development and implementation of this conceptual endophenotype approach.

A Novel Bio-Psychosocial-Behavioral Treatment Model in Schizophrenia

Despite the substantial burden of illness in schizophrenia, there has been a discrepancy between the beneficial effects of an increased use of antipsychotic medications and achieving limited recovery or remission. Because the focus of the most common antipsychotic medications is on dopamine, which is associated with positive symptoms, there is an unmet need for patients with negative symptoms. Since cognitive and negative symptoms rather than positive symptoms are more closely associated with psychosocial impairments in patients with schizophrenia, the non-dopaminergic systems including glutamate and γ-aminobutyric acid (GABA) of the prefrontal cortex should be of concern as well. The balance of excitation and inhibition has been associated with epigenetic modifications and thus can be analyzed in terms of a neurodevelopmental and neural circuitry perspective. Hence, a novel bio-psychosocial-behavioral model for the treatment of schizophrenia is needed to account for the non-dopaminergic systems involved in schizophrenia, rather than dopaminergic mechanisms. This model can be understood from the viewpoint of neurodevelopment and neural circuitry and should include the staging care, personalized care, preventive care, reducing the cognitive deficits, and reducing stigma. Thomas R. Insel proposed this as a goal for schizophrenia treatment to be achieved by 2030.