Point-counter-point: psychotherapy in the age of pharmacology

Integrated Behavioral Health Care: Reflections of the Past

Humans have long sought to be provided with optimal health care, and the research continues in the twenty-first century. In the spirit of Galen from 19 centuries ago, empowering the patient's physician remains an important approach in health care. There is an emphasis on primary care and integration of behavioral consultation services in primary care. It remains a work in progress with help from the past and realistic hope for the future.

Facial emotion recognition in psychiatrists and influences of their therapeutic identification on that ability

OBJECTIVES

Although emotional cues like facial emotion expressions seem to be important in social interaction, there is no specific training about emotional cues for psychiatrists. Here, we aimed to investigate psychiatrists' ability of facial emotion recognition and relation with their clinical identification as psychotherapy-psychopharmacology oriented or being adult and childhood-adolescent psychiatrist.

METHODS

Facial Emotion Recognition Test was performed to 130 psychiatrists that were constructed by a set of photographs (happy, sad, fearful, angry, surprised, disgusted and neutral faces) from Ekman and Friesen's.

RESULTS

Psychotherapy oriented adult psychiatrists were significantly better in recognizing sad facial emotion (p=.003) than psychopharmacologists while no significant differences were detected according to therapeutic orientation among child-adolescent psychiatrists (for each, p>.05). Adult psychiatrists were significantly better in recognizing fearful (p=.012) and disgusted (p=.003) facial emotions than child-adolescent psychiatrists while the latter were better in recognizing angry facial emotion (p=.008).

CONCLUSION

For the first time, we have shown some differences on psychiatrists' facial emotion recognition ability according to therapeutic identification and being adult or child-adolescent psychiatrist. It would be valuable to investigate how these differences or training the ability of facial emotion recognition would affect the quality of patient-clinician interaction and treatment related outcomes.

Antidepressants and adolescent brain development

Despite being a first-line treatment for adolescent depression and anxiety, antidepressant drugs appear to have questionable efficacy and carry an increased risk of adverse effects in this population. The neural mechanisms underlying this phenomenon are currently unknown. Recent research into the neural effects of alcohol and recreational drugs suggests that the developmental trajectory of the adolescent brain may be particularly vulnerable to pharmacological disturbance. It is therefore important to consider whether prescription psychotropic drugs may have analogous effects. This article reviews the contribution of recent preclinical, clinical and pharmacogenetic literature to current knowledge on the short-term and enduring neural effects of antidepressants on the adolescent brain, with a particular focus on the major neurotransmitter systems and neuroplasticity.