The future of psychiatry

Karolinska Institutet and Stockholm Psychiatry Lectures arranged the event The future of psychiatry yesterday, with lectures, discussions, and a poster session. A special guest at the event was Dr Joshua Gordon, the director of National Institute of Mental Health (NIMH) in the United States, which is the federal agency that funds research into mental health.

Ole Petter Ottersen - Sweden and Karolinska Institutet on the global arena

The first speaker was Ole Petter Ottersen, president of Karolinska Institutet. He mentioned how psychiatric disorders account for an increasing part of the global burden of disease. Sweden has a unique opportunity to advance research on psychiatric disorders, since the national registers and twin registry are well developed. He also pointed out that Karolinska Institutet needs a cohesive strategy for mental health across the university, as well as outreach to the public and important decision makers. Ottersen emphasised that Karolinska Institutet should strive to improve health not only in Sweden but also on a global level, because the challenge is global.

Nitya Jayaram-Lindström - Milestones achieved and future directions of CPF

Nitya Jayaram-Lindström is the head of Center for Psychiatry Research (CPF), the unit for clinical psychiatry research in Stockholm. She gave examples of the successful implementation of internet-delivered cognitive behavioural therapy, which is now offered both within child and adolescent psychiatry as well as adult psychiatry. Importantly, the interventions offered are evidence-based and have been evaluated in randomised controlled trials prior to implementation. Among the future directions for CPF and psychiatric research at large are efforts to prevent or intervene early, to broaden the scope of care (for example physical activity, adaptive treatment strategies in a stepped-care model), viewing psychiatric disorders through a life-span perspective, and combining research data with information on the lived experiences of individuals with mental illnesses.

Joshua Gordon - Challenges and opportunities in mental health research

Dr Joshua Gordon is the director of NIMH and was the keynote speaker of the event. He gave his view on the challenges and opportunities in mental health research.

Challenges

A longstanding challenge in psychiatry is the use of symptoms to classify mental illness. This means that overlap between diagnoses and high rates of comorbidity is the norm rather than the exception. Differences between conditions become vague and there is lots of variation within diagnoses as well.

Another issue is the lack of useful biomarkers in psychiatry. There are no biomarkers–a biological process that can be reliably observed and measured–that reliably give us prognostic, diagnostic, or predictive information for mental illnesses. There is a lot of research underway to try to identify biomarkers, but so far none have become useful in everyday clinical practice.

Dr Gordon also mentioned that our treatments fail to help a substantial minority of patients with mental illness. We have come a long way with psychological treatments such as cognitive behaviour therapy and pharmacological treatments such as antidepressant medications, but we still have a “one size fits all” approach that fails to help everyone.

Opportunities

Modern neuroscience has given us new tools to identify and control the neural circuits involved in mental illnesses, and Dr Gordon sees this as one of the major opportunities going forward. For example, we can use the new tools to find new clues about which processes in the brain are involved in mental illness. These processes are potential biomarkers and can be used to develop novel treatments.

The rapid development of research in psychiatric genetics also gives us pointers to brain regions and biological processes of interest.

Another opportunity comes from the field of computational psychiatry. The goal of computational psychiatry is to develop mathematical models of how the brain works. Using the increased computational power and new statistical techniques, we can make use of the information gained from brain scans and other assessments in new ways. For example, machine learning algorithms are able to detect patterns across many different types of data that would be hard or impossible for researchers to detect themselves.


After the presentations there was time for questions from the audience, as well as a poster session where members of CPF presented their research in three categories: clinical, translational, and epidemiology. There was also time to chat with friends and colleagues!

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Oskar Flygare
PhD Student in psychology