Global Journal of Medical Research, A: Neurology & Nervous System, Volume 23 Issue 3

Untangling Psychology from Biology in the Treatment of Psychiatric Disorders Michael Raymond Binder, M.D. Abstract- Due to the lack of a clear distinction between mentally-driven psychiatric symptoms and neurologically- driven psychiatric symptoms, determining which patients would best be treated with psychotherapy, which patients would best be treated with pharmacotherapy, and which patients would best be treated with both is a challenge that every behavioral health clinician faces. In an effort to overcome this challenge, this article will discuss the anatomical and functional relationship between the mind and the brain as it relates to the various treatment options that are currently available and introduce a groundbreaking new paradigm that is destined to transform the treatment of mental illness from a symptom-based practice to a pathology-based practice. In addition to putting the assessment and treatment of mental illness on par with other medication specialties, the new paradigm ushers in the first objective way to distinguish biologically-based psychiatric symptoms from psychologically- based psychiatric symptoms. This is of critical importance because it has the potential streamline treatment, better define the target for treatment, and more accurately inform the planning of treatment. It also has the potential to improve patient education and treatment outcomes by better explaining how psychotherapy works, how pharmacotherapy works, and how these two treatment modalities can complement or, in some cases, antagonize each other. Beyond all of these advantages, the new paradigm offers the potential to ward off psychiatric symptoms before they even begin. With the prevalence of psychiatric and substance use disorders at epidemic proportions, these long-awaited advances could not be more timely. Keywords: psychotherapy, medication, biomarkers, mind-brain dynamics, neuronal hyperexcitability, antidepressants, antipsychotics, psychostimulants, anticonvulsants, mood stabilizers, neuroregulators, mental health, treatment options. I. I ntroduction oth in the United States and other developed countries, the prevalence of anxiety, depression, and other common psychiatric disorders has reached epidemic proportions. Consequently, there is a desperate need for improved treatment outcomes, yet the effectiveness of mental healthcare is not much better now than it was fifty years ago [1]. Psychotherapists continue to employ various psychotherapeutic techniques, and psychiatrists continue to prescribe antidepressants, antipsychotics, and psychostimulants in various combinations. Typically, patients who have Author: Adult and Adolescent Psychiatry, 5 Revere Drive, Suite 200, Northbrook, USA. e-mail: mbinder@drmichaelbinder.com relatively mild psychiatric symptoms enter the behavioral healthcare system by consulting with a psychotherapist in the hope of avoiding treatment with medication. Patients who have more severe symptoms sometimes initiate treatment with a psychotherapist, sometimes with a psychiatrist, and sometimes with both. There are also some patients who initiate treatment with an internist and then either continue with the internist or receive a referral to a specialist. Unlike in the past, most contemporary psychiatrists do not practice psychotherapy, and most psychotherapists exhaust the benefits of their craft before referring the patient to a psychiatrist. One of the fundamental problems with this triage system is that patients largely self-select the modality of treatment they receive. Another problem is that there is no objective way to determine which patients would best be treated with psychotherapy, which would best be treated with medication, and which would best be treated with a combination of the two. Yet another problem is the potential lack of communication between the psychotherapist and the psychiatrist when both services are being provided simultaneously. These potential problems underscore the need for clinicians and prospective patients to better understand the mechanisms through which various psychotherapeutic and psychopharmacologic treatment modalities exert their therapeutic effects and to be able to determine, more objectively, which treatment modality would be most appropriate for which patient. In this article, current psychological and biological approaches to treatment will be reviewed, and a new formulation of the dynamic interplay between the mind and the brain will be discussed. From this fresh perspective, the puzzling relationship between mental processes and neurological processes will be clarified, and a new way of conceptualizing mental illness will be proposed. Based on this new conceptualization, which is strongly supported by converging lines of evidence, the first objective method of determining which patients should be treated with which modality—psychotherapy or biological therapy—will be introduced and, by offering the potential to treat mental illness based on pathology rather than symptomatology, a new era of behavioral healthcare will be ushered in. B 1 Year 2023 Global Journal of Medical Research Volume XXIII Issue III Version I ( D ) A © 2023 Global Journals