Most Important Research or Advancements Needed to Improve Psychiatry Care?

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For residents and physicians, what do you believe are the most important things we should do in Psychiatry to advance the field and/or improve patient outcomes? I find it interesting that there is often a greater degree of subjectivity in psych and patient outcomes are not always as predictable as in other fields of medicine treating more physical conditions (though obviously standardized and evidence-based treatments are applied as in other fields). I think this provides the opportunity for a lot more creativity in refining treatment. So out of curiosity, which specific Psych research/fellowships/etc. do you think practitioners should pursue or push for if their goal is to greatly improve mental health outcomes for the most people (and for which patient populations)?

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1) Identify what is truly genetic for diagnosis XYZ
2) have consistent readily available and cheap test for those genetic markers/disorders
3) have consistent readily available and cheap pharmacotherapy interventions that are efficacious for those disorders

Doing that would be a big win.
 
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1) Identify what is truly genetic for diagnosis XYZ
2) have consistent readily available and cheap test for those genetic markers/disorders
3) have consistent readily available and cheap pharmacotherapy interventions that are efficacious for those disorders

Doing that would be a big win.

If you are talking about SNPs or copy number variations that are specific to specific diagnoses, this is close to an empty set.
 
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I'm talking anything genetic that truly equates. Don't care what the marker or sequence is.

So, genuine question and not a troll, what exactly do you mean by "genetic for?" There are certain ways of understanding this that the past thirty years of psychiatric genetics suggests are not going to pan out. There are other ways of understanding this that may have some substance to them, but those are often not the sense of "genetic for" that is applicable to, say, sickle cell or Huntington's or even AD.
 
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Yes, I'm aware that much of the clinical syndromes we label as "depression" "anxiety" "schizophrenia" etc have not panned out and been giant flops for saying X genetic marker = Schizophrenia subtype Theta Beta Kappa Omega etc.

I'm simply responding to the OP that if there were to ever be a clear genetic identification, even if just one small fraction subtype of any psychiatric condition, similar to sickle cell or Hungtion's, etc. It could be a small, but notable "win" for psychiatry.

I'm not conjuring up a research direction, a grant proposal, or an area, or methodology to pursue, but simply saying to the OP, this could be a positive. That's it. A mile high analysis not a trenches review.
 
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Yeah, the NIMH has been quite clear there will not be a gene found for "schizophrenia" or "bipolar disorder." These are fully arbitrary descriptions of collections of symptoms based on cultural and societal expectations of what a person's behavior should be. They aren't Huntington's, to say the least. However, finding genes tied to symptoms of mental illness would be helpful and probably as close as you're going to get. For me personally, I'm a bit more concrete. I think researching LAIs is pretty huge. We need more 6 month to 1 year long injections or even systems similar to Norplant. We also need something resembling a treatment for stimulant use disorder. We have a lot of great treatments for opiates, but for stimulants we have...contingency management. So many of the overdose deaths we are seeing aren't in opiate users, but in stimulant users who had their meth spiked with fentanyl. I don't think there are particular "fellowships" that are going to lead to helping out a great number of people. If it's a pure numbers game for the OP in terms of helping the greatest number, you probably should go into federal government oversight of programs like Medicaid and Medicare, make sure it's being used efficiently and effectively. However, this would not require a fellowship or a MPH.
 
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For residents and physicians, what do you believe are the most important things we should do in Psychiatry to advance the field and/or improve patient outcomes?

So out of curiosity, which specific Psych research/fellowships/etc. do you think practitioners should pursue or push for if their goal is to greatly improve mental health outcomes for the most people (and for which patient populations)?

These are separate questions. For the field overall, I'd say the most glaring issue is we need us some actual pathophysiology. I understand that's a very broad ask. I think the neural circuits people are probably the closest to getting usable information on this.

For an individual who wants to know what type of subspecialty training would help them provide the most benefit to the most patients, at the risk of sounding like a hippie, I'd suggest psychedelics.
 
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For residents and physicians, what do you believe are the most important things we should do in Psychiatry to advance the field and/or improve patient outcomes?
I'll go to an even more basic level than others and say that research into how we define our "disorders" to come up with more consistent and specific diagnoses would be huge to advance the field. Our nosology sucks. The number of disorders we call "schizophrenia" is probably still easily in the double digits.

Best way to improve patient outcomes would be to use better nosology to determine when a "disorder" is actually a disorder vs just a symptom of something else. Cannot tell you how many times a patient is referred to me for "major depression" but actually has OSA or thyroid issues that other psychiatrists missed or just didn't ask/care about. Being able to separate these can dramatically change a treatment plan and outcomes. Imo the basic standard of care for psychiatry is pathetically low, which is great for our job security and keeping our license, but not so great for patients...
 
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I'll go to an even more basic level than others and say that research into how we define our "disorders" to come up with more consistent and specific diagnoses would be huge to advance the field. Our nosology sucks. The number of disorders we call "schizophrenia" is probably still easily in the double digits.

Best way to improve patient outcomes would be to use better nosology to determine when a "disorder" is actually a disorder vs just a symptom of something else. Cannot tell you how many times a patient is referred to me for "major depression" but actually has OSA or thyroid issues that other psychiatrists missed or just didn't ask/care about. Being able to separate these can dramatically change a treatment plan and outcomes. Imo the basic standard of care for psychiatry is pathetically low, which is great for our job security and keeping our license, but not so great for patients...
Yeah, that's what I imagined. I do think the DSM is really meh at diagnosing/treating conditions. I am somewhat surprised that the only behavioral addiction legally classified at all in Psych is gambling still.

And I am especially interested in this field since there's more wiggle room due to all the unknowns. I think the brain in general is very interesting (it's basically what make us ourselves, of course) but don't like intensive operations. I do almost wish Psych would have even more long-term patient interactions (well, I suppose it varies based on inpatient vs. outpatient) since I like talking through issues, but of course doing only talk therapy might get people to mix up the psychologists and psychiatrists since many other professions do that
 
I'll go to an even more basic level than others and say that research into how we define our "disorders" to come up with more consistent and specific diagnoses would be huge to advance the field. Our nosology sucks.
It's because we don't have the pathophysiology. It's just a bunch of grouped clinical descriptors. Without any understanding of the underlying mechanisms, rearranging the descriptors isn't going to help either.
 
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I'll go to an even more basic level than others and say that research into how we define our "disorders" to come up with more consistent and specific diagnoses would be huge to advance the field. Our nosology sucks. The number of disorders we call "schizophrenia" is probably still easily in the double digits.

Best way to improve patient outcomes would be to use better nosology to determine when a "disorder" is actually a disorder vs just a symptom of something else. Cannot tell you how many times a patient is referred to me for "major depression" but actually has OSA or thyroid issues that other psychiatrists missed or just didn't ask/care about. Being able to separate these can dramatically change a treatment plan and outcomes. Imo the basic standard of care for psychiatry is pathetically low, which is great for our job security and keeping our license, but not so great for patients...
Second that, we are still in the 'abdominal pain' stage of nosology, and other specialties are already in the necrotizing pancreatitis type II phase. No wonder our medicines are blanket neurotransmitter modulators with wildly varying responses, much like painkillers for the aforementioned abdominal pain: antipsychotics are a good example of that.

Until we find a better nosology, we will keep fumbling around.
 
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I'll go to an even more basic level than others and say that research into how we define our "disorders" to come up with more consistent and specific diagnoses would be huge to advance the field. Our nosology sucks. The number of disorders we call "schizophrenia" is probably still easily in the double digits.

Best way to improve patient outcomes would be to use better nosology to determine when a "disorder" is actually a disorder vs just a symptom of something else. Cannot tell you how many times a patient is referred to me for "major depression" but actually has OSA or thyroid issues that other psychiatrists missed or just didn't ask/care about. Being able to separate these can dramatically change a treatment plan and outcomes. Imo the basic standard of care for psychiatry is pathetically low, which is great for our job security and keeping our license, but not so great for patients...
I think our nosology is quite adequate for practical purposes, outside of schizophrenia and bipolar disorder (e.g. it seems the only reliable way to differentiate differentiating lithium-responding-BPAD from lithium-nonresponding-BPAD is trying lithium and seeing if they wind up in the hospital again).

The problem you are pointing out is really that there are a lot of bad practitioners. Low energy is a symptom of MDD when it is a product of the depressed mood or anhedonia. When low-energy seems to be (more) primary than mood, it probably isn't a symptom of MDD and you need to be looking for other causes. What I see very commonly is GAD (or other anxiety disorder) diagnosed when the patient is anxious and restless, but they are actually anxious as a product of restlessness (rather than vice-versa) and the initial diagnostician (to use the term generously) missed e.g. ADHD.

So, to answer the OPs question, the most important advance in our field would be idiot-proofing it.
 
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I think our nosology is quite adequate for practical purposes, outside of schizophrenia and bipolar disorder (e.g. it seems the only reliable way to differentiate differentiating lithium-responding-BPAD from lithium-nonresponding-BPAD is trying lithium and seeing if they wind up in the hospital again).

The problem you are pointing out is really that there are a lot of bad practitioners. Low energy is a symptom of MDD when it is a product of the depressed mood or anhedonia. When low-energy seems to be (more) primary than mood, it probably isn't a symptom of MDD and you need to be looking for other causes. What I see very commonly is GAD (or other anxiety disorder) diagnosed when the patient is anxious and restless, but they are actually anxious as a product of restlessness (rather than vice-versa) and the initial diagnostician (to use the term generously) missed e.g. ADHD.

So, to answer the OPs question, the most important advance in our field would be idiot-proofing it.
I actually disagree - I've seen many patients who fulfill criteria for major depressive disorder having WILDLY varying outcomes, response to medication, prognosis, etc, to the point where I don't actually know what patient will respond to what medication or intervention. I suspect that there are at least dozens subtypes of 'depressions', 'anxieties', 'BPDs' lumped together, etc, and if we had some type of biomarker/imaging finding, or at least a way to clinically differentiate between the subtypes, like most other fields have, we would be much better off.
 
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Best thing the field can do is stop wasting money on imaging science for mental health disorders. It is a unicorn hunt just like genetics for psychiatry.

An RCT to see if olanzapine plus fetzima works for geriatric depression is the type of junk we don't need more studies to prove. Fund novel mechanisms and application science.

And more psychiatrists need statistics/research training.
 
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It's because we don't have the pathophysiology. It's just a bunch of grouped clinical descriptors. Without any understanding of the underlying mechanisms, rearranging the descriptors isn't going to help either.
Sure, but it's also a lot more complex than that too since we don't just deal with physical processes of the body but emotional expressions as well. Differentiating subtle depressed mood verses the feeling of sadness is not something I see our field being able to objectively do anytime soon, which I think is necessary to understand large swaths of what we consider within our field. I don't think rearranging descriptors is going to fix it, but we can definitely do better than the absurdly broad checklists we call diagnostic criteria for a lot of disorders. The AMPD compared to the cluster model for PDs is a good example. Imo it's far better at identifying actual disordered traits and based on better data even if it does still leave a lot to be desired.

An RCT to see if olanzapine plus fetzima works for geriatric depression is the type of junk we don't need more studies to prove. Fund novel mechanisms and application science.
I don't think stuff like that is always bad. Auvelity seems to be a decent example where I've heard a lot more positives than negatives. I do think that there's too low of a standard in terms of when those treatments are actually seen as good options though, but that's more of a systemic/big pharma issue than a psych-specific thing.

I do love novel mechanisms, and am looking forward to seeing how the studies with TAAR1 agonists turns out. To OP again, another area I'd like to see more research in is psych symptoms related to other fields. More recently I've been noticing a lot more interactions with endocrine and auto-immune/rheum related disorders in our psych patients. I've been chatting with some of the med/psych and endocrine staff about this lately and they notice quite a bit of overlap as well. It could also be a good way to incorporate genetics that could be relevant to psych (ie, specific gene mutations --> autoimmune/endocrine disorder --> psych symptoms/"disorders").
 
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I think our nosology is quite adequate for practical purposes, outside of schizophrenia and bipolar disorder (e.g. it seems the only reliable way to differentiate differentiating lithium-responding-BPAD from lithium-nonresponding-BPAD is trying lithium and seeing if they wind up in the hospital again).
I also disagree with this. I'm consults at a large academic center, so I deal with things from the medical angle a lot more than most in our field. Imo BPAD (really mania) is one of the easiest and most valid diagnoses in psychiatry, so not really a good example at all. Differentiating lithium responding vs lithium non-responding is irrelevant imo, as many medical diagnoses may or may not respond to one med class over another (ie ACEs vs ARBs for renal HTN). It's far better than "MDD" or "GAD" and schizophrenia which I constantly see misdiagnosed or slapped on when something medical is causing psychiatric symptoms where we really are just making a best guess at which med or even which class (SSRI? SNRI? SARI? DNRI? Stimulant? Lithium? Something else?) might be helpful.

The problem you are pointing out is really that there are a lot of bad practitioners.

So, to answer the OPs question, the most important advance in our field would be idiot-proofing it.
This I do agree with. As I said, I think the standard of care in psych is pathetically low. I think this is partially because our disorders are so poorly defined and thus consistently effective treatments are far less common than many other fields. I mean, can you imagine a cardiologist saying something like "So you have crushing chest pain with moderate activity which has gotten worse over the past few months and came in today because you felt like you were dying? Let's try a beta blocker and see if that helps." That would be insane but isn't far off from what some psychiatrists do with their patients.
 
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Best thing the field can do is stop wasting money on imaging science for mental health disorders. It is a unicorn hunt just like genetics for psychiatry.
I think that really depends on the content and hypothesis. Imaging is a type of tool. There are a lot of crappy imaging studies out there. Some useful ones as well.

An RCT to see if olanzapine plus fetzima works for geriatric depression is the type of junk we don't need more studies to prove.

That type of trial is usually funded by pharma. It's the result of the fact that our health care provision is tied to a capitalist marketplace. Those trials have nothing to do with improving psychiatric care and everything to do with figuring out how to expand the markets for profitable drugs.

Fund novel mechanisms and application science.
You mean increase the NIH budget? I'm with you there

And more psychiatrists need statistics/research training.
Yes to that for sure
 
Best thing the field can do is stop wasting money on imaging science for mental health disorders. It is a unicorn hunt just like genetics for psychiatry.

An RCT to see if olanzapine plus fetzima works for geriatric depression is the type of junk we don't need more studies to prove. Fund novel mechanisms and application science.

And more psychiatrists need statistics/research training.
Are there any studies on Zyprexa + Fetzima? Zypzima sounds tasty. If marketed for geriatric depression, I could see a great indication for a liquid drug delivery system to minimize pill burden. Maybe lightly carbonated with a hint of citrus to minimize GI AE?
 
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Best thing the field can do is stop wasting money on imaging science for mental health disorders. It is a unicorn hunt just like genetics for psychiatry.

An RCT to see if olanzapine plus fetzima works for geriatric depression is the type of junk we don't need more studies to prove. Fund novel mechanisms and application science.

And more psychiatrists need statistics/research training.
Can you elaborate on the 'fund novel mechanisms and application science'? You mean translational science? Molecular explorations of schizophrenia?
 
Can you elaborate on the 'fund novel mechanisms and application science'? You mean translational science? Molecular explorations of schizophrenia?
I agree with @tr in increasing NIH budget. I also want to push budget from imaging over to novel agents. I.e. why have we funded thousands of R01s for meaningless, small N fmri studies when the best research out there shows fmri is almost meaningless unless you deep phenotype a single N (longer scan times, over multiple times) or have N approaching several thousand. No brain imaging is producing clinical improvement outside of a single tms proof of concept protocol. Over half of the “top” papers come down to unfounded statistical inferences based off a misunderstandings of what the data is saying. It’s like giving a toddler access to a ford F150 on a highway, they don’t even know how much damage they are doing to science.

Meanwhile, a novel mechanism like brexanolone or other brain penetrating steroids are barely used or researched when thousands of these agents may be critical for future psychiatry (and already have indications). Instead, pharma is forced to fund useless research to prove a novel combo is FDA cleared so they are allowed to market to left handed people with type 2 bipolar and left foot right foot stomp disorder . Who gives a flying $&@$ about another carbon copy antipsychotic. It’s all just marketing and nothing has edged out other compounds.

The way academia, industry, and government interfaces currently is deeply frustrating and profoundly wasteful. I have colleagues at a top department who’s whole careers have been meaningless for society, cranking junk science, and showing once again that rat eats pellet if we delete SNP x47zy2. Who cares? Get a real job. SNPs and voxel by voxel brain imaging has not and will not be the path forward for psychiatry. Accept it and move on. Find real science by real thinkers. Instead we just publish pretty brain photos in top journals and think we’re doing science. We are not, and it’s a joke.
 
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For residents and physicians, what do you believe are the most important things we should do in Psychiatry to advance the field and/or improve patient outcomes? I find it interesting that there is often a greater degree of subjectivity in psych and patient outcomes are not always as predictable as in other fields of medicine treating more physical conditions (though obviously standardized and evidence-based treatments are applied as in other fields). I think this provides the opportunity for a lot more creativity in refining treatment. So out of curiosity, which specific Psych research/fellowships/etc. do you think practitioners should pursue or push for if their goal is to greatly improve mental health outcomes for the most people (and for which patient populations)?

Inpatient care across the board needs to improve. Length of stay should increase, individual counseling provided, nutrition eval, exercise mandated, and we should actually do a half decent eval. I’m tired of seeing inpatient evals with minimal HPI, no collateral, no coordination of care, and lazy plans. Example: Patient presents irritable with suicidal thoughts of 1 day after not sleeping last night. Denies hallucinations. Dx Psychosis Start Olanzapine 10mg. My MDD patient with 1 night of insomnia arrives back in my care without suicidal thoughts or rather much of any thoughts completely snowed.
 
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Inpatient care across the board needs to improve. Length of stay should increase, individual counseling provided, nutrition eval, exercise mandated, and we should actually do a half decent eval. I’m tired of seeing inpatient evals with minimal HPI, no collateral, no coordination of care, and lazy plans. Example: Patient presents irritable with suicidal thoughts of 1 day after not sleeping last night. Denies hallucinations. Dx Psychosis Start Olanzapine 10mg. My MDD patient with 1 night of insomnia arrives back in my care without suicidal thoughts or rather much of any thoughts completely snowed.
Lol patients will not like length of stay increases in psych facilities...
 
Lol patients will not like length of stay increases in psych facilities...

If the facilities provided better care and didn’t appear like dungeons, they would probably appreciate it. Call up Menninger and ask what people are willingly paying per day to stay their longer.
 
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I agree with @tr in increasing NIH budget. I also want to push budget from imaging over to novel agents. I.e. why have we funded thousands of R01s for meaningless, small N fmri studies when the best research out there shows fmri is almost meaningless unless you deep phenotype a single N (longer scan times, over multiple times) or have N approaching several thousand. No brain imaging is producing clinical improvement outside of a single tms proof of concept protocol. Over half of the “top” papers come down to unfounded statistical inferences based off a misunderstandings of what the data is saying. It’s like giving a toddler access to a ford F150 on a highway, they don’t even know how much damage they are doing to science.

Meanwhile, a novel mechanism like brexanolone or other brain penetrating steroids are barely used or researched when thousands of these agents may be critical for future psychiatry (and already have indications). Instead, pharma is forced to fund useless research to prove a novel combo is FDA cleared so they are allowed to market to left handed people with type 2 bipolar and left foot right foot stomp disorder . Who gives a flying $&@$ about another carbon copy antipsychotic. It’s all just marketing and nothing has edged out other compounds.

The way academia, industry, and government interfaces currently is deeply frustrating and profoundly wasteful. I have colleagues at a top department who’s whole careers have been meaningless for society, cranking junk science, and showing once again that rat eats pellet if we delete SNP x47zy2. Who cares? Get a real job. SNPs and voxel by voxel brain imaging has not and will not be the path forward for psychiatry. Accept it and move on. Find real science by real thinkers. Instead we just publish pretty brain photos in top journals and think we’re doing science. We are not, and it’s a joke.
There is too much blue sky reasearch in psychiatry ("after very careful and extensive research, we have concluded that the sky is definitely blue").

In our area, it manifests as people rediscovering for the Nth time that depression, indeed, has some neurobiological correlates. If underpinning subtypes of anxiety disorders is hard, maybe a focus on novel mechanisms as you suggest would be a much better use of time and resources.
 
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I actually disagree - I've seen many patients who fulfill criteria for major depressive disorder having WILDLY varying outcomes, response to medication, prognosis, etc, to the point where I don't actually know what patient will respond to what medication or intervention. I suspect that there are at least dozens subtypes of 'depressions', 'anxieties', 'BPDs' lumped together, etc, and if we had some type of biomarker/imaging finding, or at least a way to clinically differentiate between the subtypes, like most other fields have, we would be much better off.

Worth noting that the pooled kappa for MDD in the DSM-V field trials is 0.28. This is lower than for many other psychiatric disorders, suggesting that in clinical practice, we as a field are really not very good at agreeing on who does or does not fall under the rubric of MDD.
 
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I agree with @tr in increasing NIH budget. I also want to push budget from imaging over to novel agents. I.e. why have we funded thousands of R01s for meaningless, small N fmri studies when the best research out there shows fmri is almost meaningless unless you deep phenotype a single N (longer scan times, over multiple times) or have N approaching several thousand. No brain imaging is producing clinical improvement outside of a single tms proof of concept protocol. Over half of the “top” papers come down to unfounded statistical inferences based off a misunderstandings of what the data is saying. It’s like giving a toddler access to a ford F150 on a highway, they don’t even know how much damage they are doing to science.

Meanwhile, a novel mechanism like brexanolone or other brain penetrating steroids are barely used or researched when thousands of these agents may be critical for future psychiatry (and already have indications). Instead, pharma is forced to fund useless research to prove a novel combo is FDA cleared so they are allowed to market to left handed people with type 2 bipolar and left foot right foot stomp disorder . Who gives a flying $&@$ about another carbon copy antipsychotic. It’s all just marketing and nothing has edged out other compounds.

The way academia, industry, and government interfaces currently is deeply frustrating and profoundly wasteful. I have colleagues at a top department who’s whole careers have been meaningless for society, cranking junk science, and showing once again that rat eats pellet if we delete SNP x47zy2. Who cares? Get a real job. SNPs and voxel by voxel brain imaging has not and will not be the path forward for psychiatry. Accept it and move on. Find real science by real thinkers. Instead we just publish pretty brain photos in top journals and think we’re doing science. We are not, and it’s a joke.
I feel too ignorant of fmri science to have a great sense of why said field is not useful. Is the neural circuits thing not the most promising potential "pathophys" we have for psych and learned primarily through imaging studies?
 
I feel too ignorant of fmri science to have a great sense of why said field is not useful. Is the neural circuits thing not the most promising potential "pathophys" we have for psych and learned primarily through imaging studies?
fMRI largely just detects changes in bloodflow, so while the postulation is that greater neural activity increases blood flow it's not concrete. Imaging (in general) has yielded some helpful information for some disorders like ADHD, but ironically hasn't been particularly helpful for a lot of the disorders that we still have so many questions about (like depression). Imo our basic understanding of the actual definitions of our "disorders" likely isn't good enough for imaging to be meaningful in the way we want it to be at this point.
 
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I definitely agree imaging research needs to reduce. It doesn't need to stop, but I think it is way overfunded for the actual practical results it generates or is likely to generate. Love the idea of increasing inpatient stays. We dramatically swung the pendulum in the complete other direction with deinstitutionalization and we need to go down a more middle road, ie some institutionalization. Some states like CA are definitely headed in that direction.
 
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I feel too ignorant of fmri science to have a great sense of why said field is not useful. Is the neural circuits thing not the most promising potential "pathophys" we have for psych and learned primarily through imaging studies?
I think the biggest problem with fMRI specifically is low temporal and spatial resolution. You can't study a functioning circuit where neuronal firing takes place on the order of milliseconds by measuring a blood flow signal that peaks 5-6 seconds after the stimulus. Furthermore, individual functional neuroanatomy varies very widely and most of these studies are using predefined 'regions of interest' that may or may not contain the circuit that is actually intended to be studied.

I think Nolan Williams' use of fMRI for individual functional neuroanatomical mapping to guide TMS is a really good use of this technology. Trying to use it to define and study neural circuit activity directly, not so much.
 
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Let's have a really good study comparing hospitals/health systems/insurance organizations run by physicians vs MBAs and see which ones produce better outcomes for lower cost....oh wait, we have those and decided to ban physician ownership of hospitals anyway.

Totally agree with longer inpt stays and well-run tertiary care psych hospitals. From what I've personally experienced of tertiary care in non-US settings, they offer high quality care and promote recovery for the most ill psych pts; and can be a safe and caring home for some pts who otherwise cannot be cared for the community and would otherwise end up deceased or in jail.
 
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Our current pharm and non-pharm therapies work quite well when you consider the NNT. For actual bread and butter conditions (depression, mania, psychosis, anxiety), the percentage of treatment-resistant disease is negligible. There is a big distinction between treatment-resistant disease vs. patient resisting treatment. There's also the big distinction between psychiatric disease vs. societal issue.

So, I think the 2 biggest advancements would be:
1. Stop medicalizing social issues
2. Open and adequately fund asylums for SMI and reduce the bar for involuntary commitment

But none of that will ever happen because the status quo benefits the current social/political structure. And med students and academics will continue to wring their hands about when the next advancement in psychiatry will take place.

Lol patients will not like length of stay increases in psych facilities...

Who cares what patients don't like? What patients need to do and what they want to do are usually diametrically opposite. Most patients don't enjoy treatment that works. This is medicine in general. Especially in psychiatry.
 
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