the future of psychiatry?

[jjmack]

hey,

i am an M2 MSTP student who is considering psychiatry. I have recently started to wonder about the future of the field. By the time I get out of residency (9 yrs of so) what will the field be like?

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[la_tortuga]

Psychiatrists will probably be helping patients with mental illnesses through a combination of therapeutic counseling, psychotropic medications (with some additional somatic treatments like ECT, gene therapy, and TMS), and psychosocial treatments like pet therapy.

Some things will never change however: The great satisfaction of helping others will far outweigh the substantial financial reward of the profession.

Hope that clears everything up, and you can continue in your studies well-assurred that everything will work out alright.

 

[50960]

I think the future of psychiatry is very promising. In the next 20 years there will be all sorts of new treatments including gene-specific pharmacology, gene therapy, maybe procedures, and most likely some great new ways to see and understand the brain. I look very forward to working with the new psychiatrists........

 

[whopper]

The Good: New & better meds. Lessed side effects, better compliance becuase of better meds. Better testing methods to diagnose. Better methods of treatment such as TMS may be approved (still under scrutiny, but the point is maybe there'll be some treatments)

The Bad: The future of healthcare may benefit or suffer from some extreme changes due to continuing rising healthcare costs. A socialized healthcare system may become a reality. This could make matters better or worse depending on how it is handled.

the Ugly: Some current practices will be viewed upon as barbaric just as ECT as a means of punishment and lobotomies are currently seen as barbaric and were once the standard of care. IMHO, one current practice: the medication of children because of lazy parents will be the thing that will be vilified by future psychiatrists.

 

[lloyd braun]

I see the future of psychiatry incorporating more general medicine training in residency and requiring psychiatrists to bear more responsibility in the primary care issues of their patients. There is well-known data that chronically mentally ill patients die, on average, 25 years earlier than the general population. This is due to many things, but one of which is lack of access to primary care. I believe psychiatrists should and will begin to take on this moral and professional responsibility to attend to some of the more primary care issues.

 

[OldPsychDoc]

The Good: New & better meds. Lessed side effects, better compliance becuase of better meds.

I'm not pessimistic about the future of psychiatry, but I'm not sure I buy this.
We had a revolution in meds about 15-20 years ago with the SSRIs and atypicals, but there really have not been huge changes in the pharmacopoeia since then--the "lessened side effects" and "better meds" since have largely been reformulations of the above standards with longer-acting preps, etc. Pharmaceutical companies are hurting precisely because there are no new blockbusters in the works--and their previous generation of blockbusters is going generic.
If one extrapolates from the past 10 years to predict the next 10, the place I expect to see progress will be in reduced stigma and greater attention given to access and delivery systems for mental health needs, not in the next Wonder Drug.

 

[50960]

OPD, why do you feel there have been no real good pharm breakthroughs in the past 10 years? Is it the limits of current science or fear on the part of drug companies with all the litigation out there?

 

[OldPsychDoc]

OPD, why do you feel there have been no real good pharm breakthroughs in the past 10 years? Is it the limits of current science or fear on the part of drug companies with all the litigation out there?

My impression would be more A than B--we need to admit that we still dont know what schizophrenia is or why D2 blockers help. (Ditto for depression & anxiety and SSRIs).
I used to go to lots of basic research-heavy meetings--I wouldn't say you'd ever see a poster from a drug company touting something promising "if only we could get it past the lawyers and the FDA"...

 

[i61164]

Pharmaceutical companies are hurting precisely because there are no new blockbusters in the works--and their previous generation of blockbusters is going generic.

Viagra doesn't go generic until 2011.

 

[OldPsychDoc]

Viagra doesn't go generic until 2011.

But I keep getting all of these emails offering to sell it to me without a prescription!!!!

 

[nutcancer]

But I keep getting all of these emails offering to sell it to me without a prescription!!!!

isn't neuorology trying to get rid of you guys?

 

[OldPsychDoc]

isn't neuorology trying to get rid of you guys?

I'd worry about it--except that everytime a neurologist gets even a whiff of someone "crazy" they come screaming to us to take them off their hands...

 

[sunlioness]

I'd worry about it--except that everytime a neurologist gets even a whiff of someone "crazy" they come screaming to us to take them off their hands...

LOL. Too true. Apparently yesterday a neurologist tried to consult us because one of her outpatients was "making birdy noises." We managed to duck (pun not intended) that one somehow.

 

[Dartos Vader]

isn't neuorology trying to get rid of you guys?

I'm working with a great group of Neuro docs right now, who really enjoy treating the psych issues of their patients (MS is like, half psych), but like any other field, they know their limitations. They are probably the best group I have encountered when it comes to handling psych patients, but they still don't hold a candle to someone who has spent 4+ years training in psychiatry.

 

[OtisRSB]

i think the idea that the brain is the final frontier makes the field so exciting as there is still so much we don't know which allows for so much discovery, so much change and means every day is exciting and every new patient is a chance to learn more as opposed to medicine where algorithms are the norm.

 

[Chewbacca Jung]

isn't neuorology trying to get rid of you guys?

That's because psychiatrists deal with disorders that involve the mind that are actually somewhat treatable. If they can steal those patients, they can not only make a bundle running expensive diagnostic tests on them, but they can get in on the chronic pain med management thing too (which they still may be able to get PCP's to do fthe dirty work for them, and they get the consult, if they work it right). The only draw back to their plan is that patient interaction thing. They just need to figure out how to diagnose Schizophrenia with a reflex hammer and an fMRI and they'll be all set...

 

[nutcancer]

you psych types are real friendly. i was worried you guys would harrass me for suggesting your field is easily capable of being brushed over by neuro (which i don't even believe btw). thanks for the polite and rational responses. you guys are great!!!

 

[OldPsychDoc]

you psych types are real friendly. i was worried you guys would harrass me for suggesting your field is easily capable of being brushed over by neuro (which i don't even believe btw). thanks for the polite and rational responses. you guys are great!!!

It's just our way of seducing people over to the Dark Side...

 

[whopper]

I'm not pessimistic about the future of psychiatry, but I'm not sure I buy this.
We had a revolution in meds about 15-20 years ago with the SSRIs and atypicals, but there really have not been huge changes in the pharmacopoeia since then--the "lessened side effects" and "better meds" since have largely been reformulations of the above standards with longer-acting preps, etc. Pharmaceutical companies are hurting precisely because there are no new blockbusters in the works--and their previous generation of blockbusters is going generic.

Depends on how long a scope you consider. 5 years? 20? 50? I agree with you in shorter scope, but make the scope broader and my predictions will come true though it could take a long long long long time.

From what I can gather for the next few years.
The speculation is Da agonists such as Abilify may become the newer standard. Several companies are working on their own Da agonists and several more will be introduced.

There's a 2nd generation Clozaril in the works, currently called ACP-104. Still under testing. It may or may not be better.

ACP-103 is still in the works. A Serotonin modulating medication that hopefully will augment currently existing antipsychotics.

TMS may eventually be approved. Neuronetix (I believe that's the company) had its TMS device rejected by the FDA but the FDA still acknowledged that the device and the field still hold promise for future approval.

Anyways all of the above still need further work & study. We'll see.

 

[toby jones]

I guess you could ask about psychiatry's future as a science or psychiatry's future as an applied discipline.

With respect to the scientific project I anticipate a merger with the sciences of the mind / brain.

The notion is that sciences such as genetics, neuropsychology, cognitive psychology, developmental psychology, sociology, etc enable us to construct models of 'normal' mind / brain functions. Both neurological and psychiatric disorders are typically conceived of as 'breakdowns' or 'malfunctions' and hence we can model mind / brain dysfunctions as deviations from the model in certain specifyable respects.

The current distinction between neurology and psychiatry seems to be more a function of contingent facts of history rather than being motivated by a real distinction in the nature of the subject matter. There might be some way to motivate the distinction, but I haven't heard a good account yet.

Some candidates might be:

- Neurology deals in brain dysfunction whereas psychiatry deals in mental dysfunction. Trouble with this is that dualism is so centuries ago ;-)
- Neurology deals in modules whereas psychiatry deals in central system processes. Trouble with this is that the modular / central systems debate is far from settled (hence can't be relied upon for the current distinction)
- Neurology deals in mind / brain dysfunctions where the neurological causes are relatively understood. Trouble with this is that as our understanding increases psychiatric disorders will all come to be viewed as neurological.

With respect to practice...

I defer to the experts.

There is something to the 'they might want to claim that our disorders are neurological at base (hence part of neurology) but they also want to claim that some of their patients are psychiatric at base (hence should be treated by psychiatrists).

Lol.

 

[OldPsychDoc]

...Some candidates might be:

- Neurology deals in brain dysfunction whereas psychiatry deals in mental dysfunction. Trouble with this is that dualism is so centuries ago ;-)
- Neurology deals in modules whereas psychiatry deals in central system processes. Trouble with this is that the modular / central systems debate is far from settled (hence can't be relied upon for the current distinction)
- Neurology deals in mind / brain dysfunctions where the neurological causes are relatively understood. Trouble with this is that as our understanding increases psychiatric disorders will all come to be viewed as neurological.
....

OR--Neurology deals with "plumbing and packaging", and psychiatry deals with the REAL brain functions.

 

[swanny]

I'm glad to hear that you're interested in the field, and I think it's wise to "look before you leap." IMHO, I believe that the next several decades will be a time of great change within the field. Our understanding of the etiology and treatment of various psychiatric problems will evolve considerably, just as they have over the past fifty years. Future psychiatrists will need to be flexible and willing to consider alternative explanations and theories. I'm sure that there will be a very strong attempt to delineate specific diagnoses using procedures such as genetic analysis or brain imaging (and if we are fortunate, some may be discovered). However, I believe we will continue to find that people are not reducible to chemicals, genes, cells, electricity and environmental experiences. There will be a great need for compassionate psychiatrists who can listen well, who will provide a balance of therapy and medication management, and who will recognize the limitations that science and medicine face when dealing with individual human beings.