Brain-immune interactions in neuropsychiatry: highlights of the basic science and relevance to pathogenic factors and epiphenomena

Unraveling the significant complexity of brain-immune interactions could provide essential new insights and potential treatment considerations for the clinical neurosciences. Despite considerable research relating immunological changes to major neuropsychiatric disorders, it has been difficult to establish that immunological processes are involved in the development of central nervous system pathology associated with these disorders. This brief article highlights some of the landmark basic studies and seeks to convey essential principles guiding research in brain-immune interactions. Research in this area often incorporates several disciplines, ranging from psychology and neuroscience to immunology and molecular genetics. The clinical implications of this area of research are discussed, with emphasis on the challenge of disentangling pathogenic factors and valid markers of disease from epiphenomena.     

Thirty years of teaching psychotherapy skills

The author outlines a basic model for teaching psychotherapeutic skills that includes five modules relating to (1) the dynamics of exploration, designed to encourage the patient's affective expression; (2) relationship structure, considering patterns of patient-therapist interaction along a closeness/separateness continuum; (3) affect, empathy, and distance regulation, emphasizing the crucial significance of identifying correctly and responding empathically to patients' affective messages; (4) basic cognitive interventions, focused on techniques for facilitating the patient's narrative flow and capacity to analyze experiences, and for formulating the patient's psychopathology; and (5) the therapist's use of self. The author concludes by examining why systematic psychotherapy training is particularly important at this time, in light of such pressures as managed health care, neuroscientific advances and psychopharmacologic breakthroughs, and the wave of self-help organizations.     

Attachment-dissociation network: some thoughts about a modern complex theory

The paper revises the complex theory in the light of modern infant research, neurosciences and object relation theory. The author takes up Jean Knox's idea to understand complexes as analogies to the internal working models of attachment theory. The author proposes to understand complexes as dissociated sub-networks out of the network structure of the psyche; these sub-networks contain the internal working models, the characteristic affects and unconscious expectation phantasies. With this network model one can try to understand severe defensive organizations in some patients as a pathological organization of different complexes. This is illustrated by a clinical example.     

Treatment of developmental stress disorder: mind,body and brain – analysis and pharmacology coupled

The schism between psychiatry, psychology and analysis, while long present, has widened even more in the past half‐century with the advances in psychopharmacology. With the advances in electronic brain imaging, particularly in developmental and post‐traumatic stress disorders, there has emerged both an understanding of brain changes resulting from severe, chronic stress and an ability to target brain chemistry in ways that can relieve clinical symptomatology. The use of alpha‐1 adrenergic brain receptor antagonists decreases many of the manifestations of PTSD. Additionally, this paper discusses the ways in which dreaming, thinking and the analytic process are facilitated with this concomitant treatment and hypervigilence and hyper‐arousal states are signficiantly decreased.     

The case for neuropsychoanalysis: Why a dialogue with neuroscience is necessary but not sufficient for psychoanalysis

Recent advances in the cognitive, affective and social neurosciences have enabled these fields to study aspects of the mind that are central to psychoanalysis. These developments raise a number of possibilities for psychoanalysis. Can it engage the neurosciences in a productive and mutually enriching dialogue without compromising its own integrity and unique perspective? While many analysts welcome interdisciplinary exchanges with the neurosciences, termed neuropsychoanalysis, some have voiced concerns about their potentially deleterious effects on psychoanalytic theory and practice. In this paper we outline the development and aims of neuropsychoanalysis, and consider its reception in psychoanalysis and in the neurosciences. We then discuss some of the concerns raised within psychoanalysis, with particular emphasis on the epistemological foundations of neuropsychoanalysis. While this paper does not attempt to fully address the clinical applications of neuropsychoanalysis, we offer and discuss a brief case illustration in order to demonstrate that neuroscientific research findings can be used to enrich our models of the mind in ways that, in turn, may influence how analysts work with their patients. We will conclude that neuropsychoanalysis is grounded in the history of psychoanalysis, that it is part of the psychoanalytic worldview, and that it is necessary, albeit not sufficient, for the future viability of psychoanalysis.     

Quanta, quarks, and families: implications of quantum physics for family research

This paper offers recommendations for family research in light of the scientific paradigm ushered in by quantum physics in the early twentieth century. After summarizing the basic discoveries of quantum physics, the author discusses philosophical implications of these discoveries, and then presents implications for conducting scientific research about families within a post-Newtonian paradigm that emphasizes relations, process, and dynamic causation. The author argues for using complementary research models, including linear and systemic, because no one theory or methodology can illuminate fully the inscrutable nature of family processes.     

Brain‐mind philosophy

The remarkable advances in continuing elucidation of the anatomy, physiology, and pathology of the central nervous system in recent experimental animal and clinical studies have provided new contexts for evaluating earlier historical and current controversies on human brain‐structure‐function and brain‐mind relationships. Churchland's Neurophilosophy reviews and critically evaluates the implications of the recent advances in the various neurosciences for formulation of a comprehensive concept of the nature of the mind and the historical controversies on human structure‐function and brain‐mind relationships. Although uneven, it is a monumental effort and a remarkable achievement that will provide new, broader, and deeper contexts for philosophers as well as for those engaged in the various neurosciences.     

Issues in the psychopharmacologic assessment and treatment of the orthodox Jewish patient

As with members of other cultural and religious groups, patients within the Orthodox Jewish community present with their own distinct clinical psychiatric issues related to their unique beliefs and practices. This article reviews the existing literature and anecdotal experience on the psychopharmacologic assessment and treatment of Orthodox Jewish patients. Specific aspects examined include this group's perceived intense stigma in receiving treatment, the priority this community places on cognitive functioning, and how the influence of Jewish laws on marriage and sexual practices impacts one's treatment decisions. The relevance of Jewish dietary laws, the Sabbath, and the community's interest in alternative treatments are also discussed. The limited ethno-psychopharmacology research related to Orthodox Jewish psychiatric patients is reviewed. We conclude that understanding issues such as these is critical if one is going to work within this cultural system in order to successfully address their mental health issues. However, the dearth of controlled research in this community needs to be addressed to provide more effective treatment.     

Time to get rid of the ‘Modular’ in neuropsychology: A unified theory of anosognosia as aberrant predictive coding

Cognitive neuroscience, being more inclusive and ambitious in scope than cognitive neuropsychology, seems to have taken the place of the latter within the modern neurosciences. Nevertheless, recent advances in the neurosciences afford neuropsychology with epistemic possibilities that simply did not exist even 15 years ago. Human lesion studies still have an important role to play in shaping such possibilities, particularly when combined with other methods of enquiry. I first outline theoretical and methodological advances within the neurosciences that can inform and shape the rebirth of a dynamic, non‐modular neuropsychology. I then use an influential computational theory of brain function, the free energy principle, to suggest an unified account of anosognosia for hemiplegia as a research example of the potential for transition from a modular, cognitive neuropsychology to a dynamic, computational and even restorative neuropsychology. These and many other adjectives that can flexibly, take the place of ‘cognitive’ next to ‘neuropsychology’ will hopefully designate the much needed rebirth and demarcation of a field, neuropsychology itself, that has somehow lost its place within the modern neurosciences and yet seems to have a unique and important role to play in the future understanding of the brain.     

Publishing in the Psychological Sciences: Enhancing Journal Impact While Decreasing Author Fatigue

ABSTRACT— The publication process in the psychological sciences is unduly tedious and would benefit from the adoption of a publishing model typical of the neurosciences and basic sciences. The author argues that such a change would result in higher impact publications in the psychological sciences and would also conserve the time of busy scientists.     

Neuropsychopharmacologic treatment of depression and other neuropsychiatric disorders in HIV-infected individuals

How can neuropsychiatric disorders and syndromes be underdiagnosed and inadequately treated in individuals infected with human immunodeficiency virus? Depression in particular is among the most prevalent diagnoses and there is a solid foundation of data from controlled clinical studies that has begun to examine the efficacy of various antidepressants in HIV-infected persons. This article summarizes essential findings pertaining to the use of psychotropic medications to treat depression and other neuropsychiatric disorders in the context of immunodeficiency. This includes discussion of clinically significant treatment considerations (eg, efficacy, side effects, drug-drug interactions) derived from the existing literature. Taken together, there is compelling evidence that psychopharmacologic intervention can improve the quality of life of mentally ill HIV-infected individuals.     

Ethics and Intuitions

For millennia, philosophers have speculated about the origins of ethics. Recent research in evolutionary psychology and the neurosciences has shed light on that question. But this research also has normative significance. A standard way of arguing against a normative ethical theory is to show that in some circumstances the theory leads to judgments that are contrary to our common moral intuitions. If, however, these moral intuitions are the biological residue of our evolutionary history, it is not clear why we should regard them as having any normative force. Research in the neurosciences should therefore lead us to reconsider the role of intuitions in normative ethics.     

Smoking research: basic research, intervention, prevention, and new trends

Smoking is a behavior that is influenced by a variety of factors that cut across methodologies, disciplines, and content areas within health psychology. The present article is designed to show the diversity and richness of smoking research by examining smoking from four perspective: basic laboratory research, intervention, prevention and deterrence, and new directions in smoking research. Methodologies that were derived from such varied sources as psychopharmacology, behavioral pharmacology, behavior therapy, clinical psychology, public health and health promotion, and social and developmental psychology have been used to study the smoking problem. The subject populations in these investigations ranged from animal models, to the individual smoker attempting to quit, to communities involved in health promotion and public health approaches. Future research should seek to provide new and improved examples of interdisciplinary research within the field of health psychology to multidisciplinary approaches from the basic and applied sciences.     

PSYCHOANALYSIS IN SCANDINAVIA: PART ONE

During recent years, the neurosciences have entered into a dialogue with psychoanalysis, which has opened new perspectives for their integration. Despite these developments, reservations remain concerning the reducing effects of the neurosciences by overtly or covertly hiding the core elements of psychoanalysis. However, Freud made an explicit parallel between psychoanalysis and physics in their relationship with the unknown reality, and in their task of filling in gaps in knowledge. Freud's epistemological view implies that the relationship with the unknown reality unites rather than separates psychoanalysis from other sciences. On the other hand, in the clinical realm, Freud emphasized the autonomy of psychoanalysis. Instead of offering causal explanations, the value of the neurosciences to psychoanalysis depends on how well the knowledge derived from them can be integrated in psychoanalysis and given a clinical meaning. The primacy of clinical relevance also pertains to the findings of empirical outcome research.     

Facial expressions and the regulation of emotions

In the two decades since contemporary psychologists produced strong evidence confirming Darwin's century-old hypothesis of the innateness and universality of certain facial expressions of emotions, research on expressive behavior has become well established in developmental, social, and personality psychology and in psychophysiology. There are also signs of increased interest in emotions in clinical psychology and the neurosciences. Despite the success of the work on emotion expression and the upward trend of interest in emotions in general, the fundamental issue of the relation between emotion expression and emotion experience or feeling state remains controversial. A new developmental model of expression-feeling relations provides a framework for reevaluating previous research and for understanding the conditions under which expressions are effective in activating and regulating feeling states. The model has implications for research, socialization practices, and psychotherapy.     

Role of norepinephrine in the pathophysiology of neuropsychiatric disorders

The concatenation of convergent lines of evidence from basic to clinical research continues to reveal that norepinephrine (NE) is a crucial regulator of a myriad of behaviors ranging from stress response to memory formation. Furthermore, many neuropsychiatric disorders involve neurocircuitry that is directly modulated by NE. This report summarizes the physiological roles of NE, as well as the main findings implicating a role for NE system dysfunction in mood and anxiety disorders, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and Alzheimer's disease. In each of these disorders, there appears to be a complex dysregulation of NE function, with changes in locus ceruleus firing, NE availability, and both pre- and postsynaptic receptor regulation. Many symptoms of these disorders are attributable to abnormalities within distributed neural circuits regulated by NE. Appreciation of NE's role in modulating the neural circuitry mediating cognition and affect should help elucidate the pathophysiology of a variety of neuropsychiatric disorders and the development of novel treatments.     

Interfaces: toward a new generation of systemic models in family research and practice

After reviewing Engel's bio-psycho-social proposal and Kandel's "principles for an integration between mind and brain," the author introduces a set of akin propositions that aim at integrating neurosciences, genetics, the mind, and the social world into a succinct set of systemic formulations focusing on interlevel interfaces, with profound implications for the training, practice, and research in the field of family processes and therapy.     

Placebo in the investigation of psychotropic drugs,especially antidepressants

The paper presents major ethical, legal and methodological problems related to the use of placebo in mental disorders, especially in depression. It is pointed out that although authoritative groups of experts and numerous publications in the field of psychopharmacology indicate advisability of the double blind design with placebo in clinical trials of antidepressants, in recent years there have been more and more voices questioning legitimacy of this method. Objections of an ethical nature are raised, and reliability of this approach is put into doubt from the methodological viewpoint. These issues are discussed in more detail in the paper. Available alternative solutions should be implemented in psychotropic drug studies. The author shares these objections and doubts of an ethical nature, and believes that the placebo procedure is not a necessity in clinical trials of antidepressants. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Bruno Bettelheim and the Chazon Ish: Toward a New Jewish Psychotherapy

Jeremiah is quoted and cited to show the basic optimism of Judaism. Why did Freud create an “Oedipus Complex,” rather than a “Joseph Phenomenon”?—especially since Freud had such a great knowledge of the Bible, including the Joseph story; and the Biblical Joseph made frequent appearances in Freud's dreams. Many of the advances in psychology and psychiatry were made in part as a rebellion against the ideology of psychoanalysis—this includes family therapy, behavioral therapy, and psychopharmacology. Bettelheim saw the shortcomings of psychoanalysis, both as a theory to explain human behavior and as a cure for psychological problems. The experiences of Bettelheim and of The Chazon Ish can give us new hope. The Chazon Ish and Bettelheim both sought to help in the context of a type of community. Reading of the Bible throws light on people's problems; and people can be helped by identification with Biblical characters. There is often specific advice in the Bible. Bible therapy can strengthen the bond between the therapist and the patient, which is important for patient improvement. There is a need for this type of psychotherapy.     

Psychopharmacology of depression in the next millennium

Over the last half of the 20th century, there have been a series of psychopharmacologic strategies for treatment of depression. As we approach the next century, new therapies in varying stages of American release are being developed. This review will focus on information available for the following proposed antidepressants: 1) reboxetine, a norepinephrine selective reuptake inhibitor; 2) milnacipran, a combined serotonin/norepinephrine reuptake inhibitor; 3) a new enantiomer of fluoxetine, a selective serotonin reuptake inhibitor; 4) duloxetine, another combined serotonin/norepinephrine reuptake inhibitor; 5) sunepitron, a combined 5-HT1A agonist and a2 antagonist; and 6) MK-869, a substance P inhibitor. Finally, other possible developing directions will be reviewed, including corticotropin-releasing factor.