This issue of Psychiatric Annals guest-edited by Gregory A. Bayer, PhD, Rhonda Robinson Beale, MD, and George I. Viamontes, MD, PhD, focuses on brain-body interactions and provides clinicians with a great challenge. Thinking about complex interacting stress response systems in play in our patients makes it more difficult to be simplistic about the clinical presentations we encounter. We need to avoid separating mental and physical manifestations as we assess and treat our patients. Instead, we need to think about the stress response systems that are malfunctioning in our patients, their level, and how we can intervene to normalize them.
Clinicians are naturally programmed to think in terms of interventions. A successful intervention disrupts a pathological process to the extent of reducing symptoms, which are causing distress and disability in our patients. If a clinician confronts a patient with major depression, severe anxious ruinations, severe fatigue, severe anhedonia, insomnia with nightmares, and muscle pain with a past history of childhood sexual and emotional abuse, perhaps we have to think beyond prescribing our favorite selective serotonin reuptake inhibitor (SSRI). We need to think of the many stress-activated processes involved and how we might intervene to fully address the patient’s symptoms.
In psychiatry, we have several different classes of treatment modalities: chemical, electrical, and learning (psychotherapy and behavioral inputs). We have different medications to try to intervene in various pathological process. It seems that different types of learning (different psychotherapies) may have both general and, possibly, specific effects. Great progress is being made in electrical therapies, but their application is currently limited to more severe or treatment resistant conditions.
Psychopharmacotherapy and psychotherapies are helpful in the treatment of depression and posttraumatic stress disorder (PTSD), but the types of these therapies that are helpful may differ. It seems that the type of symptom presented may be helped or targeted by specific inputs (eg, the use of prazosin, an alpha blocker for PTSD-related anxiety). It appears that a patient’s profile of symptoms may call for an individualized palette of treatments required to intervene in different mechanisms underlying these clinical manifestations. It seems we are moving toward treating specific symptom combinations that are not always captured by a given diagnosis.
We learn from this series of articles that we may also be able to intervene in the development of life-diminishing and life-threatening medical disorders. This broadens the way we think of the disorders we treat, as well as expanding our opportunities to intervene to benefit our patients. It is an exciting time to be practicing psychiatry.