Brain chemistry reveals psychiatry’s false divisions – new study

[Sly Saint]

Brain chemistry reveals psychiatry’s false divisions – new study

Dopamine clues reveal a common thread in psychosis.

theconversation.com

For decades, psychiatrists have treated psychosis as if it were separate conditions. People experiencing hallucinations and delusions might be diagnosed with schizophrenia, bipolar disorder, severe depression and related diagnoses, and receive completely different treatments based on diagnosis. But new research suggests this approach may be fundamentally flawed.

Our latest study, published in Jama Psychiatry, reveals that the brain changes driving psychotic symptoms are remarkably similar across these supposedly distinct mental health conditions. The findings could change how doctors choose treatments for the millions of people worldwide who experience psychosis.

Psychosis itself is not a disease, but rather a collection of generally deeply distressing symptoms, where people may struggle to distinguish reality from normal perception. They might hear voices that are not there, hold false beliefs with unshakeable conviction, or find their thoughts becoming jumbled and incoherent. These symptoms are new in onset, and terrifying – regardless of whether they occur alongside depression, mania, or without these mood symptoms.

We studied 38 people experiencing their first episode of psychosis with mood symptoms, comparing them with healthy volunteers. Using sophisticated brain scanning technology, we measured the synthesis of dopamine – a brain chemical tied to motivation and reward – in different regions of the brain.

We found that while most people with manic episodes showed higher dopamine synthesis in emotion-processing areas of the brain compared to those with depression, there was a common pattern across all participants: higher dopamine synthesis in thinking and planning regions were consistently linked to more severe psychosis symptoms (hallucinations and delusions), regardless of their official diagnosis.

This discovery challenges some aspects of modern psychiatric practice. Currently, treatment decisions rely heavily on diagnostic categories that may not reflect what is actually happening in people’s brains. Two people with identical symptoms might receive entirely different drugs simply because one was diagnosed with bipolar disorder and another with depression.

(It's funny how they like to separate Psych conditions and yet are so keen to club physical ones together as PPS).

 

[rvallee]

Weird how defining subjective experience based on the opinions of people witnessing, and never actually experiencing, superficial aspects of the thing does not yield good results. Most likely if they were able to actually talk with the patients, listen to that experience without pre-judging things, most of this could have been avoided.

As textbook an example of how a little knowledge can be dangerous as it gets. Normally in technology development follows a curve where an initial burst of discovery plateaus then regresses a little, though still a higher state of knowledge than when things began, until more discoveries open up new paths.

In medicine they seem to follow a different curve, where initial knowledge pushes them farther away from looking at the right place, until some chance breakthrough manages to pull things back down to an increase in total knowledge. All because of the secretive dictatorial nature of the work, where they can impose their opinions onto people who categorically reject that it has anything to do with how they experience it.

Much closer to an old aristocratic system than a professional one. They just want the mind to influence the body, not the other way around. Plus, they want a separate magical mind involved, no matter how much they pretend otherwise. They want the magic to be real more than they want science to work. At least until science does the work, then it's as if none of this silly nonsense ever happened, all the mistakes either buried or silenced.

The implications could be profound. Rather than basing treatment solely on psychiatric categories, doctors might soon use biological markers to identify which drugs will work best for individual people. This approach, known as precision psychiatry, mirrors how oncologists already tailor cancer treatments to the genetic makeup of specific tumours.

Uh. I think they actually call this thing... medicine. It's an idea, for sure. Involving biology. Which happens to be the thing they train on, and what all their tools and science are about.

This does not mean psychiatric diagnoses are worthless. They remain crucial for organising healthcare services, facilitating communication between professionals, and determining access to treatment. But they may no longer be the best guide for choosing medications.

Oh, actually, some of them are explicitly dangerous and destructive. Even more so when they make up an additional layer of bullshit with this "not quite medical, not quite psychiatric, not quite psychological" which no one actually believes and is simply bullshit for public consumption.

As our understanding of the brain advances, the rigid categories that have dominated psychiatry for decades are beginning to blur. If the brain (and mother nature) does not respect diagnostic boundaries, neither should our treatments.

Oh, don't be silly, none of this is happening. They have several decades more of this to go on. Every change will happen piecemeal, the "holistic" folks only ever looking at one thing in isolation, only ever generalizing when it goes their way. Not until they are stopped. With consequences.

 

[bobbler]

Brain chemistry reveals psychiatry’s false divisions – new study

Dopamine clues reveal a common thread in psychosis.

theconversation.com

(It's funny how they like to separate Psych conditions and yet are so keen to club physical ones together as PPS).

Two people with identical symptoms might receive entirely different drugs simply because one was diagnosed with bipolar disorder and another with depression.

Neither of these necessarily require psychosis as part of these? And I'd assume for example if someone was being treated for depression and developed psychosis then the person treating them would then be looking into 'treating the psychosis' or 'looking at the diagnosis being more specific or changing in line with this new development/information'?

And the other conditions mentioned aren't just psychosis or just dopamine. PLus of course dopamine changes with exercise, excitement and other conditions that don't involve psychosis and do they know what those all look like on a scan too in order to isolate out things related to that?

I have that worrying hark back to the potential with 'treat the symptoms' for the days of coshing or calming rather than trying to work out the full picture of what has changed and when to see the mechanism/cause.

I'm not arguing that treatments shouldn't be better and psychiatry can't be hugely improved but I'm not sure this suggestion of direction of travel is it. Why not just 'more accurate and checked diagnoses' rather than logging it by symptom-base. What if someone then has 4-5 symptoms combined - are they going to be looking carefully at whether eg if something isn't looking for the cause or mechanism but the downstream those other symptoms are improved or made worse by treatment for one, or just have psychosis treaters?

Lots to get my brain around here as to what is being suggested

Just because for 38 people whose first psychotic episode it was apparently looked similar enough on the measures used I'm not sure that it draws a line on the inferences or conclusions. We don't know anything else about those 38 people. And some conditions are more common than others to be picked up.

PS I'm also intrigued how they managed to get 'the first' and for it to be 'live' because I'm sure it wouldn't then be from the start surely because by it being someone's first were they already on the ward but we assume it is this or were they somehow triaged that quickly, whilst in a psychotic episode into a machine and experiment - and how does informed consent work around that, or indeed it being 'therapeutic' given that being put in an MRI machine doesn't sound like the most sensible thing to do without a lot of careful prep if someone is in that state and it's a state that they haven't even experienced before.

 

[bobbler]

I'm a bit confused by the suggestion given the following also:

Main Outcomes and Measures Striatal Kicer and scores on the Positive and Negative Syndrome Scale, Hamilton Depression Rating Scale, Montgomery-Åsberg Depression Rating Scale, and Young Mania Rating Scale were determined.

Results: People with psychosis and MDE had lower Kicer compared with those with psychosis and mixed/mania syndromes (β [SE], 0.014 [0.001]; P = .02), with the largest difference observed in the limbic striatum (Cohen d = 1.57; P < .001). In the overall psychosis sample, higher striatal Kicer was associated with greater positive psychotic symptoms (R2 = 0.13; β [SE], 0.000066 [0.000030]; P = .03), notably in the associative striatum (R2 = 0.15; P = .02).

 

[Sean]

If the brain (and mother nature) does not respect diagnostic boundaries, neither should our treatments.​

Sounds awfully transdiagnostic. Which is a concern.