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Psychiatric Heuristics: Contrasting Conceptualizations of Brain Functioning

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Length: 49 minutes

Dalia S. Manjarres Cohen, Alyssa Fredrick, MA, Ewelina Lakomy & Sandra Steingard, MD

This panel explores two ways in which conceptualizations of the role of brain science lead to specific ideas about intervention in psychosis. One account speaks to the genesis of at least some cases of psychotic illness and the other to possible new ways of thinking about pharmacological treatment. First, Dalia Manjarres Cohen, Alyssa Fredrick and Ewelina Lakomy highlight TBI as a risk factor in the development of later psychosis, discussing brain changes evident in the neuroimaging studies of those with psychosis and the potential of TBI to create similar changes. They argue that distinguishing TBI-induced schizophrenia from other forms might lead to more specifically tailored and thus effective treatments, and also to increased understanding of both manifestations of psychotic illness. Then Sandra Steingard speaks to an increasing trend in psychiatry towards mechanistic understandings and treatments, as psychiatry has strayed from its original focus on the broad effects of psychopharmacological interventions in its search for specific and localized medication effects. As an alternative, Steingard’s paper offers a proposal to reform modern psychiatric practice, following Moncrieff in arguing that psychiatry abandoned its initial focus of understanding the broad nature of psychoactive drug effects to shift towards a model that assumed these drugs had effects that targeted specific disease processes. This shift in focus has tended to minimize the risks of drug discontinuation and long-term use. The author applies the drug-centered concept to examining the history and current understanding of two classes of drugs: neuroleptics and psychostimulants. She concludes by suggesting that a need-adapted approach might be integrated with a drug- centered pharmacology to reclaim psychiatry and offer a way forward. 



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