Evolutionary biology provides a crucial foundation for medicine and behavioral science that has been missing from psychiatry. Its absence helps to explain slow progress; its advent promises major advances. Instead of offering a new kind of treatment, evolutionary psychiatry provides a scientific foundation useful for all kinds of treatment. It expands the search for causes from mechanistic explanations for disease in some individuals to evolutionary explanations for traits that make all members of a species vulnerable to disease. For instance, capacities for symptoms such as pain, cough, anxiety and low mood are universal because they are useful in certain situations. Failing to recognize the utility of anxiety and low mood is at the root of many problems in psychiatry. Determining if an emotion is normal and if it is useful requires understanding an individual's life situation. Conducting a review of social systems, parallel to the review of systems in the rest of medicine, can help achieve that understanding. Coping with substance abuse is advanced by acknowledging how substances available in modern environments hijack chemically mediated learning mechanisms. Understanding why eating spirals out of control in modern environments is aided by recognizing the motivations for caloric restriction and how it arouses famine protection mechanisms that induce binge eating. Finally, explaining the persistence of alleles that cause serious mental disorders requires evolutionary explanations of why some systems are intrinsically vulnerable to failure. The thrill of finding functions for apparent diseases is evolutionary psychiatry's greatest strength and weakness. Recognizing bad feelings as evolved adaptations corrects psychiatry's pervasive mistake of viewing all symptoms as if they were disease manifestations. However, viewing diseases such as panic disorder, melancholia and schizophrenia as if they are adaptations is an equally serious mistake in evolutionary psychiatry. Progress will come from framing and testing specific hypotheses about why natural selection left us vulnerable to mental disorders. The efforts of many people over many years will be needed before we will know if evolutionary biology can provide a new paradigm for understanding and treating mental disorders.
{"title":"Evolutionary psychiatry: foundations, progress and challenges.","authors":"Randolph M Nesse","doi":"10.1002/wps.21072","DOIUrl":"10.1002/wps.21072","url":null,"abstract":"<p><p>Evolutionary biology provides a crucial foundation for medicine and behavioral science that has been missing from psychiatry. Its absence helps to explain slow progress; its advent promises major advances. Instead of offering a new kind of treatment, evolutionary psychiatry provides a scientific foundation useful for all kinds of treatment. It expands the search for causes from mechanistic explanations for disease in some individuals to evolutionary explanations for traits that make all members of a species vulnerable to disease. For instance, capacities for symptoms such as pain, cough, anxiety and low mood are universal because they are useful in certain situations. Failing to recognize the utility of anxiety and low mood is at the root of many problems in psychiatry. Determining if an emotion is normal and if it is useful requires understanding an individual's life situation. Conducting a review of social systems, parallel to the review of systems in the rest of medicine, can help achieve that understanding. Coping with substance abuse is advanced by acknowledging how substances available in modern environments hijack chemically mediated learning mechanisms. Understanding why eating spirals out of control in modern environments is aided by recognizing the motivations for caloric restriction and how it arouses famine protection mechanisms that induce binge eating. Finally, explaining the persistence of alleles that cause serious mental disorders requires evolutionary explanations of why some systems are intrinsically vulnerable to failure. The thrill of finding functions for apparent diseases is evolutionary psychiatry's greatest strength and weakness. Recognizing bad feelings as evolved adaptations corrects psychiatry's pervasive mistake of viewing all symptoms as if they were disease manifestations. However, viewing diseases such as panic disorder, melancholia and schizophrenia as if they are adaptations is an equally serious mistake in evolutionary psychiatry. Progress will come from framing and testing specific hypotheses about why natural selection left us vulnerable to mental disorders. The efforts of many people over many years will be needed before we will know if evolutionary biology can provide a new paradigm for understanding and treating mental disorders.</p>","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 2","pages":"177-202"},"PeriodicalIF":73.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10168175/pdf/WPS-22-177.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9436375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
World Psychiatry 22:2 June 2023 forces have pushed us to a genetic sweet spot regarding a cer tain trait that does not tail off gradually but, with relatively minor changes in the allele distribution, suddenly transforms into dis order. Many psychological traits may need to stay within narrow bounds to enable adaptive social interaction, so small variations may yield cliff edge disorder vulnerability. Emergent properties of specific allele combinations may exist for other unexpected reasons. For example, a recent study found that certain combinations of positively selected alleles yield ing cognitive advantage increased risk for autism spectrum dis order. Moreover, beyond alleles, at the trait level, there can be dysfunction causing combinations of individually selected posi tive traits (e.g., certain combinations of individually selected per sonality traits can yield personality disorders such as psychopa thy). All of this goes to show that it is not dimensionality per se but the way selective processes operated on various elements on a dimension that determines normality and disorder. Evolutionary psychiatry’s role thus transcends the current dis pute over psychiatry’s nosological future. Whichever proposal triumphs, psychiatry’s status as a medical discipline requires distinguishing normal variation from mental disorder, which rests on understanding human psychobiological design. Symp tom networks, extremes on symptom dimensions, and intense brain circuitry activations can be normal or abnormal depend ing on context. These proposals, whatever their merits, rearrange the symptomatic deck chairs on our nosological Titanic without addressing the root problem: i.e., that DSM psychiatric nosology is sinking due to lack of attention to the evolved nature of human normality, yielding invalid normal/disorder demarcations. Only evolutionary psychiatry provides a scientifically defensible answer to the fundamental nosological normal/disorder “demar cation” problem. Because the way people are biologically designed does not always fit social values and ideals, evolutionary psychiatry treads on potentially controversial ground. There is a tension between social idealizations – what we want to believe about ourselves and demand of our society’s members – versus the scientific reality of human nature. M. Foucault correctly observed that a society’s view of human nature tends to be distorted and permeated by its values and biases, rationalizing its efforts at social control. If psychiatry is to make scientific progress, it must understand the truth of human nature that lies beyond cultural preconceptions as a basis for valid diagnostic concepts that support psychiatric science. The promise of evolutionary psychiatry is that it is the one subdiscipline of psychiatry devoted to realizing this foundational goal.
{"title":"Biomarkers in psychiatric disorders: status quo, impediments and facilitators.","authors":"Michael Berk","doi":"10.1002/wps.21071","DOIUrl":"https://doi.org/10.1002/wps.21071","url":null,"abstract":"World Psychiatry 22:2 June 2023 forces have pushed us to a genetic sweet spot regarding a cer tain trait that does not tail off gradually but, with relatively minor changes in the allele distribution, suddenly transforms into dis order. Many psychological traits may need to stay within narrow bounds to enable adaptive social interaction, so small variations may yield cliff edge disorder vulnerability. Emergent properties of specific allele combinations may exist for other unexpected reasons. For example, a recent study found that certain combinations of positively selected alleles yield ing cognitive advantage increased risk for autism spectrum dis order. Moreover, beyond alleles, at the trait level, there can be dysfunction causing combinations of individually selected posi tive traits (e.g., certain combinations of individually selected per sonality traits can yield personality disorders such as psychopa thy). All of this goes to show that it is not dimensionality per se but the way selective processes operated on various elements on a dimension that determines normality and disorder. Evolutionary psychiatry’s role thus transcends the current dis pute over psychiatry’s nosological future. Whichever proposal triumphs, psychiatry’s status as a medical discipline requires distinguishing normal variation from mental disorder, which rests on understanding human psychobiological design. Symp tom networks, extremes on symptom dimensions, and intense brain circuitry activations can be normal or abnormal depend ing on context. These proposals, whatever their merits, rearrange the symptomatic deck chairs on our nosological Titanic without addressing the root problem: i.e., that DSM psychiatric nosology is sinking due to lack of attention to the evolved nature of human normality, yielding invalid normal/disorder demarcations. Only evolutionary psychiatry provides a scientifically defensible answer to the fundamental nosological normal/disorder “demar cation” problem. Because the way people are biologically designed does not always fit social values and ideals, evolutionary psychiatry treads on potentially controversial ground. There is a tension between social idealizations – what we want to believe about ourselves and demand of our society’s members – versus the scientific reality of human nature. M. Foucault correctly observed that a society’s view of human nature tends to be distorted and permeated by its values and biases, rationalizing its efforts at social control. If psychiatry is to make scientific progress, it must understand the truth of human nature that lies beyond cultural preconceptions as a basis for valid diagnostic concepts that support psychiatric science. The promise of evolutionary psychiatry is that it is the one subdiscipline of psychiatry devoted to realizing this foundational goal.","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 2","pages":"174-176"},"PeriodicalIF":73.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10168162/pdf/WPS-22-174.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9436369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The promise of evolutionary psychiatry.","authors":"Jerome C Wakefield","doi":"10.1002/wps.21070","DOIUrl":"https://doi.org/10.1002/wps.21070","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 2","pages":"173-174"},"PeriodicalIF":73.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10168155/pdf/WPS-22-173.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9442878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"WPA education initiatives in the triennium 2020-2023.","authors":"Roger M K Ng","doi":"10.1002/wps.21107","DOIUrl":"https://doi.org/10.1002/wps.21107","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 2","pages":"346-347"},"PeriodicalIF":73.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10168174/pdf/WPS-22-346.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9442884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
World Psychiatry 22:1 February 2023 3. Koblan KS, Kent J, Hopkins SC et al. N Engl J Med 2020;382:1497-506. 4. Thase ME. CNS Spectr 2017;22:39-48. 5. Tabuteau H, Jones A, Anderson A et al. Am J Psychiatry 2022; doi: 10.1176/appi.ajp.21080800. 6. Fava M, Stahl S, Pani L et al. Am J Psychiatry 2021; 179:122-31. 7. Gunduz-Bruce H, Silber C, Kaul I et al. N Engl J Med 2019;381:903-11. 8. Davis AK, Barrett FS, May DG et al. JAMA Psychiatry 2021;78:481-9.
{"title":"The future of psychopharmacology: challenges beyond efficacy and tolerability.","authors":"Robin Emsley","doi":"10.1002/wps.21065","DOIUrl":"https://doi.org/10.1002/wps.21065","url":null,"abstract":"World Psychiatry 22:1 February 2023 3. Koblan KS, Kent J, Hopkins SC et al. N Engl J Med 2020;382:1497-506. 4. Thase ME. CNS Spectr 2017;22:39-48. 5. Tabuteau H, Jones A, Anderson A et al. Am J Psychiatry 2022; doi: 10.1176/appi.ajp.21080800. 6. Fava M, Stahl S, Pani L et al. Am J Psychiatry 2021; 179:122-31. 7. Gunduz-Bruce H, Silber C, Kaul I et al. N Engl J Med 2019;381:903-11. 8. Davis AK, Barrett FS, May DG et al. JAMA Psychiatry 2021;78:481-9.","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 1","pages":"82-83"},"PeriodicalIF":73.3,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840489/pdf/WPS-22-82.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9164324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Accelerating Medicines Partnership<sup>®</sup> Schizophrenia (AMP<sup>®</sup> SCZ): developing tools to enable early intervention in the psychosis high risk state.","authors":"Linda S Brady, Carlos A Larrauri","doi":"10.1002/wps.21038","DOIUrl":"10.1002/wps.21038","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 1","pages":"42-43"},"PeriodicalIF":73.3,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840500/pdf/WPS-22-42.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9164326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marco O Bertelli, Annamaria Bianco, Luis Salvador-Carulla, Afzal Javed
{"title":"WPA Working Group on Defining and Managing Autism Spectrum Disorder: spreading knowledge for the next generations of psychiatrists.","authors":"Marco O Bertelli, Annamaria Bianco, Luis Salvador-Carulla, Afzal Javed","doi":"10.1002/wps.21051","DOIUrl":"https://doi.org/10.1002/wps.21051","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 1","pages":"168-169"},"PeriodicalIF":73.3,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840480/pdf/WPS-22-168.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9164331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marco Colizzi, Alexis E Cullen, Natasha Martland, Marta Di Forti, Robin Murray, Tabea Schoeler, Sagnik Bhattacharyya
{"title":"Association between stressful life events and psychosis relapse: a 2-year prospective study in first-episode psychosis.","authors":"Marco Colizzi, Alexis E Cullen, Natasha Martland, Marta Di Forti, Robin Murray, Tabea Schoeler, Sagnik Bhattacharyya","doi":"10.1002/wps.21046","DOIUrl":"https://doi.org/10.1002/wps.21046","url":null,"abstract":"","PeriodicalId":23858,"journal":{"name":"World Psychiatry","volume":"22 1","pages":"159-160"},"PeriodicalIF":73.3,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840498/pdf/WPS-22-159.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9164757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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