International Review of Psychiatry最新文献

The phenocopy syndrome of behavioural variant frontotemporal dementia (phFTD) refers to patients exhibiting clinical features of the behavioural variant of frontotemporal dementia (bvFTD), but lacking objective functional decline and neuroimaging abnormalities consistent with bvFTD. Although symptoms do not progress into dementia, they are disruptive and cause long-term family dysfunction. This case study aims to explore the social, biographical and demographic features of 8 patients with phFTD and their partners. The feasibility and subjective experience of a support group were explored. Eight phFTD patients and their partners completed self-report questionnaires assessing quality of life, family functioning, and coping styles. Most phFTD patients had some psychological vulnerability or reported a positive family history for psychiatric disorders. All couples showed challenges within family functioning and low quality of life (QOL) in both patients and their spouses. PhFTD patients predominantly utilized passive coping strategies whereas their partners tended to employ more active coping strategies. Our explorative study supports the hypothesis of a multifactorial biopsychosocial vulnerability in phFTD patients. In contrast to bvFTD patients, phFTD patients selfreport low quality of life. The discrepancy in coping styles between patients and their partners possibly contributes to the heavy impact on expressed burden.

Aim: Neuropsychiatric symptoms (NPS) are core features of behavioral variant frontotemporal dementia (bvFTD), but their association with functional decline is incompletely understood.

Methods: Participants (N = 219) were individuals enrolled in Alzheimer's Disease Research Centers between 2005 and 2024 with early-stage bvFTD (CDR ≤ 0.5). Functional status was coded as a binary variable based on the Functional Activities Questionnaire. Behavioral data were derived from the Neuropsychiatric Inventory Questionnaire and Clinician Judgement of Symptoms. Descriptive statistics and Cox proportional hazard analyses were used to characterize functional impairments and their association with NPS.

Results: Impairments in transactions (47%) and verbal communication (44%) were common at baseline, while impairments in self-care and incontinence (<10%) were rare. Apathy (65%), disinhibition (55%), depression, anxiety, irritability, and agitation were common at baseline (>40%). Psychosis was rare at baseline (<10%). By visit 4, impairments in transactions (81%), meal-preparation (65%), self-care (55%) and verbal communication (61%) were common. Emergence of apathy, disinhibition, depression, anxiety, and irritability were associated with an increased hazard of impairments in ambulation, meal preparation, self-care, and transactions.

Conclusion: NPS in bvFTD are frequent, occur early, and are associated with functional decline. Timely recognition and treatment of NPS may mitigate their impact on function.

This narrative review probes the future trends of psychiatry from the perspectives of professionals working in the field of early intervention for psychosis and youth mental health. The review is co-constructed by a diverse group of clinicians and researchers, including those with lived experience, working in high- to low-resource settings in the Asia-Pacific. Grounded in the consideration of psychiatry as a medical discipline. When the early intervention lens is applied to the state of psychiatry itself, several 'at-risk' factors have been observed: dilution of the doctor-patient relationship, lack of a robust integrated model of the human person and psychopathology, increased commercialisation, excessive reliance on other professionals, disconnection of knowledge generation and transmission, and tension between the healing and public safety roles of psychiatry. The complexity of mental illness, coupled with high stigma and low resources (even in relatively affluent populations), continues to undermine the proper functioning of psychiatry as a medical speciality. These challenges are likely to intensify in the future. Psychiatry as a profession needs to consolidate a robustly integrated medical approach to mental illness that resists splitting into 'biomedical' and 'psychosocial' perspectives, in the form of a biopsychosocially-informed medical psychotherapeutic practice. It will need to work with other stakeholders in the broader landscape of public mental health without diluting the healing roles in treating mental disorders. Behind a number of recent changes, the 'invisible hand' of the market economy is potentially driving psychiatry towards more inequity and escalating costs. Some of these have been fuelled by decreased effectiveness of the conventional academic platform and the rise of new information platforms that are increasingly challenging to manage. A thoughtful, prudent, and coordinated approach by the profession is essential in ensuring a healthy trajectory for the future of mental health care.

This paper overviews the future of clinical practice in psychiatry, covering diagnosis, treatment, and public health. We consider recent advances and new controversies as psychiatry moves from a categorical to a dimensional approach to diagnosing and classifying mental illness; as well as the potential pitfalls of overdiagnosis, underdiagnosis, and misdiagnosis. We also review some of the most exciting new developments in treatment modalities, such as psychedelic treatments, ketamine, and new antipsychotics. The potential of interventional psychiatry using technology, and review techniques including neuromodulation, neurofeedback, brain-computer interfaces, AI-assisted psychotherapy, and virtual reality is also discussed in the context of future of public mental health strategy, including the important issue of online disinformation and how it can influence the public's understanding of mental health. Finally, we consider the evolving understanding of addiction, particularly behavioural and technological addictions. We conclude with a brief discussion of how best to influence the political leadership in using these new advances to develop evidence-based, scientifically-informed healthcare policy.

From 1995 to 2025, psychiatry evolved from a primarily syndromic discipline toward a field increasingly shaped by neuroscience, digital technology, globalization, and shifting social expectations surrounding mental health. This transformation included major advances in diagnostic frameworks, brain imaging and genomics, psychopharmacology, evidence-based psychotherapies, and global mental health initiatives. The COVID-19 pandemic accelerated the adoption of telepsychiatry and exposed critical gaps in mental health infrastructure, while growing recognition of health disparities brought social determinants and equity to the forefront of research and clinical priorities.

Psychiatry is a discipline emergent from parts of other disciplines. This places it in a precarious position in society. Its practitioners must work with great uncertainty, formulate complex problems and respond to issues that fall outside the scope of other disciplines. Knowledge is always being added across psychiatry's biopsychosocial domains, and its purpose is constantly evolving in response to shifting societal perspectives on its role. Change in the coming decades will span data and knowledge, contexts of care, roles and relationships, as well as treatment advances. These changes will not manifest as obvious examples of linear progress, but instead as twists and turns characterised by rejections and revisions of ideas. This paper aims to explore how early career psychiatrists might navigate such changes by drawing on the enduring core skills and contributions of psychiatry. In doing this, one realises that while there may be observable differences in 30 years' time, at a deeper level, much may remain the same. This is not a pessimistic view, but instead one of optimism which highlights the continuous value psychiatry in the complex terrain of mental health care amongst its many other practitioners, systems and structures. In times of growth, our roots will be our guide.

Eating disorders (EDs) are complex conditions at the interface of mental and physical health, associated with high morbidity, mortality, and chronic disability. Historically, ED psychiatry has shifted from early medical observation to psychiatric formulation and, more recently, to psychology- and nursing-led service models. Despite advances in evidence-based psychological therapies and community expansion, outcomes remain modest and access to treatment is limited. Recent workforce growth centred on allied health professionals has not been paralleled by investment in psychiatric training, academic capacity, or consultant posts, resulting in limited specialist expertise. This imbalance has produced fragmented care and a two-tier system in which child and adolescent services have advanced while adult provision remains critically underfunded. Future progress will depend on revitalising eating-disorder psychiatry through sustained investment in training, workforce, and translational research. Integrating metabolic psychiatry, neurobiology, behavioural science, and digital health offers a path toward comprehensive, equitable, and improved treatments.

India, with its vast sociocultural diversity faces unique and complex mental health challenges that reflect profound regional, economic, and demographic variations. This paper examines the current landscape and future directions of mental health practices in India, arguing that a paradigm shift is essential to move beyond traditional, clinic-based approaches toward integrated, community-oriented care models. It highlights key challenges including significant treatment gaps, urban-centric service delivery, stigma, and insufficient workforce capacity. In response, the paper proposes a reimagined role for psychiatry - one that embraces multidisciplinary collaboration, leverages digital health technologies, and prioritizes culturally resonant frameworks. By anchoring mental health care within communities, strengthening primary care integration, and adopting scalable, socially responsive interventions, Indian psychiatry can not only address its own systemic challenges but also emerge as a leader in global mental health, particularly for low- and middle-income countries. The recommendations underscore the need for policies that support task-sharing, innovative training, and public engagement to build a more inclusive, effective, and resilient mental health ecosystem for India's future.

In Pakistan, mental health disorders constitute an escalating global burden of disease. Under-resourced healthcare systems coupled with recent economic and environmental challenges exacerbate mental health distress and impedes the recovery of those suffering from mental health issues. Psychosocial rehabilitation provides a sustainable pathway to strengthen health systems capacity by focusing on functional recovery and community reintegration. Since 1971, Fountain House has been providing psychosocial rehabilitation to people suffering from mental health issues in Pakistan through its community-based social services. Poverty is both a cause and consequence of mental illness. Akhuwat, a non-profit organization, aims to address this gap by providing interest-free micro loans, vocational training and subsidized health and housing assistance to those deprived of formal financial services. This article explores early outcomes of a collaborative venture between Fountain House and Akhuwat, working at the intersection of poverty and mental health with the combined goal of psychosocial rehabilitation and economic empowerment.

Psychiatry has long felt itself to be under threat. The authors examine how the perception of threats to psychiatry has evolved over the last 35 years, as exemplified in papers from 1990 and 2011, and how recent development is linked to the current concerns about overmedicalisation and overdiagnosis in medicine and psychiatry. They examine this in the context of the developing technologies and cultures of information and artificial intelligence. They argue that, while psychiatry has always understood the workings of the mind through contemporary social, cultural and technological constructs, and always understood the mind to be embodied by the brain, the task of reaching a diagnosis remains difficult, vital and central to the question of the future of psychiatry.