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PRAKAT KARKI

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PSEng (3rd year)

18th November, 2022

GUEST LECTURE
on

Current Trends and Issues in Psychiatry and Clinical Psychology

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Prakat Karki

Resource person

DOB: May, 1992

Nationality- Nepalese

Current Address: Koramangala, 560029, Bangalore, INDIA.

Permanent Address: Lalitpur, Ward no-14, Kathmandu, NEPAL

Email: prakatkarki@gmail.com

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PRAKAT KARKI

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    EDUCATION

  • 2019 - : PhD in Psychology (UGC-JRF), CHRIST (Deemed to be) University, Bangalore, INDIA

  • 2014 - 2016: MSc in Clinical Psychology, CHRIST (Deemed to be) University, Bangalore, INDIA

  • 2011 - 2014: BA in Psychology Honors, CHRIST (Deemed to be) University, Bangalore, INDIA

  • 2008 - 2011: Cambridge University GCE A Levels (for 11th & 12th), GEMS Institute of Higher Education (GIHE), Lalitpur, NEPAL

  • 2008: School Leaving Certificate (SLC) from Galaxy Public School, Kathmandu, NEPAL

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Scope for Input sessions in following areas/skills/tools

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  • Scientific Writing using MS Word

  • Data management and Descriptive Statistics using MS Excel

  • Hypothesis testing and Inferential Statistics using SPSS

  • Logical and Quantitative Reasoning for Competitive Exams/Higher Education

  • Steps in Reviewing Scientific Literature

  • Experimental Psychology Tools- PEBL, E-Prime, PsychLab 101, PsyToolKit, z-Tree

  • Statistics Tools- SPSS, R, Factor, AMOS, Jamovi, JASP, MPlus

  • Academic Tools- Microsoft package and Google Suite

  • Data management Tools- Zenodo, OSF, Dryad Digital, Harvard Dataverse

  • Web tools- Wix, Wordpress, Canva

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Current Trends and Issues in Psychiatry and Clinical Psychology​

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An overview of the various global issues, trends and challenges prevalent in the field of mental health and psychiatric diagnosis based on an article published in World Psychiatry in October, 2022; titled 'Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration' (Stein et al., 2022).

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https://doi.org/10.1002/wps.20998

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The journal 'World Psychiatry' also published input and commentaries by few of the most prominent scientists in Psychiatry/ Clinical Psychology on the article.

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Presents the argument of whether Psychiatry as a discipline is on the verge of a paradigm shift or if new newer evidences will integrate with existing frameworks.

 

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Background

  • History of Psychiatry- different models and approaches to mental disorders over the centuries.

  • Key events of institutionalization, marginalization and mistreatment

  • Moved to a more 'Scientific approach' in the last century with advances in Psychoanalysis by Freud.

  • In latter half of 20th century, shift towards Evidence based Pharmacotherapies and Psychotherapies for the treatment of mental disorders.

  • Psychiatric diagnosis as a 'nosological science'- DSM-5 & ICD-11, Research Domain Criteria (RDoC)

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Current Models & Approaches in Psychiatry

  • Psychiatry training: Years of general and specialized training in most places worldwide

  • Inpatient Psychiatry for severe mental disorders (schizophrenia, bipolar) and Outpatient Psychiatry focuses on mostly common mental disorders (anxiety, depression, substance use)

  • Multi disciplinary team of mental health professionals

  • DSM and ICD systems- considerable influence on modern psychiatry; increase reliability of diagnosis, and have clinical utility, since they provide clinicians with an approach to conceptualizing disorders; also implications in research and community epidemiological surveys.

  • Also considerable critique of the reliance of modern psychiatry on the DSM and the ICD; it advocates a checklist type approach and is detached from real practice.

  • Biopsychosocial model still dominates the understanding of etiology of mental disorders (although criticized for being eclectic and vague)

  • Growing emphasis on Pharamacotherapy interventions.

  • Data points to a Treatment gap as well as Research-Practice gap

  • Need for accurate estimates of effctive treatment coverage globally

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[Context of India: Mental Health]

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1. Clinical Neuroscience & Personalized Pharmacotherapy

  • Rise of Biological Psychiatry- due to discovery of psychiatric medications and advances in molecular, genetic and neuroimaging methods

  • Emerging contributions from clinical neuroscience, translational psychiatry, precision psychiatry, and personalized psychiatry

  • Research findings demonstrate that there is considerable
    overlap of genetic architecture across different DSM and ICD mental disorders

  • This paradigm views psychiatry as a clinical neuroscience, which
    should rest on a firm foundation of neurobiological knowledge

  • Despite promising results, search for accurate biomarkers for mental disorders still om.  

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2. Novel Statistical approaches in Psychiatric Research & Assessment 

  • Endearing challenge of producing a causal nosology that is able to direct treatment.

  • DSM and ICD  criticized for overly focusing on reliability at the expense of validity; syndromic definition lacks specificity, and there are likely different causal pathways that lead to same disorders.

  • Factor analysis and related statistics to uncover unobserved, common factors to mental disorders (similar to personality research).

  • HiTop (Hierarchical Taxonomy of Psychopathology) Paradigm: factor
    analysis ultimately points towards the existence of a single latent trait that would explain all psychopathology; “p”, or general psychopathology factor {similar to g factor in intelligence).

  • Neural networks and deep learning have advanced artificial intelligence, and are increasingly being applied to the investigation of psychiatric disorders,

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3. Deinstitutionalization and Community Mental Health Care

  • Downscaling of large psychiatric institutions and the transition of patients into community care [last 70 years, mostly in West)

  • Development of community based specialized services for treatment and management of mental health disorders; collaborative care, shared decision making, recovery models

  • Mental health also integrated into insurance schemes.

  • Factors for deinstitutionalization: New psychiatric medications, costs of institutionalization, and rise of human rights movement in 1950s.

  • In developing nations, the transition has still not happened fully.

  • Deinstitutionalization has its critics too- revolving door of care.

  • 52.7$ per capita on mental health in high income countries, only 0.08$ in low income countries

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4. CBT and the scale up of Evidence based Psychotherapy

  • Since 1970s, Cognitive Behavioral Therapy (CBT) has been at the core of  shift  towards evidence based psychotherapies in clinical practice.

  • Used for wide range of mental disorders, including depression, anxiety disorders, substance use disorders, bipolar disorder, psychotic disorders,
    somatoform disorders, eating disorders, personality disorders    , and also other conditions, such as anger and aggression, chronic pain, and fatigue.

  • CBT highly consistent with a neurological model of mental disorders.

  • Despite strong evidence of CBT's efficacy, it has not been integrated into mental health systems globally.

  • Take up of psychotherapy has declined whereas use of medication has increased since the 1990s.

  • The extent and breadth of CBT and related therapies in developing countries is still low. 

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5. Digital phenotyping and Digital Therapies

  • Expansion of internet and widespread use of electronic and smart devices.

  • Examples: VR as exposure therapy for phobias and PTSD, chatbots to
    deliver remote CBT anonymously,  computer analysis of closed circuit television (CCTV) images can identify suicide attempts, etc.

  • Furthermore: widespread use of digital medical records, vast collection of individual data, and new analysis techniques have enabled big data analysis

  • Smartphones- a host of passive data (ex- sleep data from smart watch) that enables continuous inexpensive surveillance. 

  • Need to identify digital markers for mental disorders. 

  • Issues of digital inequality is also rampant, especially in developing nations

  • Digital mental health industry- driven by the information technology industry and commercial interests, rather than from a clinical one

  • Screen time may also be associated with mental health problems. 

  • Technology has changed the relationship between physician and patients.

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6. Global mental health and Task sharing

  • With growing recognition of the burden of non­communicable diseases, including mental, neurological and substance use disorders, global mental health became an important focus.

  • World Health Organization (WHO): recognition of the burden of mental disorders, and advocacy that this burden needs to be urgently and appropriately addressed.

  • Far too few mental health clinicians in low and middle income countries. 

  • In non West countries- Few psychiatrists and resources (brain drain) and  task shifting (non specialized healthcare workers providing mental health care).

  • Idea of mental health as an investment to society: in terms of costs saved in healthcare costs and loss of productivity.

  • Need for more efforts on stigma reduction. 

  • Governments need to address fundamental social injustices such as inequality, high unemployment, high conflict, etc. 

Discussion

in psychiatry there is a particular need for pluralistic and pragmatic approaches that integrate a range of different concepts, methods and findings.

Need to be  cautious in concluding that we are facing a crisis in psychiatry which necessitates a disruptive transitioning from traditional to new practices.

Paradigm shift seems unlikely

PS. CALL FOR PARTICIPANTS

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Research study on Polysusbtance use & its risk factors

Participate in this PhD research study by Mr. Prakat Karki on the topic of polysubstance use. Youths between 18 and 26 years and currently enrolled in college education in India are eligible to participate.

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