What Do You See As the Single Biggest Challenge Facing Psychiatry?

by Manuel Mota-Castillo | February 17, 2012 10:01 PM EST

There are many challenges but if I have to choose the "single biggest"I will have to go with the "desmedicalization" of psychiatry. This is the only field of medicine that allows non-physician to make medical diagnoses and doctors from other specialties to prescribe some of the more potent psychotropic medications as if they were placebos.

I believe that psychiatrists need to reclaim his field and to return to practice the art of medicine instead of the blinded use of outdated diagnostic tools as a routine.

Unless your name is Nassir Ghaemi and you are a wizard of statistics, doctors (not only in psychiatry) should first listen to the patients and their family and then to what studies say… because they can be wrong.

I can think of several examples:

1- Prevalence of ADHD: Experts continue saying "close to 10%" in complete disregard for the studies that show that too many children are diagnosed with something different when they reach adulthood. And I am not even talking about the lack of rationale for diagnosing an autistic child with ADHD.

2- Oppositional-Defiant diagnosis: Is been kept alive even though it was conceived at a time when children were not allowed to have serious psychiatric Dxs and their behavior needed an explanation. What could have been better than to blame "the little ones" for aggression and defiance despite all those developmental theories been teach at those very same times?

3- Antidepressants for bipolar disorder: I understand that multiple studies show they are safe for use in bipolar depression but, for God Sake, what could the justification to start an antidepressant on a patient hospitalized involuntarily in a manic state?

4- Antidepressants induce suicidal thoughts: Really? How come the FDA, the AMA and the APA ignored the fact that millions of OCD patients around the world never had one incident of feeling suicidal while on SSRIs unless they have co-morbid bipolar disorder?

I could make a long list but 4 is my favorite number and besides, the APA is like the Red Sox, they never change.

Manuel Mota-Castillo, M.D.
Lake Mary, FL
www.psychiatricanswers.com

by Richard Folger | February 23, 2012 11:39 AM EST

I think that it's parity of care... Or getting HMOs to cover more psychiatric care. I work for state government and our beds are shrinking, who's going to care for long-term psych illness? Or even acute stays?

by Deborah Cody | February 23, 2012 1:50 PM EST

I believe that the fact of stigma toward the mentally ill among health care providers as well as the general public is the single biggest challenge. Funding, etc will follow the reduction of stigma.

by michael loscalzo | February 23, 2012 1:51 PM EST

Irrelevance- With psychiatrist doing nearly exclusively medication management, there is no reason that "medication management" could not become a subspecialty of internal medicine or family practice. With psychiatrist making more on average than either it is no longer a joke. Add to this that psychiatric residencies continue to teach and focus on dynamic psychotherapy while psychologist become experts in complex psychotherapies like Prolonged Exposure. While cognitive science has wildly expanded, psychiatry has not and basically has given up on the neurotic level patient. The psychiatrist continues to train and act as a generalist while the world demands greater levels of specialization than ever before.

by Susan Jahn | February 23, 2012 10:11 PM EST

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