Monday, July 06, 2020

Brain effects of antipsychotic medication

An article in JAMA Psychiatry reports a secondary analysis of a randomised controlled trial of antipsychotic medication to show that antipsychotic medication is associated with changes in brain structure. Exposure to olanzapine compared with placebo was associated with significant decreases in cortical thickness in the left hemisphere in those who sustained remission. This kind of finding is is not new (see previous post). Postmortem studies in animals have been linked to imaging findings (Vernon et al, 2013, Konopaske et al, 2007). 

The clinical significance of these findings is unclear. How adverse these apparent brains changes are requires further elucidation.

(With thanks to Mad in America research news item by Peter Simons)

Reifying the mind

Mohammed Abouelleil Rashed (whose book I have recently reviewed) has an article on ‘The identity of psychiatry and the challenge of mad activism: Rethinking the clinical encounter’. He suggests that medicine is committed to the hypostatic abstraction (from Charles Pierce) which implies that doctors treat "things" that people "have". Mohammed does recognise that physicians frame their work to take account of the whole person and psychiatry is different from the rest of medicine because it focuses on mental disorders rather than physical disorders. 

I have argued throughout this blog (eg. see previous post) that psychiatry should not reify psychiatric disorder. Mohammed does acknowledge that some psychiatrists do not think the hypostatic abstraction is central to their work. He accepts that the clinical encounter can provide understanding and have therapeutic aims without such an assumption, but falls short of wanting to "rethink the entirety of mental health practice".

As I've said before (eg. see previous post),  our modern concept of illness only really goes back to the mid-nineteenth century. Understanding illness in terms of underlying physical pathology does make disease a thing that people have (in Mohammed's terms). The trouble is that psychiatry never really fitted with this development of the anatomoclinical method, which related clinical symptoms and signs to underlying pathology. Most mental illness (apart from organic illness) is functional, in the sense that there is no underlying pathology in the brain (see eg. another previous post).

This situation was why Engel proposed the biopsychosocial model (see eg. previous post). Medicine needs to be person-centred (see eg. another previous post) and this is more obviously the case in psychiatry where there is no physical illness. I'm not suggesting taking the challenge of mad activism as far as abolishing the notion of mental disorder (see eg. yet another previous post) but I would encourage Mohammed to take further his analysis of the critical challenge to the biomedical model of psychiatry. Despite what he seems to think, psychiatry does not need to accept the hypostatic abstraction to be a medical speciality (see eg. previous post).