Psychiatric disorders account for an estimated 13% of the global disease burden and are among the most challenging diseases to treat. These disorders have a diverse array of symptoms, complex genetic risk associations, and poorly understood etiology. Currently, most available treatments are designed to ameliorate symptoms, rather than address the underlying pathology.
Therapeutic Strategies of Psychiatric Disorders
The therapy of psychiatric disorders has been challenging due to highly complex and heterogeneous disease mechanisms. This complexity has hampered the development of reliable clinical diagnostics and therapeutics. The difficulties in biomarker and therapeutic development may also be the result of lacking knowledge of the psychiatric disease interactome. At this stage, due to the complexity of psychiatric disorders, the treatment for patients with psychiatric disorders usually adapts a combination consisting of several strategies.
The past 50 years could easily be characterized as the age of psychopharmacology. From an economic perspective, we spend more money on psychotropic drugs than on any other class of pharmaceuticals. From a clinical perspective, especially in the case of psychiatry, psychiatrists have become much more comfortable prescribing an antidepressant than interpreting a patient’s unconscious motivations. From a scientific perspective, psychotropic drugs have made possible fundamental insights into how the brain functions. However, while helpful, psychotropic drugs cannot and will not (at least for the foreseeable future) treat the ravages of mental illness by themselves adequately. At present, the enormous complexities of interactions between human psychological life, the brain, and the social world request a combination of multiple therapeutic strategies.
Cognitive-behavioral therapy (CBT) is the most evidence-based form of psychotherapy for psychiatric disorders. CBT comprises two components: cognitive reappraisal and behavioral intervention. Individual and group CBT (that is, ERP with cognitive reappraisal), delivered in-person or by internet-based protocols, are effective for the treatment of psychiatric disorders. The most robust predictor of good short-term and long-term outcomes with CBT is patient adherence to between-session homework, such as carrying out exposure and response prevention (ERP) exercises in the home environment.
Fig.1 Diagram of the digital CBT process. (Kim, 2020)
The treatment of neurological and psychiatric disorders with physiotherapeutic strategies is characterized by the need for long-term or repetitive treatment. As an example, transcranial direct current stimulation (tDCS) is an emerging noninvasive brain stimulation (NIBS) technique that consists of the application of weak currents through electrodes placed on the head. There are dosage-dependent effects of tDCS, for example, in major depressive disorder and that maintenance treatment should be carried out in short intervals in the post-acute treatment of depression.
Patients and their family members can experience considerable relief when they are told by a professional that they have a relatively common disorder that is increasingly well understood and that the available treatments bring at least partial symptom reduction and improved quality of life. Factors such as stigma, prejudice, and the role of the family and significant others in aggravating or maintaining psychiatric disorders (such as family accommodation) should be addressed so that all involved can contribute to treatment success. For this reason, treatment should include the family whenever possible (and particularly in the case of children or adolescents with psychiatric disorders).
With the complexity of psychiatric disorders, therapeutic strategies still need further research. However, the development of omics tools, imaging techniques, as well as biomarker and target discovery will help us one day step over this obstacle.
Reference
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Kim, M.; et al. Multidimensional cognitive behavioral therapy for obesity applied by psychologists using a digital platform: Open-label randomized controlled trial. JMIR Mhealth Uhealth. 2020, 8(4): e14817. Distributed under Open Access license CC BY 4.0, without modification.
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