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Chapter 20 - Evolutionary Thinking and Clinical Care of Psychiatric Patients

Published online by Cambridge University Press:  08 September 2022

Riadh Abed
Affiliation:
Mental Health Tribunals, Ministry of Justice, UK
Paul St John-Smith
Affiliation:
Hertfordshire Partnership University NHS Foundation Trust, UK
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Summary

Psychiatric therapeutics is facing a major crisis that originates from its limited efficacy and dubious scientific credibility. Such a crisis requires a radical change in the paradigm that inspires psychiatric research and clinical practice. The new paradigm should integrate in a meaningful way all of the variables that mediate the aetiology and pathogenesis of psychiatric disorders: biological, psychological, developmental, behavioural and social. The essence of the evolutionary study of human psychology and behaviour is just such an integration. Therefore, evolutionary thinking has great potential to improve the clinical care of psychiatric patients. According to a modern view of medicine, the aims of therapy are not only to lessen symptoms and to reverse the pathogenic mechanisms, but also to restore the congruence between a patient’s functional capacities and the conditions of the environment. Evolutionary thinking suggests replacing symptoms with functional capacities as the primary targets of psychiatric treatment. Most mental disorders are conditions of compromised functional capacities. Therapy should aim at improving patients’ capacities necessary to enact behaviours associated with goal achievement. When treating patients, clinicians should distinguish between symptoms caused by dysfunctional mechanisms and symptoms that are adaptive reactions to environmental situations with negative cost–benefit outcomes.

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Chapter
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Evolutionary Psychiatry
Current Perspectives on Evolution and Mental Health
, pp. 305 - 318
Publisher: Cambridge University Press
Print publication year: 2022

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References

Alexander, R., Aragón, O. R., Bookwala, J., Cherbuin, N., Gatt, J. M., Kahrilas, I. J., Kästner, N., Lawrence, A., Lowe, L., Morrison, R. G., Mueller, S. C., Nusslock, R., Papadelis, C., Polnaszek, K. L., Helene Richter, S., Silton, R. L. and Styliadis, C. (2021). The neuroscience of positive emotions and affect: implications for cultivating happiness and wellbeingNeurosci Biobehav Rev121, 220249.CrossRefGoogle ScholarPubMed
Andrews, P. W,. Thomson, J. A. Jr, Amstadter, A. and Neale, M. C. (2012). Primum non nocere: an evolutionary analysis of whether antidepressants do more harm than good. Front Psychol, 3, 117.CrossRefGoogle ScholarPubMed
Blease, C. R. (2018). Psychotherapy and placebos: manifesto for conceptual clarity. Front Psychiatry, 9, 379.CrossRefGoogle ScholarPubMed
Bracken, P., Thomas, P., Timimi, S., Asen, E.Behr, G.Beuster, C.Bhunnoo, S.Browne, I.Chhina, N.Double, D., Downer, S.EvansC., Fernando, S., GarlandM. R., Hopkins, W., HuwsR., Johnson, B., Martindale, B., Middleton, H.Moldavsky, D.MoncrieffJ., Mullins, S., Nelki, J.Pizzo, M.Rodger, J.SmythM., Summerfield, D.Wallace, J. and Yeomans, D. (2012). Psychiatry beyond the current paradigmBr J Psychiatry, 201, 430434.CrossRefGoogle ScholarPubMed
Childs, B. (1999). Genetic Medicine: A Logic of Disease. Baltimore, MD: Johns Hopkins University Press.Google Scholar
Cuthbert, B. N. (2020). The role of RDoC in future classification of mental disorderDialogues Clin Neurosci, 22, 8185.CrossRefGoogle Scholar
Davies, W. and Roache, R. (2017). Reassessing biopsychosocial psychiatry. Br J Psychiatry, 210, 35.CrossRefGoogle ScholarPubMed
Drukarch, B., Jacobs, G. E. and Wilhelmus, M. M. M. (2020). Solving the crisis in psychopharmacological research: cellular-membrane(s) pharmacology to the rescue? Biomed Pharmacother, 130, 110545.CrossRefGoogle Scholar
Engel, G. L. (1980). The clinical application of the biopsychosocial model. Am J Psychiatry, 137, 535544.Google ScholarPubMed
Flaum, M. (2010). Strategies to close the ‘mortality gap’. Am J Psychiatry, 167, 120121.CrossRefGoogle Scholar
Fuchs, T. (2004). Neurobiology and psychotherapy: an emerging dialogue. Curr Opin Psychiatry, 17, 479485.CrossRefGoogle Scholar
Ganev, K. (2000). Long-term trends of symptoms and disability in schizophrenia and related disorders. Soc Psychiatry Psychiatr Epidemiol, 35, 389395.CrossRefGoogle ScholarPubMed
Guina, J., Rossetter, S. R., DeRhodes, B. J., Nahhas, R. W. and Welton, R. S. (2015). Benzodiazepines for PTSD: a systematic review and meta-analysis. J Psychiatr Pract, 21, 281303.CrossRefGoogle ScholarPubMed
Guze, S. B. (1992). Why Psychiatry Is a Branch of Medicine. OxfordOxford University Press.Google Scholar
Harmer, C. J., Duman, R. S. and Cowen, P. J. (2017). How do antidepressants work? New perspectives for refining future treatment approaches. Lancet Psychiatry, 4, 409418.CrossRefGoogle ScholarPubMed
Helliwell, J. F. and Aknin, L. B. (2018). Expanding the social science of happinessNat Hum Behav2, 248252.CrossRefGoogle ScholarPubMed
Henningsen, P. (2015). Still modern? Developing the biopsychosocial model for the 21st century. J Psychosom Res, 79, 362363.CrossRefGoogle ScholarPubMed
Holt-Lunstad, J. (2018). Why social relationships are important for physical health: a systems approach to understanding and modifying risk and protection. Annu Rev Psychol, 4, 437458.CrossRefGoogle Scholar
Humphrey, N. and Skoyles, J. (2012). The evolutionary psychology of healing: a human success story. Curr Biol, 22, R695R698.CrossRefGoogle ScholarPubMed
Huneke, N. T. M., van der Wee, N., Garner, M. and Baldwin, D. S. (2020). Why we need more research into the placebo response in psychiatry. Psychol Med, 50, 23172323.CrossRefGoogle Scholar
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R.Pine, D. S.Quinn, K.Sanislow, C. and Wang, P. (2010). Research Domain Criteria (RDoC): toward a new classification framework for research on mental disordersAm J Psychiatry, 167, 748751.CrossRefGoogle Scholar
Jordan, J. R. and Neimeyer, R. A. (2003). Does grief counseling work? Death Studies27, 765786.CrossRefGoogle ScholarPubMed
Klinkman, M. S. (2009). Assessing functional outcomes in clinical practice. Am J Manag Care, 15, S335S342.Google ScholarPubMed
Kothgassner, O. D., Pellegrini, M., Goreis, A., Giordano, V.Edobor, J.Fischer, S.Plener, P. L. and Huscsava, M. M. (2021). Hydrocortisone administration for reducing post-traumatic stress symptoms: a systematic review and meta-analysis. Psychoneuroendocrinology, 126, 105168.CrossRefGoogle ScholarPubMed
Lebowitz, M. S. and Appelbaum, P. S. (2019). Biomedical explanations of psychopathology and their implications for attitudes and beliefs about mental disorders. Annu Rev Clin Psychol, 15, 555577.CrossRefGoogle ScholarPubMed
Lilienfeld, S. O. (2007). Psychological treatments that cause harmPerspect Psychol Sci, 2, 5370.CrossRefGoogle ScholarPubMed
Locher, C., Koechlin, H., Gaab, J. and Gerger, H. (2019). The other side of the coin: nocebo effects and psychotherapyFront Psychiatry, 10, 555.CrossRefGoogle ScholarPubMed
Margraf, J. and Schneider, S. (2016). From neuroleptics to neuroscience and from Pavlov to psychotherapy: more than just the ‘emperor’s new treatments’ for mental illnesses? EMBO Mol Med, 8, 11151117.CrossRefGoogle Scholar
Matar, M. A., Zohar, J., Kaplan, Z. and Cohen, H. (2009). Alprazolam treatment immediately after stress exposure interferes with the normal HPA-stress response and increases vulnerability to subsequent stress in an animal model of PTSD. Eur Neuropsychopharmacol, 19, 283295.CrossRefGoogle Scholar
McGuire, M. T. and Troisi, A. (1998). Darwinian Psychiatry. Oxford: Oxford University Press.CrossRefGoogle Scholar
McQueen, D. and St John-Smith, P. (2012). Placebo effects: a new paradigm and relevance to psychiatry. Int Psychiatry, 9, 13.CrossRefGoogle ScholarPubMed
Miresco, M. J. and Kirmayer, L. J. (2006). The persistence of mind–brain dualism in psychiatric reasoning about clinical scenarios. Am J Psychiatry, 163, 913918.CrossRefGoogle ScholarPubMed
Moncrieff, J., Gupta, S. and Horowitz, M. A. (2020). Barriers to stopping neuroleptic (antipsychotic) treatment in people with schizophrenia, psychosis or bipolar disorderTher Adv Psychopharmacol, 10, 2045125320937910.CrossRefGoogle ScholarPubMed
Nesse, R. M. (1990). The evolutionary functions of repression and the ego defensesJ Am Acad Psychoanal, 18, 260285.CrossRefGoogle ScholarPubMed
Nesse, R. M. (2005). Evolutionary psychology and mental health. In Buss, D. (ed.), Handbook of Evolutionary Psychology. Hoboken, NJ: Wiley, pp. 903927.Google Scholar
Nesse, R. M. (2018). The smoke detector principle: signal detection and optimal defense regulationEvol Med Public Health, 2019, 1.CrossRefGoogle ScholarPubMed
Nesse, R. M. (2019). Good Reasons for Bad Feelings: Insights from the Frontiers of Evolutionary Psychiatry. London: Penguin Random House.Google Scholar
Norcross, J. C. and Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy (Chic), 55, 303315.CrossRefGoogle ScholarPubMed
Oades, L. and Mossman, L. (2017). The science of wellbeing and positive psychology. In Slade, M., Oades, L. and Jarden, A. (eds.), Wellbeing, Recovery and Mental Health. Cambridge: Cambridge University Press, pp. 723.CrossRefGoogle Scholar
Price, J., Cole, V. and Goodwin, G. M. (2009). Emotional side-effects of selective serotonin reuptake inhibitors: qualitative study. Br J Psychiatry, 195, 211217.CrossRefGoogle ScholarPubMed
Read, J., Cartwright, C. and Gibson, K. (2014). Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants. Psychiatry Res, 216, 6773.CrossRefGoogle ScholarPubMed
Read, J., Gee, A., Diggle, J. and Butler, H. (2017). The interpersonal adverse effects reported by 1008 users of antidepressants; and the incremental impact of polypharmacy. Psychiatry Res, 256, 423427.CrossRefGoogle ScholarPubMed
Rosa, A. R., Reinares, M., Franco, C., Comes, M., Torrent, C., Sánchez-Moreno, J., Martínez-Arán, A., Salamero, M., Kapczinski, F. and Vieta, E. (2009). Clinical predictors of functional outcome of bipolar patients in remission. Bipolar Disord, 11, 401409.CrossRefGoogle ScholarPubMed
Sansone, R. A. and Sansone, L. A. (2010). SSRI-induced indifference. Psychiatry (Edgmont), 7, 1418.Google ScholarPubMed
Saris, I. M. J., Aghajani, M., van der Werff, S. J. A., van der Wee, N. J. A. and Penninx, B. W. J. H. (2017). Social functioning in patients with depressive and anxiety disordersActa Psychiatr Scand, 136, 352361.CrossRefGoogle ScholarPubMed
Seligman, M. E. P. (2019). Positive psychology: a personal history. Annu Rev Clin Psychol, 15, 123.CrossRefGoogle ScholarPubMed
Singewald, N., Schmuckermair, C., Whittle, N., Holmes, A. and Ressler, K. J. (2015). Pharmacology of cognitive enhancers for exposure-based therapy of fear, anxiety and trauma-related disorders. Pharmacol Ther, 149, 150190.CrossRefGoogle Scholar
Troisi, A. (2012). Mental health and well-being: clinical applications of Darwinian psychiatry. In Roberts, S. (ed.), Applied Evolutionary Psychology. New York: Oxford University Press, pp. 277289.Google Scholar
Troisi, A. (2015). The evolutionary diagnosis of mental disorder. Wiley Interdiscip Rev Cogn Sci, 6, 323331.CrossRefGoogle ScholarPubMed
Troisi, A. (2017) The Painted Mind: Behavioral Science Reflected in Great Paintings. New York: Oxford University Press.CrossRefGoogle Scholar
Troisi, A. (2019). The biology of mental disorders: what are we talking about? Behav Brain Sci, 42, e29.CrossRefGoogle Scholar
Troisi, A. (2020a). Are we on the verge of Darwinian psychiatry? In Workman, L., Reader, W. and Barkow, J. (eds.), The Cambridge Handbook of Evolutionary Perspectives on Human Behavior. Cambridge: Cambridge University Press, pp. 409418.CrossRefGoogle Scholar
Troisi, A. (2020b). Social stress and psychiatric disorders: evolutionary reflections on debated questions. Neurosci Biobehav Rev, 116, 461469.CrossRefGoogle ScholarPubMed
Troisi, A. and McGuire, M. T. (2000). Psychotherapy in the context of Darwinian psychiatry. In Gilbert, P. and Bailey, K. G. (eds.), Genes on the Couch: Explorations in Evolutionary Psychotherapy. Philadelphia, PA: Taylor & Francis, pp. 2841.Google Scholar
Uher, R. (2014). Gene–environment interactions in severe mental illness. Front Psychiatry, 5, 48.CrossRefGoogle ScholarPubMed
Ustün, B. and Kennedy, C. (2009). What is ‘functional impairment’? Disentangling disability from clinical significance. World Psychiatry, 8, 8285.CrossRefGoogle Scholar
Wager, T. D. and Atlas, L. Y. (2015). The neuroscience of placebo effects: connecting context, learning and health. Nat Rev Neurosci, 16, 403418.CrossRefGoogle ScholarPubMed
Zimmerman, M., Martinez, J., Attiullah, N., Friedman, M., Toba, C. and Boerescu, D. A. (2012a). Why do some depressed outpatients who are not in remission according to the Hamilton Depression Rating Scale nonetheless consider themselves to be in remission? Depress Anxiety, 29, 891895.CrossRefGoogle ScholarPubMed
Zimmerman, M., Martinez, J. A., Attiullah, N., Friedman, M.Toba, C.Boerescu, D. A. and Rahgeb, M. (2012b). Why do some depressed outpatients who are in remission according to the Hamilton Depression Rating Scale not consider themselves to be in remission? J Clin Psychiatry, 73, 790795.CrossRefGoogle Scholar
Zimmerman, M., McGlinchey, J. B., Posternak, M. A., Friedman, M., Attiullah, N. and Boerescu, D. (2006). How should remission from depression be defined? The depressed patient’s perspective. Am J Psychiatry, 163, 148150.CrossRefGoogle ScholarPubMed

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