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The article examines developments in psychiatry between the 1950s and the 1990s. It also examines the science base of psychiatry and its significance for understanding the relationship between mind and brain. It focuses on three research areas: the role of experience in constructing the anatomy of the brain, regeneration in the central nervous system and gene effects in a social context.

Tao Gu,1 Debra F Eisenberg Lawrence,1 Judith J Stephenson,1 Jingbo Yu2 1HealthCore, Wilmington, DE, 2Merck & Co., Inc., Kenilworth, NJ, USA Background: Noncompliance with bisphosphonate therapy among osteoporosis patients attenuates the reduction of fracture risk. The objective of this study was to assess physicians’ prescribing considerations, preferences for osteoporosis treatments, and perceptions of patients’ compliance with oral bisphosphonates. Methods: This was an online survey of US physicians identified in the HealthCore Integrated Research Database (HIRDSM) as prescribing oral bisphosphonates to women aged ≥55 years. The survey gauged physicians’ prescribing considerations and preferences for various types of osteoporosis medications. The physicians were asked to predict patient persistence and compliance, and rate various reasons for noncompliance. Results: Bone mineral density, long-term medication use (eg, corticosteroids), and a history of fracture were ranked as major considerations by 94.9%, 88.6%, and 86.7% of participating physicians (N=158), respectively, when deciding whether to treat an osteoporosis patient. Most physicians expressed a preference for prescribing weekly or monthly oral bisphosphonates, for both newly diagnosed patients (54.4% and 34.2%, respectively) and long-term users of oral bisphosphonates (40.5% and 36.1%, respectively). Most physicians (23.4% always, 58.9% sometimes) incorporated a drug holiday into their prescribing patterns. Although most physicians predicted that more than half of the patients would comply with the prescribed medication for at least a year, 17.7% predicted that less than half of the patients would be compliant in the 1st year, and 29.7% predicted the same result for compliance beyond 1 year. In the opinion of the majority of physicians, the major reasons for noncompliance with oral bisphosphonates were intolerance of a medication due to a gastrointestinal condition (71.5%) and medication side effects (69.6%). Conclusion: US physicians consider several relevant risk factors when deciding whether to prescribe pharmacotherapy and exhibit a preference for weekly or monthly regimens. The physicians estimated a substantial minority of the patients to be noncompliant with oral bisphosphonates, for reasons including primarily gastrointestinal intolerance and medication-related side effects. Keywords: osteoporosis, bisphosphonates, physician’s practice patterns, cross-sectional studies, patient compliance

Looks at some studies of depression and the implications of findings for primary care physicians. Study by Kenneth Wells and his colleagues; Findings about the relation between depression and disability; The tendency of some primary care patients to somatize their emotional distress; Physicians who unwittingly collude with patients in ignoring psychiatric problems; Why patients with psychiatric disorders should be treated by mental health specialists; More.

The dysfunctional consequences of the Cartesian dichotomy have been enhanced by the power of biomedical technology. Technical virtuosity reifies the mechanical model and widens the gap between what patients seek and doctors provide. Patients suffer "illnesses"; doctors diagnose and treat "diseases". Illnesses are experiences of discontinuities in states of being and perceived role performances. Diseases, in the scientific paradigm of modern medicine, are abnormalities in the function and/or structure of body organs and systems. Traditional healers also redefine illness as disease: because they share symbols and metaphors consonant with lay beliefs, their healing rituals are more responsive to the psychosocial context of illness. Psychiatric disorders offer an illuminating perspective on the basic medical dilemma. The paradigms for psychiatric practice include multiple and ostensibly contradictory models: organic, psychodynamic, behavioural and social. This mélange of concepts stems from the fact that the fundamental manifestations of psychosis are disordered behaviours. The psychotic patient remains a person; his self-concept and relationships with others are central to the therapeutic encounter, whatever pharmacological adjuncts are employed. The same truths hold for all patients. The social matrix determines when and how the patient seeks what kind of help, his "compliance" with the recommended regimen and, to a significant extent, the functional outcome. When physicians dismiss illness because ascertainable "disease" is absent, they fail to meet their socially assigned responsibility. It is essential to reintegrate "scientific" and "social" concepts of disease and illness as a basis for a functional system of medical research and care. [ABSTRACT FROM AUTHOR]

The article focuses on the contrast between British and American social psychiatry. Social psychiatry is defined as an elastic concept to include all social, biological, educational and philosophical considerations which may come to empower psychiatry in its striving towards a society which functions with greater equilibrium and fewer psychological casualties. The importance of social context for health status had to be re-evaluated because of the spectacular triumphs of bacteriology in the last decades of the 19th century completely pre-empted medical vision. The response to medical treatment is in itself a profoundly psychosocial phenomenon.

What is known about the biology of AIDS is reviewed, and the social factors which influence disease transmission and public attitudes are considered. After an evaluation of the methods available to control the epidemic, the reasons for the limited success of public health measures thus far undertaken are considered. The ethical debate on public health policy is analysed, and the need for a nationwide educational programme on AIDS is emphasised--one which is responsive to the rights and obligations of citizens in a democratic society. [ABSTRACT FROM AUTHOR]

The rationale upon which public policy for the support of psychiatric research has been fashioned and the extent to which the results of that research are used to shape public mental-health policy are examined. Support for research competes with other claims for resource allocation and the decisions made reflect the relative strength of the interested constituencies. When research findings promise cost savings, they are readily adopted (sometimes unwisely so), but when they require substantial new outlays or changes in bureaucratic agencies, they are all too often ignored. [ABSTRACT FROM AUTHOR]

The article presents a lecture by Leon Eisenberg on the role of brain and mind in psychiatry. He explains the unique purpose of psychiatry in medicine and said that it will be found in the extent to which it contributes to the understanding of psychosomatic and somatopsychic integration. He added that the quality and duration of mental illness experience are shaped by a sick role constructed out of cultural beliefs and psychological traits idiosyncratic to the patient.