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Today
psychopharmacology has made it possible to cure many psychiatric complaints,
very often completely, and this currently represents the fastest growing
pharmacological sector. Psychiatric diagnostics, using increasingly
more sophisticated empirical and statistical methods, has managed to
paint a very precise syndromic picture indeed of psychiatric complaints
and is close to the final goal of diagnostics based on aetiopathogenic
criteria. Finally, the exponential growth of neuro-sciences has led
to a growing knowledge of the pathophysiological brain mechanisms behind
psychiatric complaints. In the light of new discoveries and new treatment
methods, the way of considering psychiatric complaints has changed completely
in just a few years.
The
old mental homes have been shut once and for all. New and more agile
hospital structures have sprung up which have helped see "mental illnesses"
in a new light, more similar to other illnesses. The diagnosis and cure
of psychiatric complaints have become an increasingly bigger priority
in terms of state and private investments in the field of medicine.
Today,
psychiatry has greatly extended its areas of competence following a
growing awareness that emotional complaints, anxiety and an addiction
to substances result in high morbidity and are among the major causes
of temporary or permanent invalidity among all world populations (1,2).
The greater knowledge of operating possibilities in the psychiatry field
at both diagnostic and therapeutic level has resulted in a growing number
of people who suffered from psychiatric complaints (and did not realise
this) turning to psychiatrists in order to alleviate their suffering.
The development of neuro-sciences has made psychiatric complaints more
explainable or understandable.
The language of psychiatrists, in terms of aetiology, pathogenesis,
symptomatology and therapy is now the same as that used in all the fields
of medicine and above all "psychic suffering" is no longer grounds for
marginalisation and social rejection. This increase in knowledge has,
on the other hand, also deeply changed the conceptual models of psychiatry.
The dominant model until just a few years ago had its roots in the historical
dichotomy of "mind" and "brain", "organic" and "non-organic", "biological
and "psychic", "neurology" and "psychiatry". Within the field of competence
of neurology came demonstrated brain damage with possible psychic consequences.
Within
the field of competence of psychiatry came emotional, cognitive and
behavioural changes, where no structural alteration of the brain could
be demonstrated. Molecular biology and brain display have profoundly
changed this model. Molecular biology techniques applied to brain functions
have shown how events, emotions, memories and thoughts can change both
neurone structure and function through a chain of post-synaptic biochemical
events that link the neurone environment with genic transcription mechanisms
(FIG. 1).
In turn, molecular changes can radically condition emotions, behaviours
and cognitive processes.
Drugs and psychoactive substances, emotional stressors, events in life,
personal interactions, intrapsychic events interact at neuronal DNA
transcription level (neuronal plasticity) affecting the metabolism of
the neurotransmitters, the sensitivity and density of the ceptors, the
number and arborization of the synapse, and intraneuronal proteine synthesis
procedures (3-6). The brain display techniques (PET, SPECT, and fRMN)
have also highlighted how emotional states extended over time can functionally
trigger a series of related brain areas and how the extended or repeated
triggering over time of specific brain structures causes changes to
the biochemical environment in those areas. Changes in the biochemical
environment, in turn, trigger a chain of post-synaptic events that cause
persistent changes in nuclear genic transcription.
This
way, events usually considered of "psychological" type actually change
the molecular structure of the brain, which in turn becomes the cause
of the persistence of the emotions caused by the events. In this new
context, the borderline between "organic" and "psychic" obviously loses
its original meaning and one enters a new dimension, where structure,
function and intrapsychic events appear as different aspects of an identical
brain continuum. This conceptual revolution has also been based on the
extrapolation of the way the brain works from notions obtained from
information technology applications.
The concepts of "hardware" and "software", immediately understandable
for any PC operator, have, when applied to brain functions, shown how
psychiatric complaints can be caused either by "hardware faults" (structure)
and "software faults" (information management programs). The difference
between our data processing tools and the brain is that software alterations
(management programs) can, in the brain, affect the structure, while
obviously this is not the case as regards our daily "artificial intelligence"
tools.
A new discipline has thus seen the light over recent years within psychiatry
which has taken the name of "molecular psychiatry". Molecular psychiatry
studies are currently centred on identifying molecular substrates (for
instance, individual genes and proteins) through which various types
of genetic and environmental factors associate to produce alterations
in the processing procedures of the information that could be at the
bottom of specific psychopathologic situations. Molecular psychiatry
thus covers a broad spectrum of knowledge relating to the interaction
between external environment, management programs and molecular changes
at neurone level. Neurotransmission, neuronal plasticity, relationship
between environmental factors, genic transmission and finally molecular
genetics are the main subject of this area of research
(TAB. I)
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CURRICULUM
