Current State of Psychopharmacology, Psychotherapies and Other Interventions in Mental Health Problems and Disorders
DOI:
https://doi.org/10.14738/aivp.95.10994Keywords:
Psychopharmacology; Psychotherapy; Mental Health; Mental Disorder; Stigma; MindfulnessAbstract
Proposal: The article broadly aims to emphasise the current relevance of physical and psychological treatments for most mental and behavioural disorders. Design: Critical analysis and reasoned opinion of a selected compilation of the best, widely read, high-quality scientific literature. Methodologically, it is a brief meta-synthetic review. Results and interpretation: In general, for almost all mental disorders, combined treatment with psychotropic drugs and psychotherapy seems to be more effective than psychotherapy or pharmacotherapy alone. Particularly in Spain (European Union), the risk for psychotherapies of therapeutic intrusion by non-specialists who are not medical psychiatrists or clinical psychologists is high. A similar situation occurs with the routine prescription of psychotropic drugs by other physicians. The frequent stigma associated with any mental pathology is then addressed, as well as the obligation to obtain informed consent for any therapeutic intervention. Lastly, mention is made of the usefulness of the personal state of full awareness, more commonly called mindfulness, training for which is included in numerous help programmes based on its continued practice, whether or not mental disorders are diagnosed. Conclusions: More randomised clinical trials with low risk of bias and accidental errors are needed to properly assess the effects of psychotherapeutic interventions. From a scientific perspective, based on multiple evidence, the efficacy of properly prescribed psychopharmacotherapy is not in question.
References
Moncrieff, J. What does the latest meta-analysis really tell us about antidepressants? Epidemiology and Psychiatric Sciences, 2018. 27(5): 430–632. https://doi.org/10.1017/S2045796018000240
Moncrieff, J. Un enfoque alternativo del tratamiento farmacológico en psiquiatría. [An alternative approach to drug treatment in psychiatry.] Revista de la Asociación Española de Neuropsiquiatría, 2018. 38(133): 181–193. https://doi.org/10.4321/S0211-57352018000100010
Barbato, A., D'Avanzo, B., and Parabiaghi, A. Couple therapy for depression. Cochrane Database of Systematic Reviews, 2018. 6(6): CD004188.
Cuijpers, P., Oud, M., Karyotaki, E., Noma, H., Quero, S., Cipriani, A., et al. Psychologic treatment of depression compared with pharmacotherapy and combined treatment in primary care: A network meta-analysis. Annals of Family Medicine, 2021. 19(3): 262–270. https://doi.org/10.1370/afm.2676
Weitz, E., Kleiboer, A., van Straten, A., Hollon, S.D., and Cuijpers, P. Individual patient data meta-analysis of combined treatments versus psychotherapy (with or without pill placebo), pharmacotherapy or pill placebo for adult depression: A protocol. BMJ Open, 2017. 7(2): e013478. https://doi.org/10.1136/bmjopen-2016-013478
Skapinakis, P., Caldwell, D.M., Hollingworth, W., Bryden, P., Fineberg, N.A., Salkovskis, P., et al. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 2016. 3(8): 730–739. https://doi.org/10.1016/S2215-0366(16)30069-4
Enck, P., and Zipfel, S. Placebo effects in psychotherapy: A framework. Frontiers in Psychiatry, 2019. 10: 456. https://doi.org/10.3389/fpsyt.2019.00456
Hadjipavlou, G., Hernandez, C.A., and Ogrodniczuk, J.S. Psychotherapy in contemporary psychiatric practice. The Canadian Journal of Psychiatry, 2015. 60(6): 294–300. http://dx.doi.org/10.1177/070674371506000609
Bertolín-Guillén, J.M. Psychotherapies in current clinical psychology and psychiatry in Spain. Revista de Psiquiatría y Salud Mental (engled), 2020. S1888-9891(20)30023-9. https://doi.org/10.1016/j.rpsm.2020.01.004
Fernández-Hermida, J.R, Santolaya, F., and Santolaya, J.A. La acreditación en psicología clínica en España. [Accreditation in clinical psychology in Spain.] Terapia Psicológica, 2017. 35(1): 95–110. http://dx.doi.org/10.4067/S0718-48082017000100009
Muse, M. Convergencia de la psicoterapia y la psicofarmacología: el uso de programas para la administración conductual de la medicación. [Psychotherapy and psychopharmacology meeting point: Programmes' use for behavioural administration of medication.] Revista de Psicoterapia, 2007. 18(69): 5–10. https://doi.org/10.33898/rdp.v18i69.911
Bertolín-Guillén, J.M. Las especialidades facultativas del ámbito de la salud mental ante los tribunales de justicia. [Medical specialities in the field of mental health before the courts of justice.] Gaceta Internacional de Ciencias Forenses, 2021. [11](40): 33–42. https://www.uv.es/gicf/4A2_Bertolin_GICF_40.pdf
Bertolín-Guillén, J.M. Deontología y confidencialidad en psiquiatría y psicología clínica en España. [Deontology and confidentiality in psychiatry and clinical psychology in Spain.] Revista de Bioética y Derecho, 2021. 23(52): 173–183. https://doi.org/10.1344/rbd2021.52.32034
Quinlan, E.B., Banaschewski, T., Barker, G.J., Bokde, A.L.W., Bromberg, U., Büchel, C., et al. Identifying biological markers for improved precision medicine in psychiatry. Molecular Psychiatry, 2020. 25(2): 243–253. https://doi.org/10.1038/s41380-019-0555-5
Deif, R., and Salama, M. Depression from a precision mental health perspective: Utilizing personalized conceptualizations to guide personalized treatments. Frontiers in Psychiatry, 2021. 12: 650318. https://doi.org/10.3389/fpsyt.2021.650318
Carvalho, A.F., and McIntyre, R.S. (eds). Mental disorders in primary care: A guide to their evaluation and management. Oxford, UK: Oxford University Press; 2017.
Kim, K., and Jeon, H.J. Psychopharmacology and psychotherapy research. In: Kim YK. (ed). Frontiers in psychiatry. Artificial intelligence, precision medicine, and other paradigm shifts. Singapore, SG: Springer; 2019.
Stupak, R, and Dobroczyński, B. From mental health industry to humane care. Suggestions for an alternative systemic approach to distress. International Journal of Environmental Research and Public Health, 2021. 18(12): 6625. https://doi.org/10.3390/ijerph18126625
Solmi, M., Miola, A., Croatto, G., Pigato, G., Favaro, A., Fornaro, M., et al. How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations. Brazilian Journal of Psychiatry, 2021. 43(2): 189–202. https://doi.org/10.1590/1516-4446-2020-0935
Ijaz, S., Davies, P., Williams, C.J., Kessler, D., Lewis, G., and Wiles, N. Psychological therapies for treatmentresistant depression in adults. Cochrane Database of Systematic Reviews, 2018. 5(5): CD010558. http://dx.doi.org/10.1002/14651858.CD010558.pub2
Masdrakis, V.G, and Baldwin, D.S. Anticonvulsant and antipsychotic medications in the pharmacotherapy of panic disorder: A structured review. Therapeutic Advances in Psychopharmacology, 2021. 11: 20451253211002320. https://doi.org/10.1177/20451253211002320
Imai, H., Tajika, A., Chen, P., Pompoli, A., and Furukawa, T.A. Psychological therapies versus pharmacological interventions for panic disorder with or without agoraphobia in adults. Cochrane Database of Systematic Reviews, 2016. 10(10): CD011170. http://dx.doi.org/10.1002/14651858.CD011170.pub2
Bighelli, I., Castellazzi, M., Cipriani, A., Girlanda, F., Guaiana, G., Koesters, M., et al. Antidepressants versus placebo for panic disorder in adults. Cochrane Database of Systematic Reviews, 2018. 4(4): CD010676.
Everitt, H., Baldwin, D.S., Stuart, B., Lipinska, G., Mayers, A., Malizia, A.L, et al. Antidepressants for insomnia in adults. Cochrane Database of Systematic Reviews, 2018. 5(5): CD010753.
Bandelow, B., Michaelis, S., and Wedekind, D. Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 2017. 19(2): 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
World Health Organization. Pharmacological treatment of mental disorders in primary health care. Geneva, CH: World Health Organization; 2009.
Liu, Z., Hu, Y., Zhang, Y., Liu, W., Zhang, L., Wang, Y., et al. Altered gray matter volume and structural covariance in adolescents with social anxiety disorder: Evidence for a delayed and unsynchronized development of the fronto-limbic system. Psychological Medicine, 2021. 51(10): 1742–1751. https://doi.org/10.1017/S0033291720000495
González-Palma, A.M., Sánchez-Sánchez, L.C., and Garcia-Montes, J.M. Is “self-experience” really a transdiagnostic concept? Preliminary evidence in favor of the transdiagnostic conception of functional analytic psychotherapy. Frontiers in Psychiatry, 2021. 12. https://doi.org/10.3389/fpsyt.2021.671223
Bertolín-Guillén, J.M., and Porcel-Torrens, A. Mental health: Stigma, language and nosology. OSP Journal of Health Care and Medicine, 2021. 2(2): 1–6. https://www.ospublishers.com/Mental-Health-Stigma,-Language-and-Nosology.html
Scott, J., Crouse, J.J., Ho, N., Iorfino, F., Martin, N., Parker, R., et al. Early expressions of psychopathology and risk associated with trans-diagnostic transition to mood and psychotic disorders in adolescents and young adults. PLoS One, 2021. 16(6): e0252550. https://doi.org/10.1371/journal.pone.0252550
Vieta[-Pascual], E. Personalised medicine applied to mental health: Precision psychiatry. Revista de Psiquiatría y Salud Mental (engled), 2015; 8(3): 117–118. https://doi.org/10.1016/j.rpsmen.2015.03.007
Stuber, J.P., Rocha, A., Christian, A., and Link, B.G. Conceptions of mental illness: Attitudes of mental health professionals and the general public. Psychiatric Services, 2014. 65(4): 490–497. https://doi.org/10.1176/appi.ps.201300136
Eiroa-Orosa, F.J., Lomascolo, M., and Tosas-Fernández, A. Efficacy of an intervention to reduce stigma beliefs and attitudes among primary care and mental health professionals: Two cluster randomised-controlled trials. International Journal of Environmental Research and Public Health, 2021. 18(3): 1214. https://doi.org/10.3390/ijerph18031214
Mak, W.W.S., Chan, R.C.H., Wong, S.Y.S., Lau, J.T..F, Tang, W.K., Tang, A.K.L., et al. A cross-diagnostic investigation of the differential impact of discrimination on clinical and personal recovery. Psychiatric Services, 2017. 68(2): 159–166. https://doi.org/10.1176/appi.ps.201500339
Turan, J.M., Elafros, M.A., Logie, C.H., Banik, S., Turan, B., Crockett, K.B., et al. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Medicine, 2019. 17(1): 7. https://doi.org/10.1186/s12916-018-1246-9
Jahn, D.R., Leith, J., Muralidharan, A., Brown, C.H., Drapalski, A.L., Hack, S., et al. The influence of experiences of stigma on recovery: Mediating roles of internalized stigma, self-esteem, and self-efficacy. Psychiatric Rehabilitation Journal, 2020. 43(2): 97–105. http://dx.doi.org/10.1037/prj0000377
Catalano, L.T., Brown, C.H., Lucksted, A., Hack, S.M., and Drapalski, A.L. Support for the social-cognitive model of internalized stigma in serious mental illness. Journal of Psychiatric Research, 2021. 137: 41–47. https://doi.org/10.1016/j.jpsychires.2021.02.014.
Cunningham, K.C., and Lucksted, A. Social cognition, internalized stigma, and recovery orientation among adults with serious mental illness. Psychiatric Rehabilitation Journal, 2017. 40(4): 409–411. https://doi.org/10.1037/prj0000248
Walsh, D.A.B., and Foster, J.L.H. A call to action. A critical review of mental health related anti-stigma campaigns. Frontiers in Public Health, 2021. 8: 569539. https://doi.org/10.3389/fpubh.2020.569539
Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet, 2016. 387(10023): 1123–1132. https://doi.org/10.1016/S0140-6736(15)00298-6
Bertolín-Guillén, J.M. Informed consent and mental health, mainly in Spain, EU. International Journal of Psychiatry and Mental Health, 2020. 2(1): 1–7. https://doi.org/10.36811/ijpmh.2020.110007
Bertolín-Guillén, J.M. Community treatment orders: Bioethical basis. The European Journal of Psychiatry, 2011. 25(3): 134–143. https://doi.org/10.4321/S0213-61632011000300003
Kabat-Zinn, J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 1982. 4(1): 33–47. https://doi.org/10.1016/0163-8343(82)90026-3
Bertolín-Guillén, J.M. Full awareness or mindfulness in the practice of current clinical psychology and psychiatry: Explanatory contributions. Annals of Psychiatry and Treatment, 2019. 3(1): 3–10. https://doi.org/10.17352/apt.000010
Muñoz, J.E. Disidentifications: Queers of color and the performance of politics. Cultural studies of the Americas. 3 vol. Minneapolis, US: University of Minnesota Press; 1999.
Bertolín-Guillén, J.M. Conciencia plena y salud mental. [Full awareness and mental health.] Madrid, ES: Triacastela; 2014.
Jarukasemthawee, S., and Pisitsungkagarn, K. Mindfulness and eudaimonic well-being: The mediating roles of rumination and emotion dysregulation. International Journal of Adolescent Medicine and Health, 2021. http://dx.doi.org/10.1515/ijamh-2021-0009
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 José Manuel BERTOLÍN-GUILLÉN

This work is licensed under a Creative Commons Attribution 4.0 International License.