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April 2017

Integrating a Neuroscience Perspective Into Clinical Psychiatry Today

Author Affiliations
  • 1Department of Psychiatry, Columbia University Medical Center, New York, New York
  • 2New York State Psychiatric Institute, New York
  • 3Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 4Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
JAMA Psychiatry. 2017;74(4):313-314. doi:10.1001/jamapsychiatry.2016.3849

As psychiatrists, we are asked to treat patients with extremely complex illnesses. There are many possible ways to think about and formulate cases, including a range of psychological and social perspectives, each with their own strengths and limitations. To varying degrees, these perspectives have rightfully guided the development of our field and continue to shape the standards of our practice.

During the past 20 years, revolutionary new tools and approaches in neuroscience have led to unprecedented progress in our ability to understand the biological underpinnings of psychiatric illnesses.1 This work very much complements rather than competes with our other rich traditions. In fact, distinctions between “psychological” and “biological” are rapidly fading as evidence demonstrates that all effective treatments (whether psychotherapy or pharmacologic agents) alter core brain networks and thus are all biological in nature.2 Cognitive neuroscience is providing contemporary neural system models for understanding psychodynamic concepts such as our sense of self, defenses and drives, and unconscious thoughts and motivations.1 In addition, an understanding of epigenetics offers novel insights into how social context and environmental factors translate into biological changes at the level of gene expression.3