Neuroscience-Informed Therapies in Psychiatry

I had the pleasure of guest-editing this issue of Focus on neuroscience-informed therapies. Neuroscience has progressed in leaps and bounds in the past few decades. Much of what we now understand about brain and behavior, thanks to advances on many fronts, can be useful to clinicians. However, when surveyed, most clinicians do not feel adequately prepared to access and use this information. Why might that be the case? Neuroscience is a vast and rapidly moving field, and its language can be alien to clinicians. Moreover, the complexity of the brain and of psychiatric disorders is such that no simple explanations of pathophysiology and treatments are readily available. Training psychiatrists who can read and assess relevant neuroscience literature and put it to use in their clinical reasoning as well as in their communication with patients constitutes a major challenge. One extreme has been to define relevant neuroscience in a very limited way, for example, focusing on the effects of drugs on neurotransmitter systems. Another extreme has been to teach basic science—sometimes without using adult learning principles—that has not been vetted for clinical relevance. The former approach misses much of what is relevant to psychiatrists, and the latter confirms their sense that neuroscience is not for them. See the Ask the Expert column in this issue (1).

A similar challenge presented itself when deciding which treatments to include in this issue. The title “Neuroscience-Informed Treatments” may seem to restrict itself to novel drugs that have emerged from a neuroscience-based understanding of the pathophysiology of psychiatric disorders. Taking this approach alone would limit the scope of this issue to experimental treatments in early phases of Food and Drug Administration approval, which may or may not pan out. More important, such an approach embodies a dichotomous view of psychiatric disorders that separates brain and mind and undermines a neuroscientific basis for the efficacy of psychosocial treatments. If, in contrast, we consider the brain–mind connection as inseparable— “thinking matter,” as it were—then all effective psychiatric treatments are neuroscience based. Several of the contributions in this issue take this approach to help clinicians use clinical neuroscience to inform their interactions and communication with patients (2, 3). The media is full of news stories, podcasts, postings, and commentaries about the brain and human behavior. Patients often ask about the relevance of all this to their own suffering and treatment. The Communication Commentary in this issue is an example of how to address such questions (4).

The treatments highlighted in this issue are practical treatments, some of which have been used in psychiatry for some time and are now better understood from the neuroscience perspective. See the piece on therapeutic uses of seizures, for instance (5). Others are newer treatments, with immediate clinical relevance for particular disorders (6, 7). Finally, and perhaps least familiar to clinicians, is a review informing us about transcranial direct current stimulation (8).

I hope you find the contents of this issue to be clinically relevant and intellectually stimulating. Most of all, I hope the information contained in this issue of Focus will inspire you to use a clinical neuroscience perspective in your practice.