Since positron emission tomography (PET) can already detect amyloid and tau in the brain, clinical practice of dementia will be able to similarly treat disease when anti-amyloid drugs and anti-tau drugs become available. 3 However, in other medical areas, mechanistic and pragmatic science are already integrated for example, in the field of cancer, molecularly targeted drugs are used based on genomic sequencing data from cancer tissues. Possibly, psychiatrists function in this gap because negative capability – a capacity to tolerate uncertainty – is a necessary asset for a psychotherapist. In clinical practice, psychiatrists do not always consider the disease mechanism or the brain state of the patient, and, yet, they prescribe drugs that act on the brain. 2 In modern psychiatry, pragmatic science is represented by operational diagnostic criteria and randomized controlled trials (RCT), and mechanistic science, such as neuroscience research using animal models, is performed in parallel. There is dispute about whether biomarkers should be based on mechanistic science 1 or pragmatic science. However, these two lines of research – the biological basis and treatment of BD – are completely isolated. Research on the biological basis and treatment of BD has made significant progress in the last decade. In the future, pharmacological and psychosocial treatments may be combined and optimized based on the biological basis of each patient, which will realize individualized treatment.īipolar disorder (BD) is a major mental disorder that causes severe psychosocial impairment. At the systems level, social rhythm therapy targets circadian rhythm abnormalities, and cognitive behavioral therapy may target emotion/cognition (E/C) imbalance. Recent genetic findings suggest the roles of polyunsaturated acids. Efficacy of anticonvulsants, animal studies of candidate genes, and studies using induced pluripotent stem cell-derived neurons have suggested a relation between bipolar disorder and the hyperexcitability of neurons. The genetic vulnerability of mitochondria causes calcium dysregulation and results in the hyperexcitability of serotonergic neurons, which are suggested to be susceptible to oxidative stress.
Elucidation of the neural circuits affected by calcium signaling abnormalities is critical, and our previous study suggested a role of the paraventricular thalamic nucleus. Involvement of intracellular calcium signaling has been supported by genetics and cellular studies. Thereafter, based on the mechanism of action of lithium, intracellular signal transduction systems, including inositol metabolism and intracellular calcium signaling, have drawn attention. Biological studies of bipolar disorder initially focused on the mechanism of action for antidepressants and antipsychotic drugs, and the roles of monoamines (e.g., serotonin, dopamine) have been extensively studied.
0 kommentar(er)
