Objective: The biopsychosocial (BPS) model remains the predominant theoretical framework underpinning contemporary psychiatric training and practice. Like all models, it has its limitations and its critics. In light of recent censure, The purpose of this article was to (a) review key aspects of the history, development and contemporary utility of the BPS model and, (b) review key contributions of George Engel. Conclusion: An aetiological model for mental disorders that involves psychological, biological and sociocultural factors has existed since at least the 1940s. The term “biopsychosocial” was arguably first coined by Roy Grinker in 1952. Spurred on by his interest in systems theory, Engel expanded upon the model in 1977 and used it to hypothesise about the integration of mind and body. Despite its shortcomings, the BPS model remains relevant and useful.
Objectives: Tardive dyskinesia, psychotic relapse and treatment-refractory psychosis have long been associated. A common underlying mechanism involving antipsychotic-induced ‘supersensitivity’, albeit in different brain pathways, was proposed as early as 1978. This piece seeks to reappraise the concept and potential implications of antipsychotic-induced supersensitivity. Conclusions: Evidence increasingly suggests that chronic antipsychotic exposure induces neuroadaptive physiological changes in dopaminergic, and other, neurotransmitter systems that may render some individuals more vulnerable to psychotic relapse - including those receiving continuous antipsychotic treatment. It is possible that in treating every episode of psychosis with prolonged or indefinite antipsychotic therapy, we paradoxically increase the risk of psychotic relapse in a significant proportion of people. A greater appreciation of supersensitivity may allow us to optimise any potential benefits of antipsychotics while minimising the risk of inadvertent iatrogenic harms. More research is needed to improve our understanding of the underlying neurophysiology of supersensitivity and to better identify which individuals are most vulnerable to its development. It is time we paid more attention to the concept, emerging evidence and potential implications of antipsychotic-induced supersensitivity and, where appropriate, adjusted our practice accordingly.
medical therapy, 49 studied 4.3 years after adrenalectomy), the prevalence rates for depressive disorder (⩾5) were 50% for untreated PA, 42% for mineralocorticoid (MR) antagonisttreated patients and 38% for patients who had undergone adrenalectomy (Apostolopoulou et al., 2014). Compared to the German reference population, the mean values of brief patient health questionnaire (PHQD) were significantly higher in untreated PA and MR antagonist-treated group (p < 0.01). Using the general anxiety disorder questionnaire (GAD-7), the prevalence rates for anxiety disorder (⩾5) were 50% for untreated PA, 42% for MR antagonist-treated patients and 38% for patients who had undergone adrenalectomy (Apostolopoulou et al., 2014).The MR function in the central nervous system has been implicated in the response to anti-depressants
FundingThe author(s) received no financial support for the research, authorship, and/or publication of this article.
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