Ban Thomas A
Vanderbilt University, Nashville, TN, USA.
Prog Neuropsychopharmacol Biol Psychiatry. 2006 May;30(3):429-41. doi: 10.1016/j.pnpbp.2005.11.014. Epub 2006 Jan 27.
In the second half of the 19th century new drugs introduced by the pharmaceutical industry helped lead to the establishment of academic departments in psychiatry. Causal treatment of cerebral pellagra by nicotinic acid and cerebral syphilis by penicillin in the first half of the 20th century led to major changes in the diagnostic distribution of psychiatric patients. In the second half of the 20th century with the introduction of a rapidly growing number of psychotropic drugs, pharmacotherapy became the primary form of treatment in mental illness. Psychiatrists today perceive neuropharmacology as one of the basic sciences of psychiatry and psychopharmacology as the bridge between the mode of action and the clinical indications of psychotropic drugs. Pharmacotherapy with psychotropic drugs focused attention on the differential responsiveness to the same drug within the same diagnostic category. Yet, instead of re-evaluating psychiatric nosology and conducting research in psychopathology, a statistical methodology was adopted for the demonstration of therapeutic effectiveness in pharmacologically heterogeneous populations. Employment of consensus-based classifications and psychiatric rating scales in the clinical development of psychotropic drugs led to semi-finished products, which are prescribed indiscriminately. Replacement of single-center clinical trials by multi-center centrally coordinated clinical investigations led to the control of education in pharmacotherapy by the pharmaceutical industry. To separate education from marketing, the identification of the treatment-responsive forms of illness and the delineation of the therapeutic profile of psychotropic drugs are proposed with the employment of a new methodology, the "Composite Diagnostic Evaluation System." It is postulated that development of a pharmacologically valid psychiatric nosology with the employment of a "nosologic matrix" would provide the pharmaceutical industry with the necessary feedback to develop clinically selective drugs in mental illness and to break the impasse of progress in "translational research" in psychiatry.
19世纪下半叶，制药行业推出的新药推动了精神病学学术部门的建立。20世纪上半叶，用烟酸对脑型糙皮病进行病因治疗以及用青霉素对脑梅毒进行病因治疗，导致了精神病患者诊断分布的重大变化。20世纪下半叶，随着精神药物数量的迅速增加，药物治疗成为精神疾病的主要治疗形式。如今，精神科医生将神经药理学视为精神病学的基础科学之一，将精神药理学视为精神药物作用方式与临床适应证之间的桥梁。精神药物的药物治疗使人们关注同一诊断类别内对同一种药物的不同反应。然而，人们没有重新评估精神病学分类法并开展精神病理学研究，而是采用一种统计方法来证明在药理异质性人群中的治疗效果。在精神药物的临床开发中使用基于共识的分类法和精神病评定量表，导致了一些半成品药物被不加区分地开具处方。多中心集中协调的临床研究取代单中心临床试验，使得制药行业控制了药物治疗方面的教育培训。为了将教育与营销分开，建议采用一种新方法“综合诊断评估系统”来识别对治疗有反应的疾病形式，并描绘精神药物的治疗概况。据推测，采用“分类矩阵”来开发具有药理学有效性的精神病学分类法，将为制药行业提供必要反馈，以开发针对精神疾病的临床选择性药物，并打破精神病学“转化研究”进展的僵局。
