Kotsyubinsky Aleksandr P, Kotsyubinsky Daniil A
V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology.
Independent Not-For-Profit Educational Organization of Higher Education "European University at St.Petersburg".
Consort Psychiatr. 2023 Dec 22;4(4):75-84. doi: 10.17816/CP15476.
The substantial progress in neurobiological technologies has narrowed the horizons of many psychiatrists, ultimately leading them to focus exclusively on biomedical research, primarily aimed at studying the biological basis of mental illnesses. This has led to an unjustified dominance of the biomedical paradigm in understanding the nature of mental disorders, while virtually ignoring the study of other components of the disease related to the psychosocial maladjustment of patients. This trend, largely associated with advancements in neuroscience employing neuroimaging techniques to study the brain's activity as a biophysical object, has contributed to the development of such innovative field as evidence-based medicine. The methods of evidence-based medicine are seen as adequate in terms of determining the effectiveness of therapy for predominantly biologically determined components of mental illness (including the selection of medications) and only partially for psychological interventions. However, it seems that the predominant use of evidence-based medicine principles is insufficient for a holistic diagnostic approach, which includes a multilevel (diversified) representation of the criteria of effectiveness for pharmacological and psychological interventions. In this regard, it is promising to establish a scientifically and clinically productive combination of, on the one hand, the evidence-based concept of effectiveness assessments based on high-quality randomized scientific studies, and on the other, expert opinions of highly qualified scientific specialists, as well as practicing physicians with their personal professional experience in individualized therapy. This makes it reasonable to develop a personality-oriented personalized psychiatry, based on a biopsychosocial understanding of the nature of mental disorders, their holistic assessment, and the development of comprehensive therapeutic measures.
神经生物学技术的重大进展拓宽了许多精神科医生的视野，最终使他们只专注于生物医学研究，主要目的是研究精神疾病的生物学基础。这导致了生物医学范式在理解精神障碍本质方面占据了不合理的主导地位，而几乎忽视了对与患者心理社会适应不良相关的疾病其他组成部分的研究。这种趋势在很大程度上与神经科学的进展有关，神经科学采用神经成像技术将大脑活动作为一个生物物理对象进行研究，推动了循证医学等创新领域的发展。循证医学的方法在确定主要由生物学决定的精神疾病组成部分（包括药物选择）的治疗效果方面被认为是足够的，而在心理干预方面仅部分适用。然而，似乎循证医学原则的主要应用对于整体诊断方法来说是不够的，整体诊断方法包括对药物和心理干预效果标准的多层次（多样化）呈现。在这方面，一方面将基于高质量随机科学研究的循证有效性评估概念与另一方面高素质科学专家以及具有个性化治疗个人专业经验的执业医生的专家意见进行科学和临床有效的结合是很有前景的。这使得基于对精神障碍本质的生物心理社会理解、对其进行整体评估以及制定综合治疗措施来发展以个性为导向的个性化精神病学变得合理。
