International Medical School, University of Rome Tor Vergata, Viale Montpellier 1, Rome 00133, Italy.
Neurosci Biobehav Rev. 2024 Sep;164:105818. doi: 10.1016/j.neubiorev.2024.105818. Epub 2024 Jul 18.
In the last decade, no other branch of clinical pharmacology has been subject to as much criticism of failed innovation and unsatisfactory effectiveness as psychopharmacology. Evolutionary psychiatry can offer original insights on the problems that complicate pharmacological research. Considering that invalid phenotyping is a major obstacle to drug development, an evolutionary perspective suggests targeting clinical phenotypes related to evolved behavior systems because they are more likely to map onto the underlying biology than constructs based on predetermined diagnostic criteria. Because of their emphasis on symptom remission, pharmacological studies of psychiatric populations rarely include functional capacities as the primary outcome measure and neglect the impact of social context on the effects of psychiatric drugs. Evolutionary psychiatry explains why it is appropriate to replace symptoms with functional capacities as the primary target of psychiatric therapies and why social context should be a major focus of studies assessing the effectiveness of drugs currently used and new drugs under development. When the focus of research shifts to those questions that go beyond the "disease-based" concept of drug action, evolutionary psychiatry clearly emerges as a reference framework to assess drug effectiveness and to optimize clinicians' decisions about prescribing, deprescribing, and non-prescribing.
在过去的十年中，没有哪个临床药理学分支像精神药理学那样受到如此多的关于创新失败和疗效不佳的批评。进化精神病学可以为使药理学研究复杂化的问题提供独到的见解。考虑到无效表型是药物开发的主要障碍，进化的观点建议针对与进化行为系统相关的临床表型，因为它们比基于预先确定的诊断标准的构建更有可能映射到潜在的生物学上。由于强调症状缓解，精神科人群的药理学研究很少将功能能力作为主要的结果测量指标，也忽略了社会环境对精神药物效果的影响。进化精神病学解释了为什么用功能能力代替症状作为精神治疗的主要目标是合适的，以及为什么社会环境应该成为评估当前使用的药物和新开发药物有效性的研究的主要焦点。当研究的重点转移到超越药物作用的“基于疾病”概念的那些问题时，进化精神病学显然成为评估药物有效性和优化临床医生关于开处方、停药和不开处方决策的参考框架。
