Psychiatrist as Clinical Neuroscientist, Dr. Tarek Okasha, Athens Conference

This was a particularly rewarding lecture by a truly brilliant man. His broad reaching eclectic presentation was so packed that I only caught a sentence here and there in my notes and from his slides. He speaks fast and succinctly. I expect he assumes that people are following him when he's miles ahead ideologically in the biological, psychological and sociological system world he inhabits so easily.

The Psychiatrist as a Clinical Neuroscientist; A Multidisciplinary Approach”  

Professor Tarek A. Okasha

Professor of Psychiatry, 

Ain Shams University, Cairo, Egypt

The problems that pscyhiatrists are facing are with identity ,as others are taking away from them core components of historic psychiatry or are they finding  a new identity - are pscyhiatrists an endangered species?

Psychiatry is the most artistic of Sciences and now is faced with advances in brain disease.

Henry Miller - 1967 - The psychiatrist must be first and foremost a physician

Challenges from inside

1. Decreasing confidence about the knowledge ( diagnosis and classification)

• 2 different international diagnosis codes -DSM and ICD

1. Validity of diagnosis

-where is the line of demarcation between normal sadness and abnormal depression

1. Lack of coherent theoretical basis

-ask 3 psychiatrists and get 4 answers

Challenges from outside

• client, consumer, user, service user, - by replacing the word patient distancing ourselves  from the rest of medicine
•  now confusing new words like ex-user, ex pateint
• recovery as outcome or process?
• wording confuses relatives, not just patients

Competition from other professionals

• family physicians, neurologists, psychologists, clinical social workers

Negative Image

• portrayal of pscyhiatrists in the media
• people assume psychiatrist will treat them with medication despite the majority of psychiatrists recommend psychotherapy

Where is Psychiatry going

200,000 certified psychiatrists around the world

only one pschiatrist per 640000 in Pakistan and 1 in a million in Ethiopia

WPA task force discussed ‘brain drain’ of psychiatrists from developing countries.

Reasons for decline of recruitment 

-lack of intellectual challenge

-lack of status

-fear of violence

Strength of Psychiatry

• needed by society
• Traditional strengths
• clinical experience, comprehensive knowledge of psychopathology, skills of communication with affected patients.
• Prof Eisenburg - the one medical specialty with persistent interest in the patient as a person in an increasingly organ dominated era’
• Interface between physical and emotional and  psychiatric
• psychiatry and comorbidity
• psychiatrist is uniquely placed to understand the big picture, biological, psychological and sociological
• disorders of brain and disorders of mind
• Physical effects of psychiatric therapy, both medications and psychotherapy
• Disorders of the CNS
• cerebellum and basal ganglia involved in thought and emotion
• Recognition of psychosocial factors
• Alzheimers and Neurodevelopmental disordrs
• TWilight zone between neurology and psychiatry’ depression, autism, dementia
• Medicalizing Psychiatry would help recruitment
• Closer collaboration 
• Psychiatrist shall prevail - 200 years as a speciality
• 450 million people suffer from some form of psychiatric illness
• 20 % of patients have a psychiatric illness
• Psychiatrists should never retreat
• Psychiatry is in a developmental crisis - lets stop blaming ourselves - we have a ‘unique niche’, we are best qualified to address and integrate biological, psychological and sociological 
• Consider adopting the term ‘clinical neuroscientist’ for our profession’