Biopsychosocial model in psychiatry as an optimal paradigm for relevant biomedical research
https://doi.org/10.31363/2313-7053-2020-2-3-15
Abstract
The biopsychosocial model, as well as a number of approaches and paradigms based on it (scientific, clinical, preventive, therapeutic), currently cause a lot of criticism up to the complete denial of its use in psychiatry possibilities. The aim of this paper is to propose a modern interpretation of the biopsychosocial model in psychiatry for the further studies of the mental disorders etiopathogenesis and for the research of new opportunities for their therapy and prevention. Progress in biological medicine and the emergence of new research technologies today open up new opportunities for the actual interpretation of the biopsychosocial model and its application for the modern biopsychosocial paradigm, which can be used both as a research strategy and for the relevant scientifically based methods of therapy and prevention. Thus, it is important to understand that the biopsychosocial model is not a competitor or antithesis of the biomedical model, but allows one to expand the biological boundaries beyond a simple description of the organs and systems functioning.
About the Authors
N. G. Neznanov
V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology;
I.P. Pavlov First Saint-Petersburg State Medical University
Russian Federation
Russian Federation
G. V. Rukavishnikov
V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
Russian Federation
Russian Federation
E. D. Kaysanov
V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
Russian Federation
Russian Federation
D. S. Philippov
Editorial board of «Psychiatry & Neurosciences» portal
Russian Federation
Russian Federation
A. O. Kibitov
V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology;
V.P. Serbsky National Medical Research Center for Psychiatry and Narcology
Russian Federation
Russian Federation
G. E. Mazo
V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
Russian Federation
Russian Federation
References
1. Vid VD, Vovin RYa, Mazo GE. Integraciya psihofarmakoterapii i psihoterapii v lechenii depressivnyh sostoyanij. Obozrenie psihiatrii i medicinskoj psihologii imeni V.M. Bekhtereva. 1995;3:5—13 (In Russ.).
2. Kabanov M.M. Psihosocial’naya reabilitaciya i social’naya psihiatriya. Sankt-Peterburg: S- Peterburg, 1998:255 pp.
3. Kibitov AO. Biopsihosocial’naya model’ etiopatogeneza psihicheskih zabolevanij: kriticheskaya rol’ geneticheskih faktorov. Biomarkery v psihiatrii: poisk i perspektivy. Tomsk, 2016:59-61 (In Russ.).
4. Kocyubinskij A.P. Mnogomernaya (holisticheskaya) diagnostika v psihiatrii (biologicheskij, psihologicheskij, social’nyj i funkcional’nyj diagnozy). Sankt-Peterburg: «SpecLit», 2017:285 pp. (In Russ.).
5. Lutova NB, Makarevich OV, Novikova KE. The correlation of sociopsychological characteristics and selfstigmatization of patients with mental disorders (Result of original study). Obozrenie psihiatrii i medicinskoj psihologii imeni V.M. Bekhtereva. 2019;2:46-54 (In Russ.). doi: 10.31363/2313- 7053-2019-2-46-54
6. Mazo GE, Kibitov AO, Rukavishnikov GV, Ganzenko MA, Gricevskaya EM, Faddeev DV, Palkin YuR, Limankin OV, Neznanov NG. Therapeutic resistance in depression as a subject for interdisciplinary biomedical investigation. Social’naya i klinicheskaya psihiatriya. 2017;27(4):70-80 (In Russ.).
7. Neznanov NG, Akimenko MA, Kocyubinskij AP. The meaning of V.M. Bekhterev’s school in formation of biopsychosocial concept of neuro-psychiatric disorders. Sibirskij vestnik psihiatrii i narkologii. 2013;1(76):77-82 (In Russ.).
8. Pribytkov AA, Erichev AN, Kocyubinskij AP, Yurkova IO. Therapy of somatoform disorders: pharmacological and psychotherapeutic approaches. Social’naya i klinicheskaya psihiatriya. 2014;24(4):73-80 (In Russ.).
9. Sallivan G. The interpersonal theory of psychiatry. Sankt-Peterburg: KSP+, YUventa, 1999:347 pp. (In Russ.).
10. Holmogorova AB. Biopsihosocial’naya model’ kak metodologicheskaya osnova izucheniya psihicheskih rasstrojstv. Social’naya i klinicheskaya psihiatriya. 2002;12(3):97-104 (In Russ.).
11. Holmogorova AB. The nature of the social cognition violations in mental disorders: how to reconcile biological and social? Konsul’tativnaya psihologiya i psihoterapiya. 2014;4(83):8-29 (In Russ.).
12. Holmogorova AB, Rychkova OV. 40 years of Bio-Psycho-Social model: what’s new? Social Psychology and Society. 2017;8(4):8-31 (In Russ.). doi: 10.17759/sps.2017080402
13. Shejnina N.S., Kocyubinskij A.P., Skorik A.I., Chumachenko A.A. Psihopatologicheskij diatez. predvestniki psihicheskih zabolevanij. Sankt- Peterburg: SPb NIPNI im. V.M. Bekhtereva, 2008: 24 pp. (In Russ.)
14. Shmukler A.B. Psychiatry as a medical discipline. Social’naya i klinicheskaya psihiatriya. 2019;29(1):79- 81 (In Russ.).
15. Adler RH. Engel’s biopsychosocial model is still relevant today. Journal of Psychosomatic Research. 2009;67(6):607–611. doi: 10.1016/j.jpsychores.2009.08.008
16. Agnafors S, Svedin CG, Oreland L, Bladh M, Comasco E, Sydsjö G. A Biopsychosocial Approach to Risk and Resilience on Behavior in Children Followed from Birth to Age 12. Child Psychiatry Hum Dev. 2017 Aug;48(4):584-596. doi: 10.1007/ s10578-016-0684-x
17. Balestri M, Calati R, Serretti A, De Ronchi D. Genetic modulation of personality traits. International. Clinical. Psychopharmacology. 2014. 29(1):1-15. doi: 10.1097/YIC.0b013e328364590b
18. Benning TB. Limitations of the biopsychosocial model in psychiatry. Adv Med Educ Pract. 2015 May 2;6:347-52. doi: 10.2147/AMEP.S82937
19. Bienvenu OJ, Davydow DS, Kendler KS. Psychiatric ‘diseases’ versus behavioral disorders and degree of genetic influence. Psychol. Med. 2011. 41(1):33-40. doi: 10.1017/S003329171000084X
20. Bratlien U, Oie M, Haug E, Moller P, Andreassen OA, Lien L, Melle I. Environmental factors during adolescence associated with later development of psychotic disorders—a nested case-control study. Psychiatry Res. 2014;215 (3):579–585. doi: 10.1016/j.psychres.2013.12.048
21. Clarke TK, Nymberg C, Schumann G. Genetic and environmental determinants of stress responding. Alcohol Res. 2012;34(4):484-494.
22. Cross-Disorder Group of the Psychiatric Genomics C, Lee SH, Ripke S, Neale BM, Faraone SV, Purcell SM, et al. Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs. Nat Genet. 2013;45:984–94. doi: 10.1038/ng.2711
23. Docherty AR, Moscati AA, Fanous AH. Cross-Disorder Psychiatric Genomics. Curr Behav Neurosci Rep. 2016;3(3):256-263. doi: 10.1007/s40473-016- 0084-3
24. Engel GL. The need for a new medical model: a challenge for biomedicine. 25. Science. 1977 Apr 8;196(4286):129-36. doi: 10.1126/ science.847460
25. Fischer A. Epigenetic memory: the Lamarckian brain. EMBO J. 2014;33:945-967. doi: 10.1002/embj.201387637
26. Freudenreich O. et al. The Muddles of Medicine: A Practical, Clinical Addendum to the Biopsychosocial Model Psychosomatics. 2010; 51(5):365–369. doi: 10.1176/appi.psy.51.5.365
27. Gask L. In defence of the biopsychosocial model. Lancet Psychiatry. 2018 Jul;5(7):548-549. doi: 10.1016/S2215-0366(18)30165-2
28. Ghaemi SN. Paradigms of psychiatry: eclecticism and its discontents. Curr Opin Psychiatry. 2006 Nov;19(6):619-24). doi: 10.1097/01. yco.0000245751.98749.52
29. Ghaemi SN. The rise and fall of the biopsychosocial model. Br J Psychiatry. 2009 Jul;195(1):3-4. doi: 10.1192/bjp.bp.109.063859
30. Graff J, Kim D, Dobbin MM, Tsai LH. Epigenetic regulation of gene expression in physiological and pathological brain processes. Physiol.Rev. 2011;91:603-649. DOI: 10.1152/physrev.00012.2010
31. Grinker RR, Sr. A struggle for eclecticism. Am J Psychiatry. 1964;121:451– 457. doi: 10.1176/ ajp.121.5.451
32. Grissom NM, Reyes TM. Gestational overgrowth and undergrowth affect neurodevelopment: simi- larities and differences from behavior to epi- genetics. Int. J. Dev. Neurosci. 2013;31:406–414. doi: 10.1016/j.ijdevneu.2012.11.006.
33. Henningsen P. Still modern? Developing the bio- psychosocial model for the 21st century Journal of Psychosomatic Research. 2015 Nov;79(5):362-3. doi: 10.1016/j.jpsychores.2015.09.003
34. Hontschik B. Thure von Uexküll. Eine Würdigung. Dr med Mabuse. 2005;153:1–4.
35. Klengel, T., Binder, E.B., 2013. Gene-environment interactions in major depressive disorder. Can. J. Psychiatry 58, 76–83. DOI: 10.1177/070674371305800203
36. Lamb SD. Pathologist of the Mind: Adolf Meyer and the Origins of American Psychiatry. Baltimore, Maryland, Johns Hopkins University Press, 2014: 320 pp.
37. Lewis M, Lewis DO. Depression in childhood: a biopsychosocial perspective. Am J Psychother. 1981 Jul;35(3):323-9.
38. Lo MT, Hinds DA, Tung JY, Franz C, Fan CC, Wang Y, Smeland OB, Schork A, Holland D, Kauppi K, Sanyal N, Escott-Price V, Smith DJ, O’Donovan M, Stefansson H, Bjornsdottir G, Thor- geirsson TE, Stefansson K, McEvoy LK, Dale AM, Andreassen OA, Chen CH. Genome-wide analyses for personality traits identify six genomic loci and show correlations with psychiatric disorders. Nat. Genet. 2017;49(1):152-156. doi: 10.1038/ng.3736
39. McLaren N. Interactive dualism as a partial solution to the mind-brain problem for psychiatry. Med Hypotheses. 2006;66(6):1165-73. Epub 2006 Feb 3. doi: 10.1016/j.mehy.2005.12.023
40. McOmish CE, Burrows EL, Hannan AJ. Identifying novel interventional strategies for psychiatric disorders: integrating genomics, ‘enviromics’ and gene-environment interactions in valid preclinical models. Br. J. Pharmacol. 2014;171(20):4719-4728. doi: 10.1111/bph.12783.
41. Oberlander TF, Weinberg J, Papsdorf M, Grunau R, Misri S, Devlin AM. Prenatal exposure to maternal depression, neonatal methylation of human glucocorticoid receptor gene (NR3C1) and infant cortisol stress responses. Epigenetics. 2008;3(2):97- 106. doi: 10.4161/epi.3.2.6034
42. Oher FJ, Demjaha A, Jackson D, Morgan C, Dazzan P, Morgan K, Boydell J, Doody GA, Murray RM, Bentall RP, Jones PB, Kirkbride JB, The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study. Psychol. Med., 2014;1–12. doi: 10.1017/S0033291713003188
43. Pourcain B., Haworth C., Davis O. Heritability and genome-wide analyses of problematic peer relationships during childhood and adolescence. Hum. Genet. 2014; 134(6):539-551.
44. Reiser MF. Implications of a biopsychosocial model for research in psychiatry. Psychosom Med. 1980;42(1 Suppl):141-51. doi: 10.1097/00006842-198001001-00009
45. Richter D. Chronic mental illness and the limits of the biopsychosocial model. Med Health Care Philos. 1999;2(1):21-30. doi: 10.1023/a:1009968106317
46. Sapolsky, R. M. Monkeyluv: And Other Essays on Our Lives as Animals—New York : Scribner, 2005. 209 p. ISBN 978-0-7432-6015-2
47. Schubert С. Biopsychosocial research revisited. Journal of Psychosomatic Research. 2010;68:389– 390. doi: 10.1016/j.jpsychores.2010.01.018
48. Smith RC, Fortin AH, Dwamena F, Frankel RM. An evidence-based patient- centered method makes the biopsychosocial model scientific. Patient Educ Couns. 2013 Jun;91(3):265-70. doi: 10.1016/j. pec.2012.12.010.
49. Stankiewicz AM, Swiergiel AH, Lisowski P. Epigenetics of stress adaptations in the brain. Brain Res. Bull. 2013;98:76-92. DOI: 10.1016/j.brainresbull.2013.07.003
50. Stier M. The biopsychosocial model between biologism and arbitrariness. A Commentary to H. Helmchen. Front Psychol. 2014;5:126. doi:10.3389/ fpsyg.2014.00126
51. Strauss J, Bernard P, Harper A. To- wards a Biopsychosocial Psychiatry. Psy- chiatry. 2019 Summer;82(2):103-112. doi: 10.1080/00332747.2019.1579609
52. Tyrka AR, Price LH, Marsit C, Walters OC, Carpenter LL. Childhood adversity and epigenetic modulation of the leukocyte glucocorticoid recep tor: preliminary findings in healthy adults. PLoS One. 2012;7(1): 301-348. doi: 10.1371/journal. pone.0030148
53. Vasile RG, Samson JA, Bemporad J, Bloomingdale KL, Creasey D, Fenton BT, Gudeman JE, Schild- kraut JJ. A biopsychosocial approach to treating patients with affective disorders. Am J Psychiatry. 1987 Mar;144(3):341-4. doi: 10.1176/ajp.144.3.341
54. Walter H. The third wave of biological psychiatry. Front. Psychol. 2013;4:582. doi:10.3389/ fpsyg.2013.00582
55. Weaver ICG, Cervoni N, Champagne FA, D’Alessio AC, Sharma S, Seckl JR, Dymov S, Szyf M, Meaney MJ. Epigenetic programming by maternal behavior. Nature neuroscience. 2004;7(8):847-854. doi: 10.1038/nn1276
56. Weissman, M.M., Olfson, M., 1995. Depression in women: implications for health care research. Science. 1995; 269:799–801. DOI: 10.1126/sci- ence.7638596
57. Wojcik W, Lawrie SM. Towards a Biopsychosocial Model of Gulf War Illness? EBioMedicine. 2016;3:6- 7. doi:10.1016/j.ebiom.2015.12.021
58. Wright CD, Tiani AG, Billingsley AL, Steinman SA, Larkin KT, McNeil DW. A Framework for Understanding the Role of Psychological Processes in Disease Development, Maintenance, and Treatment: The 3P-Disease Model. Front Psychol. 2019 Nov 20;10:2498. doi: 10.3389/fpsyg.2019.02498
59. Zhao H, Nyholt DR. Gene-based analyses reveal novel genetic overlap and allelic heterogeneity across five major psychiatric disorders. Hum. Genet.—2017;136(2):263-274. doi: 10.1007/s00439- 016-1755-6.
Review
For citations:
Neznanov N.G., Rukavishnikov G.V., Kaysanov E.D., Philippov D.S., Kibitov A.O., Mazo G.E. Biopsychosocial model in psychiatry as an optimal paradigm for relevant biomedical research. V.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY. 2020;(2):3-15. (In Russ.) https://doi.org/10.31363/2313-7053-2020-2-3-15
Views:
3775
Email this article 