Jose de Leon, M.D.

This editorial proposes that 2013 may someday be known as the year psychiatry was at a crossroad. Practicing psychiatrists were pressured with paradoxical messages including (1) assurances from the National Institute of Mental Health (NIMH) that better psychiatric medications are forthcoming, which would decrease the impact of mental illness, even as pharmaceutical companies are leaving the field because they have failed to produce revolutionary new medications, (2) encouragement from the  American Psychiatric Association (APA) to use the DSM-5, which further increases the prevalence of mental illness, and its apparent agreement with overprescription of psychiatric medications to control behaviors, even if they are not a consequence of severe mental illness.
     The most important message not heard or heeded is that people with severe mental illness are not receiving appropriate treatment because budgets for such are “evaporating”.  Consequently, these patients will increasingly be placed in the penal system, the “new asylum.”  If the trend continues, and there is no sign that it will not, psychiatrists may need to rename themselves “alienists,” as in the 19th century.
     Finding solutions for this complex set of problems facing US psychiatry at the beginning of the 21st century is crucial, not only for the US, but for the world, since US psychiatry became the undisputed world leader upon publication of the DSM-III. Although the author is somewhat pessimistic about psychiatry, he is much more optimistic about the possibility of improving psychopharmacology. As psychiatric drugs were mainly a product of serendipity, he is not sure when new breakthroughs will occur, but he is very sure that we can do a much better job of training psychiatry residents and other prescribers to better use each psychiatric drug in the individual treatment of patients.  Moreover, psychiatry can better emphasize the crucial role of medications (and electroconvulsive therapy) in severe mental illness while stressing the limited role of medication (with serious consideration of its risks) in minor psychiatric disorders, which may respond to other interventions, including psychotherapy.
 
The article above is the summary of the following publication: de Leon J. Paradoxes of US Psychopharmacology Practice in 2013: Undertreatment of Severe Mental Illness and Overtreatment of Minor Psychiatric Problems. J Clin Psychopharmacol. 2014 Oct;34(5):545-8. The summary was written by Prof. Jose de Leon, the author of the original publication.