Interfaces of Psychiatry Vinay Kumar, Sandeep Grover
Page numbers followed by b refer to box, f refer to figure, and t refer to table
Academic stress 253
Acne excoriée 106f
Acotiamide 82
Acquired immunodeficiency syndrome 258
Activity observation network 273
Addictive disorders 303
Additional psychiatric disorder 250
Adrenocorticotropic hormone 91, 109
Alcohol 257
Alleviate sickness symptoms 195
Alopecia areata 103, 108
Alpha-synuclein 30
Alzheimer's disease 30, 119
Amantadine 25
Amateur tango dancers 273
Amnesia 267
Analytical psychology 212
Ankylosing spondylitis 60
Anorectal pain 75
Anthropology 286, 287, 289, 289f, 290, 295
branches of 286f
field of 286
Antibiotics 81
Antidepressants 51, 54, 82, 116
Antiepileptics 52
Antiphospholipid syndrome 90
Antipsychiatry 147, 162, 166, 168
Antipsychotics 51, 54, 117
Antiretroviral therapy 96
Antituberculosis treatment 96
Anxiety 27, 29, 43, 114, 237, 241, 303
disorder 25, 32, 33, 55, 92, 254
generalized 24, 29, 32
high level of 130
Apathy 31, 32
Appropriate facial expression, lack of 250
Archaeological anthropology 286
Archetypal psychology 212
Arousal reduction training 84
Arrhythmias 119
Art therapy 208
evidence base of 213
scope of 215
task force on 216
Arthur Kleinman's theory 292
Artificial intelligence 242
Asexuality spectrum 127
Asthma 215
Astrological influences 195
Atopic dermatitis 108, 109
Attachment theory 257
Attention deficit hyperactivity disorder 26, 36, 56, 249, 250
Autism 9, 104
spectrum disorder 26, 36, 249, 250, 279
diseases 90
disorders 47
encephalitis 34
encephalomyelitis 24
thyroiditis 90
Autonomic dysfunction 77
Autonomic nervous system 3, 75, 124
Autoscopy 233
Bacterial mutations 184
Bacteriotherapy 81
Bahujan Hitaye, Bahujan Sukhaye 136
Bender Gestalt test 212
Benzodiazepines 20, 53
Bethanechol 82
Biological anthropology 286
Biology 9
Bipolar disorder 9, 24, 35, 55, 114, 191, 196
Blood tests 150
dysmorphic disorder 102
mass index 95
Bolitho test 224
Borderline personality disorder 27
Brain 248, 273
decade of 168
interactions 75
psychotherapies 83
relevance of 182
Breastfeeding 53
Briquet's syndrome 78
Cancer 215
Cardiology 112
Cardiovascular disease 112, 113, 116, 117
Catecholamine 109
Central nervous system 3, 19, 72, 99
Centrally mediated abdominal pain syndrome 74
Cerebrospinal fluid 12
Cerebrovascular disorders 31
Child sexual abuse 300
Child's cognitive development 252
Childhood psychiatric disorders 279
Cholesterol 119
Chronic fatigue syndrome 3, 62
Civil law 22
cases 218
Clozapine 51, 54
Coercion 187
Cognitive behavioral therapy 24, 44, 84, 113, 200, 215, 242
Communication system 209
Complex-partial seizures 196
Conduct disorders 251
Confusion assessment method 21
Congestive cardiac failure 119
Contemporary dance 276
Contraception 49
Convolutional neural network 243
Cornelia de Lange syndrome 104
Coronary artery disease 20, 112, 118
Coronary bypass graft surgery 119
Coronary heart disease 113
Stockholm women's intervention trial for 118
Corticosteroids 96
Corticotropin-releasing hormone 109
Cortisol 109
COVID-19 6, 57, 240
pandemic 242
Criminal law 222
Cultural mental health 290
Culture bound syndromes 170, 289, 290
Culture specific disorders 291
Curricular stress 253
Cushing's disease 91
Cushing's syndrome 91
Cycloserine 90
and music 282
therapy 272
classes 281
components 275
movement therapy 277, 278
effectiveness of 278
music 274
and mind 272
performer-choreographer 272
therapy 275, 279, 281
field of 275
role of 277
Daydreaming 233
Deep brain stimulation 29
Delirium 19, 20
differential diagnosis of 21t
risk factors for 20t
tremens 19
Delusional disorders 101
Dementia 9, 22, 30
etiology of 22t
psychological symptoms of 23
treatment for 278
Depression 29, 31, 33, 43, 55, 113, 118, 119, 191, 197, 199, 201, 241, 254, 267, 277, 279, 303
incidence of 198
management of 55
mild 29
moderate 29
moderate-to-severe 277
perimenopausal 48
severe 29
severity of 198
symptoms 278
Dermatillomania 105
artefacta 103, 104f
para-artefacta syndrome 106
Dermatological disorders 100, 107
Dermatological obsessive-compulsive disorders 102
Dermatology 99, 100t
interface of 100
Dermatomyositis 60
Dextromethorphan 25
Dhat syndrome 128
Diabetes mellitus 20, 89, 95, 118, 276
Digital phenotyping 241
Disability benefits 181
Disaccharides 78
Disgust 273
cultural concepts of 291
idioms of 170, 291
District Mental Health Programme 221
Divergence, phase of 168
Divine wrath 195
Domestic Violence
Act 221
female victims of 278
Dopamine 12
dysregulation syndrome 30
Double-blind randomized controlled trials 271
Down syndrome 183
Dozing 233
Drama therapy 282, 283
Drapetomania 288
Draw-a-man test 212
Drug hypersensitivity syndrome 106, 106f
Dualism, theory of 73
Dysbiosis 76
Dysmetria, cognitive 35
Dysmorphic facies 250
Dyspareunia 128
Dyspepsia, functional 74
Eating disorders 56, 104, 254257
Ebstein's anomaly 52
Efavirenz 90
Electra complex 178
Electroconvulsive therapy 24, 150, 266, 267
Electroencephalogram 26, 241
Electronic health records 242
Emotional resilience 252
Emotions, active expression of 279
Empirical adequacy 184
Endocrine disorders 91, 130
Enteric nervous system 3
Epigastric pain syndrome 74
Epilepsy 25, 26, 26t, 27
Epistemic injustice 146
Erectile dysfunction 125, 130
Escherichia coli 81
Ethnographic fieldwork, hallmark of 286
Euphoria 25
Exfoliative cheilitis 106f
Extrasensory perception 229
Eye movement desensitization 162
Facial expressions 271
Factitious dermatitis 103
Feelings 274
Fermentable oligosaccharides 78
Fitness 305
Follicular-stimulating hormone 48
Food safety 305
Foramen magnum 19
Forensic psychiatry 218
Freud's psychoanalysis 160
Functional abdominal pain 74
Functional gastrointestinal disorders 4, 72, 72b, 73, 85
assessment of 79
management of 81
pathophysiology of 75
Gamma-aminobutyric acid 11, 21
Gastroenterology 3, 72
Gastrointestinal system 4
Gender identity 123
Gestalt therapist 212
Glutamate 11
Gouty arthritis 60
Grandiose delusions 193
Guru-chela paradigm 179
brain interaction, disorders of 72
microbiome 76
psychopharmacology 81
Gynecological oncology 57
Habit and impulse disorders 103
Haloperidol 117
Hanuman complex 179
Hashimoto's thyroiditis 96
Health Insurance Portability and Accountability Act 243
Health Promotion Using Life Skills in Adolescent Program 260
Health, promotion of 305
Heart disease 115, 118
B virus 95
C virus 95
Hermaphroditism 178
Hindu Marriage Act 224
Hodgkin lymphoma 183
Holism, principle of 73
Hospital anxiety and depression scale 61
Human behavior 265
Human communication systems 209
Human immunodeficiency virus 47, 90, 215
Human mind 287
Hyperparathyroidism 92
Hyperprolactinemia 130
Hypertension 89, 119
arterial 131
Hypnotherapy 84
Hypothalamic-pituitary-adrenal axis 114
dysfunction 48
Ideographs 209
Immune dysfunction 77
Impulse control disorders 30
Indian Education System 248, 249f
Indian Journal of Social Psychiatry 170
Indian Psychiatry Society 151, 269
Induced abortion 49
Infectious diseases 90
Infertility 48
psychological effects of 49
Inflammatory diseases 90
Influence 187
Information technology 239
Insanity plea 225
Insomnia 43
Institutional neurosis 168
Intellectual disability, prevalence of 249
Intensive care units 20
Internal psychokinesis 232
International Association on Political Use of Psychiatry 5
International Classification of Diseases 4
International Journal of Social Psychiatry 170
Interpersonal therapy 113
Irritability 43
Irritable bowel syndrome 73
Ischemic heart diseases 89
Isolation, feelings of 237
Jacobson's progressive muscle relaxation training 84
Joint researches 288
Judicial psychiatry 151
Judiciary, role of 226
Kidney diseases, chronic 89
Kinesthetic reaction 210
Kleine-Levin syndrome 34, 178
Lactobacillus plantarum 81
Language and speech disorder 249
Law regulating psychiatry profession 220
Legal system 189
Lesch-Nyhan syndrome 104
Levator ani syndrome 75
Levodopa 25
Lewy bodies 30
Limbic encephalitis 96
Linguistic anthropology 286
Lip-lick cheilitis 102f
Lipoprotein, high-density 118
Literature, types of 231
Lorazepam 54
Lower depressive symptoms 198
Luteinizing hormone 48
Lyme disease 90
Lysergic acid diethylamide 11
Magnetic resonance
imaging 25
spectroscopy 12
Major depressive disorder 23, 24, 50, 113
Major histocompatibility complex 10
Major psychiatric disorders 90
Male erectile disorders 128
Mania 31, 33
Marriage and divorce 224
Martha Mitchell effect 146
Matchbox sign 101
McDonald criteria 23
Media, traditional forms of 301
Medical Council Act 222
illness 276
insanity 225
issues 95
Medication adherence 191, 197
Mefloquine 90
Menarche 43
Menopause 48
Menstrual cycle 43
Mental disorders 181, 288
care for 195
severe 289
statistical manual of 290
Mental disturbances 267
Mental health 149, 154, 215, 239, 240, 270, 283
action plan 144
care 139t
act 220, 221
implementation of 219
services 220, 221
conditions 266
education 254
hospitals 289
impact on 298
issues 254, 256
risk factor for 253
legislation 219, 220, 221
problems 255, 281
professionals 266, 269, 270, 283
portrayal of 266
promotion of 283
scope of 248
symptoms 214
themes, realistic portrayals of 268
Mental illness 18, 57, 129, 191, 193, 218, 219, 223, 226, 227, 254, 274, 280, 283, 288, 295, 303
absence of 248
depiction of 266
development of 241
music therapy for 279
representation of 269
severe 1, 95, 129, 196
symptoms of 191
treatment for 275
types of 276
Mental Retardation and Multiple Disabilities Act 221
Mental stress
acute 115
chronic 115
Metabolic syndrome 112, 118
Microbiota-gut-brain axis 77
Midface toddler excoriation syndrome 104
Migration 149
philosophy of 181, 182
theory of 183
Mini-mental state examination 22
Mirtazapine 25, 54
Monoamine oxidase inhibitors 117
Monosaccharides 78
Monozygotic twins 232
disorder 27, 36
disturbances 254, 256
stabilizers 52, 54
Multiple sclerosis 23, 24, 90
Murphy argues 184
Muscle tension, electromyographic biofeedback for 84
advantages of 275
and dance 276, 280
therapy 274, 275, 279, 281
Myocardial infarction, acute 113
Mythology 174, 175
and mind 175
and therapy 179
Narcissistic personality disorder 178
Narcotic Drugs and Psychotropic Substances Act 222, 256
National Institute of Mental Health and Neurosciences 93
National Mental Health Programme 221, 259, 294
Near-death experiences 231, 233
Necrotic deep ulcers 101f
Neostigmine 82
Neurodevelopmental disorders 104, 248
Neurodiversity theory 188
Neuroimmunocutaneous system 93
Neuroimmunopathogenesis 9
Neurological disorders 23
Neurological soft signs 34, 34t, 35
Neurological system 248
Neurology 2, 18
Neuropsychiatry 18, 19, 89
Neurosyphilis 90
Neurotic excoriations 102f
Neuroticism 78
Neutral posture 287
Nitric oxide 124
N-methyl-D-aspartate 11
acid 23
Noncommunicable diseases 89, 221
Nonreductive physicalism 186
Nonsteroidal anti-inflammatory drugs 67
Nonverbal communication 208
Nonverbal language 209
Norepinephrine reuptake inhibitor 25
North American Psychiatry, growth of 160
Nosological system 295
Nosology 289
Obsessive-compulsive disorder 3, 9, 24, 33, 36, 55, 91, 102, 119, 191, 199, 242, 267
Obstetrics and gynecology 2, 42
Oedipus complex 178
Official classification systems 184
Olanzapine 54
Onychotillomania 102f
Orbitofrontal cortex 33
Orgasmic disorders 128
Osteoarthritis 60
Out-of-body experiences 232, 233
Oxidative stress 12
Pain 94
Palliative care 94
Panic disorder 29, 177
Paralysis agitans 28
Paranormal phenomena 229, 233, 234
types of 231
Parapsychology 229, 230
Parkinson's disease 28, 29t, 31t
Paroxetine 24
Paroxysmal supraventricular tachycardia 119
Pathological laughter and crying scale 32
Pediatric autoimmune neuropsychiatric disorders 3, 63, 91
Pentazocine addiction 101f
Perinatal psychiatric illness 45
Personal data protection bill 243
Personality disorder 27, 104
Pharmacological management 44, 67
Phenomenology 181, 183
Philosophy 6, 181
Phonological awareness skills 280
disability 216
exercise 276
fitness 272
Political psychology 144
Polycystic ovarian syndrome 57
Polymyositis 60
Polyols 78
Poor neonatal adaptation syndrome 52
Positive and negative syndrome scale 277
Positive emotions 278
Positron emission tomography scanner 273
Postencephalitis syndromes 90
Postpartum bipolar disorder 47
Postpartum blues 45, 47
Postpartum depression 45, 47
effects of 46
management of 46
Postpartum mood disorder 47t
Postpartum psychosis 46, 47
management of 47
Postprandial distress syndrome 74
Poststroke depression 31
Post-traumatic stress
diagnosis scale 256
disorder 33, 120, 130, 149, 160, 209, 241
Post-war victims, well-being of 275
Prebiotics 81
Pregnancy 47, 57
loss of 49
Premenstrual dysphoric disorder 43, 44b
Priapism 178
Probiotics 81
Problematic behaviors 280
Proctalgia 75
chronic 75
fugax 75
Prokinetics 82
Prolactin 109
Protection of Children from Sexual Offenses 256
Protection of Human Rights Act 221
Proximity 210f
Prurigo nodularis 105f
Pseudobulbar affect 25, 32
Pseudoseizures 27, 28t
Psoriasis 131
area severity index 108
Psoriatic arthritis 60
advanced directives, use of 188
anthropologists 287
assessment 290
categories 234
comorbidity 78
conditions 182
curriculum 216
diagnosis 290
disorders 24t, 26, 26t, 29, 29t, 42, 63, 92, 100, 101, 107, 118, 254, 277
brain plasticity basis for 11
causal association of 64
management of 66
neurobiology of 36
neurological aspects of 34
neurotransmitter basis for 11
nonpharmacological management of 68
pharmacological management of 67
primary 90
somatic treatment for 69
treatment of 54
evaluation 64
illness 296
diagnosis of 289
implications 100, 107
issues 92
medications, cardiac side effects of 116
morbidity 64b
epidemiology of 61
nosology, aspect of 289
phenotypes 184
research, internal stages of 185
researchers 185
moral responsibilities of 184
side effects of cardiac drugs 116
symptoms 277
rating scale 294
treatment of 187
assisting judiciary system 222
role of 95, 222
Psychiatry 1, 18, 62, 88, 100t, 136, 159, 162, 166, 169t, 181, 184, 186, 229, 265, 269, 276, 282, 287, 289f, 295
and law 219
interface 220f
central institute of 276
deals 229
field of 295
global initiative on 5
interface of 100
philosophy of 181183
practice of 138
sociology of 166
Psychoactive substance use 25
Psychocardiology 89
Psychodermatology 93
Psychodrama 282
Psychoeducation 83
Psychogenic nonepileptic seizures 27
Psychogynecology 89
Psychokinesis 232
kind of 232
Psychological issues 68, 258
Psychonephrology 89, 94
Psycho-oncology 89, 92
Psycho-ophthalmology 89
Psychopathology 193, 196
Psychopharmacology, basic principles of 68b
Psychosis 25, 27, 29, 32, 33
Psychosocial factors 77, 112
Psychosomatic diseases 130
Psychotherapy 283
Psychotic symptoms 277, 294
Psychotropic drugs 27
effects of 27t
Psychotropics 50, 51
medication 53
Pyridostigmine 82
Quarantine 187
Quasi-legal instruments 220
Quetiapine 54
Quinidine 25
Racial attitudes 239
Racial disparity 266
Randomized controlled trials 213
Rashtriya Bal Swasthya Karyakram 260
Relaxation therapy 84
Religiosity 192
impact of 198
Religious assistance, acceptance of 196
Renal disease, end-stage 95
Repetitive transcranial magnetic stimulation 29
Reproductive medicine 42
Rheumatic diseases 3
Rheumatoid arthritis 3, 60, 90, 131
Rheumatological diseases 60, 61, 63, 64, 64b, 65b, 66
Rheumatology 3, 60
interface of 62
Rorschach's inkblot test 212
Schizophrenia 9, 11, 35, 54, 95, 115, 191, 193197, 241, 267, 277, 279
awareness association 267
disorders 279
negative symptoms of 12
proportion of 195
treatment of 54
School health systems, part of 259
School mental health 260
programs 280
promotion of 259f
Science, philosophy of 181
Scientific Foundation for Dance Therapy 276
Scleroderma 60
Sedatives 54
Selective serotonin reuptake inhibitors 12, 24, 44, 114, 117
Self-awareness mode 272
Sensationalize violence and substance use 266
Serotonin 11
Sertraline 24, 54
antidepressant heart attack randomized trial 113
Sex education, role of 250, 253, 254, 256
Sexting 299
Sexual abuse 256
Sexual assaults 257
Sexual behavior 123
high-risk 254
Sexual disorders 122
Sexual dysfunction 63, 115, 128, 130, 131
primary 131
secondary 131
tertiary 131
Sexual functioning 129, 130
Sexual health 305
Sexual identity 123, 126t
Sexual orientation 123
components of 126f
Sexual response cycle 123
neurobiology of 124
Sexuality 4, 122, 125
Michael storms model of 127f
spectrum concept of 125
Sexually transmitted diseases 256, 304
screening for 258
Sheehan's syndrome 47
Shell shock 159
Sjögren's syndrome 60, 131
Skin-picking disorder 105
Sleep 300
disorders 30, 31t, 56
Small intestinal bacterial overgrowth 76
and political philosophy 188
and psychiatry 181
anthropology 287
anxiety, levels of 303
blackmail 299
cultural anthropology 286
epidemiology 166
gesture 294
hygiene 189
media 269, 297, 303
impact of 252
use of 297
medicine 167
networking sites 297
psychiatry and psychiatric epidemiology 170
skills 249, 279
smile, lack of 250
Sociocultural intervention 212
Socioemotional theory 257
Sociology 6, 166, 169t, 290
Somatoform disorders 102
Specific learning disorder 249, 251, 254, 259f
Spirit 195
intrusion 195
Split attraction model 128f
Stevens-Johnson syndrome 106
Strengthens cardiovascular health 272
Streptococcal infection 3, 63, 91
Streptococcus pyogenes infection 91
Stress 254
impact of 63
reduction 272
Subpoena 226
Substance abuse 254, 256
disorders 101
Substance use 301
disorder 56, 267
Suicidal behavior 191, 198, 200, 254, 256
Suicidal ideation 199, 267
presence of 255
Suicide 27, 167, 301
attempts 201
Synbiotics 81
Synchronicity 235
Systemic lupus erythematosus 3, 60, 90
Teachers, training of 251
Telepathy 231
Temporal lobe epilepsy 26
Testamentary capacity 223
Testosterone 125
Thematic apperception test 212
Tic disorders 103
Tort law 224
Tourette syndrome 119
Toxic epidermal necrolysis 106
Transcendental meditation 84
Transcranial magnetic stimulation 150
Transcultural psychiatry 288
Traumatic brain injury 32, 34t, 92
Trichotillomania 102f, 103, 103f, 105
Tricyclic antidepressant 24, 51
Vaginal dryness 131
Vaginismus 128
Valve replacement 120
Valvular heart disease 119
Verbal language 209
Vietnam war and psychiatry 161
Visceral hypersensitivity 76
Visual communication, characteristics of 209
Visual language 209
components of 211
Vitiligo 108
War and psychological warfare, psychological costs of 148
Watching television 239
Weakness 267
Wernicke's encephalopathy 34
Working memory 209
World Association of Social Psychiatry 171
World Health Organization 144
Yudhishthir syndrome 178
Ziplock sign 101
Zippy's friends program 260
Zolpidem 53
Zopiclone 53
Chapter Notes

Save Clear

Interfaces of Psychiatry: An OutlineCHAPTER 1

Vinay Kumar,
Shahbaz Ali Khan
Psychiatry today stands at a juncture where it touches almost all aspects of human life, interacting with philosophy, culture, religion, sociology, jurisprudence, politics, economics, and cinema among others, apart from sister medical streams. One has to appreciate the ripple effect of collective emotions on rise and fall of the Sensex to understand the impact of mind on aspects as distant as economy. Thus, it traverses various frontiers and makes significant interfaces at every front. Let us briefly look at the various interfaces before we take the jump into the ocean of knowledge that this book provides to the readers.
If we look at the interface of psychiatry with biology in general, it is evident that psychiatry is now significantly integrated with other medical and surgical specialties than in the past. Psychiatric disorders are highly prevalent among medically ill patients. Studies done in our country found 38.6% of psychiatric comorbidity with depressive disorder (28.2%) being the most common psychiatric diagnosis in the outpatient medically ill.1 The interface between psychiatry and medical specialties is very vast. It starts from the etiopathogenesis of a medical illness due to psychological and emotional problems to psychiatric consequences of medical diseases, especially those which are chronic or life-threatening, and this interface also deals with psychiatric side effects of medications and procedures, as well as drug interactions between drugs for medical treatment and psychopharmacological agents. In contrast to the few known subspecialties of psychiatry such as addiction, child, and geriatric psychiatry, some of the interfaces have developed into super specialties such as psycho-oncology, psychonephrology, psychocardiology, psycho-ophthalmology, psychogynecology, neuropsychiatry, and psychodermatology.
Severe Mental Illness
Another matter of concern with psychiatric illness is the high prevalence and poor outcome of physical illnesses associated with them—the issue of medical diseases in psychiatry patients. Several reviews and studies have shown that people with severe mental illness (SMI) have an excess mortality, being two or three times as high as that in the general population.2 About 60% of this excess mortality is due to physical illness. Evidence suggests that persons with SMI are, compared to the general population, at increased risk for overweight, obesity, metabolic syndrome, diabetes mellitus, cardiovascular diseases, cancer, and even infectious diseases such as hepatitis B and C, which are much more prevalent in psychiatric patients than the general population.3 This further underlines2 the need for the psychiatrist to work in close cooperation with the medical and surgical specialties and her multidimensional role in healthcare.
If we consider primary major mental illness schizophrenia as a prototype of SMI, one wonders whether schizophrenia is the evolutionary price we pay for continuing creativity? Is it the risk humans take collectively to keep creativity alive to aid future survival in an ever-changing world. As we know the only fixed thing in the universe is change. To cope up and survive in this fast-changing world, our weapon is creativity, and schizophrenia is the risk we take to toy with creativity. For every Albert Einstein who helps humanity survive, we have Eduard Einstein, a schizophrenic, or John Nash has to suffer schizophrenia to contribute with his genius creativity for the human race. Sometimes it is both; Bertrand Russel had to suffer from schizophrenia himself and so did many of his relatives. Is schizophrenia then a small price to pay for human survival through continuous creativity?.4 A lot is happening at this interface of psychiatry and computational biological research due to the unlimited ability of computers to handle big data.
Psychiatry and neurology are like twins, born together but got separated. One where the cause was clear and this branch picked up motor, sensory, and such clear domain abnormalities with elicitable physical signs, established etiologies, and demonstrable anatomic pathology and came to be called neurology while the more elusive and complex domain function of the brain—emotions, perception, cognition, behavior which could not be easily allocated to one brain area of Broadman or even one region had no clear etiologies or demonstrable pathologies—came under the umbrella of psychiatry. So, the more tangible and evident aspect inside the head was taken away and the more complicated, complex, nuanced functions were left for psychiatry. With relation between the mind and the brain still not very definitely understood, the Siamese twins better stay together with a clear need for this interface, for the nonphysical mind is forever dependent on the physical brain though not entirely reducible to brain.5 Nonreductive physicalism is the most prevalent philosophy of psychiatry as of now. It is the need of the hour to encourage psychiatric training for a neurologist and potentiate the neurology training of a psychiatrist, so that both the facilities can work hand in hand, supplement each other in areas of cross-fertilization, and lead to a successful future alliance of both the branches.
Obstetrics and Gynecology
Coming to the interface of psychiatry and reproductive health, we know that psychiatric disorders are equally prevalent in both males and females. However, there exist some gender-specific differences in onset, clinical course, prognosis, treatment resistance, etc. Also, some disorders are specific to females. Women experience various stages of life starting from menarche, menstrual cycle, pregnancy, postpartum period, and menopause, which are greatly influenced by hormonal changes and impact the psychological vulnerability and, in turn, lead to the predisposition of women to certain psychiatric illnesses. While a woman passes through these times along with the transitional stages, she has to go through tremendous hormonal and psychological challenges and biological alterations, which have potential consequences in her mood, behavior, and thought processes. The interface between psychiatry and female psyche has been very sensitive. When psychiatry was3 blind to this interface, it ostracized women, and as science grew it understood the female biology behind psychic issues specific to the females better.
An important interface that psychiatry has is with psychosomatic medicine. Rheumatoid arthritis (RA) was included as one of the seven psychosomatic disorders in the original description of “holy seven” by Alexander. Over the years with the improvement in the understanding of various rheumatological disorders, there is also an improvement in understanding about the prevalence of various psychiatric disorders in patients with rheumatic diseases, especially systemic lupus erythematosus (SLE) and RA. Available data suggest a wide range of psychiatric morbidity in patients with SLE and RA and other such immune-related disorders of the body, with depression and anxiety disorders being the most commonly reported morbidities.6 At the interface also sits the big masquerader like chronic fatigue syndrome (CFS), which is commonly diagnosed as depression.7 Then there are many rheumatological diseases which first present to the psychiatrist as psychiatric symptoms much before or along with other physical symptoms; a case in point is SLE.
The role of autoimmune factors in the manifestation of obsessive–compulsive disorders (OCDs) are well known. Patients with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) can present to the psychiatrists with features of tics, obsessive-compulsive behavior, and other neuropsychiatric symptoms.8 Hence, when a young patient presents with first-episode psychosis/schizophrenia, catatonia, or OCD-like symptoms, a thorough physical examination needs to be conducted to look for features of SLE and other autoimmune disorders, and if required, the clinician should order diagnostic tests. There is a bidirectional relationship between various psychiatric disorders, psychosocial factors, and manifestations of rheumatological diseases. The role of autoimmunity and inflammation is well known in various psychiatric disorders, which are considered to be at the core of all rheumatological diseases. It is suggested that in patients with rheumatological diseases, alteration in the inflammatory markers impacts the brain. Chronic inflammation leads to impairment in the normal physiological stress responses and results in psychiatric symptoms. The inflammatory changes also directly influence the brain and lead to the development of psychiatric manifestations. Sleep disturbances can influence the perception of the pain, inflammatory response, and the levels of various cytokines. As we see, liaison between psychiatry and rheumatology is inescapable in the management of rheumatological diseases and the interface is bidirectional and well established, and a close cooperation between the treating physicians, the psychiatrist, and a good therapeutic alliance will go a long way in patient care in this domain.
The complex and seminal bidirectional interactions between the enteric nervous system (ENS), autonomic nervous system (ANS), central nervous system (CNS), and the hypothalamic–pituitary–adrenal (HPA) axis are evolving and throwing a new light on the gut–brain interactions where emotions and thinking affect the visceral sensitivity, gut motility, secretions, mucosal and immune functions, and gut microbiome and vice4 versa. In the specialty of the gastrointestinal (GI) system, research has proven that a biopsychosocial approach is the best way forward in management of the plethora of symptoms referred to as functional GI disorders (FGIDs). These are syndromes that include a set of GI symptoms that cluster together, in the absence of any structural disease. These are also called “disorders of gut–brain interaction.” To emphasize this hugely important interface of psychiatry with GI system disorders, suffice it to say that there are 33 adult and 20 pediatric FGIDs, which the International Classification of Diseases (ICD) describes as somatoform disorder category.9
Sexuality is a primary instinct of human species, enabling pleasure and survival. Various biopsychosocial factors can help us understand the etiopathogenesis of sexual disorders. Race, ethnicity, religion, socioeconomic factors, interpersonal relationships, social stigma, and personality of an individual interact in complex ways to influence the sexuality of an individual. With contributions from Alfred Kinsey to Fritz Klien, the understanding of sexuality as a spectrum, and with sexual identity itself being assessed under sexual attraction, sexual behavior, sexual fantasies, emotional preference, social preference, self-identification, and homosexual/heterosexual lifestyle, sexuality has become a complex construct.10
Sexuality is such a fundamental aspect of life that any aberration/convolution/deviation, biological or acquired, is bound to affect the psyche significantly apart from inviting social scrutiny and stress. Apart from that, mental illness has an intricate relationship with sexuality at different levels whether in the form of increased prevalence of sexual disorders in SMI, abuse of persons with mental illness (PMI), or effect of psychotropics. Hence, sexuality is an interface that is extremely pertinent to psychiatry and psychiatrists. With the fast-changing horizons of sexuality, with rising feminism bringing down the age-old bastion of male dominance, with more power to individualism and liberalism, the traditional concept of sexuality is bound to be stressed and lead to distress and disorder (for where there is stress, there is disorder), as is wont and when things change and when societies reorganize around new constructs/domains. Higher incidences of distress, anxiety, and depression in the LGBTQI community are a case in hand. Hence, this interface becomes even more important, and psychiatry has to be ready to face this challenge.
The field of psychiatry is unique in its place, as cultural values, norms, and ideals have an influence in its practice more than in any other branch of medicine. Humans are but a product of their culture and ethics, the rules governing the good and bad arise from cultural norms. Psychiatry has a very intimate interface with culture and ethics, much more than any other discipline of science due to the fact that the very concept of normalcy and deviance in behavior is intertwined with culture and social norms to a large extent. Also, the stigma and prejudice attached to psychiatric diagnosis are a baggage from eternity that we have to carry and manage. The situations where involuntary treatment may be required against the free will of the individual and the private and personal nature of divulgences made in therapeutic relationship add to the importance of ethics specific to psychiatry. Considering these special domains of psychiatry, ethics plays a crucial role in protecting the rights of the PMI as well as safeguarding psychiatry as a profession itself.5
There is ample evidence that religiosity and its various dimensions influence many mental illnesses. The influence of religiosity and its dimensions has been understood concerning the development of the disorder (especially depression), with some evidence to suggest that religiosity plays a protective role in the development of depression. Contemporary research also sheds light on the association of religiosity/religious beliefs with symptoms of mental illness (i.e., symptoms with religious content and suicidality), help-seeking, pathways to care, medication adherence, treatment response, psychosocial adaptation, relapse rates, social integration, and quality of life (QoL), etc.11
Literature and Fine Arts
Literature and fine arts may look unscientific from a distance, but they have been part of sociocultural existence and journey. All these creative pursuits are primarily mental activities, hence the process and the products both influence mental functioning and health. Artworks and literary writings not only reflect thoughts and aesthetics but also the underlying pathology. Therapeutic effects of reading, expressive writing and viewing, listening, and creatively involving in fine arts work have been studied. The jury is still not out with robust evidence supporting as well as refuting its benefits. However, with the concept of holistic and integrative care of concept in mental illness, and the shift in focus from symptom reduction to mental well-being and QoL, these therapies have an active interface with psychiatry, especially in management and rehabilitation domain, with ever-expanding footprint and huge potential, and has been recommended as such in many guidelines. These interfaces are integral to the existence of an evolved mental healthcare system and psychiatry.
The interface of politics and psychiatry is a double-edged sword with both advantages and disadvantages that affect both the disciplines with rising conflict and controversy. On the positive side of this interface, the international and national political partners have started emphasizing the role of mental health by celebrating World Mental Health Day, bringing reforms in existing laws, incorporating mental health indicators to be achieved in the global sustainable goals in World Health Organization (WHO) Mental Health Action Plan, and thereby paving way to the universal coverage for mental health services and equal rights for the mental disability. However, the catastrophic effects of intrusion of political ideology into the realm of mental health have carved a strong impression in the face of history of the world politics and continue to do so. “Personal and political are different domains and the two shall never meet” is an interesting paradigm except that it is false. Politics evolves from personal, and personal is affected by political. A positive relationship between the two results in healthy ecosystem, thriving minds, and great policies to further the cause of universal mental health and its determinants, and a toxic, overbearing, ideological mix of the two or the use of psychiatry as a political tool is pure catastrophe as has been seen time and again. The branch of political psychology must remain independent and scientific for it studies the interface of political behavior and psychological processes. Realizing the importance of this interface, in 1980, the International Association on the Political Use of Psychiatry (IAPUP) was formed in order to fight against political misuse of psychiatry, and since 2005 this is renamed as Global Initiative on Psychiatry (GIP) that focuses on not only political abuse of psychiatry but also human rights monitoring throughout the world with6 goal of implementing humane, ethical, and effective mental health care.12
The mental health professionals need to be aware and alert to the interface of political history and psychiatry lest a “sluggish schizophrenia” may raise its ugly head again.
Sociology deals with the study of groups and their collective consciousness. It is the study of social behavior or society whereas psychiatry, as per the current biomedical model, is a disorder of an individual. However, a closer look makes it inevitable to be aware of the interactions between the two. An individual lives in, to, and for a society. Therefore, societal influence on the individual is undeniable. The disciplines of psychiatry and sociology share a dynamic relationship. Before the 20th century, interaction between these fields was regarded as inconceivable. The very society which, not very long ago, banished mental illness and psychiatry and kept it away from its borders soon saw the development and predominance of sociological view to understand mental illness; the roosts had come home. The two streams again seemed to come apart with the predominance of biological psychiatry, evidence-based medicine, and psychopharmacology in the 1970s before swinging widely toward “Sociatry,” egged by Emil Durkheim's social roots of suicide, before finding a comfortable balance with a well-defined interface today seeded in Engel's biopsychosocial dimension.13
Social psychiatry's seminal contribution to knowledge in the field of mental health and mental illness, in the form of psychosomatic medicine, abnormal illness behavior, therapeutic community, expressed emotions, and culturally bound idioms of distress, cannot be overemphasized.14
Regarding philosophy, the dimension has shifted from philosophy and psychiatry to philosophy of psychiatry, and the tide seems to be turning full circle from rejection of Cartesian dualism to rekindled interest in “property dualism” as the quest of mind's relation with brain searches for newer paradigm. Such is the importance of this interface of psychiatry with philosophy that the external goals of psychiatric research (e.g., deciding which research programs to fund, which research designs are ethically permissible, and how to apply research results to develop more efficacious treatments) are hugely determined by ethical and epistemological domains, which are but core branches of philosophy.
Talking of technology and its interface with mental health, it can be safely said that technology is intricately linked to modern human existence. Our social life is linked to our battery life, our connections are as strong as our network, and we log on and log off on life every day. The word is consumption; we consume technology and technology in return consumes us, affecting the mental health in the bargain. Also, the mental health of an individual can influence the way she uses and interfaces with technology. Technology thus is a culture tool now, to be wielded for benefit or harm, but it cannot be ignored. From its role in development of personality to psychopathology, as our childhood and adolescence are immersed in it, to its use in assessment, evaluation and treatment, technology, especially information technology, social media, and such other forms of technology have a huge interface with psychiatry. Digital phenotyping [artificial intelligence (AI)-based real-time psychological monitoring and assessment], personalized psychopharmacology (gene-based individualized drug effect and tolerability), huge growth of telemedicine and its application during the COVID-197 pandemic, and Food and Drug Administration (FDA)-approved mobile apps for substance use disorders are just a few instances of the potential of this interface between psychiatry and technology, which has been dealt in detail by the domain experts.15
Cinema not only reflects the society it is set in but also acts as a reflector to the society. From spreading awareness and changing public perception to use of cinema in psychiatry teaching programs to mental health advocacy and stigma mitigation, cinema has potential to bring about huge impact on mental health and psychiatry. Similarly the fields of art, theater, music, and dance are creative expressions of human beings and universal modes of communication of ideas and emotions. There is evidence base for their therapeutic potential in mental health, mental illness, and rehabilitation, and these disciplines have an interface with psychiatry, which is beautifully laced, dancing to glory, in tune with each other, singing in rhythm, and synced musically. This aspect has been dealt in detail too, in respective chapters.
To conclude, as we discussed in brief here, no sister specialty is complete without exploring the psychological factors; be it at prevention, treatment, or rehabilitation level, the management will have deep voids and will be grossly inadequate and often frustrating if the psyche behind the physical illness is not addressed. Such is the importance of psyche and psychiatry that a close interaction between psychiatry and all the sister specialties, and all the branches of knowledge, is the need of the hour. From the realms of madhouses, psychiatry has come to claim its rightful place in the center of medical science and man's existence itself. We believe that if mental health is an integral part of health and is an absolute human right of everyone irrespective of gender, race, culture, ethnicity, and nationality as propounded by the WHO, then the psychiatrists have to be the advocates of these rights, and be active and alert at all these interfaces outlined above.
In many ways, psychiatry is a social institution, not merely an academic/medical discipline. It is a social institution in the sense that it is embedded and intertwined with other social institutions and has an interface with all of them. This increases the moral obligation and responsibility of the psychiatrists to which they must be alive.
In this context, the interface of psychiatry is with vast and varied fields ranging from biology to culture to religion/spirituality to history to philosophy and more. Through this effort in the form of a book, a humble attempt has been made to explore the various interfaces of psychiatry and take a holistic view of the stream. In general, with the expanding boundaries, bloom in knowledge, and research challenging old concepts by the moment, there is felt need for a balancing interface which psychiatry is well poised to provide. If these interfaces are recognized and realized, it is hoped that it will finally lead to better understanding of concepts and help in collaborative decision-making. This is a humble attempt in that direction. We have collected thoughts of greats in the field on this contemporary and challenging topic to address this interface in a holistic approach to the topic.
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