A comparison of psychiatry and internal medicine: a bibliometric study
Acad Psychiatry. 2012 Mar 1;36(2):129-32
Stone K, Whitham EA, Ghaemi SN
Abstract
OBJECTIVE: Psychiatric education needs to expose students to a broad range of topics. One resource for psychiatric education, both during initial training and in later continuing medical education, is the scientific literature, as published in psychiatric journals. The authors assessed current research trends in psychiatric journals, as compared with internal-medicine counterparts and examined their relevance to psychiatric education.
METHODS: The authors classified abstracts and original articles as biological or non-biological, based on methodology, from 2008 in Archives of General Psychiatry and The American Journal of Psychiatry, as compared with The Archives of Internal Medicine and Annals of Internal Medicine.
RESULTS: Biological and non-biological studies were similarly frequent in psychiatric journals (48.2% and 51.8%, respectively). Internal-medicine journals had a non-biological and epidemiological predominance (22.2% biological, 77.8% non-biological: epidemiological, 59.9%; reviews, 21.4%; clinical, 13.2%; other, 5.4%).
CONCLUSION: Psychiatric journals publish more biological studies than internal-medicine journals. This tendency may influence psychiatric education and practice in a biological direction, with less attention to psychosocial or clinical approaches to psychiatry.
PMID: 22532204
The authors must be kidding.
In my experience, clinical psychiatrists ignore the medical and biological aspects of mental illness. Many have lost their medical skills, avoiding or being unable to do a physical exam nor consider appropriate lab testing, nor strongly consider the physiologic causes of mental illness. Many may not even look at their patient as they speak to them.
Too often, they focus on psychosocial aspects of mental illness, preferring to do therapy while ignoring the biological and pathophysiologic basis of mental illness. There is significant resistance to psychiatry being “medical”.
This is not a criticism of the psychosocial aspects of mental health. Psychosocial theories and psychotherapeutic interventions are the best theories and forms of treatment we currently have. However, it is the easy way out when being a psychiatrist. The heart of being a physician is to determine the pathophysiology of an illness. That is the hard problem particularly when the mind has never been defined. But, until we address the pathophysiology of mental illnesses, the treatments we have will forever be incomplete and unsatisfactory.
Psychiatrists are settling with poorly effective treatments and are generally not improving the craft of medicine. Medications for schizophrenia at most reduce psychosis by an average of 20% and become much less effective as the illness progresses. Antidepressants result in less than 3% remission (though research defines remission as being half-ill). Mood stabilizers are less effective than psychotherapy in bipolar disorder – both are unsatisfactory in effectiveness.
The biologic psychiatry movement died in the 1990s.
Psychiatrists can do better if they actually paid attention to the biology of the illness. Much is written but not read.