Toward a biopsychosocial understanding of the patient-physician relationship: an emerging dialogue

Complexity theory has been used to view the patient-physician relationship as constituted by complex responsive processes of relating. It describes an emergent, psychosocial relational process through which patients and physicians continually and reciprocally influence each other\u27s behavior and experience. As psychosocial responses are necessarily biopsychosocial responses, patients and physicians must likewise be influencing each other\u27s psychobiology. This mutual influence may be subjectively experienced as empathy, and may be skillfully employed by the clinician to directly improve the patient\u27s psychobiology

Salivary biomarkers in psychobiological medicine.

The value of salivary biomarkers for diagnostic and prognostic assessments has become increasingly well established in medicine, pharmacology, and dentistry. Certain salivary components mirror the neuro-endocrine status of the organism. Other saliva products are protein in nature, and can serve to reflect immune surveillance processes. The autonomic nervous system regulates the process of salivation, and the concentration of yet other salivary components, such as alpha-amylase, which provide a reliable outcome measure of the sympathetic response. Here, we discuss molecular technologies that have permitted giant steps in the utilization of salivary samples and micro-fluidics for the benefit of diagnostic medicine and dentistry, and their putative role in springing forward research in psychobiology

In Search of the Neurobiological Substrates for Social Playfulness in Mammalian Brains

Play behavior is a fundamental and intrinsic neurobehavioral process in the mammalian brain. Using rough-and-tumble play in the juvenile rat as a model system to study mammalian playfulness, some of the relevant neurobiological substrates for this behavior have been identified, and in this review this progress. A primary-process executive circuit for play in the rat that includes thalamic intralaminar nuclei, frontal cortex and striatum can be gleaned from these data. Other neural areas that may interact with this putative circuit include amygdala, ventral hypothalamus, periaqueductal gray (PAG), and deep tectum, as well as ascending dopamine systems which participate in all types of seeking urges At the neurochemical level, considerable evidence points to specific cholinergic and dopaminergic controls, but also endogenous opioids and cannabinoids as having a positive modulatory influence over playfulness, with all europeptides known to have aversive effects to reduce play. Monoamines such as norepinephrine and serotonin certainly modulate play, but they influence all psychobehavioral systems, suggesting non-specific effects. We proceed to discuss how increased insights into the neurobiological mechanisms of play can inform our understanding of normal and abnormal childhood development

Effects of Neonatal Handling on Play Behavior and Fear Towards a Predator Odor in Juvenile Rats

The effects of brief daily separation, also known as handling, during the first 2 weeks of life on play behavior and fearfulness toward a predatory odor were assessed in juvenile rats. Handled rats were more playful than nonhandled control rats, and while handling had no effect on the direct response of these rats toward a predatory odor, handled rats did not exhibit a conditioned suppression of play when tested later in the same context where they had been exposed to the predatory odor. Handled rats were still wary of the environment in that they continued to show a heightened level of risk assessment behavior. These data suggest that early postnatal experiences may play a significant role in determining how an animal deals with predatory threats later in life

Fluoxetine: a case history of its discovery and preclinical development

Introduction: Depression is a multifactorial mood disorder with a high prevalence worldwide. Until now, treatments for depression have focused on the inhibition of monoaminergic reuptake sites, which augment the bioavailability of monoamines in the CNS. Advances in drug discovery have widened the therapeutic options with the synthesis of so-called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine. Areas covered: The aim of this case history is to describe and discuss the pharmacokinetic and pharmacodynamic profiles of fluoxetine, including its acute effects and the adaptive changes induced after long-term treatment. Furthermore, the authors review the effect of fluoxetine on neuroplasticity and adult neurogenesis. In addition, the article summarises the preclinical behavioural data available on fluoxetine’s effects on depressive-like behaviour, anxiety and cognition as well as its effects on other diseases. Finally, the article describes the seminal studies validating the antidepressant effects of fluoxetine. Expert opinion: Fluoxetine is the first selective SSRI that has a recognised clinical efficacy and safety profile. Since its discovery, other molecules that mimic its mechanism of action have been developed, commencing a new age in the treatment of depression. Fluoxetine has also demonstrated utility in the treatment of other disorders for which its prescription has now been approved

Conscience Sensitive Psychiatric Diagnosis of Maltreated Children and Adolescents

The sequelae of maltreatment are conceptualized according to the DSM IV multiaxial system expanded for heuristic purposes. Axis I and Axis IV are expanded to take into account important variables of maltreatment. Differential Axis I diagnoses are identified with special emphasis placed on PTSD, Dissociation, Depression and Disruptive Behavior Disorders. Axes II and III are heuristically expanded to call attention to developmental psychopathology, particularly in the domains of conscience, and associated putative neurobiological sequelae of maltreatment, indicating a pathway to the psychobiology of conscience. Conscience sensitive assessment of maltreated children is illustrated with two case vignettes and selected conscience drawings. A ‘transaxial,’ conscience sensitive approach to DSM nosology is recommended as a corrective. There will likely be additional implications for the psychobiology of conscience as neuroimaging and assessment of conscience functions in health and psychopathology become more refined.Support for this and other work by the I.U. Conscience Project conducted in collaboration with Pleasant Run Inc. has been generously provided by Mr. and Mrs. Jim Irsay and The Indianapolis Colts, The Moore Foundation and other individual anonymous donors