l.ADHD: The window to the future of Psychiatry

The only way to discover the limits of the possible is to go beyond them into the impossible. Arthur C.Clarke

Psychiatry and Psychology both are rooted in the term “psych” a Greek term meaning “soul”. While the whole human’s history had dealt with our emotions and behaviors as a “soul” thing mostly in the field of philosophy, it was not until the past two centuries that first the term “psychiatry” was first coined by the German physician, Johann Christian Reil in 1808 then the term or field of psychology branched out of philosophy in 1870s. So both psychology and psychiatry were born out of medicine and dealt with mental illnesses, until after Freud, a physician and pediatric neurologist who introduced psychoanalysis and psychologized both fields.

Despite the great influence of Freud due to his genius, both field came back to their root and from the second half of 20th century until now, psychiatry and psychology’s subject of study has been the brain and its function. With the advent and ever growing expansion of neuro-genetics and neuro-imagings, this has been to the extent that the term “psych”, hence “psychology” and “psychiatry” at least in terminology do not make sense any longer as they do not deal with the “soul” or any Freudian or psychoanalytic concept! Psychiatry and modern Psychology are totally biological and truly both field belong to medicine. This is so much that to in fact, both fields are Neuroscience and need to be labeled as such.

 ADHD could be the window to the future of Psychiatry and modern psychology that both principally comprise the field of Neuroscience. ADHD could be the frontier in the field and an example for other psychiatric disorders, not to be diagnosed solely on symptomatology and symptoms grouping that is still the rule in psychiatry, but basing the diagnosis and treatment on the biological underpinning of the disorder and the pathophysiology for the following reasons:

  1. Despite ADHD still suffering from an outdated diagnostic system and symptoms grouping in DSM, now in 5th edition and despite the convincing evidence and strong contention in the literature that its subtyping could be flawed and the disorder is homogenous not heterogeneous, it is one of the psychiatric disorders with the highest genetics linkage. The twin studies indicate that the disorder is highly heritable with about 75 percent hereditability. Longitudinal twin studies also show that the continuity of symptoms from childhood through adolescence is predominantly due to common genetic influences. By improving the diagnostic criteria of ADHD and homogenizing it, the heritability factor could reach almost 100%.
  2. ADHD, among psychiatric or even medical disorders is unique with an early life onset, age 4 or even earlier and enduring across life span.       ADHD is a disorder of developing brain, lacking some needed neurotransmissions influential in most domains of cognition and behavior. In the near future, studying, diagnosis and treatment of ADHD needs to be parallel with a full knowledge of brain development. Through following ADHD subjects across different stages of brain development or life stages, we will be able to gain a better knowledge of these stages in health and pathology.
  3. ADHD involves quite a few neurotransmitters, influential in many domains of cognition, behavior, reward and novelty seeking, disinhibition and intelligence. ADHD studies need to consist the biological study of all these domains. This in cognition requires probing and studying all aspects of cognition, and not limiting ourselves to a gross “attention deficit”, without dissecting this one component to its different types, e.g. sustained, selective, divided, alternating or switching attentions. In the domain of behavior, we need to go beyond a simple physical hyperactivity as a main feature of ADHD, but all other aspects of this phenotype. A major behavioral component of the disorder is behavioral disinhibition that goes beyond a simple impulsivity and has been ill-defined in DSM system, needs to be explored and verified. Reward and novelty seeking are prominent human’s behavior that reach their peaks in ADHD. In this disorder, these features could be studied in depth across all their variations and consequences or post-morbidities, e.g. substance, gambling and addiction seeking behaviors. Reward and novelty seeking present in health and in ADHD not as pathological and negative features, but as innovations, inventions and discoveries.
  4. ADHD, since connected to hyper-attention, and dynamic attention on one side, intelligence on the other side, plus novelty seeking and lastly fitted best in a natural selection process for adaptation to the modern era, it is a brain evolutionary condition. Therefore through ADHD we learn that the evolution of our brains has not stopped million years ago, but still evolving. Moreover we recognize that there is more into the evolution of the brain, than an increase in size and number of neurons, and inter-species’, but intra-species’ specification and evolution. In fact evolutionists need to study ADHD in depth to understand the peak of evolution in general and our brain in particular.            

 

Dr.Mostafa Showraki, MD, FRCPC Lecturer, University of Toronto,Head, Community Psychiatrists Association of Toronto (CPAT),Author: “ADHD:Revisited” Book “adhdrevisited.com”/”medicinerevisited.com”   

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