Certain Aspects of Immunopychiatry.

Immunopsychiatry is based on the assumption that schizophrenia, bipolar disorders, and major depressive disorders are related with atypical immune reactions or inflammatory processes. It has also been suggested that the neurotoxic effects of COVID-19 due to the perverted autoimmune reaction could offer fresh acumens into psychotic process. Even acute psychotic symptoms have a subtle pre-psychotic phase and unless treatments are aimed at this preceding phase, newer therapies are not going to achieve their targets. Identifying biosignatures of psychotic disorders lead to better understanding of the etiological mechanism involved in such disorders and aid early diagnostic assays. Interestingly, the search for biomarkers also stimulates new experimental treatment strategies as evidenced by the experiments of newer immunological therapies for psychotic disorders. Characterizing biosignatures are thought to play a significant role in the early detection, treatment, and implementation of preventive strategies in psychotic disorders. The search for identifying biosignatures should go hand in hand with newer experimental therapies for psychotic disorders for the benefit of introducing treatments at an early stage of psychosis development. The identification of biomarkers may lead to a shift from symptom based diagnostic category into subtypes based on immunological alterations and brain biology and such a change might have an advantage to make more precise diagnosis aiding better treatment. The field of immunopsychiatry requires more research to put their findings in context.

The Association of Creativity with Divergent and Convergent Thinking.

The inspirational aspect of creativity remains shrouded in mystery. Methodological problems have hindered research into creativity, and such a situation makes the interpretation and comparison of studies problematic. The link between creativity and psychopathology is overstated by the print, electronic, and celluloid media. This paper attempts to explain the creative process from a psychological and psychiatric perspective leaving room for different unexplained aspects of generativity for open discussion. A selective survey of the literature was performed to identify scholarly views of creativity and psychopathology. Data sources included PubMed, Google Scholar, and Scopus. The concept of inspiration was examined from psychological, psychopathological, and biological standpoints. A better understanding of creativity has clinical implications. Psychopathology can facilitate creativity, but it is not the maker of creativity that involves a harmonious blending of divergent and convergent thinking. The present trend in psychiatry of medicalizing all unusual behavior is not at all productive in fostering creativity among children. The cognitively gifted children differ widely from children with autistic spectrum disorders; the creative thinking of gifted children is polythetic, whereas such potentials of autistic individuals are generally monothetic. The study of creativity helps develop an expanded model of the mind. However, research into creativity has produced contradictory results. The assumed link between creativity and mental disorder could be clarified only when we elucidate the creative process. Further research is needed in regard to the psycho-biological nature of creativity, including genetic links, implications for neuropharmacology, and the treatment of pathology or psychological disorders.

Challenges of Treatment-resistant Depression.

Guidelines for the management of treatment-resistant depression (TRD) do not meet the criteria of evidence-based medicine and better-quality research is required to inform clinical practice. Current treatments of resistant depression remains largely empirical. There are no bench-mark antidepressants. Clear and justifiable rationale should be followed while initiating new treatment strategies; systematic planning and careful monitoring of progress implemented while new treatment components are added. Biological psychiatrists should give due importance to the non-biological aspects of depression and psychotherapists should not overlook the biological correlates. Unidimensional solution will not work for a complex illness like refractory depression and a single answer should not be sought as a cure because the aetiology of depression is multifactorial and the pathophysiology itself remains unknown. Psychopharmacological interventions are still the main stay of treatment of TRD. There are two major alternatives to pharmacotherapy: neuromodulation and psychotherapy. Alternative terminologies for TRD like MTR-MDD (Multiple Therapy Resistant-Major Depressive Disorder) are being introduced reflecting the frustrations of clinicians and patients with the conventional definition of TRD and treatment modalities.

Clinical challenges of bipolar depression.

The observation that atypical antipsychotic drugs have some role in treating bipolar disorders has revived interest in the management of bipolar disorder. Given the prevalence of and the disability associated with bipolar depression, current medication is inadequate and new research to help patients with this condition is overdue.

Atypical and conventional depot medications.

The introduction of atypical antipsychotics created a therapeutic dilemma between choosing the oral novel antipsychotic or the conventional depot form. Clinicians want the advantages of both, resulting in higher levels of polypharmacy. Modern psychiatry is probably in a transitional stage from the depot culture to safer oral medications or even to a safer depot culture.

The long-acting depot antipsychotic drugs.

The novel antipsychotics have reduced the use of depot medications, but the introduction of the atypical depot antipsychotic has rekindled an interest in the long-acting antipsychotic formulations. The use of atypical antipsychotics is recommended, except where patients are otherwise stable on classical antipsychotics without unwanted side effects.