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Una psichiatria al di là dell’attuale paradigma (Psychiatry beyond the current paradigm)
Autori/Curatori: Pat Bracken, Philip Thomas, Sami Timimi, Eia Asen, Graham Behr, Carl Beuster, Seth Bhunnoo, Ivor Browne, Navjyoat Chhina, Duncan Double, Simon Downer, Chris Evans, Suman Fernando, Malcolm Garland, William Hopkins, Rhodri Huws, Bob Johnson, Brian Martindale, Hugh Middleton, Daniel Moldavsky, Joanna Moncrieff, Simon Mullins
Anno di pubblicazione: 2013 Fascicolo: 1 Lingua: Italiano
Numero pagine: 14 P. 9-22 Dimensione file: 95 KB
DOI: 10.3280/PU2013-001002
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Alcuni recenti editoriali del British Journal of Psychiatry hanno argomentato che la psichiatria sta attraversando una crisi, e che tra le soluzioni vi sarebbe un rafforzamento della sua identità come essenzialmente "neuroscienza applicata". Senza sminuire l’importanza delle neuroscienze e della psicofarmacologia, gli Autori sostengono che la psichiatria deve superare l’attuale paradigma tecnologico dominante. Questo rifletterebbe maggiormente le evidenze empiriche e servirebbe anche a rafforzare una collaborazione più significativa col movimento degli utenti dei servizi psichiatrici. Vengono presi in rassegna vari studi controllati randomizzati (RCT) che mostrano l’efficacia degli interventi non specifici e non tecnologici.

Keywords: Paradigma tecnologico in psichiatria, interventi non specifici, relazione terapeutica,psichiatria basata sulle evidenze, movimento degli utenti dei servizi psichiatrici

  1. Ablon J.S. & Jones E.E. (1998). How expert clinicians’ prototypes of an ideal treatment correlate with outcome in psychodynamic and cognitive-behavioral therapy. Psychotherapy Research, 8, 1: 71-83., DOI:10.1080/10503309812331332207
  2. Andrews G. (2001). Placebo response in depression: Bane of research, boon to therapy. British Journal of Psychiatry, 178, 3: 192-94., DOI:10.1192/bjp.178.3.192
  3. Angell M. (2011). The epidemic of mental illness: Why? The New York Review of Books, 58, 11 (June 23): 20-22; The illusions of psychiatry. The New York Review of Books, 58, 12 (July 14): 20-22 (trad. it.: L’epidemia di malattie mentali e le illusioni della psichiatria. Psicoterapia e Scienze Umane, 2012, XLVI, 2: 263-282. Dibattito nella rubrica “Letters” con interventi di John Oldham, Daniel Carlat, Richard Friedman, Andrew Nierenberg, e una risposta di Marcia Angell: The New York Review of Books, 58, 13 (August 18)., DOI:10.3280/PU2010-002007
  4. Angermeyer M.C., Holzinger A., Carta M.G. & Schomerus G. (2011). Biogenetic explanations and public acceptance of mental illness: Systematic review of population studies. British Journal of Psychiatry, 199: 367-372., DOI:10.1192/bjp.bp.110.085563
  5. Aviram U., Syme S.L. & Cohen J.B. (1976). The effects of policies and programs on reduction of mental hospitalization. Social Science & Medicine, 10, 11/12: 571-577., DOI:10.1016/0037-7856(76)90027-5
  6. Beck A.T. (1993). Cognitive therapy: Past, present, and future. Journal of Consulting and Clinical Psychology, 61: 194-98., DOI:10.1037/0022-006X.61.2.194
  7. Bola J.R., Kao D.T. & Soydan H. (2012). Antipsychotic medication for early-episode schizophrenia. Schizophrenia Bulletin, 38: 23-25., DOI:10.1093/schbul/sbr167.
  8. Budd R. & Hughes I. (2009). The Dodo Bird verdict – Controversial, inevitable and important: A commentary on 30 years of meta-analyses. Clinical Psychology and Psychotherapy, 16: 510-522., DOI:10.1002/cpp.648
  9. Bullmore E., Fletcher P., Jones P.B. (2009). Why psychiatry can’t afford to be neurophobic. British Journal of Psychiatry, 194: 293-295., DOI:10.1192/bjp.bp.108.058479
  10. Campbell P. (2009). The service user/survivor movement. In: Reynolds J., Muston R., Heller T., Leach J., McCormick M., Wallcraft J. & Walsh M., editors, Mental Health Still Matters. Basingstoke, UK: Palgrave Macmillan, 2009, pp. 46-52.
  11. Carey B. & Harris G. (2008). Psychiatric group faces scrutiny over drug industry ties. The New York Times, July 12, 2008 (
  12. Castonguay L.G. & Beutler L.E. (2006). Common and unique principles of therapeutic change: What do we know and what do we need to know? In: Castonguay L.G. & Beutler L.E., editors, Principles of Therapeutic Change that Work. New York: Oxford University Press, 2006, pp. 353-369.
  13. Castonguay L.G., Goldfried M., Wiser S., Raue P. & Hayes A.M. (1996). Predicting the effect of cognitive therapy for depression: A study of unique and common factors. Journal of Consulting and Clinical Psychology, 64, 3: 497-504.
  14. Choudhury S. & Slaby J., editors (2012). Critical Neuroscience: A Handbook of the Social and Cultural Contexts of Neuroscience. Oxford, UK: Blackwell
  15. Cooper M. (2008). Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly. London: Sage.
  16. Kendall T. (2011). The rise and fall of the atypical antipsychotics. British Journal of Psychiatry, 199: 266-268., DOI:10.1192/bjp.bp.110.083766
  17. Kendell R. (1981). The present state of ECT. British Journal of Psychiatry, 139: 265-293., DOI:10.1192/bjp.139.4.265
  18. Craddock N., Antebi D., Attenburrow M.-J., Bailey A., Carson A., Cowen P., Craddock B., Eagles J., Ebmeier K., Farmer A., Fazel S., Ferrier N., Geddes J., Goodwin G., Harrison P., Hawton K., Hunter S., Jacoby R., Jones I., Keedwell P., Kerr M., Mackin P., McGuffin P., MacIntyre D.J., McConville P., Mountain D., O’Donovan M.C., Owen M.J., Oyebode F., Phillips M., Price J., Shah P., Smith D.J., Walters J., Woodruff P., Young A. & Zammit S. (2008). Wake-up call for British psychiatry. British Journal of Psychiatry, 193: 6-9., DOI:10.1192/bjp.bp.108.053561
  19. Davidson L. (2003). Living Outside Mental Illness: Qualitative Studies of Recovery in Schizophrenia. New York: New York University Press.
  20. Foley D.L. & Morley K.I. (2011). Systematic review of early cardiometabolic outcomes of the first treated episode of psychosis. Archives of General Psychiatry, 68, 6: 609-616., DOI:10.1001/archgenpsychiatry.2011.2
  21. Fournier J.C., DeRubeis R.J., Hollon S.D., Dimidjian S., Amsterdam J.D., Shelton R.C. & Fawcett J. (2010). Antidepressant drug effects and depression severity: A patient-level meta-analysis. JAMA, 303, 1: 47-53., DOI:10.1001/jama.2009.1943
  22. Frances A. (2010). The first draft of DSM-V: If accepted, will fan the flames of false positive diagnoses. BMJ, 340: c1168., DOI:10.1136/bmj.c1168
  23. Frank A.F. & Gunderson J.G. (1990). The role of the therapeutic alliance in the treatment of schizophrenia. Archives of General Psychiatry, 47, 3: 228-236., DOI:10.1001/archpsyc.1990.01810150028006
  24. Gronfein W. (1985). Psychotropic drugs and the origins of deinstitutionalization. Social Problems, 32, 5: 437-454., DOI:10.1525/sp.1985.32.5.03a00040
  25. Halliburton M. (2004). Finding a fit: Psychiatric pluralism in South India and its implications for WHO studies of mental disorder. Transcultural Psychiatry, 41, 1: 80-98., DOI:10.1177/1363461504041355
  26. Harré R. & Gillett G. (1994). The Discursive Mind. London: Sage (trad. it.: La mente discorsiva. Milano: Raffaello Cortina, 1996).
  27. Harrow M. & Jobe T.H. (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: A 15-year multifollow-up study. J. Nerv. Ment. Dis., 195: 406-414. Internet edition: http://, DOI:10.1097/01.nmd.0000253783.32338.6e
  28. Heath I. (2011). Divided we fall. The 2011 Harveian oration delivered to the Royal College of Physicians on October 18th, 2011. Clinical Medicine, 11, 6: 576-86.
  29. Ingleby D. (1980). Critical Psychiatry: The Politics of Mental Health. New York: Pantheon
  30. Insel T.R. & Quiron R. (2005). Psychiatry as a clinical neuroscience discipline. JAMA, 294: 2221-2224., DOI:10.1001/jama.294.17.2221
  31. Jacobson N.S., Dobson K.S., Truax P.A., Addis M., Koerner K., Gollan J.K., Gortner E. & Prince S.E. (1996). A component analysis of cognitive-behavioural treatment for depression. Journal of Consulting and Clinical Psychology, 64: 295-304., DOI:10.1037/0022-006X.64.2.295
  32. Johnstone E.C., Lawler P., Stevens M., Deakin J.F.W., Frith C.D., McPherson K. & Crow T.J. (1980). The Northwick park electroconvulsive therapy trial. Lancet, 2: 1317-1320.
  33. Kay S.R., Fiszbein A. & Opler L.A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 2: 261-276., DOI:10.1093/schbul/13.2.261
  34. Kazdin A.E. (1997). A model for developing effective treatments: Progression and interplay of theory, research, and practice. Journal of Clinical Child Psychiatry, 26, 2: 114-129.
  35. Kingdon D. & Young A. (2007). Research into putative biological mechanisms of mental disorders has been of no value to clinical psychiatry. British Journal of Psychiatry, 191: 285- 290., DOI:10.1192/bjp.bp.107.035675
  36. Kirmayer L.J. & Gold I. (2012). Re-socializing psychiatry: Critical neuroscience and the limits of reductionism. In: Choudhury & Slaby, 2012, pp. 307-330.
  37. Kirsch I., Deacon B.J., Huedo-Medina T.B., Scoboria A., Moore T.J. & Johnson B.T. (2008). Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. Public Library of Science: Medicine, 5, e45. Internet edition:, DOI:10.1371/journal.pmed.0050045
  38. Kirsch I. & Sapirstein G. (1998). Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication. Prevention and Treatment, 1, 2., DOI:10.1037/1522-3736.1.1.12a
  39. Kleinman A. & van der Geest S. (2009). “Care” in health care. Remaking the moral world of medicine. Medische Antropologie, 21, 1: 159-168. Internet edition:
  40. Leamy M., Bird V., Le Boutillier C., Williams J. & Slade M. (2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. British Journal of Psychiatry, 199: 445-452. Internet edition: http://, DOI:10.1192/bjp.bp.110.083733
  41. Lepping P., Sambhi R., Whittington R., Lane S. & Poole R. (2011). Clinical relevance of findings in trials of antipsychotics: Systematic review. British Journal of Psychiatry, 198, 5: 341-345. Internet edition:, DOI:10.1192/bjp.bp.109.075366
  42. Longmore R.J. & Worrell M. (2007). Do we need to challenge thoughts in cognitive behavior therapy? Clinical Psychology Review, 27: 173-187.
  43. Mancini M.A., Hardiman E.R. & Lawson H.A. (2005). Making sense of it all: consumer providers’ theories about factors facilitating and impeding recovery from psychiatric disabilities. Psychiatric Rehabilitation Journal, 29: 48-55., DOI:10.2975/29.2005.48.55
  44. McQueen D. & St John Smith P. (2012). Placebo effects: a new paradigm and relevance to psychiatry. International Psychiatry, 9: 1-3 (
  45. Moerman D. (2002). Meaning, Medicine and the “Placebo Effect”. Cambridge, UK: Cambridge University Press
  46. Moncrieff J. (2008). The Myth of the Chemical Cure: A critique of psychiatric Drug Treatment. Basingstoke, UK: Palgrave Macmillan.
  47. NICE (National Institute for Health and Clinical Excellence) (2009a). Depression: The Treatment and Management of Depression in Adults. NICE Clinical Guideline CG90. London: NICE (
  48. NICE (National Institute for Health and Clinical Excellence) (2009b). Quick Reference Guide. Depression: Treatment and Management of Depression in Adults, including Adults with a Chronic Physical Health Problem. London: NICE (
  49. Overall J.E. & Gorham D.R. (1962). The brief psychiatric rating scale. Psychological Reports, 10: 799-812.
  50. Oyebode F. & Humphreys M. (2011). The future of psychiatry. British Journal of Psychiatry, 199: 439-440., DOI:10.1192/bjp.bp.111.092338
  51. Porter R. (1987). A Social History of Madness: Stories of the Insane. London: Weidenfeld and Nicolson
  52. Warner R. (2003). How much of the burden of schizophrenia is alleviated by treatment? British Journal of Psychiatry, 183: 375-376., DOI:10.1192/bjp.183.5.375
  53. Radden J. (2008). Thinking about the repair manual: Technique and technology in psychiatry. In: Philips J., editor, Philosophical Perspectives on technology and psychiatry. Oxford, UK: Oxford University Press, 2008, pp. 263-277
  54. Raguram R., Venkateswaran A., Ramakrishna J. & Weiss M.G. (2002). Traditional community resources for mental health: a report of temple healing from India. BMJ, 325: 38-40., DOI:10.1136/bmj.325.7354.38
  55. Rasmussen K. (2009). Sham electroconvulsive therapy studies in depressive illness: A review of the literature and consideration of the placebo phenomenon in electroconvulsive therapy practice. Journal of ECT, 25, 1: 54-59., DOI:10.1097/YCT.0b013e3181719b23
  56. Read J. & Bentall R. (2010). The effectiveness of electroconvulsive therapy: A literature review. Epidemiologia e Psichiatria Sociale, 19: 333-347., DOI:10.1017/S1121189X00000671
  57. Roberts G. & Wolfson P. (2004). The rediscovery of recovery: Open to all. Advances in Psychiatric Treatment, 10: 37-49. Internet edition: http://, DOI:10.1192/apt.10.1.37
  58. Rogers A., Pilgrim D. & Lacey R. (1993). Experiencing Psychiatry: Users’ Views of Services. London: MacMillan
  59. Romme M. & Escher S. (1993). Accepting Voices. London: Mind Publications
  60. Rose S. (2012). The need for a critical neuroscience: from neuroideology to neurotechnology. In: Choudhury & Slaby, 2012, pp. 53-66
  61. Seebohm P., Henderson P., Munn-Giddings C., Thomas P. & Yasmeen S. (2005). Together We Will Change: Community Development, Mental Health and Diversity. London: The Sainsbury Centre for Mental Health.
  62. Shedler J. (2010). The efficacy of psychodynamic therapy. American Psychologist, 65, 2: 98- 109. (trad. it.: L’efficacia della terapia psicodinamica. Psicoterapia e Scienze Umane, 2010, XLIV, 1: 9-34. DOI: 10.3280/PU2010-001002)., DOI:10.1037/a0018378
  63. Slade M. (2009). Personal Recovery and Mental Illness. Cambridge, UK: Cambridge University Press.
  64. Stastny P. & Lehmann P., editors (2007). Alternatives Beyond Psychiatry. Shrewsbury, UK: Peter Lehmann Publishing
  65. Stiles W.B., Barkham M. & Mellor-Car J. (2008). Effectiveness of cognitive-behavioural, person- centred, and psychodynamic therapies in UK primary-care routine practice: Replication in a larger sample. Psychological Medicine, 38, 5 (May): 677-688., DOI:10.1017/S0033291707001511
  66. Tew J., Ramon S., Slade M., Bird V., Melton J. & Le Boutillier C. (2012). Social factors and recovery from mental health difficulties: a review of the evidence. British Journal of Social Work, 42: 443-460., DOI:10.1093/bjsw/bcr076.
  67. Thompson J.J., Ritenbaugh C. & Nichter M. (2009). Reconsidering the placebo response from a broad anthropological perspective. Cult. Med. Psychiatry, 33, 1: 112-152., DOI:10.1007/s11013-008-9122-2
  68. Thornicroft G. (2011). Physical health disparities and mental illness: The scandal of premature mortality. British Journal of Psychiatry, 199: 441-442., DOI:10.1192/bjp.bp.111.092718
  69. Tyrer P. & Kendall T. (2009). The spurious advance of antipsychotic drug therapy. Lancet, 373, 9657: 4-5., DOI:10.1016/S0140-6736(08)61765-1
  70. Vul E., Harris C., Winkelmann P. & Pashler H. (2009). Puzzlingly high correlations in fMRI studies of emotion, personality, and social cognition. Perspectives on Psychological Science, 4, 3: 319-324., DOI:10.1111/j.1745-6924.2009.01125.x
  71. Wallcraft J., Read J. & Sweeney A. (2003). On Our Own Terms: Users and Survivors of Mental Health Services Working Together for Support and Change. London: The Sainsbury Centre for Mental Health
  72. Warner R. (2010). Does the scientific evidence support the recovery model? The Psychiatrist, 34: 3-5., DOI:10.1192/pb.bp.109.025643
  73. Westen D., Morrison Novotny K. & Thompson-Brenner H. (2004). The empirical status of empirically supported psychotherapies: Assumptions, findings, and reporting in controlled clinical trials. Psychological Bulletin, 130: 631-663. (trad. it.: Lo statuto empirico delle psicoterapie validate empiricamente: assunti, risultati e pubblicazione delle ricerche. Psicoterapia e Scienze Umane, 2005, XXXIX, 1: 7-90. Una sintesi su Internet:, DOI:10.1037/0033-2909.130.4.631
Pat Bracken, Philip Thomas, Sami Timimi, Eia Asen, Graham Behr, Carl Beuster, Seth Bhunnoo, Ivor Browne, Navjyoat  Chhina, Duncan Double, Simon Downer, Chris Evans, Suman Fernando, Malcolm Garland, William Hopkins, Rhodri Huws, Bob Johnson, Brian Martindale, Hugh Middleton, Daniel Moldavsky, Joanna Moncrieff, Simon Mullins, Una psichiatria al di là dell’attuale paradigma in "PSICOTERAPIA E SCIENZE UMANE" 1/2013, pp. 9-22, DOI:10.3280/PU2013-001002


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