Vol 2 n° 3 - From Research to Treatment in Clinical Neuroscience
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Conventional psychiatric diagnosis is founded on symptom description; this then governs the choice of psychotropic

medication. This purely descriptive approach resembles a

 description of diphtheria from the premicrobiology era. Based  on  current  advances  in  basic  and  clinical  neuro- science,  we  propose  inserting  an  intermediate  level  of analysis between psychiatric symptoms and pharmacologic modes of action. Paradigm 1 is to analyze psychiatric symp- toms in terms of which higher brain function(s) is (are) abnormal, ie, symptoms should be analyzed as higher brain dysfunction: a case study in obsessive-compulsive disorder reveals pointers in four common symptoms to the higher functions of working memory, emotional overlay, absence of voluntary control, and the ability to evaluate personal mental phenomena. Paradigm 2 is to view psychotropic drugs as modifying normal higher brain functions, rather than merely treating symptoms, which they do only sec- ondarily: thus depression may respond to agents that act on related aspects of mental life derived from higher brain functions, eg, the ability  to enhance bonding. We advocate a strategy in which psychiatric illness is progressively reclas- sified through knowledge in clinical neuroscience and treat- ment targets are revised accordingly. The  last  decades  have  been  a  time  of  active research and discovery in the fields of psychotropic med- ication, the identification and classification of psychi- atric disorders, and the physiology of higher brain func- tions,  such  as  emotions,  memory,  or  consciousness. A very impressive effort has been made at the interna- tional level to reach a consensus for making reliable psy- chiatric diagnoses, which represents a huge progress. In this article, we explore the nature of the relationship between psychopharmacology, psychiatric symptoma- tology, and higher brain functions. Psychotropic medication Psychotropic drugs, such as chlorpromazine, imipramine, or diazepam, were developed by astute researchers, at a time when several neurotransmitters had not yet been discovered and when little was known about the physi- ology of neurotransmitters.The modes of action of these first psychotropic drugs were discovered years after they had been successfully used clinically, and are still under- going   further   study.  A   psychotropic   drug   can   be described according to the way in which it influences receptors, transporters, and enzymes, ie, the cellular sites of its pharmacological actions.These drugs can be selec- tive to a greater or lesser extent.There are the so-called “dirty” drugs that influence a large number of brain sys- tems. Chlorpromazine  is  an  example  of  such  a  non- selective psychotropic drug as it acts as an antagonist of many dopaminergic, adrenergic, serotonergic, choliner- gic, and histaminergic receptors and has a membrane- stabilizing action. Clozapine is another example of a drug  that  acts  on  many  cell-membrane  receptors  or transporters; it is difficult to explain why blocking all Psychotropic medication, psychiatric disorders, and higher brain functions Pierre Schulz, MD; Thierry Steimer, PhD

Keywords: symptoms; syndromes; psychotropic drug

 Author affiliations: Clinical Psychopharmacology Unit, Department of Psychiatry, Geneva University Hospitals, Chêne-Bourg, Switzerland Address for correspondence:  Pierre Schulz, MD, Unité de Psychopharmacologie Clinique, Département de Psychiatrie, Hôpitaux Universitaires de Genève, Domaine Belle-Idée, 1225 Chêne-Bourg, Switzerland
(e-mail: schulz-pierre@diogenes.hcuge.ch) 1 7 7 C l i n i c a l   r e s e a r c h