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Dr. Dave's Clinicians Corner

Have comments, questions or, better yet, insights? Just call me maybe: (540) 342-2844 or contact me through the website.

My Stream of (Un)Consciousness

The PreRamble

Touring the country preaching the good word, I get a lot of requests for more information about the psycho-neuro-immunological aspects of contemporary psychiatric diagnosis and treatment. Would love to one day create a comprehensive curriculum to better a/_uploaded_files/no-emotion-no-more-than-a-.jpgddress the pent up demand for this type of information. Until that utopian day arrives, however, I plan to, in no certain order, post blogs, images, quotations, thoughts, articles, slide decks, and other such rot. I've always been a big fan of William James and proud of my Freudian roots so let's just call this web page my "Stream of (un)Consiousness."

Have fun. Hope this helps. Let me know what in particular interests you.

One theme stands out for me these days: the dramatic heterogeneity of depression. Mainstream psychiatry's failure to adequately appreciate this facet of the diagnosis has no doubt contributed to the poor treatment (and research) outcomes we routinely see. The following image links to an abbreviated PDF file of a presetation I did a few months back.

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Introduction to Integrative Psychiatry

To recognize Mental Health Awareness Month I wrote a blog back in May reviewing our overarching philosophy here at Integrative Psychiatry, Inc. (Integrative Psychiatry: Putting Together the Pieces of Modern Mental Illness). Briefly, we believe that the strict use of a "descriptivist methodology for psychiatric nosology" has historically limited our profession's view, narrowed our scope, delayed the advance of new technologies, and resulted in suboptimal outcomes for many who suffer from psychiatric illness.

Rather, we combine clinical symptoms, observable behaviors, and neurobiological measures into our diagnoses and treatments. The best unifying theory I've been able to find that incorporates these aspects is called Psycho-Neuro-Immunology (PNI). PNI, a term originally coined in 1975 by Robert Ader and Nicholas Cohen (Ader R. Psychosomatic Medicine 1975;37:4), represents “a convergence of disciplines – namely, the behavioral sciences, the neurosciences, endocrinology, and immunology – intended to achieve a more complete [as opposed to mere guesswork] understanding of the way the interaction among these systems serves homeostatic ends and influences health and disease.”

This theory is based on the hypothesis that recurrent stress (stressors plus response) causes progressive imbalances among multiple physiological systems. These psycho-neuro-immunological perturbations (PNIPs - my own homemade acronym) caused by life stressors have coincided with the steep rise in common diseases of civilization including most degenerative brain disorders.

Because these progressive imbalances can be measured, they should be measured. Hence, our motto: Test Don’t Guess. Moreover, this PNI approach is integral to our overall practice of integrative psychiatry.

Our approach considers one's individual symptoms and their associated biological (hormonal, adrenal, neurotransmitter, and immune) correlates to develop a specific treatment plan incorporating lifestyle, psychotherapies, nutritional supplements, adrenal support, and, when necessary, medications.

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