March 19, 1999

Although the explosion of scientific knowledge will revolutionize psychiatric diagnosis and treatment in the 21st century, the field will continue to be defined by its integrative biopsychosocial approach, said Jeffrey Houpt, M.D., outgoing president of the American College of Psychiatrists (ACP), in remarks at the ACP's 36th annual meeting in San Francisco last month.

"We embrace neither a mindless biology nor a psychology without biology. We are the specialty of integration," declared Houpt, who turned over the gavel to new ACP President Carolyn Robinowitz, M.D., on the last day of the meeting. "We bring a variety of perspectives to bear on our understanding of human cognition, feeling, and behavior," he added.

As psychiatry strides into the 21st century, there is much cause for optimism, Houpt averred. The field will benefit from advances in areas as diverse as functional genomics and bioinformatics, providing an opportunity for "a richer understanding of human behavior than ever experienced before."

The evolution of medicine in general and the neurosciences in particular will lead to explosive growth in the number of new pharmaceuticals and other technologies, Houpt continued. These will make possible far more accurate psychiatric diagnosis and treatment, but will also present the 21st-century physician with "a host of new challenges" in integrating this new therapeutics into a humane and ethical framework.

The theme of this year's ACP meeting was "Bridges to the Future." The sessions ranged over a variety of topics, including the interaction between brain, environment, and genes; the development of gender identity; new and evolving treatments; prognostications on the changing psychiatric workplace and changing face of psychiatric education; updates on diagnosis and treatment of premenstrual dysphoric disorder; and a special lecture on the latest thinking about the genesis and development of schizophrenia.

Neuroscientist Robert Sapolsky, Ph.D., captured the imagination with his elegant explanation of gene therapy for the brain, holding out hope that one day the technology may be applied to treating psychiatric disorders . Robin Murray, M.B., told meeting participants that symptoms of schizophrenia are apparent well before the first full-blown episode of the disease. His research has led him to conclude that this tragic disorder doesn't suddenly emerge in adolescence.

Joseph Schildkraut, M.D., was honored with the ACP's Mood Disorders Research Award for his work on catecholamines in affective disorders. Schildkraut discussed how he became interested in the research that led to his "catecholamine hypothesis of affective disorders." His article about the catecholamine hypothesis, published in 1965 in the American Journal of Psychiatry, became one of the most often cited research articles in the psychiatric literature.

Barbara Rothbaum, Ph.D., took observers through the looking glass of virtual reality (VR) exposure therapy, explaining her successful use of VR in treating anxiety disorders including phobias and post-traumatic stress.