COMMENTARY

Practicing Positive, Integrative Psychiatry

Helen Lavretsky, MD, MS

Disclosures

June 28, 2016

At the recent 2016 American Psychiatric Association (APA) meeting in Atlanta, Georgia—the theme of which was "Psychiatry: Reclaiming Our Future"—a number of symposia addressed prevention in psychiatry with an emphasis on positive psychiatry and integrative psychiatry.

Positive psychiatry is the science and practice of psychiatry that seeks to understand and enhance well-being through assessments and interventions involving positive psychosocial characteristics in people with mental or physical illnesses. The newly emphasized focus signifies a paradigm shift in the development of mental health care models. Although traditionally, psychiatry has focused on treatment of mental illness with symptom reduction and relapse prevention, there is a growing recognition that medicine should also promote well-being and mental health. Preventive efforts that originally focused on interventions in at-risk children after traumatic experiences recently expanded to younger and even older adults in areas such as prevention of postpartum psychosis, postmyocardial infarction or poststroke depression, posttraumatic stress disorder (PTSD), and, to a lesser extent, some types of dementia.

Modifications of unhealthy lifestyle behaviors with physical exercise, proper nutrition, activity participation, and regular health screenings and vaccinations are among the most powerful and modifiable predictors of health throughout the lifespan. In addition to the positive effects of healthy behaviors on the cardiovascular system, improvements in brain structure and functioning can also be attained.

The APA meeting session[1] on advances in medicine chaired by Dr Dilip Jeste, director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego, focused on positive psychiatry, with several presentations devoted to well-being and resilience-building interventions used as prevention strategies. Positive psychiatry suggests that positive psychosocial factors such as resilience, optimism, and social engagement are associated with better outcomes, including lower morbidity, greater longevity, and a heightened sense of patient well-being.

As a branch of medicine, positive psychiatry seeks to understand the underlying biological mechanisms of health and well-being through behavioral and biological interventions. The concepts of positive psychiatry date back at least to 1906, when William James, a physician and psychologist, recommended a new approach to study and apply psychological principles underlying the success of the "mind-cure," based on positive emotions and beliefs.

Speakers at the session covered recent findings in positive psychiatry. Dr Jeste presented his study of a community-based sample of adults between 20 and 103 years of age, as well as samples of middle-aged and older persons with various mental disorders. The strongest predictors of well-being were resilience and absence of depression but not demographics, physical health, cognitive functioning, or severity of illness. He emphasized that aging can have a positive effect on overall health if optimal physical, cognitive, and psychosocial stimulation is provided.

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