Innovations in psychiatry: challenges and future directions

Severe mental disorders are leading causes of disability and significant risk factors for premature mortality worldwide. It has been estimated that more than 800 million people are suffering from any mental disorder and its related burden is steadily increasing (Collins, 2020). Moreover, the COVID-19 pandemic is adding further impairment on mental health of the general population, thus contributing to increased prevalence of mental disorders (Greenberg & Rafferty, 2021; Unützer et al., 2020). In fact, it is anticipated that the mental health consequences of the pandemic will be even worse in the near future and are not expected to reduce in the aftermath of this international health, economic and social crisis (Adhanom Ghebreyesus, 2020; Wang et al., 2021). According to the most recent estimates of the global burden of diseases (Arias et al., 2022; Knapp & Wang 2020), at least 16% of global DALYs can be attributable to mental disorders, with economic loss of 5 USD trillion.

Therefore, patients suffering from mental disorders need to be adequately and timely identified, diagnosed, and managed with appropriate personalised treatment plans. The starting point for an optimal management of patients with severe mental disorders is the clinical characterisation of each individual case (Maj et al., 2020, 2021; Stein et al., 2021), which include the following clinical factors: symptom profile (Tanner et al., 2019), clinical subtypes and severity of the disorder (Wu et al., 2022), level of functioning and quality of life (Mollon et al., 2021), personality traits (Mulder, 2021; Santesteban-Echarri et al., 2021), antecedent and concomitant psychiatric conditions (Balachander et al., 2022; Erzin et al., 2021; Silove, 2021; van der Wal et al., 2020; Glover, 2020), physical comorbidities (Luciano et al., 2022; Plana-Ripoll et al., 2020), family history (Ayerbe et al., 2020; Duarte et al., 2020), and the presence of protective factors (Feldman, 2020). All these aspects are transdiagnostic and are too often overlooked, especially by younger generation of trainees and early career psychiatrists, which prefer to search for the exact number of diagnostic criteria to be satisfied. Recent data have confirmed that the transdiagnostic approach is useful for identifying risk and protective factors of mental disorders (Heckers & Kendler, 2020; Pettersson et al., 2020). For example, common risk factors such as childhood adversities or being exposed to stressful events are mostly involved in the early neurodevelopmental period for all mental disorders (Arango et al., 2021). Another aspect which needs to be taken into consideration is related to the reciprocal influence of environment on genes, particularly pollution, climate change and urbanicity, which are common risk factors for several physical (e.g. cancer, infectious diseases) and mental disorders (e.g. psychosis, affective disorders).

The personalised approach to mental disorders is necessary in order to achieve patient’s recovery (Reynolds, 2020; Swift et al., 2021). Unfortunately, recovery rates for patients with severe mental disorders are still far to be satisfying. In the case of patients with major depressive disorders, full recovery happens only in 30% of patients, with the remaining 70% having residual symptoms (Salzer et al., 2018), treatment-resistance (Fonseca de Freitas et al., 2022; Kadra-Scalzo et al., 2022; Zhdanava et al., 2021) and functional impairment (Karpov et al., 2017). It appears mandatory to identify innovative treatment strategies to promote recovery in patients with severe mental disorders. A recent innovation is represented by telepsychiatry and telemental health, which gives patients the ability to meet with mental health professional without having the necessity to leave their home. It improves the availability of mental healthcare, reducing delays in care that can lead to emergency room trips or the need for expensive inpatient care. A further innovation in telepsychiatry is represented by the adoption of digital tools for youth mental health, as discussed by Orsolini et al. (2022). In order to introduce innovative approaches, it is necessary to rethink the ethiopathogenesis of mental disorders and searching for new determinants of mental health. In this special issue, the role of noise pollution has been evaluated as a possible innovative determinant for mental health and mental health problems, which has been a neglected topic in psychiatry for many years. Another important innovation in mental health is the discovery of the gene-environment interaction in the development of mental disorders, which has been highlighted by Fusar-Poli et al. (2022).

Other innovations summarised in this issue include the topic of community psychiatry (Carrà et al., 2022), clinical psychiatry (Carmassi et al., 2022; Demyttenaere, 2022; Jovanović et al., 2022; Provenzani et al., 2022), clinical decision making (Luciano et al., 2022), psychopharmacology (Cuomo et al., 2022; De Giorgi et al., 2022; Pompili et al., 2022; Sani et al., 2022), non-invasive brain stimulation (Piccoli et al., 2022), neuroimaging (Janiri & Frangou, 2022), mental health policies (Ventriglio et al., 2022), and psychosocial rehabilitation (Sampogna et al., 2022). These are just some examples of recent innovations introduced in psychiatry and in ordinary clinical practice, which are likely to represent the future of research and clinical psychiatry.

We hope that innovations proposed in this special issue can be useful to inform mental health clinicians and will contribute to overcome some of the limitations of current psychiatric clinical practice.

Disclosure statement

No potential conflict of interest was reported by the author(s).