Internationalization of psychiatric research – the prospective for the European Association of Psychiatrists

The last century has witnessed some unprecedented international efforts to join forces in attempts to fight war and health problems for mankind. In the physical sciences the exploration of outer space and elemental particles build on mutual intellectual and financial forces from many countries. These questions have a magnitude that seldom makes it possible for scientists in a single country to resolve. Mental disorders represent severe international health problems of a similar magnitude, with enormous suffering for patients and families. Each Western country has enormous costs and budgets for treating psychiatric patients. Are these budgets spent in a rational way – considering the present lack of knowledge of etiology and pathophysiology of the most current forms of the mental disorders. In relation to the current costs for treating mental patients, budgets for psychiatric research are low or non-existent. This partly explains why, in spite of more than 100 years of research, the etiology and pathophysiology of most of the mental disorders is still unknown. What is the best way to fight the stigma of psychiatric disorders. For most psychiatrists it should be evident that collecting and joining forces to fight the causes should be the most rational way. The terror of mental disorders can only be efficiently fought by the search for and finding of the causes and their consequences and to develop rational counteractive measures. The big challenge for the psychiatric community in the new millenium is to clarify etiology and pathophysiology of the major mental disorders and also to validate the disease concepts within a biomedical framework. The past few decades have revolutionized the research methods in psychiatry. The development of molecular genetics and brain imaging as well as methods for exploring psychoand electrophysiology in combination with conventional epidemiological and clinical methods has given psychiatrists new dimensions of very powerful tools to explore the psychobiology of mental phenomena. The formulation of operational criteria for diagnostics and symptom evaluation represent other suitable tools for large scale psychiatric research projects. Experience from the past century have demonstrated that heterogeneity within current diagnostic groups is considerable. To resolve heterogeneity clinical materials of the order of thousands of patients rather than up to a few hundred examined in current research projects are required. The development of computers, relational data base technology and biomathematics have assured possibilities for efficient handling of the vast number of data that such projects will generate. The past few decades have witnessed great efforts with regard to standardization of psychiatric clinical research methods. Such standardization will in the future be required regarding the brain imaging modalities and methods for recording other types of psychophysiological and electrophysiological data. Another important research area concerns the cross-checking and sharing of methods and results between various research centers. Psychiatry as an academic discipline has its deepest roots in Europe, where in the latter half of the nineteenth century the beginning of our current conceptualization of mental disorders took place. Observant clinicians in France, Germany, Austria and England made the first systematic descriptions of clinical phenotypes assumed to represent more or less homogeneous disease entities based upon common features in the symptomatology and course of the perturbations observed. At the beginning of last century several European schools emerged where different emphases were placed on the role of environmental factors of psychological, social and physical type in relation to biological genetic mechanisms. In the middle of the twentieth century the introduction of physical treatment modalities, i.e. electroconvulsive treatment and selective psychopharmacological agents as neuroleptics, lithium and antidepressants, with specific actions on different forms of mental perturbations to some extent validated earlier classification Acta Psychiatr Scand 2002: 105: 321–323 Printed in UK. All rights reserved Copyright a Blackwell Munksgaard 2002