As doctors caring for patients, and researchers attempting to understand the pathophysiology of neuropsychiatric disorders, we are united by a collective goal to improve the outcomes for those who suffer from mental illness. This aspiration is fundamental to all we do and, when considered in abstract terms, is an irrefutable principle that is both self-evident and seemingly easy to support and implement. However, in clinical practice, diagnostic and treatment decisions are often not clear-cut with respect to the benefits they provide to patients. Furthermore, determining the means by which advances in research are achieved and whether these impinge upon the rights of an individual, or a society as a whole, can often prove challenging.
In this issue of Acta Neuropsychiatrica, a number of articles address aspects of this matter. Lopez-Munoz and Alamo Reference Lopez-Munoz and Alamo(1) address psychotropic drug research in Nazi Germany in an editorial with a commentary provided by Robertson and Walter Reference Robertson and Walter(2). Almeida et al. Reference Almeida, Macedo-Soares and Issler(3) report upon the long-term side-effects of psychotropic medications and examine the metabolic syndrome in patients with bipolar disorder. However, the crux of the issue, namely our potential relationship with patients, is explored in one of our regular sections, Intervention Insights, and the overall salience of research is touched upon in Pictures and Prose.
In addition to this theme, three other articles report aspects of ‘multi-modal imaging and assessment’ using electrophysiological, neuropsychological and eye movement analysis tools (Reference Debagriele and Lagopoulos4–Reference Cocchi, Bosisio and Berchtold6). Each of these investigational leads holds much promise and ultimately hopes to translate into earlier and more reliable diagnosis, the development of targeted treatments and the monitoring of progress and outcome . Until such halcyon times, however, clinicians remain precariously poised in their management of patients knowing fully well that there are actions they can institute but that their treatments and strategies are as yet imperfect and may in reality confer more harm than benefit .
Therefore, perhaps ‘do no harm’ is an unrealistic expectation and, instead, we should continually strive to simply do our best.
