Research in psychiatry: a view from general medicine
Research in psychiatry: a view from general medicine
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精神病学研究：普通医学的视角
DOI：
10.1017/s0033291700030695
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发表时间：
1979
影响因子：
6.9
通讯作者：
W. Peart
中科院分区：
文献类型：
--
作者：
W. Peart
如果在精神病学方面的研究太少，而我觉得接受这种观点没有困难，那么原因和可能的解决方案就值得研究。在人类大脑功能的知识在生理学、药理学和生物化学等基础科学领域迅速发展的时候，临床研究却没有进展。最近的诺贝尔医学奖，一方面是因为大脑的生理学、生物化学和内分泌学的结合（Schally和Guillemain），另一方面是因为动物行为研究（Lorenz和Tinbergen），目前很难想象在精神病学领域会有类似的成就被接受过精神病学培训的人取得。我不打算探讨造成这种情况的可能的历史原因，而只考虑目前的情况。进行研究有各种各样的原因，并不是所有的原因都同样重要，我认为最重要的是天生的好奇心，以及做出个人贡献的个人抱负。这带有一种拒绝接受显而易见的权威观点的意味，我怀疑临床精神病学是否缺乏这种品质。据推测，优秀的学生不会进入这个领域，而且过去有很多证据表明，无论是对学生的调查，还是对主修精神病学的毕业生人数的统计，都存在着数量和质量上的不足。这得到了注册商和高级注册商的支持，其中一半或更多来自国外。虽然其他医学分支在注册级别上有大量的外国毕业生，但在高级级别上却不是这样。为什么本科生要进入医学的某个分支？猜想很容易，也容易出错，但他们肯定必须看到人们以一种让他们钦佩的方式来实践和研究这个问题，如果他们自己也想进入这个领域的话。因此，对本科院校学术精神病学的现状进行考察是必要的。这类科室的数量确实是最近十年才发展起来的，但相对于大量的临床负荷，一位教授和两位讲师很可能被临床和教学任务压得喘不过气来，完全无法完成研究。此外，精神科的研究经验和培训也不多。这门学科在很大程度上取决于那些不仅有思想，而且能够利用基础科学中所有新发展的人，他们的信心来自于适当的训练。他们在每一个医学学科中都是非常重要的桥梁，他们把纯粹的临床和基础科学结合起来，相互丰富。目前，崭露头角的精神病学研究工作者必须走的道路很长，可能包括普通医学和精神病学，以获得在我们这个严格管制的时代和认证委员会中被视为不可或缺的论文资格。公平地说，英国皇家精神科医学院（Royal College of Psychiatrists）确实对花在研究上的时间给予了一些豁免，但如果很多人被吓住了，也不足为奇。
If there is too little research in psychiatry, and I find no difficulty in accepting this view, then causes and possible solutions deserve examination. At a time when knowledge of the function of the human brain is advancing rapidly in the basic sciences of physiology, pharmacology and biochemistry, the clinical counterpart is not. When recent Nobel Prizes in medicine have been awarded for, on the one hand, a combination of physiology, biochemistry and endocrinology of the brain (Schally and Guillemain), and on the other, for animal behavioural studies (Lorenz and Tinbergen), it is at present difficult to imagine a similar achievement in the field of psychiatry with the lead being taken by anyone with a psychiatric training. I shall not attempt to go into possible historical reasons for this situation but shall look at the present. Research is carried out for various reasons, not all with equal emphasis, and I would give prime place to natural curiosity allied to a personal ambition to make an individual contribution. This carries with it a refusal to accept the stated obvious, the authoritative view, and I wonder if there is too little of this quality about in clinical psychiatry. Presumably the exceptional students do not enter the field and there is much past evidence, either from student surveys or from counting the number of graduates who take up psychiatry, that there is both a quantitative and qualitative deficiency. This is supported by the derivation of registrars and senior registrars of whom one half or more come from abroad. While other branches of medicine have a large number of foreign graduates at registrar level, this is not so at the senior level. Why do undergraduates enter any particular branch of medicine? Conjecture is easy and fallible, but surely they must see people practising and investigating the subject in a way they can admire if they are themselves to enter it. Therefore the state of academic psychiatry in the undergraduate schools needs examination. It is really only in the last ten years that such departments have developed in number, but in relation to large clinical loads, a professor and two lecturers may well be overwhelmed by the clinical and teaching tasks and completely unable to achieve research. Furthermore, the research experience and training in departments of psychiatry is not great. The subject depends very much on those not only with ideas, but able to make use of all the new developments in the basic sciences with confidence born of adequate training. They are the bridge men so important in every medical subject who bring together the purely clinical with the basic science for mutual enrichment. The path which the budding psychiatric research worker must follow at present is very long, and may include periods in general medicine as well as psychiatry in order to gain those paper qualifications regarded as indispensable in our regimented times and accreditation committees. To be fair, the Royal College of Psychiatrists does give some dispensation for time spent in research but it would not be surprising if many were deterred.