Little attention has been paid to iatrogenic disorders in psychiatry

In a paper published in the current issue of Psychotherapy and Psychosomatics, Giovanni Fava and Chiara Rafanelli analyze the literature concerned with iatrogenic disorders in psychiatry, which may be due to medications or psychotherapy.

The side effects and risks associated with the medical intervention are defined as iatrogenesis. In psychiatry, iatrogenesis has traditionally been concerned with medical complications of psychotropic drug treatment. As it happened with medical therapy, side effects of psychiatric treatments have been conceptualized as the unavoidable drawbacks of any form of medical therapy. Little attention has been paid to the adverse psychological and behavioral effects of psychiatric treatment on psychopathology and illness course.

Current classification systems in psychiatry fail to consider the iatrogenic components of psychopathology related to behavioral toxicity. Affective disturbances caused by medical drugs, as well as paradoxical effects, manifestations of tolerance (loss of clinical effect, refractoriness), withdrawal and post-withdrawal disorders, are increasingly common due to the widespread use of psychotropic drugs in the general population. Such neglect is serious, since manifestations of behavioral toxicity are unlikely to respond to standard psychiatric treatments and may be responsible for the wide spectrum of disturbances subsumed under the generic rubric of treatment resistance. The term "iatrogenic comorbidity" refers to the unfavorable modifications in the course, characteristics, and responsiveness to treatment of an illness that may be related to previously administered therapies. Such modifications may also lead to a serial development of multiple medical and psychiatric complications (cascade iatrogenesis).

The notion of psychiatric disease is no longer in line with the changed spectrum of health and the complex interplay of biological, iatrogenic and psychosocial factors. Consideration of iatrogenic factors challenges most of the current practices of prescription of psychotropic drugs. Currently, the prescribing physician is driven by evidence-based medicine and guidelines, the marketing arm of pharmaceutical industry, to an overestimated consideration of potential benefits, little attention to the likelihood of responsiveness and neglect of potential vulnerabilities to the adverse effects of treatment.

Authors concluded pointing out that long-term outcomes of psychiatric disorders may be unsatisfactory not because technical interventions are missing, but because our conceptual models that ignore iatrogenic forms of psychopathology are inadequate.

Journal reference:

Fava, G.A. &Rafanelli, C. (2019) Iatrogenic Factors in Psychopathology. Psychotherapy and Psychosomatics.


  1. Thomas Roth Thomas Roth United States says:

    This excellent News-Medical article review speaks the much-needed truth that, indeed, “little attention has been paid to iatrogenic disorders in psychiatry,” as Dr. Fava and Dr. Rafanelli correctly conclude that current conceptual models ignore iatrogenic forms of psychopathology. Accordingly, it is not surprising that the World Health Organization predicts that mental illness will be the leading disease burden globally by 2030. This is especially expected given the clear mounting evidence of an international pandemic in psychiatric iatrogenesis as proven in my ethics teaching and the best-in-class expert witness references in my 5/2/18 letter to the editor of the British Medical Journal, and my 3/1/18 and 8/16/18 public comments (which are set in the context of two real-life current-events public health policy examples and) available for free at the following three URL addresses:

    To further emphasize the crucial need for much more research in this area, Robert Whitaker and Derek Blumke in there excellent 11/10/19 report “Screening + Drug Treatment = Increase in Veteran Suicides,” make the sad and astounding finding that the increase in American veteran suicides associated with the increase in VA marketing of and use of psychiatric standards of care, clearly accounts for a greater number of U.S. veteran deaths than all U.S. combat deaths since 9/11:  

    In Biblical Love for All Patients and Physicians and Medical Researchers Everywhere,

    Thomas Steven Roth, MBA, MD
    Religious and Scientific Refugee from the Clinical Practice of Psychiatric Standards of Care
    P.O. Box 24211
    Louisville, KY 40224
    May 1, 2020

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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