Two steps forward, one step back; paradigmatic changes in psychiatry

The initial scientification of psychiatry after the European discovery of p sychotropic drugs via psychopharmacology and biological psychiatry has grad ually ended in an impasse. As a result of at least four developments, psych iatry is re-orientating in a more dimensional and functional direction in o rder to adapt to the progress in the neurosciences. Rigid adherence to noso logical systems should be replaced by a careful observation and description of psychopathology as well as a search for relevant psychological dysfunct ions and their putative pathophysiological basis. Psychotropics have to be developed that do not suppress symptoms but promote potentially intact func tions. Emphasis should be given to the brain mechanisms that are involved i n habit formation and chronicity. Modern genetics will drive the discipline towards early intervention and prevention and will elucidate the relations between genetic disorders and the behavioural phenotype. The basis, howeve r, remains clinical observation, dynamically reshaped by neuroscience.