Leo Sher, M.D.

Today, we publish an interview with an eminent European psychiatrist, Dr. Maurizio Pompili.

Maurizio Pompili, M.D., Ph.D. is Full Professor of Psychiatry, Director, Psychiatry Residency Training Program, and Director, Suicide Prevention Center, Department of Neurosciences, Mental Health and Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, Italy. The “Expertscape” medical professionals rating service ranks Dr. Pompili as the 2^nd leading world expert in the field of suicidology.

Leo Sher: What is the most important issue in contemporary psychiatry?

Maurizio Pompili: Psychiatry as a branch of medicine is no doubt focused on diagnostic criteria and the development of standardized measures as a common language worldwide for assessing psychiatric disorders. However, psychiatrists should bear in mind the uniqueness of each patient, for whom diagnostic criteria may not fit. DSM-5 offers a unique opportunity to deliver some innovative concepts. In the introduction of this manual it is stated “The diagnosis of a mental disorder should have clinical utility: it should help clinicians to determine prognosis, treatment plans, and potential treatment outcomes for their patients. However, the diagnosis of a mental disorder is not equivalent to a need for treatment. Need for treatment is a complex clinical decision that takes into consideration symptom severity, symptom salience (e.g., the presence of suicidal ideation), the patient’s distress (mental pain) associated with the symptom(s), disability related to the patient’s symptoms, risks and benefits of available treatments, and other factors (e.g., psychiatric symptoms complicating other illness). Clinicians may thus encounter individuals whose symptoms do not meet full criteria for a mental disorder but who demonstrate a clear need for treatment or care. The fact that some individuals do not show all symptoms indicative of a diagnosis should not be used to justify limiting their access to appropriate care”. This is of great importance for any individual whose sufferance leads him or her to seek psychiatric care. Psychiatrists should not therefore start from the diagnosis but rather go on with getting to know the individual first. This is also very important for suicide risk assessment which may be independent from a given psychiatric diagnosis.

Leo Sher: How do you see the future of psychiatry?

Maurizio Pompili: I would see psychiatry as less stigmatized discipline having the unique position to understand human individuals from a strategic point of view. Of course, the role of neuroimaging and biological marker should be matched with characteristic and developmental process of individuals. I would see a discipline proposing changes in the civil society such as fighting against child abuse, reducing the absence of parental care and pointing to the damaging role of substance abuse.

Leo Sher: What needs to be done to reduce suicide rates in Italy and around the world?

Maurizio Pompili: Each year, on average 4000 individuals die by suicide in Italy and there are about 880,000 death by suicide annually in the world. Despite great progress in the knowledge of suicide as a complex multifactorial phenomenon, there is a reason to suppose that most efforts are dedicated to awareness, assessing, treating, etc. from a theoretical point of view. Facing suicidal individuals is a totally different matter. Efforts should be dedicated to focused education of mental health professionals not just with knowledge of the suicidal phenomenon but also how to remove difficulties to deal with this topic. Very often medical professionals find it difficult to ask about suicide. If such questions are asked in the daily practice suicide would be reduced.

Of course, there are many more items to consider to reduce suicides. Lithium treatment is of paramount importance as well as some psychotherapies.

There should be efforts tailored on cultural settings and considering each group of individuals at risk (youths, military personnel, elderly, psychiatric patients, etc.). Helplines are also very important and should be implemented worldwide. New technologies also have an important role with dedicated aps and websites.

I believe that exploring psychological pain is extremely important for providing relief to suffering individuals.