• Vol. 36 No. 4, 229–231
  • 15 April 2007

One Size Does Not Fit All: Observations on the “Phenomenon of Two-thirds” in Clinical Psychopharmacology



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In clinical medicine the diagnosis is often established according to a known aetiology or an elucidated patho-physiology. A recent trend in management is to follow certain “evidence-based medicine” guidelines, which are often established by some consensus and then recommended as the “gold standard”.1 Psychiatric diagnoses, and the definition of a psychiatric disorder, are generally based on a cluster of symptoms or a syndrome, with a duration criterion as well. With advances in biological psychiatry, psychopharmacology and neuron-imaging, the patho-physiology of mental illness is often understood in terms of neuroanatomy, neuronal circuitry, neurotransmitters, and receptor systems.2 Eisenberg3 has succinctly summarised the aspirations of the biological school of psychiatry: “For every twisted thought there is a twisted molecule”.

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