Major affective and anxiety disorders represent the most common psychiatric illnesses and are those encountered most often by primary-care clinicians. Major depression may represent a spectrum of disorders, varying in severity from mild and self-limited conditions to extraordinarily severe, psychotic, incapacitating, and deadly diseases. The antipsychotic, antianxiety, antimanic, and antidepressant drugs affect cortical, limbic, hypothalamic, and brainstem mechanisms that are of fundamental importance in the regulation of arousal, consciousness, affect, and autonomic functions. Physiological and pharmacological modifications of these brain regions may have important behavioral consequences and useful clinical effects regardless of the underlying cause of any mental disorder. The lack of diagnostic or even syndromal specificity of most psychotropic drugs tends to reduce the chances of finding a discrete mechanistic correlate for a specific disease based simply on the actions of therapeutic agents. There is no definitive link between discrete biological lesions and the pathogenesis of the most severe mental illnesses (other than delirium and dementias). Nonetheless, we can provide effective medical treatment for most psychiatric patients. It would be clinical folly to underestimate the importance of psychological and social factors in the manifestations of mental illnesses or to overlook psychological aspects of the conduct of biological therapies.
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