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Recognizing that favorable clinical outcomes are associated with earlier initiation of treatment—and even more ideally with prevention—this volume addresses the current status of early intervention in, and prevention of, major mental and substance use disorders. A team of distinguished participants addresses this problem at many levels—from the DNA molecule to public policy—in order to show how prevention efforts should be informed by a better understanding of etiology and by a knowledge of indicators of vulnerability.
In considering the current standing of
etiological knowledge, Recognition and Prevention of Major Mental and
Substance Use Disorders addresses issues that are critical
precursors to the prevention of mental disorders and offers an understanding
of factors that contribute to the disorders' development. The contributors
review genetic methodologies and current findings in mental disorders, with
an emphasis on schizophrenia, and then show how biological and psychosocial
environmental variables may affect vulnerability. Chapters devoted
specifically to lessons in prevention drawn from recent research into
schizophrenia discuss the implications of prodromal studies and
relationships between stress, critical periods, and the development of the
disorder. The book includes contributions from NIH representatives on how
basic scientific understanding of mental disorders can be translated into
public policy. It also features chapters that describe cutting-edge projects
in prevention research for Alzheimer's disease, drug dependence, antisocial
behavior, and posttraumatic stress disorder—each providing compelling
accounts of how existing knowledge can be adapted to promising prevention
efforts. Among the volume's contributions:
• New data on the role of substance abuse—particularly marijuana and
psychostimulants—in increasing vulnerability to schizophrenia
• Review
of vulnerability factors for several relevant disorders, examining stress
and its concomitant psychobiological responses and the contribution of
cognitive factors to vulnerability to depression
• Intriguing approach
for translating successful treatment methods for schizophrenia into efforts
to prevent the transition from the prodrome of the disorder to the
full-blown illness
• Program for prevention of antisocial behavior that
can be implemented as early as the first grade
• Secondary prevention
efforts for posttraumatic stress disorder, with a focus on pharmacological
interventions
Each chapter reviews clinical implications of the research presented, contributing to a volume that will benefit clinicians and researchers who share the goal of preventing these debilitating conditions. This multidimensional, interdisciplinary work represents a major step toward cutting the social costs of these disorders—and, more important, their untold cost in human suffering.
I found this to be an intriguing book, helpfully focusing a large body of work that I would not likely other wise have been able to digest. The articles are clearly written, in the main, and with mindfulness of the audience, which includes clinicians not familiar with the details of much of the basic science recounted here. It is a commendably useful text, to be read for its evident importance to our understanding of a critical and expanding area of investigation.
Overall, this is a nice review of research into the still young field of prevention in psychiatric illness. The overarching clinical emphasis is on improving outcomes through earlier interventions. The book is probably essential reading for anyone in this field of research, but it provides less practical clinical guidance on the topic than one might desire.
Generally speaking, the chapter authors have done a careful job, considering the multiple factors leading to the manifestation of each disorder covered. They take an analytic approach and are conscientious about reporting studies in enough detail to allow the reader to see how changing one contributing factor influenced outcomes. Many of the chapters employ or report the results of meta-analyses in the service of examining patterns of data across studies. They note areas in which the results are consistent and other areas in which consensuses among outcomes has not been reached. The authors are also careful to make distinctions among theories for which data are still being evaluated, and theories with mixed support. More impressive, they accomplish this in a writing style that is engaging.
Ming T. Tsuang, M.D., Ph.D, D.Sc., is University Professor at the University of California; Distinguished Professor of Psychiatry and Director of the Center for Behavioral Genomics in the Department of Psychiatry at the University of California, San Diego, in La Jolla; Adjunct Professor and Director of the Harvard Institute of Epidemiology and Genetics in the Department of Epidemiology at the Harvard School of Public Health in Boston, Massachusetts; and Senior Lecturer at the Massachusetts Mental Health Center Academic Division of Public Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, at Harvard Medical School in Boston, Massachusetts.
William S. Stone, Ph.D., is Assistant Professor of Psychology in the Department of Psychiatry at Massachusetts Mental Health Center Academic Division of Public Sector Psychiatry; Assistant Professor in the Department of Psychiatry at Beth Israel Deaconess Medical Center; and Harvard Medical School Training Coordinator at the Harvard Institute of Psychiatric Epidemiology and Genetics in Boston, Massachusetts.
Michael J. Lyons, Ph.D., is Professor and Director of Clinical Programs in the Department of Psychology at Boston University; and Chief of Twin Studies at the Harvard Institute of Psychiatric Epidemiology and Genetics in Boston, Massachusetts.
Contributors
Introduction
Part I: Etiology of Major
Mental and Substance Use Disorders
Chapter 1. Genetic Risk Factors for
Mental Disorders: General Principles and State of the Science
Chapter 2.
Environmental Determinants of Psychosis: A Focus on Drug Abuse
Chapter
3. Social Environment and Psychiatric Disorders: A Historical Review
Presented on Receipt of the Paul H. Hoch Award
Part II: Vulnerability to
Major Mental and Substance Use Disorders
Chapter 4. Psychobiology of
Resilience to Stress: Implications for Prevention of Anxiety
Chapter 5.
Cognitive Vulnerability to Depression: Implications for
Prevention
Chapter 6. Vulnerability to Alcohol and Drug Use
Disorders
Part III: Prevention: Lessons From Schizophrenia
Chapter
7. Treatment of the Schizophrenia Prodrome
Chapter 8. Adolescent
Neurodevelopment: A Critical Period for Preventive Intervention
Chapter
9. Toward Prevention of Schizophrenia: Early Detection and
Intervention
Part IV: NIH Perspectives on Prevention
Chapter 10.
Prospects for the Prevention of Mental Illness: Integrating Neuroscience and
Behavior
Chapter 11. Drugs and Alcohol: Treating and Preventing Abuse,
Addiction, and Their Medical Consequences
Chapter 12. Alcoholism:
Developmental Patterns of Drinking and Prevention of Alcohol Use
Disorders
Part V: Challenges for the Near Future
Chapter 13.
Prevention of Alzheimer's Disease: Principles and Prospects
Chapter 14.
Five Facts About Preventing Drug Dependence
Chapter 15. Prevention of
Aggressive Behavior Through Middle School Using a First-Grade
Classroom-Based Intervention
Chapter 16. Conceptually Driven
Pharmacological Approaches to Acute Trauma
Index