Recognition and Prevention of Major Mental and Substance Use Disorders

It is becoming increasingly clear that postnatal development may contribute substantially to the onset of mental illness in susceptible individuals. This book edited by Tsuang, Stone, and Lyons presents a series of papers that address this issue from different perspectives. The chapters are organized into five different, but interrelated, sections that cover a broad range of topics that all converge on the theme of prevention. The central thesis is that changes in the brain during the postnatal period can contribute to the appearance of various clinical phenotypes, such as schizophrenia, depression, and substance abuse.

In Part I, genetic and environmental risk factors are discussed in the context of the onset of these disorders. Stephen Glatt and his colleagues discuss the methodologies that are being employed to study the genetics of psychiatric disorders. The following two chapters deal with environmental issues and how they increase the vulnerability for different psychopathologic states. Jane Murphy concludes this section by providing a discussion of how psychosocial factors may play a role in the appearance of symptoms in various psychiatric disorders. In Part II, the principle emphasis is on vulnerability. The concept of cognitive vulnerability for depression and drug abuse as well as the role of stress resilience in decreasing or increasing vulnerability are addressed. In Part III, the emphasis is on prevention. Dr. Tsuang’s chapter discusses the very controversial issue of prescribing neuroleptic drugs prophylactically for first-degree relatives of individuals with schizophrenia who show subclinical manifestations of the disorder. A chapter by Elaine Walker and colleagues presents a compelling hypothesis regarding the relationship among stress and postnatal development in the vulnerability for schizophrenia. In Part IV, which is entitled NIH Perspectives on Prevention, representatives of the NIMH, NIDA, and NIAAA discuss how basic science findings can be translated into public policy regarding major forms of mental illness and substance abuse. In the final section, Part V, the challenges for future research are addressed. In the first chapter, John Breitner uses Alzheimer’s disease as a model and demonstrates how a prodrome for this disorder probably exists during the mid-life period and can be forestalled by the use of nonsteroidal anti-inflammatory drugs (NSAIDS). For the most part, these agents have only been found to be effective in delaying the onset, and dementia eventually does develop. Breitner emphasizes that different interventions may be required at different stages of the disease process and a similar paradigm might be applicable to our understanding of mental illnesses. Other chapters in this section deal with the development of strategies for preventing aggression, drug abuse, and posttraumatic stress, particularly during adolescence.

Overall, this book provides a scholarly overview of evolving concepts regarding the prevention of neuropsychiatric disorders. The general style of writing throughout the volume is clear, even when empirical data and statistics are described. The chapters end with a “clinical implications” section that delineates the relevance of each topic for the nonscientist reader. Most of the chapters are written in a relatively nontechnical manner that should be appreciated by the majority of clinicians. The most disappointing aspect of this book is that it does not include much information from developmental neuroscience and the influence of brain maturation on behavior during childhood, adolescence, and adulthood. Perhaps, basic neuroscientists foraging for new directions to pursue in their research will find fertile ground with novel avenues to pursue.