Recognition and Prevention of Major Mental and Substance Use Disorders

Ming Tsuang has been a luminary in the field of psychiatric research for more than 35 years. He has contributed greatly to our knowledge of psychiatric epidemiology, nosology, genetics, and etiology. In this text he has concentrated the work of research teams focused on a goal that clinicians must imagine to be unreachable: the possibility of intervening to prevent the development of major psychiatric disorders.

The title of this work is provided by a pivotal research project—detailed in the critical central section on schizophrenia research—the Hillside Recognition and Prevention Program. Data from this series of studies has identified the presence and importance of prodromal neurocognitive deficits among persons with schizophrenia and the possibility of early treatment in selected populations. This program has also challenged preconceptions, for example, by demonstrating that antidepressants may be as effective as antipsychotics in ameliorating the course of schizophrenia among at-risk individuals.

In one chapter, Barbara Cornblatt and her coauthors discuss the ethics of the Hillside research design, its limitations, and why they and others think that prevention of schizophrenia is possible. This latter issue engenders a review of a changing perspective in schizophrenia research, which accords less importance to Kraepelin's century-old postulate that schizophrenia is primarily a neurodegenerative disorder, instead viewing the illness as neurodevelopmental with multiple variables and markers of risk. It is the presence of those markers, and the possibility of intervention to influence susceptibility to "triggers" among persons at risk because of neurodevelopmental anomalies, that has excited interest in this topic.

Tsuang's group adds a chapter on this subject in which they review more than 20 years of their research. In addition to discussing their family studies that describe characteristic neurocognitive and behavioral abnormalities or markers, Tsuang and his colleagues detail the molecular genetics and neurophysiology of schizophrenia. This fascinating research is the underpinning of our clinical psychopharmacology and adumbrates the direction of future clinical practice.

Introductory chapters review etiological risk factors, including genetic determinants and general environmental influences, and a thought-provoking chapter focuses on the role of the social environment in the development of major mental illnesses. Other chapters review the work of various authors, focusing on important contributors in matters relating to the themes of vulnerability and prevention.

The term "recognition" in the title does not imply a review of research on diagnostic tools or strategies, which I had mistakenly anticipated. The contributors here are principally concerned with identifying vulnerability markers, which may then suggest therapeutic targets, especially in the prodromal context.

I found this to be an intriguing book, helpfully focusing a large body of work that I would not likely otherwise 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.