How will we view schizophrenia in 2030? Schizophrenia today is a chronic, frequently disabling mental disorder that affects about one per cent of the world’s population. After a century of studying schizophrenia, the cause of the disorder remains unknown.
Just as research during the Decade of the Brain (1990-2000) forged the bridge between the mind and the brain, research in the current decade is helping us to understand mental illnesses as brain disorders. As a result, the distinction between disorders of neurology (e.g., Parkinson’s and Alzheimer’s diseases) and disorders of psychiatry (e.g., schizophrenia and depression) may turn out to be increasingly subtle.
Psychiatrists have a range of treatments to offer patients with depression. Randomized controlled trials have demonstrated the efficacy of tricyclic antidepressants, SSRIs, cognitive behavior therapy, and interpersonal therapy. For each of these interventions, one can say with some confidence that at least 40% of a cohort with depression will show statistically significant reductions in unbiased ratings of depression.
Mental disorders cause more disability than any other class of medical illness in Americans between ages 15 and 44 years. The suicide rate is higher than the annual mortality from homicide, AIDS, and most forms of cancer.
Genomics and neuroscience, 2 areas of science fundamental to psychiatry, have undergone revolutionary changes in the past 20 years. Yet methods of diagnosis and treatment for patients with mental disorders have remained relatively unchanged.
Over the past 2 decades, the National Institute of Mental Health supported ambitious population-based efforts in psychiatric epidemiology. The landmark 5-site Epidemiological Catchment Area (ECA) study of the 1980s provided the first comprehensive picture of the prevalence of DSM-III mental disorders in the United States.
Several issues were raised in the Observer article (“Hitting the Bricks,” February 2005) about NIMH funding for basic behavioral science that can benefit from clarification. First let me state that behavioral science is crucial to our success in meeting the very serious — and growing — challenge of reducing the burden of mental and behavioral disorders. Refining phenotypes, detecting gene-behavior-environment interactions, developing diagnostic tests and new interventions for prevention and treatment, and enhancing rehabilitation and recovery all require basic behavioral science.