Abstract

Psychiatry has traditionally been based on tertiary prevention, whereas scientific evidence gathered these past decades should move our field toward the more ambitious primary and secondary prevention and promotion of mental health. Although there has been a recent increase of interest in earlier detection and treatment of mental disorders including conditions such as psychoses, there is a gap between our recently acquired knowledge about ways to promote mental health, primary and secondary prevention, and public health, and clinical initiatives to pursue them.
Potentially preventable variables such as poor nutrition, exposure to drugs, infection, or toxic substances during pregnancy, obstetric complications, maternal depression during pregnancy or after delivery, parental neglect, bullying, physical, emotional, and sexual abuse, social discrimination, cannabis use, and other forms of trauma and lack of stimulation have an impact on the risk of developing mental disorders and psychotic symptoms. In fact epidemiological studies show that the symptoms that are part of the many different diagnostic categories are present in the general population, sometimes as state phenomena, but sometimes as trait phenomena with cumulative effects.
One of the major advances in mental health research in recent years is the understanding that there may be risk factors not mapped by the present diagnostic categories. Many of these risk factors – whether at the level of aetiology or pathophysiology – seem to increase the likelihood of many different DSM or ICD mental disorders.  There are no apparent risk factor “silos” for the current diagnostic criteria, as there seem to be different neurodevelopmental trajectories leading to a wide range of final outcomes in terms of mental disorders. This opens an optimistic window of opportunity for a preventive approach. If only we could prevent someone who is at risk for or who is already undergoing very early abnormal neurodevelopment from ending up with a disorder that will impose an even greater burden by intervening in the process of anxiety, depression, bipolar disorder, schizophrenia, or autism. While the treatment of early mental distress may prevent transition to a mental disorder, it could also mean that, in the long run, the mental disorder (if it develops) causes less disability, either because it is a disorder generally associated with less burden (e.g. depression vs schizophrenia) or because, within the same disorder, it has less severity (e.g. mild rather than moderate major depression, with or without psychotic symptoms, etc.).

View or download Celso Arango's original slide presentation (pdf, 136 slides).