Early Detection and Management of Mental Disorders by Mario Maj
A common theme in the recent literature on most mental disorders is that they often remain undetected and untreated for quite a long time, not rarely for several years, after the occurrence of their first manifestations. For some disorders – namely bipolar disorder, schizophrenia and some anxiety disorders – clinical research has directly documented the average interval between their onset and the time of their diagnosis and the start of appropriate treatment.
For depressive disorders, a different way to document the same phenomenon has been the finding that a high proportion of cases are missed by general practitioners, although part of them are recognized in subsequent consultations. For other conditions -especially eating disorders and some anxiety disorders – the main focus has been on the multiple barriers to help seeking, which often delay recognition and treatment. In the case of Alzheimer’s disease, neuropsychological and biological research has been decisive in documenting the latency between the first manifestations of the disease and the clinical diagnosis.
The argument underlying this vast and diverse body of literature has been that an early diagnosis and management of the various disorders may be essential in improving their course and outcome and in reducing or even preventing their social consequences. This hypothesis has received up to now only a partial empirical support for most of the above-mentioned disorders, but represents a major focus of research for virtually all of them.
Moreover, it has been repeatedly pointed out that the reconstruction of the early phases of development of mental disorders may contribute significantly to the elucidation of their etiopathogenesis and, in the case of some of them, may allow devising prevention programmes.
Early detection and management of a mental disorder implies the availability of a thorough description of the prodromal manifestations of the disorder, the existence of assessment and screening instruments with a satisfactory sensitivity and specificity, the feasibility of screening programmes in the general population or in vulnerable groups, the successful engagement of a significant proportion of the subjects found to be at high risk, and the availability of validated programmes of intervention focused on the early phases of the disorder.
All these elements are currently being developed for most of the above-mentioned mental disorders, and are already part of clinical practice in several contexts for some of them (notably schizophrenia).
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