Saturday, May 4, 2013

A spectrum of mental health disorders

I have written a lot of about management and grants and lab equipment, but I have not written much about science. I was trying to keep the blog consistent, but the nature of the internet is not linear: readers come in and leave at any point on anything their web browser selected for them. I usually talk about science with colleagues and friends, but it may also make sense to repost some interesting findings or discussion points.

An issue very close to my heart is the study of mental illness, which is what I do. A few weeks ago I was discussing autism with a foundation and I was asked whether I believe that autism is a mental illness. I found it an odd question. "Of course autism is a mental illness" I replied "it is diagnosed according to the DSM, the Diagnostic and Statistical Manual of Mental Disorders. What else is it supposed to be?" Clinically, by definition autism is a mental illness because it is a change in brain function which severely disrupts behavior and life, and it is a psychiatric disorder. It is a disorder, like many other disorders of other parts of the body, but mental illness still carries a different kind of stigma it shouldn't carry (which could be a discussion to have in another post).

I was looking at a recent editorial on the journal Nature, Mental health: On the spectrum, which  discusses the imminent publication of the new edition of the DSM, the DSM-5, and talks about what is a mental illness and how different disorders relate to each other. The piece describes how the diagnosis of psychiatric disorders in the past 60 years has changed and on how research has modified the way medicine approaches the problem. It also proposes that multiple mental disorders from intellectual disability to OCD, may lie on a continuum, a clinical spectrum without the clear boundaries defined by the diagnostic textbooks. I am a strong proponent of the spectrum view, but clinically you want to group cases that look the same together so that you can draw some conclusions. Yet, the genetics of mental disorders has shown that reality is much more complicated. The editorial is a very good read and food for thought.

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