November 2010

Vol. 22. No. 4


Preventive psychiatry: We are getting closer to fulfilling the promise of reducing mental illness

Subramoniam Madhusoodanan, MD, DLFAPA

“An ounce of prevention is worth a pound of cure” goes the adage. The concept of primary prevention in psychiatry has been under-recognized until recently. In 1994, David F. Duncan, DrPH, described in an ironic manner the barriers that have kept primary prevention of mental illness from realizing its potential. Congress passed the Community Mental Health Centers Act in 1963 in response to an address by President John F. Kennedy calling for better mental health care and emphasizing the possibility of preventing psychiatric illness. However,
community mental health centers (CMHCs) were mandated to provide only negligible preventive efforts such as consultation and education. More than a decade later, primary prevention occupied <5% of CMHC staff time nationally.



Effects of exogenous glucocorticoid on combat-related PTSD symptoms

Alina Suris, PhD, ABPP | Carol S. North, MD, MPE | Bryon Adinoff, MD | Craig Powell, MD, PhD | Robert Greene, MD, PhD

BACKGROUND: Very few systematic human studies focus on changing the underlying traumatic memory after posttraumatic stress disorder (PTSD) has been established. Evidence from animal and human studies indicates that cortisol can be used to address traumatic memories. This translational pilot study is based on our previous rodent research in which extinction of fear memories was enhanced by glucocorticoids. The current study aims to assess the effectiveness of glucocorticoids in augmenting memory extinction and reducing clinical symptoms in veterans with combatrelated PTSD.



Primary psychiatric prevention in children and adolescents

Mark Opler, PhD | Dimple Sodhi, MD | Deval Zaveri, MD | Subramoniam Madhusoodanan, MD, DLFAPA

BACKGROUND: Approximately 21% of US children age 9 to 17 have a diagnosable mental illness with some degree of impairment. As early-onset mental illness may persist throughout the life span, effective primary mental health prevention programs are of paramount importance.


Primary prevention in psychiatry— adult populations

Subramoniam Madhusoodanan, MD, DLFAPA | Ronald Brenner, MD | Sharath Puttichanda, MD | Prakash Chandra, MD

BACKGROUND: The concept of prevention in psychiatry is unique. It includes promotion of mental health, identification of risk factors across the life cycle, and appropriate early interventions. Recent emphasis on intervention early in the development of mental illness has resulted in several preventive programs with varying degrees of success.


Primary prevention in geriatric psychiatry

Subramoniam Madhusoodanan, MD, DLFAPA | Fayaz A. Ibrahim, MD | Arsalan Malik, MD

BACKGROUND: It is estimated that the number of older adults with mental illness will increase from 4 million in 1970 to 15 million by 2030. The cost of untreated mental illness in the United States is estimated to be >$100 billion annually and nearly half of that cost can be attributed to persons age ≥60. In this paper we present a comprehensive review of empiric data available on primary prevention for the most common psychiatric illnesses in this patient population.