Mental disorders

What is understood as 'mental disorders' comprises a variety of quite diverse clinical conditions in terms of aetiology, symptomatology, clinical course, prognosis, and response to treatment. Therefore, whenever the prevention of mental disorders is referred to, an effort must be made to obtain some precision.

From a nosological point of view, most of the mental disorders are conceptually at a syndromal level; depression, schizophrenia, and dementia are appropriate examples. In this respect, dementia is one step ahead of the other two, in so far as vascular dementia is now clearly differentiated from Alzheimer's disease, with important implications for prevention.

Therefore a strategic shift is necessary in order to obtain greater efficiency in the successful prevention of some mental disorders. The first step is for an effort to be as specific as possible in relation to the target condition: for instance Down syndrome or phenylketonuria instead of mental retardation, fetal alcohol syndrome and delirium tremens instead of alcoholism, and vascular dementia and dementia following brain injury instead of dementia in general.

The second step applies to those conditions which cannot be meaningfully broken down into more specific conditions, such as schizophrenia or depression. In these cases, the target is displaced from the appearance of the conditions towards future relapses, once a first episode has occurred; this conveniently applies to schizophrenia, depression, and dependence on alcohol and other drugs.

Finally, there are some violent behaviours, such as suicide, parasuicide, and violence against others, the control (and prevention) of which are largely expected by society to come from the field of mental health. They do not characterize a mental disorder in particular, but are frequently associated with one or more of them. Their prevention, therefore, requires specifically dedicated interventions.

With this wide range of issues considered as mental disorders, it becomes clear that the coverage of their prevention goes well beyond the limits of this chapter. A detailed conceptual approach to the prevention of mental and psychosocial disorders can be found in a recent publication of the World Health Organization ( WHO).(2)

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