Marcella Rietschel

 

Available research indicates that mental illness is complex, and results from the interplay of environmental and genetic factors. Various environmental factors have been implicated in psychiatric illness, and over the past decade, researchers have identified a large number of genes with a possible involvement in mental illness. These insights may lead to breakthroughs in our understanding and treatment of mental illness.

To optimize psychiatric research in the 21st century, we are of the opinion that the following seven prerequisites must be realized: 

1.    Accounting for patient individuality: Each patient is unique in terms of their genetic make-up, experiences, and coping strategies. To determine how genetic and environmental factors interact to produce mental illness, these individual factors must be taken into account.

2.    Accounting for ethnic diversity: Current research focuses predominantly on the investigation of selected ethnicities from the so-called developed world. As a result, a large proportion of the world’s psychiatrically ill population, with all their biological and cultural differences, is excluded from the research process. Future psychiatric research must include patients from all ethnicities if all relevant factors are to be identified.

3.    Ending the use of traditional disease classification: Because the causes of mental illness remain unknown, mental illness is diagnosed and classified according to what the patient says and how s/he behaves, rather than on the basis of blood tests or other objective physical evidence. Reliance on this traditional and non-biological method of classification is unsatisfactory, and must be replaced with consideration of specific symptoms.

4.    Studying disease course: Two patients with the same diagnosis may experience a very different course of illness. For example, one patient may experience a single episode with full recovery, while the other may suffer recurring bouts of illness or chronic symptoms with a loss of normal day-to- day functioning. Current research approaches tend not to account for this, as they typically study patients at one time-point only. Future research should follow up patients across the lifespan in order to identify those factors which determine outcome.