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Minus Ten: Prevention And Early Intervention

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Medicine is always looking for the magic bullet. Unfortunately it does not exist. But there are even more dramatic forms of cure. They are prevention and early intervention.

No surgical technique has been more successful than having surgeons wash their hands. The most dramatic medicine of the last century was the virtual eradication of smallpox and poliomyelitis. The cessation of smoking, healthy eating and exercise have all helped to prolong life. Quality of life has also improved. Social intervention and rapid intervention have helped enormously in our fight against AIDS. We have delayed and prevented onset of diabetes and hypertension. When they occur they are dealt with rapidly and effectively.

We are screening for cancer of the breast, bowel and pancreas with great success. Modern medicine knows what causes an illness. Modern medicine can take steps to prevent it. It seems that if we act ten years 'in front' we can eliminate or minimize the diseases that the most expensive of medications do not cure effectively.

Can psychiatry perform similarly? It would seem that mental health has not even changed its approach. We know that over twenty percent of the population will suffer from anxiety, panic and depression. These illness can last a month or more. It will return, on average three times or more times.

We know that approximately two percent will have serious debilitating psychotic disorders; the majority of which are schizophrenics. The majority of the schizophrenics will never return to what they were. They will need support and care for large part of their remaining lives. This is even more distressing as the illness tends to start relatively early in life.

Mental illnesses start earlier than other illnesses. Yet we treat them as we treated depression and diabetes twenty years ago. We are waiting for the disease to develop, waiting for the damage to occur and then apply rehabilitation and damage control.
Are there steps that we can take that prevent, delay onset and intervene at an early stage?

It is universally accepted by professionals that the use of addictive drugs including the 'safe drugs' can and does precipitate psychosis. There is alarm at that use of Ritalin. All in the profession agree that Ritalin is prescribed far too easily. People are not given Ritalin in accordance with 'accepted practice'. It would seem that people who have received Ritalin are more liable to later be treated with medication used in psychosis than people who did not receive Ritalin.

Strangely the same group, who received Ritalin, receives fewer medications for Depression than those who did not receive Ritalin. We know that children brought up in social stress and with a poor family support system are more prone to mental illness. We know that schizophrenia has genetic loading. We know that certain behavior traits in childhood are prone to develop psychoses. We have a good idea who is prone to develop Schizophrenia. We know what the prodromal signs occur before the first psychotic breakdown. Psychotic breakdowns do not occur overnight. They are festering for weeks before the break. More distressingly we can prevent a psychotic breakdown if we intervene at the right time. Yet we do nothing.

We know that not everyone will develop depression or anxiety. The family doctor is never surprised when one of his patients does develop theses illnesses. We know who is going to develop the illnesses. He or she is typically of two types. They are either the rigid worrier or the very dependent personality. They have in common a defect. Their coping style is inadequate. We can readily and easily correct this defect. Cognitive Behavioral Therapy, CBT, can improve coping. Over forty percent of people feel that they want to improve the way that they cope. By doing so they would prevent depression and anxiety and improve significantly their quality of life.

It would seem that mental health should re-align itself with the rest of medicine. We can reasonably hope that prevention and early intervention in mental health issues will become as important as they are in the other fields of medicine.

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