Ernst Strüngmann Forum

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Youth Mental Health

A Paradigm for Prevention and Early Intervention

Edited by Peter J. Uhlhaas and Stephen J. Wood

With 'youth health' as a fresh paradigm for innovative mental health science, the book summarizes best evidence and wise counsel beyond a bio-psycho-social view of early intervention. Interleaving ethical, population, and systems factors, the authors present a compelling case for applied science as a social investment to transcend the constraints of current health care organizations. A must-read.

Peter B. Jones

Professor of Psychiatry, University of Cambridge; Past-President IEPA: Early Intervention in Mental Health

The authors of this impressive book are a veritable 'who's who' of researchers in the area of youth mental health. Beautifully written and comprehensive, this volume could serve as a core text for those who are studying in this area but is also suitable for nonscientists. A genuine game changer.

Mary Cannon

Psychiatrist, Royal College of Surgeons in Ireland; coauthor of The Mental Health of Young People in Ireland, The Epidemiology of Psychosis, and Journey Through the Brain

Over the past three decades, conventional views of mental illness have yielded few novel therapeutics and have done little to shorten the tragically long ten-year gap between onset of illness and treatment. This team of world-renowned scientists uses a hammer forged by recent advances in developmental neuroscience to shatter conventional paradigms and elucidate a path toward new and better interventions.

Jay N. Giedd

Director of Child and Adolescent Psychiatry, University of California, San Diego

Mental illness represents one of the largest disease burdens worldwide, yet treatments have been largely ineffective in improving the quality of life for millions of affected individuals—in part because approaches taken have focused on late-stage disorders in adulthood. This volume shifts the focus by placing the developmental stage of “youth” at the center of mental health. The contributors challenge current nosology, explore mechanisms that underlie the emergence of mental disorders, and propose a framework to guide early intervention. Offering recommendations for the future, the book holds that early intervention in youth has the potential to transform outcomes for people with mental disorders and to reconfigure the landscape of mental health.

The contributors discuss epidemiology, classification, and diagnostic issues, including the benefits of clinical staging; the context for emerging mental disorders, including both biological and sociocultural processes; biological mechanisms underlying risk for psychopathology, including aspects of neural circuitry; and developing and implementing prevention and early intervention, including assessment and intervention modalities and knowledge translation in early treatment of schizophrenia.

Contributors

Nicholas B. Allen, Mario Alvarez-Jimenez, G. Paul Amminger, Shelli Avenevoli, Hannah F. Behrendt, Tolulope Bella-Awusah, Maximus Berger, Byron K. Y. Bitanihirwe, Drew Blasco, John D. Cahill, Joanne S. Carpenter, Andrew M. Chanen, Eric Y. H. Chen, Shane D. Colombo, Christoph U. Correll, Christopher G. Davey, Kim Q. Do, Damien A. Fair, Helen L. Fisher, Sophia Frangou, John Gleeson, Robert K. Heinssen, Ian B. Hickie, Frank Iorfino,Matcheri S. Keshavan, Kerstin Konrad, Phuong Thao D. Le, Francis Lee, Leslie D. Leve, Sarah A. Lieff, Cindy H. Liu, Beatriz Luna, Patrick D. McGorry, Urvakhsh Meherwan Mehta, Andreas Meyer-Lindenberg, Shreya V. Nallur, Cristopher Niell, Merete Nordentoft, Dost Öngür, George C. Patton, Tomáš Paus, Ulrich Reininghaus, Bernalyn Ruiz, Fred Sabb, Akira Sawa, Michael Schoenbaum, Gunter Schumann, Elizabeth M. Scott, Jai Shah, Vinod H. Srihari, Ezra Susser, John Torous, Peter J. Uhlhaas, Swapna K. Verma, T. Wilson Woo, Stephen J. Wood, Lawrence H. Yang, Alison R. Yung

ISBN: 9780262043977
Series Editor: J. R. Lupp
Editorial Assistance: M. Turner, A. Ducey-Gessner, C. Stephen
Photographie: N. Miguletz
Lektorat: BerlinScienceWorks

This Forum is supported by the Deutsche Forschungsgemeinschaft

The German Research Foundation

Youth Mental Health

Vulnerability and Opportunities for Early Intervention and Prevention

Peter J. Uhlhaas and Stephen Wood, Chairs

Program Advisory Committee

Andrew Chanen, Julia Lupp, Matcheri S. Keshavan, Andreas Meyer-Lindenberg, Stephen Wood, and Peter J. Uhlhaas

Goals of the Forum

To understand the nature of emergent psychopathology underlying causal factors and mechanisms
To develop a framework for prevention and early intervention
To identify gaps in knowledge, key questions, and strategies to guide future research

Mental disorders continue to constitute one of the largest disease burdens worldwide. One reason for the continued bottleneck in improving mental health has been the long-held assumption that the most effective approach in targeting mental disorders is a focus on conditions once they are fully manifested as opposed to preventive efforts aimed at reducing incidence of major syndromes. The latter has gained significant support through a growing awareness and empirical evidence that the large majority of major mental health conditions emerge during the transition from adolescence to adulthood. This is furthermore supported by an increasing recognition that the brain is developing rapidly during this period, providing neurobiological windows of vulnerability and resilience for emerging psychopathology.

This Forum addresses these fundamental challenges by integrating data from different disciplines: basic neuroscience, psychology, cognitive neuroscience, psychiatry, and sociology. Its overall goal is to establish a coherent framework for a novel approach toward youth mental health that will target basic scientists, neuroscientists, clinicians, epidemiologists, and policy-makers.

This Forum is supported by the Deutsche Forschungsgemeinschaft

The German Research Foundation

Group 1: Epidemiology, classification, and diagnostic issues in youth mental health

Central Question: What are the most effective and natural methods for humans, robots, and AI agents to interact in support of instruction and learning?

Epidemiological evidence suggests that the transition from childhood to adulthood is the developmental period with the highest incidence of mental disorders across the life span. This group will develop a comprehensive framework to guide assessment, diagnosis, and early intervention for emerging major mental disorders in young people. Questions to be addressed:

How can we best characterize emerging psychopathologies?
Are there early features that indicate trajectories toward mental disorders?
What are the temporal sequences and stages of the differential evolution of premorbid phases?
What is the relationship between normal functional trajectories and trajectories for psychopathology?
What are the best indicators of need for intervention during the unfolding course of mental disorder?

Group 2: Biological, psychological, and sociocultural processes in emerging mental disorders in youth

The transition from childhood to adulthood is a developmental period that is highly influenced by social and cultural context, but our understanding of the way these contexts interact with individual differences (such as genetic variation) to generate or moderate psychopathology is limited. Combined with known transcultural variation in mental health, there is a critical need to better understand the general applicability of models of youth mental health which could be important for the development of appropriate interventions as well as the identification of risk and resilience factors. This group will delineate the contextual factors (e.g., gene-environment interactions, cultural, social and economic variations) that are important in the development of psychopathology during youth. Key questions:

What are the key precursors susceptible to contextual modification?
Which contextual factors confer resilience and risk for emerging psychopathology?
How can we characterize/quantify social and cultural context in the context of psychopathology?
How do these precursors, risk and resilience factors evolve over time and interact?

Group 3: Biological mechanisms underlying risk for emerging psychopathology in youth

For many years it was believed that the fundamental properties of the brain were sculpted mainly in utero and in the early postnatal years, but data from a range of disciplines have forced a reassessment of this notion. The transition from childhood to adulthood involves a profound reorganization of both architecture and functionality of large-scale networks, which is likely to constitute a vulnerability for emerging psychopathologies and opportunities for intervention. The mission of this group is to identify the central neurobiological processes that might give rise to mental disorders during youth: from basic circuit modification to higher cognitive functions. Questions to be addressed:

What are the core modifications to circuit properties during the transition from childhood to adulthood?
How might animal models guide the understanding of the development of psychopathology and interventions?
How do earlier risk factors interact with the expression of mental disorders in youth?
What are the implications for the development of biomarkers during this period?
How can these findings inform the development of interventions?

Group 4: Developing and implementing tools for prevention and early intervention

There is strong evidence supporting a link between youth and the emergence of the major mental disorders, which has supported development of specific treatment approaches and services for young people. Implementation of such services has presented a range of challenges across different cultures, communities, and health systems. This group will take stock of the international experience thus far and address the opportunities and challenges ahead for developing appropriate and acceptable youth mental health interventions. In particular, it will discuss the clinical, social, and economic opportunities and challenges for implementation, along with opportunities offered by novel online tools, psychosocial and biotherapies. Key questions:

What political, economical, and systemic issues need to be addressed in order to deliver effective prevention and early intervention?
How can translational basic science be used to improve assessment, treatment, and clinical decision making?
What are the prospects of delivering interventions to young people through e-mental health and how might these be studied?
What might be the optimal way to adapt and establish youth mental health services in current health systems?
How might such interventions take into account the social, cultural, economic and political contexts in which the transition from childhood to adulthood takes place?

This Forum is supported by the Deutsche Forschungsgemeinschaft

The German Research Foundation