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Perspectives |

Translating Scientific Opportunity Into Public Health Impact A Strategic Plan for Research on Mental Illness

Thomas R. Insel, MD
Arch Gen Psychiatry. 2009;66(2):128-133. doi:10.1001/archgenpsychiatry.2008.540.
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Context  Research has transformed many areas of medicine, with profound effects on morbidity and mortality. Exciting advances in neuroscience and genomics have transformed research but have not yet been translated to public health impact in psychiatry. Current treatments are necessary but not sufficient for most patients.

Objectives  To improve outcomes we will need to (1) identify the neural circuitry of mental disorders, (2) detect the earliest manifestations of risk or illness even before cognition or behavior appear abnormal, (3) personalize care based on individual responses, and (4) implement broader use of effective psychosocial interventions.

Results  To address these objectives, NIMH, working with its many stakeholders, developed a strategic plan for research. The plan calls for research that will (1) define the pathophysiology of disorders from genes to behavior, (2) map the trajectory of illness to determine when, where, and how to intervene to preempt disability, (3) develop new interventions based on a personalized approach to the diverse needs and circumstances of people with mental illnesses, and (4) strengthen the public health impact of NIMH-supported research by focusing on dissemination science and disparities in care.

Conclusions  The NIMH is shifting its funding priorities to close the gap between basic biological knowledge and effective mental health care, paving the way for prevention, recovery, and cure.

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Figure 1.

Clinical progress in mental health care requires the development of new, effective psychosocial and biomedical therapies. This figure depicts a reverse translational approach to the development of new medications based on an understanding of the molecular pathophysiology of mental disorders. FDA indicates Food and Drug Administration; HTS, high throughput screening; siRNA, small interfering RNA.

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Figure 2.

Potential neurodevelopmental stages of schizophrenia. This model presumes that psychosis is a late stage of schizophrenia. Earlier stages could be detected either by identifying biomarkers or cognitive deficits (potentially with challenge tests), analogous to the detection of early stages of coronary artery disease.

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Figure 3.

Personalized medicine will require clinical trials that assess individual patterns of response in addition to group means. Moderators are potential predictors of response that can then be tested in prospective trials. The pathway includes discovery, development, and dissemination with the ultimate goal of tailoring clinical practice to the needs of each individual.

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Figure 4.

Much of the psychotherapy workforce is not trained to provide evidence-based treatments. A, The number of practitioners within mental health–related clinical disciplines in the United States.42 B, The percentage of mental health–related clinical training programs that do not require gold standard training (both didactic and clinical supervision) in any evidence-based psychotherapies. More than 50% of psychology and social work programs do not require gold standard training in any evidence-based psychotherapies. Psychology data include both PhD and PsyD training programs.43 EBT indicates evidence-based therapy.

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