Someone is not listening to the facts: there is little psychiatry outside child and adolescent psychiatry

Abstract

Given these trying economic times, let us start with some economic evidence. We have recently learned from a study funded by the European College of Neuropsychopharmacology (ECNP) and the European Brain Council (EBC) that brain disorders, and mental disorders in particular, are not only one of the main causes of burden and suffering for European countries, but they cost the EU more than cardiovascular and oncologic disorders combined. The incredible figure of roughly 798 billion euros was the cost of mental disorders to European citizens in 2010 [4]. In theory only 5.2 million correspond to the category of ‘‘childhood/adolescent disorders’’. However this clearly does not reflect the real costs of mental disorders caused by abnormal growth and rearing, abnormal neurodevelopment, or a more distal cause of a later mental disorder in adulthood, i.e. trauma, abuse, neglect, or social exclusion during childhood and adolescence. New environmental factors affecting brain development as early as in utero that increase the risk of developing a mental disorder later in life (in adolescence or early adulthood) are reported every month. In this issue Atterman et al. (in press) review the available data on how prenatal exposure to hormones may increase the risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD). In their study with an impressive sample size, female twins with a twin brother scored significantly lower in parent-reported traits of ADHD and ASD as compared to those with a twin sister. An intrauterine environment affected by the sex of the co-twin could be one of the plausible explanations for this finding. Another article in this issue reflects that some environmental factors, such as sexual abuse, are far more common than expected. Using data from a longitudinal randomised controlled trial of a school-based intervention programme for reducing adolescent sexual assault and related risk behaviours, Brasmen et al. (in press) assessed the prevalence of adolescent peer-on-peer sexual victimisation over a 6-month period. The worrisome percentage of 18.5 % of the 15-year-old females were sexual victims of peers in such a short follow-up period. In the future more research in the interaction between genetic risk factors and early environmental factors is clearly needed. As Van Os [7] recently stated, this is especially relevant for child psychiatry research. We now know that, although not diagnosed until adulthood, the first symptoms of most mental disorders appear during childhood and adolescence. It has been calculated that up to 70 % of mental disorders have their first symptoms during or before adolescence [3]. Many of these disorders persist throughout the life span. In fact there are very few psychiatric disorders that develop during adulthood that do not have antecedents, at the symptomatic or pathophysiological level, during childhood. How many cases of anxiety disorders has anyone seen that did not have anxiety traits during childhood or adolescence? Even conditions such as schizophrenia and bipolar disorders, traditionally seen as adult psychiatric disorders, are neurodevelopmental disorders. Whether the psychotic or manic symptoms appear at the age of 18, 20 or 28, what causes those symptoms is clearly present during childhood and adolescence, and probably in most cases even in early development in utero. Therefore preventive intervention should take place either prenatally, perinatally or in early childhood, when the brain is more plastic. C. Arango (&) Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Maranon, Instituto de Investigacion Biomedica Gregorio Maranon, CIBERSAM, Madrid, Spain e-mail: carango@hggm.es