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The child at psychiatric risk
189
Book
Review
The Child at Psychiatric Risk Oxford
University
Press, New York (1983).
Edited by Ralph E. Tarter Although research on psychiatric risk is relatively recent, it is a rapidly developing field of investigation with sophisticated methodologies and a productive core of investigators. Recognition of the importance and potential of risk research is exemplified by the recent establishment by the John D. and Catherine T. MacArthur Foundation of a research network on risk and protective factors in the major mental illnesses, involving investigators from five institutions. Of note, more than half of the authors of The Child at Psychiatric Risk are from three of the institutions (University of California at Los Angeles; Washington University, St, Louis; and University of London) involved in the MacArthur network. From my perspective as an academic child psychiatrist involved in client-based clinical research, this book offers an understandable and comprehensive overview of methodologies employed and results obtained from highrisk studies of major psychiatric disorders. Following Tarter’s brief introduction, there are two chapters on methodologies in high-risk research, one reviewing genetic, the other longitudinal approaches. This is followed by eight chapters on various disorders. The genetic methodologies chapter by Brian Suarez. John Rice, and Theodore Reich summarizes strategies for establishing whether a disorder is familial; whether the transmission of the disorder is genetic, cultural, or both; and what genes might be involved in transmission. Although the nongeneticist may find that the discussion of various genetic models is too brief for thorough understanding, this chapter provides a clear overview of the various genetic strategies employed to address specific questions in high-risk research. The chapter on longitudinal methodology by Terrie E. Moffitt, Sarnoff A. Mednick, and Robert Cudeck reviews the advantages and limitations of prospective high-risk approaches, 0165-1781
X4 $03.00
‘a 1984 Elsevier
Science
choices in research design, and issues in data analysis. Together, the methodology chapters provide a comprehensive, clear, and thoughtful overview of strategies and issues in risk research. The content and structure of the chapters on major disorders are somewhat uneven, reflecting, perhaps, variation in the current status of research in different disorders, and/or the individual author’s particular interests. The chapters on learning disabilities by Paul Satz and Robin Morris and on affective disorders by Robert E. Smith and George Winokur focus primarily on classification. Satz and Morris’ discussion of the use of descriptive multivariate statistics in the search for learning disability subtypes, particularly in the review of the research design and data-analysis methods used in the Florida longitudinal study, is stimulating and suggests that similar statistical approaches could be used for subtyping other heterogeneous disorders. Following a review of classification studies, Smith and Winokur emphasize the need for evaluation of populations at risk for developing an affective disorder. Donald W. Goodwin’s chapter on alcoholism and Raymond R. Crowe’s chapter on antisocial personality disorders emphasize genetic approaches. Goodwin persuasively points out that assessment of biological mediators of alcoholism requires evaluation of individuals at risk for developing alcoholism, since the ingestion of alcohol may affect endogenous production of these mediators. Robert A. Asarnow’s review of neuropsychological and neurological studies of children at risk for schizophrenia is the most comprehensive. Asarnow reviews numerous genetic, cross-sectional, and longitudinal highrisk studies. He discusses the convergence strategy for cross-sectionally studying the prodromal, active, and postpsychotic stages of schizophrenia. Finally, Asarnow identifies
Publishers
B.V
190 a convergence of findings from the studies of children at risk for schirophrenia. and. based on the cumulative findings. speculates about a psychobiological substrate. The potential power of high-risk research is most obvious in this chapter. The remaining three chapters. although informative. do not fit as well into the overall structure and apparent intent of the book. Michael Rutter. Oliver Chadwick. and Russell Schachar discuss primarily their own epidemiological work regarding questions of cause and classification of hyperactivity and minimal brain dysfunction. Their conclusions (e.g., hyperactivity and attentional deficits do not constitute a unitary syndrome and “pervasive” hyperactivity is quite rate). which may be familiar to many readers. are provocative and differ from some of the conclusions of clinically based American studies. Tarter and Andrea M. Hegedus briefly review studies regarding etiology and psychiatric sequelae of hyperactivity and minimal brain dysfunction. learning disability. epilepsy. and cerebral palsy. In the concluding chapter, Hans J. Eysenck summarizes his work and that of others on the inheritance and psychophysiology of neuroticism and introversionextraversion. A discussion of core questions is lacking and could have been useful for the reader. For example, ( I) what arc the basic assumptions underlying high-risk research? (2) what are the problems and limitations of prevailing diagnostic and classification schemes for high-risk research? (3) does a disorder identified in childhood continue as the same diagnostic entity into adulthood? and (4) are risk factors identified in subjects at risk for a particular disorder specific for that disorder,
or. do these factors convey a more generaliled vulnerability? It is disappointing that a book published in 1983 failed to discuss the importance of new genetic methodologies. For example, the identification of numerous restriction fragment length polymorphisms (RFLPs) makes it feasible to do linkage studies in humans and possibly to identify individuals at risk for specific disorders due to allelic variation of a single major locus. Despite these limitations. this is an informativ>e and stimulating book written by recognized experts. Recent developments in diagnosis and classification (e.g., structured interviews and operational diagnostic criteria), molecular biology (e.g., the rapid identification of new RFLPs that can be used in linkage analysis), population genetics (e.g.. the development of more sophisticated models such as Reich’s multifactorial multiple threshold model ofdisease transmission). and imaging techniques (e.g.. positron emission tomography. which. as noted by Asarnow. has been used to identify decreased metabolic activity in certain brain areas of schizophrenic patients) suggest that risk research may be on the threshold of major advances. The Child at P.s_\,c,hia/ric, Risk should provide anyone interested in following these advances with a broad base of essential knowledge about current high-risk research strategies and results.
Book
Review
The Child at Psychiatric Risk Oxford
University
Press, New York (1983).
Edited by Ralph E. Tarter Although research on psychiatric risk is relatively recent, it is a rapidly developing field of investigation with sophisticated methodologies and a productive core of investigators. Recognition of the importance and potential of risk research is exemplified by the recent establishment by the John D. and Catherine T. MacArthur Foundation of a research network on risk and protective factors in the major mental illnesses, involving investigators from five institutions. Of note, more than half of the authors of The Child at Psychiatric Risk are from three of the institutions (University of California at Los Angeles; Washington University, St, Louis; and University of London) involved in the MacArthur network. From my perspective as an academic child psychiatrist involved in client-based clinical research, this book offers an understandable and comprehensive overview of methodologies employed and results obtained from highrisk studies of major psychiatric disorders. Following Tarter’s brief introduction, there are two chapters on methodologies in high-risk research, one reviewing genetic, the other longitudinal approaches. This is followed by eight chapters on various disorders. The genetic methodologies chapter by Brian Suarez. John Rice, and Theodore Reich summarizes strategies for establishing whether a disorder is familial; whether the transmission of the disorder is genetic, cultural, or both; and what genes might be involved in transmission. Although the nongeneticist may find that the discussion of various genetic models is too brief for thorough understanding, this chapter provides a clear overview of the various genetic strategies employed to address specific questions in high-risk research. The chapter on longitudinal methodology by Terrie E. Moffitt, Sarnoff A. Mednick, and Robert Cudeck reviews the advantages and limitations of prospective high-risk approaches, 0165-1781
X4 $03.00
‘a 1984 Elsevier
Science
choices in research design, and issues in data analysis. Together, the methodology chapters provide a comprehensive, clear, and thoughtful overview of strategies and issues in risk research. The content and structure of the chapters on major disorders are somewhat uneven, reflecting, perhaps, variation in the current status of research in different disorders, and/or the individual author’s particular interests. The chapters on learning disabilities by Paul Satz and Robin Morris and on affective disorders by Robert E. Smith and George Winokur focus primarily on classification. Satz and Morris’ discussion of the use of descriptive multivariate statistics in the search for learning disability subtypes, particularly in the review of the research design and data-analysis methods used in the Florida longitudinal study, is stimulating and suggests that similar statistical approaches could be used for subtyping other heterogeneous disorders. Following a review of classification studies, Smith and Winokur emphasize the need for evaluation of populations at risk for developing an affective disorder. Donald W. Goodwin’s chapter on alcoholism and Raymond R. Crowe’s chapter on antisocial personality disorders emphasize genetic approaches. Goodwin persuasively points out that assessment of biological mediators of alcoholism requires evaluation of individuals at risk for developing alcoholism, since the ingestion of alcohol may affect endogenous production of these mediators. Robert A. Asarnow’s review of neuropsychological and neurological studies of children at risk for schizophrenia is the most comprehensive. Asarnow reviews numerous genetic, cross-sectional, and longitudinal highrisk studies. He discusses the convergence strategy for cross-sectionally studying the prodromal, active, and postpsychotic stages of schizophrenia. Finally, Asarnow identifies
Publishers
B.V
190 a convergence of findings from the studies of children at risk for schirophrenia. and. based on the cumulative findings. speculates about a psychobiological substrate. The potential power of high-risk research is most obvious in this chapter. The remaining three chapters. although informative. do not fit as well into the overall structure and apparent intent of the book. Michael Rutter. Oliver Chadwick. and Russell Schachar discuss primarily their own epidemiological work regarding questions of cause and classification of hyperactivity and minimal brain dysfunction. Their conclusions (e.g., hyperactivity and attentional deficits do not constitute a unitary syndrome and “pervasive” hyperactivity is quite rate). which may be familiar to many readers. are provocative and differ from some of the conclusions of clinically based American studies. Tarter and Andrea M. Hegedus briefly review studies regarding etiology and psychiatric sequelae of hyperactivity and minimal brain dysfunction. learning disability. epilepsy. and cerebral palsy. In the concluding chapter, Hans J. Eysenck summarizes his work and that of others on the inheritance and psychophysiology of neuroticism and introversionextraversion. A discussion of core questions is lacking and could have been useful for the reader. For example, ( I) what arc the basic assumptions underlying high-risk research? (2) what are the problems and limitations of prevailing diagnostic and classification schemes for high-risk research? (3) does a disorder identified in childhood continue as the same diagnostic entity into adulthood? and (4) are risk factors identified in subjects at risk for a particular disorder specific for that disorder,
or. do these factors convey a more generaliled vulnerability? It is disappointing that a book published in 1983 failed to discuss the importance of new genetic methodologies. For example, the identification of numerous restriction fragment length polymorphisms (RFLPs) makes it feasible to do linkage studies in humans and possibly to identify individuals at risk for specific disorders due to allelic variation of a single major locus. Despite these limitations. this is an informativ>e and stimulating book written by recognized experts. Recent developments in diagnosis and classification (e.g., structured interviews and operational diagnostic criteria), molecular biology (e.g., the rapid identification of new RFLPs that can be used in linkage analysis), population genetics (e.g.. the development of more sophisticated models such as Reich’s multifactorial multiple threshold model ofdisease transmission). and imaging techniques (e.g.. positron emission tomography. which. as noted by Asarnow. has been used to identify decreased metabolic activity in certain brain areas of schizophrenic patients) suggest that risk research may be on the threshold of major advances. The Child at P.s_\,c,hia/ric, Risk should provide anyone interested in following these advances with a broad base of essential knowledge about current high-risk research strategies and results.