Little is known about the etiology of major psychiatric disorders, and a diagnostic
differentiation based on biological markers or objective laboratory methods is
currently not available. Accordingly, it is hardly surprising that only incomplete
treatments for these disorders are in use and that there is no cure in the majority
of cases. Pharmacological treatment, though effective, is unsatisfactory in the sense
that (1) a large proportion of patients (35% - 45%) exhibit a refractory clinical
picture which is resistant to all treatment modalities, and (2) the question of
predicting treatment response in the individual patient is not answerable for any of
the currently available antipsychotics and antidepressants.
Evidence from twin, family and adoption studies suggests that, ultimately, genetic
markers may represent the most important trait-like characteristics in the etiology
of major psychiatric disorders. However, genetic predisposition appears to vary
across patients and to "explain" no more than 25% to 60% of the observed phenotypic
variance, depending on the onset of illness, severity of illness, and long-term
course of clinical syndromes. Therefore, genetic predisposition has been conceptualized
as acting nonspecifically, by elevating a subject's "vulnerability" (or "sensitivity")
to environmental or endogenous challenges. Vulnerability, however, is neither necessary
nor sufficient for the development of psychiatric disorders.
A subject's vulnerability is typically compensated, at least in part, by resilience
factors. The term "resilience" is used here as a broader concept than just neurogenesis,
encompassing all those intrinsic/endogenous mechanisms that support and maintain health,
thereby enabling patients to cope with stressful situations (includes the concept of
autotherapeutic capacity). This may include personality traits supporting or impeding
social skills.
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methodological and empirical results. J Psychiat Research 1987; 21: 347-355
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depression? Psychiat Genetics 1997; 7: 27-34
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Fähndrich E, Möller HJ (eds): Syndromale Diagnostik psychischer Störungen. Hogrefe, Göttingen
1998: 5-12
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over 34 to 38 years. J Aff Disorders 2002; 68: 167-181
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Erkrankungen. Springer Heidelberg 2004: 107-125
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disorders: results of a long-term prospective study of hospital admissions. J Aff Disorders
2005; 84(2-3): 149-157
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genetischen Faktoren abhängig? Leading Opinions, Neurologie & Psychiatrie 2005; 6: 25-27
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Affektkrankheiten und Schizophrenien. Die Psychiatrie 2005; 2: 85-95
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syndrom-orientierter Modelle. In: M. Leuzinger-Bohleber, S. Hau, H. Deserno (hsg): Depression
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underlying antidepressant drug response? Evidence from 2848 patients. J Clin Psychiatry
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