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Genetic epidemiology explores the interrelationship of genetic and environmental risk factors in which genes are measured indirectly in ways that reflect aggregate effects "averaged" across the entire genome. This chapter describes the principles and methodology of psychiatric genetics using four-paradigm framework: basic genetic epidemiology, advanced genetic epidemiology, gene finding, and molecular genetics. Each of these paradigms has strengths and limitations, and they are in a process of dynamic interaction with each other. Genetic epidemiology has proved a reliable method to answer basic questions about the overall importance of genetic risk factors for psychiatric illness. The advanced genetic epidemiology paradigm has been used to study the relationships between neuroticism and depression. Molecular genetics is an entirely laboratory-based discipline applying a range of modern methods from genomics to neuroscience to try to identify and then trace pathophysiological pathways.
Although there is good evidence that interventions for carers of people with Alzheimer's disease can reduce stress, no systematic studies have investigated psychotherapeutic intervention for patients themselves. This may be important in the earlier stages of Alzheimer's disease, where insight is often preserved.
The aim was to assess, in a randomised controlled trial, whether psychotherapeutic intervention could benefit cognitive function, affective symptoms and global well-being.
Individuals were randomised to receive six sessions of psychodynamic interpersonal therapy or treatment as usual; cognitive function, activities of daily living, a global measure of change, and carer stress and coping were assessed prior to and after the intervention.
No improvement was found on the majority of outcome measures. There was a suggestion that therapy had improved the carers' reactions to some of the symptoms.
There is no evidence to support the widespread introduction of brief psychotherapeutic approaches for those with Alzheimer's disease. However, the technique was acceptable and helpful individually.
The exclusion of services for older people from the Mental Health National Service Framework and the delays in publication of the National Service Framework for the elderly have caused many old age psychiatrists to be concerned that, as in many other areas of health service planning and provision, the needs of older people are not being adequately addressed by Government and health service planners. The recent Audit Commission Report, entitled Forget Me Not: Mental Health Services for Older People†, gives us much encouragement that the needs of older adults have not been forgotten. Its recent publication should provide an authoritative focus, which will help old age psychiatrists, their multi-disciplinary and management colleagues and commissioners of services to push forward improvements in services for older people with mental illnesses.