randolph nesse

Evolutionary biology is an essential basic science for medicine, but few doctors and medical researchers are familiar with its most relevant principles. Most medical schools have geneticists who understand evolution, but few have even one evolutionary biologist to suggest other possible applications. The canyon between evolutionary biology and medicine is wide. The question is whether they offer each other enough to make bridge building worthwhile. What benefits could be expected if evolution were brought fully to bear on the problems of medicine? How would studying medical problems advance evolutionary research? Do doctors need to learn evolution, or is it valuable mainly for researchers? What practical steps will promote the application of evolutionary biology in the areas of medicine where it offers the most? To address these questions, we review current and potential applications of evolutionary biology to medicine and public health...

BACKGROUND: The DSM-5 encompasses a wide range of symptoms for Major Depressive Disorder (MDD). Symptoms are commonly added up to sum-scores, and thresholds differentiate between healthy and depressed individuals. The underlying assumption is that all patients diagnosed with MDD have a similar condition, and that sum-scores accurately reflect the severity of this condition. To test this assumption, we examined the number of DSM-5 depression symptom patterns in the "Sequenced Treatment Alternatives to Relieve Depression" (STAR*D) study...

Previous studies have established that scores on Major Depressive Disorder scales are correlated with measures of impairment of psychosocial functioning. It remains unclear, however, whether individual depressive symptoms vary in their effect on impairment, and if so, what the magnitude of these differences might be. We analyzed data from 3,703 depressed outpatients in the first treatment stage of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Participants reported on the severity of 14 depressive symptoms, and stated to what degree their depression impaired psychosocial functioning (in general, and in the five domains work, home management, social activities, private activities, and close relationships)...

PURPOSE OF REVIEW: The development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and- of the 11th edition of the International Classification of Disease (ICD-11) have led to renewed attention to the conceptual controversies surrounding the nosology of mental disorder. This article reviews recent work in this area, and suggests potential ways forward for psychiatric nosology, focusing in particular on the need for improved classification approaches for public and global mental health...

OBJECTIVES: Mental health professionals have suggested that widowed persons experience heightened psychological distress on dates that had special meaning for them and their late spouse, such as a wedding anniversary or the late spouse's birthday. This study examined the effects of such occasions on grief, anxiety, and depressive symptoms in a community sample of older widowed persons. METHODS: OLS regression models were estimated using data from the Changing Lives of Older Couples (CLOC) study, a large prospective probability study of late-life widowhood...

New applications of evolutionary biology are transforming our understanding of cancer. The articles in this special issue provide many specific examples, such as microorganisms inducing cancers, the significance of within-tumor heterogeneity, and the possibility that lower dose chemotherapy may sometimes promote longer survival. Underlying these specific advances is a large-scale transformation, as cancer research incorporates evolutionary methods into its toolkit, and asks new evolutionary questions about why we are vulnerable to cancer...

The interface between evolutionary biology and the biomedical sciences promises to advance understanding of the origins of genetic and infectious diseases in humans, potentially leading to improved medical diagnostics, therapies, and public health practices. The biomedical sciences also provide unparalleled examples for evolutionary biologists to explore. However, gaps persist between evolution and medicine, for historical reasons and because they are often perceived as having disparate goals. Evolutionary biologists have a role in building a bridge between the disciplines by presenting evolutionary biology in the context of human health and medical practice to undergraduates, including premedical and preprofessional students...

Evolution has long provided a foundation for population genetics, but some major advances in evolutionary biology from the twentieth century that provide foundations for evolutionary medicine are only now being applied in molecular medicine. They include the need for both proximate and evolutionary explanations, kin selection, evolutionary models for cooperation, competition between alleles, co-evolution, and new strategies for tracing phylogenies and identifying signals of selection. Recent advances in genomics are transforming evolutionary biology in ways that create even more opportunities for progress at its interfaces with genetics, medicine, and public health...

No abstract text is available yet for this article.

Psychiatric nosology is widely criticized, but solutions are proving elusive. Planned revisions of diagnostic criteria will not resolve heterogeneity, comorbidity, fuzzy boundaries between normal and pathological, and lack of specific biomarkers. Concern about these difficulties reflects a narrow model that assumes most mental disorders should be defined by their etiologies. A more genuinely medical model uses understanding of normal function to categorize pathologies. For instance, understanding the function of a cough guides the search for problems causing it, and decisions about when it is expressed abnormally...

No abstract text is available yet for this article.

Evolutionary approaches are particularly valuable for studies of sexually transmitted diseases. Methods for tracing evolutionary phylogenies have powerful new applications that use genetic data to trace the history of pathogens across millions of years, within outbreaks lasting years, and even within individuals. Equally valuable are less widely appreciated evolutionary methods for analyzing how host-pathogen co-evolution shapes extreme traits whose costs can be substantial. These and other applications of Darwinian medicine will improve understanding and treatment of sexually transmitted diseases...

Study of the anxiety disorders may be a particularly useful vehicle for demonstrating how foundational sciences (e.g. cognitive-affective neuroscience, evolutionary psychology) can advance psychiatric theory and research. Here we consider important potential advances and remaining future challenges when basic research on threat detection and precautionary responses is used to address the anxiety disorders. We emphasize the potential value of a model of threat detection and precautionary responses that integrates cognitive-affective neuroscience and evolutionary approaches for understanding the anxiety disorders...

Heralding the 200th anniversary of Darwin's birth, Randolph Nesse affirms, in the December 2008 issue of The Lancet, his vision that the basic science curricula of medical school include evolutionary biology. Nesse suggests that evolutionary biology would unite the basic science principles of the preclinical years and serve as an explanatory tool in the doctor-patient encounter.This article visits this same question, but from a different vantage. Here, the author argues that the primacy of the basic sciences in medical education sanctions medical practice based on reasoning from scientific principles...

No abstract text is available yet for this article.

Darwin's On the Origin of Species was published 150 years ago, but evolution is just now being recognised as the missing half of a truly biological psychiatry. The general framework offered by an evolutionary perspective may be as valuable as its specific applications.

New applications of evolutionary biology in medicine are being discovered at an accelerating rate, but few physicians have sufficient educational background to use them fully. This article summarizes suggestions from several groups that have considered how evolutionary biology can be useful in medicine, what physicians should learn about it, and when and how they should learn it. Our general conclusion is that evolutionary biology is a crucial basic science for medicine. In addition to looking at established evolutionary methods and topics, such as population genetics and pathogen evolution, we highlight questions about why natural selection leaves bodies vulnerable to disease...

Emotions research is now routinely grounded in evolution, but explicit evolutionary analyses of emotions remain rare. This article considers the implications of natural selection for several classic questions about emotions and emotional disorders. Emotions are special modes of operation shaped by natural selection. They adjust multiple response parameters in ways that have increased fitness in adaptively challenging situations that recurred over the course of evolution. They are valenced because selection shapes special processes for situations that have influenced fitness in the past...

OBJECTIVE: The study objective was to estimate the prevalence and correlates of antidepressant use by black and white Americans. METHODS: Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) were analyzed to calculate nationally representative estimates of past-year antidepressant use by black and white Americans ages 18 years and older (N=9,723). RESULTS: Among individuals with depressive and anxiety disorders in the past year (N=516), black respondents (14...

No abstract text is available yet for this article.