Thursday, August 2, 2012
News from NAMNI
While other illnesses have seen vast improvements in their recovery rates, for individuals living with mental illness, the recovery rate has not improved dramatically. Twenty years ago AIDS was essentially a death sentence. If you contracted AIDS you measured your life expectancy in months. However, the most recent figures find that if someone contracts HIV and develop AIDS by age 19 or 20 he or she will probably die of heart disease in their 60s or 70s.
Unfortunately for mental illness, the current reality is not as optimistic. These illnesses are still being diagnosed by observations rather than using biomarkers, the method the rest of the medicine world uses to identify illnesses. Consequently, treatment often doesn’t arrive until late in the course of the illness. This lack of timely treatment has led neuropsychiatric disorders to become the leading cause of disability in the world, more than heart disease, cancer or injuries.
“But it’s not just morbidity, it’s mortality,” says Dr. Tom Insel, Director of the National Institute of Mental Health (NIMH) at the National Institutes of Health (NIH). and served as the Chair of the Interagency Autism Coordinating Committee The latest data from the Center for Disease Control (CDC) shows that nearly 36,000 Americans die by suicide each year, virtually all are thought to be a result of mental illness, more than twice the number of homicides and more than number of traffic fatalities.
In the military, suicide has become a true crisis. Since 2009, more soldiers have been lost to suicide than combat. Posttraumatic stress disorder (PTSD), traumatic brain injuries (TBIs), depression and suicide are quickly becoming the signature wounds of the current wars in Afghanistan and Iraq.
So why haven’t we done better? Why with all the treatments, such as psychotherapy and medication, have recovery rates not improved?
Many reasons have been put forward but the most loudly stated and often cited is the lack of access to services; people simply don’t have the ability to get the best treatments. New data from Great Britain seems to suggest otherwise. Although everyone has access to healthcare is in the U.K, the outcomes for individuals living with mental illness, however, are almost exactly the same.
According to Dr. Insel the reason we have not seen better results is that we simply do not know enough. Mental illnesses are complicated problems and we are still at a very early stage in trying to understand them. “In many ways we are about where cancer was 35 or 40 years ago or where heart disease was 45 or 50 years ago,” claims Dr. Insel. “We are still learning to navigate around a new area of research.
We have just now begun to look at mental disorders at the initial onset of symptoms in hopes to provide more effective treatments.
New techniques such as diffusion spectrum imaging have allowed scientists to begin to map the neural fiber pathways of the brain. While these methods are still in their infancy they show promise. They allow us to decode the “bowl of spaghetti” as Dr. Insel puts it. With the new technologies we can now begin to see into that mass in the middle. Dr. Insel hopes that by the end of this year we will be able to tell what the actual connectivity is between two parts of the brain. Ultimately being able to discover what is exactly different between individuals with depression and individuals with schizophrenia, what part of the brain changes with treatment.
“For the first time we can begin to say, ‘So this is what depression looks like… these are the parts of the brain that are involved in PTSD or the parts that are involved in OCD [obsessive-compulsive disorder] or schizophrenia,’” says Dr. Insel.
New forms of treatment, such as the use of video games, are now being used to target specific processes and ultimately change the neural circuitry of the brain. With the new technology we can finally begin to move past merely describing mental illness by its physical descriptions and instead begin to identify particular circuits in the brain that aren’t working the way they should be. Ultimately, as Dr. Insel notes, we will probably discover that depression is not just depression. Rather, we might discover that it is a collection of many disorders that affects distinct parts of the brain.
For Insel, the understanding of mental illness as a neurodevelopmental disorder is key. Continued research on the early stages of the development of mental illness will result in treatments that can truly begin to address the core of the problem rather than focusing on mitigating the visible expressions of the illness.
Research into the circuits of the brain is not the only thing to be done, Dr. Insel notes. It’s not just a matter of getting clearer pictures of the brain, identifying the neurons, cells and structures in the brain. Evidence has continued to show one thing, over and over: “If you look at those things that help to build resilience… one of the best is simply by getting families involved.” It’s not just all the brain talk that’s important, it’s the human talk too.