There is good news and bad news.
The bad news is that unlike much of the rest of medicine, the prevalence of mental illness has not decreased in recent times, and mortality has not decreased for any mental illness, Thomas Insel, M.D., director of the National Institute of Mental Health (NIMH) told NAMI's national convention in June.
"The good news is that I feel very strongly that that is all about to change," Insel said. "And it's going to change very quickly because of a different vision and different tools."
Insel spoke in a session along with Nora Volkow, M.D., Ph.D., director of the National Institute on Drug Abuse, on current research that will lead to the development of better treatment for people with mental illnesses and people with substance abuse disorders.
Research in mental illness has traditionally trailed behind studies in other areas, such as cancer and heart disease.
In the past, Insel explained, researchers primarily focused on medicines and how they worked, but a new focus on pathophysiology, the functional changes in the brain associated with a mental illness, may lead to significant research advances.
"The problem with that was that we learned an awful lot about pharmacology, but not very much about physiology," said Insel. "We didn't really learn why some people get these disorders, and what these disorders really mean in terms of changes in brain function. The hope is that pathophsyiology will get us to biomarkers and to new treatments."
"Where we really want to go is personalized care, and strategies like strategies for preventing heart disease, where we start very early and we're able to intervene long before the worst part of the illness develops—and for those who develop the illness, to talk about recovery in terms of a cure, in terms of a lasting change."
For the first time, researchers have new technology to do this.
"We are really, in a sense, in this extraordinary moment in science, where we have, for the first time, the kinds of tools that allow us to understand pathophysiology, understand what goes wrong at each of these levels of analysis from genes to cells to brain systems to studying the whole individual and to understanding even social systems with very new technologies," said Insel.
By working with whole genome association approaches, which allow researchers to look at variations in genes, researchers will be able to identify the important "players" for the first time, define mechanisms of disease, and ultimately develop novel therapeutics.
Technology has already led to remarkable breakthroughs in diabetes and prostate cancer, among other diseases.
Many NIMH-funded studies on ADHD, bipolar disorder, schizophrenia and depression have recently been completed, while others will be completed by this fall. Reports will enter the public domain for interrogation about the relationship between genetic variations and brain disorders.
|Dr. Thomas Insel of NIMH and Dr. Nora Volkow of NIDA field questions from attendees following their presentations at Friday's research plenary.|
"We don't speak about drug addiction [in talking about mental illness]" said Volkow.
"We know it's there, but we don't speak about it. Well, if we don't speak about it, if we don't recognize it, it's not going to go away. Not only is it not going to go away, the outcomes of our patients are much worse. And in the end, the family, the society and the medical system basically are paying for this."
Dr. Volkow explained the connection between the "thinking" part of brain and the "emotional" part of the brain that allows us to control emotions.
During adolescence the connection between these two parts of the brain is not fully developed. A high school student may perform well in school, but also take part in drug experimentation. Lack of connection accounts for the emotional intensity of adolescence and explains why the symptoms of mental illness tend to surface during developmental stages.
Researchers are currently studying whether early exposure to drug use during developmental stages could lead to mental illness in those who are vulnerable due to genetic factors.
Volkow explained that research has illustrated that most people with a mental disease have a higher risk of taking drugs, as many gravitate towards self-medicating with cigarettes, alcohol, etc.
Volkow used the example of a person with depression who may smoke, inhaling nicotine and other compounds that may have anti-depressant properties and cause biochemical changes in the brain. If the depressed person stops smoking, they will experience an increase in depressive properties. An addiction to smoking relieves them of some of those stresses.
Dr. Volkow challenged the notion that when treating a person with both mental illness and a substance abuse problem, one should overlook the latter because the patient has "more important problems."
"Most of the private medical insurance will not cover the treatment of drug addiction, and if they do, they will cover inadequately," said Volkow. "If you have an individual with a mental disorder and substance abuse, the probability that the substance abuse will never be treated is very high, and the likelihood that that will affect the outcome is almost certain."
Patients will only receive the best outcomes once the stigma of drug abuse—as well as that of mental illness—is erased and people are able to get the holistic treatment they need.
NAMI is pleased to present the audio of Dr. Insel's remarks online. To play the audio on your computer, simply click the link below. If you wish to download the file for playback on an iPod or other MP3 device, right-click on the link and choose "Save Target As...".
Total running time: 27 minutes
2007 NAMI Convention – Research Plenary: Dr. Thomas Insel (MP3 file – 9.5 MB)
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