During the fourth day of the American Psychiatric Association 2008 annual meeting in Washington, DC, National Institute of Mental Health Director Thomas Insel, MD, discussed the obstacles to advancing mental health research; Col. E. Cameron Ritchie, MD, described the traumatic effects of war on US troops and the barriers to treatment; and Prof. Charles Nemeroff, MD, delineated the implications of prevention and treatment of mental health disorders in abused and neglected children.
Rethinking Mental Disorders: How Research Will Change Practice
Serious mental illness affects 6% of the US population and levies the highest burden of disease on people 15-44 years old. However, according to Thomas Insel, MD, Director of the National Institute of Mental Health, Bethesda, Maryland, research has failed to change the prevalence or decrease the mortality of any mental health disorder. This is in contrast to the impact of research on heart disease, which has led to a 63% decrease in mortality, and the impact of research on cancer, whereby annual cancer deaths in the United States have fallen and the number of survivors continues to increase. Advances in research in mental health are limited by the fact that the etiology of mental health disorders remains unknown, diagnosis is by observation, detection is late, and prediction is poor. Prevention is empirical and not well developed for most mental health disorders. Treatment is trial and error, with no cures or vaccines.
Recent studies highlight the inadequacy of current mental health treatment: 74% of patients with schizophrenia discontinue their antipsychotics and have limited access to psychosocial treatments. Only 67% of people with depression have remission at 1 year, and they have limited access to cognitive-behavioral therapy. Only 21% of bipolar patients are stable for 8 weeks in the first 6 months, and they have high rates of medical comorbidity.
Dr. Insel explained that mental health disorders are now being viewed as brain disorders. For example, a recent paper demonstrated that children with attention-deficit/hyperactivity disorder have a delay in cortical maturation of about 3 years compared with normal children and that this delay can be quantitated on cortical imaging. This is the first documentation of cortical growth delay in children with attention-deficit/hyperactivity disorder.
Brain differences have also been observed in depression, whereby PET imaging has revealed hyperactivity in the subgenual cingulate. When the depression is treated effectively, there is a reduction in the hyperactivity of this region.
Dr. Insel suggested that we may be able to identify people who are at risk of developing mental illness and begin treatment before symptoms become severe. For example, the constellation of genetic risk, unusual thought content, suspicion/paranoia, social impairment, and a history of substance abuse leads to a 68% to 80% accurate prediction of youths who will develop schizophrenia. Earlier recognition of mental disorders will lead to more effective treatment, according to Dr. Insel.
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Cite this: Repercussions of Abuse, Neglect, and Trauma on the Neurobiology of the Brain and Their Implications for Prevention, Diagnosis, and Treatment -- From APA 2008: May 6, 2008 - Medscape - May 07, 2008.