Mental Illness: Faulty Brain Circuits April 13, 2010Posted by Crazy Mermaid in mental illness, Psychiatrists, Therapy.
Tags: mental illness, Psychotic, Therapy
Faulty Circuits, an article in Scientific American magazine’s April 2010 issue, summarizes the leaps in neuroscience technology that reveals that psychological disorders have underlying malfunctioning physical brain connections, much like faulty circuiting in electrical wiring. This new evidence-based thinking is a paradigm shift in the way mental illness is thought of not just in the scientific and medical communities, but as this thinking infiltrates the mainstream, it will result in a shift in our perception of how people with mental illness are perceived.
The author, Thomas R. Insel, a psychiatrist and neuroscientist, is director of National Institute of Mental Health, the federal agency that supports the study of mental illness. In describing new findings in the neurocircuitry of mood disorders, Insel tries to bridge divisions between biology and psychology by highlighting the inter-relatedness between neural activity and behavior.
For the first time, we can see in real time problems in brain circuitry by the use of the newest imaging technologies, called neuroimaging. While the details of each disorder’s “circuit diagram” are still emerging, the new views are already producing seismic shifts in the way we think about mental illness. We’re getting insight into their underlying causes, and that means quicker and more accurate diagnosis as well as better and more effective treatment.
With the new neuroimaging techniques, brain circuits are diagrammed out like electrical circuits, allowing scientists to see exact locations and nature of specific problems. Some of the problems are coordination problems, where areas that are usually synchronized are out of synch. Other problems involve activity levels in, or communication between, brain areas. Areas that should be talking with each other aren’t.
One of the more interesting points the author makes is that the behavioral and cognitive symptoms that we perceive as a mental illness may be late manifestations of dysfunction in a circuit. He points out that it wasn’t that long ago that heart disease was diagnosed only when a person had a heart attack, just like clinical depression is diagnosed today only when a person exhibits clinically depressed symptoms. But in reality, it’s quite likely that in clinical depression as in heart disease and a whole host of other illnesses, observable symptoms only emerge after other compensatory mechanisms no longer suffice.
With this new view of mental illness, we will no longer have to wait until those other compensatory mechanisms fail in order to diagnose mental illness. A Schizophrenia diagnosis won’t have to wait for a psychotic episode. Not having to wait for the psychotic episode to show up will take some of the fear out of a diagnosis of schizophrenia, since with an accurate diagnosis will come a more targeted therapy that will mitigate some of the more extreme symptoms.
To take clinical depression as an example, we have come a long way in its diagnosis and treatment, and yet we have a long way to go. Back in the early 1960’s for example, there were no predictors of risk, the diagnosis was done by interview, interventions were limited to institutionalization, electroconvulsive therapy and insulin coma, and the outcomes were a very high risk of relapse and a high rate of suicide.
In 2010, we have come a little further. Predictors of risk now include a family history and/or history of trauma. Diagnosis is still done by interview. Interventions are antidepressants and cognitive behavioral therapy, and outcomes are a 50 percent response after 12 weeks. Mortality and relapse are still very high.
The goal for 2020 is ambitious and yet I hope doable. As a predictor of risk, we will use gene and protein analysis as well as brain imaging. Interventions will include preventatives such as a vaccine and/or cognitive therapy as well as treatment options tailored to individual need including improved medications, cognitive therapy and brain stimulation. The goal for outcomes is to have the patient respond to treatment within 24 hours, and to reduce relapse risk and mortality risk to low.
The author notes that although mental disorders are currently classified by their symptoms, which overlap in many conditions and aren’t linked to any particular biological evidence, he suggests that reclassifying disorders based on brain function would be very beneficial because it could yield a system of diagnosis based on biological signs such as chemical or structural changes to the brain specific to the condition. He argues that using this new classification system could allow disorders to be diagnosed earlier and with more precision, based on their biological markers.
Changing the way diagnoses are made from interview-based to biological-marker based will change public perception of mental illness in a major way. A scientific approach to the diagnosis and treatment of mental disorders, he notes, could help eliminate the stigma associated with mental illness.
Source: Magazine Article: Faulty Circuits, Scientific American, April 2010, pgs 44 through 51