Finding A Curative And Preventive Basis For Mental Illness.

Mentally ill people need help not stigma
Image credit to Imagebuddy

I just finished a 4-week rotation through Psychiatry, and I must say I have learnt a lot about the disorders of the mind. Before the rotation, I used to have this stigma and nausea towards anything that has to do with mental illness and those with it because of the way the society has painted them--they are mad people. But the truth is people with illness of the mind are normal human beings with families, friends, dreams and ambitions; some have good education and are in different professions. Our first lecture introduced us to Psychiatry, and in it I learnt that everyone's mind is like an elastic spring suspended from a hook, with a board on one end. Now, life drops different loads on this board (what we call psychological stressors--challenges and trials), which stretch the elastic spring (remember Hooke's Law in Physics); but almost all the time, our minds will return to their original length after a "normal brief period" of reacting to the stretching (in the form of crying, sadness, feeling depressed, losing interest in everything, fear and anxiety, and so on) when we've got over the psychological stressors (every challenging period passes). It's important to note that some people's minds have higher elastic limits than others' (they can withstand much more severe psychological stressors than others) because of their genetic makeup. Hence, when those whose minds have low threshold for withstanding challenges are faced with very severe psychological stressors, their minds are stretched beyond their elastic limits and what results is mental illness--a state in which their minds remains in this stretched mode for an unusual length of time, in the form of depression, mania, obsession, hallucinations, compulsion, changes in personality and so on. 

And that's where the field of Psychiatry comes in--to study the mechanisms of these disorders of the mind and find solutions to them. But unfortunately, these solutions are not permanent because there are currently no clear cut (pathognomonic) basis for the development of pure mental illness unlike in other medical fields where there are definitive cause-effect mechanisms for a lot of diseases and the correction of which would permanently cure the patient of such a disease. Hence, most psychiatric conditions have a remission-relapse pattern in which the patient is treated and he or she gets well, but may likely come back with that mental illness after a long period of time (some patients are placed on medications for life). 

Throughout the rotation I saw people of different ages and backgrounds with different disorders of the mind which have impaired their functioning--social, educational, professional and even physical aspects of their lives. I became burdened with the thought that there should be efforts geared towards finding permanent treatment and cure and designing preventive measures for these pure disorders of the mind: nobody deserves to live with mental illness for life. And I started asking my consultants and lecturers whether there is such thing as Preventive Psychiatry like there's Preventive Medicine, where tests and strategies are designed to identify people whose minds have low threshold for psychological stressors so as to train these people to be able to handle challenging circumstances without losing their minds. To my disappointment there is nothing remotely close to this in Nigeria; I haven't researched whether this service exists in other parts of the world. 

But I have come across a few research efforts that are looking towards identifying people at risk of developing some types of mental illness based on definitive parameters and trying to find ways to prevent the illness by tackling the identified parameters. Schizophrenia is a psychiatric condition that occurs more commonly in males than females, starting in late teen and early adulthood. It's a debilitating mental illness characterised by disorders in one's thought form and speech, auditory hallucinations, delusions, impairment in cognition and judgement, social withdrawal, and many other unpleasant symptoms, all of which worsen with time. No set of well-defined causative factors for pure schizophrenia has been worked out as it seems to stem from several roots--the individual's genetic makeup, family history of the illness, life events that come with psychological stressors and so on-- which culminate to cause it. However, since the human brain and mind are mirrors of each other (hundreds of millions connections occur simultaneously and accurately between neurons in the brain for proper functioning of the body and mind), disorders of the mind must have some definitive basis in the brain's structural and functional architecture, which if delineated could open the window into efforts at pinpointing mental illness long before they begin to manifest. 

The Brain Circuitry in Mental Illness
Image credit to University of California San Francisco 

And it seems some concerned ingenious human beings are already working in this direction. According to a research published last month in the American Journal of Psychiatry, the immune cells of the brain called microglia have been implicated in patients with schizophrenia and those at high risk of developing it. In the study, a chemical agent with high affinity for microglial cells was injected into a number of individuals with schizophrenia and those at high risk, after which they underwent what is called a translocator-protein positron emission tomography (PET) imaging of their brains. The neuroimaging revealed that these microglial cells react excessively in the brains of the two groups when compared to healthy participants in the study, implying that these cells which defend the brain against infection and regulate proper connections between neurons could, in this over reactive state, lead to wrong connections and interactions between neurons which would be the beginning of the different symptoms of schizophrenia and some other psychiatric conditions. Corroborating this research are previous studies in which genomic analysis of patients with schizophrenia have shown abnormalities in the genes controlling their immune system. Scientists are now working towards carrying out trials that will use anti-inflammatory drugs to modulate the immune system in order to treat patients with schizophrenia and probably prevent it in those at high risk. 

In addition, other efforts are looking at diagnosing these psychiatric conditions at a very early stage so as to maximise the treatment options for the patients and reduce the effects of the illness on their functioning. One such endeavour is the CANTAB series of tests developed from the research works of Professors Barbara Sahakian and Trevor Robbins at the Cambridge University Behavioural and Clinical Neuroscience Institute and adapted for the Ipad as a touchscreen based neuropsychologic test. The CANTAB mobile software tests for episodic spatial memory (where we placed our stuff), the decline of which is one of the earliest pointers to dementia, a mental illness seen mostly in the elderly; the test takes about 10 minutes to complete, and it has been shown to reduce the time for diagnosis of dementia from 18 months to 3 months. 

And more recently, a virtual reality based test is gathering authenticity at providing clues to subtle characteristics in people at risk of developing Alzheimer disease decades before they develop it. The study carried out by German neuroscientists and published in the journal Science, involved individuals aged between 18 and 30 navigating through a virtual reality world with both their navigating accuracy and brain activities being monitored. Those with a genetic predisposition to having Alzheimer disease performed relatively differently compared with those who had no genetic predisposition, and there was also a reduction in function in their brain cells involved in spatial orientation. 

While these efforts are ongoing, I believe more are in the pipeline. And with rapid advances in technology, I envisage a time when there would be a computer model of the standard mind and its response to psychological stressors which will serve as a routine mind health checkup for everyone. This model will work by taking inputs such as every area of a person's genetic architecture involved in mental health, their family history and socioeconomic status; such a person will also be given a kind of a headband with sensors to wear and go about their daily activities. This headband will record how the person responds to different stressors that life events bring over a month, after which the data gathered will be used together with already input information to construct what I call a mind health profile/map of the person. With this mind health map, everyone will be empowered to proactively ensure healthy mind.