Progress remains limited
Everything we know about mental illness, from diagnosis to treatment, begins with a symptom-based checklist.
Imagine being diagnosed with cancer based on an interview examination, then being told there is no test to confirm the diagnosis nor to determine which treatment approach is optimal for you.
Despite the magnitude and growing recognition of the global impact of mental illness, the prevention, diagnosis and treatment of mental disorders has made limited progress in the last decade.
The problem with symptom-based diagnosis
Notwithstanding significant improvements in drug therapies and the promises inherent in genomic research, there have been few revolutionary advancements in the treatment and management of mental illnesses since the development of psychopharmacological treatments in the 1950s. The mental health field remains a subjective science: mental disorders are still diagnosed through symptom-based check lists.1 Although there have been thousands of studies looking for illness-specific biological markers, none has proven clinically actionable.2 Thus, there are no biological (blood, salvia, etc.) or genetic tests nor MRI scans that can confirm a diagnosis. Diagnostic manuals list some 300 to 400 mental disorders. Symptomatic of the subjective nature of diagnosis, this list grows or contracts with each new edition. Symptom-based diagnosis also creates potential for diagnostic error and delays in identifying an appropriate treatment approach.
Treatment, a game of trial & error
There is still no cure, although, there are effective psychiatric medications and therapies to manage the symptoms. Finding the right treatment assumes a correct initial diagnosis and the availability of an ‘effective treatment’: a relative term meaning a treatment outperformed a placebo by a significant margin in some, but not all, study participants. Thus, effectiveness is dependent on finding the right therapy or the right medication and dosage, if one exists, and can take months to years of trial and error.
Prevention, early intervention is key
Most mental illnesses and some physical illnesses that manifest across the lift spectrum right into old age are now being linked through epigenetic research to prenatal and early childhood experiences.3 However, we are only beginning to understand the impact of environmental factors such as stress, nutrition, poverty, etc. Investment in research on normal brain development and a better understanding of epigenetic factors that manifest in mental illnesses could eventually lead to interventions that significantly reduced exposure to risk factors.
Research, hampered by symptom-based diagnosis
Currently, because the brain remains a black hole -relatively unmapped- the primary approach to mental illness research begins with symptom-based diagnoses, which is problematic. In a given study, how do we know if (1) the control groups is really representative of ‘normal’ brain development and (2) the subject-participants, responders and non-responders alike, really had the mental illness being studied? How do we know if illnesses such as bipolar disorder and schizophrenia, which share some genetic similarities,4 are really two separate illnesses and not just part of a spectrum?5 Or conversely, like breast cancer or lung cancer, further break down in numerous subcategories.6 These are crucial questions pertinent to the development and testing of psychotic medications and other treatment approaches, as well as to the identification of prevention strategies.
What is normal or abnormal brain development?
Despite numerous advancement, we still do not have a clear physiological picture of what constitutes normal or abnormal brain development. New technologies, such as those being developed by the Ludmer Centre, will enable us to better map the brain, identify biomarkers, and deconstruct symptom-based categories of mental disorders.
- Girard, John Strategic Data-Based Wisdom in the Big Data Era, Suzanne Roff-Wexler, Chapter 6: On the Road to Ephesus, IGI Global, Feb 28, 2015,p 103
- Tomas Insel, New scientist, 19 August 2015, Psychiatry is reinventing itself thanks to advances in biology: https://www.newscientist.com/article/mg22730353-000-psychiatry-is-reinventing-itself-thanks-to-advances-in-biology/
- Government of Canada (2006). The human face of mental health and mental illness in Canada.
- W Differences in Resting-State Functional Magnetic Resonance Imaging Functional Network Connectivity Between Schizophrenia and Psychotic Bipolar Probands and Their Unaffected First-Degree Relatives
Meda, Shashwath A. et al. Biological Psychiatry, Volume 71, Issue 10, 881-889.
- Möller HJ. Bipolar disorder and schizophrenia: distinct illnesses or a continuum? J Clin Psychiatry. 2003;64 Suppl 6:23-7; discussion 28.
- Tomas Insel, New scientist, 19 August 2015, Psychiatry is reinventing itself thanks to advances in biology: https://www.newscientist.com/article/mg22730353-000-psychiatry-is-reinventing-itself-thanks-to-advances-in-biology