Mental illness: why we know so little #ahcj13

Kristin Gourlay

About Kristin Gourlay

Kristin Gourlay is a health journalist at Rhode Island Public Radio. She is attending Health Journalism 2013 on an AHCJ-Rhode Island Health Journalism Fellowship, which is supported by The Rhode Island Foundation.

Since the tragedy in Newtown, Conn., many of us have had to report on mental illness and found ourselves wrestling with what we know and, more often, don’t know about its causes and effects. Psychiatrists on AHCJ’s “Redefining Mental Disorders” panel on Friday pointed to reasons why we know so little. But they also shared signs of hope that better insights for doctors and patients lie ahead.

Diagnosis needs more precision

Part of what limits our ability to understand a psychiatric disorder – like schizophrenia, or autism – is the difficulty of diagnosis, says Paul Summergrad, M.D., who heads the Department of Psychiatry at Tufts University School of Medicine and Tufts Medical Center (and also is president-elect of the American Psychiatric Association). Doctors can identify the clinical signs of a disorder, but still know very little about the underlying cause, or pathophysiology. Plus, what’s “mental” about a mental illness isn’t always clear. Summergrad says more precise diagnoses might do more than help doctors find better treatments; they might help reporters combat stigma. He urges journalists to go beyond the recently released Associated Press guidelines for covering mental illness by identifying the specific disorder a person has.

Better treatment will require a better understanding of the brain

When it comes to treating psychiatric disorders, doctors are just as limited as they are diagnosing them, according to Bruce M. Cohen, M.D., Ph.D., who heads the Shervert Frazier Research Institute at the Harvard-affiliated McLean Hospital. Patients rarely achieve complete relief of their symptoms; the drugs in the current war chest often work slowly and have debilitating side effects. “We are particularly weak,” said Cohen, “in understanding and treating disorders in children and adolescents.”

But Cohen sees reason for hope: The understanding of the genetic background of several psychiatric disorders is evolving. Progress is slow because the brain is so complex. But the future could bring better brain imaging, the ability even to repair or replace some damaged brain cells or circuits, and perhaps more ways to identify people at risk and to prevent disease from developing.

Pharmaceutical industry has left the building

We might be making progress – and doing it faster and cheaper – on understanding the genetic contribution to psychiatric disease, but we still haven’t zeroed in on the precise molecules in the brain we could target with treatments, says Steven E. Hyman, M.D., who oversees the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard. And despite the fact that depressive and other mental disorders account for the top 10 causes of disability worldwide — a big market for new treatments —  the pharmaceutical industry has been exiting psychiatry because it’s too difficult to find the right “biomarkers” or targets for psychiatric therapies.

A few tips from the panelists:

  • Be cautious about simple explanations or promises of dramatic cures. Research progress is usually incremental.
  • Be skeptical about evidence from animal trials.
  • Consider the DSM V, the recently updated manual of psychiatric diagnoses, a conservative revision and imprecise document.
  • Watch the language you use to cover mental illness. Example: is someone “drugged” or “treated”?
  • Be aware that current screening tools cannot predict who will commit out-of-the-ordinary, violent acts, but most of those who committed such acts recently were known to be ill and didn’t get enough help.

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