From The Quarterly, Fall 2010
A major focus in current biomedical research, including mental illness research, is the search to understand the disrupted genetic mechanisms that underlie pathogenic processes.
One of the puzzles about schizophrenia genetics is that the genes that predispose to the illness are believed to affect early brain development, but symptoms that are strong enough to diagnose usually don’t manifest until adolescence or early adulthood. What has been learned is that treatment at this initial stage is effective, with good prospects for recovery. For those untreated at an early stage, on the other hand, there is a lifelong threat of recurrence, and as the illness wears on, there tends to be an increase in the degree of psychosis and of cognitive impairments and difficulty in functioning socially and/or vocationally.
The goal of early treatment is to prevent progressive loss of gray matter in the brain, composed of neuronal cells. Antipsychotic drugs have become a mainstay of treatment. Clozapine, developed by NARSAD Scientific Council member and Distinguished Investigator Herbert Meltzer, M.D., and introduced in 1989, is the most effective, but it has adverse side effects. This and other drugs in the class of “atypical antipsychotics” suppress psychotic symptoms, and prevent relapses and loss of gray matter, but they don’t work for everyone. They don’t alleviate cognitive and functional impairments and they can’t regenerate already lost gray matter.
What is being learned through research currently underway to develop better medications is that there probably will not be one single magic bullet, but multiple medications that work on different targets. Prominent among these targets likely will be the protein products of the genes identified as being associated with vulnerability to schizophrenia. What would make treatment more efficient and safer — ideally, treatment administered at early signs of risk before full-blown symptoms erupt — would be a reliable diagnostic test. The current lack of diagnostic criteria to identify people who are at risk is a huge limitation. A number of diagnostic measures currently in development look very promising. One developed at Columbia University by Scott Schobel, M.D., and Scott Small, M.D., and supported by NARSAD, uses magnetic resonance imaging (MRI) to identify mild cognitive impairment by examining the degree of metabolic activity in the hippocampus, the brain’s major seat of learning and memory.
Jeffrey A. Lieberman, M.D.
NARSAD Scientific Council Member
Lawrence C. Kolb Professor
Chairman, Department of Psychiatry
Lieber Professor of Schizophrenia Research
Director, New York State Psychiatric Institute
Psychiatrist-in-Chief, Columbia University Medical Center,
New York-Presbyterian Hospital
In partnership with Columbia University, New York State Psychiatric Institute, Hellman Auditorium
HEALTHY MINDS ACROSS AMERICA
Discovery to Recovery through Science
More than 40 institutions across the United States and Canada partnered with NARSAD in presenting its “Healthy Minds Across America” series of public talks. Each event helped to bring science to families seeking hope for better treatments of a broad range of mental illnesses.