Mental Illness – One Treatment to Cure Them All, One Network to Bind Them?by Carla Clark, PhD | February 20, 2016
Imagine: A cure all for ALL mental illnesses… sounds illogical, perhaps impossible, something straight out of fantasy, no? Well, at the SharpBrains Virtual Summit, Monitoring & Enhancing Brain Health in the Pervasive Neuroscience Era, where presenting cutting-edge innovative research was the norm, I was lucky to be witness to a truly tantalizing talk by psychologist Dr. Madeleine Goodkind that will likely change your perspective.
“One treatment to cure them all, one technique to find them, one network to bring them all and in the heterogenity bind them.”
The current problem with finding a treatment that works for everyone is that each person’s presentation of mental illnesses is different, no one’s full set of symptoms and experiences are the same. And neither are their responses to treatment. This is something that Dr Goodkind is well aware of in her work treating veterans with post-traumatic stress disorder (PTSD):
“With the 20 different symptoms of PTSD that we have, there are in fact over 600,000 different combinations that would all yield a diagnosis of PTSD, and this level of heterogeneity is in fact quite common in psychiatric diagnosis.”
As Dr. Goodkind explains, even within one mental illness, there are vastly diverse combinations of symptoms and responses to treatment, as well as comorbity (i.e. shared symptoms) with many other disorders. Basically, it’s not clear cut, and neither is treatment success!
So instead of focusing on symptoms, Dr. Goodkind and coworkers looked to the source of the river and asked:
“…can we cut across psychiatric diagnosis and identify brain areas implicated in mental illnesses that could be a target for future treatments?”
To investigate, the researchers identified 193 studies that included over 15,000 healthy controls and patients with either major depressive disorder, bipolar disorder, schizophrenia and substance abuse disorders, as well as obsessive compulsive disorder, PTSD, and other anxiety disorders such as phobias.
They specifically used voxel-based morphology studies, a standardised statistical fMRI approach to identify differences in brain anatomy between groups of people. The method involves breaking the entire brain into three dimensional units of space called voxels, allowing the comparing of these digitized brain bits across patients in a study.
The result? They identified:
“…three regions of the brain that commonly have decreased volumes across psychiatric illnesses, the left and right bilateral anterior insula, and the dorsal anterior cingulate cortex.”
They then looked at how these three regions function when healthy controls perform regular simple tasks, or when they are at rest in the fMRI and letting their minds wander. They found that these same three regions co-activate both when at rest and on task.
Outside of the brain scanner, they performed tests on participants to test their degree of cognitive functions, such as tests of memory, sustained attention and executive functioning, to see if there was any relationship between the size of these three brain structures and cognitive function. The results revealed that when these structures where smaller in volume this correlated with poorer performance on cognitive tests, yet test scores where better when the sizes of these three structures were larger.
Together the brain areas in question are part of a coherent network called the salience network. Salience network activity is associated with many processes required for healthy mental functioning such as detecting, integrating, and filtering irrelevant information, concentrating in the face of distractions, multitasking, planning, decision making and inhibiting impulses.
In fact, the insula has been described as the anatomical substrate in humans for awareness of themselves, others and the environment, with all of the structures being involved in self-awareness, interoception and emotional processing. It is no wonder that these three areas are the common neurobiological substrate for all of the mental illnesses assessed in the study!
So in Dr. Goodkind’s talk, did she suggest that we simply throw personalized symptom-based treatment to the wind? Did she simply design and test some kind of brain training treatment that enhances neuronal growth in these three areas and taa daa the world is cured of mental illness? While the realistic implications of her research are not so fantastical, they are just as profound:
“Can we do some cognitive, brain motivated training [or repetitive transcranial magnetic stimulation etc.] that can help patients with executive functioning and emotional regulation before they go into some treatment, because I think that the treatments that are symptom specific are important, but there are underlying brain deficits that may be present that we can address first to make treatment more effective.”
Or as Alvaro Fernandez, the CEO of SharpBrains mentioned at the summit, there could be phenomenal implications for improving the functioning of these three areas at the school level, helping prevent potential psychiatric problems before they even get given the opportunity to present themselves.
Thankfully, we may not have to wait too long to get a clearer idea of where this revolutionary research is taking us. Dr. Goodkind is continuing research into the cognitive training domain as we speak, and other researchers on the team, like Dr. Amit Etkin, are hunting out new ways to identify commonalities in the brain across psychiatric diagnosis…watch this space!
Goodkind, M., Eickhoff, S., Oathes, D., Jiang, Y., Chang, A., Jones-Hagata, L., Ortega, B., Zaiko, Y., Roach, E., Korgaonkar, M., Grieve, S., Galatzer-Levy, I., Fox, P., & Etkin, A. (2015). Identification of a Common Neurobiological Substrate for Mental Illness JAMA Psychiatry, 72 (4) DOI: 10.1001/jamapsychiatry.2014.2206
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