Mental health breakthroughs in 2010

Thomas Insel, Director of NIMH, who I have mentioned in a previous post, has listed his top 10 research events and advances of 2010 on his blog. I'm not quite as convinced as he is that these represent advances for psychiatry and I think we do need to question whether we are really getting value for money from NIMH (see previous post).

Insel concentrates on genetic research. I'm not saying this research doesn't need to be done, but would question its value for psychiatry. For example, whole genome sequencing has demonstrated the surprising number of variants in normals - as he says each child shows "50 – 100 new mutations not present in his or her parents". But it's speculation to correlate rare “structural” variations in the genome with autism, schizophrenia and other neurodevelopmental disorders. Parental imprinting is an interesting phenomenon and we need to understand it further, but it's unlikely to change the way we approach mental disorders. Epigenomics does need to be developed as a basic science but it's unlikely to provide us with a new way of understanding mental illness.

I don't think funding for genetic research should be obtained on the back of what is provided for psychiatry. Nor can I see induced pluripotent stem cells (iPSCs) cell technology, despite its interest and potential, contributing to psychiatry. Similarly, the Human Connectome Project may well produce basic scientific advances in the understanding of patterns of brain-function connections. It's the belief that this will uncover abnormal brain circuits that worries me. HIV/AIDS is also an important condition for research but so-called potential progress in its prevention isn't really going to help psychiatry. There was a thought that we could all take medication to prevent us developing mental illness, but this seems to have dropped off the horizon for the moment. I think we should also be sceptical about the value of expensive antiretroviral chemoprophylaxis for HIV/AIDS - shouldn't we be spending money more on prevention through condoms?

I'm not exactly sure why pharmaceutical companies have moved away from the development of psychiatric medication. Insel makes out that there are various basic science developments that they could pursue. In terms of the basic science hypotheses, I think the ones he mentions are just as likely to end up on the failed heap of neurobiological hypotheses of the basis of mental illness. Nor have we really made the advances this year in the understanding of the autistic brain that he implies. And surely it's scraping the barrel to screen for chemicals capable of enhancing neurone formation in the hippocampus of adult mice to develop them as antidepressants.

I hadn't realised that Nature had produced a whole issue on schizophrenia this year, which Insel classes as one of the events for psychiatry of 2010. I'll have to look at it further.