A system to improve mental health disorder diagnoses

Researchers are developing a method that integrates advances in genetics, neurosciences and behavioral sciences to increase the understanding of the causes of disorders such as depression, schizophrenia and bipolar disorder.

By Elton Alisson

Agência FAPESP – Researchers linked to the National Institute of Mental Health (NIHM) in the United States are developing a new system of diagnosis for mental disorders such as depression, schizophrenia and bipolar disorder. The most recent version of the system was presented by Bruce Cuthbert, director of the Adult Translational Research and Treatment Development (DATR), during the São Paulo School of Advanced Sciences for Prevention of Mental Disorders (Y Mind).

Sponsored by Universidade Federal de São Paulo (Unifesp), in partnership with Universidade de São Paulo (USP), Universidade Federal do Rio Grande do Sul (UFRGS), Columbia University (United States) and King’s College (England), the event organized under the auspices of FAPESP’s São Paulo School of Advanced Sciences Program was held from March 25 to 29 on the campus of Unifesp in São Paulo. Of 270 applicants, 102 graduate and post-graduate students were chosen to participate in the school. Some 25 of those chosen were from São Paulo state; 27 were from other Brazilian states; and 50 were from abroad (from 25 countries).

The diagnosis of mental disorders is currently conducted based on clinical observations of a set of signs and symptoms presented by patients in a given period. According to Cuthbert, although useful and broadly disseminated by medical, legal and social services, the system is outdated because it was developed in a time when knowledge of genetics, neuroscience and human behavioral sciences was limited. “We must integrate genetics, neurobiology and environmental and other fundamental components to develop reliable and valid measures of mental disorders that can be utilized in basic and clinical studies to clarify the causes,” he said.

In its 2008 strategic plan, the NIHM established the goal of developing new ways of classifying mental disorders based on dimensions of observable behavior and neurobiological measures.

Since then, researchers at NIHM have been dedicated to identifying and incorporating recent discoveries on genetic, neurobiological and behavioral components that can be present in several types of mental disorders in their research, with a view to improving the diagnosis and treatment of patients.

“A mental disturbance has many mechanisms, and each mechanism covers many types of disorders,” affirmed Cuthbert. “We have to shift from the traditional perspective of clinical phenomenology – based on aspects of cognition, emotion, mind and brain – to a behavioral approach based on the analysis of major brain circuits,” he added.

According to Cuthbert, no one is currently exploring approaches based on brain circuitry for the development of relevant diagnoses and treatments that can indicate the classification and measurement of mental disorders.

In an attempt to close this gap, the new method, known as the NIHM Research Domain Criteria Project (RDoc), will include an analysis of the brain circuits of patients as one of the units of study for the diagnosis and measurement of the level of mental disorder.

“Analysis of the brain circuits of patients with mental disorders can provide pathways for physiopathology [studies of the mechanisms and causes that lead to the appearance of a disease]. Mental diseases are now being studied specifically as a disturbance of brain circuits,” said Cuthbert. In addition to brain circuits, other candidates for NIHM’s new model of classification for mental disturbances are genes, molecules, cells, physiology, behavior and personal interviews, (including information about symptoms)”.

Cuthbert explains that the studies have proven that certain genetic variations can increase the risk of developing a mental disturbance. Additionally, environmental influences and experiences, such as traumatic stress, can interact with specific genetic variations during sensitive periods of human development.

“The complex interaction between genetics, environment, experiences and development can worsen the risk of mental disturbances, changing the structure and function of relevant neural pathways for some forms of adaptive behavior,” he said.

The challenge, however, is to show how interactions between genes, environment, experience and the trajectory of personal development contribute to the formation and functions of brain circuits. Very little is known, for example, about the information stored in neural circuits.

Focus on youth

In the assessment of Professor Jair de Jesus Mari of Unifesp’s Psychiatry Department, one of the coordinators of Y Mind, the new system of diagnosis of mental disorders in development at NIHM should especially contribute to the early diagnosis of mental diseases that emerge in adolescence, when the human brain is reorganizing itself. Because of this, according to Jesus Mari, the prevention of mental disorders in Brazil should be focused on youth, as is the case in other countries.

“Studies conducted in Brazil and abroad indicate that if we can interfere earlier in this group of the population, during the critical phase of development in which mental disorders emerge, it will be possible to reduce the incidence of serious mental disturbances, delaying the onset or at least reducing the damage as the disease progresses. For this reason, we want to develop a mental health model that prioritizes adolescents” commented Jesus Mari.

Brazilian researchers intend to replicate an experiment conducted in countries such as Australia. Australia implemented mental disorder prevention centers for youth. These centers, called Headspace Centers, were designed to help diagnose adolescents that present with, or are exposed to risk factors that potentially lead to the development of, addictions, depressive states and serious mental disorders, such as schizophrenia and bipolar disorder.

Another project that can be implemented in Brazil, according to Jesus Mari, is the development of a curriculum on mental health for youth, following Canada’s example.

The researchers plan to create a youth center that offers socio-educational activities (such as reading clubs, theater, music and sport) and concentrates on several mental health prevention actions. “The idea is that we conduct and articulate action with the school, health authorities and families of these youths,” explained Jesus Mari.