That makes neuropsychiatry a terribly borderline discipline, which has to know about phenomena that are between the physiological and the psychological and that deals with reactions as different as a change in mood, a loss of memory, a psychotic break or a malformation disabling congenital.
Just a century ago – in some areas of the world, not even that long – that high percentage of people suffering from mental illnesses were considered victims of a more spiritual than physical evil. Little by little, medicine has been laying the foundations for a physical understanding of evil. It was first by searching for anatomical peculiarities of diseased brains; then tracking the presence or absence of humors, biochemicals or substances in the body that cause evil. Finally, with the advent of genetics, the scrutiny of medicine focused on the discovery of hereditary traits and genes involved in the production or inhibition of symptoms.
As the “madman” comes to be considered sick, the foundations of evil become more physical and less spiritual.
But, in what phase of the process are we? At present, although there is strong evidence in favor of genetic susceptibility to mental disorder, it has not been possible to identify any gene that causes , by itself, any specific disease. This is probably due to the fact that environmental factors also play an important role in the development of the disease.
In any case, that does not rule out the possibility of investigating genetic causes. Recently, researchers have identified a gene related to Huntington’s disease, a disease that causes serious physical and mental disorders. Evil is transmitted by what are known as simple Mendelian models; that is, a child can receive the dominant or recessor gene that causes the disease transmitted by one of their parents.
The problem is that most mental illnesses do not respond to this transmission pattern. Rather, they involve several genes that increase or decrease susceptibility. The more genes involved in the process, the more difficult it is to tackle the problem of the biological bases of a disorder and, therefore, of its possible pharmacogenomic treatment.
To top it all, in the case of behavioral evils, the environment, education, exposure to very high emotional thresholds … they can complicate matters by becoming triggers or inhibitors of the outbreak of evil.
One of the challenges of recent neuropsychiatry is to refine the tools used to unravel the biological factors involved in “diseases of the soul.” In this sense, genetic screening is playing a role as crucial today as that played by advances in neuroimaging technologies during the 80s and 90s. Thanks to new scanners, tomographs and CTs, not only the structural modifications of the brain of many patients, but how these affected neuronal function. Thus, it was possible to establish physiological patterns typical of some manias, some forms of schizophrenia, certain modes of obsessive-compulsive syndrome or autism. Neurobiology was for years a fertile ground for pure neurophysiology.
But times have changed and, especially with the advance in the knowledge of the Human Genome, the anatomical study has given way to the molecular study. Today, the tools most used to unravel the origin of mental disorders are increasingly fine-tuned genomic map designs. It is known that, although the genome of all human beings is 99.99% identical, small variations in that one hundredth of a percentage point are responsible for the great individual diversity, for the plurality of physical and temperamental traits and, therefore, Of course, the susceptibility to suffering from syndromes. Genetic predisposition to evil occurs when a particular gene “makes a mistake” when transferring information to carry out a specific instruction. Comparing the genetic maps of mentally healthy people with those corresponding to those suffering from schizophrenia, clinical depression, bipolar affective disorder or obsessive-compulsive syndrome, for example, the researchers hope to find small variations in a gene that are repeated, only, in the affected population.
The next step would be to design strategies to repair this gene or, more simply, drugs that inhibit its action or that enhance that of other suppressor genes.
One of the tricks that is used for this purpose is the identification of families of individuals in which there are higher rates of disease than normal. Afterwards, specific sections of their DNA known as markers are isolated and it is studied how they are present in individuals suffering from a certain disease.
The discovery of genes specifically related to a mental disorder opens up great possibilities for the diagnosis and cure of said disorder. For example, the genetic approach allows discovering subcategories of the same disease that the doctor is unable to detect with simple clinical practice and that require different treatments. It is even possible to carry out preventive screenings that allow the patient and their families to prepare themselves medically, emotionally and financially for the ravages of, for example, a psychotic outbreak, even before the first irreparable symptoms appear.
But, as the genomic future makes its way, medicine continues to rely on the great discoveries that neuro-psychiatrists have made about the anatomy of the deranged mind. Knowing how today we know the normal functioning of neuronal connections and the influence of the synaptic relationship in the appearance of certain disorders, it has been possible to develop a varied pharmacopoeia that allows action in different phases of the synapse and improves therapeutic efficacy.
A very obvious example is that of the new antidepressants . There are molecules that intervene in the presynaptic phase, such as the so-called tricyclic antidepressants. Others are involved in the postsynaptic cell, such as dopamine receptor blockers that have antipsychotic effects. Both are the result of scientific efforts to understand the biological sources of mental illness. Both, like all current and future treatments, shed hope for those affected and would have been impossible to imagine in a world that would have continued to regard insanity as a mere dysfunction of the soul.
Six diseases cornered by the new psychiatry
Among the vast array of mental disorders, some have become the workhorses of modern psychiatry. The scientific resources available to experts provide hope for their future control.
DEPRESSION
Depression is the disease of the soul par excellence. It is manifested by an extremely negative feeling towards the self and a host of thoughts of self-censorship. In Spain, this disease affects between 2 and 3 percent of the population, which is a much lower rate than in other neighboring countries. Although the manifestations of the disorder are fundamentally psychological, the hope of neuropsychiatry is to definitively find the biological roots of its origin or, at least, of the degree to which it is expressed in each patient.
The search for biological markers would favor the finding of more effective treatments and the design of preventive strategies. In the case of clinical depressions, this search focuses on the discovery of the neurochemical bases of the disease and on the detection of “dysregulations” in the neurotransmitter or neuro-receptor function of certain substances.
A second line of work is dedicated to the identification of genetic bases of the state of mind. In this sense, the finding of the involvement of a gene, DEP1, in the development of the disease in more than 400 families in Utah with histories of high incidence of depression is of great value.
BIPOLAR AFFECTIVE DISORDER
Nowadays, the name of bipolar affective disorder is grouped together with the set of pathological symptoms that were previously known as manic-depressive psychosis. It is a disease of mainly endogenous origin characterized by the succession of periods of mania (euphoria, irritability, reckless behavior) and depression in the patient. In recent years, not only has a flow of psychiatric attention to this disease been created, but considerable progress has been made in understanding its etiology. Most studies agree that this is a polygenetic disease in which alterations in several chromosomes are involved. It is also known that there is a certain relationship between some structural lesions in the basotemporal region, the parathalamic structures and the temporal lobe, and the appearance of manic symptoms. Finally, the presence of biochemical alterations in the levels of certain cholinergic neurotransmitters and increases in synaptic norepinephrine among people suffering from this disease is known.
All this makes bipolar disorder an ideal disease to be attacked from the point of view of neurobiology, contrary to what happens with other disorders with major environmental components. However, the presence of environmental factors that collaborate as triggers for the outbreak of the disease or as modulators of its symptoms is known. At times of seasonal change, bipolars are at higher risk of relapse. Likewise, a high degree of emotional tension or a sudden psychological change (job loss, moving …) can favor the emergence of evil. The biological basis of the disorder favors that it can be treated with a very varied battery of drugs that ranges from mood stabilizers to antipsychotics and have different degrees of therapeutic efficacy.
AUTISM
Not long ago, neurologists and psychiatrists have known that the roots of autism are biological and incurable. However, science is advancing by leaps and bounds to ensure that people who suffer from this disease can lead a life adapted to the social behavior of those around them. Actually autism cannot be considered a disease as such but rather an alteration in the development of brain functions.
Just because autism is a biologically based disorder does not mean that its causes are easy to identify. Researchers have been discovering some genetic peculiarities as well as the presence of certain viruses or specific physiological characteristics in the neurological structure that are directly related to the phenomenon.
It has also been possible to discard some falsehoods of the past such as the mistaken idea that some childhood vaccines caused the appearance of autism.
One of the lines of action that have advanced the most in recent years is the tracking of genetic variabilities linked to the disorder. Specifically, related genes have been detected on chromosomes 2, 3, 7, 15 and on the sex chromosome X. In fact, the data point to the existence of genes that increase susceptibility to suffering from the disease. There is currently no cure for autism. The therapies used are aimed at improving the quality of life of the patient and remedying specific symptoms. They include medical interventions and behavior modification therapies.
OBSESSIVE COMPULSIVE
Obsessive-compulsive disorder is a disease that manifests itself with the recurrent presence of unwanted intrusive ideas in an obsessive way and accompanied by repetitive behaviors. The age of onset is usually between 13 and 15 years in men and 20 and 24 years in women and is expressed in extreme phobic attitudes such as desire to wash hands constantly, fear of knocking on doors … The main problem for the Diagnosis of the disease is that, in its early stages, the patient is usually not aware that he is sick. In fact, on average, 17 years pass from the appearance of the first symptom until the first therapeutic measures are taken with the individual in question.
Although the triggering factor is usually environmental and implicated genes have not been detected, it is possible to establish some biological variables such as certain alterations in brain structure and the presence of immunological markers of streptococcal infection. Modern treatments use serotonin reuptake inhibitors as the drug of choice.
POSTTRAUMATIC STRESS
Sometimes, when an individual suffers a traumatic experience such as an accident, a rape, a kidnapping, a war … they run the risk of being affected by a mental disorder about which more and more data is becoming known: the stress syndrome post-traumatic. The patient is subjected to a constant repetition of the episode suffered, with a memory so vivid and realistic that it makes it impossible for him to lead a normal life. Often, it is accompanied by the presence of unpleasant somatic symptoms when passing through the scene or a sensation that mimics the events or a phenomenon of avoidance of everything that can be related to the origin of the trauma is perceived.
It is evident that it is a disease of exogenous origin and, as such, the search for its biological roots is meaningless beyond the mere inquiry into the greater vulnerability of some individuals than others. The treatments are very varied and usually combine psychotherapeutic strategies with pharmacology. Among the former, since 1989 eye movement desensitization therapy, which is still highly controversial, has gained interest. Among the latter, monoamine oxidase inhibitors, tricyclic antidepressants, serotonin reuptake inhibitors and benzodiazepines stand out, although these should be used with caution.
EATING DISORDERS
From the confusion and dramatic lack of information with which eating disorders were faced a few decades ago, we have moved to a scientific state of knowledge that allows us to know the etiological bases, the consequences and the best therapeutic tools in the face of such devastating diseases like anorexia or bulimia. This type of disorder has, in part, a biological origin since temperament has a certain relationship with genes, although it is remote. Some personality types are more likely than others to suffer from anorexia, for example. It has also been discovered that, once the individual stops eating, the neurochemical alterations that occur in their body accelerate the progress of the disease. But there is no doubt that the fundamental basis of this group of disorders is not genetic or physiological, but psychological and, to a certain extent, socio-familial. The latest therapeutic advances have improved the strategies of hospitalization, weight recovery, antidepressant medication, social and family support, and reintegration into the habit of eating habitually.
