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"Just four days ago my wife and I attended the graduation of our son, Gary, who is now 36, from a local community college," said Willick. Gary received an associate's degree and will attend a local college to complete his B.A. But 18 years ago, Willick recalled, he and his wife had attended their son's high school graduation in far different circumstances.
"At that time he was one of the top three students in his class, scored 1500 on his SAT's, and was accepted by Harvard. He had a steady girlfriend, played on the high school tennis team, and was an accomplished jazz drummer. The intervening 18 years have been--as they are for so many families--like a nightmare for us. Gary dropped out of Harvard, has had three hospitalizations, and had to suffer the effects of being the less than 1 percent of patients [with schizophrenia] who develop agranulocytosis on clozapine" (see "Dreams for the Future").
Willick said he spoke "for all families, parents, siblings, children, people with mental illness, in thanking [NARSAD President] Connie Lieber and thanking NARSAD for the enormous job that they have done in raising funds and giving grants" to young as well as established researchers.
Because of NARSAD, the prognosis for anyone who has a first episode of psychosis today is much better than that for someone who became ill a decade ago, said Willick.
Despite the progress and awareness that schizophrenia is a brain disease, those with the disease, and their family members, still struggle with feelings of shame, Willick said. "For example, in order to visit Gary during one of his hospital stays, I had to shout out to a clerk sitting behind a glass partition my name and his name. Many people were standing around. If I, who certainly should know that this is an organic illness, could experience a feeling of shame, imagine what it is like for the average family who has so little knowledge about schizophrenia. And each time I visited Gary in the hospital, I thought to myself, Gary should be the psychiatric resident here, not the patient."
Floyd Bloom, M.D., who chairs the department of neuropharmacology at the Scripps Research Institute in La Jolla, Calif., discussed breakthroughs in neuroscience involving genes and neurotransmitters. "We already know about 100 different molecules that can serve as neurotransmitters in the brain. Every one of them is a candidate substance or a combination of substances for having either deficiencies or excesses as part of the responsibility for setting mental disorders," he noted.
Neuropeptides are "the way in which the brain controls the master gland of the body, the pituitary gland, and ultimately gives us the molecular clues by which events in the world around us, producing stress, allow the body to adapt to that stress," he noted. It is through further breakthroughs in the understanding of such brain chemicals and processes that better pharmacological treatments will be developed, said Bloom.
Neuroscience provides tremendous "opportunities for mental health research," remarked Judith Rapoport, M.D., director of the child psychiatry branch at NIMH. Basic science and neuroscience are increasingly merging, she observed.
"The combination of imaging and molecular genetics makes the interface no longer even an interface; the barrier is now completely permeable, in neuroscience terms. And the sort of thing that happens, for example, is that the people in my group working on hyperactive children follow the circuitry of attention and impulse control very carefully in the primate and the rodent literature."
Another development, previously impossible, is the capacity to study normal brain development in children through neuroimaging. "We are now following a group of 200 children, knowing curves of development for every part of the brain anatomy, and the results have been fascinating," said Rapoport.
John Kane, M.D., chair of the department of psychiatry at Long Island Jewish Hillside Medical Center, said there are many issues impacting clinical research related to managed care, capitation, and the delivery of health care in the United States.
"And that has lots of implications for research. The ability to help support young investigators through a transitional stage in developing clinical research careers, in this context, is obviously very, very important," he asserted.
The funding provided by NARSAD has made a tremendous difference in treatment research on schizophrenia and clinical psychopharmacology, and such funding is even more important in the current economic environment, he observed.
"We're beginning to see the evolution of a new generation of antipsychotic drugs, some of which were developed as a result of basic strategies in the neurosciences, as opposed to many of the earlier medications that we had, which were much more serendipitous in terms of how we came to identify their clinical effects. We're now in a position to develop medications with a much more targeted and rational strategy, looking at receptor effects, looking at gene regulation and so forth. This is still quite complex, and it doesn't mean we're going to have totally innovative treatments tomorrow."
One struggle for clinicians is the need to do research with extant drugs, balancing that research against the insights that may be achieved in the near future through research with new treatments, said Kane. "And we have to do both of those simultaneously, which is very important."
Steven Hyman, M.D., director of the National Institute of Mental Health, gave an overview of neuroscience and the culture of research.
Elucidating the complex genetics of mental disorders will require a broad, interdisciplinary effort, said Hyman. "We will need clinicians expert in phenotype. We will need statistical geneticists. We will need molecular biologists, molecular geneticists, all working together. Indeed, we will need teams of these people willing to collaborate and share data in a way that will give us statistical power to find vulnerability genes."
The new technologies in neuroimaging are "tantalizingly at our fingertips but not quite jelled yet," observed Hyman. Exploiting these technologies will require an interaction between clinicians who understand clinical syndromes, neuroanatomists, and patients willing to participate in neuroimaging trials.
"We need to enlist these people, the anatomists, the cognitive neuroscientists, along with the clinicians, if we are really going to tap the potential of these marvelous technologies and not let the potential slip away," said Hyman. "This requires young minds, new investigators, hopefully who are trained in part in basic science labs."
In particular, said Hyman, NARSAD should be lauded for "efforts to help early and mid-career investigators--literally the forgotten souls in all of this, but the people who are most productive and in some ways are the most valuable mentors for the young people who are at the cutting edges."
The forum was chaired by Herbert Pardes, M.D., who chairs NARSAD's Scientific Council, with help from Constance Lieber, NARSAD's president, and Harold Pincus, M.D., director of APA's Office of Research.
(Psychiatric News, July 4, 1997)