Mental illness and what causes it

One out of four people affected:

By Omar RAJARATHNAM

Mental illness is arguably one of the biggest challenges facing a country's health system. Not only is it invisibly prevalent in patients but the degree of illness varies from one patient to another, some patients simply overlook it and struggle to get on with life. Is ignorance still the biggest issue surrounding mental health illness?

No, says The Director of the National council for Mental Health (NCMH) Sahanaya and Consultant Psychologist Dr Nirosha Mendis. Unlike before, mental health patients have sufficient avenues of help now and plenty of patients make use of it. Stigma and ignorance are history.

The logical criteria for stigma attached to mental health is that the condition has to be rare, but when according to statistics however close to one third of the population suffers from it and therefore holding a stigma against mental health becomes baseless. The only factor that makes it seem overlooked is that those who approach us do not talk about it and truly they do not have to, he said.

NCMH Sahanaya has a day treatment centre at 92/26, Kithulwatta Road, Colombo 8 and another residential treatment centre in Gorakana, Panadura. The facility offers three types of services, counselling, rehabilitation and training.

According to Dr Mendis, the past five years have marked a drastic change in the trend of mental illness. Sales agents or those who have target oriented jobs especially in the private sector suffer from psychiatric pathologies. Not only in mental health but general health depends on the balance between the mind and body.

The mind can be relaxed by a recreation and the body through healthy diet and exercise.

When a job deprives you of that, it is obvious that your mental health is disrupted.

Failed foreign employment also contributes to the high number of mental illnesses in this country he said.

Dr Mendis added that schoolchildren contribute to this trend too. Short temper, memory issues, decline in academic performance is widely found in children nowadays.

Concerned parents refer children to psychologists and they are treated and then assisted to cope with their daily pressure. Unlike in the developed world, our patients expect solutions from a counsellor, they are not satisfied with being given tools to find their own solutions, so we accommodate solutions to the treatment he said.

Dementia is one of the highest contributors to mental illness in Sri Lanka, said Dr Mendis. Over five percent of the 65-year-old and over 20 percent of the 80 year old suffer from Dementia. Vascular Dementia, a condition where blood flow clogs certain parts of the brain creating dead cells around them is now widely found too.

Schoolchildren who are the country's future, suffer from mental illnesses, the working population who are part of the country's economy suffer from mental illness and then the elderly population where all the wisdom lies are also affected by mental illnesses. So therapy and treatment is vital for us to protect all these age groups and have a mentally healthy country, he said.

Alcohol and smoking has a direct impact on mental illnesses too said Dr Mendis. 60 percent of those who consume alcohol show signs of clinical depression and substance abuse through the use of cannabis and cocaine is causing grave concern to the mental health of people too, he said.

Apart from this rates of depression have increased and so has the rate of suicide.

It is proved that over 90 percent of those who take their own lives suffer from acute depression. Educating people on preventing substance abuse and increasing awareness of its adversities must be given constant importance, he said.

Unless in some rare cases, most of unexplained physical illnesses are related to an underlying mental illness. Depression is capable of shutting one's whole immune system down if untreated. Feeling a lack of energy, sustained depressed moods, loss of appetite, sexual dysfunction, weight loss, insomnia (sleep disorders) and digestive issues are symptoms of depression.

In some cases cancer has a direct impact with untreated mental illness too. Some patients develop depression as a result of suffering from another disease. Fifty percent of stroke patients suffer from depression as they recover from their temporary immobility or restricted mobility.

Thyroid patients, ulcer patients, hyper and hypoglycaemic patients are prone to develop depression during recovery stages too, he said.

Dr Mendis also added that dengue which is posing a threat in the country again, viral flues and chikungunya can make one fall prey to depression. Although it may never be thought that such a thing will take place, Dr Mendis added that Oral hygiene is very important for mental health because it helps develop confidence and that is why NCMH - Sahanaya has a mobile dental clinic to check the oral health of inmates.

Trips, music, soft skills development is all part of the facilities we offer here, he said.

With the exception of a genetic condition, good mental health means maintaining a lifestyle that helps blood circulate freely to all parts of the body and getting this step right can prevent many of us from developing a mental illness, he said.

Improving understanding of alcohol's damaging effects on the brain

While alcohol has a wide range of pharmacological effects on the body, the brain is a primary target. However, the molecular mechanisms by which alcohol alters neuronal activity in the brain are poorly understood. Participants in a symposium at the June 2010 annual meeting of a Research Society on Alcoholism addressed recent findings concerning the interactions of alcohol with prototype brain proteins thought to underlie alcohol actions in the brain.

Proceedings will be published in the September 2011 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Alcohol is the most common drug in the world, has been used by diverse human communities longer than recorded history, yet our understanding of its effects on the brain is limited when compared to other drugs," said Rebecca J. Howard, a postdoctoral fellow at The University of Texas.

Howard explained that neuroscientists have discovered how marijuana, cocaine, and heroin each bind to a special type of protein on the surface of brain cells, fitting like a key into a lock to change that protein's normal function. Yet alcohol has special properties that make it difficult to characterize its lock-and-key binding in detail, for example, alcohol is much smaller than other drugs, and appears to interact with several different types of proteins.

"The adverse effects of alcohol abuse are devastating on a personal level and on a societal level," added Gregg Homanics, a professor of anaesthesiology and pharmacology & chemical biology at the University of Pittsburgh. "Alcohol abuse costs our society more than the costs of all illegal drug abuse combined. For many years, most investigators thought that alcohol exerted nonspecific effects on the brain and simply perturbed neuronal function by dissolving in the membranes of nerve cells. However, our understanding of alcohol action has dramatically shifted in the last 10 to 15 years or so. There is now solid experimental evidence that alcohol binds in a very specific manner to key protein targets in the brain to cause the drug's well-known behavioral effects. This review summarizes some of the most recent research."

Some of the key points were:

* Combining X-ray crystallography, structural modelling, and site-directed mutagenesis may be better suited to studying alcohol's low-affinity interactions than traditional techniques such as radioligand binding or spectroscopy.

"One major problem in studying alcohol binding to brain proteins is that the alcohol key does not fit very tightly into any particular protein lock," said Howard. "That is, alcohol has a 'low affinity' for proteins, compared to how other drugs interact with their own protein targets. We think this is one reason it takes such a large quantity of alcohol to affect the brain: whereas users of cocaine or heroin may consume just a few milligrams at a time, a person drinking a shot of strong liquor consumes about 1,000 times that much alcohol (several grams). The low affinity of alcohol for its protein targets [also] makes it difficult to study by traditional methods that rely on detecting stable drug-protein complexes over a long period of time." * Some common themes are beginning to emerge from a review of diverse proteins such as inwardly rectifying potassium, transient receptor potential, and neurotransmitter-gated on channels, as well as protein kinase C epsilon.

"It is now very clear that hydrophobic pockets exist in the structure of various brain proteins and alcohols can enter those pockets," said Homanics. "Alcohols interact with specific amino acids that line those pockets in a very specific manner." * In particular, evidence is emerging that supports characteristic, discrete alcohol binding sites on protein targets.

"Different drugs bind to different types of proteins on the surface of brain cells, each fitting like a key, or drug, into a lock, or binding site, on a protein to change its normal function," explained Howard.

"Understanding the exact shape of that lock and key helps us understand how individuals with special mutations may be affected differently by drugs, and can help scientists design new medicines to help people with drug abuse or other problems."

"I feel that there is now overwhelming evidence that specific alcohol binding sites exist on a variety of brain protein targets," added Homanics.

"This is significant because we can now focus on defining these sites in greater detail, ultimately at the level of each atom involved. This will allow for, one, a more complete understanding of the molecular pharmacology of alcohol action, two, the discovery of similar sites on other important brain proteins, and three, the rational design of drugs that can selectively target these binding sites."

"Our review summarizes very recent advances in understanding the molecular details of alcohol binding sites, which now include human brain targets, not just metabolic enzymes and receptors from other species," said Howard.

"This information will give researchers new opportunities to characterize human mutations and design new medicines. Furthermore, common themes emerging about alcohol binding sites may help scientists identify important binding sites in other important brain proteins."

"In other words," said Homanics, "alcohol exerts its effects via binding sites on target molecules just like all other drugs we know about.

There is now solid evidence from several different putative alcohol targets using several different techniques that alcohol interacts with specific brain targets in a highly selective manner.

This is particularly important for more senior clinicians and researchers that were trained years ago when the predominant theory of alcohol action was via nonspecific effects on the nervous system." Both Howard and Homanics are hopeful that this research will aid the development of therapies and treatments for individuals with alcohol problems.

"Great progress is being made in understanding how alcohol exerts its effects on the brain at the molecular level," noted Homanics.

"Understanding how alcohol affects brain proteins on a molecular level is essential if we are to effectively develop rational treatments to combat alcohol use disorders."

Source: The University of Texas at Austin Gregg Homanics, University of Pittsburgh

Using olive oil may prevent stroke

A new study suggests that consuming olive oil may help prevent a stroke in older people. The research is published in the June 15, 2011, online issue of the medical journal Neurology.

"Our research suggests that a new set of dietary recommendations should be issued to prevent stroke in people 65 and older," said study author Cecilia Samieri. "Stroke is so common in older people and olive oil would be an inexpensive and easy way to help prevent it."

For the study, researchers looked at the medical records of 7,625 people ages 65 and older from three cities in France: Bordeaux, Dijon and Montpellier. Participants had no history of stroke. Olive oil consumption was categorized as "no use," "moderate use" such as using olive oil in cooking or as dressing or with bread, and "intensive use," which included using olive oil for both cooking and as dressing or with bread. Samieri said the study participants mainly used extra virgin olive oil, as that is 98 percent of what is available in France.

After a little over five years, there were 148 strokes.

After considering diet, physical activity, body mass index and other risk factors for stroke, the study found that those who regularly used olive oil for both cooking and as dressing had a 41 percent lower risk of stroke compared to those who never used olive oil in their diet (1.5 percent in six years compared to 2.6 percent).

Olive oil has been associated with potentially protective effects against many cardiovascular risk factors, such as diabetes, high blood pressure, high cholesterol and obesity. In an accompanying editorial, Nikolaos Scarmeas, MD, of Columbia University noted that it is not clear which particular elements of olive oil could be protective, while the effects of olive oil could even be indirect by making other healthy foods tastier. He also cautioned that only future clinical trials can increase confidence in the findings and potentially lead to stroke prevention recommendations.

Source: American Academy of Neurology (AAN)

 Non-invasive brain stimulation helps curb impulsivity

Inhibitory control can be boosted with a mild form of brain stimulation, according to a study published in the June 2011 issue of Neuroimage, Elsevier's Journal of Brain Function. The study's findings indicate that non-invasive intervention can greatly improve patients' inhibitory control. The study demonstrates that when a weak electrical current is applied over the front of participants' scalps for ten minutes, it greatly improved their ability to process responses effectively jumpstarting the brain's ability to control impulsivity. The treatment has the potential to serve as a non invasive treatment for patients with conditions such as attention-deficit, hyperactivity disorder (ADHD), Tourette's syndrome, drug addictions, or violent impulsivity.

Professor Chi-Hung Juan who led the research team noted, "The findings that electrical stimulation to the brain can improve control of their behavioral urges not only provide further understanding of the neural basis of inhibitory control but also suggest a possible therapeutic intervention method for clinical populations, such as those with drug addictions or ADHD, in the future".

Sources: Elsevier, AlphaGalileo Foundation

Researchers show reducing ability of the ageing brain

Researchers have published new data on why the ageing brain is less resilient and less capable of learning from life experiences. The findings provide further insight into the cognitive decline associated with aging and neurodegenerative diseases like Alzheimer's. The study is published in the May 25 issue of the Journal of Neuroscience.

The Mount Sinai team evaluated the prefrontal cortex the part of the brain that controls a wide range of cognitive processes and mediates the highest levels of learning. Nerve cell circuitry in the prefrontal cortex of young animals is highly plastic, and life experiences, particularly those that involve learning, can profoundly alter prefrontal circuitry.

For example, stress causes nerve cells to shrink and lose synapses the sites of communication between nerve cells in this brain area of young animals and the nerve cells recover once the stress ends.

In order to investigate the effects of age on such plasticity, young, middle-aged, and aged rats were subjected to a behavioral stress test known to elicit nerve cell changes in the prefrontal cortex.

The research team then used microscopic techniques to visualize the spines on nerve cells within the prefrontal cortex. Spines are specializations on nerve cells that form the synapses that are critically important to the process of learning.

In the young rats, the spines were able to adjust and change, indicating that the brain responded to the experience and initiated a compensatory change. In the middle-aged rats, and even more so in the aged rats, the spines did not change, demonstrating that age is accompanied by a profound loss in the capacity of prefrontal cortex to "re-wire" in response to life events.

"We suspected that these nerve cells would be altered by age, but the loss of synaptic plasticity in the context of life experience has profound implications for age-related cognitive decline," said John H. Morrison, PhD.

"This study identifies precisely the synaptic basis for age-related loss of experience-dependent plasticity, which is likely required for adaptive learning."

This study was supported by the National Institute of Mental Health and the National Institute of Aging.

(Source: Mount Sinai Medical Centre)