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Basic Science in Psychiatry

Independent of the billions and billions of dollars that mental illness costs our society is the devastation of the quality of life. It is impossible to imagine the quality of life if you were to lose control of your thoughts, feelings, perceptions, and, indeed, your behavior. During the next decade, a major goal of neuroscience research, perhaps the ultimate goal, is to understand how the brain produces representations of the world and to develop a much more sophisticated understanding of how these mechanisms can malfunction to cause mental illness. The different types of neuroscience research from the very basic research on topics such as the molecular basis of brain development, or the genetic basis of behavior in very simple organisms, such as flies and worms, to more clinically relevant neuroscience research, have something very important to tell and will further the understanding of what goes wrong in the brain causing mental illness. It is very difficult to predict which specific area of research eventually is going to have the greatest impact on our ability to diagnose and treat mental illness. Nevertheless, there have been many exciting findings over this decade that had significant impact on clinical psychiatry. Two specific research areas warrant highlighting. They are examples of the types of advances that have had a major impact on clinical psychiatry and, in the future, will have an even greater impact. The first is the use of human brain imaging techniques. Although the advances in human brain imaging techniques are just beginning to be applied in clinical psychiatry, it is clear that they have the potential to revolutionize our diagnosis, prevention, and treatment of these devastating disorders. For example, the basal brain activity pattern is dramatically different in patients who are depressed compared with control subjects. Various subtypes of depression appear different, as well. The pattern of brain activity in people who have been diagnosed with unipolar depression is different from that of those with bipolar depression. Why is this distinction important? It is potentially important because looking at these images—looking directly at brain activity—may help predict the best treatment for these different subtypes of patients. Simply talking to patients is not sufficient to differentiate the subtypes of depression reliably because the symptoms are similar. Changes in brain activity following treatment for a major psychiatric disorder are not limited to pharmacological treatment. It has been shown that behavioral or psychological treatment can impact abnormal brain activity in highly specific ways, for example, the brain of a patient who has obsessive–compulsive disorder. Following about 10 weeks of behavioral treatment, which significantly decreased the severity of the patient’s symptoms, the abnormal hyperactivity in a specific brain region, known as the caudate nucleus, is significantly decreased. Thus, imaging studies have shown that behavioral and psychological treatment as well as medication can profoundly impact specific brain regions. Although much research remains to be done, imaging techniques may help physicians eventually tailor treatment to the specific pattern of brain activity in an individual patient. They may also help physicians monitor progress of the treatment, in just the way that cardiologists use an electrocardiogram, ECG, to diagnose and monitor the progress of heart disease. In addition, and perhaps of equal importance, imaging techniques, along with molecular genetic studies, may help researchers identify children and adolescents who are more prone to develop specific mental illnesses. This will facilitate early intervention, which will prevent the devastating consequences of these mental illnesses when they become apparent in adulthood. Imaging techniques have provided firm scientific evidence for what many neuroscientists and psychiatrists believed, but previously could not prove, namely, that both medication and behavior therapy impact the brain. They affect abnormal brain activity Neurobiology of Disease 7, 537–539 (2000) doi:10.1006/nbdi.2000.0349, available online at http://www.idealibrary.com on