Sunday, October 10, 2010

Brain plasticity and the future of treating mental illness

I have been hearing about brain plasticity from many different sources.  Most recently, I watched the Nature of Things - Changing Your Mind, which was very interesting and worth watching if you get a chance.  The basic message I have been hearing from articles, TV shows, and expert speakers is the same - that our brains are incredibly changeable, both for good and for bad.  Scientists are just starting to learn how to harness this power, and I think it has incredible potential to change the way we address psychiatric disabilities, and huge potential to improve people's quality of life.

When I went to University (which does not seem all that long ago), we were taught that new neurons in the brain could not be formed, but the pathways between them could be strengthened.  Now, there seems to be a lot of research that has shown that new neurons are indeed formed, and there are many different factors that contribute to their health and the networks that are formed.

For serious and persistent mental illnesses, cognition is a huge determinant of functional outcome.  Research has even suggested that it is an even more powerful determinant of independent living than positive or negative symptoms.  In general, medications seem to work fairly well on positive symptoms, a little on negative symptoms, and not well on cognition.  Yet scientists are starting to use computer programs to target areas commmonly impaired by mental illness, and finding that significant improvements can be made in these areas.  Will this translate to improved ability to live independently?  I'm not sure a computer program will be enough, but I do think it is a good start.

It seems to make sense - a "use it or lose it" philosophy.  An enriched environment will help our brains to work better, and an impoverished environment will cause our brains to not work as well.  OT's have talked about the importance of meaningful occupations for a long time, which is an extension of this way of thinking.  If a person keeps his or her brain engaged in stimulating activities that are rewarding, positive neural connections will be formed.  If we allow ourselves to dwell on negative thought patterns, these are the pathways that will be reinforced.  Many of our current forms of therapy address this e.g. Cognitive Behaviour Therapy and Mindfulness.

So, the researchers are finding that enriched environments help improve brain health, and prevent future decline (e.g. dementia).  What else tends to be helpful?  I have heard several different ideas, including supplements.  However, the one other thing that I have heard consistently is exercise.  Apparently, it increases you blood levels of a brain fertilizer substance.  It also has many other positive side effects including better sleep, better mood, weight control, etc.  Yet another reason for me to get up off the couch!

So what does this mean for the future treatment of mental illness?  I see that at some point, people will receive not only a medication prescription (and possibly a prescription for some supplements), but also a prescription for a cognitive remediation program, and hopefully an exercise program.  New cognitive remediation programs will have to be created, as there seem to be very few of them now.  There is currently a serious lack of support for people wanting to start an exercise program.  I think the process of getting from here to where the evidence is suggesting we should go will be incredibly frustrating and slow due to the lack of pharmaceutical company funding.

Somehow, this makes me want to go do a few Sodoku puzzles...

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