Nair, A; Pariante, C; (2014) Neuroscience and mental illness. In: Davis, S and Mehta, N, (eds.) Annual Report of the Chief Medical Officer 2013: Public Mental Health Priorities: Investing in the Evidence. (pp. 59-71). Department of Health: London, UK.

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Abstract

In this chapter we discuss recent advances in our understanding of the biology of mental illness. Alongside important social and psychological factors, the biology of psychiatric disorders plays an important role in their development and prognosis. The inclusion of this chapter in this report reflects the need to widen public awareness of the quality and breadth of scientific work currently under way to help those suffering from mental illness. There is a stark mismatch between the funding for such research and the considerable cost of these disorders to our society, exacerbated by the recent disengagement of many pharmaceutical companies from research related to brain disorders. Translating the promising findings presented here into improved clinical care requires this mismatch to be addressed urgently. One way of doing this is by building bridges between the diverse fields involved in the common pursuit of the promotion of public mental health, which is one of the aims of this chapter. It would be impossible to summarise the entire field of biological psychiatry for such a chapter. Instead, we have adopted a ‘horizon-scanning’ approach to demonstrate the variety of techniques used in this area, and to highlight a few examples that are more likely to have a rapid impact on patients’ care. The chapter is divided, by technique, into sections covering neuroimaging, neuropsychology, genetics, blood-based biomarkers and animal and cellular models of disease. Some of the work presented here is already available clinically, such as the genetic analysis in autism. Other work could have widespread clinical utility within the next 10 years, especially in the area of ‘personalised’ treatment – identifying a priori the best treatment for the individual patient. However, translating this neuroscience research into better patient care requires sustained support of experimental medicine and clinical trials. It is our hope that this chapter demonstrates how biological research may aid diagnosis, risk stratification and the development of novel medications for the treatment of mental illnesses. Rather than distancing psychiatry from important psychological and social factors, much of modern biological research is aimed at understanding how these factors interact to produce disease states. Biological advances are likely to play a valuable part in the holistic management of patients. We write this chapter to advocate that the biomedical and psychosocial models of mental illness are not antithetical, but are in fact increasingly conceptualised within a single unifying framework. While most of the important factors determining the risk and course of mental illnesses can be measured in a clinical interview, rather than in a laboratory, neuroscience research offers the exciting opportunity to understand the mechanisms by which these factors affect their clinical action. Unfortunately, at a public health level it appears that, while a biological model of mental illness enhances the acceptance of treatment, it does not seem to be associated with a reduction in stigma among the general population. Our understanding of the biological correlates of mental health and illness is growing exponentially. As showcased in this chapter, we are beginning to see how this understanding could be developed to improve the medical care patients with mental illness receive, and to widen our understanding of mental illness as a truly bio-psycho-social construct.

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