Mental disorders are a global problem and represent one of the biggest challenges for health care systems. In the world, there are some 500 million people suffering from mental disorders, and in the European Union, mental disorders range as one of the leading causes of disease burden. What makes the situation worse is that the prevalence of mental and neurological disorders is expected to grow for a variety of reasons: an ageing population will lead to an increased risk for age-related mental illness and neurological disorders, especially dementia and Parkinson´s disease. By 2040, Alzheimer´s disease will double in Western and triple in Eastern Europe (Jané-Llopis & Gabilondo, 2008). Furthermore, with increasing economic troubles, work-related psychosocial risk factors such as reduced job security, work intensification, and a poor work-life balance become more widespread, affecting both men and women.
Most European countries have recognised mental health as a priority area in recent years. The European College of Neuropsychopharmacology (ECNP), a scientific forum established in 1987, has set itself the task to bridge the gap between basic research and medical practice, paving the way for improved pharmacological treatments in mental disorders. With the 22nd ECNP Congress 2009 in Istanbul, the ECNP once again marks a contribution to meet the enormous burden and amount of suffering associated with mental disorders.
Fighting the burden of mental disorders
Our brain creates our life: perception, movement, thought and emotion, memories, speech and intelligence are features of this extraordinary and most complex organ. As a consequence, disorders of the brain deeply affect the life of people, and are associated with immense costs for health care systems.
Due to work-related stress and mental health problems, levels of absenteeism, unemployment and long-term disability claims are increasing. In many EU Member States they are the leading cause of sickness absence from work and permanent withdrawal from the labour market. Poor mental health can account for more than 40% of all long-term disability claims. Premature retirement on the grounds of poor mental health is also increasing (McDaid, 2008). In the EU, work-related costs due to mental health problems are more than 2.5 times greater than those associated with cardiovascular disease: The total costs of absenteeism and premature retirement due to mental health disorders in the EU-25 (plus Norway, Iceland and Switzerland) were €136.3 billion in 2007, including €99.3 billion for depression and anxiety-related disorders (McDaid, 2008).
Furthermore, mental disorders are common in older people and represent a barrier for active ageing (Jané-Llopis & Gabilondo, 2008): Poor physical health and functional limitations are central to the concerns of many older people and often intertwined with poor mental health. In the EU, 10% of those over 65 suffer from depression, and over 5 million people have dementia. The prevalence of Alzheimer´s disease is expected to rise dramatically with an ageing population. In addition, older people are the group with the highest suicide rates in Europe (18.75 per 100000).
Preventing and managing mental health problems and helping reintegrate people back into work through a range of medical and psychosocial measures is essential. Positive mental health is an integral part of the well-being of people, and mental disorder prevention and treatment have been shown to bring about health, social and economic development (Jané-Llopis et al., 2005).
New discoveries in brain research
Over the last years, our understanding of the brain has increased dramatically. Advances in brain imaging, the mapping of the brains´ biochemical circuitry and breakthroughs in molecular genetics have significantly enhanced the possibilities of the neurosciences. These advances have given physicians and scientists greater insight into the brain. Today neural activity in normal and pathological conditions can be monitored and measured through modern research methods. Imaging techniques have become extremely sensitive, including functional magnetic resonance imaging (fMRI), positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Contrary to previous concepts, recent research has proven that the adult brain is capable of generating new nerve cells (neurons), and that this process of ´neurogenesis´ can be influenced by positive and negative modulators - the study of which may stimulate the development of new treatments for a series of neuropsychiatric disorders like depression or Alzheimer´s disease (Sahay & Hen, 2007; Kuhn et al., 2007). Furthermore, genetic manipulation in animal studies has elucidated mechanisms involved in mental disorders. Breakthroughs in molecular genetics shed light on hereditary diseases, i.e. Huntington´s disease and other life-threatening disorders.
The interaction between nerve cells that underlies complex mental functions such as thinking, learning, memory or emotion is mediated by a large number of chemical neurotransmitters and neuromodulators. Disturbances in neurotransmitter function are seen as the main cause of mental and certain neurological disorders. The essential knowledge of central features of neurotransmission was first gained at the end of the 20th century. By mapping the networks of neurotransmission, scientists are looking for specially tailored therapies to influence various neurotransmitter systems. The discovery of specific receptors in the brain has led to the identification of endogenous chemicals playing a crucial role in various physiological systems. For instance, the discovery of endocannabinoids has been of central importance in establishing the existence of a new biochemical system involved in the protective reaction to a long list of neurological diseases such as multiple sclerosis, Alzheimer´s and Parkinson´s disease (Pachter et al., 2006).
In studying how the brain cells, neurotransmitters and neuropeptides interact and communicate with the rest of the body, researchers are working to develop improved treatments for people incapacitated by psychiatric and neurological disorders. The term used to summarise all of the biological sciences involved in understanding the brain, and how drugs can be made to affect it, is neuropsychopharmacology.
The detailed way fundamental processes of the brain have been discovered in the last years is showing great promise of yielding methods to treat and prevent disorders of the brain.
The role of neuropsychopharmacology
Neuropsychopharmacology, which developed out of previously isolated fields, bridges the gap between basic neurosciences and the treatment of neuropsychiatric diseases. It engages a broad range of professionals from psychiatrists and neurologists to researchers in brain imaging, genetics, molecular biology, chronobiology, neuroimmunology or neurochemistry. As an interdisciplinary science related to neurosciences and psychopharmacology (how drugs affect the mind), it includes research of neuropathology, pharmacodynamics (drug action), psychiatry and neurology. It also has an impact on emerging cross-disciplinary disciplines such as neuroethics, neuropedagogics, neurophilosophy or ´neurotheology´.
A central assumption in neuropsychopharmacology is that all states of mind as well as diseases involving mental or cognitive dysfunction have a neurochemical basis. Thus, the understanding of neurons in the brain is central to understanding the mind, and essential for the understanding and treatment of mental disorders. On a practical level, the goal of neuropsychopharmacology is to develop specific therapeutic agents to regulate the biological mechanisms of mental disorders, i.e. the neuronal interactions that give rise to these disorders. For this purpose, neuropsychopharmacology investigates the effect of drugs on the central nervous system (CNS) and their use in treating disorders such as anxiety, mania, depression, schizophrenia, dementia or neurological and addictive disorders in the most rational and empirical manner.
Neuropsychopharmacological research provides data that are required to develop drugs, which act on specific receptors within a neurotransmitter system. The pharmacological progress achieved in recent decades is mainly due to the development of receptor-specific drugs. For instance, the currently most commonly used antidepressant drugs, the SSRIs, selectively inhibit the transport of the neurotransmitter serotonin, prolonging its activity in the synapse between the nerve cells. In the next step, the development of receptor subtype-specific drugs is currently encouraged. So-called ´hyperselective´ drugs are thought to allow the direct targeting of specific sites of relevant neural activity, thereby maximising the efficacy of the drug within the clinical target and minimising adverse events. For instance, the signalling of serotonin is mediated by 14 receptor subtypes. As one of the main mediators of the neurotransmitter action the serotonin (1A) subtype is of particular interest, since evidence indicates that it is a target for novel therapeutic advances in several neuropsychiatric disorders (Ogren et al., 2008). Furthermore, cognitive and neural mechanisms involved in emotion processing can be manipulated pharmacologically, and research continues to identify novel targets for anxiolytic drugs (Garner et al., 2009).
New developments in neuropsychopharmacology may lead to targeted treatment options for a wide variety of mental disorders.
European College of Neuropsychopharmacology (ECNP)
The European College of Neuropsychopharmacology (ECNP) is a non-profit scientific society established in 1987 on the initiative of scientists and clinicians working in Europe in neuropsychopharmacology and related areas. ECNP serves as a unique and remarkably broad interdisciplinary platform, which strongly emphasises the complementary nature of research at the bench and at the bedside or clinic. This so-called ´translational research´ is target-oriented, promoting the development of diagnostic procedures and laboratory outcomes in the service of discoveries that will result in improved patient care (Zerhouni 2005).
To facilitate the flow of information among researchers and clinicians, ECNP has set up in recent years a number of activities stimulating cross-disciplinary forces - ranging from psychiatry to neurology, pharmacology and psychology - to carry out research on brain mechanisms and functions.
Recently the ECNP School of Neuropsychopharmacology has been established with the aim to teach junior clinicians high standard practice in neuropsychopharmacology and to involve them in the development of local good practice in teaching and training. The first ECNP School of Neuropsychopharmacology was held in Oxford, UK, from 5 July 2009.
ECNP is dedicated to the progressive integration of basic research, clinical neuroscience and medical practice, which can guide advances in neuropsychopharmacology and lead to a next generation of promising new treatments for mental disorders.
Highlights of the 22nd ECNP Congress 2009
From 12 September 2009, renowned experts from 25 countries will meet in Istanbul to present, discuss and evaluate the latest achievements and future perspectives in the fields of affective disorders, schizophrenia, drugs & addiction, brain plasticity, basic neuroscience and psychopharmacology. Great emphasis will be put on clear take-home messages that can easily be translated into clinical practice by medical professionals.
The scientific programme includes over 100 topics to be presented by more than 600 experts, and will comprise, among others, the following topics:
- The role of genetic factors in adult ADHD
- The future of schizophrenia
- Are the monoamines involved in shaping conduct disorder?
- Vaccination for Alzheimer´s disease in dementia
- Novel treatment for smoking
- Maternal serotonin
- Deep Brain Stimulation (DBS): new perspectives for treatment
- News on the NewMood project
Three poster sessions with in total more than 900 poster presentations from scientists from all over the world will offer an exciting insight into the research activities of (young) scientists.
Furthermore, ECNP is proud to present the report of the ECNP Consultation Meeting 2009 on 'Biomarkers and experimental medicine in developing new treatments in neuropsychopharmacology'. Through annual consultation meetings on specific topics, ECNP aims to facilitate the dialogue and exchange advice between the participating parties, i.e. scientists, regulatory authorities and the pharmaceutical industry.
The high-calibre and well-balanced programme of the 22nd ECNP Congress is dedicated to promoting the dissemination of new research findings and the exchange of ideas and information among clinicians and scientists in order to improve the situation of people struck by mental disorders.
References
- Garner M, Möhler H, Stein DJ, et al. Research in anxiety disorders: from the bench to the bedside. Eur Neuropsychopharmacol 2009;19(6):381-390
- Jané-Llopis E; Anderson P (Eds.) Mental health promotion and mental disorder prevention across European Member States. Luxembourg: European Communities, 2006
- Jané-Llopis E; Barry M, Patel V, Hosman C (Eds.). The evidence of mental health promotion: strategies for action. Promotion and Education, Supplement 2, 2005.
- Jané-Llopis E; Gabilondo A (Eds.). Mental Health in Older People. Consensus Paper. Luxembourg: European Communities, 2008
- Kuhn HG, Cooper-Kuhn CM, Boekhoorn K, Lucassen PJ. Changes in neurogenesis in dementia and Alzheimer mouse models: are they functionally relevant? Eur Arch Psychiatry Clin Neurosci 2007;257(5):281-289
- McDaid (Ed.). Mental Health in Workplace Settings. Consensus Paper. Luxembourg: European Communities, 2008
- Ogren SO, Eriksson TM, Elvander-Tottie E, et al. The role of 5-HT(1A) receptors in learning and memory. Behav Brain Res 2008;195(1):54-77
- Pachter P, Batkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev 2006;58:389-462
- Sahay A, Hen R. Adult hippocampal neurogenesis in depression. Nature Neuroscience 2007;10:1110-1115
- World Health Organization (WHO). Policies and practices for mental health in Europe - meeting the challenges. WHO Regional Office for Europe, Copenhagen, 2008
- Zerhouni EA. Translational and clinical science - time for a new vision. N Engl J Med 2005;33:1621-1623
Sonja Mak
European College of Neuropsychopharmacology