Latest achievements in brain research and treatment for mental disorders

Aug. 28-Sept. 1, 2010, Amsterdam, the Netherlands

Mental disorders, such as depression, anxiety disorders, addiction and schizophrenia are the core challenge of most health care systems around the world. In the EU alone, each year 27% of the total adult population - this corresponds to 83 Million citizens - suffer from mental disorders. Depression alone affects almost 20 million ranking in the EU as the most disabling disorder of all diseases. Unless appropriately treated, mental disorders are typically associated with a wide range of complications and sequelae for the subjects affected, their partners and families as well as society as a whole, and they can be lethal. Suicide - a frequent complication of depression and other mental disorders - is a major cause of premature death in Europe with over 160.000 completed suicides every year; rates of attempted suicides are at least 10 times higher. Nevertheless - despite the tremendous suffering and burden of mental disorder and the fact that mental disorders are treatable - the majority of persons with mental disorders in the EU remain untreated.

The EU over the past three years has recognized with increasing emphasis the urgent need to change this, calling for concerted mental health action on all levels: science and research, improved public health and outreach activities and improved policies in its member states. The 2008 'European Pact for Mental Health and Well-being' reflects the EU's strong commitment for this mission, highlighting that mental health and well-being in the population is a key resource for the success of the EU as a knowledge-based society and economy. Confronting the high and increasing prevalence of mental disorders and their currently deficient care in many areas, health care systems and schemes are encouraged to act, striving for improved early recognition and diagnosis and ensuring the provision of adequate and state of the art treatment and comprehensive rehabilitation programmes for all.

Mental disorders are "complex disorders of the brain", bound to the way we perceive, think, feel and behave. Understanding such brain dysfunctions in mental disorders is of core relevance for their prevention and their treatment. The interdisciplinary field of neuropsychopharmacology links the core disciplines of neuroscience, psychology and pharmacology and is devoted to this aim. It covers basic and clinical neuroscience from the molecule to system approaches over the establishment of improved diagnostic and treatment standards to fostering their implementation in the health care system for patients with neurological and mental disorders. The European College of Neuropsychopharmacology (ECNP) is Europe's largest and most comprehensive interdisciplinary forum in this field, dedicated to translating new knowledge on fundamental disease mechanisms into clinical practice, paving the way for improved pharmacological and non drug treatments for the prevention and treatment of all mental disorders and disorders of the brain in general.

The 23rd ECNP Congress 2010 in Amsterdam is Europe's leading and largest scientific meeting on mental health in Europe, providing insight into the latest achievements in brain research and treatment, providing a unique and stimulating forum for scientists and clinicians in the mental health field.

Mental health: an ever-changing challenge

Mental disorders cause immense suffering for individuals, families and communities, and represent over all and by far the leading cause of disability-associated burden in the EU of all diseases. Across the EU, pressure is being put on the health, the social welfare and the educational systems as well as the labour market, employers and economy in general. Due to the financial and economic crisis, the situation since 2008 has aggravated and poses even more and new challenges to these systems.

In its communication 'Driving European recovery', the European Commission highlights the need of supporting the EU population through the crisis and of reducing its human cost. A key aspect in this context is to minimise its harmful impact on mental health, which is based on a complex interaction between neuropsychopharmacological and psychosocial factors. The crisis is not only believed to have a harmful effect on the provision of the already deficient health care system, but is also believed to be associated with a deterioration of several socio-economic determinants of mental health and well-being. While protective psychosocial factors, such as a stable professional and social life, get weakened, risks increase: impaired social contacts due to unemployment, social isolation, financial hardship, lack of personal recognition, fear and uncertainty about the future, etc. The European Union, therefore, has identified specific challenges and called for action in five priority areas: prevention of depression and suicide, mental health in youth and education, mental health in older people, mental health in workplace settings, and combating stigma and social exclusion.

The human brain, the most complex structure ever investigated by science, is the basis of our behaviour, mental functions and inner life. Over the past decades, new techniques of investigation of brain structure and function have become available, allowing further penetration of the mysteries of human feelings, thoughts, and emotions, and consequently even human values, relationships, and belief. Today scientists are truly beginning to learn about the structure and function of the human brain, which is physically shaped by contributions from our genes as well as from our experience. This understanding strengthens the view that mental disorders are both caused and can be treated by biological and experiential processes, working together. As the breathtaking progress in modern neuropsychopharmacology begins to integrate knowledge from biological as well as behavioural sciences, a fundamental realisation is taking place that treatment of mental disorders works - whether in the form of a somatic intervention such as a medication, or a psychosocial intervention such as psychotherapy - by actually changing the brain.

In recent decades, a wealth of information has become available about brain function and dysfunction in neuropsychiatric disorders. As a consequence, many people have benefited from treatments that have arisen from our understanding of how the brain works and how it may be disordered in neuropsychiatric illnesses.

Neuropsychopharmacology: a comprehensive, interdisciplinary approach

Neuropsychopharmacology is the trans-disciplinary field of science that is of core relevance for examining and understanding how the brain works and functions. As such it includes many disciplines: the neurosciences (e.g. molecular biology, genetics, chronobiology, neuroimmunology, brain imaging), the psychological sciences (e.g. cognition, emotion, behaviour and environmental interactions), psychopharmacology (neurochemistry, pharmacodynamics and drug action), and the respective applied clinical fields (psychiatry, psychotherapy, clinical psychology and neurology.

The goal of neuropsychopharmacology is to understand (1) how the brain works and functions and how and why it may get dysfunctional promoting disorders of the brain. (2) Moreover it is the field that allows the derivation of effective pharmacological interventions, to treat and to prevent mental disorders. This implies to develop specific therapeutic agents to regulate the neurobiological mechanisms of mental disorders, understanding the causes of mental disorders and the investigation of the effect of drugs on the central nervous system (CNS), respectively their use in treating disorders such as anxiety, mania, depression, schizophrenia, dementia, addictive and neurological disorders in the most rational and empirical manner.

Clinical advances: from molecules to effective treatments

The pharmacological progress achieved in recent decades is based on fundamental biochemical and physiological discoveries, translated into clinical practice through randomised, double-blind and placebo-controlled drug studies.

Progress in neuropsychopharmacology has contributed in a crucial way to the fundamental transformation of our mental health systems, allowing in particular patients with severe mental disorders such as psychotic disorders and schizophrenia as well as recurrent and chronic depression to avoid long-term hospitalization and disability and to live and function independently in the community. So-called atypical antipsychotics were the outcome of a search for efficacious drugs for psychotic disorders showing a better tolerability profile than conventional neuroleptics, especially with regard to limiting motor side effects such as tardive dyskinesia improving significantly the prognosis and quality of life of patients affected. Similarly, the introduction of new antidepressants, including the generations of new selective serotonin reuptake inhibitors (SSRIs) that have fewer adverse effects and pose less danger in overdose than older agents, have improved dramatically the situation and prognosis of patients with anxiety and depressive disorders allowing the majority of patients to live without significant impairment and disability.

However, research in neuropsychopharmacology has also informed exciting non-pharmacological developments. One example are chronotherapeutics, which comprise direct manipulations of sleep (e.g. wake therapies) as well as controlled exposure to environmental cues (e.g. light therapy) in order to achieve therapeutic effects in patients with mental disorders. Normalisation of circadian rhythms by chronotherapeutics represents a promising new direction in the search for novel non-pharmacological and pharmacological treatments that might avoid the limitations of current drug treatments in this field. Benefits through chronotherapeutic applications have been achieved for a broad range of patients with depression, bipolar disorder, seasonal affective disorder (SAD), premenstrual dysphoric disorder, bulimia nervosa, attention-deficit/hyperactivity disorder (ADHD), dementia, Parkinson-s disease, and shift and jet lag disturbances.

Another example is the identification of areas in the central nervous system that correlate with pathological mood states, suggesting targets for novel therapeutic interventions. Through modern imaging techniques including functional magnetic resonance imaging (fMRI), positron emission tomography (PET) and single-photon emission computed tomography (SPECT) neuronal activity in psychiatric conditions can be monitored and measured. Modern imaging studies of the brain circuitry underlying normal and pathological behaviours may contribute to a better understanding of the neural basis of mental disorders and identify novel targets for pharmacological treatment. Brain imaging has revealed a breakdown in normal patterns of emotional processing that impairs the ability to suppress negative emotional states. Mood disturbances thus may reflect the exaggeration of emotional responses or abnormalities in emotional processing. Recent findings have identified an extended neural network during self-referential processing in the brain, contributing to the exploration of the concrete neural bases of the depressive self. Imaging researchers are also studying depression-related circuits to see how they may arise from genetic variations known to put people at risk for depression. Imaging genetics is a novel research strategy that attempts to identify gene effects with regard to the brain and has provided significant contributions to the understanding of the complex impact of hereditary factors on psychiatric illness.

Clinical advances based on neuropsychopharmacological research are enabling people struck with mental disorders to make the way from isolation back to social reintegration.

Neuropsychopharmacology: mental disorders and beyond

In recent years, neuropsychopharmacology has expanded its interdisciplinary focus, and dialogues with other medical fields such as internal medicine have been initiated. The interaction between mental disorders and somatic disease is explored thoroughly, and the role of mental disorders in increasing vulnerability to physical morbidity and poorer outcomes is well documented. Mental disorders are frequently associated with metabolic disorders and cardiovascular disease, with evidence for reciprocal pathways and interactions. For example, chronic depression increases the risk for diabetes; conversely, in adult diabetics depression is much more frequent compared to metabolically healthy subjects. Furthermore, research has shown links between depression and anxiety, and cardiovascular and cerebrovascular diseases. The influence of specific psychiatric disorders in contributing to adverse cardiac disease trajectories and death has been established, and depression has been identified as a risk factor for the development and progression of coronary artery disease.

In addition, the risk for metabolic syndrome in patients with schizophrenia and mood disorders is increased compared to the general population. Even the single components of the metabolic syndrome (overweight, hypertension, hyperlipidemia) are significantly more frequent in schizophrenia and mood disorders. Whether these metabolic and cardiovascular conditions are primarily due to the illness or secondarily induced by psychopharmacological treatment is subject to current research. Since metabolic and cardiovascular risk in long-term psychopharmacological treatment has been evaluated extensively, cardio-metabolic risk factors in patients with severe mental illness, especially when treated with antipsychotic agents, are now much better recognised, and efforts to ensure improved physical health screening and prevention are becoming established.

Psychopharmacologic approaches have increasingly expanded the boundaries to treat numerous other disorders not traditionally part of practice including obesity, hypoactive sexual desire disorder, fibromyalgia, perimenopausal vasomotor symptoms, numerous dementias, pain management, and even gambling. Increasing evidence for the intrinsic analgesic effect of antidepressants and the antidepressant efficacy of neurological treatments in patients with Morbus Parkinson has opened up the way to new treatments. In the future, neuropsychopharmacologic approaches will have to increasingly deal also with non-pharmacologic devices, including not only classical electroconvulsive therapy but also vagus nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation.

Neuropsychopharmacology is a dynamic field that is continuously expanding the boundaries of research and practice. New developments in neuropsychopharmacology are improving the interdisciplinary health care and patient management.

European College of Neuropsychopharmacology (ECNP)

The European College of Neuropsychopharmacology (ECNP) is Europe's largest and leading forum for the exchange and dissemination of interdisciplinary research on the brain and brain dysfunction. ECNP is an independent scientific association founded in 1987 by European scientists and clinicians working in neuropsychopharmacology and related disciplines to encourage innovative research across the neurosciences and to translate new knowledge on fundamental disease mechanisms into clinical applications.

ECNP serves as a uniquely 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.

To achieve its objectives, ECNP has established a number of activities and programmes stimulating interdisciplinary forces designed to promote the communication and cross-fertilisation of research results and ideas in the field of neuropsychopharmacology. These include the ECNP Congresses, the largest high-level scientific meeting on neuropsychopharmacology and mental disorders in Europe, Regional Meetings, Seminars and Consultation Meetings, as well as activities for young scientists. The scientific journal of ECNP, European Neuropsychopharmacology (ENP), publishes original findings from basic and clinical research. Recently the ECNP School of Neuropsychopharmacology has been established with the aim of teaching junior clinicians high-standard practice in neuropsychopharmacology and to involve them in the development of local good practice in teaching and training. The second ECNP School of Neuropsychopharmacology has been held in Oxford, UK, from 11 to16 July 2010.

Through all its activities, ECNP aims to increase the understanding of brain disorders, helping to pave the way to improved treatments, and to promote the development of common standards in Europe.

Highlights of the 23rd ECNP Congress 2010

From 28 August to 1 September 2010, renowned experts and 7,000 anticipated participants will meet in Amsterdam to present, discuss and evaluate the latest achievements and future perspectives in the fields of schizophrenia, depression, bipolar disorder, drugs and addiction, Alzheimer-s disease, chronopsychiatry, eating disorders, autism spectrum disorders, as well as basic and clinical 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 more than 35 sessions to be presented by more than 150 speakers from 20 countries, and will comprise, among others, the following topics:

• The neural basis of the depressive self
• Gene-environment interactions in psychosis
• Circadian rhythms: their role and dysfunction in affective disorder
• Predictors of relapse in alcohol dependence
• Avenues to novel antipsychotics: moving to exploratory strategies
• Fear memory and extinction: options for new treatments
• Stress and affective disorders
• Neuroprotective therapies: common potential targets in multiple sclerosis, stroke and neurodegenerative disease

The educational update sessions at the ECNP Congress will deal with the neurobiology and neuropharmacology of compulsivity in addictive behaviour, pain and neuropsychopharmacology, the placebo in psychiatry, neurostimulation techniques in mood disorders, metabolic and cardiovascular risks in the long-term psychopharmacological treatment of patients with psychiatric disorders, as well as psychiatric symptoms and their treatment in neurological disorders. Three poster sessions with in total more than 750 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 results of the ECNP Consultation Meeting 2010 on -The future of the placebo in clinical trials in brain diseases-. Through annual Consultation Meetings on specific topics, ECNP aims to facilitate the dialogue and exchange of advice between the participating parties, i.e. scientists, regulatory authorities and the pharmaceutical industry.

Invitation: meet the scientists!

Experts will be available for questions by journalists in the course of press conferences at the 23rd ECNP Congress. Please refer to the detailed schedule of press conferences in the enclosed -press information and procedures-.

The 23rd ECNP Congress will once again present a high-calibre and balanced scientific programme, in which the latest achievements and future perspectives in neuropsychopharmacology and related disciplines of virtually all disorders of the brain are discussed, including the various aspects of pharmacotherapy in order to improve the life of patients with psychiatric and neurological disorders.