"New drugs for Alzheimer's disease eliminate the cause of pathology"
Effective antibody-based drugs for dementia have already been registered and are used in the United States, but they need to be used in the early stages of the disease, so the introduction of drugs will require changes in the entire system of care for the elderly. On World Alzheimer's Day, Olga Karpenko, chief researcher at the Department of External Scientific Relations at the Alekseev Psychiatric Hospital, told Izvestia about the most advanced methods of treating pathology, as well as how new heroes, artificial intelligence and computer games affect the human psyche.
"Medicines for Alzheimer's disease that eliminate the cause of pathology"
— On September 21, World Alzheimer's Day is celebrated all over the world. This pathology remained incurable for a long time. However, technology is evolving. What successes have been achieved in this area?
— There are new drugs for Alzheimer's disease that eliminate the cause of the pathology. But for their implementation, the healthcare system itself will have to be rebuilt. These are antibody-based drugs that remove amyloid plaques. They are effective for the prevention of the disease in the early stages, have already been registered in the USA and are used in practice.
In the UK, there have also been meetings of specialists from the country's National Health System on this topic. They said that in order to put this technology into practice, it is necessary to shift the focus in the system of care for the elderly towards prevention. That is, it is necessary to conduct routine genetic testing and look at the human genotype, because the new drug has certain contraindications and it cannot be prescribed to everyone. For prevention, it is necessary to introduce MRI scans of the brain everywhere, and this makes it necessary to make certain changes in the provision of medical services.
— At what age should this be done in order for the new medicine to work?
— In general, it is believed that there is a certain genetic predisposition. The APOE gene is associated with an increased risk of Alzheimer's disease. Although this position is still in the field of research, it is one of the most proven. Therefore, it is possible to know about the predisposition of the patient even from birth.
It is believed that the first physiological changes in brain tissue appear around the age of 40, but they are still not clinically manifested. Classically, the clinical manifestation develops somewhere around the age of 60. Therefore, if we are talking about prevention, it should be phased. Genetic screening — the sooner the better. It is necessary to carry out an MRI scan or tomography, which, of course, is very expensive and unlikely to find mass use. In any case, you need to start this job at the age of 40.
"The plot of delusional experiences can even somehow capture the spirit of the times"
— Modern technologies are significantly changing people's lives. How does this affect mental health and the characteristics of mental illnesses? Is it still possible to meet a person in hospitals who considers himself Napoleon, or are "Ilona Masks" more common now?
— I must say that not only technology is evolving and not only the characters are changing, but also psychopathology. The disorders and manifestations that we observed in the 19th century, during the time of Napoleon, are different from what we observe in the 21st century. This is due, in particular, to the fact that new methods of treatment have appeared, and therefore we no longer allow mental illness to develop into such a severe form, which was possible before the medicinal era.
Therefore, clinical manifestations, when a person feels like Napoleon or any other hero or character, are now extremely rare. Such cases can be counted on the fingers. But, on the other hand, people who develop mental disorders always keep up with the times — what is on the agenda is usually embedded in the structure of the disease.
Patients with such mental characteristics are very sensitive. They pick up the smallest signals from the environment, and this is immediately integrated into their clinical picture. For example, they are very interested in everything related to cryptocurrency or artificial intelligence. But at the same time, traditional themes are also preserved, such as biblical ones, as well as ideas of connection with God or some mystical themes. All this remains.
— Is there a difference for a psychiatrist, for example, if a person says that he communicates with Elon Musk live or it seems to him that he is corresponding with him in a messenger? Are nuances important for the treatment of such a disorder?
— In general, this is not very important for treatment. It's just that different sensory systems are involved: it's one thing if a patient sees it, it's a hallucination, but if they're texting on a gadget, it's a more complicated thing.
— Let's continue the topic of self-identification. Computer games are very popular today, where the user can feel like a character of any gender and age. How dangerous can it be for the psyche?
— People have always played these games — if in the 18th century they painted on their moustaches or held a carnival, now there are more technical possibilities. However, human nature has remained the same. People like to play games, they like to transform themselves and pretend to be someone else.
But there is another danger. Now the fashionable topic is "fake news", that is, the ability to create fakes when it is difficult to distinguish a fraudster even from his friend. If a person's intellectual abilities are fully preserved, he will always distinguish falsehood from the truth.
But if they weaken, for example, due to age or due to some stressful situation, scammers often use this. They call mostly elderly people, or they artificially create a stressful situation for a person, posing, for example, as his boss. They put people in conditions where they lose the ability to criticize and they are less able to distinguish a fake from the real one.
— How is artificial intelligence used in your field?
— The emergence of artificial intelligence provides amazing opportunities in terms of therapy of mental disorders. There have been studies comparing real psychotherapists and virtual ones. AI wins in the most structured methods of psychotherapy, for example, cognitive behavioral therapy. It has a specific algorithm for working with patients. And it is believed that the closer the therapist is to this algorithm, the better the treatment result will be.
— Can this technology become widespread?
— Yes, this trend has been going on for about 10 years. For example, this is being actively studied in the Scandinavian countries and Northern Europe. It takes a lot of effort to raise one psychiatrist. There are always not enough such specialists, so their role is delegated to general practitioners, psychologists, and now robots. Of course, when you have the opportunity to talk to a human psychiatrist, it's always better. Over time, such servants will become more and more privileged. But a robot is still better than nothing.
— How do patients tend to perceive artificial intelligence? As a positive authority or an "evil genius"?
— It doesn't matter, because it's not about artificial intelligence, but about the person who got sick. The plot can be very different, positive and negative. Of course, the psyche is designed in such a way that people are more inclined to pessimism. If we analyze emotions, we have much more words to express negative feelings than positive ones. This is a necessary strategy for survival. It is better to expect the worst and always assess the risks.
— How can the active use of social networks affect the psyche?
— There were such "glasnost booths" in the early 1990s. Anyone could go in there and say anything to the camera. Social media is practically the same thing. People were given a podium, and each person chooses how to use it further. But there are studies confirming that too much, excessive immersion in social media is associated with a higher risk of depression.
Psychologically, social media is often a narcissistic environment where a person puts himself in the best possible light and tells only the best about his life. Therefore, other users have the feeling that they are complete losers because they did not go to the seaside or did not earn money for an expensive car. In fact, it works like any mass media, it's just that now it's available to everyone.
— It has long been known that an abundance of bad news increases stress levels.
— Yes, just when the coronavirus pandemic was taking place, the entire world psychiatric community was talking about an "infodemia." That is, the information background that was created often harmed the mental health of the population more than the virus itself.
— How valuable can social media provide psychiatrists with research material?
— Linguistic analysis of social networks and their content opens up new possibilities. With their help, it is possible to solve the painful issue of psychiatry — to make possible the early diagnosis and prevention of mental disorders. Through the analysis of social networks and the texts that people write in them, today they are trying to identify early signs of mental disorders in order to offer help to a person in time.
However, difficulties arise when trying to put this technology into practice. It is not entirely clear how to correctly invite such a patient to a psychiatrist in order to help him at an early stage.
"Today we return to psychedelics again"
— How are classical methods of treating mental disorders developing now?
— The problem with psychiatry is that we have very few new drugs. They are constantly trying to synthesize them, but, unfortunately, there is not as much success in this area as we would like. Most of the drugs in this area were discovered by accident. When we consciously try to create new drugs, it rarely makes sense. As I have already said, the most breakthrough today is the treatment of Alzheimer's disease. The rest of the developments are, in one way or another, variations of long—known compounds. By and large, we haven't made much progress since the 1950s. Today we return to psychedelics again, exploring them as potential treatments.
— And what specific pathologies?
— The most diverse. But most often they talk about resistant forms of depression and eating disorders. There are attempts to treat schizophrenia, but the best way is to look for ways to combat anorexia nervosa. We are talking about methods combined with psychotherapy, as well as purely pharmacological research.
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