The future of Costa Rican psychiatry depends on dedicated young
psychiatrists such as Sylvina Riondet, M.D. (left), and Andrea Mesen, M.D.
Riondet is an assistant professor at Costa Rica's National Psychiatric
Hospital, and Mesen is a clinician and psychiatric researcher. Joan
Andrea Mesen, M.D., a young Costa Rican psychiatrist, is busy working in a
private psychiatric practice, helping improve government-sponsored psychiatric
care in Costa Rica, and teaching psychiatry courses at the University of Costa
Rica. But his top priority, he stressed in an interview with Psychiatric
News, is conducting psychiatric research.
For the past nine years, he, along with Costa Rican and American
colleagues, has amassed genetic information about some 2,000 Costa Ricans
whose family pedigrees contain a number of cases of schizophrenia. Most of the
subjects come from the Central Valley region of Costa Rica. Their ancestors
were Spaniards who lived isolated in that region for some 400 years, that is,
since the 16th century, when Spaniards settled the region. Thus, while they
are not as homogenous as the Icelandic people, for example, they are fairly
homogenous and thus a rich genetic pool in which to search for genes linked to
Mesen and his co-workers have published three reports of their findings to
date. Their principal finding is that there is a region on chromosome 5 that
appears to be implicated in schizophrenia cases in these families. A related
region on that chromosome has also been linked with schizophrenia in some
Puerto Rican families, Mesen said.
Currently Mesen and his colleagues are performing MRI scans and
neurophysiological tests on a number of their subjects, as well as on
controls, in hopes of pinpointing brain peculiarities that might reflect a
genetic pre-disposition to schizophrenia. "We are the first to ever do
this in Costa Rica," he said.
During the past four years, Mesen has received funds to finance his
research from two American sources—the National Alliance for Research on
Schizophrenia and Depression and the Pritzker Neuropsychiatric Disorders
Research Consortium. He is grateful for their contributions, especially as
there is no money available for such research in Costa Rica.
Still another challenge to conducting schizophrenia research in Costa Rica,
he pointed out, comes from Costa Ricans who believe that persons with a
serious mental illness do not have the mental capacity to participate in
research. Mesen strongly disagrees with this position: "For nine years,
I have been visiting schizophrenia patients in their homes to conduct my
research. I know their reality, I can talk with them, I respect them as
individuals. And I believe that they have the same right as you and I do to
participate in research."
Mesen also takes issue with the position of some Costa Ricans that Costa
Rica should leave psychiatric research to the United States and European
countries. "We especially need to undertake our own psychiatric
epidemiological studies," he contended, "because epidemiological
studies help with psychiatric service planning and can be used to lobby for
government funds for psychiatric care." For example, Costa Rican
psychiatrists can only guess at the prevalence of various mental disorders in
their country because a prevalence study has never been conducted.
All in all, Mesen concluded, "We need to develop our own research
ideas, our own research culture, and our own research projects. And I assure
you that we take American medical research laws, as well as Costa Rican ones,
into consideration when conducting our research." ▪