San José, Costa Rica, since 1956

Eyes Trained on the Brain

Even after William Chaves started taking meds for bipolar disorder, he suffered  the symptoms.

He went on extravagant shopping sprees. He left projects half-finished. He sank into long bouts of deep depression.

“I had to try countless drugs before I found ones that stabilized me,” said Chaves, who works for the Costa Rican Water and Sewer Institute.

Now he takes five pills a day, and they still don’t work perfectly, he said.

Scientists from Costa Rica and three other countries are on a quest to help people like Chaves. With more than $1 million in grants from the U.S. National Institutes of Health (NIH), they are testing hundreds of patients to identify genes that influence the development of bipolar disorder, schizophrenia and Alzheimer’s disease. Their findings could be used to develop new and better medicines.

“These are very complex diseases, and the (existing) treatments still aren’t the best,” said Henriette Raventós, a geneticist at the University of Costa Rica (UCR) who leads the studies here.

Teams from California, Texas, Mexico, Guatemala and Costa Rica have so far recruited more than 1,000 subjects for a study on bipolar disorder. Over the next three years, the scientists plan to recruit thousands more, then interview them and analyze their DNA.

Some 275 Costa Ricans have already signed on.

“People here are eager to collaborate,” Raventós said. “They won’t benefit from participating, but they understand how hard it is to have these sicknesses.”

She has already made one find, together with Dr. Michael Escamilla at the University of Texas Health Science Center in San Antonio. Working with about 1,200 Tico blood samples, the scientists identified three genes that could increase the likelihood of developing schizophrenia. Two had never before been discovered, Raventós said.

With new money from NIH, scientists at the University of Southern California in Los Angeles will now further scrutinize the blood samples using a high-tech process that costs $400 per person.

“It’s marvelous,” said Alexis Cruz, president of the Costa Rican Foundation for People with Schizophrenia (Fucopez). “One expects the great cures to be developed by superpowers – the United States, Europe.

The fact that Costa Rica is working on such an important project is a change.”

Others are less confident. The study’s potential benefits seem remote to Maribel Juarez, president of ACOTAR, an association that helps people with depression, anxiety and bipolar disorder.

“What we need is money to help more people,” she said.

Based on global incidence rates, Raventós estimates that bipolar disorder and schizophrenia each affect about 1 percent of Ticos, for a total of about 86,500 people.

They have limited options. Only three state hospitals allow mental illness patients to stay the night, said José Miguel Rojas, director of health development at Costa Rica’s Social Security System, the Caja.

The Caja has only about 80 psychiatrists, said Rigoberto Castro, hospitalization director at the NationalPsychiatric Hospital. That means patients wait three to eight months for an appointment, he said.

“It’s dangerous because oftentimes the (patient) is having a health crisis,” said Cruz of Fucopez, who also works as a therapist for the Caja. “The family can’t sustain (him) through a crisis for that long.”

Further, the Caja gives schizophrenic patients older “first-generation” psychotic drugs, even though newer drugs with fewer side effects are on the market. The new drugs are offered as a last resort for cases in which the patient is resistant to other treatments, said Javier Contreras, a post-doctoral fellow in genetic psychiatry at the UCR.

“A lot of people are buying these drugs from the United States, and they are enormously expensive,” said Cruz, who plans to challenge the Caja’s restrictions before the Constitutional Chamber of the Supreme Court (Sala IV).

As the Caja falls short, many Ticos with mental illnesses look to private support groups.

ACOTAR, based in downtown San José, offers three two-hour group chats a week with a psychologist for ¢10,000 ($18.50) a month.

Fupopez, in the eastern suburb of Sabanilla, organizes free chats with health specialists for schizophrenic Ticos and their families.

But these resources aren’t enough, said Chaves. He is working to form a foundation to help bipolar patients.

Chaves said he supports the UCR’s study and has offered to collaborate. But, he said, such studies are only part of the solution.

Developing new meds won’t help unless the Caja offers them — and people agree to take them.

“The most important thing was for me to understand I had a mental illness,” he said. “We have to raise awareness about this sickness so that people seek help.”

About Bipolar, Schizophrenia


Bipolar disorder afflicts the brain, causing two radically different and alternating moods: mania (high energy, euphoria or irritability, exaggerated self-esteem, little need for sleep, spending sprees) and depression (deep sadness, low energy, difficulty concentrating, little interest in life).

Schizophrenia is characterized by delusions (false and sometimes bizarre beliefs), hallucinations, and decreased ability to make plans, speak, express emotion or find pleasure in life.


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