IMSMAGAZINE THINK, LEARN, DISCOVER.
Mood Disorders Breaking barriers to mental health
Highlights from the sensational speakers of IMSâ€™ first TEDMED event
IMS Scientific Day Speaker Dr. Jeffrey Mogil discusses his experiences in pain research
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TABLE OF CONTENTS
Cover design by Brendan Polley; Photo of 3D heart model courtesy of Michael Corrin; Viewpoint Photo courtesy of www.istockphoto.com; ID # 17061678.
IN THIS ISSUE... Commentary .................................... Letter from the Editor....................... News at a Glance ........................... Director’s Message ......................... IMS Scientific Day Speaker ............ Feature............................................. Expert Opinion ................................. Book Review ................................... TEDMED Highlight .......................... Viewpoint ........................................ Biomedical Communications .......... Future Directions ............................. IMS Experience ............................... Ask the Experts ............................... Past Events ...................................... Diversions .......................................
04 09 10 13 14 16 28 30 32 34 36 38 40 41 42 43
Leaders in the field help us understand the evolution, pathophysiology, treatment, and discriminatory concerns related to mood disorders.
MAGAZINE STAFF Editor-in-Chief Natalie Venier Managing Editor Nina Bahl Assistant Managing Editors S. Amanda Ali Nancy Butcher Anna Podnos Adam Santoro Brittany Rosenbloom Departmental Advisors Marika Galadza Mary Seeman Design Editors Catherine Au-Yeung Jean Yi-Chun Lin Brendan Polley Andrew Q Tran Andrew Tubelli Advertising Manager Laura Seohyun Park Magazine Committee Salvador Alcaire Anna Badner Jill Cates Danielle Cha Josephine D’Abbondanza Yekta Dowlati Aaron Kucyi Sarah Gagliano Winny Li Benjamin Mora Zeynep Yilmaz Photography Chuvng Ho Leung Laura Feldcamp Henry Ma Paulina Rzeczkowska
Viewpoint: Social Chameleon-ism Amanda Ali explains the science behind the changes in our behaviour that allows us to be ‘social chameleons’ in different social environments.
Copyright © 2013 by Institute of Medical Science, University of Toronto. All rights reserved. Reproduction without permission is prohibited. The IMS Magazine is a student-run initiative. Any opinions expressed by the author(s) are in no way affiliated with the Institute of Medical Science or the University of Toronto.
Biomedical Communications Maeve Doyle explains the revolutionary new simulator, developed by Michael Corrin, that prepares doctors for the operating room.
Cover Art Cover design by Brendan Polley. This cover focuses on the neural basis of mood disorders.
IMS MAGAZINE FALL 2013 MOOD DISORDERS | 3
WHAT OUR READERS ARE SAYING
Dear Editor, In the Spring 2012 issue of the IMS Magazine, Tetyana Pekar wrote an illuminating piece on the state of employment postgraduate school. She emphasized the need for a more upfront dialogue, as universities should acknowledge that the progression from graduate studies to academia is a rare occurrence. Potential solutions are to “create mandatory courses, or provide internship opportunities to help students prepare and successfully compete in the non-academic job market.” In this commentary I wish to provide a more anecdotal analysis of the issue, and focus instead on the reasons why an individual may enter graduate school, as well as on the job prospects that may follow. It is my opinion that the career outlook of PhD graduates is not as bleak as it seems, and that more responsibility must fall on the student when deciding whether to partake in graduate studies. I don’t have the official numbers, but I can confidently state (based on dialogue with fellow students) that a large proportion of individuals enter graduate school to satisfy their intellectual curiosity. Many undergraduate students get their first taste of science by working in laboratories and find that they love tackling unsolved problems with their own hands. Others simply develop an insatiable thirst for knowledge after completing undergraduate survey courses and wish to dive deeper into a topic that captures their heart. I am guilty of the latter; I took a pro-
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found interest in cognitive neuroscience, and specifically set out to shape my brain and develop a worldview centered on the lessons I would learn from studying science. My decision to pursue graduate studies was more philosophical than practical. I was aware that I would be learning more than just subtle minutiae on a topic only four people in the world knew well enough to discuss over dinner. I hoped that my thirst for knowledge was more than just curiosity; sure enough, the answers I obtained from studying science, and moreover the scientific method, would evolve into a personal philosophy and would influence the way I thought about economics, society, religion, politics—anything. Studying science would turn me into a thinker, not an extremely skilled pipetter. The true value of graduate school does not lie in learning esoteric facts or particular mechanical techniques. Successful graduate students will learn how to think. They will understand how to pose questions and how to answer them. They will know how to deduce and how to infer. They will know how to extract similarities and how to point out differences. They will learn how to parse data and how to extract relevance. Intellectually armed, a PhD graduate is, no doubt, fully capable of pursuing a career in academia, since a successful scientist is a successful thinker. But when viewed from this vantage point, a successful thinker is capable of more than academia. A number of (if not all) consulting companies acknowledge this fact and actively pursue the best thinkers to join their teams (with PhD graduates getting a head start up
the career progression ladder). More and more PhD graduates are starting their own companies, pursuing professional degrees, and working in biotechnology companies. I see this as a good thing; perhaps we are finally in a position to acknowledge what graduate school truly teaches. So, indeed, are graduate schools training students for jobs that don’t exist? The crux of that question lies in the word “training.” The graduate student must take responsibility and understand what they are being trained to do. Is it to pipette? To know the binding partners of a newly discovered protein in some single-celled organism? Or are they being trained to develop methods of thought and new perspectives? Tetyana Pekar mentioned that universities need to lift the silk screen and tell students the reality of their careers post-training. But are they really hiding anything? What is it exactly that they are training graduate students to do? Professional school, which trains students for precise career paths, is not to be confused with graduate studies in science. By training students how to think, universities are setting individuals up with a cerebral palette that can be used throughout their life—at the job and at home. So, perhaps the question we should be asking is whether universities are actually successful at training students as thinkers, or whether there is actually a Ponzi scheme set up, enforcing trivial skills on future scientific doers. I can only speak for myself, and my experience has been very positive. Adam Santoro
COMMENTARY Evolution of The Postdoctoral Fellowship
Separating the Reality from the Myth When It Comes to Expectations Among students enrolled in a PhD program, the most commonly cited reason to pursue graduate education is the desire to be a professor in an academic setting. Yet recent statistics show that only about 20% of PhDs end up in academia,1 for reasons that include, but are not limited to, university hiring freezes and decreases in grant availability.2 With the harsh realities of today’s economy and the lack of available academic positions, many hopeful PhD graduates pursue postdoctoral fellowships to prepare themselves for when (or if) an academic opening becomes available. However, numerous myths surround this important rite of passage, and there is confusion as to what one can expect from postdoctoral fellowships in these highly competitive times. Postdoctoral fellowship expectations have changed significantly over the years. If you have a senior researcher with a PhD as your supervisor who tells you all you need is two productive years in a good laboratory before landing your academic opportunity, it is time for a reality check. Although two to three years used to be all it took for an academic position, the norm nowadays is either multiple short postdoctoral fellowships or one long one; up to seven years between a PhD defense and an assistant professor position is not uncommon. In terms of pay, salaries are quite low for individuals having completed a PhD. Low salaries may be due to the perception of postdoctoral fellowships as glorified internships or practicums (as a matter of fact, some institutions view postdocs as trainees3), where the fellows are expected to prove themselves as future independent academic researchers through long hours of hard work. Universities may even see postdoctoral fellowships as cheap and disposable labour,4,5 which may increase a fellow’s risk of burnout. However, low salaries also mean that fellowship positions are not as selective as they could be, so
candidates are more likely to have a chance at being hired as a fellow by the institution of their choice. What about students interested in working in industry? The common perception is that applicants forindustry jobs do not need to complete a postdoctoral fellowship. However, for candidates without previous industry experience (i.e., most PhD graduates), having done a postdoctoral fellowship may be regarded positively. Considering that PhD students neither have the time nor the opportunity to seek industry experience, completion of a postdoctoral fellowship may serve as job experience in which the candidate has proven independent working skills in a professional environment as a non-student. Alternately, PhD graduates interested in academia have the option of pursuing postdoctoral positions in industry, since many pharmaceutical companies offer fellowships that come with the opportunity to work with some of the biggest researchers in the field who are also cross-appointed with an educational institution. Despite the uncertainty, long hours, and low pay, postdoctoral fellowships are not without advantages. From a research perspective, fellows can pursue novel, interesting ideas without the additional burdens and responsibilities of being a principal investigator. With the right supervisor and laboratory, opportunities to collaborate not only broaden one’s horizons, but also help make invaluable academic connections. If you have external funding, it is a great time to travel to confer-
“Considering that less than a quarter of postdoctoral fellows land a tenure-track academic position, it is important to set realistic goals, consider alternate career paths, and explore all available options [...] for your life after a postdoctoral fellowship.”
ences to promote your work. For those interested in pursuing the academic route, a number of things can maximize what you get out of your postdoc experience. First, willingness to relocate for a great position may give you an advantage over other academic candidates. In addition, it is a fellow’s prerogative to apply for any suitable funding opportunity regardless of the dollar value; grant writing is an invaluable skill to master, and every funding opportunity added to your Curriculum Vitae makes you a stronger candidate for an academic position. Finally, considering that less than a quarter of postdoctoral fellows land a tenure-track academic position, it is important to set realistic goals, consider alternate career paths, and explore all available options—without necessarily giving up on your academic dreams—for your life after a postdoctoral fellowship. Zeynep Yilmaz
References 1. http://scienceadvocacy.org/Blog/2010/04/12/old-debatemore-participants-what-do-80-of-phd-holders-do-for-a-career/ 2. http://blogs.sciencemag.org/sciencecareers/2012/01/nihreport-iden.html 3. Postdoctoral research trainees. http://www.mcgill.ca/gps/ postdocs/trainee 4. http://www.nature.com/news/2011/110302/full/471007a.html 5. http://www.economist.com/node/17723223
Additional readings • http://chronicle.com/article/Making-the-Most-of-Your/66265/ • http://www.hhmi.org/bulletin/feb2011/features/index.html • http://www.hhmi.org/bulletin/feb2011/features/choosing_ postdocs2.html • Feibelman PJ. A PhD is not enough!: a guide to survival in science.2nd ed. New York: Basic Books, 2011.
Disclaimer: The opinions expressed by the author(s) are in no way affiliated with the Institute of Medical Science or the University of Toronto. Comments are welcome at theimsmagazine@ gmail.com.
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COMMENTARY Dear Editor, In a timely fashion, the article about PhDs and employment (see “PhDs: Training For Jobs That Don’t Exist,” Spring 2013 edition) revealed an exciting opportunity. With all the media attention given to the “teacher surplus folly” in Ontario, legitimate concern has been raised regarding the functional alignment of academic institutions. Unchecked academic development is great for improving mental acuity in the general population, but bad when it wounds graduates with debilitating debt. Compounded by poor job prospects, PhD students that comprise Canada’s sharpest human cohort can start their careers with dulling disappointment. To be clear, having a surplus of teachers and PhD graduates with highly differentiated minds is not necessarily a bad thing. Not utilizing these valuable human resources is the problem, or at least the opportunity lost. Canada is facing a plethora of intense national challenges that require research-based solutions. Why not employ our brightest minds to generate solutions to these problems and have our surplus of citizens specifically trained in education teach these concepts to the public?
“The opportunities are boundless for highly differentiated minds, as long as they’re guided in the right direction and connected with the real pressing demands of our nation.” A couple macro-level issues begging for intelligent intervention are the impending demographic demands facing our country and the unsustainable approach of our healthcare system. Over the next two decades, Canada is going to experience a demographic double whammy, as National Post columnist Andrew Coyne calls it. The proportion of workers to retirees will change from a 5:1 ratio to 2.5:1 and the percent of our population over 65 from 12% to 25%.1
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Our nation will have half the relative workforce to support twice the amount of elderly dependents. As retirees live longer than ever before, they will collect pensions and place increasing levels of financial stress on the health care system. Less tax revenue and higher expenditure demands equal a double whammy indeed. So what’s the solution, Canada? I perceive this problem as a forced opportunity to evolve our western approach to health management. At the moment, our healthcare system functions like an illness service industry. We don’t intervene until a Canadian is already sick or injured. As our system approaches the vertex of clinical and financial unsustainability, doctors of medicine need to focus on health promotion and the prevention of illness. IMS graduates with marvelous medical minds can help design health intervention that improves the health of Canadians, rather than waiting until they succumb to illness. Author Tetyana Pekar mentioned in her article that 49.3% of all doctoral candidates in Canada were students in science, engineering, and health sciences.2 Graduate students who are well versed in the scientific method, incredible at collaborative projects, and recognize measurable medical success when they see it. Perfect! As she suggested, IMS can create “mandatory courses” that teach students how to translate their skills to the job market. Furthermore, why not extend the course purview even further to embrace solutions to our national challenges? I have personal experience with this kind of innovative occurrence. A Club for Undergraduate Biomedical Engineers (CUBE), affiliated with The University of Toronto (U of T) and led by students, hosts an annual evening seminar. Through a natural interdisciplinary collision, I met the president. He told me about the seminar and how a few industry representatives show up, deliver some fast facts about their company, hand out business cards and leave. He asked me if I would offer a more innovative chat on real world applications. I gladly agreed and twice delivered a short lecture on the non-academic applications of biomedical engineering. More importantly, I grounded the discussion in reality by ex-
plaining the functional significance of such pursuits. Rather than discussing commercial success in the illness service industry like the other speakers, I talked about translating knowledge and civic ambition into actual improvements in population health. Jokingly on a night that had been raining, I mentioned how stupid it would have been if I had waited until I was soaking wet before opening my umbrella on the way to the lecture. What is the point of having an umbrella if you aren’t going to use it until you are soaking wet? The same is true of our healthcare system, I quipped. Why does Canada wait until its citizens are already ill before intervening with health professionals? The laughter turned quiet and questions became quite firm when the other speakers took the floor. One female engineer stood up to ask: If your medical device is three times as expensive, is it also three times as effective in terms of health outcomes? A short informative lecture about clinical and financial sustainability in the healthcare system sharpened the mindset of the students. Offered examples and extended challenges ignited their imaginations, making non-academic career opportunities more clear and attractive to their intellectual passions. Over the next 20 years our country requires revitalization. Not just teaching and preach-
COMMENTARY ing, but real solutions executed with measurable success. Unleashing brilliant minds into unsustainable industry, government, and commercial enterprises will provide the mental acuity needed for organizations to accurately reflect upon their measured effects and functional purpose. IMS is a ripe arena where students can help transition provincially funded illness service into a thriving health care system. Complementary courses that connect graduates with population health solutions will translate into practical and measurable advances in human health. For medical doctors working within the current healthcare system the old Hippocratic Oath will remain the same: “do no harm.” But to the doctors at IMS working outside the system, a more active approach may seem suitable for modern times. If you agree with my umbrella logic and appreciate the art of integrative thinking, you will realize why it is far too late to intervene with Canadians on the sick side of the health spectrum. A passive approach to health is no longer clinically or financially sustainable. The demographics of the country are forcing us to heighten our attention and raise expectations. As outstanding academics, I invite IMS students to translate their intelligence into exceptional citizenship. We must address our national challenges with a proactive pledge to “allow no harm,” meeting fellow Canadians on the healthy side of their lives and strive to keep them there. To “do no harm” is a static backward ping ambition, a low aiming goal that only glitters when illness already abounds. On the contrary, to “allow no harm” is a dynamic statement, an assertive proclamation and systemic attitude that aims to protect health conditions from deteriorating in the first place. As hardworking doctors do their best to service illness, we need another body of medical doctors with more legal flexibility cultivating health in the population. I’m interested to see how the IMS responds moving forward. The opportunities are boundless for highly differentiated minds, as long as they’re guided in the right direction and connected with the real pressing demands of our nation. Or maybe the pub-
lic is right? Maybe there is such a thing as a “surplus” of intelligent citizens? If so, there is a dark prognosis for health in Canada. I have intentionally developed my education and career to help transition our country through this large demographic shift and assure that the process is one of revitalization. I hope the IMS considers providing similar guidance to their graduates pursuing non-academic careers. With Canada’s most refined minds in their hands, complementary programs geared toward a much needed transition in health management could shape the future of our nation and the health of our children for decades to come. Will the IMS produce non-academic leaders who evolve western medicine from a passive unsustainable state into a dynamic system that evokes a cultural passion to “allow no harm”? Who? How? When did it happen? Could a virtual institute with no walls, dispersed across U of T, hospitals and international locations, mobilize its highly differentiated intelligence to create a clinically and financially sustainable health care system to share with the world? Like Banting and Best,3 with a little bit of integrative thinking we can make medical history, IMS. I promise you, our pressing national problems are an opportunity in disguise. Stay tuned, Canada.
Call for Articles The IMS Magazine is looking for scientific content to post on the IMS Magazine website. Whether you are a current blogger looking to cross-post your scientific musings, or are just looking to get your ideas out there on our platform, your submissions are welcome. Submissions are expected to be approximately 800 words in length (with considerable leeway) and priority will be given to individuals who comment and report on IMS specific issues (i.e. research in the department, conferences, general scientific issues that affect the IMS faculty and students, etc.) although viewpoints and commentaries are also welcome. Send an email to firstname.lastname@example.org for more information.
Contact Us We encourage our readers to send their feedback, comments, questions, corrections, and letters to the editor to theimsmagazine@ gmail.com. Please also visit us at imsmagazine.com. Engage in dialogue with fellow IMS students and faculty, and even post your own article to our website. We are always looking for IMS student journalists to contribute to our content, whether they wish to discuss new research around the IMS, or wish to comment on a controversial topic in science and scientific training.
Matthew Ferguson Executive Director of A Canadian Vision
References 1. Coyne, A. Canada is Still Unprepared for Ageing Double Whammy. The National Post.2012 Sept 3. [Cited 2013 July 10]. Available from: http://fullcomment.nationalpost. com/2012/09/03/andrew-coyne-canada-needs-to-increase-productivity-to-combat-an-aging-workforce/ 2. Williams, G. Doctoral Education in Canada: 1900 - 2005. Canadian Association for Graduate Studies. 2005 Sept. [Cited 2013 July 10]. Available from: http://www.cags.ca/documents/publications/doctoral_education_canada_1900-2005.pdf 3. The Discovery of Insulin. Nobel Media AB 2013. [Cited 2013 July 10]. Available from: http://www.nobelprize.org/educational/ medicine/insulin/discovery-insulin.html
Disclaimer: The opinions expressed by the author(s) are in no way affiliated with the Institute of Medical Science or the University of Toronto. Comments are welcome at theimsmagazine@ gmail.com.
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LETTER FROM THE EDITOR
Letter from the Editor A
s my term as the founding Editor-in-Chief of the IMS Magazine comes to an end, I feel incredibly grateful for and inspired by the many experiences that the magazine has brought me. I have had the privilege to interact and work with a number of world-class physicians and scientists who have left me in utter amazement of their scientific discoveries and passion for medical science. From discussing sports-related injuries with Dr. Charles Tator, to understanding metabolic disorders with Dr. Roger McIntyre and Dr. Allan Kaplan, learning about prostate cancer chemoprevention with Dr. Laurence Klotz, traumatic injury with Dr. Sandro Rizoli and Dr. John Marshall, multiple sclerosis with Dr. Paul O’Connor, to stem cells with Dr. Andras Nagy and Dr. Derek Van der Kooy, among so many others, the past nine issues of the IMS Magazine would not have been possible without the many world-class experts who contributed their knowledge and expertise. Nevertheless, I think the one thing that I have been most inspired by is the creativity and determination of graduate students who have really guided and shaped this publication into what it is today. I would like to recognize the dedicated and brilliant IMS Magazine Committee (past and present), as well as the incredibly talented Design Editors (Biomedical Communications students) who have been integral to the development of the IMS Magazine. I would also like to send a special thank you to a number of individuals who have supported the development and growth of the magazine: Firstly, Dr. Ori Rotstein, the former director of the IMS, who graciously supported me in the creation and development of the IMS Magazine when it was merely an idea in my head; Avi Vandersluis, a fellow graduate student, who helped with project initiation and fruition of the first few issues; Kamila Lear, who served as the departmental advisor for the first eight issues of the IMS Magazine; and last but not least, my right-hand woman and the Managing Editor of the magazine, Nina Bahl, whose attention to detail has allowed the IMS Magazine to achieve the highest level of professionalism. In this tenth issue, we bring you cutting-edge research from experts in mental health and mood disorders. Dr. Roger McIntyre, Dr. Sidney Kennedy, Dr. Jeffrey Meyer, Dr. Z. Jeff Daskalakis, Dr. Thomas Ungar and Dr. Rivian Weinerman help us understand of the evolution, pathophysiology, treatment, and discriminatory concerns related to mood disorders. I hope that our feature will aid in reducing stigma and promoting equal rights for affected individuals.
Editor-In-Chief Natalie Venier is a PhD Candidate at the Institute of Medical Science. She is currently studying prostate cancer chemoprevention at Sunnybrook Health Sciences Centre.
I also strongly encourage a review of the some of our articles, including the spotlight on this year’s IMS Scientific Day speaker, Dr. Jeffrevy Mogil, the exciting TEDMED day highlights, and controversial piece on “social chameleon-ism” by our own scientific journalist, Amanda Ali. To conclude, I would like to acknowledge Dr. Allan Kaplan and the IMS department for their ongoing support and encouragement, and to congratulate Adam Santoro on his new role as Editor-in-Chief of the IMS Magazine. I’m sure he will continue to produce a high quality publication that will continue to bridge the gaps within the medical science community and promote scientific communication.
Photo by Paulina Rzeczkowska
Natalie Venier Editor-In-Chief, IMS Magazine
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NEWS AT A GLANCE
NEWS VIEWS AUGUST 12
Registration for fall session begins
Summer Undergraduate Research Program Research Day
Last date for payment of tuition fees to meet registration deadline
School of Graduate Studies Graduate Orientation 2013
IMS New Student Orientation and Reception
Ori Rotstein Lecture in Translational Research
Feedback: Please send your comments and suggestions to: email@example.com For information on IMS news and events, please see: http://www.ims.utoronto.ca For more information on IMSSA/IMSSA-related events, please visit: http://imssa.sa.utoronto.ca
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NEWS AT A GLANCE
SPOTLIGHT ON IMS FACULTY OUR FACULTY, OUR PRIDE
Recognizing IMS faculty achievements The Department of Surgery’s Professor and IMS faculty member Clement Hamani has won the Scientific Award from the World Society for Stereotactic and Functional Neurosurgery. He received his award at the WSSFN’s 16th Quadrennial Meeting, held in Tokyo, Japan.
SCIENTIFIC DAY RECAP This year’s Scientific Day was held on May 28th at the Chestnut Conference Centre, to one of the largest audiences the IMS has seen thus far. The morning session featured six presentations by students shortlisted from the Laidlaw Manuscript Competition. Just before lunch, over 140 students presented posters in the Alan Wu Poster Competition. The day concluded with the Bernard Langer Lecture in Health Sciences presented by Dr. Jeffrey Mogil, E.P. Taylor Professor of Pain Studies at McGill University entitled “Mice are People Too: Translation in Pain Research from Genetics to Social Modulation.” Thank you to our IMS staff, volunteer poster judges, and discussants. You made this day a great success!
WINNERS Please join us in recognizing this year’s exceptional student presenters:
Laidlaw Manuscript Competition Basic Science: 1st Prize: Susan Armstrong, PhD Candidate on “Influenza Infects Lung Microvascular Endothelium Leading to Microvascular Leak: Role of Endothelial Barrier Enhancement as a Novel Therapy” Clinical Science: 1st Prize: Charles De Mestral, PhD Candidate on “A Population-based Propensity
Professor James Rutka—Chair, Department of Surgery and IMS faculty member since May 2013—has been awarded the American Association of Neurological Surgeons/ Congress of Neurological Surgeons Section on Tumors’ Dr. Charles B. Wilson Award. This award recognizes outstanding contributions in the field of neuro-oncology, and has been presented to only three recipients since 2004.
Professor Ian Witterick (Department of Otolaryngology—Head and Neck Surgery, IMS Associate Member since 2009) has been awarded the Canadian Society of Otolaryngology—Head & Neck Surgery’s Educational Excellence Award. Professor Witterick has had a significant impact on medical education in Canada and around the world, and he is being recognized for his revolutionary contributions.
Find out more about faculty on the IMS faculty database at www.ims.utoronto.ca/faculty/directory.htm
Score Analysis of Comparative Operative Outcomes of Early and Delayed Cholecystectomy for Acute Cholecystitis” Honourable mention: Sandeep Dhillon David Qixiang Chen Anton Mihic Erica Cai
Alan Wu Poster Competition Basic Science: 1st Prize: Cynthia Luk, PhD Candidate on “Adipocyte-Specific FAK Deletion in Mice Leads to Insulin Resistance but Divergent Adipose Tissue Remodelling Under Lean and Obese Conditions” Honourable mention: Rickvinder Besla Andrew Corso Bojana Gladanac Wilfred Ip Lia Mesbah-Oskui Pedro Reck dos Santos Taimoor Sheikh Linda Vi Clinical Science: 1st Prize: Danielle DeSouza, PhD Candidate on “Altered Peripheral Nerve And Brain White Matter Microstructure In Trigeminal Neuralgia” Honourable mention: Esther Bonrath Daniel Felsky Emily Jones
Dai Yoon Lee Paola Luca Jeffrey Poynter Amanda Steiman Tatiana Valica John Zawadzki
Awards Whiteside Award presented to Emily Lam, MSc (L. Osborne, supervisor) Mel Silverman Award presented to Anne M. R. Agur, BSc(OT), MSc, PhD Roncari Book Prize presented to Richard Foty, PhD candidate (T. To, supervisor) Sara Al-Bader Memorial Award presented to Fabio Salamanca-Buentello, PhD candidate (R. Upshur, supervisor) IMS Graduate Course Director Award presented to Michael J. Wiley, PhD, Professor, Division of Anatomy, Department of Surgery IMS Graduate Course Lecturer Award presented to Muhammad Mamdani, PharmD, MA, MPH, Professor, Institute of Health Policy, Management, and Evaluation and the Leslie Dan Faculty of Pharmacy Siminovitch-Salter Lecture Award sented to Taryn Grieder, PhD
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Director’s Message T
his, the tenth edition of the IMS Magazine, helps reduce stigma related to mental health by enhancing our understanding of the evolution, pathophysiology, treatment, and discriminatory concerns related to mood disorders. A series of articles are presented by excellent leaders in the field: research articles from IMS faculty members Dr. Roger McIntyre, Dr. Sidney Kennedy, Dr. Jeffrey Meyer, and Dr. Z. Jeff Daskalakis, and an impactful article about stigma by Dr. Thomas Ungar and Dr. Rivian Weinerman. In terms of IMS news, IMS will host the annual Ori Rotstein Lecture in Translational Research on Friday, October 11, 2013. The lecture will be given this year by Professor Michael Matthay, Professor of Medicine and Anesthesia at the University of California at San Francisco (UCSF) and a Senior Associate at the Cardiovascular Research Institute at UCSF. Stay tuned for more details related to this lecture. We are in the midst of the first year of our strategic plan, moving ahead with our five strategic initiatives. In terms of our Uniqueness initiative, we have now undergone an external review of our proposal for a new Professional Masters Program in Translational Research in Health Science, the first of its kind in Canada. The program will go forward in the fall for government approval with a projected start date of September 2015. We have hired a new director for this program, Dr. Joseph Ferenbok, who will begin in this new role in the fall. Dr. Ferenbok was previously at the Knowledge and Media Design Institute (KMDI) in the Faculty of Information. We very much look forward to Joseph joining the IMS leadership team. For the Presence initiative, we are in the midst of interviewing website design companies, one of which will lead us in developing a new website. For the Belonging and Engagement initiatives, together with help from the Faculty of Medicine Alumni Affairs Office, the IMS is establishing a comprehensive alumni database; with this mind, we are planning an alumni launch with an event involving the Toronto Symphony Orchestra in the new year. Congratulations once again to Natalie Venier and her incredible team for their continued hard work and collective creative energies in producing this impressive publication. Sadly, this will be Natalie’s final issue as its inaugural Editor-in-Chief as she nears completion of her PhD. Thank you Natalie for all you have done for the IMS and best of luck in all your future endeavours. Thanks as well to Marika Galadza and Mary Seeman for their ongoing assistance in this project.
Allan S Kaplan, MSc, MD, FRCP(C) Director, IMS
Allan S. Kaplan, MSc, MD, FRCP(C), became the IMS Director in July 2011. He is currently the Chief of Clinical Research at the Centre for Addiction and Mental Health (CAMH), Vice Chair for Research in the Department of Psychiatry, and Professor of Psychiatry in the Faculty of Medicine. He is also a Senior Scientist at both CAMH and the Toronto General Hospital Research Institute. He was the inaugural holder of the Loretta Anne Rogers Chair in Eating Disorders at the University Health Network from 2002 to 2010.
The IMS Magazine has been a tremendous success and is just one of the many wonderful student initiated projects that make the IMS such a very special institute. I fully support its ongoing publication and look forward to the continued opportunities it affords us for publicizing the outstanding research conducted by our faculty and trainees.
Photo by Mohammed Sabri
Allan S Kaplan MD FRCP(C) Director, Institute of Medical Science
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IMS SCIENTIFIC DAY SPEAKER
An interview with
Dr. Jeffrey Mogil IMS Scientific Day Speaker 2013
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and earned his Ph.D. in Neuroscience from UCLA in 1993. “I ended up being a pain researcher quite randomly,” remarks Mogil. Afterwards, he moved to Oregon Health Sciences University in Portland to complete his postdoctoral fellowship before joining the Department of Psychology at the University of Illinois. In 2011, his academic career brought him to McGill University where he currently is the E.P. Taylor Professor of Pain Studies and the Canada Research Chair in Genetics of Pain. He is the head of the Pain Genetics Lab at McGill University, a worldleading centre in the field of pain research.
He has made influential contributions to the field of pain genetics and is a well-recognized authority in the field of sex differences in pain and analgesia as well as algesiometric testing (measuring the degree of sensitivity to a painful stimulus) in laboratory mice. Mogil defines pain as an unpleasant, simultaneous sensation and emotion that is caused by tissue damage or by stimulators that may not be currently damaging the tissue. Mogil’s fascinating discoveries on pain have made news around the world. One of his most significant findings was that red-haired women
Photo by ChungHo Leung
r. Jeffrey Mogil is known as a world leader in pain genetics. A native Torontonian, Mogil earned his B.Sc. (Honours) in Psychology at the University of Toronto in 1988. He had always thought that he would attend medical school until his fourth year of undergraduate studies, when he took a lab course in what would now be called behavioral neuroscience studying the reward system. He became interested in continuing on to graduate school and a career in research. As a result of one of his graduate school interviews with a scientist studying pain, he moved to California
By Yekta Dowlati
CLOSE UP display increased analgesic responsiveness to the kappa-opioid drug, pentazocine, compared with other women and men. He has conducted extensive work on individual and sex differences in pain and analgesia. He showed that different genes are involved in processing pain in the male and female brain, a discovery that could ultimately lead to analgesic medications personalized to an individual’s genetic profile. Another significant achievement by Mogil includes exciting new evidence that mice have empathy for other mice in pain, a phenomenon known as “emotional contagion.” In Mogil’s opinion, these new advancements in our understanding of pain will not affect current treatment strategies immediately because “you can’t make a treatment decision unless you can confidently predict which genes or factors explain a lot of variance and who is going to be in what category — we are decades away from that.” He believes that pain genetics is a great technique to come up with new drug development targets as “you can pull a rabbit right of your hat. I became interested in proteins that might actually make really good analgesics one day, just because I got interested in the genes that I didn’t have any prior information about.” Mogil calls his most significant accomplishment the development of the Mouse Grimace Scale for quantifying spontaneous pain, a type of pain that does not need to be evoked by anything or any sort of outside force. He has developed this scale for mouse and rats and currently other labs are in the process of developing it for other species and “I would be surprised if a version of this scale doesn’t work in every mammal…just like Darwin’s prediction in his 1872 book that facial expressions of emotions are basically the same across all mammals,” remarks Mogil. This discovery may allow researchers and veterinarians to monitor spontaneous pain and may eventually lead to the discovery of new analgesics. Mogil believes that the elephant in the room in pain research is that no one studies spontaneous chronic pain, which he considers the most important symptom of clinical pain, essentially because researchers don’t know how to measure it, can’t agree on how to measure it, or otherwise believe that that measuring it is just too difficult. Mogil takes an even-handed approach when
discussing the future of pain genetics. He refers to an old joke that states that “it’s impossible to understand the brain because we only have brains to understand it.” He also states that “the world of biology is so complicated and every time we discover something after few years of hard work, it gets dwarfed in the big complex picture. On the other hand, I am just amazed and impressed by the speed of current techniques and how they allow experiments to be done in a week that if they could have been done at the beginning of my career, it would have taken a year or two or five.”
... You have to find some-
thing very specific. The way to have a career in science is to find something that when that phrase comes up, your name is the only name that they can match to that phrase and if you can pull that off, then you can guarantee yourself a scientific career. When talking about his lab and being a principal investigator, Mogil sees himself as a part of a team saying “the way I think about it is that in military terms; my job is strategy and their job is tactics. It doesn’t matter how good your strategy is when you don’t know the tactics, and it doesn’t matter how good your tactics are if you don’t have the good strategy. You cannot win with one of them only.” Mogil describes his job as a scientist as the best job in the world where “you can literally study anything you are interested in as long as you can talk someone into paying for it every few years. Just the freedom and the flexibility of that are perfect.”
has to think of something very small in order to get oneself to be able to think of the big picture. “That’s just the way it is,” he says. Mogil is not only a world-renowned expert in the field of pain genetics, but he is also a musician. He used to play in a band and had a record contract when he was seventeen. Nowadays and after twenty years of not playing, he has started playing keyboards again and currently performs in a band. As he says, “Once un-cool becomes cool again.” Accomplishments in pain genetics will not only enhance pain management with the use of current treatments, but also leads to developing new analgesics. In this regard, without any doubt, Mogil’s unshakable interest in this field will continue creating top notch research projects and his landmark contributions may lead to new medications providing better pain relief.
References 1. Langford DJ, Bailey AL, Chanda ML, et al. Coding of facial expressions of pain in the laboratory mouse. Nat Methods. 2010;7(6):447-9. 2. Mogil JS, Wilson SG, Chesler EJ, et al. The melanocortin-1 receptor gene mediates female-specific mechanisms of analgesia in mice and humans. Proc Natl Acad Sci U S A. 2003;100(8):4867-72. 3. Mogil JS, Bailey AL. Sex and gender differences in pain and analgesia. Prog Brain Res. 186: 141-57.
A valuable piece of advice from Mogil to graduate students is that “you have to find something very specific. The way to have a career in science is to find something that when that phrase comes up, your name is the only name that they can match to that phrase and if you can pull that off, then you can guarantee yourself a scientific career.” He thinks people get in to science because they more or less want to think of the big picture. Instead, he believes that the reality is that one
IMS MAGAZINE FALL 2013 MOOD DISORDERS | 15
MOOD DISORDERS OVERVIEW In Canada, it is estimated that 1 in 5 will personally experience a mental illness in their lifetime. Mood disorders are reported to be one of the most common forms of mental illness, and they frequently accompany other mental health issues, such as anxiety disorders, personality disorders, and substance abuse and dependencies. However, the accompanying stigma can influence whether an individual seeks treatment, complies/adheres with prescribed medication, and/or seeks counseling. Stigma and discrimination associated with mental illness represent a significant barrier not only to diagnosis and treatment, but also social support and recovery.
Symptoms Distractibility Racing thoughts Unusual talkativeness Self-esteem/grandiosity Need for sleep (e.g. well rested following 3 hours of sleep) Goal-directed activity (e.g. at school/work, socially) Doing things that have a high potential for adverse consequences (e.g. unrestrained buying sprees, sexual indiscretions)
A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood that lasts ≥ 1 week (or < 1 week if hospitalization necessary). During the period of disturbed mood, ≥ 3 symptoms must be present; ≥ 4 if mood is only irritable. The mood disturbance must be severe enough to cause noticeable difficulty in daily functioning (e.g. work, school, socially), to require hospitalization to prevent harm to individual or others, or to trigger a break from reality (psychosis). A hypomanic episode is a distinct period of elevated, expansive or irritable mood that lasts ≥ 4 days, and is different from the usual non-depressed mood. During the period of disturbed mood, ≥ 3 symptoms must be present; ≥ 4 if the mood is only irritable. The mood disturbance must be severe enough to cause a noticeable and uncharacteristic change in functioning. The episode is not severe enough to cause significant difficulty in daily function, to require hospitalization, or to trigger psychosis.
Bipolar I disorder involves ≥ 1 manic/mixed episode with or without a major depressive episode.
Bipolar II disorder involves ≥ 1 major depressive episode and ≥ 1 hypomanic episode (but not a fully manic or mixed episode).
Cyclothymic disorder involves numerous hypomanic episodes and periods of
depression, but never a full manic, major depressive, or mixed episode. Symptoms last for ≥ 2 years (≥ 1 year in children/adolescents) without going longer than 2 months without symptoms.
Bipolar Disorder Not Otherwise Specified involves symptoms that do not meet criteria for Bipolar I/II Disorder or Cyclothymic Disorder but are not characteristic of the person’s normal range of behaviour.
Interest/pleasure Mood/affect Energy Concentration Weight or
Feelings of guilt Psychomotor retardation Sleep disturbance Suicidal preoccupation
Diagnosis of a major depressive episode requires presence of ≥ 5 depression symptoms over a two-week period. At least one bolded symptom must be present. Symptoms must be severe enough to cause noticeable difficulty in daily functioning (e.g. work, school, socially) and are not caused by grieving.
Major depressive disorder involves ≥ 1 major depressive episode. Dysthymia involves a chronically depressed mood on most days for ≥ 2 years (without going longer than 2 months without depressed mood) and ≥ 2 depression symptoms.
Sources: Fast Facts About Mental Illness, Canadian Mental Health Association; A Report on Mental Illnesses in Canada, Public Health Agency of Canada (2002); American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Washington, DC (2013); Mental Health and Addiction Information—Depression, Centre for Addiction and Mental Health (www.camh.ca); Bipolar Disorder, Mayo Clinic (www.mayoclinic.com).
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Graphics designed by Andrew Tubelli
Mania and Hypomania
DSM-5 Mixed Features Specifier Major depressive disorder with mixed features: meets full criteria for major depressive episode + presence of ≥ 3 manic/ hypomanic symptoms that do not overlap with symptoms of major depression.
Mania or hypomania with mixed features: meets full criteria for a manic/hypomanic episode + presence of ≥ 3 symptoms of depression.
of people who commit suicide have a diagnosable mental illness
higher suicide rate in individuals with bipolar disorder than the general population
of Canadians will experience a major depression in their lifetime
in women than in men Men are 4x as likely to commit suicide as
of Canadians will experience dysthymia
women There are equal rates of
of individuals with major depression will die by suicide
depression are 2x higher
Rates of major
bipolar disorder in men
of Canadians will experience bipolar disorder
27% 46% 49% of Canadians are fearful of being around people who suffer from a serious mental illness
of Canadians think people use the term “mental illness” as an excuse for bad behaviour
of Canadians said they would socialize with a friend who had a serious mental illness
Likelihood that people with a mental illness will commit violent acts:
greater than the general population
The amount the Canadian economy loses per year due to mental illness in the workplace: $14.4 billion
“The prediction is that, by 2020, mental health issues are going to be the leading cause of disability at Canadian universities.” -David Turpin, President at the University of Victoria
Sources: Health state descriptions for Canadians: Mental illnesses, Statistics Canada (2012); Mental Illness & Addiction in Canada, Mood Disorders Society of Canada (2009); A Report on Mental Illnesses in Canada, Public Health Agency of Canada (2002); Millar and Coli (2009) “Students take anti-depressants more than any other medication.” Maclean’s On Campus (www.oncampus.macleans.ca). IMS MAGAZINE FALL 2013 MOOD DISORDERS | 17
& 5 FEATURE
Diagnostic Statistical Manual
Roger S. McIntyre, MD, FRCPC Professor Psychiatry and Pharmacology University of Toronto Head of Mood Disorders Psychopharmacology Unit University Health Network
18 | IMS MAGAZINE FALL 2013 MOOD DISORDERS
The DSM-I, which was launched in 1952, contained 106 codable diagnostic conditions. The DSM-IV Text Revision, launched in 1994, had 365 diagnoses. At this juncture, I have not completed the enviable task of adding up all of the disorders in the DSM-5, but safe to say, there has not been a significant reduction in the number of diagnoses. I share the concern raised by many that the number of diagnoses contained in the DSM has far exceeded, in many cases, their clinical relevance. I am, however, curious at the frequently leveled complaint that the DSM lacks validity. The DSM was never intended to validate psychiatric disorders, and instead was primarily intended to provide a lingua
franca for clinicians, scientists, and other stakeholders, as well as a mechanism for registering and compensating for psychiatric visits. In my view, one of the top five papers ever published in psychiatry was the classic paper by Robins and Guze in 1970, wherein they outlined how psychiatric disorders can be validated. The first step toward validation is establishing reliability.1 Notwithstanding the foregoing, it is rather concerning that the reliability of several of the common disorders in DSM-5 are of questionable clinical significance. For example,
...The DSM-5 is the product of a decade of activity that has been dedicated to defining and operationalizing psychiatric disorders as well as estabilishing their reliability... the kappa statistic (a measure of the level of agreement between observers, over and above chance) was 0.28 for major depressive disorder (MDD) and 0.20 for generalized
Photos by Laura Feldcamp.
n May 2013, the Diagnostic and Statistical Manual 5 (DSM-5) was officially launched by the American Psychiatric Association at its annual meeting in San Francisco. The DSM-5 is the product of a decade of activity that has been dedicated to defining and operationalizing psychiatric disorders as well as establishing their reliability. The DSM-5 has generated a significant degree of interest, controversy, and disquiet within the broad ecosystem of psychiatry as well as in the general population as evidenced by the international conversation that has occurred in various media outlets.
anxiety disorder. It was reassuring that the kappas for bipolar I disorder (0.56), bipolar II disorder (0.40), schizophrenia (0.46), and borderline personality disorder (0.54) were moderate. The DSM-5 evolved significantly in the area of bipolar disorder (BD). Notably, individuals who declare hypo/mania while exposed to, or withdrawing from an antidepressant, are now diagnosed as bipolar. This is a long overdue change supported by the empirical evidence. Wisely, the DSM-5 has supplanted mixed states with the admittedly broader notion of mixed features specifier, which will apply to both BD and MDD. This latter change, which could be conceptualized as “Neo-Kraeplenian,” reminds us of the original description of manic-depression which had posited that cyclical disorders can be grouped together and phenotypically different based on the presence or absence of hypo/manic/mixed features.
...Diagnosing & categorizing mental disorders with a DSM-5 is the most practical tool available to us at this point in time...
...The next decade will be extraordinary & exciting as advances in cognitive neuroscience, ‘-omics,’ & nanotechnology, converge to unravel the complex substrates that subserve mental disorders...
The National Institutes of Health has pro posed the research domain criteria (RDoC) as an alternative diagnostic manual for mental disorders wherein the overarching aim is to define and categorize mental disorders on the basis of their underlying biological substrate. The proposal is long overdue and it is anticipated that efforts to refine the RDoC will progress the field forward with the hope that the mechanistic basis for mental disorders will be better understood. One is tempted to hypothesize that future iterations of DSM (or RDoC) may be an integrated manual wherein both phenomenological- and biologically-based criteria will apply. In the interim, diagnosing and categorizing mental disorders with a DSM-5 is the most practical tool available to us at this point in time. This reminds us of Churchill’s famous quote, “Democracy is the worst form of government, except for all those other forms that have been tried from time to time.” In contra-
distinction to forms of government, all possible alternative approaches to diagnosing and categorizing mental disorders have not yet been tried. The next decade will be extraordinary and exciting as advances in cognitive neuroscience, “-omics,” biomedical computational methods, and nanotechnology, converge to unravel the complex substrates that subserve mental disorders. Such efforts will likely change the way psychiatry diagnoses and categorizes illnesses, which will be the first step towards treating and preventing these highly disabling disorders.
1. Robins E, Guze SB, et al. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry. 1970; 126:983:987.
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The Canadian Biomarker Integration Network in Depression (CAN-BIND)
Sidney H. Kennedy, MD, FRCPC Professor of Psychiatry University of Toronto Toronto General Research Institute Psychiatrist-in-Chief University Health Network
ith the launch of the American Psychiatric Association’s new Diagnostic and Statistical Manual, DSM-5,1 comes renewed attention to the differences in diagnostic approaches to mental and physical illness. Many in the research communities of neuroscience, neuroimaging, and biological psychiatry had hoped for ‘the test’, or at least a preliminary attempt to integrate some biological measures into the vast array of symptombased checklists that characterize DSM-5. In fact, the director of the US National Institute of Health—Tom Insel—has generated considerable publicity with his criticisms of DSM-5 and promotion of the Research Domain Criteria (RDoC). 20 | IMS MAGAZINE FALL 2013 MOOD DISORDERS
What DSM-5 has done in the area of depression is attempt to clean up some of the most obvious areas of overlap and potentially overdiagnosis (e.g. bipolar disorder in children) and provide dimensions of crosscutting symptoms (e.g. anxiety) in patients with a Major Depressive Episode. If properly used, these dimensions will provide useful information about subsequent response to various treatments (evidencebased psychotherapies, like Cognitive Behavioral Therapy; antidepressant medications and device therapies, such as transcranial magnetic stimulation). The ultimate goal is to merge these symptombased predictors of response to various treatments with objective biological measures, or biomarkers. Today there are many complex analyses available to measure the intricate structure and function of genes, proteins, neural networks, and their expression in the body. The field of genetics has progressed from single gene studies to genomewide association studies and next generation sequencing.3 Epigenetics provides a model to explain how environmental events can change gene expression leading to longlasting effects on neurobiology and behavior.4 Proteomics— the study of the protein products of gene expression—has been used widely in other fields of medicine and is gaining popularity in psychiatric disorders.5 Imaging of structural, functional, and connectivity networks in the brain has allowed a whole new level of understanding of how individuals process emotional and other types of information. However, a recent review of current neuro-
imaging findings in mood disorders argues that there are no validated brain imaging biomarkers that are clinically useful in diagnosis or treatment prediction.6 Indeed, this applies equally to molecular and clinical domains. To make real progress, we need to develop a more complete picture of how all of these factors work together; this may well lead to a different classification involving clinical, imaging, and molecular markers. One way to achieve this is through large research consortia that collect and share data on a scale that would not be possible from a single site.7,8 The future will involve the convergence of data using advanced mathematical modeling and bioinformatics methods.
...Epigenetics provides a model to explain how environmental events can change gene expression leading to long lasting effects on neurobiology and behavior. This approach is the focus of the Canadian Biomarker Integration Network for Depression (CANBIND).9 University Healzh Network (University of Toronto) is the lead site with clinical collaborators at the University of British Columbia, University of Calgary, Queen’s University, McMaster University, and the Centre for Addiction and Mental Health (Table 1). Additional research sites are at the University of Guelph, McGill University, and the Ontario Cancer Biomarker Network. CANBIND is working in partnership with the Ontario Brain Institute (www. braininstitute.ca), which has designed BrainCODE, a large, secure database for storing
Photos by Laura Feldcamp.
This alternative approach to diagnosis assumes that data from genetics and clinical neuroscience will provide biosignatures that augment clinical symptoms through the integration of neural circuitry and behavioral dimensions such as reward, executive function, and impulse control.2
FEATURE Site & Principal Investigator University Health Network (Toronto) Dr. Sidney Kennedey
Centre for Addiction & Mental Health (Toronto) Dr. Arun Ravindran McMaster University (Hamilton) Dr. Benecio Frey Queen’s University (Kingston) Dr. Roumen Milev
University of Calgary (Calgary) Dr. Glenda MacQueen
University of British Columbia (Vancouver) Dr. Raymond Lam
1. Regier DA, Kuhl EA, Kupfer DJ. The DSM5: Classification and criteria changes. World Psychiatry. 2013 Jun;12(2):928 2. Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, Sanislow C, Wang P.Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010 Jul;167(7):74851. 3. Altmann A, Quast C, Weber P. Detecting rare variants for psychiatric disorders using next generation sequencing: a methods primer. Cur psychiatry Rep 2013; 15:333. 4. Saveanu RV, Nemeroff CB. Etiology of depression: genetic and environmental factors. Psychiatr Clin North Am. 2012; 35:5171. 5. Filiou MD, Turck CW, MartinsdeSouza. Quantitative proteomics for investigating psychiatric disorders. Proteomics Clin Appl. 2011; 5:3849. 6. Savitz JB, Rauch SL, Drevets WC. Clinical application of brain imaging for the diagnosis of mood disorders: the current state of play. Mol Psychiatry. 2013 May;18(5):52839. 7. Hyman SE. Revolution Stalled. Sci Transl Med. 2012; 4:155cm11. 8. Kapur S, Phillips AG, Insel TR, Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Mol Psychiatry 2012: 17:11741179. 9. Kennedy SH, Downar J, Evans KR, Feilotter H, Lam RW, MacQueen GM, Milev R, Parikh SV, Rotzinger S, Soares C. The Canadian Biomarker Integration Network in Depression (CANBIND): advances in response prediction. Curr Pharm Des. 2012;18(36):597689. 10. Mayberg HS, Lozano AM, Voon V, McNeely HE, Seminowicz D, Hamani C, Schwalb JM, Kennedy SH Deep Brain stimulation for treatment resistant depression. Neuron 2005; 45:651660. 11. Kennedy SH, Giacobbe P, Rizvi SJ, Placenza FM, Nishikawa Y, Mayberg HS, Lozano AM. Deep brain stimulation for treatmentresistant depression: followup after 3 to 6 years. Am J Psychiatry. 2011 May; 168(5):50210.
Tricia firstname.lastname@example.org Tracy email@example.com Kathleen firstname.lastname@example.org Glenda email@example.com Cindy firstname.lastname@example.org
Table 1. CAN-BIND Clinical Site Contact Information an unprecedented repository of clinical, imaging, and molecular data, housed at the High Performance Computing Virtual Laboratory (HPCVL) in Kingston. CANBIND is the recipient of peer-reviewed research funding from the Canadian Institutes of Health Research (CIHR), the Ontario Brain Institute, and generous donations to the Toronto General and Western Hospital Foundations from Lundbeck Canada and Servier Canada. CANBIND has a series of studies planned, with the first already underway, to collect and integrate data from carefully characterized depressed patients and healthy controls. It is hoped that in addition to the discovery of biomarker panels that can guide diagnosis and treatment of mood disorders, this research can also guide the development of novel treatments. At the University of Toronto, we identified a specific target for deep brain stimulation based on neuroimaging studies showing overactivity of the subgenual cingulate area in treatment resistant depression,10 and longterm followup after 36 years shows this to be a safe and effective option for patients who are refractory to other treatments.11 Repetitive transcranial magnetic stimulation (rTMS) is another neurostimulation treatment that is being ex-
plored as a method to directly influence the function of brain circuits involved in mood and emotional regulation. Other members of the CANBIND group, Drs. Jonathan Downar and Peter Giacobbe at University Health Network, are leading this research to identify the biomarker profiles most predictive of response to rTMS. The question for the future is whether we can use integrated tools based on current clinical and biological knowledge to make the best treatments available to the majority of patients. Once we discover the key proteins, genes, imaging markers, or clinical features that aid in the diagnosis and treatment of Major Depressive Disorder and other psychiatric disorders, how can we translate these findings into clinical practice? Knowledge Translation (KT) is another focus of the CANBIND program, which is being led by Dr. Sagar Parikh at UHN. We will employ ‘integrated KT’ throughout the program and will be engaged in dialogue with patient groups and frontline health care workers to communicate our findings and to learn about the needs of stakeholder groups.
IMS MAGAZINE FALL 2013 MOOD DISORDERS | 21
Temerty Centre For Therapeutic Brain Intervention Elizabeth McEwen
Jennifer Bennie, MEd
Z. Jeff Daskalakis, MD, PhD
BA Candidate, Queenâ€™s University IMS SURP student
Research Manager, Temerty Centre for Therapeutic Brain Intervention Centre for Addiction and Mental Health
Associate Professor of Psychiatry, University of Toronto Director, Temerty Centre for Therapeutic Brain Intervention Centre for Addiction and Mental Health
Background Scientists are researching new treatment options for individuals with treatment-resistant mood disorders at the Temerty Centre for Therapeutic Brain Intervention in Toronto. Mood disorders are often chronic and are accompanied by altered emotional experiences.1,2 As a result, patients experience changes in their ability to feel pleasure and joy. Of the mood disorder spectrum, depression and bipolar disorder can be particularly detrimental to an individualâ€™s ability to function daily. Mood disorders are far from uncommon; about 10% of Canadians will experience a mood disorder at some point in their lives.1 Of those diagnosed, roughly 30% will be unresponsive to the typical dose and course of medication. These patients are classified as treatment-resistant and are the focus of therapeutic brain interventions studied by scientists at the Temerty Centre.2,3 Depression and Bipolar Disorder Depression is characterized by severely low mood and can be accompanied by feelings of despair for an extended period of time. Depression involves a number of additional symptoms including fatigue and irritability, which can greatly impair everyday life.2 Bipolar disorder (BD), in contrast, causes extreme mood swings, such that patients experience both depression and mania, the latter being associated with disordered elevations in mood.4 BD is conventionally divided into bipolar I and bipolar II although other less common divisions exist. Bipolar I disorder is characterized by depressive episodes and manic or mixed episodes, which involve both mania and depression within a short period of time. Bipolar II disorder elicits depressive episodes and hypomanic episodes, the latter of which is conventionally regarded as a less intense form of mania.4 Like depression, the effects of BD can be devastating, with high rates of recurrence and suicide.4 While the exact causes of depression and BD are not fully understood, many things are known to contribute. These include but are not limited to genetics, emotional vulnerability, stress, and biological factors. The Mental Health Commission of Canada recently reported that 30% of short- and 22 | IMS MAGAZINE FALL 2013 MOOD DISORDERS
long-term disability leaves from work are due to mental illness. Missed work days and a lack of productivity while at work are specific challenges for individuals with mood disorders. Depression and bipolar disorder are also associated with higher mortality rates. In fact, depression is comparable to smoking in relation to mortality risk.6 Additionally, 38% of homeless people in Canada suffer from a mood disorder and there are fewer resources available to them.7 Therapeutic Brain Interventions The typical treatments for depression and BD including pharmacological treatments and psychotherapy. In severe and resistant cases of mood disorder (i.e. when other treatments fail), electroconvulsive therapy (ECT) is also used. ECT involves stimulation of the brain with repetitive electrical fields for the purpose of inducing a seizure. ECT, however, often causes memory worsening. The Temerty Centre researches therapeutic brain interventions and specific forms of brain stimulation, as an alternative to pharmacological treatments and ECT. Temerty Centre scientists have had successes in the application of repetitive transcranial magnetic stimulation (rTMS) and magnetic seizure therapy (MST) that are both alternative treatments to ECT.
Repetitive transcranial magnetic stimulation (rTMS) involves repetitive stimulation of the brain with magnetic as opposed to electrical fields. Using a coil placed on the scalp, the magnetic field travels into the brain where the electric current stimulates the targeted area.8 The process is painless and the patient is conscious throughout. By contrast, ECT uses a direct electrical current applied to the scalp to elicit a seizure while the patient is under general anesthesia.9 While rTMS and ECT both involve an electrical current being transmitted into the brain, rTMS uses a magnetic field to do so and does not result in a seizure. ECT is known to produce cognitive side effects and patients often have difficulties with re-orientation post-treatment.9 This occurs because the scalp acts as a barrier to the electrical current produced by ECT, and the stimulus is often shunted away from the area of focus in the brain. As a result, the electrical current impacts multiple areas of the brain and these multiple affected areas (e.g. hippocampus) are the areas typically associated with memory. However, MST has been introduced as a promising alternative with the ability to localize the area targeted in the brain. MST works by producing a seizure with very high-frequency rTMS, thus a high-
FEATURE frequency magnetic field.9 The magnetic pulse passes freely through the scalp, allowing more control over the areas targeted for stimulation. The Research At the Temerty Centre, rTMS is used to treat both treatment-resistant depression and BD, and research has shown decreased symptomtology in depressive features in patients with either disorder.10,11 Results vary by study, but George, Taylor and Short (2013) reported remission rates of 35-40% in depressed patients following rTMS combined with antidepressants, and Dell’Osso et al. (2009) found a significant decrease in depression in bipolar patients following rTMS. While research on rTMS is ongoing, results indicate that it is an effective treatment option for resistant psychiatric disorders. Currently, clinical trials for magnetic seizure therapy (MST) are being conducted at the Temerty Centre to assess the potential of MST as a treatment for depression. Results from preliminary MST research are promising, and have shown decreases in depression while leaving cognitive processes such as memory and orientation intact.12 In fact, MST was shown to be just as effective as antidepressants in treating depression.12 Dr. Zafiris Daskalakis, psychiatrist and Director of Brain Stimulation Research at the Temerty Centre, calls the improvements elicited by MST an “impressive.” As more research is conducted on MST, we will undoubtedly learn more about this exciting new intervention and its suitability for other treatmentresistant disorders. Temerty scientists are not just interested in treatment interventions; they are actively exploring the biomarkers in the brain for depression and BD. Biomarkers are biological indications of the presence of a specific disorder.12 While the biomarkers of many diseases have been identified, more research is needed on those of psychiatric disorders. Dr. Daskalakis explains, “I have patients asking me, ‘Well, how do you know I have depression?’ or ‘How do you know I have schizophrenia? Is there an objective set of tests that lead me to demonstrate that fact?’ That’s what we’re exploring.” Biomarkers are precisely the objective sets
of tests that can be used to determine the presence of a psychiatric disorder, and this information is very useful for diagnosis and treatment.13 Research on the biomarkers of treatment-resistant depression has shown differences in brain activity between patients with treatment-resistant depression and patients with responsive depression.14 With this knowledge, patients can be more efficiently diagnosed, and more effective treatment can be implemented without the patient having to go through a trial-and-error process. The high prevalence rate and negative impact of mood disorders emphasize the importance of developing effective treatments. While antidepressants work for many patients, there remain a large number of patients who require alternative interventions. rTMS and ECT have proven effective for many patients with treatment-resistant depression and BD, and studies on MST have shown promising results so far. Increased understanding of the biomarkers of mood disorders will also continue to provide new information to improve diagnosis and treatment. This is an exciting time for brain stimulation research. The Temerty Centre is working towards establishing a Canadian Brain Stimulation Network in addition to partnering with other countries such as the United States and Germany. In the coming years, the Temerty Centre will be expanding its research scope and will welcome more students and scientists to its team. Plans are also being made for a Fellowship in Brain Stimulation. With further research, we can continue to develop treatments that increase the likelihood of remission and lessen the negative impact of devastating mood disorders.
References 1. Canadian Mental Health Association. (2013). Facts About Depression and Bipolar Disorder. In Mental Health. Retrieved May 20, 2013, from http://www.cmha.ca/mental_health/factsabout-depression-and-bipolar-disorder/. 2. Hammen, C. & Keenan-Miller, D. (2013). In Stricker, G., Widiger, T. A., Weiner, I. B. (Eds.), Handbook of Psychology, Clinical Psychology (2nd Ed.). Hoboken, NJ, US: John Wiley & Sons Inc. 3. Fava, M. & Davidson, K. G. (1996). Defi-
nition and epidemiology of treatment-resistant depression. Psychiatric Clinics of North America, 2, 179-200. 4. Muller-Oerlinghausen B, Berghofer A, Bauer M. (2002). Bipolar disorder. TheLancet, 359, 241–247. 5. Mental Health Commission of Canada. (2013). Issue: Workplace. Retrieved June 6, 2013, from http://www.mentalhealthcommission.ca/English/Pages/workplace_guide. aspx?routetoken=d464469213f808685d6aeb c1167dbff9&terminitial=30. 6. Mykletun, A. (2009). Levels of anxiety and depression as predictors of mortality: The HUNT study. British Journal of Psychiatry, Vol 195, p. 118 – 125 7. Mental Health Policy Research Group (1998). Mental illness and pathways into homelessness: Proceedings and recommendations. Available through: The Centre for Addiction and Mental Health 8. Barker, T. A., Jalinous, R. & Freeston, I. L. (1985). Non-invasive magnetic stimulation of human motor cortex. The Lancet, 1, 11061107. 9. Hoy, K. E. & Fitzgerald, P. B. (2011). Magnetic seizure therapy for treatment-resistant depression. Expert Review Medical Devices, 6, 723-732. 10. George, M. S., Taylor, J. J. & Short, E. B. (2013). The expanding evidence base for rTMS treatment of depression. Current Opinion in Psychiatry, 26, 13-18. 11. Dell’Osso, B., Mundo, E., D’Urso, N., Pozzoli, S., Buoli, M., Ciabatti, M. … Altamura, A. C. (2009). Augmentative repetitive navigated transcranial magnetic stimulation (rTMS) in drug-resistant bipolar depression. Bipolar Disorders, 11, 76-81. 12. Fitzgerald, P. B., Hoy, K. E., Herring, S. E., Clinton, A. M., Downey, G. & Daskalakis, Z. J. (2013). Pilot study of the clinical and cognitive effects of high-frequency magnetic seizure therapy in major depressive disorder. Depression and Anxiety, 30, 129-136. 13. Boska, P. (2013). A way forward for research on biomarkers for psychiatric disorders. Journal of Psychiatry and Neuroscience, 38, 75-77. 14. Levinson, A. L., Fitzgerald, P. B., Favalli, G., Blumberger, D. M., Daigle, M. & Daskalakis, Z. J. (2010). Evidence of cortical inhibitory deficits in major depressive disorder. Biological Psychiatry, 67, 458-464.
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Neuroimaging In Depression: One Pathological Biomarker at a Time
alone are not helpful as spontaneous remissions are infrequent and they tend to occur only early in the course of clinical depression. On the other hand, therapies from psychological models have been successful. Such models can, and should, be integrated into a broad biological understanding, including key markers of pathology. Even so, most clinicians and researchers recognize that only a subset of those with clinical depression are likely to benefit from therapy; our biological understanding, therefore, remains vital.
Jeffrey H. Meyer MD, PhD, FRCPC
Institute of Medical Science PhD Candidate
Canada Research Chair, Neurochemistry of Major Depressive Disorder Centre for Addiction and Mental Health Department of Psychiatry, University of Toronto
ccording to the World Health Organization, clinical depression is currently the leading cause of death and disability in moderate- to high-income nations and will be the leading cause of death and disability worldwide by 2030.1,2 Clearly it is imperative that we increase our ability to prevent this illness and improve its treatment to avoid this concerning prediction. One approach towards understanding this illness at a biological level is to identify its fundamental changes in order to develop better strategies for prevention and treatment, just like any other medical illness. On the surface, this may sound overly challenging. It is sometimes said that there are no defining biological markers of clinical depression; however, the evidence accumulated suggests otherwise. There are a number of influential changes in the brain in clinical depression, such as reduced volume of the hippocampal memory structures of the brain, reduced levels of supporting type cells called glial cells, suboptimal levels of cellular signalling molecules, greater vulnerability of brain cells towards dying, and changes in chemical binding sites and enzymes reflecting deficiencies in levels of mood-controlling chemicals called monoamines.3,6 These differences each represent important pathological biomarkers, meaning they are abnormal changes implicated in either initiating or perpetuating symptoms of this disease. The complicated issue is that it is becoming increasingly evident that several changes are required to tip the balance from health to clinical depression. Another challenging issue pertains to the idea of control: since mood is something that is controllable through personal will and effort in health, should this not also be possible in illness? Unfortunately, the “snap out of it” or “pull yourself up by the bootstraps” approaches
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Are MAO-A levels different in clinical depression? In 2006, we led the first investigation of MAO-A levels in early onset clinical depression (before age of 40 years). We discovered that the concentration of MAO-A in clinically depressed patients was elevated by about 35% in comparison to healthy individuals.7
Photos by Laura Feldcamp.
Yekta Dowlati BSc, MSc
In this article, we demonstrate the approach of investigating important biomarkers of pathology, primarily through brain imaging monoamine oxidase A (MAO-A) density in people with clinical depression and depressed mood states. MAO-A is a protein in the brain with several important functions. One of these functions is to metabolize monoamine brain chemicals such as serotonin, norepinephrine, and dopamine. Depletion of these chemicals can induce sad mood and this was originally demonstrated in the 1950s when an antihypertensive medication called reserpine was developed that depleted these monoamines. People taking reserpine would sometimes develop a side effect of clinical depression, which, upon stopping the medication, often resolved.7 Another function of MAO-A is to create oxidative stress through the creation of hydrogen peroxide. Also, brain cells can make more MAO-A at times as a tool to bring such cells towards death. While we investigate MAO-A throughout the brain, our key interest is in the regions active in generating sad mood states and psychological symptoms of pessimism (i.e. the prefrontal cortex and anterior cingulate cortex).
FEATURE We chose early onset clinical depression because it is the most common type of depression and it is the type of depression usually induced by chronic stress, which had been implicated in raising MAO-A levels. Previous studies, which were negative, focused on late onset depression—which can be common to a variety of conditions such as Parkinson’s disease, Alzheimer’s disease, and strokes—while the question of an abnormal rise of MAO-A in early onset depression had been overlooked. We subsequently replicated our finding in a separate sample in 2009.9 In 2011, an independent laboratory reported similar elevated MAO-A levels and activity in a postmortem study of the prefrontal cortex, with a 40% difference between clinical depression and health.10 How do MAO-A levels relate to the state of clinical depression? Clinical depression is characterized by repeated episodes of major depression with variable levels of interepisode recovery. We have found that MAO-A levels often remain elevated even during recovery, and their elevation is associated with recurrence of a subsequent depressive episode.9 Unfortunately, the most commonly prescribed antidepressants, such as the Prozaclike selective serotonin reuptake inhibitors (SSRIs), do not target MAO-A.9,10 There is a partial match between this abnormality of elevated MAOA and SSRI treatment: MAO-A breaks down serotonin, and SSRIs counter this in part by raising serotonin where brain cells communicate with each other. However, MAO-A also creates oxidative stress, participates in apoptosis (programmed cell death), and breaks down other brain chemicals. We hypothesize that this mismatch may contribute to the inadequate response to treatment seen in 40% of people treated with SSRIs.9,10 Also, given the association of high levels of MAO-A with recurrence, we think this mismatch contributes to the high recurrence rates of 20% to 50% seen over 2 years with SSRI treatment in clinical settings. SSRIs are known to normalize some important pathological targets such as abnormal signalling in cells,11 but they do not normalize MAO-A levels. How does our environment influence MAO-A levels? We have identified several high risk states for depression, such as postpartum depression and heavy cigarette smoking. These are associated with elevated MAO-A levels, par-
ticularly in the brain structures that influence mood generation and pessimism. In 2009, it was discovered that estrogen decline is associated with greater MAO-A levels in cell lines and in rodents, but MAO-A had never been studied in early postpartum in any species. Estrogen levels drop over 100 fold during the first few days postpartum. In 2010, we discovered that MAO-A levels are elevated tremendously during days 4 to 6 postpartum, by an average of 43%. This is a timepoint of healthy range “baby blues” (a brief mood disturbance and mild depressive state linked to child birth, occurring in nearly 84% of women during the first week after delivery) for which the degree of sad mood is predictive of the likelihood for later clinical depression.12 Postpartum depression is the most common complication of childbearing with a 13% prevalence rate.13 In 2011, we discovered that heavy cigarette smoking, a strong risk factor for the onset of clinical depression and depressed mood, is also associated with greater MAO-A levels in mood controlling brain regions.14 It is becoming clear that our environment can temporarily lead to brain changes resembling the pathologies found in clinical depression. What can we do about elevated MAO-A levels? Our research targets three main areas for implementation. The first area that we are studying is how to reduce and/or reverse the elevation in MAO-A levels as a consequence of exposure to stress, estrogen, and toxic substances (e.g. cigarette smoke). Secondly, for situations where the elevation in MAO-A level is temporarily high (e.g. early postpartum), we are developing strategies to compensate for elevated MAO-A levels. An example of a targeted strategy includes the ingestion of dietary supplements containing the building blocks of the chemicals removed by MAO-A that might prevent the onset of postpartum depression. Thirdly, we are advancing our imaging technique to facilitate the development of antidepressants that specifically target MAO-A for depression that is resistant to traditional treatment options. We are hopeful that a step-by-step approach of preventing, compensating, and reversing key biomarkers of pathology will yield improved strategies for reducing the burden of clinical depression.
1. World Health_Organization. The Global Burden of Disease: 2004 Update. Switzerland: Department of Health Statistics and Informatics, Information Evidence and Research Cluster, WHO; 2008. 2. Murray CJL, Lopez AD. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Geneva, Switzerland; World Health Organization, 1996. 3. Shelton RC, Claiborne J, SidorykWegrzynowicz M, et al.: Altered expression of genes involved in inflammation and apoptosis in frontal cortex in major depression. Mol Psychiatry; 16: 751-62 4. Meyer JH: Neuroimaging markers of cellular function in major depressive disorder: implications for therapeutics, personalized medicine, and prevention. Clin Pharmacol Ther; 91: 20114. 5. Duman RS, Aghajanian GK: Synaptic dysfunction in depression: potential therapeutic targets. Science; 338: 68-72. 6. Rajkowska G, Stockmeier CA: Astrocyte pathology in major depressive disorder: insights from human postmortem brain tissue. Curr Drug Targets; March 2013. 7. Freis ED: Mental depression in hypertensive patients treated for long periods with large doses of reserpine. N Engl J Med 1954; 251: 1006-8. 8. Meyer JH, Ginovart N, Boovariwala A, et al.: Elevated monoamine oxidase a levels in the brain: an explanation for the monoamine imbalanceof major depression. Arch Gen Psychiatry 2006; 63: 1209-16. 9. Meyer JH, Wilson AA, Sagrati S, et al.: Brain monoamine oxidase A binding in major depressive disorder: relationship to selective serotonin reuptake inhibitor treatment, recovery, and recurrence. Arch Gen Psychiatry 2009; 66: 1304-12. 10. Johnson S, Stockmeier CA, Meyer JH, et al.: The reduction of R1, a novel repressor protein for monoamine oxidase A, in major depressive disorder. Neuropsychopharmacology; 36: 2139-48. 11. Dowlatshahi D, MacQueen GM, Wang JF, Young LT: Increased temporal cortex CREB concentrations and antidepressant treatment in major depression. Lancet 1998; 352: 1754-5. 12. Sacher J, Wilson AA, Houle S, et al.: Elevated brain monoamine oxidase A binding in the early postpartum period. Arch Gen Psychiatry; 67: 468-74. 13. O'Hara MW, Swain AM: Rates and risk of postpartum depression: a meta analysis. Internationalreview of psychiatry 1996; 8: 37-54. 14. Bacher I, Houle S, Xu X, et al.: Monoamine oxidase A binding in the prefrontal and anterior cingulate cortices during acute withdrawal from heavy cigarette smoking. Arch Gen Psychiatry; 68: 817-26.
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Mental Health Stigma tattooed, burned, or branded into the skin of people that society wanted to easily identify as outsiders, different, and easily distinguishable from others in society. Stigma has been defined as “a mark of disgrace” by which persons were socially shunned. Stigmatized individuals “possess (or are believed to possess) some attribute or characteristic that conveys a social identity that is devalued in a particular social context” and separates “us” from “them.”2
Associate Professor of Psychiatry, University of Toronto Chief of Psychiatry and Medical Director Mental Health Program, North York General Hospital
ental health stigma remains one of the only areas of socially accepted discrimination, often so inherent that it goes unnoticed. While significant progress has been made in decreasing stigma and discrimination based on gender, race, sexual orientation, and religion, stigma against people with mental illness and psychiatric issues remains prevalent in society. Think for a moment if you would go to visit a friend in a hospital, who is there because of a physical health condition. Now think if this person had a mental health problem. Would you visit? Would you tell others if you had a mental health problem? The growing area of anti-stigma activities includes: work by the Opening Minds group of the Mental Health Commission of Canada; several national mental health awareness campaigns; a recent anti-stigma position
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Rivian Weinerman MD, BSc (Med), FRCPC
Associate Clinical Professor, University of British Columbia Regional Head Division of Collaborative Care Psychiatry, Vancouver Island Health Authority Collaborative Care Psychiatrist, Collaborative Care Services, Victoria, British Columbia statement by the Canadian Psychiatric Association;1 and Canada’s first nationally accredited continuing education module “Combating Stigma for Physicians and Other Health Professionals,” launched in 2012 (www.cma. ca/antistigma). The University of Toronto’s Department of Psychiatry has identified antistigma activities as a key pillar in its strategic priorities and held the inaugural Mindfest public forum at Hart House in the spring of 2013.
What is Stigma? Stigma is a complex social process that is the culmination of prejudice and discrimination. Social stigma is severe social disapproval of or personal discontent with a person on the grounds of their unique characteristics, which distinguish them from others in society. The ancient Greek symbol “stigma” was
The 3 forms of stigma recognized by Goffman include: the experience of a mental illness (or the imposition of such a diagnosis); a physical form of deformity or an undesired differentness; or an association with a particular race, religion, belief, etc.4 Goffman’s theory has been criticized to associate blame with the individual. Power imbalance has been identified as a likely prerequisite, and “in many instances power differences are so taken for granted as to seem unproblematic.”5
Stigma subtypes Self-stigma is the term used when people internalize public attitudes of prejudice and discrimination with many negative effects to themselves. Courtesy stigma or stigma by association is a phenomenon that occurs when people who provide care or services to vulnerable populations are also stigmatized by association with the group receiving care.6 Structural stigma and discrimination refers to “institutional accumulated practices that work to the disadvantage of mental health patients even in the absence of individual
Photos courtesy of Dr. Ungar and Dr. Weinerman.
Thomas Ungar MD, MEd, CCFP, FCFP, FRCPC, DABPN
Almost all stigma is based on a person differing from social or cultural norms. Erving Goffman defined stigma as “the process by which the reaction of others spoils normal identity,” and thought that stigmatized individuals possess “an attribute that is deeply discrediting and reduces the bearer from a whole and usual person to a tainted, discounted one.”3
FEATURE prejudice or discrimination. This ‘disabling environment’ is created by the barriers to participation in receiving care that reside in the architecture or structures we have constructed.”5
The Impact of Stigma Stigma is one of the major barriers preventing people from seeking help. Many people with mental health conditions report feeling ashamed, unworthy, and undeserving, don’t tell others about what is going on, and report that the stigma is often worse than their illness. As a result, they often keep mental health issues secret. Survey statistics demonstrate that 40% of Canadian parents would not tell anyone if their child had a mental illness. Only 1 child in 6 who is diagnosed with a mental health problem gets help.7 One third of the news stories about mental health focus on murder and violent crimes, sensationalizing and misrepresenting the facts. This has a negative effect on primary care, as there is a relatively high prevalence of mental health issues in the general population. One in 10 people in Canada struggle with mental illness in a given year, and 1 in 5 in a lifetime.8 In Canada, mental health conditions are the leading cause of workplace disability, and economic costs are estimated at $6 billion annually. In 2020, depression will be the single leading cause of global disease burden, surpassing both cancer and heart disease.9 The adverse effects of stigma include delays in seeking medical treatment, early treatment discontinuation, difficulties in obtaining housing, adverse economic effects, poor quality of care, and increased mortality.10 Within health care, stigma has been described as the primary barrier to treatment and recovery.
Stigma Intervention Strategies Protest initiatives to change offensive language or behaviour have demonstrated limited benefit and can backfire. Traditional education focusing on improving literacy, help-seeking, as well as social marketing campaigns aimed to improve awareness and attitudes have shown modest benefit. One of this paper’s authors has created a public multi-media social marketing and information website at
Contact-based education involves interaction and contact with a person with mental health condition in recovery and has amongst the best evidence to improve attitudes. Structural change intervention includes both legislative and policy changes aimed to improve equity and social justice, and it is also an evidencebased recommendation. Structural change is informed by the Social Justice Model of autonomy, civil rights, and a right to health, as outlined in the UN convention on the Rights of Persons with Disabilities (2007) and the Canadian Charter of Rights and Freedoms (1982).
1. Abbey S, Charbonneau M, Tranulis C, et al. (2012) Stigma and discrimination. Can J of Psychiatry; 56: 1–9. 2. Crocker J, Major B, Steele C. 1998. Social stigma. In The Handbook of Social Psychology, ed. DT Gilbert, ST Fiske, 2:504-53 Boston ,MA : McGraw-Hill 3. Goffman E. 1963 Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice Hall 4. Goffman E. 1990. Stigma: Notes On The Management of Spoiled Identity Penguin Group, London, England. 5. Link BG, Phelan JC. Conceptualizing stigma. Annu. Rev. Sociol. 2001. 27:363–85 6. Benoit C, Shumka L, Barlee D. Stigma and the health of vulnerable women. Research Brief 2. March 15, 2010. Women’s Health Research Network. http://www.whrn .ca/ http://www.whrn.ca/documents/WHRN_ Brief_Stigma.pdf 7. Nettleton S. The Sociology of Health and Illness. Cambridge, UK: Polity Press; 2006 pp.95 8. Mood Disorders Society of Canada (2009). Quick facts: Mental illness and addiction in Canada (3rd Ed.) Available from: http:// www.mooddisorderscanada.ca/documents/ Quick Facts 3rd Edition Eng Nov 12 09.pdf 9. Murray CJ, Lopez AD. Global health statistics. Cambridge, MA, Harvard School of Public Health, (Global Burden of Disease and Injury Series, vol. II), 1996. 10. Atzema CL, Schull MJ, Tu JV. The effect of a charted history of depression on emergency department triage and outcomes in patients with acute myocardial infarction. CMAJ. 2011: Apr 5;183(6):663-9. http://www.ncbi. nlm.nih.gov/pubmed/21398248 11. Weinerman R, Campbell H, Miller M, Stretch J, Kallstrom L, Kadlec H, Hollander M. Improving mental healthcare by primary care physicians in British Columbia. Healthc Q. 2011;14(1):36-8. http://www.ncbi.nlm. nih.gov/pubmed/21301237 12. Ungar T ,Knaak S. The Hidden Medical Logic of Mental Health Stigma. Aust N Z J Psychiatry on line first Feb 12, 2013 http://anp.s agepub.com/content/e arly/2013/02/11/0004867413476758 13. Arboleda-Florez J, Stuart H. (2012) From Sin to Science: Fighting the stigmatization of mental illnesses. Can J Psychiatry Aug; 57 (8): 457-63.
Strategies targeting physicians and health care providers include a benchmark onlineaccredited Continuing Education module “Combating Stigma for Physicians and Other Health Professionals” (www.cma.ca/stigma), created by this paper’s authors by using the Cognitive Behavioural Interpersonal Skills (CBIS) manual to introduce clinical skills enhancement to family physicians, shown to increase mastery and combat avoidance.11 A current debate about anti-stigma interventions is whether to share biologic disease state information about mental illness. This can worsen stigma for the public and lead to the incorrect conclusion that mental health disorders are permanent brain damage. But health providers may have a different paradigm for biology, so teaching the biology of mental illness may be as useful as an intervention to legitimize mental illness and improve quality of care.12
Future Directions Future efforts will likely embrace the human right to health, social justice advocacy, with policy and legislative change, and contactbased education.13 The Recovery and Hope movements increasingly perceive stigma as a social problem and advocate for an individual’s autonomy, responsibility, and participation in their own recovery. For scientists, scholars, and advocates looking for maximal impact of their work, anti-stigma studies is rich with opportunity.
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EXPERT OPINION for psychiatric illnesses, nor has understanding more about the etiology of these disorders greatly improved clinical practice. In fact, most drug treatments in psychiatry have been developed from trial and error without an a priori understanding of the brain mechanisms involved. Even at the individual patient level, the “trial and error” method is used to determine the most effective dosage or cocktail of drugs for the patient, as wellexemplified by treatment practices of patients with depression.1 This slow progress in understanding psychiatric illnesses can be attributed to the complexity of the brain, the most enigmatic organ in the human body. In contrast to cancer, which in some cases can now be diagnosed and treated at the genomic level, psychiatric disorders lack a clear pathological signature, thus leading to difficulties in characterization.2
Why Should We Care About Neuroscience?
r. Albert Wong is not your traditional white-coat psychiatrist. Long flowing hair, black t-shirt and jeans, Wong has the look of a rock star. In fact, he is the lead singer and guitarist of an electronic psychedelic band that performs at local concerts in Toronto. But during the day, Wong works as a full-time psychiatrist at the Center for Addiction and Mental Health (CAMH) and as an associate professor at the Institute of Medical Science (IMS) and the Departments of Psychiatry and Pharmacology at the University of Toronto (U of T). As both a clinician and neuroscientist, Wong splits his time between treating patients with schizophrenia and researching the underlying mechanisms of their illness in the lab. In his recent talk, entitled “Why should we care about neuroscience?” at the TEDMED IMS Day, Wong presented the rationale for why neuroscience should represent the basis of psychiatry. He simply explains, “Neuroscience can help us understand the emotions and behaviors in our patients. While we do not know the neurobiology of schizophrenia, we do know a lot about the neurobiology of anger, love, and fear.” These concepts of neu-
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By Jill Cates roscience are further examined in the weeklong neuroscience lecture series that Wong runs for second-year psychiatry residents at U of T. With wide-ranging topics such as partner preferences in mates, violence and aggression, cross-species comparisons, and receptor biology, the lectures are meant to expose interesting, quirky, and controversial elements of human behavior that have a neurobiological explanation. The lectures showcase breakthroughs and discoveries in neuroscience to reveal the potential impact that neuroscience research may have on the future of psychiatry. The overarching goal of the lecture series is to provide residents with a greater appreciation and understanding for the role that neuroscience plays in psychiatry. Wong, though, still has difficulties convincing others that neuroscience is important to psychiatry. “There is a lack of interest in neuroscience among psychiatry residents because—just like any other resident— they want to learn practical things that will help them directly treat their patients,” says Wong. These residents raise a good point: our current knowledge of neuroscience has not yet led to breakthrough new treatments
Studies have identified some subtle structural abnormalities in the brains of individuals with psychiatric illnesses. For example, brain volumes and the architecture of the cortex is abnormal in schizophrenia.3 However, such abnormalities are too subtle, variable, or non-specific to the disease to be used to distinctly identify a diseased brain. “At present, no animal model can capture the complexity of human psychiatric disease,” explains Wong, “but some models can highlight certain parts of disease that allow us to indirectly test treatments.” The complexity of the brain has resulted in slower advances in the field of psychiatry than other disciplines. Wong explains, “In psychiatry, we are at the same stage that people were at treating other symptoms 50 years ago.” Despite current limitations, the future of neuroscience is promising. The recent development of cutting-edge tools has opened new opportunities for neuroscientists to study the pathways involved in psychiatric illness. Understanding these pathways may lead to novel hypothesis-driven treatments that effectively target the root cause of illness, and change the way psychiatrists diagnose their patients. At CAMH, Wong’s research group is investigating the mechanisms underlying schizophrenia at the genetic, cellular, developmental, and clinical level. His lab takes both a basic science and clinical science approach to the study of schizophrenia. Wong’s wet
Photos by Chung Ho Leung.
Dr. Albert Wong
EXPERT OPINION bench research uses mouse models to investigate gene-environment interactions, epigenetics, gene transcription, and neurodevelopment. More specifically, his research team studies the disrupted in schizophrenia 1 (Disc1) gene in mutant mouse models to characterize genetic and environmental effects on neuron migration during cortical development. A former graduate student, Frankie Lee, showed that Disc1 mutants have abnormal cortex lamination, reflecting irregularities in neuron migration.4 In terms of clinical applications, Wong hopes that these mouse models can be used as “a platform to test novel drugs that directly target the biology of illness rather than only counteracting symptoms of the illness.”5
Neuroscience can help us understand the emotions and behaviors in our patients. In a recent research endeavour at the clinical level, Wong and his IMS graduate student, John Zawadzki, investigated spatial navigation in patients with schizophrenia using a virtual reality (VR) environment. An early example of using VR technology in psychiatry comes from Emory University, where Dr. Kerry Ressler’s group treated patients with post-traumatic stress disorder (PTSD) and anxiety by using a virtual environment for exposure therapy.6 For example, war veterans with PTSD view VR environments that resemble war zones in order to help desensitize them to the anxiety responses those stimuli provoke.7 Others have used virtual environments to understand how humans navigate
through space,8,9 and Wong aims to expand the use of VR technology to study the mechanisms underlying schizophrenia through spatial navigation simulations. “There are many brain areas that have to work together to complete any complicated task,” Wong explains, “and there are some that are more critical than others.” In spatial navigation, the striatum and hippocampus are two critical parts of the brain that support two different navigational strategies. The striatum is used for stimulus-response memory to navigate (e.g. using landmarks to find your way home), while the hippocampus supports a virtual map to navigate (e.g. the relative spatial positions of various locations). Most people switch back and forth between these two navigation strategies. However, in patients with schizophrenia, the hippocampus appears to be dysfunctional. Wong plans to explore how hippocampal navigation is altered in patients with schizophrenia, using a VR cityscape environment that his research team has developed in collaboration with Sheridan College in Oakville, Ontario. The VR cityscape is meant to simulate the experience of exploring an unfamiliar city for the first time. Preliminary results have shown that patients with schizophrenia take more time to navigate in the VR city compared with healthy participants, suggesting that abnormalities in brain regions that control navigation (hippocampus and striatum) exist in this psychiatric population.10 The next phase of their study will incorporate functional magnetic resonance imaging to study hippocampal and striatal activity in patients with schizophrenia in a VR environment.
Between his work in Disc1 mutant mice and VR schizophrenia studies, Wong is at the forefront of exciting and cutting-edge neuropsychiatric research. Neuroscience is reaching a “golden age” era where recent major breakthroughs are starting to unravel mysteries of the brain. From brain-computer interface technology, memory storage on microchips, and the Brain Mapping Project led by President Obama, to name a few, neuroscientists are furiously working to better understand the brain and what causes psychiatric illness. While Wong currently has two separate roles of “psychiatrist” and “neuroscientist,” his research in the lab may one day directly influence the way he and his colleagues diagnose and treat patients.
Neuroscience is reaching a “golden age” era where recent major breakthroughs are starting to unravel mysteries of the brain.
References 1. Rush AJ, Trivedi MH, Wisniewski SR, et al. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med. 2006;354:1231-42. 2. Kapur S, Phillips AG, Insel TR. Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Mol Psychiatry. 2012;17:11749. 3. Harrison PJ. The neuropathology of schizophrenia. A critical review of the data and their interpretation. Brain. 1999;122:593-624. 4. Lee FH, Fadel MP, Preston-Maher K, et al. Disc1 point mutations in mice affect development of the cerebral cortex. J Neurosci. 2011;31:3197-206. 5. Lipina TV, Haque FN, McGirr A, et al. Prophylactic valproic acid treatment prevents schizophrenia-related behaviour in Disc1-L100P mutant mice. PLoS One. 2012;7:e51562. 6. Ressler KJ, Rothbaum BO, Tannenbaum L, et al. Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry. 2004;61:1136-44. 7. Gerardi M, Rothbaum BO, Ressler K, et al. Virtual reality exposure therapy using a virtual Iraq: case report. J Trauma Stress. 2008;21:209-13. 8. Maguire EA, Burgess N, Donnett JG, et al. Knowing where and getting there: a human navigation network. Science. 1998;280:921-4. 9. Ekstrom AD, Kahana MJ, Caplan JB, et al. Cellular networks underlying human spatial navigation. Nature. 2003;425:184-8. 10. Zawadzki JA, Foussias G, Rodrigues A, et al. Spatial navigation in schizophrenia using a realistic virtual city. Schizophr Bull. 2013;39:S254.
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Book Reviews Excellent
Worth missing a day at the lab
Squeeze in between experiments
person outside this particular field of philosophy could fully grasp Popper’s writing.
Karl Popper The Logic of Scientific Discovery (Karl Popper). First Published 1935. Routledge Classics, English Edition 1959, Reprinted 2010; 488 pages Sir Karl Popper stands as one of the greatest philosophers of science to have ever lived. Popper’s seminzal text The Logic of Scientific Discovery is among the most influential works of 20th century philoso phy. Originally published in German as Logik der Forschung (“The Logic of Research”) in 1935, with the first English edition appearing in 1959, The Logic of Scientific Discovery is a coherent, intellectually exhilarating masterpiece. With Popper’s lucid thought composition, one could easily comprehend the ideas expounded by the author. However, the text is so rich with a vast array of complex philosophy, logic, and probability theory—compounded by the pervasive usage of mathematical equations, Greek symbols, and quantum mechanics—it is a wonder that any 30 | IMS MAGAZINE FALL 2013 MOOD DISORDERS
Popper assumes the reader has a thorough grasp on a broad range of concepts common in philosophy, science, and physics. In a footnote, Popper actually advises at first reading to skip large portions of the text dealing with probability theory, Bernoulli’s Theorem, statistical interpretations of Heisenberg’s uncertainty relations, indeterminist metaphysics, and so on. The original text only comprises half of the book, with the rest being appendices, 19 in total, delving into the mathematics of even more complicated concepts, including the general calculus of frequency in infinite classes, derivations of binomial formulae, and construction of models of random sequences. It seems safe to assume The Logic of Scientific Discovery is not easily accessible to educated readers, never mind to lay readers. Nonetheless, with the mathematics and equations aside, Popper’s chef-d’oeuvre should be widely read and discussed by the philosophers, and perhaps more importantly, the scientists of today. An understanding of Popper’s theories is indispensible for an appreciation of what differentiates science from other branches of knowledge, and what propels the advance of scientific discovery. A scientist constructs hypotheses, or systems of statements, and tests them step by step against experience by observation and experiment. Popper in his book ventures to give a logical analysis of this scientific procedure. What are the ‘methods of the empirical sciences’, and do we call ‘empirical science’? It is widely believed that empirical science is established using inductive methods/logic—a position actually opposed by Popper. An inductive inference is one that passes from particular statements to universal statements. However, it does not seem we are logically justified in inferring universal statements from singular ones—a thus far insoluble dilemma known as the ‘problem of induction’. Popper opposes all attempts to operate with the ideas of inductive logic in science and instead advances a theory that is described as the ‘deductive method of testing’.
Wait for the weekend
Wait until degree is complete
By rejecting the ‘method of induction’, it would seem that Popper’s theory is open to the charge of depriving empirical science of its most important characteristic, viz. inductive logic, which functions as a ‘criterion of demarcation’, separating science from metaphysical speculation. Inductive logic is rejected by Popper as a suitable criterion of demarcation and replaced by—what would come to popularly characterize his theory—‘falsifiability’. Popper states, “I shall certainly admit a system as empirical or scientific only if it is capable of being tested [and refuted] by experience.” Popper wraps up with a series of concise and elegant conclusions. Science does not contain certainties, Popper states, nor does it steadily advance towards some state of finality. “Bold ideas, unjustified anticipations, and speculative thought, are our only means of interpreting nature…. Those among us who are unwilling to expose their ideas to the hazard of refutation do not take part in the scientific game.” “[Science advances] towards an infinite yet attainable aim: that of ever discovering new, deeper, and more general problems, and of subjecting our ever tentative answers to ever renewed and ever more rigorous tests.”
Column by Benjamin Mora
If you are an IMS faculty member or student and would like to have your book review published in a future issue of the IMS Magazine, please send a 50-word review to email@example.com.
BOOK REVIEWS great-grandniece of Napoleon. Unsettled by her difficulty in reaching sexual orgasm, Marie sought to explain this by measuring the distance between the clitoris and vagina in 243 subjects, and later comparing the distance to their frequency and ease of orgasm. Apparently for women, size does matter.
Mary Roach Bonk: The Curious Coupling of Science and Sex W.W. Norton & Company, 2008; 319 pages Her unquenchable curiosity doesn’t simply end at the strange lives of our body’s post-mortem and the possibility of an afterlife. In Bonk, Mary Roach forays into the provocative and perhaps most arousing subject of all: sex, and answers questions that we’ve all wondered, but were too shy to ask. Packed with humorous punches and sprinkles of interesting factoids, Roach details the journey of sexual physiology research from the present day harking all the way back to the ancient Greeks. Roach begins her thorough survey of sex research with Alfred Kinsey, who is best known for his daring encyclopedic surveys of sexual behavior in the in 1940s and ‘50s. What Kinsey is less known for are his “attic films”—secret recordings of thirty sexual couplings—to observe and document the physiological response of the body to sexual simulation, all of which took place on a mattress in his very own attic. Although controversial, Kinsey became a pioneer of sex research and provided the foundation for the myriad of sexual research that would follow, in particular ones involving a “penis-camera.” Occasionally, Roach takes us past Kinsey’s times and unveils one of history’s lesser-known amateur scientist, Princess Marie Bonaparte, the
As you can imagine, not all sex researchers welcome Roach’s inquisitive nature, but when appropriate or possible, Roach travels to meet the scientists and doctors who have risked their reputation and career “for the sake of understanding the world.” The author visits a Dutch farm where pig farmers are advised by the government to sexually stimulate a sow while they artificially inseminate her. The farmers are provided with a government-backed Five-Point Stimulation Plan, complete with instructional DVD. According to Dutch researchers, this course of action leads to a six percent improvement in fertility, as the resulting uterine contractions (also known as the “upsuck” theory) are said to produce more piglets. Could female orgasm serve another purpose outside the realm of pleasure? Roach also traveled across the world to Taiwan, where she visited renowned urological surgeon Dr. Geng-Dong Hsu, who specializes in microsurgical restoration of male potency. Dr. Hsu provides a comforting word about the crooked penis, “Most men are communists! Lean to the left! Second most common: bow down, like Japanese gentleman! Number three, to the right. Four up! Like elephant!” Roach takes us on a journey behind the closed doors of research laboratories, pig farms, operating rooms, MRI centers, the development of Viagra for both men and women, and the world of sex-toys’ Research & Development labs. The author’s participation is not limited to observation alone, she frequently throws herself enthusiastically into her work, giving her an added appreciation for the volunteer subjects who contribute to the scientific study of sexuality. In Bonk, Roach details her experiences with a vaginal photoplethysmograph—a light source detector that assesses vaginal blood flow as a measure of sexual arousal—as the experimenters measured her level of arousal while watching an erotic video. The author spares no one, especially not herself or her husband. When Roach came across Dr. Deng’s research on the experimentation of 4-D ultrasound imaging to capture real-time images of human intercourse, Roach and her graciously willing husband, Ed, became the first volunteers to participate in this study.
In Bonk, Mary Roach demonstrates her unique yet pleasant sense of humor and her fully immersed approach that has popularized her previous books, Stiff and . Coupled with a fascinating survey of sexology, Bonk is a delightful read. Laughter and curiosity aside however, Roach is appreciative and sympathetic to the lives of sex researchers, “their lives are not easy. But their cocktail parties are the best.” She notes the difficulties for sexologists to acquire research funding and while often snubbed by other scientific disciplines. Let’s learn to embrace that sexuality is one of the most fundamental aspects of human existence and “the aggregation of all that has been learned, the learning tango of academe and popular culture, has led us to a happier place.”
Column by Winny Li Nina Bahl, MSc, recommends The Art of Happiness: A Handbook for Living by the Dalai Lama and Howard C. Cutler
Happiness is a product of our mind rather than circumstance: The Art of Happiness inspires thoughtful exploration of this age-old notion by merging the “western” perspective of Cutler, an American psychiatrist, with Buddhist philosophies put forth by the Dalai Lama. In a series of conversations between the two, Cutler poses honest questions (Why do we suffer? How do you handle the death of a loved one?) that prompt candid, meaningful answers from the Dalai Lama. Their dialogue helps relate the Dalai Lama’s wisdom to our everyday lives and transcends any spiritual or cultural biases. Truly an uplifting read.
Brittany N. Rosenbloom, MSc candidate, recommends How the Mind Works by Steven Pinker
How the Mind Works is not just a book about the brain, its structures, and hypothesized functions. Pinker articulately draws from every avenue of life—including the arts, history, psychology, astronomy and, perhaps obviously, neuroscience—to explain the mind and how we came to find information on the brain and how it works, all while exploring questions that have yet to be answered. Though the content is dense, Pinker uses witty humour and rhetorical questions allowing for reflection and understanding of these complex topics. IMS MAGAZINE FALL 2013 MOOD DISORDERS | 31
n April 19th, 2013 the Institute of Medical Science (IMS) proudly presented the first ever TEDMED Day at the University of Toronto (Faculty of Medicine). TEDMED is an exceptional event where world-class “doers and thinkers” share their vision of the future for health and medicine. TEDMED Day featured inspira-
tional live talks by experts from the IMS and broadcasted selected live presentations from the TEDMED Conference at the Kennedy Centre in Washington, DC. There was a wide range of fascinating health topics covered by the speakers, including neuroscience, cancer biology, genetics,
and organ transplantation. TEDMED Day provided a great opportunity to get to know fellow students and to learn from our very own leading scientists and clinicians. The IMS faculty speakers left their audience with some memorable and inspirational ideas and quotes!
By Anna Podnos, Nancy Butcher
Dr. Gillian Einstein Sex and the brain
“We need to do biological science that takes diversity, plasticity, and the social into account.”
Dr. Ori Rotstein Trauma care: What to do on the way to surgery
“What can we do better in the ambulance to treat trauma?”
“Neuroscience is important because it can teach us about human behaviour and nature – what it really is and not what we think it should be.”
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Photos by Chung Ho Leung.
Dr. Albert Wong Why should we care about neuroscience?
Dr. Anne Bassett Can genetics illuminate the darkness in psychiatry?
“[We are beginning to see] glimmers of light in understanding schizophrenia through knowledge of [genetic] structural variants [and] reducing blame and stigma for patients and their families.”
Dr. Gary Rodin Research and the meaning of life
“No one is comfortable sitting by a dying patient, but our goal is to help the process and to allow patients and their families to hold on to life, while also facing its ending.”
Dr. Randy McIntosh The virtual brain
“The virtual brain sets up a dialogue between real brains and brain models, opening the possibility for new global collaborations to understand brain function and dysfunction in ways we never thought possible.”
Dr. Shaf Keshavjee Lung transplantation and the quest to build a new lung
“Our goal is to replace, repair, and regenerate lungs… In fact, we just finished a baby lung transplant this morning.”
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Social chameleon-ism Survival of the fittest schmoozer
By S. Amanda Ali
Depending on the crowd, we draw on different aspects of our personalities and relate to others in different ways. Among co-workers we behave in a professional manner; cordial with everyone, friendly with some, but guarded at all times. Among friends we adjust the conversation accordingly from colloquial to contemplative to corporate depending on the group, be they highschool friends, weekend friends, university friends, work friends, or whatever friends. Among family we are more likely to let our guard down and show more than one version of ourselves, depending on our mood at a given time.
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These changes in our behaviour make us social chameleons. Also described as impression management, self-monitoring, and social control, our ability to adapt to different social settings is truly a skill.2 As with any skill, some people are better than others, practice makes perfect, and extremes can be deleterious. Those who are exceptionally good at social “chameleon-ism” verge on sociopathic, while those who are particularly bad at it can be social outcasts.1 This ability to blend-in may be construed negatively, as having a poor sense of self, as needing the approval of others, as being a push-over. Conversely, it may be construed positively, as having the ability to acclimatize to different contexts, as being relatable and versatile, as being agreeable.1 Now take an individual who is potentially already socially inept (see “Social Ineptitude”, IMS Magazine, Fall 2012), immerse them in one small subject to the point of expertise, surround them with like-minded scientists, make them highly educated compared to the general population, and what do you get? An utterly one-dimensional graduate student with no hope of relating to those in the outside world.
...Unless a scientist has the
ability to interact with these different groups of people on a basic level, barriers are erected. Barriers to translation, to funding, to commercialization. Barriers to progress. Barriers to success. Graduate school does not exactly provide exposure to diverse environments or personalities. Scientists are trained in a specific way of thinking for the specific goal of pursuing academia. But with more PhDs being trained than needed (see “PhDs: Training for Jobs that Don’t Exist”, IMS Magazine, Spring 2013), there is increasing motivation for scientists to pursue relationships with clinicians, government, industry, and other sectors. Unless a scientist has the ability to interact with these different groups of people on a basic level, barriers are erected. Barriers to translation, to funding, to commercialization. Barriers to progress. Barriers to success. Overcoming these barriers requires network-
Photo courtesy of www.istockphoto.com; ID # 17061678.
short subway ride from the city centre to the suburbs can transform a person: from a student completing a degree to a child obeying parents’ rules, from a professional in a board room to a parent in a play room, from a pedestrian commuter to a car-oholic. Our surroundings influence us in such a way that we adjust our behaviour to assimilate and “fit in” with those around us. We do it because we want to be liked, because we seek acceptance, because social norms stipulate that certain behaviours are appropriate in certain settings.1
VIEWPOINT ing–the essence of which is well understood by the social chameleon. Genuine networking is facilitated by the ability to strike up a conversation with anyone, comfortably, and find common ground. This creates a memorable interaction and causes both parties to leave feeling connected. The connection can be established over rare commonalities (like having both gone skydiving) or popular commonalities (like support for a sports team). The number of commonalities we identify in those initial interactions contributes to us liking a person, remembering them, and wanting to see them again.3 Whether for a professional opportunity, a romantic date, or a new friend, the dance is the same. This “schmooze” factor comes more naturally to the social chameleon with diverse experience to draw from, experience which makes them more relatable. Juxtapose this to a dry conversation with an awkward scientist and the problem is evident. Today’s society places great value on our ability to network. No longer relevant is a deep-rooted friendship with your next-doorneighbour, instead the goal is to maximize your social network with Facebook friends, Twitter followers, LinkedIn connections, and so on. While the old adage, “It’s not what you know, it’s who you know,” is truer than ever, the way in which we now get to “know” people has taken a turn towards superficiality. You meet a person, find a common interest, discuss it, and decide whether to exchange email addresses. Crucial to this equation is finding that common interest, feeling the “click”, establishing the connection–it’s what sets some interactions (and some graduate students) apart from others. Hope for reform remains for the one-dimensional graduate student who chooses to pursue extracurricular activities, to participate in cultural events, to travel to exotic destinations. These activities serve to broaden perspectives, cultivate life experience, and enrich thinking. These activities provide basis for maintaining conversation with individuals outside of one’s typical network, simply because there is more chance to find common ground. A diversity of experiences both creates and strengthens the social chameleon by allowing them a worldliness that facilitates interaction with others. Consider the hiring process and advantages
enjoyed by social chameleons. Having recently sat on two very different hiring committees (one for a teaching assistant, the other for a director of a graduate program), there was one resounding commonality: when all candidates are equally accredited (with PhDs, for example), hiring committees look for unique and distinguishing accomplishments. Volunteer service? Triathlons? Business ventures? If taken too far, an applicant who gushes about their extracurricular activities can be seen as unfocused or lacking substance. If presented properly, these diverse experiences can set an applicant apart from the others by making them appear better rounded. If all candidates are equal, the one who started their own restaurant may be chosen; a hiring committee can interpret this to represent vision, creativity, and drive. In other words, hiring committees are looking for multidimensionality, and this is a typical characteristic of the social chameleon.
...The more exposure an in-
dividual has to different realms of life, the better their ability to schmooze with others and advance their goals, be they career, romantic, or otherwise. This experience is gained by venturing outside of one’s proverbial “box” and trying new things. Overall, social chameleons appear to have a special competence in social contexts, and this affords them an advantage in networkbased endeavours; but there are drawbacks to having multiple versions of the self. The mental effort that is required to keep the superficial-self malleable while maintaining the core-self fixed can be taxing if constantly demanded. Also arduous is orchestrating the intersection of different worlds (describing your thesis project to your family, or explaining your hang-over to your supervisor). Furthermore, if the superficial-selves conflict, it may cause questioning of the core-self, and confuse our true values. A classic example is presented by the collision of religious and secular beliefs. If the social chameleon subscribes to creationism among religious circles but evolution among scientific communities,
they may find themselves in epistemological crisis. Some people are better than others at harnessing their inner social chameleon. They have a healthy ability to strike up conversation and find commonalities with diverse groups of people while maintaining a clear sense of self. This ability can be developed and fortified by accumulating diverse experiences. The more exposure an individual has to different realms of life, the better their ability to schmooze with others and advance their goals, be they career, romantic, or otherwise. This experience is gained by venturing outside of one’s proverbial “box” and trying new things. In support of social chameleon-ism, Aristotle noted, “It is the mark of an educated mind to be able to entertain a thought without accepting it.” Disclaimer: The opinions expressed by the author are in no way affiliated with the Institute of Medical Science or the University of Toronto. Comments are welcome at theimsmagazine@gmail. com.
References 1. Goleman D. ‘Social Chameleon’ May Pay Emotional Price. The New York Times. 1985. 2. Riggio R. Are You a Skilled Social Actor or a Social Chameleon? Psychology Today. 2012. 3. Morry MM. The attraction-similarity hypothesis among cross-sex friends: Relationship satisfaction, perceived similarities, and self-serving perceptions. Journal of Social and Personal Relationships. 2007 February 1, 2007;24(1):117-38.
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Revolutionary New Simulator Preps Doctors for the OR
“What Michael has done is revolutionary,” says Dr. Gordon Tait, the founder of Peri36 | IMS MAGAZINE FALL 2013 MOOD DISORDERS
operative Interactive Education (PIE) at the Toronto General Hospital and an assistant professor in the Department of Surgery at the University of Toronto. Cardiologists, trained ultrasound technologists and, increasingly over the past ten years, anesthesiologists, perform TEE to evaluate the structure and function of the heart. They perform TEE before, during, and after surgery to look for problems. After an artificial valve surgery, for example, the anesthesiologist might look around using TEE, find a leak, and send the patient back to the operating room. In a TEE exam, a trained echocardiographer inserts a flexible probe into the patient’s esophagus to examine the heart. The esophagus passes directly behind the heart. Attached to the end of the probe is a device called a transducer. The transducer sends out
ultrasounds waves to the heart. The sound waves bounce off the heart and a computer converts them into images displayed on a screen. Performing TEE requires two skill sets: manual skills to acquire the images and the knowledge to interpret the images. Doctors learn the manual skills through observation, mentored practice in the operating
PIE creates interactive teaching modules for anyone around the world who wants to learn about perioperative medicine. room, and more recently, through practice on an echocardiography simulator mannequin. Depending on the options it comes
Photo by Nick Woolridge
trainee clicks and drags a mouse to push and pull a virtual probe. She positions the probe at one of the “standard” positions from an onscreen menu. She manipulates the probe to try to obtain another view of the virtual heart and checks her results. She continues to manipulate the probe to navigate between views. In response, the trainee receives the same visual feedback of a slice of the heart that she would receive on the screen in the operating room. But in this simulation of transesophageal echocardiography (TEE), developed and written by Biomedical Multimedia Developer Michael Corrin, the trainee can practice the diagnostic examination of the heart over the web.
BMC ARTICLE Before Corrin’s innovation, the TEE exam could only be simulated with a real probe on a mannequin. “But now, Corrin has done it in software,” says Tait. And the computer program can be transferred to other online diagnostic simulators like PIE’s virtual transthoracic echocardiography learning tool. “It can be used all over the place,” says Corrin. Vegas, Corrin, and Tait also intend to measure how it impacts trainee performance. They designed a study that includes two groups. The first group will use the mannequin to find certain features of the heart with the probe. The second group will learn with the TEE simulator before using the mannequin. Tools within the mannequin will record performance based on speed and accuracy. The researchers predict that the TEE tool will improve the performance of the second group.
with, a mannequin simulator costs between $40 000 to $160 000. “Only a minority of trainees around the world have access to this relatively new, very costly mannequin,” says Dr. Annette Vegas, Director of Perioperative Education at Toronto General Hospital. And, only one trainee at a time can learn on it. Doctors learn how to interpret the images through textbooks, seminars, and web-based programs. Frustrated by websites that offered dated material, Dr. Vegas decided that PIE could do a better job by starting from the beginning and capitalizing on new web-based technology. PIE creates interactive teaching modules for anyone around the world who wants to learn about perioperative medicine. PIE makes the modules available through their website for free. Medical educators can incorporate them into classroom teaching. Students can use them for self-study. The TEE simulator supplements textbooks, other image- and text-based web resources, observation, and practice. Novice echocardiographers must learn how to acquire 20 standard views of the heart and how to maneuver between them. The TEE simulator helps trainees develop the knowledge required to interpret the moving images acquired through TEE. By the time a trainee gets to a mannequin, they have al-
ready worked through some of the learning. With PIE’s web-based tool, an almost unlimited number of people — restricted only by access to computers and the web — from anywhere around the world can work and train at the same time. “It’s really robust that way,” says Corrin. PIE receives unsolicited feedback from users through a feedback form on its website. “Simply the best tool for education I have ever seen since performing TEE (more than 15 years now),” wrote one user. “It really helps to get a 3D impression of the sectional views which is essential for understanding the anatomy presented by TEE,” wrote another. “People love this thing,” says Tait. To build the simulator, Corrin extracted 3D data from a radiological application called OsiriX. He built an accurate, 3D model of the human heart using modeling software. Corrin then brought the heart into Unity, a software engine used to build video games. Within Unity, Corrin wrote the algorithm that resulted in the simulation of the TEE procedure. “That is not the nuts and bolts of my skillset,” says Corrin, who also teaches in the Master of Science in Biomedical Communications Program at the University of Toronto. “For me, that was a great challenge. It took a lot of love and a lot of labour.”.
Corrin already has plans for improvements to the TEE simulator. He based the simulator on a normal functioning heart. He would like to incorporate models with pathologies, like narrowing or blockage of the arteries, into the simulator so a trainee can perform an exam to practice diagnostic skills. On the screen in the operating room, structures within a beating heart — like a flapping valve — move in and out of the frame, even if the probe has not moved. Corrin would like to build a beating model of the heart to add complexity for learning at a higher level. “I always imagined this as an environment that would include almost game-like elements,” says Corrin. Trainees could be tasked with finding specific views in a timed environment that emulates the few minutes in the operating room before surgery begins. Educators could also use this feature for examination purposes. Looking ahead, Corrin would like to involve Biomedical Communications graduate students in building further modules. Right now, Corrin supervises a student in the development of a module that teaches TEE of the aortic valve specifically. “Surgeons and anesthesiologists are very knowledgeable about the heart and the space it occupies,” says Corrin. “Our job is to make them even better.”
Article by Maeve Doyle Graduate Program Officer Biomedical Communications firstname.lastname@example.org IMS MAGAZINE FALL 2013 MOOD DISORDERS | 37
with David Piccin, PhD
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following this advice was one of the main reasons why he was fortunate enough to enjoy such a rich and rewarding PhD experience as a member of the IMS. Originally from London, Ontario, Piccin studied biochemistry at McGill University as an undergraduate. At that time he developed a keen interest in the field of stem cells, and subsequently moved to the University of
Toronto to pursue graduate studies. He was attracted to the idea of studying the mechanisms underlying symmetrical division of neural stem cells. Piccin joined Dr. Cindi Morshead’s laboratory and enrolled at the IMS as an MSc candidate. It was his intention from the beginning to transfer into the PhD program with the ultimate goal of becoming a PI himself. Fast-forward about six years, and with a PhD degree in hand; Piccin has
Photo by ChungHo Leung
hen presenting a final deck to a client, management consultants are taught to make their recommendations up front, and follow with the details. In this tradition, David Piccin’s advocates that IMS graduate students “who think they have no time outside the lab, do.” He insists that “it will make [them] more successful and efficient with [their] time. Get involved outside the lab!” Piccin believes that
By Anton Mihic
FUTURE DIRECTIONS adapted to a fast-paced career as a consultant at the prestigious Boston Consulting Group, is married, and has a son, Oliver. What events led to this abrupt shift in course? As a student in Morshead’s laboratory, Piccin was given the freedom to explore new ideas and decide his own path, and his supervisor supported that vision. She was also supportive in terms of her guidance, which helped Piccin achieve specific research goals and maintain research productivity throughout his graduate studies. “I felt supported but not micromanaged.”
...He has successfully trans-
lated his problem solving skills into the business world, and is consistently challenged in his job to focus on high level thinking when solving problems. Piccin excelled in this environment and published three first-author articles in highly respected journals, including a key 2011 paper in the journal Stem Cells.1 Piccin’s work has contributed significantly to the field of Wnt signaling and has helped scientists in their quest to understand the complex nature of neural stem cells. Piccin’s favorite study involved investigating progenitor cells in adult brains that were less capable of forming multipotent, self-renewing neurospheres than their embryonic counterparts.2 He hypothesized that the younger brains possessed factors in the stem cell niche that enhance neural stem cell function. Piccin proved this hypothesis by labeling pure populations of progenitor cells (excluding neural stem cells) and overexpressing Notch. This resulted in the numbers of neurospheres formed from the adult neural stem cells to approach those reported in embryonic cells. When asked about his proudest accomplishment as a PhD student, Piccin did not mention any of his numerous scholarships or fellowships, his papers, or his involvement in extracurricular activities. Instead, he spoke about his research. Piccin has a great sense of pride in knowing that his research had an impact on the way scientists approach problems in the neural stem cell field today. “I still have a passion for science—it doesn’t go away.”
Piccin’s interest in extracurricular life outside of the lab was not sparked for almost three years, until he became involved in a variety of student organizations including the Life Science Career Development Series (LSCDS), the SGS Graduate Education Council, and as a co-founder of the Graduate Management Consulting Association (GMCA). With a close group of like-minded friends as his support network, Piccin further enhanced the skills required for a successful career in management consulting by organizing activities and networking opportunities through the GMCA at a time when it was incredibly rare for a University of Toronto PhD to make the transition into management consulting. Piccin’s passion for his extracurricular activities faced an impasse when he felt that he needed to make a decision about his future career. In doing so, he says that one of his best supporters was his supervisor. “Most supervisors may be disappointed that you may not want to pursue a career in academia, but despite this, they will be supportive and interested in making your life more fulfilling.” Piccin continues, “As long as you show a commitment to the lab, are respectful and hard working, you will be fine.” But he cautions that “once you leave academia, it is exceptionally rare to go back.” So the decision should be made very carefully with all of the options carefully weighed. Piccin encourages students to discuss these options with their supervisor before it is final, and to allow them the opportunity to become a thoughtful participant in the decision making process.
to think about problems has been capitalized on in a very rewarding way.” Management consulting appealed to Piccin because of its potential to have rapid and real-world impact on a client. He has successfully translated his problem solving skills into the business world, and is consistently challenged in his job to focus on high level thinking when solving problems. Piccin stresses that while there is a recent trend for management consulting firms to hire more advanced degree candidates (such as PhDs) than in the past, the numbers are still very low. The Boston Consulting Group has become a natural fit for many of these types of candidates because of its pedigree. Every one of the 5 600 consultants at BCG worldwide come from a wide variety of exceptional backgrounds, and this is necessary to provide solutions to their clients which include many of the world’s largest companies. It is therefore not surprising that there are a few places for extraordinary PhD students in the firm that has been widely regarded as the world’s leading advisor on business strategy. Piccin explains that BCG is looking for unique and motivated individuals, and while a certain level of business acumen may be helpful, it is not necessary to show the firm that you can do the work. He stresses that one way to set you apart from the other PhD applicants is to demonstrate balance in academic and extracurricular aspects of your graduate experience. “Get involved outside of the lab!”
...one way to set you apart References
from the other PhD applicants is to demonstrate balance in academic and extracurricular aspects of your graduate experience. “There is no such thing as an average day in the life of a management consultant,” explains Piccin. When a client is looking for a solution, they will hire a firm to help define the problem, as well as develop a strategy and implementation plan for addressing the issue. Piccin considers the “so-what?” of a question and its implications. He states that since commencing his career, “the learning has been tremendous, and [his] desire
1. Piccin, D., Morshead, C. (2011). Wnt signaling regulates symmetry of division of neural stem cells in the adult brain and in response to injury. Stem Cells, 29(3):528-38. 2. Piccin, D., Yu, F., Morshead, C. (2013). Notch signaling imparts and preserves neural stem characteristics in the adult brain. Stem Cells and Development, 22(10):528-38.
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Volleyball Without Stigma An hour a week of freedom
The volleyball program with the schizophrenia patients is a tradition that has been going on for decades at CAMH. Every week the participants are randomly divided into two teams, each of which includes a mix of staff, students, and schizophrenia patients. One of the patients keeps track of the score while playing. At the end of each game, the front row of both teams switch creating different teams for the next game. The playing continues until the end of the allotted time. The patients involved in this volleyball program are those currently seeking treatment at CAMH and are referred to the program by their psychiatrist. The research staff participants need to have some basic training for interacting with individuals with psychiatric disorders, which is provided at the mandatory staff orientation at CAMH. “It’s an hour of freedom,” says Danielle Taylor, who co-leads the program with Daniel Felsky. Both are students at the Institute of Medical Science. Taylor is in the Master of Science program and Felsky is in the Doctoral stream. Although their research involves non-clinical work, volleyball allows them to interact with schizophrenia patients. As coordinators, Felsky and Taylor have several roles to ensure that the program runs smoothly, such as maintaining the equipment, ensuring that safety is upheld, and participating in the volleyball games themselves. They both appreciate the positive atmosphere during the volleyball games. “The patients are non-judging. It’s a refreshing environment,” says Taylor. “It’s not about feeling bad.”
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Taylor explains that during the games everyone claps to reward good performances, but at the same time, constructive feedback is offered since there is always room for improvement among all of the participants: staff, students, and patients. Felsky has been participating since 2008, and Taylor since 2011. Before them, Clement Zai, from the Neurogenetics section at CAMH and the Department of Psychiatry at the University of Toronto, was the coordinator from 2004 to 2011.
Taylor thinks that by putting in effort, the staff and students are “setting the bar higher by challenging [the schizophrenia patients].” The patients appreciate this effort.
“No experience is necessary. It is a friendly game,” says Zai. “The participants really enjoy the activity and look forward to it every week. We also organize annual barbeques and Christmas parties.”
Mike enjoys playing volleyball with the staff and students at CAMH. “Some of them try really hard. So, it’s good to see them put in the effort. They’re quite enjoyable to play with,” he says.
Zai appreciates that the events have provided him with the opportunity to interact with the patients and to understand what they were experiencing with regard to their symptoms, medication side effects, lifestyles, and careers. He adds that it has been personally rewarding to see the patients do well.
Taylor comments that people are often skeptical when she explains that she plays volleyball with schizophrenia patients on a weekly basis. This response is a reminder of the often negative preconceived notions that society has regarding people with schizophrenia.
One patient, who will from herein be referred to as Mike for the purposes of anonymity, has been playing since he joined the clinic in 1977. He comes nearly every week. He got involved because he wanted to get some exercise and to be with his friends. Mike speaks positively about his experiences. “It’s good exercise, a lot of fun, and it’s enjoyable. It’s my hope that the volleyball program goes on indefinitely.” Although the atmosphere is non-competitive, at the same time all participants are encouraged to take the games seriously with regard to putting in effort. Felsky explains that as with any other sport, there are times when the players get frustrated. “You see them trying so hard. It gets exciting. They enjoy it when you try.”
“Over the weeks you become more comfortable with the patients. You’re actually building rapport. They’re not so different than anyone else,” Taylor says. Although the volleyball program was created primarily for the benefit of the schizophrenia patients who are referred for participation, Felsky and Taylor recognize that there are also benefits for them, in addition to getting a break in the middle of the week from academics. “It’s fun and it’s addicting,” Felsky says. “It’s therapeutic for us, just as it is for them.”
Photo by Henry Ma
or an hour every week, schizophrenia outpatients, research and clinical staff from the Centre for Addiction and Mental Health (CAMH) as well as University of Toronto students gather for recreational volleyball in a CAMH gymnasium.
By Sarah Gagliano
What is Plagiarism?
Plagiare in Latin means ‘to kidnap’. The root of the word is plaga, a trap or a net. To plagiarize is to surreptitiously steal or appropriate. Whenever you pass someone else’s work off as your own, whether it be ideas, words, scientific results, or visual images, you are taking something that doesn’t belong to you and pretending it is yours. You are thereby committing identity theft, a serious academic crime. If you self-plagiarize, you are passing something off as new that is, in reality, not new – a form of academic fraud.
Thesis writing can be a daunting task and during this process, we may easily fall into the trap of plagiarism. Here are some important points to consider this thesiswriting season! Literature Review Q. The literature review is meant to summarize other people’s work, so how can I be accused of plagiarizing? A. Yes, it’s meant to summarize previous work in the area you are studying but make sure to attribute by proper referencing. If you use direct quotes, put quotation marks around them and reference the exact page. Q. Can I re-use a model or other illustration that someone else has published? A. You have to get permission from the author and the copyright owner. If youchange enough of the details, you do not need to ask permission. In either case, you still need to attribute. Q. Can I use material from an ethics or a grant application I have previously written? A. Yes, but if the applications were cowritten with someone else, you need to say so. Probably best to rewrite. For ethics or grant applications, though not published, they too must not be cut and pasted from elsewhere.
Hypothesis Q. If someone else has entertained a similar hypothesis to mine in the past, do I have to reference it? A. Yes, say that you are trying to confirm or disconfirm previous research, and reference it. If your hypothesis is somewhat different, explain the difference. Methods Q. When I describe my method, do I have to say if someone has used it before? A. Yes, and reference them. If your method varies from theirs, explain how. Results Q. Can I quote from my own previously published abstract or paper? A. Yes you can, but reference it and, if it was multi-authored, explain in a footnote what part you were responsible for. If the copyright belongs to the journal or book publisher, obtain permission from them. Q. Can I re-use tables, figures or other illustrations from my previous papers?
elsewhere, mention that they are not new. Discussion Q. I compare my results with those of others and then I make theoretical statements about what it means. If someone else has previously come to similar theoretical conclusions using different words, do I need to cite them? A. Yes, and also those who have come to different conclusions on the same issue. Future Directions Q. When I mention possible future directions and someone has already done some of them, do I cite them? A. Yes.
Q. If I’ve presented the results at a conference, what do I say?
Some have said that plagiarism is a crime without victim and that no one get hurt. However, the plagiarist, peers and colleagues, mentors and the institution, and the person(s) whose work has been stolen can all suffer from plagiarism.
A. Footnote a reference to the conference. With respect to presentations, if you show slides that have been previously shown
Do you have a question for the experts? Please send it to email@example.com. (ATTN: Experts).
A. Same answer as above.
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IMS students are having a good time getting to know the faculty over drinks at IMSSA’s Careers Development Seminar. (Above) It’s a great day to recharge outside with fellow IMS colleagues at Toronto Western’s Site Specific Event. (Right)
The IMS Talent Show at the Hard Rock Cafe brought out the best in everyone! (Above)
Yekta is happy because IMSSA did such an awesome job fundraising for Kids Now! (Right)
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Photos courtesy of I
The IMS Talent Show team did a great job organizing this night to remember at the Hard Rock. (Left)
TRAVEL BITES Conference Name: Y-Mind Centre for Prevention of Mental Disorders Conference - São Paulo School of Advanced Science for Prevention of Mental Disorders Conference Attendee: Danielle S. Cha Stream: MSc Type of Presentation: Oral & Poster Presentations Conference City, Country: São Paulo, Brazil Trip Date: March 25-29 2013
The global burden of mental, emotional, and behavioral (MEB) disorders is large and represents a serious public health concern. Prevention may be the most effective strategy for reducing mental illness burden; unfortunately, limited biological knowledge, poor treatment and service availability, as well as social stigma impede the appropriate diagnosis, treatment, management, and prevention of MEB disorders. The Y-Mind Centre for Prevention of Mental Disorders Conference was organized to foster prevention of MEB disorders by selecting projects worldwide in areas of: 1) Epidemiology and Risk Factors; 2) Translational Research—Animal Models; 3) Neurobiology, Neurodevelopment, and Brain Circuits in Early Stages of MEB Disorders; 4) Effective Interventions to Prevent MEB Disorders; 5) Services, Stigma & Awareness. The purpose of this conference was to gather experienced academics and young researchers/trainees worldwide, to promote an environment for global knowledge exchange and translation across different fields of research, and to build international partnerships. Attending The Y-Mind Centre for Prevention of Mental Disorders Conference provided a great opportunity to explore Brazil’s largest city, São Paulo. Known as Brazil’s cultural capital, São Paulo is filled with nightclubs, bars, and world-famous museums. We asked Danielle to give us the details of her São Paulo experience.
By Anna Badner
How much time did you have to explore São Paulo?
What did you enjoy the most about your trip to São Paulo?
Symposia, presentations, and courses ran from 9:00AM to 7:00PM. Students were able to explore the city during lunch hours and in the evenings. The conference program also incorporated time for students to participate in guided tours of nearby academic and research institutions in the São Paulo area.
What I enjoyed the most about São Paulo were the people. The relationships that were built over the course of this conference are invaluable. Students were encouraged and given time to interact with their group mentors, lecturers, and colleagues following each of the symposia and lecture sessions. Moreover, because students were all accommodated at the same location, we were better able to acquaint ourselves on a more personal level outside of the academic setting.
What did you have a chance to see? During my week in São Paulo, I was able to visit the São Paulo Museum of Art, which is located on the famous Paulista Avenue (free admission on Tuesdays). Ibirapuera Park was a short walk away from our hotel and made for a scenic morning running route. I was also able to enjoy the tastes of Brazil from the legendary street markets to their famous Brazilian BBQ (Fogo de Chao). Lastly, I was able to enjoy the city’s nightlife at different pubs and clubs that came highly recommended by some of the native Brazilian students I had met and continue to keep in touch with.
Do you have any essential tips for other travelling students? Travel light, check the weather prior to leaving for your destination, and don’t forget your camera!
“Piled Higher and Deeper” by Jorge Cham www.phdcomics.com
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A magazine highlighting the research, students and faculty at the Institute of Medical Science at the University of Toronto. This issue's fe...