Nyspi 2008 jun1

2007-2008

ANNUAL REPORT Columbia University Department of Psychiatry New York State Psychiatric Institute NewYork-Presbyterian Hospital

2007-2008 Annual Report The New York State Psychiatric Institute Department of Psychiatry of Columbia University College of Physicians and Surgeons Psychiatric Services at CUMC NewYork-Presbyterian Hospital July 1, 2007 to June 30, 2008

Table of Contents Report from the Director Mission Statement in Action: Saving Lives Selected Grants

3

4 8

Research Divisions

19

Education in Psychiatry

45

Clinical Divisions

49

Behavioral Medicine

20

Biostatistics and Data Coordination

21

Clinical Services at NYSPI

49

Brain Stimulation

22

Clinical Services at CU and NYPH

49

Child and Adolescent Psychiatry

23

Program Statistics

50

Funding the Dream

12

Clinical Phenomenology

24

NYSPI

51

Financials

13

Clinical Therapeutics

26

CU

52

Cognitive Neuroscience

27

NYPH

53

14

Developmental Neuroscience

29

Faculty

14

Epidemiology

30

New Faculty

15

Epidemiology of Substance Abuse

31

Geriatric Psychiatry

31

HIV Center for Clinical and Behavioral Studies

32

Integrative Neuroscience

33

Law, Ethics and Psychiatry

34

Mental Health Services and Policy Research

35

Molecular Imaging and Neuropathology

36

Molecular Therapeutics

38

Neurobiology and Behavior

39

Psychiatrics and Medical Genetics

41

Social Psychiatry

41

Substance Abuse

42

Translational Imaging

43

Departmental Summary

Centers Special Events

16 18

Support Services Selected Support Services From Two Sides

Front Cover: Mice that have been genetically modified to produce extra brain cells in adulthood will help us understand why the creation of new neurons in the adult brain (neurogenesis) can enhance cognition and regulate mood. These newly generated brain cells (green) and older brain cells (red) are in the hippocampus, a region associated with cognition and mood.

Image courtesy of Dr. Amar Sahay, Division of Integrative Neuroscience.

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TABLE OF CONTENTS

55 55 59

Report from the Director Dear Friends and Colleagues, I am delighted to share the Columbia Psychiatry and New York State Psychiatric Institute Annual Report for 2007-2008 with you.

Despite the economic crisis that has challenged our communities this year, we continue to make progress in our core mission: to improve the lives of people who suffer from mental disorders by advancing the quality of treatment through research, training, and clinical care. Every year brings us closer to our overarching goal of transforming psychiatric medicine, to reduce the suffering of people with mental illnesses and enable them to achieve recovery and lead productive and fulfilling lives.

Our strength lies in our dedicated and inspired faculty and staff, and our historic and valuable partnerships with the New York State Office of Mental Health, Columbia University Medical Center, and NewYork-Presbyterian Hospital. These interwoven affiliations enable us to pursue our mission and enable us to do what no single institution could do alone.

New York State, through its Office of Mental Health, has championed psychiatric research and the cause of the mentally ill for over a century. We appreciate New York State’s financial and moral commitment to this cause, and are pleased to report on our efforts to improve the quality of mental health care and the lives of the people of New York State. Of particular note this year are the accomplishments of the Division of Mental Health Services and Policy Research and the Division of Law, Ethics and Psychiatry, whose work has been instrumental in bridging the gap between research and practice, demonstrating the effectiveness of our publicacademic partnership.

Our affiliations with the Columbia University Medical Center and the NewYork-Presbyterian Hospital allow us once again to provide unsurpassed medical education and clinical care. Under the leadership of Maria Oquendo, Vice-Chair for Education and Training, educational initiatives were developed to maintain our position at the leading edge of psychiatric training. Our wide range of psychiatric services at NewYork-Presbyterian Hospital contributed to achieving the US News and World Report rank as the top hospital for psychiatry in the New York metropolitan area and the third best hospital for psychiatry in the US. At the hospital, at the institute, at all of our inpatient and outpatient clinics, our expert and caring clinicians provide state-of-the-art evaluations and treatment to individuals, families, and groups across a wide spectrum of psychiatric disorders. Clinical initiatives begun this year provide important new services, from the establishment of the Lieber Clinic at the Columbia Day program for individuals with psychotic disorders, to intensive day treatment services for eating disorder patients.

This year our researchers were awarded more NIH grants than any other psychiatry department nation-wide and total grants amounting to over $90 million. Our faculty published hundreds of articles, chapters, and books, and, as highlighted in this report, made scientific advances in clinical, translational and basic research.

Among many notable events, the HIV Center for Clinical and Behavioral Studies marked its 20th year; the New York State Legislature funded a Center for Cultural Competence at NYSPI; and Gray Matters at Columbia awarded its first fellowship for research on genes associated with schizophrenia. These are just a few of the accomplishments of the past year. As you read this report, you will find that 2007-2008 has indeed been filled with progress, innovation, and discovery.

I extend my appreciation to our talented scientists and clinicians, our clinical staff and trainees; our administrators and support staff in finance, administration, security, housekeeping, facilities, engineering and communications, whose dedicated work supports our shared mission. I thank also those generous individuals and foundations whose philanthropic support greatly extends the depth and breadth of our research, training and clinical care.

And finally, I want to acknowledge those who are the focus of our work: our patients, whose courage and perseverance in the struggle for recovery both inspires and humbles us.

Sincerely,

Jeffrey A. Lieberman, MD

REPORT FROM THE DIRECTOR

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Mission Statement in Action: Saving Lives Here are just a few of the many people at Columbia Psychiatry who embody the Mission Statement as researchers, clinicians, innovators in policy, and educators on a single topic: saving lives.

Dr. Arango looks at a brain slice from her collection. During the past twenty years or so, Dr. Arango has collected over 260 brains and clinical information about the people to whom they once belonged.

Research Victoria Arango, PhD When Dr. Victoria Arango was studying at SUNY Downstate Medical Center in Brooklyn, a close friend used her pharmacology textbook to find out how to commit suicide by drug overdose. Two of Arango’s cousins also took their lives.

However it was chance, rather than these personal tragedies, that led Dr. Arango to search for the biological basis of suicide.

Early in her career, when she was teaching neuroscience to medical students, Dr. Arango answered an ad for a postdoctoral fellowship at Cornell without knowing what kind of work was involved.

This fortuitous act led to a long collaboration with Dr. J. John Mann, now

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MISSION STATEMENT

Division Chief of Molecular Imaging and Neuropathology at Columbia Psychiatry.

Drs. John Mann, Victoria Arango, and her husband, Mark Underwood, discovered that people with depression who killed themselves had fewer neurons in a part of the prefrontal cortex believed to be involved with behavioral flexibility in primates.

Further, Dr. Arango found a major difference in the brains of people who committed suicide compared with those who died of natural causes: the former had about a third fewer transporters to ferry serotonin, a neurotransmitter involved with mood, across the space between the neuron that created the transmitter and the neuron

that was supposed to receive it. At the same time, the brains of people who committed suicide had about a third more receptors set to receive the neurotransmitter compared with control brains. In short, the brains of people who killed themselves were not producing enough serotonin, and the brain was trying to compensate for that by creating extra receptors to get the serotonin to the right part of the brain.

Dr. Arango and her colleagues are developing ways to monitor serotonin levels using Positron Emission Tomography tracers to identify patients who have the greatest imbalance of serotonin and are, therefore, at the highest risk of suicide.

Dr. David Shaffer has devoted his life to the diagnosis, treatment, and prevention of depression and suicide in children and adolescents.

Clinical Care David Shaffer, MD Dr. Shaffer, until recently Division Chief for Child and Adolescent Psychiatry at Columbia, conducted his first research on the topic of teen suicide when he was still a trainee. Later he showed that a purely didactic approach to suicide prevention offered no benefits and was not without risk. In other words, however counterintuitive it might seem, trying to reduce suicide through education was not a helpful strategy.

Consequently, Dr. Shaffer became a strong proponent of suicide prevention through screening for, and identifying, disorders that predispose youth to suicide. He also founded the enormously successful,

evidence-based Columbia TeenScreen Program (CTSP).

CTSP started with a pilot program in 1999 and now, after parents or legal guardians give written permission, screens teens for suicide risk using questionnaires. If adolescents indicate they have risk factors, a mental health professional interviews them.

If the professional decides there is a problem, he or she alerts the parents. To avoid stigmatizing them, teens are not given diagnoses.

Our mission is an ambitious one: to reduce the suffering of people with brain disorders that are manifest by disturbances in mental functions and behavior by discovering their causes and cures. We seek to transform the field of psychiatric medicine and define the standards of mental health care through leading edge research, clinical services, policy, and training. In doing so, we will reduce the burden of illness for individuals and society. – Jeffrey Lieberman, MD

MISSION STATEMENT

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Dr. Posner publishes and speaks internationally on the risks, benefits, and public health implications encompassed by recent drug controversies.

Policy Kelly Posner, PhD In the middle of a furor over whether antidepressants increased suicide, the FDA tried to answer the question, but awoke to a nightmare: its data were inconsistently classified. For example, a four-year-old who slapped herself in the face was labeled suicidal, while the death of a distressed man who called his lawyer for help was categorized as an accident.

Dr. Kelly Posner, along with Drs. Maria Oquendo, Madelyn Gould, and Barbara Stanley, of Columbia defined suicide and suicide attempts, classified the data, and analyzed them. Their research led to the development of the Columbia

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MISSION STATEMENT

Classification Algorithm of Suicide Assessment (C-CASA), and the FDA, stating that C-CASA “set a standard in the field,� mandated that researchers apply it to many clinical trials.

Dr. Posner continues to work with the FDA on drug safety issues, direct assessments for the NIMH-sponsored research unit for pediatric psychopharmacology, and serve as an expert participant in a Centers for Disease Control and Prevention (CDC) group working on standardized nomenclature for suicidality surveillance efforts.

Dr. Oquendo’s areas of expertise include the diagnosis, pharmacologic treatment, and neurobiology of bipolar disorder and major depression, with a special focus on suicidal behavior.

Education Maria Oquendo, MD “The best way to learn is to teach,” says Dr. “Further, there are few topics that are more Maria Oquendo, Vice Chair of Education at critical in psychiatry in terms of the need to Columbia Psychiatry. Dr. Oquendo, who find ways to prevent the suffering suicidal worked as a teaching assistant in behavior inflicts on the patient and his or mathematics and chemistry in college and her loved ones. Thus, the study of suicide is won the prize for teaching medical students both fascinating and highly relevant.” as a resident, thinks teaching keeps you up For that reason, last year, Dr. Oquendo on the literature. She also enjoys being added a course on Suicidal Behavior taught constantly challenged by questions from

by Drs. Kelly Posner and Barbara Stanley, a smart, engaged learners. distinguished researcher on suicide and “I find that residents and medical students borderline personality disorder. Previously, are very curious about suicide,” remarks Dr. the residents would get one lecture about Oquendo. “It is not observed in the animal suicidal behavior in the context of a course kingdom, as a rule, and it is, therefore, about affective disorders even though difficult to develop an animal model to help suicidal behavior cuts across a variety of us understand it as we do when we study so diagnoses, not only mood disorders. many other phenomena.

MISSION STATEMENT

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Selected Research Grants On the heels of a tremendously productive year came the news that the Department was awarded more NIH grants than any other psychiatry department in the country. As the Department continues to make inroads in research, clinical care, education, and policy, it remains appreciative of the funding critical to its mission.

More than $90 million in grants was awarded to the Department in the last year. Here we show a snapshot of awards received this year and the work they support.

New NIH Awards

Frances Levin, MD

Research Fellowship in Substance Abuse Disorders Anissa Abi-Dargham, MD won a new NIH award for "Imaging Dopamine Transmission in Comorbid Schizophrenia and Cannabis Dependence." This study will test for simultaneous occurrence of opposite dopaminergic alterations characteristic of both disorders within separate subdivisions of the striatum. This co-occurrence of opposite dopaminergic dysregulation can underlie the therapeutic challenges presented by these patients.

Claude Mellins, PhD

Adapting CHAMP+ for South Africa: Supporting HIV-Infected Youth and Families Jonathan Morgenstern, PhD

Component Analysis of Motivational Interviewing Jonathan Morgenstern, PhD

NIH Support for Conference and Scientific Meetings Michael Myers, PhD

Research Training – Psychobiological Sciences Edward Nunes, MD

Clinical Trials Network: Long Island Regional Node

Ivan Balan, PhD

HIV-Prevention Intervention Targets in High-Risk Alcohol Venues in Argentina Susan Barrow, PhD

Center Grant: Center to Study Recovery in Social Contexts Cristiane Duarte, PhD, MPH

Maternal Depression and Child Weight: Early Pathways Miriam Ehrensaft, PhD

Can Family-Based Prevention of Conduct Problems Prevent IPV Development?

Anke Ehrhardt, PhD

Behavioral Sciences Research in HIV Infection

Madelyn Gould, PhD, MPH was awarded a new NIH grant, "Effectiveness of Suicide Hotline Training and Assessment of Usage Patterns." The project’s main aim is to evaluate the National Suicide Prevention Lifeline, the national network of telephone crisis services, which currently serves as the “safety net” for many national public health initiatives to prevent suicide. This is of great policy import due to the emergent use of hotlines and their expanded use by the Department of Veterans Affairs.

Jonathan Javitch, MD, PhD

Schizophrenia Research Fellowship

Laszlo Papp, MD

R. Jurgen Kayser, PhD

Development of a Multimodal Treatment for Late life Generalized Anxiety Disorder

Olfaction and Emotion in Depression: Behavioral Electrodermal and ERP Measures

Angel Peterchev, PhD

Development of a Novel TMS Device with Controllable Pulse

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RESEARCH GRANTS

Bruce Luber, PhD B. Timothy Walsh, MD won a new NIH award to develop an “Eating Laboratory for Overweight Adolescents.” This research will focus on the development of objective measures of eating and of hormonal release following eating among normal and overweight teens.

Neural Basis of Cognitive Reserve: fMRI/TMS Studies of Memory and Aging Sapana Patel, PhD

Patient-Centered Care for Underserved Minorities In Primary Care Joanna Steinglass, MD

Cognitive Neuroscience of Anorexia Nervosa Jennifer Wisdom, MD, MPH

Adolescent Recovery from Drug Abuse During Transitions in Care

Robert Remien, PhD

Multimedia Social Support Intervention: Adherence To HIV Care in South Africa Steven Roose, MD

Research Training: Affective and Related Disorders Steven Roose, MD

Research Training in Geriatric Neuropyschiatry Gorazd Rosoklija, MD, PhD

A Macedonian Center for Ultrastructural Studies in Schizophrenia Gorazd Rosoklija, MD, PhD

Morphology of Hippocampal Neurons in Depression Dongrong Xu, PhD

An Integrated Package for the Processing and Analysis of Diffusion Tensor Imaging

Anthony Pinto, PhD received a K23-Award from NIMH entitled "Phenomenology of Obsessive Compulsive Personality Disorder (OCPD)." Dr. Pinto plans to use this funding to further understanding of the disorder, beginning with an exploration of its phenomenology and neurocognition, and moving toward the development of treatments. He is also particularly interested in elucidating the relationship of OCPD to Obsessive Compulsive Disorder (OCD).

R01s

K-Awards

Anissa Abi-Dargham, MD Eric Fertuck, PhD won a K-Award for “Social Neuroscience of Borderline Personality Disorder.” This Mentored Career Development Award will support Dr. Fertuck and colleagues in their investigations of the neural and social cognitive systems that subserve the profound interpersonal disturbances of Borderline Personality Disorder.

Mark Ansorge, PhD

Developmental Origins of Affective Disorders Kenneth Carpenter, PhD

Imaging Dopamine Transmission in Cannabis Dependence Jonathan Javitch, MD, PhD

Molecular Determinants for the Action of Psychostimulants: Youth and Families

Imaging Dopamine Transmission in Cannabis Dependence Efrat Aharonovich, PhD

Modified Behavioral Treatment for Cocaine Patients with Cognitive Deficits Howard Andrews, PhD

Multicenter Vitamin E Trial in Persons with Down Syndrome Carlos Blanco, MD, PhD

Improving the Effectiveness of Treatment for Depression in Hispanics Alan Brown, MD, MPH

Prenatal Factors and Risk of Schizophrenia in a Finnish National Birth Cohort Andrew Dwork, MD

Myelin Pathology in Schizophrenia Suzette Evans, PhD

Progesterone Treatment for Cocaine-Dependent Women

RESEARCH GRANTS

9

Jonathan Stewart, MD Frances Levin, MD was awarded an RO1 grant from NIH for “Extended Release Mixed Amphetamine Salts for Adult ADHD and Cocaine Dependence.” This multicenter collaborative project will investigate the efficacy of extendedrelease mixed amphetamine salts for cocaine-dependent adults with ADHD by combining pharmacotherapy for ADHD with individual cognitive behavioral therapy.

Suzette Evans, PhD

Sex Differences in Stress and Impulsivity in Cocaine Abusers Richard Foltin, PhD

Translational Approach to Models In Relapse Abby Fyer, MD

OCD Collaborative Genetics Association Study Jay Gingrich, MD, PhD

Combining Antidepressants to Hasten Remission from Depression C. Daniel Salzman, MD, PhD

Neural Mechanisms Underlying Reinforcement Learning Joanna Steinglass, MD

Addressing Fear of Food in Anorexia Nervosa B. Timothy Walsh, MD

Translational Research on Eating Disorders: Reward Systems Myrna Weissman, PhD

Parental Remission from Depression and Child Psychopathology NARSAD Awards Young Investigator Deidre Devier, PhD

Clinical MR Measures of Neurogenesis in Depression Andrew Gerber, MD, PhD

MRI of Brain Change During Psychotherapy for Panic Disorder Marianne Gorlyn, PhD

Serotonin and the Modulation of Brain Development

Aggressive Behavior in Depression and Suicide: Biochemical, Behavioral & Cognitive Aberrations in Stress

Denise Hien, PhD

David Kimhy, PhD

Combined Treatment of Alcohol-Dependent Women with PTSD

The Influence of Arousal on Paranoid Ideation

Christina Hoven, DrPH

Diane Klein, MD

Paternal Criminal Justice Involvement and Substance Use in Children & Adolescents

Effects of Mifepristone in the Treatment of Anorexia Nervosa

Maria Karayiorgou, MD

Functional Analysis of 22Q11 Schizophrenia Susceptibility Genes

rTMS in the Treatment of Panic Disorder with Comorbid Major Depression

Roberto Lewis-Fernandez, MD

Rachel Marsh, PhD

Motivational Antidepressant Therapy for Hispanics

An fMRI Study of Self-Regulatory Control in Depressed Adolescents with Bulimia Nervosa

J. John Mann, MD

Suicidal Behavior in Mood Disorders: Genes and Intermediate Phenotypes John Markowitz, MD

Psychotherapies for Chronic Posttraumatic Stress Disorder Edward Nunes, MD

Treatment Studies Using Depot Naltrexone (4/6) Columbia Protocol Treatment Site Claudia Schmauss, MD

Genetic and Environmental Modulation of RNA Editing

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RESEARCH GRANTS

Antonio Mantovani, MD, PhD

Christine Mangurian, MD was awarded a NARSAD grant for “Effect of Behavioral Therapy on Adiposity In Antipsychotic-Treated Hispanic Patients with Major Mental Illness." This study will try to determine the effect of a culturallymodified weight loss program for overweight and obese people with severe mental illness.

Robert J. Merker, PhD Alexandra Sporn, MD

The Involvement of DNA Damage and DNA Repair Mechanisms on Neurodevelopmental Trajectory of Mice Exposed to Methylazoxymethanol (MAM) on Embryonic Day 17

won a NARSAD award for "Genetic Predictors of Therapeutic Response to Repetitive Transcranial Magnetic Stimulation in Treatment-Resistant Depression." This study will evaluate whether certain genetic polymorphisms can predict treatment response to rTMS. The research may also elucidate genetic correlates of treatment-resistant depression in general.

Amar Sahay, PhD

The Role of a Novel Regulator of Hippocampal Circuit Maturation in Mediating the Behavioral Effects of Antidepressants Jason Scalia, PhD

The Effects of Conclusive Therapies for Depression on the Neuronal Organization of the Hippocampus Joanna Steinglass, MD

D-Cycloserine and Exposure Therapy: A Novel Treatment Approach in Anorexia Nervosa

NARSAD Distinguished Investigator Jeffrey Lieberman, MD

Jeffrey Miller, MD won a NARSAD award for "Predicting Remission from Major Depression: Combining Function MRI and Positron Emission Tomography.� The purpose of this grant is to identify biological predictors of treatment outcome in major depression that may eventually have a role in guiding treatment selection.

Elizabeth Sublette, MD, PhD

A Twelve-Week Double-Blind Placebo-Controlled Add-On Trial of AL-108 to Ongoing-Antipsychotic Treatment J. John Mann, MD

Imaging Ketamine-Induced Changes In Glutamate Release with Magnetic Resonance Spectroscopy (MRS) in the Treatment of Depression Other Grants American Foundation for Suicide Prevention Andrew Dwork, MD

White Matter Integrity and Suicide Risk: Histologic Evaluation of Potential DTI Targets

Assessing the Relationships between Plasma Fatty Acid Levels and Brain Serotonergic Functioning in Major Depressive Disorder and Suicide Risk

Transmission of Suicidal Behavior in Three Generations of the Same Families: A 30-Year Community Study

Ardesheer Talati, PhD

The Foundation for AIDS Research

The Genetics of Panic Disorder and Social Anxiety Disorder: a Pilot MRI Study

Theodorus Sandfort, PhD

Kenji Tanaka, MD, PhD

Minority Stress, Social Support, and Sexual Risk in South African MSM

The Role of Serotonin Receptor 1b Signals on ObsessiveCompulsive Disorder Symptoms

Stephanie Kasen, PhD

National Center for Injury Prevention and Control

Noelia Victoria Weisstaub, PhD

Miriam Ehrensaft, PhD

5-HT2a and mGLU2 Receptors Interaction in Psychosis

Can Family Based Prevention of Conduct Problems Prevent IPV Development?

RESEARCH GRANTS

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Funding the Dream We dream of understanding and eliminating mental illness, and we acknowledge that to do so, we need funds not only from others, but from ourselves.

With this recognition, a mother who lost her son to suicide after his long and difficult struggle with schizophrenia established Gray Matters at Columbia. Each spring, Gray Matters awards a fellowship to a young scientist with outstanding work in the genetics of brain disorders.

Gray Matters research is a memorial to those who have been lost and a sign of hope to all who struggle with brain disorders.

Dr. Laura Rodriquez Murillo, a member of the Karayiorgou lab, uses biostatistics to look for genes associated with schizophrenia.

Her research is funded by an award from Gray Matters.

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FUNDING THE DREAM

Financials CU Gift and Endowment Income

CU and RFMH Grants Received

($ in millions)

($ in millions)

During the past three years, gift and endowment income has consistently increased. Over the last year, gift and endowment income jumped by over 30%.

Over the past three years, the increase in grant monies received increased slowly but surely. Over the last year, income from grants increased by 2%.

Combined Sources of Operating Funds 2007-2008 Columbia University Department of Psychiatry (CU), RFMH, and NYSPI ($ in millions)

Government Grants - RFMH (Direct) 20.6% ($35.0)

NYSOMH 25.0% ($42.1*) *Does not include capital funding, NYSOMH direct spending on facilities, or fringe.

Total Direct Grants 43.4% ($73.6)

Government Grants - CU (Direct) 12.7% ($21.6)

CUMC Clinical Practice 5.3% ($8.9) NYPH 5.0% ($8.6)

Non-Gov. Grants - RFMH (Direct) 7.2% ($12.2)

Other 4.0% ($6.2)

Non-Gov. Grants - CU (Direct) 2.8% ($4.8) Gifts & Endowment 8.1% ($13.7)

TOTAL: $169.5 Total Indirect Costs (RFMH only) 10.4% ($17.7)

TOTAL: $169.5 FINANCIAL SUMMARY

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Departmental Summary Columbia Psychiatry consists of more than 1,000 faculty members and staff, in:

Named Professorships Paul Appelbaum, MD

Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law Michael Goldberg, MD

and in the Taub Institute on Alzheimer’s Disease and the Aging Brain) Bradley Peterson, MD

Suzanne Crosby Murphy Professor of Psychiatry

David Mahoney Professor of Brain & Behavior in the Department of Neurology (in Psychiatry and in the Center for Neurobiology & Behavior)

Professor of Psychiatry and Pediatrics and the Irving Philips Professor of Child Psychiatry

Laurence L. Greenhill, MD

Katherine Shear, MD

• eleven Clinical Divisions; and

Ruane Professor of Clinical Child and Adolescent Psychiatry

Marion E. Kenworthy Professor of Psychiatry in the Faculty of Social Work

• twenty-two supportive services

Barry Gurland, MD

Richard Sloan, PhD

Department of Psychiatry Faculty

Sidney Katz Professor of Psychiatry in the Morris W. Stroud, III, Center for Studies on Quality of Life

Faculty 1126

Myron A. Hofer, MD

Nathaniel Wharton Professor of Behavioral Medicine (in Psychiatry) at the NewYorkPresbyterian Hospital at the Columbia University Medical Center

(616 salaried, 510 voluntary)

Sackler Institute Professor of Developmental Psychobiology

• thirteen research and training Centers, eight of which are supported by the National Institute of Health; • twenty-two Research Divisions; • one Education Division;

University Professor 1 Named Professorships/ Endowed Chairs 18 Professors 145 Associate Professors 129 Assistant Professors

433

Instructors 168 Lecturers, Special Lecturers, and Others 112 Officers of Research 70 Adjunct Faculty

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Jeffrey A. Lieberman, MD

Lieber Professor of Schizophrenia Research Lawrence C. Kolb Professor of Psychiatry Frances R. Levin, MD

Kennedy-Leavey Professor of Psychiatry in the Division of Substance Abuse J. John Mann, MD

Paul Janssen Professor of Translational Neuroscience (in Psychiatry and in Radiology) Karen Marder, MD, MPH

Sally Kerlin Professor of Neurology (in the Gertrude H. Sergievsky Center, the Taub Institute on Alzheimer’s Disease and the Aging Brain, and Psychiatry) at the NewYork-Presbyterian at the Columbia University Medical Center

David Shaffer, MD

B. Timothy Walsh, MD

William and Joy Ruane Professor of Pediatric Psychopharmacology (in Psychiatry) Nancy Wexler, PhD

Higgins Professor of Neuropsychology (in Psychiatry, Neurology and Neuroscience) Senior Promotions Evelyn Attia, MD

Clinical Professor of Psychiatry Ravi Bansal, PhD

Associate Professor of Clinical Neurobiology (in Psychiatry) Lirio Covey, PhD

Professor of Clinical Psychology (in Psychiatry) Jay Gingrich, MD, PhD

Associate Professor of Clinical Psychiatry Richard Hersh, MD

Laurel Mayer, MD,

Associate Clinical Professor of Psychiatry

Herbert Irving Assistant Professor of Clinical Research

Lila Kalinich, MD

Clinical Professor of Psychiatry Richard Mayeux, MD

Gertrude H. Sergievsky Professor of Neurology, Psychiatry and Epidemiology (in the Gertrude H. Sergievsky Center

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DEPARTMENTAL SUMMARY

Charles Kaufmann, MD

Clinical Professor of Psychiatry

Sarah Lisanby, MD

Professor of Clinical Psychiatry Andrew Lotterman, MD

Associate Clinical Professor of Psychiatry David Lowenthal, MD, JD

Associate Clinical Professor of Psychiatry Eric Marcus, MD

Professor of Clinical Psychiatry R. Todd Ogden, PhD

Associate Professor of Biostatistics (in Psychiatry) Deb Pal, MD, PhD

Research Scientist Kelly Posner, PhD

Associate Clinical Professor of Medical Psychology (in Psychiatry) Peter Shapiro, MD

Professor of Clinical Psychiatry Mark Slifstein, PhD

Associate Professor of Clinical Neurobiology (in Psychiatry) Barbara Stanley, PhD

New Faculty Dr. Fredrik Jarskog joined the department as Research Director of the Psychotic Disorders Clinical Services at the New York State Psychiatric Institute on August 1, 2007.

He focuses on testing medications with novel mechanisms of action for cognitive deficits, negative symptoms, and treatment resistance in schizophrenia. This research is funded by the NIH academic/industry collaborative Treatment Units for Research on Neurocognition and Schizophrenia (TURNS) project for cognition, as well as other federal/foundation/industry sponsored studies.

On September 7, 2007, famed author and neurologist Dr. Oliver Sacks joined the faculty as a Professor of Clinical Neurology and Clinical Psychiatry, a joint appointment that reflects his broad range of interests. His work has not only inspired countless students to go into neurology and psychiatry, but it has made the public aware of many neurological and psychiatric conditions. Dr. Sacks’s work was the basis for the 1990 Hollywood movie, “Awakenings,” starring Robin Williams and Robert De Niro, as well as major theatrical works by Harold Pinter, Peter Brook, and Brian Friel. Dr. Sacks is pursuing a long-time interest in schizophrenia with department chair Dr. Jeffrey Lieberman as well as other projects.

Dr. Edward Smith, one of the world’s leading cognitive psychologists, joined the Department of Psychiatry as Chief of the Division of Cognitive Neuroscience on January 1, 2008. In collaboration with other researchers, Dr. Smith uses neuroimaging to study deficits in core cognitive domains – including working memory, cognitive control, and episodic memory – that affect people with schizophrenia. He also conducts research on behavioral and neural studies of working memory, executive processes, and knowledge representation. Dr. Smith remains the William B. Ransford Professor of Psychology at Columbia, a post he has held since 2004.

Professor of Clinical Psychology Christoph Wiedenmayer, PhD

Associate Professor of Clinical Neurobiology Ping Wu, PhD

Associate Professor of Clinical Epidemiology (in Psychiatry) Senior Appointments Enrique Baca-Garcia, MD, PhD

Adjunct Associate Professor of Psychiatry Fredrik Jarskog, PhD

Associate Professor of Clinical Psychiatry Thomas White, MD

Associate Clinical Professor of Mental Health Informatics (in Psychiatry)

Fredrik Jarskog, MD

Oliver Sacks, MD

Edward Smith, PhD

NYSPI historically has been at the forefront of research on schizophrenia, from genetics to antipsychotics. This year, it recruited three faculty members who will continue to advance our understanding of this disorder.

NEW FACULTY

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Centers

• a study of an interpreter service model that will use teleconferencing technology; and

The Department has an impressive seventeen Centers, seven of which are NIH-funded. Five Centers are described here.

• an evaluation of a tailored depression literacy tool for Hispanics with low literacy.

Center of Excellence for Cultural Competence Roberto Lewis-Fernández, MD, Director

In November 2007, the New York State Legislature allocated funding for two centers of excellence for cultural competence: one at the Nathan Kline Institute in Orangeburg, New York, and the other at the NYSPI. The NYSPI Center is dedicated to the study and development of culturally and linguistically appropriate mental health services for people throughout the state with serious mental illness. With the technical assistance and financial support of the New York State Office of Mental Health (OMH), the Center combines intervention, services, and community-based participatory research to improve service availability, accessibility, and quality of care across the state.

During the Center’s first year, its major research included a community-based assessment of the provision of culturally and linguistically appropriate physical health services to racially, ethnically, and linguistically diverse people with serious mental illness in northern Manhattan.

Now it is developing:

In addition, the Center has broadened its focus to address the cultural and linguistic needs of children and families receiving mental health services in New York State.

Implementing Evidence-Based Practices for Children in a State System Kimberly E. Hoagwood, PhD, Director

This NIMH-funded Developing Center for Innovation in Services and Intervention Research bridges the OMH and NYSPI/Columbia University in three academic Divisions: Mental Health Services and Policy Research; Child and Adolescent Psychiatry; and Biostatistics and Data Coordination.

The Center’s overarching goals are to: • advance knowledge about effective implementation and dissemination strategies to increase the adoption of evidence-based clinical services for children and families in outpatient clinics and schools; • provide guidance to other States on implementation of evidence-based practices; and

• a Learning Collaborative with our community partners to improve the integration of health and mental services in underserved communities;

• promote a participatory research agenda that reflects the partnership of treatment developers, families and family advocates, clinicians, supervisors, clinic directors, and OMH policy-makers, including the Commissioner and Deputy Commissioners.

• a web-based clearinghouse of data on the intersection of race/ethnicity, serious mental illness, and health outcomes;

Specific studies examine a set of organizational contextual strategies to improve implementation efficiency and

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CENTERS

effectiveness, to enhance engagement and activation of clinicians and families, and to refine measurement tools for assessing multi-level change. Locating this Center directly within the OMH addresses the widely-recognized gap between research and practice and provides a forum for accelerating the integration of researchbased approaches directly into the public mental health system.

Neurobiology of Dopamine in Schizophrenia Jeffrey Lieberman, MD

The unifying hypothesis of the Center is that schizophrenia is associated with an imbalance of dopamine (DA) systems. This imbalance is characterized by a persistent deficit in prefrontal cortical DA function (contributing to the cognitive impairment observed in these patients) and an intermittent excess of subcortical DA function (contributing to the emergence of psychotic states).

The overall goal of the Center is to combine clinical imaging with Positron Emission Tomography and epigenetic and transgenic animal models in mice and rhesus monkeys to test this hypothesis. A set of interrelated clinical and preclinical investigations aim to: • better characterize the existence of a DA imbalance in schizophrenia; • explore the underlying biological mechanisms that might account for this DA phenotype; and • understand the consequence of this imbalance for brain functions, clinical symptoms, and treatment.

Projects include two clinical imaging projects in patients with schizophrenia and

four preclinical projects performed in rhesus monkeys or mice. Research investigates this single hypothesis about the association of schizophrenia and imbalances in dopamine with state-of-the art methodologies and prominent collaborators from three institutions. By integrating basic and clinical research in a unique way, the Center fundamentally advances our understanding of schizophrenia.

The Reiner Center for Behavioral and Psychosomatic Medicine Ralph Wharton, MD, and Richard Sloan, PhD

The Reiner Center for Behavioral and Psychosomatic Medicine seeks to: • understand the interaction of psychological, psychosocial, and behavioral risks in determining the onset, progression, and management of physical and mental disease; • identify the mechanisms linking psychological states to disease; and • create treatments that target these mechanisms.

Projects range from the molecular to the behavioral. Specific studies look at how: • psychological risk factors, such as hostility, depression, and anxiety, contribute to the risk of heart disease; • gender affects the ability of exercise to prevent heart disease;

The Sackler Institute for Developmental Psychobiology Myron Hofer, MD

The Sackler Institute, established in April 2001 within the College of Physicians and Surgeons and the Department of Psychiatry, supports research on the developmental origins of vulnerability to psychiatric illness. The endowment funds innovative projects and preliminary studies that provide the basis for long-term federal support for new research directions, such as the annual Sackler awards.

In 2008, the Institute received additional funding for an interdisciplinary study of the developmental effects of serotonin transporter function, involving six different laboratories and all faculty members. This project seeks to better understand the untoward effects of SSRI type drugs in younger patients and during the fetal period, as well as the seemingly paradoxical effects of genetic polymorphisms of the serotonin transporter gene in clinical populations, and of targeted serotonin transporter gene alterations in mice. In both of these latter populations, vulnerability to depression (or depressionlike behaviors) is unexpectedly increased.

The Institute is applying for federal major support based on the preliminary findings from this project.

Centers and Directors Advanced Centers for Intervention and Services Research (ACIRS): Pediatric Psychiatry Disorders* Bradley Peterson Center of Excellence for Cultural Competence Roberto Lewis-Fernández Columbia University Center for Psychoanalytic Training and Research Eric Marcus Conte Center for the Neuroscience of Mental Disorders: The Neurobiology of Suicidal Behavior* J. John Mann Developing Centers on Interventions for the Prevention of Suicide (DCIPS): Intervention with High Suicide Risk Populations* Barbara Stanley Implementing Evidence-Based Practices for Children* Kimberly Hoagwood Imprints Center for Genetic and Environmental Lifecourse Studies Ezra Susser The Kavli Institute for Brain Science Eric Kandel Lieber Center for Schizophrenia Research and Treatment J. Jonathan Javitch Mahoney Center for Brain and Behavior Michael Goldberg Neurobiology of Dopamine in Schizophrenia* Jeffrey Lieberman Pathological and Functional Impact of Tauopathy In Vivo* Karen Duff Reiner Center for Behavioral and Psychosomatic Medicine Richard Sloan and Ralph Wharton Ruane Center for Early Detection of Mood Disorders David Shaffer

• expectant mothers’ stress and mood affects fetal and infant development;

Sackler Institute for Developmental Psychobiology Myron Hofer

• anxiety in older adults can be treated in new ways;

Stroud Center for Aging Studies Barry Gurland

• treatment for cancer may increase risk for cognitive dysfunction.

Substance Abuse Medications Development Center* Herbert Kleber * NIH-Funded Centers

CENTERS

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Special Events HIV Center Marks 20th Year as a Leader on the World Stage March 2008

On March 27, 2008, the HIV Center sponsored a full-day event at NYSPI reflecting on the Center’s first two decades, as well as on the challenges ahead that will be met with another five-year, $10 million grant from NIMH. Speakers provided both contemporary and historical overviews of the work of the HIV Center, and how its research agenda has evolved to meet the changing demands of an increasingly global epidemic. This event was possible because in 1987, NIMH awarded three NYSPI researchers – Drs. Anke Ehrhardt, Zena Stein, and Robert Spitzer – what was then its largest single grant ever.

Musicophilia: Tales of Music and the Brain April 2008

Celebrated researcher and novelist Dr. Oliver Sacks, Columbia’s first Artist in Residence, presented excerpts from his most recent book, Musicophilia: Tales of Music and the Brain on April 8, 2008. The occasion? The Herbert G. Cohen Memorial Lecture in Neuroscience. Dr. Sacks invited the audience on a journey exploring the brain’s malleability and its potential to change in response to music. Dr. Sacks witnessed patients who had a seemingly irrevocable loss of speech and lucidity recapture a once dormant part of themselves when they heard music. Some patients even sang and danced. His presentation raised the question: Just how is music appreciation hardwired in us?

Dialogues in Science February 2008

Despite snow, ice, and ensuing traffic jams, about fifty guests joined broadcast journalist and author Jane Pauley at the Department’s third Dialogues in Science program on February 12, 2008. Department chairman Dr. Jeffrey Lieberman moderated a lively exchange between Ms. Pauley and Vice Chair for Clinical Affairs Dr. David Kahn on “New Research and Treatments for Bipolar Disorder” at the Arader Gallery. Ms. Pauley’s participation came on the heels of the publication of her memoir Skywriting, which details her diagnosis and treatment for bipolar disorder. Her recounting of her first-hand experiences with mental illness and her parallel life as a successful media personality provoked laughter and recognition.

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SPECIAL EVENTS

Research Divisions After sectioning a slice of brain tissue, Manuela Douglass – a lab assistant in the Molecular Imaging and Neuropathology Division – takes care to mount the section on a slide. Here, with the warmth of her hands, she ensures that the section adheres to the slide. Later she will dry the slide and store it until it’s ready for analysis. This painstaking work is a critical part of the Division’s postmortem studies of suicide victims.

Drs. Paula McKinley, Richard Sloan, and Catherine Monk discuss ways in which psychological factors affect physical health and vice versa.

Behavioral Medicine Richard Sloan, PhD Division Chief

Behavioral Medicine Dr. Daniel Seidman and colleagues developed an Internet-based smoking intervention that presented a set sequence of interactive steps (assessment, preparation, quitting, and relapse prevention).

This intervention was more effective for smoking cessation than sitting with downloadable materials, especially for participants who were not depressed.

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The Division of Behavioral Medicine strives to understand the contribution of psychological, psychosocial, and behavioral factors to the onset, progression, and management of physical and mental disease; identify the relevant pathophysiological mechanisms linking psychological states to disease; and develop treatment interventions targeting these

mechanisms. Projects range from the purely behavioral to the cellular, with new studies extending to gene expression.

Sample topics of investigation include: • ethnic disparities in cancer; • integrative medicine in surgery; • psychosocial factors in hypertension; and the • impact of maternal incarceration on children's mental health.

In addition to conducting research, the Division maintains an active clinical service that provides state-of-the-art, evidence-based, cognitive-behavior therapies for Medical Center patients suffering from a variety of psychological conditions and medical conditions. Our clinical and research activities are closely related and mutually informative.

Biostatistics and Data Coordination Naihua Duan, PhD Division Chief

The Division of Biostatistics and Data Coordination is organized into two centers: the Biostatistics Research Center, which serves as a research unit, and the Data Coordination Center, which functions as a support unit.

As a research unit, the Division conducts primary research in biostatistical and data management methodologies of relevance to psychiatric research, and disseminates the findings to PI investigators and the psychiatric research community at large.

As a support unit, the Division supports PI investigators on a wide range of empirical research tasks, including: • study design; • development of research questions and hypotheses; • power and sample size analyses; • data analysis, statistical modeling, and the interpretation of findings; and

This year, the Division of Biostatistics and Data Coordination provided comprehensive biostatistics and data management services for a wide range of grants and funded projects, ranging from child psychiatry to geriatric psychiatry, and from cognitive deficits to mental health services delivery.

The Division encourages investigators to engage biostatisticians and data managers from the Division as early as possible in their research production process to maximize the potential contributions from the Division to their grant applications in terms of the conceptualization, design, and implementation of the study.

PI investigators, fellows, residents, and students receive training and education in biostatistical and data management methodologies from the Division. In addition, the Division helps its junior members advance their careers and contribute to the Institute’s mission.

Biostatistics and Data Coordination The faculty members in the Division published 68 journal articles, books, and book chapters, with another 22 in press, in leading psychiatric, medical, public health, and statistical journals, such as American Journal of Epidemiology, American Journal of Public Health, American Journal of Psychiatry, Archives of General Psychiatry, Biometrika, Health Services Research, Journal of the American Statistical Association, Medical Care, and Statistics in Medicine.

• manuscript preparation and revision.

Members of the Division analyze biostatistic data during their weekly meeting.

RESEARCH DIVISIONS

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The Division’s mission is to promote excellence in research and clinical work using brain stimulation. Its vision is to lead psychiatry in the burgeoning field of brain stimulation and to discover new treatments with a superior risk/benefit ratio.

Dr. Peter Bulow demonstrates Transcranial Magnetic Stimulation (TMS). The Division is exploring TMS as atreatment for schizophrenia and other psychiatric disorders.

Brain Stimulation and Therapeutic Modulation A pioneering multi-site study headed

by Sarah Lisanby, MD, demonstrated the efficacy of transcranial magnetic stimulation (TMS) for the treatment of depression, particularly depression that had not responded to prior therapy. This research was largely responsible for the FDA’s approval of TMS for treatment-resistant depression later in 2008.

This year the Division launched a multisite, randomized controlled trial of the antidepressant efficacy of Deep Brain Stimulation in a region of the brain called Broadman’s Area 25.

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Brain Stimulation and Therapeutic Modulation

The BSTM Division encompasses research programs (technology development, preclinical, translational, and clinical) and clinical services (inpatient and outpatient) using existing and emerging brain stimulation and neuromodulation interventions at NYSPI and NYPH. These techniques include: • cranial electrical stimulation;

Sarah Lisanby, MD Division Chief

• deep brain stimulation;

The Brain Stimulation and Therapeutic Modulation (BSTM) Division specializes in the use of emerging electromagnetic means of modulating brain function to study brain-behavior relationships and to study and treat psychiatric and neurological disorders. In the past few years, the ability to stimulate targeted brain structures noninvasively has opened the potential to probe the circuitry underlying brain-based disorders and represents a powerful new tool for treating disorders that fail to respond to conventional therapies.

• electroconvulsive therapy; • implanted cortical stimulation; • magnetic seizure therapy; • transcranial direct current stimulation; • transcranial magnetic stimulation; and • vagus nerve stimulation.

The Division brings together expertise in the neuroanatomical, cognitive, and neurophysiological assessment of the impact of stimulation on brain function in preclinical models and in the clinical setting. This critical mass of skills enables

the Division to advance our understanding of topics in basic science, such as neurogenesis and memory, as well as psychiatric disorders that include: • depression; • bipolar disorder; • schizophrenia; • anxiety disorders, such as panic and obsessive-compulsive disorder; and • autism.

Child and Adolescent Psychiatry Bradley Peterson, MD Division Chief

The Division of Child and Adolescent Psychiatry integrates expert clinical care with superior training and world-class research to help children and their families who are affected with psychiatric illnesses.

The Division has an extensive research program with state-of-the-art neuroimaging and therapeutic trials with medication and psychotherapy. It also conducts epidemiological studies on suicide, conduct disorder, the impact of trauma, and the determinants of suboptimal clinical interventions.

The clinical services receive 34,000 visits annually, approximately 20% of which occur in community clinics linked to the department, with the remainder being hospital-based. These institutions include the: • Children’s Anxiety and Depression Clinic; • Disruptive Behavior Disorders Clinic; • Neuropsychiatry Clinic; and • Pediatric Consultation and Liaison Clinic in the Children’s Hospital of New York.

Dr. Bradley Peterson, new Chief of the Division, studies serious childhoodonset neuropsychiatric disorders, such as Tourette syndrome, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, bipolar disorder, and autism.

Child and Adolescent Psychiatry Division New York Child and Adolescent Telepsychiatry (NYCAT) was established this year by the Division of Child and Adolescent Psychiatry, in collaboration with the Division of

At Columbia University, the Division operates a specialized Anxiety Disorders Clinic and the Developmental Neuropsychiatry Program for Autism Spectrum Disorders. It also has a clinical commitment to the local community and serves a large network of school-based mental health clinics. It is the largest child psychiatry service in Manhattan.

NewYork-Presbyterian Hospital has a large, unified clinical training program that trains twenty-six clinical fellows on the Washington Heights, Payne Whitney, and Westchester campuses. The APA–approved clinical psychology training program trains four child psychology interns each year.

The department also operates an NIMH– supported postdoctoral training program for research in the psychiatric disorders of children.

Children and Families at OMH, to help alleviate the shortage of child and adolescent psychiatrists in rural areas of New York State.

Directed by Matt Perkins, MD, MPH, MBA, the NYCAT program delivers psychiatric consultations via video teleconferencing to mental health clinicians and their patients and patients’ families who would otherwise not have access to child and adolescent psychiatric consultation.

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Dr. Margaret Spinelli, right, nationally-known expert on post-partum depression, talks with two people in the Division.

Clinical Phenomenology Jean Endicott, PhD Division Chief

The Division of Clinical Phenomenology is made up of three subdivisions: Research Assessment and Training, Biometrics, and Personality Studies. These groups share an interest in: • improving the evaluation of subject characteristics and how types of clinical phenomenology are related to diagnosis; • severity of symptoms and impairment in functioning; • course of illness; • differential treatment response; and • genetics.

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Members of the three groups develop procedures and training materials to aid investigators in their assessment of both patients and non-patients, and consult with investigators within the medical center, nationally, and internationally.

The Division continues to define psychopathology, and the researchers who developed the first Diagnostic and Statistical Manual (DSM), along with younger colleagues, are improving psychiatric classification, criteria for diagnosis, and the development of standardized instruments for evaluation.

A major study of primary care patients showing great overlap of anxiety and depression suggests that an overarching

concept for these symptoms, along with optional additional diagnostic codes, might be useful.

Other research explored Body Integrity Identity Disorder, a condition in which individuals have a lifelong desire to acquire a disability, such as amputation or paraplegia.

The Division remains centrally involved in the research planning stages of revising the next edition of the DSM, and will host eleven diagnostic conferences (three per year) to review the current literature and stimulate research for the DSM-V revision process. Further, some of the Division’s national data on substance disorders may lead to consideration of revisions to the DSM. Substantive investigations include two large multi-facility follow-up studies: the Treatment-Resistant Depression Registry study and the Collaborative Depression Study. Both focus on course of illness, predictors, and response to different treatment. The latter has resulted in 263 published papers.

Other studies of depression focus on the diagnosis and treatment of antepartum and postpartum disorders associated with the menstrual cycle.

In addition to depression, the Division conducts research on bipolar disorder, schizophrenia, and substance use disorders.

The last includes tests of the efficacy of new treatments, or modifications to existing treatments, such as:

• using a beta-blocker to reduce cueinduced drug craving in treated and untreated cocaine users; • adding daily calls to an interactive voice response system to answer questions about drinking and other experiences in the past twenty-four hours; and • modifying cognitive behavioral therapy to take into account cognitive impairments found in many substance abusers.

Members of the Division also study a variety of other topics, ranging from suicide to posttraumatic stress disorder, and from the characteristics of subjects who volunteer to serve as community controls to the use of interpersonal therapy, a specific form of psychotherapy, for people with borderline personality disorders.

Clinical Phenomenology Dr. Deborah Hasin’s group identified the alcohol metabolizing gene that interacted with age to predict drinking among Israeli adults. Among older Israelis, drinking was low and unrelated to the protective gene.

Among younger Israelis, those with the protective genes had low drinking levels, but those without them were likely to engage in binge drinking.

Clinical Therapeutics B. Timothy Walsh, MD Division Chief

The Division of Clinical Therapeutics comprises the following entities: • Anxiety Disorders Clinic; • Anxiety Genetics Unit; • Biological Studies Unit; • Center for Neuroinflammatory Disorders and Biobehavioral Medicine; Clinical Therapeutics

• Lyme and Tick-Borne Diseases Research Center;

This year, the Center published

• Clinical Psychopharmacology;

clinical results from a major clinical

• Depression Evaluation Service; and

trial on persistent Lyme

• Eating Disorders Research Unit.

encephalopathy in Neurology, revealing, among other things, that antibiotic treatment was not indicated because the risk of side effects was serious and the improvements in cognition were short-term.

Dr. Rachel Marsh recently reported fMRI findings of impaired self-regulatory control processes in women with Bulimia Nervosa.

These findings suggest that functional abnormalities may contribute to binge-eating and other impulsive behaviors.

Dr. Marsh wants to determine if abnormalities that arise early in the course of the illness may predict its development.

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RESEARCH DIVISIONS

The Anxiety Disorders Clinic studies and treats disorders ranging from social anxiety to pathological gambling, with special programs to treat Hispanic Americans in primary care and other medical settings.

The Clinic uses pharmacotherapy, cognitive-behavioral therapy, interpersonal therapy, motivational interviewing, and complementary therapy, as well as brain imaging studies in collaboration with colleagues in other Divisions. In addition, it conducts epidemiological and services research.

The Anxiety Genetics Unit conducted some of the first family studies of social and specific phobias, and has expanded to include DNA marker linkage studies of panic disorder. The Unit collaborates on traditional family/linkage, neurobiologically-based “endophenotypic,” and “translational” studies of anxiety.

The Biological Studies Unit conducts research on anxiety, such as a sequential treatment study, including both psychotherapy and medications guided by patient choice, for older patients with generalized anxiety disorder.

The Center for Neuroinflammatory Disorders and Biobehavioral Medicine studies diseases such as Lyme disease and, most recently, refractory psychosis. Targets of study include humans and ticks. Studies consist of efficacy trials and diagnostic, biomarker, neuroimaging, and molecular research.

The research efforts of Clinical Psychopharmacology focus on depression, reward systems, and their comorbidity.

Areas of interest include: • biological characteristics and treatment modalities in patients with late-life depression;

• the relationship of depression to the development of cardiac mortality/morbidity; and • smoking dependence, with special interest in the relationship between nicotine addiction and depression, as well as the prevention of smoking relapse.

The timing and cognition laboratory studies how people and animals learn about time and use it to guide behavior, with the goal of characterizing the distorted aspects of learning and behavior in psychiatric illnesses and identifying the neurocircuitry underlying specific patterns of timing errors.

The Depression Evaluation Services studies diagnosis, pathophysiology, and treatment in mood disorders and related problems using therapeutic response as a nosologic tool. Its work led to major developments in the field of psychiatry, including the addition of an “atypical” subtype of mood disorders in the DSM-IV. DES continues with studies predicting relapse after successful treatment with serotonin reuptake inhibitor antidepressant medications, treating depression when it co-occurs with alcohol or drug dependence, and investigating genetic predictors of antidepressant medication response. In addition, it has conducted longitudinal cohort studies on the emergence or exacerbation of depression in terminally ill patients.

The DES participated significantly in the design and execution of “Sequenced Treatment Alternatives to Relieve Depression” (STAR*D), a major NIMH clinical trial that was completed last year.

Since September 2007, the DES has been collaborating with sites in Canada to evaluate the advantage of using two antidepressants in combination over either one alone.

The Eating Disorders Research Unit studies topics such as: • psychological effects of bariatric surgery in overweight teens; • eating behavior in obese women with and without binge eating disorder;

• reward pathways in humans with bulimia nervosa using Positron Emission Tomography; and • how to develop an exposure therapy/response prevention treatment for outpatients who were anorectic but have regained their normal weight.

Cognitive Neuroscience Edward E. Smith, PhD Division Chief

This Division applies new developments in cognitive neuroscience to the study of psychiatric disorders that entail significant cognitive dysfunctions.

Cognitive Neuroscience Drs. Gerard Bruder and Craig Tenke, in collaboration with Drs. John Stewart and Patrick McGrath, are finding that EEG measures are of potential value for predicting whether a depressed patient will benefit from treatment with an SSRI antidepressant.

Using behavioral, cognitive, physiological, and neuroimaging techniques, the Division of Cognitive Neuroscience investigates brainbehavior relationships and the cognitive and neurobiological mechanisms underlying psychiatric disorders.

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Research involves basic and preclinical studies, the development and application of laboratory-based assessment, and clinical trials.

The Division includes the newly created Neuroimaging and Cognition Laboratory, the Cognitive Electrophysiology Laboratory, the Center of Prevention & Evaluation (COPE), the Psychophysiology Unit, the Temporal Cognition Unit, the Somatosensory and Pain Unit, and the Clinical Chronobiology Program.

The rapidly expanding Clinical Chronobiology Program treats nonseasonal depressions, including treatment-resistant depression, with light therapy. The description of this therapy in Sleep Medicine Reviews is one of the top downloaded papers in the journal’s history.

This year, the program showed that the incidence of winter depression increases linearly with latitude across the lower half of the US, but then levels off. This led to an FDA Phase I trial of a new formulation of melatonin to facilitate phase-advance shifts of the internal circadian pacemaker system without causing people to fall asleep.

In addition, the Division has a: • Cognition Laboratory to examine working memory, cognitive control, and stress, using fMRI and electrophysiological measures, to improve the quality of life for patients with schizophrenia; • Psychophysiology Laboratory to investigate the risk of inheriting a vulnerability for depression; the neurophysiology of memory deficits in schizophrenia, and other psychiatric issues; • Cognitive Electrophysiology Laboratory to look at memory, attention, and executive function in normal development using fMRIs and cognitive event-related brain potentials; • Center of Prevention & Evaluation (COPE) to evaluate clinical risk for psychosis in adolescents and young adults by using a variety of research strategies to develop safe and effective services to prevent the onset of psychosis and improve current function; • Timing and Cognition laboratory to find out how people and animals learn about time.

The Somatosensory and Pain Unit used a statistical decision-making theory this year to show that pain thresholds were more influenced by response bias (a measure of the subject’s attitude) than, as was mistakenly thought, neurosensory function. It also found that medical staff failed to collect adequate data from patients concerning the emotional aspects of their illness.

In other studies with colleagues in different countries, the Unit demonstrated widespread cultural and gender differences in the public expression of pain, and noted that these differences are important to recognize when treating patients who may be stoic.

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Elham Alkasimi is one of 400-500 volunteers working at PI. About 90% of volunteers conduct research on disorders ranging from anxiety to schizophrenia, while about 10% are involved in teaching or facilitating discussions with patients.

Emanuela Morelli, a PhD student in Dr. Jay Gingrich’s laboratory, measures the activity of dopaminergic neurons in a mouse treated with a commonly prescribed antidepressant.

Developmental Neuroscience Michael Myers, PhD Division Chief

Research in the Division of Developmental Neuroscience focuses on understanding processes involved in the development of behavior and fundamental relationships between behavior and biology.

Twelve investigators in the department study how natural events and stressful experiences interact with genetic mechanisms to shape the course of normal and abnormal development. This research is driven by the belief that the study of developmental processes provides critical clues about the origins of a wide spectrum of clinical conditions.

Ongoing activities use a variety of novel animal models to investigate the neurobiological substrates of attachment, separation anxiety, fear responses, and pain regulation. These models include targeted gene deletion of neurotransmitter receptors in mice, programming of early nutritional and other environmental experiences, and selective breeding for behavioral traits in infancy.

Studies involving human subjects examine the role of pre- and post-natal experiences on fetal, infant, child, and maternal behavior and physiology.

Developmental Neuroscience The International Society of Trauma and Dissociation bestowed the Pierre Janet Award for Best Scientific Paper on Dr. Daniel Schechter, a child psychiatrist whose research focuses on maternal posttraumatic stress disorder and its potential impact on caregiving and the social-emotional development of very young children.

Investigations are augmented by a postdoctoral training grant that NIMH has provided continuously for over thirtyfive years and by the Sackler Institute for Developmental Psychobiology.

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The Division discovered a sharp decrease recently in outpatient psychotherapy usage in the US, sparking discussion about the appropriate role of psychotherapy in the delivery of psychiatric services

Epidemiology Myrna Weissman, PhD Division Chief

The Division is organized into four related areas: • genetics/high risk research;

Epidemiology Dr. Stephanie Kasen found that obesity in young women was associated with depression and anxiety three decades later at midlife, a considerably lengthier interval than examined previously. Those results, based on longitudinal data, expand the available database on the temporal link between obesity and mental health consequences in women.

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The Division of Epidemiology studies the risk of psychiatric disorders and related disability associated with genetic, social, and environmental factors and develops interventions and programs to reduce these risks. Research methods cover the range of epidemiology and genetic studies, clinical trials, and clinical and community epidemiological surveys. Collaboration, which will integrate or translate the newest methods from genetics, imaging, and neuroscience with epidemiologic studies and training of graduate and young investigators, is strongly emphasized.

• epidemiology/health services; • prevention/therapeutics; • international mental health.

This year, the Division continued to advance our understanding of the epidemiology of depression. It showed that the remission of depression in mothers had long-lasting positive effects on their children. In addition, the Division found a connection between early-onset recurrent depression and chromosome 15q25-q26.

These advances and many others led to 2 books, 145 papers, and 12 chapters, as well as innumerable honors and awards.

Epidemiology of Substance Abuse This year, the Division found that

Epidemiology of Substance Abuse

adolescents experience symptoms

Denise Kandel, PhD Division Chief

In addition, they discovered that

This Division investigates the natural history of drug involvement, the risk factors and consequences of drug abuse, and comorbidity of substance abuse with problem behaviors and psychiatric disorders among adolescents and adults.

Research focuses on cigarette smoking and nicotine dependence, and involves epidemiological studies based on general population samples as well as secondary analyses of national data sets.

The Division has also initiated a completely novel area of research, focused on the molecular basis of epidemiological paradigms in mice, in collaboration with colleagues from the Center for Neurobiology and Behavior.

A major current research activity is a longitudinal follow-up of the Transition to Nicotine Dependence in Adolescence, which describes the natural history and risk factors for nicotine dependence. The follow-up cohort includes 1,039 urban adolescents and their mothers. The researchers collected saliva samples for future investigation of the genetics of nicotine dependence in adolescence.

This past year, the Division focused on data analysis and investigated the sequencing in the acquisition of symptoms of nicotine dependence; commonalities and differences among three different measures of nicotine dependence; and comorbidity between nicotine dependence and psychiatric disorders in adolescence. Based on national data sets, the Division also examined the relationship between educational attainment and smoking by women and the consequences for offspring of smoking in pregnancy.

of nicotine dependence at low levels of tobacco consumption. those who eventually meet criteria for the full syndrome of dependence experience symptoms much faster than those who experience only one or two criteria.

Geriatric Psychiatry Davangere P. Devanand, MD Division Chief

The Division of Geriatric Psychiatry engages in a wide range of research efforts focused on investigational studies and somatic therapies in geriatric psychiatry.

These include the operation of three outpatient research clinics: the Late Life Depression Clinic, the Huntington’s Disease Center of Excellence, and the Memory Disorders Center. The Division also has laboratories for the study of psychiatric treatments in animal models, including models of depression and neurogenesis.

Geriatric Psychiatry Dr. Devanand and his colleagues found they could strongly predict eventual conversion to Alzheimer's disease in patients with mild memory loss by jointly considering five tests, including a multiplechoice test on smelling. This combination was markedly superior to combining age and mini-mental status exam, and indicates the importance of combining several specific tests to improve the accuracy of predicting who will

The Division’s work on dementia includes:

develop Alzheimer's just as

• a pioneering study on the use of olfactory identification of deficits as an early diagnostic marker of Alzheimer’s disease;

physicians use several factors to

• a multi-center clinical trial to determine how long Alzheimer’s patients who develop psychosis or agitation need to continue on antipsychotic medication treatment; • the first prospective study of whether the use of combined antidepressants and cognitive enhancers will slow the onset of dementia in patients who present with both depression and mild cognitive impairment.

The Division’s research on neurogenesis demonstrated that this phenomenon is necessary for therapeutic effects of antidepressants and that it is correlated with performance.

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HIV Center for Clinical and Behavioral Studies

NORTHERN PROVINCE

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Provincial capital Town, village

Through the MAC AIDS Fund Leadership Initiative, the HIV Center has enabled School Principal Mantombi Nala-Preusker and 19 other fellows in South Africa to mobilize communities to empower girls and women. Because gender inequality is a driving force behind the HIV epidemic, Nala-Preusker works with her primary school students in KwaZulu-Natal province in South Africa. Change starts here: in the classroom.

S av e

ZIMBABWE

National capital

lb

ay

The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations.

ay 25°

35°

30°

35°

Department of Peacekeeping Operations Cartographic Section

women and men, persons who engage in same-sex behavior, and people with mental illness. Its goal is to help HIV+ individuals cope with infection and to reach the populations who are at highest risk, ethnically diverse, and often disenfranchised.

A particular strength of the Center is its emphasis on the intersection of the HIV/AIDS epidemic with mental health.

It documented disproportionately high rates of infection among the severely

mentally ill, and developed effective interventions to decrease sexual risk behaviors in this population.

The HIV Center is a leader in innovative training programs that attract fellows and junior investigators who become independent researchers and public health officials. The Center is, thus, a critical resource for the global scientific community, local communitybased organizations, and legislators and policy makers.

The Division collaborates with sixty-three institutions and departments – nine other departments and schools of Columbia University, thirty-nine other institutions in the US, and fifteen institutions in eight countries outside of the US. In addition to its research, the Division continues to provide clinical services at its groundbreaking Special Needs Clinic at Babies Hospital, which has met the mental health needs of more than 1,500 families affected by HIV.

Integrative Neuroscience RenĂŠ Hen, PhD Division Chief

The Division of Integrative Neuroscience seeks to understand the pathophysiology underlying psychiatric illnesses using approaches that span multiple levels of neurobiological analysis. Accordingly, the Division combines molecular and cellular neurobiological and behavioral techniques with analyses of neural circuits and neural systems to fully understand animal models of psychiatric illnesses, such as anxiety disorders, depression, and schizophrenia.

The Division has seven laboratories of its own, as well as close ties to the Department of Neuroscience and other neuroscience laboratories at Columbia University.

This mouse brain was rendered translucent so all cells expressing a cellsignaling molecule appear blue. The Division uses mouse models to understand psychiatric disorders, such as anxiety, depression, and schizophrenia.

The Hen lab focuses on the contribution of serotonin (5-HT) receptors to pathological states, such as depression and anxiety. The lab also investigates how the generation of new cells in the hippocampus is required for some of the behavioral effects of antidepressants, and it is developing antidepressant therapies aimed at targeting hippocampal stem cells.

Integrative Neuroscience The Moore lab studies structural changes in inputs to the amygdala, which is responsible for Dr. RenĂŠ Hen, right, and colleagues investigate both how the neurotransmitter serotonin affects psychiatric disorders and how antidepressants create new neurons in the hippocampus, which cause the medications to work.

fear, anxiety, and maladaptive stimulus-response habits. Changes during adolescence may underlie the progressive increase in risk for anxiety and addiction disorders during adolescence.

RESEARCH DIVISIONS

33

The Gordon lab studies mouse genetic models of psychiatric diseases from an integrative neuroscience perspective, focusing on how a given disease mutation leads to a behavioral phenotype. This work has increased our understanding of the genetic roots of anxiety and schizophrenia.

Law, Ethics and Psychiatry Robert Klitzman, MD, published his widely-acclaimed When Doctors Become Patients, a reflective and deeply empathetic examination of what he and more than fifty other physicians learned about becoming wiser and more compassionate healers when they themselves experienced serious illness.

Dr. Ruth Fischbach studies state medical board policies toward physician participation in lethal injection.

The Moore lab looks at how multiple overlapping circuits in different parts of the brain malfunction in psychiatric disorders. Since many disorders, including anxiety, addiction disorders, and schizophrenia, emerge in most individuals during adolescence or early adulthood, it is imperative to understand how these circuits change as the individual matures, and to determine how these circuits are altered by genetic alterations or environmental exposures known to increase the risk for specific psychiatric disorders.

The Dranovsky and Leonardo lab uses molecular biology techniques to generate reversible inactivation of genetically defined populations of neurons in transgenic mice (mice with a gene or genes from another species). These animal models show how disruptions in genetically defined circuits affects behavior.

The Duff lab creates mouse models to explore the mechanisms in the development and prevention of neurodegenerative diseases, such as Alzheimer’s disease.

The Balsam lab is studying the mechanisms of adaptive behavior and how they might be altered in animal models of psychiatric disorders. One project studies how animals learn about time and use it to guide behavior, and how temporal information processing is changed by alterations in dopaminergic function.

The Kottmann laboratory employs a variety of molecular, pharmacological, cellular, and genetic strategies to define the neuronal contribution towards the regulation of stem cell maintenance and/or differentiation in the adult forebrain in mice. In the course of its studies, the lab produced two novel models of neurodegenerative diseases in mice.

Law, Ethics and Psychiatry Paul S. Appelbaum, MD Division Chief

The faculty of the Division of Law, Ethics and Psychiatry engage in research and teaching on the impact of legal and ethical rules on the practice of psychiatry (including psychiatric research), and on the role of psychiatry in the legal process.

Specific topics of study include Institutional Review Board (IRB) function, adequacy of informed consent to research, and the impact of advances in genetics on the decision-making of physicians.

The Division is extensively involved in the training of residents and fellows at NYSPI, and in the education of students, faculty and staff through collaborations with the Irving Institute for Clinical and Translational Research and the Columbia Law School.

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RESEARCH DIVISIONS

Mental Health Services and Policy Research Susan Essock, PhD Division Chief

The Division of Mental Health Services and Policy Research helps bridge the gap between research and practice by developing public-academic partnerships between researchers in psychiatry and policy makers at the New York State Office of Mental Health (OMH) and elsewhere.

Conducting such policy-relevant mental health services research is essential in its own right as the ultimate end of the translational research enterprise, that is, the process of applying scientific discoveries from bench to bedside.

The Division’s work is practical.

Investigators examine the structure, content, and outcomes of services as they occur in real-world settings, and identify what interventions are most useful for recovery. This includes examining what interventions work, how well they work, for whom they work best, the cost of these

interventions, and the organizational and financing strategies that allow effective interventions to be implemented and sustained.

Policymakers should have research to guide them, yet too often the data needed are not available to inform decision-making.

Similarly, services researchers should address questions of high policy relevance to decision makers so that services issues determine research topics. Hence, the Division emphasizes research partnerships with public sector administrators and other players.

Division collaborations with the state include the Supporting Science Initiative, which OMH established in November 2007. This NYSPI-based initiative includes an Evidence-Based Practices Technical Assistance Center to identify and involve consumers, providers, academicians, and others as partners in supporting the goals of OMH and the Center.

Drs. Susan Essock and Robert Drake collaborate to create on-line courses to train thousands of front line staff state-wide in treatments for co-occurring mental health and substance use disorders. This initiative, jointly funded by OMH and the State Office of Alcoholism and Substance Abuse Services (OASAS), is part of the Evidence Based Practice Technical Assistance Center in the Division of Mental Health Services and Policy Research.

Mental Health Services and Policy Research Dr. Alice Medalia developed a test to measure insight into cognitive impairment for people with schizophrenia and found that about half of people with schizophrenia are not aware that they have cognitive deficits, even though they score in the impaired range on cognitive tests. These findings have implications for cognitive enhancement strategies.

RESEARCH DIVISIONS

35

Center components include:

• Clinic Plus Evaluation to examine the implementation of a state-wide initiative to improve outcomes for children and adolescents; and

Besides these and other research projects, the Division pursued its mission of developing leaders in public health policy.

It identified eleven OMH Policy Scholars who worked on their projects under the tutelage of a research mentor and a policy mentor. Awardees participated in a regular luncheon series, which featured speakers on areas of interest, culminating in a final luncheon featuring Commissioner Michael Hogan.

• Sexual Offenders Treatment Program to report on the characteristics of offenders and to identify predictors and correlates of recidivism.

Molecular Imaging & Neuropathology

• the 2008 Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES), an award-winning, web-based application to improve the quality of psychotropic prescribing practices in Article 31 Clinics;

Microscope images of Dorsal Raphe Nucleus slices stained for serotonincontaining cells show the density of these cells and cell processes in a person who died by accident compared with a person who committed suicide.

The Division also interviewed national and international experts on Assertive Community Treatment (ACT) Recovery Spectrum of Services, an intensive, community-based treatment for people with serious and persistent mental illness, to test a model for step-down from ACT, and to identify successful strategies for ACT discharge.

In addition, faculty addressed challenges in many other critical areas, from metabolic monitoring in state psychiatric hospitals to violence and the mentally ill.

J. John Mann, MD Division Chief

The Molecular Imaging & Neuropathology Division spans the research spectrum from basic cell biology to in vivo imaging, molecular genetics, and treatment trials. It emphasizes translational research – research that can be translated or applied from the laboratory to clinical practice – and employs a multidisciplinary approach to examine the biological substrate of mental illness at multiple levels.

Specific work includes neuroanatomical mapping, quantitative morphometric and gene expression studies in the brain, postmortem brain studies of psychiatric disorders, and the provision of neuropathology services to OMH. The Division maintains an archival collection (brain bank) of these specimens as well as other brain specimens collected for research purposes.

Major areas of clinical investigation have been the: • biological basis of mood, anxiety and psychotic disorders, and borderline personality; • the action of antidepressants and other psychotropics; and • risk factors for suicidal behavior.

36

RESEARCH DIVISIONS

Basic studies looked at neurotransmitter systems and the action of antipsychotics and antidepressants.

The Division has three centers: • Moody Center for the Study of Early Onset Bipolar Disorder, headed by Maria Oquendo, which uses functional MRI and genetics to detect early onset bipolar disorder as a step towards preventative intervention; • Suicide Intervention Center, headed by Barbar Stanley, which focuses on highrisk populations, especially people with borderline personality disorder; and the • Silvio O. Conte Center for the Neuroscience of Mental Disorders: The Neurobiology of Suicidal Behavior, which investigates risk factors for

suicidal behavior in mood disorders, schizophrenia, and personality disorders.

The Conte Center uses human postmortem studies and translational approaches, including novel Positron Emission Tomography tracers for brain imaging, new peptide assays in cerebrospinal fluid, and an investigation of candidate genes (genes that are regarded as possible contributing causes for a disorder or trait).

Within the Division, several labs have explored different aspects of suicide. For example, the neuropsychology group completed a five-year study of neurocognitive factors and their association to suicidal behavior, finding that deficits in cognitive control mechanisms are a strong correlate of past attempt status.

Molecular Imaging & Neuropathology Postdoctoral Research Fellow Maura Boldrini, MD, PhD, and colleagues showed that antidepressants could lead to the development of new neurons in both normal people and people with mood disorders.

This discovery led to the funding of three grants.

RESEARCH DIVISIONS

37

underlie behavior, with an emphasis on existing or new targets for therapeutic intervention in psychiatric disorders. The Division has a specialized expertise in dopaminergic signaling and its role in schizophrenia and drug abuse.

The Division uses animal models to explore normal physiology and its regulation, as well as to model aspects of psychiatric disorders. Projects are multidisciplinary, and include studies on the biochemical and biophysical characterization of basic molecular processes that underlie drug responses; cellular physiology; and behavior.

The Javitch lab studies signaling among G-protein receptors, a large family of proteins which are targeted by a wide variety of drugs, including antipsychotic medications.

Molecular Therapeutics Dr. David Sulzer, a member of the Molecular Therapeutics Division, was awarded a multidepartment institutional training grant from NIDA for basic neuroscience research on neural mechanisms associated with drugs of abuse. While Columbia University has a training grant to provide support for clinical research in drug abuse, there has never been a training program in basic research

The personality disorders group learned that interpersonal triggers are prominent in suicidal behavior for individuals with borderline personality disorder and that social stress reactivity of the hypothalamic pituitary axis is heightened in suicide attempters with borderline personality disorder. The group studies genes that might be responsible, alone or in combination with other genes and the environment, for suicidal behavior.

The mood disorders and suicide risk clinical research group reported this year on: • a classification system for suicidal behavior; • protective factors for suicidal behavior in mood disorders; and • a pharmacologic challenge as a marker of future suicidal behavior.

in drug abuse.

Molecular Therapeutics Jonathan A. Javitch, MD, PhD Division Chief

Research in the Division of Molecular Therapeutics focuses on understanding molecular and cellular processes that

38

RESEARCH DIVISIONS

The Javitch laboratory focuses on neurotransmitters and on the structure, function, and regulation of a large protein family of receptors that sense molecules outside the cell. These receptors are involved in many diseases and are the target of about half of all modern medicines. This group has started to elucidate the molecular mechanisms that govern this regulation.

The lab is now inserting genes from other species into mice and flies to explore these mechanisms in a physiological context and using direct structural approaches to study the structure and dynamics of bacterial transporter homologues of the human neurotransmitter transporters.

The Rayport laboratory showed that fast dopamine neuron signaling is mediated exclusively by glutamate, the most common neurotransmitter in the mammalian nervous system. The lab demonstrated that paradoxically, in a hypoglutamatergic mouse model, the enzyme that synthesized glutaminase produces a mouse with a phenotype of schizophrenia resilience, suggesting a new target for the pharmacotherapy of schizophrenia.

The Schmauss lab includes three projects: • molecular and behavioral studies on the genetic and environmental regulation of RNA editing and expression of functionally-related genes; • behavioral and anatomic studies on the role of adult hippocampal neurogenesis in the expression of depression-like behavioral phenotypes and antidepressant drug actions in genetically-different inbred strains of mice; and • behavioral and anatomic studies on gene activation mediated by regulatory transcription factors of the immediate early gene family in neuronal networks that support attention and working memory in the mouse.

Neurobiology and Behavior John Koester, PhD Division Chief

The Division of Neurobiology and Behavior believes in using an integrated approach, ranging from cellular and

molecular biology to neural systems and behavioral analysis, to understand the basis of normal and abnormal human behavior. As part of this endeavor, experimental approaches are complemented by a broad range of theoretical and computational techniques.

The Division focuses on basic science aspects of neural development and on the functions of the nervous system that underlie normal and abnormal behavior. It investigates subjects ranging from simple invertebrates to people. Many studies look at learning and memory, attention, perception, and affective behavioral traits that may be involved in mental illness.

Several ongoing projects may someday contribute to our understanding of the etiology of, and new therapeutic approaches to, anxiety disorders, benign age-related memory loss, cerebral palsy, fragile-X syndrome, Rubinstein-Taybi Syndrome, schizophrenia, and spinal cord trauma.

Neurobiology and Behavior Drs. Eric Kandel and Daniela Pollak found that conditioning mice to associate a specific noise with protection from harm, a behavior called “learned safety,” produced a behavioral antidepressant effect comparable to medications. This finding may inform further studies of the cellular interactions between antidepressants and behavioral treatments.

Joe Schumacher, a graduate student in the Doctoral Program in Neurobiology and Behavior, inspects a microelectrode.

RESEARCH DIVISIONS

39

Kelly Durbin, a volunteer, works alongside researcher David Kimhy on stress regulation and coping strategies for individuals with schizophrenia.

40

RESEARCH DIVISIONS

This year, the Division showed that categorical decision-making in humans involves a fronto-striatal cortical network different from the network involved in signal detection decisions. In ongoing research using functional Magnetic Resonance Imaging in monkeys that are awake, researchers found that monkeys have a categorical decision-making network similar to that in humans. This finding validates the hypothesis that the monkey can serve as a model system to understand the physiology of decisionmaking in humans.

Finally, the faculty found that the cat primary visual cortex, which is a model system for cerebral cortical processing more generally, operates in a regime in which recurrent excitation is strong enough to drive cortical activity to instability, and that this instability is controlled by feedback inhibition.

The Division also discovered that memory storage may depend on activity of neurons in the hippocampus.

The Division of Psychiatric and Medical Genetics continues to pursue its longstanding goals of elucidating the mechanisms and genetic liabilities underlying psychiatric disorders and other

Psychiatric and Medical Genetics L. Erlenmeyer-Kimling, PhD, DSc (hon) Division Chief

This is a schematic representation of a spontaneous copy number mutation found in one individual with schizophrenia. This mutation results in loss of genes, including a gene affecting neurodevelopment (EPHB1).

Psychiatric and Medical Genetics

behavioral anomalies. A central part of the overall research effort has been the search for specific risk factors that may predict schizophrenia, bipolar disorder, Huntington’s disease, or other neurobehavioral disorders. The Division has a long tradition of discoveries since its foundation in the late 1930’s.

Specific projects include the investigation of: • molecular-genetic pathways for neuropsychiatric disorders; • genetic mutations associated with schizophrenia drawing on a population where the availability of both biological parents mades it possible to tell which mutations are inherited; and • data already collected from a large Venezuelan pedigree with Huntington’s Disease.

The Division continues to analyze data from the New York High-Risk Project, a longitudinal study of schizophrenia risk.

The project, now more than thirty-two years old, follows individuals at high risk of schizophrenia or major affective disorders from childhood to adulthood and compares them with individuals who are not at risk.

Social Psychiatry

Dr. Karayiorgou’s group identified a significant role for a new family of

Bruce P. Dohrenwend, PhD

about four hundred genes that

Division Chief

influences expression of

The Division of Social Psychiatry has three component groups.

The Social Psychiatry Research Unit studies major substantive and methodological issues in psychiatric epidemiology. The substantive research focuses on the role of adversity and stress in the onset and course of psychiatric disorders differentially related to gender, ethnic/racial background, and socioeconomic status. The methodological issues center on how to conceptualize and measure major stressful life events as risk factors for the development of these disorders.

approximately one-third of all genes.

A study of the gene in schizophrenia, using a mouse model, demonstrated how mutations in it lead to specific alterations in neuronal architecture and cognition.

The Community Research Group investigates community-level processes that affect health and mental health. Over the years, it examined AIDS, crack, violence, tuberculosis, asthma, and other epidemics that shaped life in poor neighborhoods in the US. The Stigma and Mental Illness and Violence Group looks at the impact of stigma-related processes on people with

RESEARCH DIVISIONS

41

Dr. Mindy Fullilove Organized the CLIMB Project’s fourth Annual Hike the Heights, which brought 500 people to Highbridge Park in upper Manhattan.

Social Psychiatry Dr. Mindy Fullilove reports that work was completed on “Happy Anniversary, CRG!” This is the first

mental illnesses and their families. The initiative tracks public conceptions about mental illness, the experience of stigma for people with mental illnesses, and the connection between mental illnesses and violent behaviors.

ranked it as one of the top three in the country in rankings.

empowerment and how people solve

Substance Abuse

Resources include non-human primate studies and separate human research laboratories, all located in NYSPI, for studying heroin and prescription opioid analgesics, methamphetamine, marijuana, nicotine, alcohol, and pain.

problems; specifically it depicts how

Herbert Kleber, MD Division Chief

In addition, the Division has:

Research in this Division focuses on antecedents and consequences of substance use and abuse, with particular emphasis on the development and testing of new approaches to treatment. For almost a decade, the US News & World Report has

• a cocaine human research laboratory located in the Irving Center Institute for Clinical and Translational Studies;

segment of a documentary to accompany the reissue of a book cowritten by Dr. Fullilove and her father on community organizing in Orange, NJ. The film explores issues of

African-Americans organized for power at a point in which they were excluded from the re-organization of the city. CRG in the title stands for “Citizens for Representative Government.”

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RESEARCH DIVISIONS

• an outpatient clinical research service (STARS) for treatment trials for new medications;

This year the Division: • developed a model for studying changes in dopamine related to bingeeating and drug-taking in non-human primates; • found that the pharmacology of oxycodone, one of the most commonly abused opioid medications, rather than its greater availability on the streets, may mediate its abuse liability; and

• a new residential laboratory for studying a variety of workplace and other drugrelated issues; • a regional Node in the National Institute on Drug Abuse (NIDA) Clinical Trials Network creating research affiliations with four major community-based treatment providers in the New York Metropolitan area.

The Substance Abuse Division receives support from both NIH and the NIDA Medication Development Center for research using laboratory models of substance abuse, imaging studies, and traditional clinical trials research. A major strength of the Division is its ability to conduct initial safety and effectiveness studies with human laboratory models and then to use the results of these studies to inform the design of larger scale clinical trials.

Substance Abuse Dr. Edward Nunes and Dr. Susan Tross showed that a skills-based behavioral intervention, delivered by clinicians at community-based drug treatment programs, was effective in reducing HIV risk behavior among women in drug treatment.

• showed that a clinical dose of aripiprazole significantly increased cocaine craving, suggesting that administering aripiprazole to psychiatric patients who abuse cocaine may result in increased cocaine use.

Translational Imaging Anissa Abi-Dargham, MD Division Chief

The mission of the Division of Translational Imaging is to use imaging to uncover the neural basis of psychiatric disorders and aid in drug development.

MRI and dopamine D2 receptor PET images show striatal binding of the radiotracer [18F]fallypride at increasing daily doses of aripiprazole.

Other projects include brain imaging research that is mapping neuroreceptors (particularly of serotonin and dopamine) in response to cocaine and heroin administration. Recently, the Division added a novel clinical cognitive laboratory for the study of cognitive functioning in substance abusers and its relations to treatment outcome within the regional Node in the NIDA Clinical Trials Network.

RESEARCH DIVISIONS

43

Dual diagnosis is an increasing area of interest among researchers in the translational imaging division, where current studies include investigations of dopamine transmission in patients diagnosed with schizophrenia and marijuana dependence. Here, Liz Hackett, nuclear medicine technologist (left), Dr. Judy Thompson, and Division Chief Anissa Abi-Dargham prepare a participant for a scan.

Translational Imaging The Division found that antipsychotics intended to treat psychosis may lead to more craving, more drug use, non-adherence, and a self-perpetuating vicious circle.

This discovery has significant implications for understanding patients with dual diagnoses and

The Division develops new tools and techniques to study neurotransmission in the living human brain, and applies these techniques to unravel chemical imbalances associated with severe mental illnesses and drug addiction.

Clinical investigations within the Division focus on:

Faculty primarily use molecular imaging based on PET techniques developed in the Division to study clinical populations.

• design of paradigms to assess dopamine release in response to alcohol challenge and reward related tasks;

Development of new imaging techniques includes design of new radiotracers as well as development of new imaging paradigms based on cognitive tasks or either pharmacological or electromagnetic challenges to measure responsivity of neurotransmitter systems.

• identification of biomarkers for disease prevention or drug discovery and development.

guiding future research.

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RESEARCH DIVISIONS

• schizophrenia; • cannabis dependence and comorbidity with schizophrenia; • MDMA (ecstasy) dependence;

Additionally, the Division performs imaging studies in collaboration with other investigators who specialize in the study of anxiety disorders, mood disorders, autism, personality disorders, and alcoholism.

Education in Psychiatry Dr. Deborah Cabaniss, together with Dr. Alicia Rojas, now a PGY-IV, studied residents' supervisory experience in the program and then implemented improvements. Their efforts will further enhance the residency training program’s appeal to future enrollees.

Education in Psychiatry Maria A. Oquendo, MD Vice Chair for Education Janis Cutler, MD Director of Medical Student Education

The Graduate Medical Education Division is dedicated to training medical students, residents and fellows to become outstanding clinicians, researchers, and teachers, who will make meaningful contributions to the field of Psychiatry.

The Division is responsible for the Psychiatry curriculum of approximately five hundred medical students throughout

the four years of medical school training at the Columbia University College of Physicians & Surgeons. In addition to residency training in psychiatry, the Division offers clinical psychiatry fellowships in six subspecialties:

In addition to the specific training programs provided, the Division oversees Continuing Medical Education programs and the weekly Grand Rounds Lecture Series.

• child psychiatry; • public psychiatry; • psychosomatic medicine; • geriatric psychiatry; • forensic psychiatry; and • emergency psychiatry.

Research Fellowships are available through eleven different programs, nine of which are funded by NIH.

Dr. Paul Appelbaum chaired committees to review curricula for medical students and for residents.

This year, the Division established two committees, to review the curriculum for medical students and for residents so it could update and improve educational services.

The Committee to Evaluate the Medical Student Curriculum in Psychiatry reported that it was impressed with the scope and quality of the Columbia curriculum; none of the curricula reviewed from schools with comparable reputations appeared superior, and many were clearly not as good.

Medical student evaluations of both the first-year and second-year curricula indicate that the students overwhelmingly share our positive perceptions of the current teaching program.

To maintain the curriculum at the cutting edge of training, the Committee made several recommendations for the preclinical curriculum, including the addition of a lecture on substance abuse or dual diagnosis and a lecture on autism/Asperger’s/mental retardation.

The White Coat Ceremony marks the transition from medical student to resident.

The Committee also thought the sessions on psychodynamic psychotherapy might be reoriented to: • focus on psychodynamic models; • consider neurobiological data in support of psychodynamic concepts; and • discuss the psychodynamic issues that are likely to arise in the medical setting.

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EDUCATION IN PSYCHIATRY

To free time for some of these changes, the Committee recommended folding the lecture on social anxiety into one of the other presentations on anxiety disorders.

The Committee also made suggestions about clinical rotations, including exposing student to manualized therapies and developing additional electives that would show students subspecialty areas and clinical programs of particular strength in the Department.

The Committee to Evaluate the Medical School Curriculum in Psychiatry is implementing these changes.

The Committee to Review Clinical Training in the Adult Psychiatry Residency also concluded that the services it provided were excellent and thought the program graduates well-trained psychiatrists.

However, the Committee felt the experience of residents could be improved in some areas, for example, by adding a month of child and adolescent experience

to the CPEP program in child psychiatry and reconceptualizing training for geriatric psychiatry. The Committee also recommended that the resident rotation schedule and residency selection and interview process be reorganized.

Drs. Suzanne Dieter and Lorraine Lothringer confer in the psychiatric emergency room, where trainees learn to manage acute psychiatric disorders.

The changes recommended by the Committee to Review Clinical Training in the Adult Psychiatry Residency were implemented.

Changes recommended by Dr. Deborah Cabaniss, Director of Psychotherapy Training, were also implemented. Dr. Cabaniss spearheaded a survey to investigate gaps in residents’ understanding of supervision. She presented her study at the national meeting of the American Association of Directors of Psychiatric Residency Training in New Orleans in March 2008.

The results of this study led the Division to orient faculty supervisors to the shared mission of teaching residents

EDUCATION IN PSYCHIATRY

47

psychotherapy with specific goals during each stage of training. Supervision also functions as the “lab” component of training, where individual resident cases become the springboard to underscore concepts taught in the classroom.

• expansion of resident exposure to public psychiatry through mental health programs within the community; • creation of a project, “Walk a Mile in My Shoes: Using First-Person Narratives to Build Empathy with the Severely and Persistently Mentally Ill During Residency Training;”

Other significant changes in the Division this year include the:

• and the development of a program to teach senior residents how to teach.

• adaptation of a standardized battery of psychometric tests for patients applying for treatment in the residents' long-term therapy clinic, and a review of tests supervisors can teach residents about;

This program, “Growing Teachers: Teaching Residents using PGY-IV electives,” will be presented at the 2009 meeting of the American Association of Directors of Residency Training.

Educational Programs Medical Students 3rd year clerkships

150

4th year electives: Columbia students

13

4th year electives: Visiting students

23

21

Social work Master’s students

Postdoctoral Program

Substance Abuse Disorders

3

Center for Psychoanalytic Training & Research Adult Psychoanalysis

3

Psychodynamic Psychotherapy

2

Child & Adolescent Psychotherapy

2

Center for Neurobiology and Behavior 13

Psychology Internship Program

1

Affiliated Center Programs

Nursing Students

Schizophrenia Research

10 2

Pre-Doctoral Fellows

12

Postdoctoral Fellows

9

Stroud Center for Quality of Life and Center for Geriatrics and Gerontology Geriatric Psychiatry Fellowship

2

Research Trainings Clinical Training

Affective, Anxiety and Related Disorders

4

Behavioral Sciences Research Training in HIV

2

Child Psychiatry

3

Developmental Neuroscience and Behavior

4

Geriatric Psychiatry

5

Psychiatric Epidemiology

2

Addiction Psychiatry Adult Psychiatry

12

Child Psychiatry

12

Psychosomatic Medicine

2

Emergency Psychiatry

1

Geriatric Psychiatry

2

Forensic Psychiatry

2

Public Psychiatry

48

EDUCATION IN PSYCHIATRY

2

10

Clinical Divisions Clinical Services at NYSPI David Lowenthal, MD, JD Clinical Director

The Clinical Services at Psychiatric Institute (PI) include the Washington Heights Community Service, an inpatient and outpatient service treating the severely mentally ill living in northern Manhattan; two inpatient research units containing twelve (4-Center) and twenty-four beds (5South), respectively; Recreation Therapy; Clinical Psychology; and the Division of Clinical Social Work.

The Washington Heights Community Service had 235 inpatient admissions in the past year and followed almost 1,000 outpatients. New initiatives on that service included piloting measures designed to address the metabolic side effects of antipsychotic medications; implementing wellness self-management groups; and training in rehabilitation and recovery oriented services.

The two research units admitted a total of 276 patients, and included research subjects in numerous protocols covering, among other things: • eating disorders;

The Departments of Clinical Psychology, Nursing, Social Work, and Recreational Therapy all contributed greatly to the care of both inpatients and outpatients at Psychiatric Institute, which remains committed to a multidisciplinary approach to psychiatric care. In addition to providing excellent care and treatment, each of these Departments has extensive training programs, further supporting the clinical and research missions of PI.

NYSPI Inpatient Units

Clinical Services at Columbia University & NewYork-Presbyterian Hospital

Child Psychiatry (NYPH)

Frederic Kass, MD Medical Director

NYSPI Ambulatory Research Clinics David Lowenthal, MD, JD

Adult Psychiatry (NYPH) Ellen Stevenson, MD

Lourival Baptista Neto, MD

CUMC Psychiatry David Kahn, MD

Nursing (NYSPI) Marcia Michaelson, RN, MS, CS, CNP

• a day treatment program;

Laura Mufson, PhD

• intensive outpatient program; • neuropsychology assessment service;

Elizabeth Golden, MSW

Psychology (NYSPI)

Psychology (NYPH) Herbert Schlesinger, PhD

• comprehensive outpatient and inpatient evaluations of complex patients; and

Recreational and Rehabilitative Therapies (NYSPI)

• specialty consultative services for autism, Lyme Disease and other disorders.

Matt Gold, CTRS

Altogether, these programs treated over 2,100 individuals in 2008, providing nearly 25,000 outpatient visits.

• substance use disorders;

• services for college students with serious psychiatric disorders;

Of note, several new senior staff members began working on 5-S during the year, including a new unit chief, Dr. Elizabeth LeQuesne.

Francine Cournos, MD

Social Work (NYSPI)

New outpatient programs that were initiated include:

• depressive disorders.

Washington Heights Community Service

Through Columbia faculty practice, the Department operates:

• neuroimaging (including PET receptor studies, functional MRI); • brain stimulation and convulsive therapies; and

David Lowenthal, MD, JD

• intensive eating disorders day treatment; • the Lieber Center at the Columbia Day Program, providing cognitive remediation and case management for individuals with psychotic disorders.

In the inpatient units at New York Presbyterian Hospital, faculty psychiatrists treated an additional 1,400 individuals.

CLINICAL DIVISIONS

49

Recreational activities, such as art classes, help patients enhance their functioning and are critical to their recovery.

Program Statistics Delivering outstanding psychiatric treatment that is informed by research initiatives is the number one objective of the clinical staff who deliver care to patients and their families.

Clinical Programs 2007

2008

NYSPI Program Statistics Inpatient Discharges

512

528

Outpatient clinic visits

14,058

14,133

Outpatient day treatment

27,852

26,143

ECT inpatient procedures

222

247

Columbia University Programs (January to December)

2007

2008

NY Presbyterian Hospital (January to December) Inpatient discharges ECT Inpatient treatments Inpatient detoxification

1,489

1,180

149

130

68

63

Consultation Liaison Service/Adult

4,513

3,385

513

1,365

1,096

984

Consultation Liaison Service/Child

58

171

CPEP Adult

4,902

3,717

12,894

16,922

CPEP Child

1,420

1,080

Autism visits

1,201

1,106

Mobile Crisis Service

1,027

837

Reduced Fee-Resident visits

4,248

3,561

Anxiety (Child)

1,968

3,408

IOP visits (includes NYPD cases)

4,416

4,557

Brain Stimulation visits

197

195

Eating Disorder visits

158

50

Lyme Evaluation visits

65

146

Buprenorphine visits Comprehensive Evaluation Day Treatment visits

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CLINICAL DIVISIONS

Adult Clinic Homebound Elderly Child Clinic

24,701 1,225 32,781

18,667 919 24,566

Program Statistics NYSPI Programs (July 1, 2007 to June 30, 2008)

Inpatient Services

Patients, many of whom are diagnosed with intractable psychiatric disorders made worse without health insurance, benefit from the latest clinical initiatives available on PI’s inpatient units. Patients with major depression continue to seek out non-medication treatments like ECT.

Outpatient Services

NYSPI’s outpatient programs for residents of upper Manhattan prepare patients for greater community involvement, including job retention and school enrollment.

2007

2008

CLINICAL DIVISIONS

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Columbia University Programs (January 1, 2008 to December 31, 2008)

Outpatient Visits

Columbia continues to provide excellent clinical services to address the needs of its patients and families. The number of visits to its autism program nearly tripled in the last year. The buprenorphine program is a key resource for people dependent on opiates.

Day Treatment

New programs, including one to treat depression and prevent suicide in college-age individuals, fueled a 31% increase in the number of day treatment visits.

2007

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CLINICAL DIVISIONS

2008

Reduced Fee and Intensive Outpatient Program (IOP) Visits

For patients with limited financial means, psychiatric care by supervised residents is available at a reduced fee. The IOP exists as an option for patients who require more intensive treatment than is available in the standard outpatient setting.

Other Services

Evaluations and treatment for Lyme disease and eating disorders are among the clinical areas in which Columbia excels, so much so that it continues to attract patients from throughout the metro area and across the country.

NY Presbyterian Hospital (January 1, 2008 to December 31, 2008)

Consultation Liaison (CLS) Services

NewYork Presbyterian provides an outstanding consultationliaison service for adults and children presenting with psychiatric disorders or medical conditions presenting with psychiatric symptoms.

Clinical Services

Extensive research initiatives drive an array of psychiatric clinical services available to adults and children. Adult clinics include services for dually-diagnosed patients with HIV and mental illness. Families can take advantage of programs that meet their children’s social and developmental needs.

Emergency Services

*CPEP - Comprehensive Psychiatric Emergency Program Adults and children in the surrounding communities have access to urgent psychiatric care. Outreach services provided by the Mobile Crisis team provides psychiatric evaluation, crisis counseling and referrals.

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Recreational therapists like MariLu Zahn work in tandem with the treatment team to help patients on the psychiatric inpatient unit at NewYork-Presbyterian Hospital improve their physical and psychological well-being.

Inpatient Services

The hospital’s inpatient services are extensive and distinguished, rivaling those of hospitals on the East coast.

2007

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CLINICAL DIVISIONS

2008

Homebound Elderly Services

Expert care in geriatric psychiatry doesn’t mean the elderly need go to the hospital. For those who are homebound in Washington Heights and Inwood, treatment for their depression, anxiety or any other mental illness remains within reach.

Support Services Administrative Divisions and Directors NYS Administration Stuart Linder (Interim) CUMC Psychiatry Administration Jonathan Segal RFMH Administration Janelle Dierkens Facilities, Engineering, and Housekeeping Peter Reynolds Security Leigh Gholson Quality Assurance Amy Bennett-Staub Technology Information Services Joseph Grun Staff Education and Training Sandra Rosenblum

Department of Comparative Medicine Moshe Shalev Institutional Review Board (IRB) David Strauss Library David Lane MRI Center Bradley Peterson Pharmacy (in transition) Nutrition Justine Violante PET Chemistry and Image Analysis Ramin Parsey and Dileep Kumar IT Research Joseph Grun Biological Studies Unit Laszlo Papp

Audio Visual Services Rachel Yarmolinsky

Offices and Programs

Research Cores and Resources

Government Affairs Dolores Kreisman and David Strauss

Analytical Psychopharmacology Laboratory Tom Cooper

Medical Communications and CME David Hellerstein Telemedicine Steven Hyler

Selected Support Services Department of Comparative Medicine Moshe Shalev, MSc, VMD, DACLAM Department Chief

The Department of Comparative Medicine is the animal resource center, providing care to the laboratory animals of scientists at the New York State Psychiatric Institute (NYSPI). The research programs center on the advancement of intelligence, the pathogenesis of psychiatric and neurologic diseases, the progress of treatments for such diseases, and mechanisms for memory and learning.

The Department has modified its standard operating procedures to further increase the safety of both the animals and the facility’s users. The animal care staff continues to work hard to provide and maintain the highest standard of quality care for the animals housed at NYSPI. The Occupational Health and Safety Program is being reorganized to meet the growing needs of the research at NYSPI and the nonhuman primate enrichment program has proven to be effective in meeting the needs of a growing colony.

Environmental enrichment has also been introduced into the rodent colonies and continues to be successful.

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The animal care program is fully accredited and in compliance with the Association for Assessment and Accreditation of Laboratory Animal Care International, the New York State Department of Health, the United States Department of Agriculture, and the National Institutes of Health guidelines for the care and use of animals.

Medical Communications David J. Hellerstein, MD Director

The Office of Medical Communications, founded in 2007, oversees a variety of media through which the Department of Psychiatry communicates with key constituencies: patients and family

members; students and trainees; professionals (including clinicians and researchers); and the general public.

Through better communication processes, the Department has been able to achieve its missions of education, clinical care, and research more effectively. The departmental websites, including NYSPI.org, Columbiapsychiatry.org, and NYPPsychiatry.org, are major venues for such communications.

During the 2007-2008 year, the Office continued to integrate the NYSPI.org, Columbiapsychiatry.org, and NYPPsychiatry.org sites to enhance usability and improve the ease of referrals for clinical care and clinical studies.

Streaming videos have been added for departmental grand rounds, the

Department’s annual CME event, “Advances in Psychiatry: A Guide to Clinical Practice,” and a NARSAD special event.

“Find a Clinical Trial” – an application to enable both professionals and the general public to find actively-recruiting clinical studies within the Department – has been increasingly successful. By simply searching for a key word, such as “depression,” it is now possible to find a variety of Columbia Psychiatry/NYSPI outpatient and inpatient studies, many of which provide free evaluation and treatment.

Medical Communications developed a new Research Training website, listing research training opportunities from the undergraduate to the fellowship level, located at http://www.columbiapsychiatry.org/fellows hips/research_training.html. Research Training also includes a research faculty search capability, allowing trainees to search for research mentors.

To enhance fundraising, a new program called Gray Matters has been added at: http://www.columbiapsychiatry.org/help/G ray_Matters.html

Research Library David Lane, MS Director

This year, the NYSPI Library acquired both online services and two gems from the past: the first English edition of Constantin von Economo’s Atlas of Cytoarchitectonics of the Adult Human Cerebral Cortex, one of the greatest – and rarest – classics in the neuroscience literature, and a five-volume Lifetime Editions of Emil Kraeplin’s best work that includes Dementia Praecox and Paraphrenia, also in English.

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SUPPORT SERVICES

The library provides bibliographic support for the research, clinical, and training programs of the Institute. It offers a diverse group of mental health professionals one of the finest collections of its kind in the country. It holds over 7,500 books and, in cooperation with the Columbia Health Science Library, maintains electronic and selected paper subscriptions to all the major psychiatric journals. Access is also provided to the major databases in the mental health field, including Medline and PsycINFO. Researchers with interests ranging from the

history of psychiatry to the latest developments in neurobiology can find source material and a full range of reference services among the wealth of journals, books, and databases offered by the library.

Developments during the year included a subscription to PsychiatryOnline, a product from the American Psychiatric Publishing Inc. (APPI). PsychiatryOnline provides full text access to the following: all the APPI journals back to Vol. 1, all editions of the Diagnostic and Statistical Manuals, the American Psychiatric Association practice guidelines, and selected ebooks. Usage statistics for the year indicated that this innovative online tool has been a valuable addition to library services.

Technical services were also upgraded with the addition of a high-speed black and white/color scanner that converts paper documents to PDF in seconds. The scanner has proven to be one of our most popular services. Also, two work stations and eight new computers with Vista operating systems were added in the computer room.

Response to this upgrade has been extremely positive with numerous occasions when lines formed to use the computers.

Interlibrary loans to other institutions continued to be an important function of the library. Memberships in clearinghouse organizations such as the Northeast Regional Medical Library network have enhanced the library’s visibility and have made the collection accessible to libraries throughout the country. During the current year, loan statistics were down due to the impact of electronic journals. However, significant activity continued with over 3,000 loans supplied to other institutions. By participating in these programs, the library has taken advantage of an excellent opportunity to share its resources and contribute to scientific scholarship.

Dr. Bradley Peterson, Director of the MRI Center and new Chief of the Division of Child and Adolescent Psychiatry, uses an image of the brain to make a point about serious neuropsychiatric disorders in childhood.

MRI Center Bradley Peterson, MD Director

The MRI Center uses state-of-the-art imaging methodologies to define the pathophysiologies of major psychiatric disorders and to improve their treatments.

It is a vital core resource that is available for all members of the Department of Psychiatry and supports the acquisition, processing, and statistical analysis of pilot data for investigators planning grant submissions. It educates investigators in the uses and limitations of MRI, trains them in MRI methods, and helps them integrate those methods into their research. It also provides support for image processing for investigators who need or desire it. The Center also develops new and improved imaging methodologies, including basic MR physics, hardware and software design, image processing and biostatistics.

In addition, the unit has engaged intensively in the training of students, research fellows, and faculty members in MRI physics and image processing. In the past year, it held two concentrated courses in MR physics and three training sessions on the theory and hands-on processing of MRI data. The MRI Center this year continued training numerous postdoctoral fellows and graduate students in imaging science under the auspices of various funded training programs from NIMH, RFMH, and private foundations. The Center made possible the award of numerous grants from federal and private sources for both basic and applied research.

Quality Management Division Amy Bennett-Staub, RN, MPA Deputy Director

The Quality Management Division at the New York State Psychiatric Institute coordinates all program evaluation, quality/risk management, education and training, clinical information systems, and regulatory compliance activities.

Throughout fiscal year 2008, the quality/risk management staff worked in collaboration with senior staff, the Medical Staff Organization, unit and division chiefs, and research and support service departments to systematically monitor, analyze, and improve departmental operations and patient-related outcomes for services at the Institute.

Key activities and hospital performance for the year included: • Continued compliance with the Joint Commission and Center for Medicare and Medicaid Services; • Very low rates of restraint and/or seclusion, medication errors, and other adverse incidents recorded by the Patient Safety and Performance Improvement program; • Improved access to information resources by continuing developments of electronic information systems, including electronic treatment plans and suicide assessments for use on the clinical services, and continued support and development of MHARS, R2Net and ServiceNet;

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• Implementation of the outpatient clinical research policy and procedure manual; and • Managed medical supplies/equipment inventory, testing, and training.

In addition, the Office of Quality Management: • Oversaw the Environment of Care Program to improve procedures as well as staff’s ability to manage emergency, fire, safety, and security events at the facility; • Received overwhelmingly positive patient satisfaction ratings from inpatients, with about 95% rating their overall satisfaction with the quality of treatment as excellent or good; • Collaborated with the Workplace Improvement Committee to plan Town Hall meetings to gauge staff opinion on work-related issues and coordinated a special employee recognition day for employees who have worked at the Institute for 25 years or more; • Maintained credentialing and privileging files of physicians and psychologists at the Institute; and

Here an unsung hero helps our staff resolve computer problems.

• Chaired the Education and Training Committee, provided ongoing training programs based on staff need, and administered all tuition reimbursement and education leave programs.

Technology and Information Systems Joseph Grun, Chief Information Officer Director

During the past year, Information Technology at the New York State Psychiatric Institute has undergone an organizational and technical restructuring resulting in a centralized group branded as ‘psyIT.’ PsyIT maintains all the previous responsibilities held by Technology and Information Systems and includes an array of new initiatives. PsyIT maintains the institution-wide information infrastructure for workstations providing full access to the Internet, including E-Mail, Calendar, Groupware, and World Wide Web Services.

This year, psyIT introduced a comprehensive service desk that provides a level of desktop service not previously available. A wireless data network was introduced allowing users greater freedom and flexibility. HEAT, a ticketing and tracking system, was installed, resulting in faster turnaround time and efficiency in dealing with technical requests. The Storage Area Network (SAN) was expanded by 30%. PsyIS, the Institute’s version of the Duke Electronic Medical Records software, is now integrated with the Columbia Faculty Practice system, allowing for seamless patient billing.

A secure FTP server is now part of the standard services offered by psyIT. A HIPAA compliant email archival system has been deployed providing the GroupWise system with unprecedented data security and integrity. PsyIT has rolled-out the SMS Emergency Notification System. This system now allows the department to send SMS text messages to first responders and key personnel in case of an emergency. In addition, the department now supports networking and email on portable devices, smartphones, and PDA’s. Further, the newly deployed Juniper firewall system allows unprecedented levels of protection without compromising network speed.

From Two Sides Will Jiang, MLS

I am both a patient and staff member at the New York State Psychiatric Institute, so I have a unique perspective.

As a patient, I have been happy with the intelligence and compassion of the psychiatrists who have worked on my behalf. Over the years, their availability and dedication have impressed me.

They are a big part of the reason I am doing well as a professional and no one would guess by looking at me that I have schizophrenia.

As full-time librarian of the Patient and Family Library at PI, I recognize how valuable it is to help people learn about their diagnoses with my library's resources. This point was driven home forcefully a year ago, when I was in a chat room and an anonymous chatter approached me.

He asked if I were William Jiang, the librarian at the New York State Psychiatric Institute. When I said I was, the chatter told me that he was chatting from California, that our patient library looked like none other he had ever visited, and that he credited both me and the library for saving his life and aiding his recovery from a serious anxiety disorder.

I was happy a resource existed for him that had not existed for me when I first became a patient. I was also glad that, thanks to the treatment I received at PI and my determination to recover, I was able to become a valuable member of society and help save a life.

FROM TWO SIDES

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New York State Psychiatric Institute Columbia University Department of Psychiatry Psychiatric Services at NewYork-Presbyterian Hospital 1051 Riverside Drive, New York, NY 10032 Websites: www.columbiapsychiatry.org www.nyspi.org www.nyppsychiatry.org