UCSF Psychiatry In the News 2017

UCSF PSYCHIATRY IN THE NEWS • 2013–2017

Edited by

Matthew W. State, MD, PhD

Nicholas Roznovsky

Oberndorf Family Distinguished Professor of Psychiatry Chair, Department of Psychiatry Director, Langley Porter Psychiatric Institute Director, Langley Porter Psychiatric Hospital and Clinics Executive Director, UCSF Child, Teen and Family Center

Director of Communications, Department of Psychiatry

CONTENTS Locations

1

Advocacy and Community Education

3

Attention-Deficit Hyperactivity Disorder (ADHD)

11

Alzheimer’s, Dementia and Cognitive Aging

13

Autism and Neurodevelopmental Disorders

20

Depression, Anxiety and Mood Disorders

31

Early Psychosis and Schizophrenia

37

Eating Disorders and Nutrition

39

LGBTQ and HIV-Related Mental Health

41

Neuroscience

43

Public Mental Health and Interdisciplinary Studies

48

Sexuality and Reproduction

56

Sleep, Spirituality and Other Topics

58

Substance Use Disorder and Addiction

62

Trauma and PTSD

65

Department and Program Updates

74

Department Honors

82

1

ADVANCING MENTAL HEALTH ACROSS THE BAY AREA

1 - Langley Porter Psychiatric Hospital & Clinics 2 - San Francisco VA Medical Center 3 - Zuckerberg San Francisco General Hospital & Trauma Center 4 - UCSF Laurel Heights 5 - UCSF Medical Center at Mount Zion 6 - Rock Hall at UCSF Mission Bay

7 - UCSF Benioff Children’s Hospital San Francisco 8 - UCSF Alliance Health Project 9 - Citywide Case Management Programs 10 - UCSF Benioff Children’s Hospital Oakland 11 - Weill Neurosciences Building (2020) 12 - Dept. of Psychiatry/UCSF Child, Teen and Family Center (2020)

Langley Porter Psychiatric Hospital and Clinics Langley Porter Psychiatric Hospital and Clinics (LPPH&C) consists of an adult inpatient unit, an adult Partial Hospitalization Program, and adult/child outpatient services accounting for more than 20,000 visits per year. Primary diagnoses for patients in all services include major depression, anxiety, and psychosis.

LPPH&C serves all ethnic and socio-economic groups who reside in San Francisco and the greater Bay Area, as well as those referred from areas throughout the western United States.

The facility provides a broad range of inpatient and outpatient consultation, evaluation, and treatment interventions for emotional, psychological, or cognitive problems of adults.

Adult Inpatient Program The Adult Inpatient Program is a 22-bed acute psychiatric service. We use a biopsychosocial approach in the treatment of adults 18 years and older who suffer from severe behavioral and emotional disturbances. The unit operates 24 hours per day, 365 days a year. Admission is arranged by a referral from a mental health clinician.

Adult Partial Hospitalization Program The Adult Partial Hospitalization Program offers outpatient services for patients with mood and/or personality disorders in addition to other severe and persistent mental illnesses using a multi-disciplinary treatment team consisting of psychiatrists, psychologists, nurses, clinical social workers, and rehabilitation therapists.

Adult Outpatient Program Our outpatient clinics provide a broad range of consultation, evaluation, and treatment interventions for emotional, psychological, or cognitive problems of adults. We offer a range of brief and long-term individual psychotherapy, group psychotherapy, and ongoing medication management, and each patient is provided with an initial assessment and an individualized treatment plan.

Specialty clinics are available for those seeking treatment for anxiety disorders, bipolar disorder, depression, psychosis, geriatric psychiatry, LGBT psychiatry, women’s mental health, brief intervention, and electroconvulsive therapy.

Child and Adolescent Outpatient Program Our mission at LPPH&C Child and Adolescent Psychiatry Clinics is to provide exceptional care for children, adolescents, young adults, and families with mental health and developmental concerns while advancing scientific knowledge, and clinical training.

We treat children, adolescents, young adults, and families struggling with attention-deficit/hyperactivity disorder (ADHD), school issues, autism, depression, bipolar disorder, worry or anxiety, psychosis, post-traumatic stress disorder (PTSD), eating disorders, suicidality, cutting and other intentional self-injury, obsessivecompulsive disorder (OCD), Tourette syndrome and other tic disorders, and family challenges.

As a nationally renowned center for treatment, research, and training in child and adolescent mental health care, the Child and Adolescent Psychiatry Clinics provide state-of-the art assessments, psychotherapies, groups, and medication treatments. Our programs are evidence-based (research-supported) and family-friendly.

Our specialized teams bring together child and adolescent psychiatrists, psychologists, social workers, marriage and family therapists, pediatric neurologists, and pediatricians.

Current specialty programs include the UCSF Eating Disorders Program, STAR Center for Autism and Neurodevelopmental Disorders, Young Adult and Family Center, Hyperactivity, Attention and Learning Problems Clinic, PATH Program for Early Psychosis, and a medication management clinic.

Consultation-Liaison Services LPPH&C medical staff deliver conventional psychiatric consultations and direct psychiatric services in collaborative care models or as embedded services for UCSF Health patients and physicians at the UCSF Medical Center at Parnassus Heights.

Education and Research As with all of our sites, training and research work are deeply intertwined with our clinical operations at LPPH&C. In addition to residency programs and postdoctoral fellowships, educators at Langley Porter also provide advising and instruction for medical school students interested in pursing psychiatry as a specialization later in the their academic careers.

ADVANCING MENTAL HEALTH ACROSS THE BAY AREA

2

San Francisco VA Medical Center UCSF Laurel Heights Through its long-standing affiliation with the San Francisco VA Medical Center, UCSF Psychiatry provides consultation, evaluation, and a wide variety of treatment services to our nation’s veterans.

UCSF Psychiatry maintains an active base of researchers at the UCSF Laurel Heights campus, many of whom are affiliated with Center for Health and Community or the Center for Obesity Assessment, Study and Treatment (COAST).

In addition to 24/7 urgent psychiatric services, we offer a same-day walk-in mental health clinic, addiction recovery and treatment services, peer support, geriatric and HIV mental health programs, case management services, psychosocial rehabilitation and recovery services, support for individuals impacted by sexual trauma and PTSD, as well as focused services for women and LGBTQ veterans.

UCSF Medical Center at Mt. Zion As an integral part of the Helen Diller Family Comprehensive Cancer Center’s Psycho-Oncology Program, UCSF Psychiatry clinicians work closely with Cancer Center providers to identify and address challenges with adjusting to the illness, the stresses of medical treatment, emotional needs, relationships and caregiving, coping with pain, insomnia and other symptoms, and much more.

Zuckerberg SF General Hospital and Trauma Center UCSF Mission Bay UCSF Psychiatry operates the city’s only 24/7 dedicated psychiatric emergency room and 44 psychiatric inpatient beds at Zuckerberg San Francisco General Hospital and Trauma Center. Psychiatric Emergency Services sees approximately 8,000 patients each year, providing crisis stabilization, complete medical and psychiatric assessment and evaluation services, and initial treatment, if appropriate. The staff, which includes physicians, nurses, and social workers, works closely with a number of community agencies to develop short and long-term treatment plans.

The Consultation/Liaison Service provides mental health consultation to the medical staff of Zuckerberg San Francisco General to enhance the care of patients seen in the general health setting and foster the clinical skills of the staff. Psychiatrists deliver services designed to meet the needs of patients and their health care providers in a manner that is culturally, linguistically, and economically sensitive to the patient.

Substance Abuse and Addiction Medicine Programs UCSF Psychiatry operates a number of critical substance abuse treatment programs at Zuckerberg San Francisco General and around the Bay Area. These programs offer outpatient and mobile addiction recovery services in conjunction with other medical and psychiatric services for patients dealing with disorders involving alcohol, heroin, methadone and other opioids, cocanine, methamphetamine, and other substances.

Trauma Recovery Services

The heart of the department’s neuroscience research efforts are housed on the Mission Bay campus, primarily in Rock Hall and the nearby Sander Neurosciences Center. When completed, UCSF Psychiatry will also have a considerable amount of wet-lab space in the new Weill Institute building.

UCSF Benioff Children’s Hospitals (San Francisco and Oakland) The Department of Psychiatry provides consultation-liaison services at both of UCSF Health’s renowned children’s hospitals.

UCSF Alliance Health Project Founded in 1984 as the AIDS Health Project, the UCSF Alliance Health Project is one of the longest-running mental health organizations in the world for people with HIV- and LGBTQ-related concerns. They offer a broad range of services including therapy, support groups, crisis intervention, psychiatric care, substance abuse services, and HIV counseling and testing.

The Division of Trauma Recovery Services at Zuckerberg San Francisco General is comprised of four community-based mental health programs providing care and support for some of our community’s most vulnerable populations. It encompasses the Child & Adolescent Support, Advocacy & Resource Center (CASARC), Trauma Recovery Center, Survivors International, and the Neurotrauma Outreach Program.

Citywide Case Management Programs

Additional trauma-related resources at Zuckerberg San Francisco General include the Child Trauma Research Program and the UCSF Healthy Environments and Response to Trauma in Schools (HEARTS) Program.

Since 1981, the Division of Citywide Case Management Programs has supported the recovery of San Francisco’s highest-risk mentally ill adults and the reduction of their need for institutional and acute care (psychiatric emergency services, hospital care, and correctional facilities) while maximizing their ability to maintain stable, productive, and fulfilling lives in our community.

Forensic/Justice Programs Established in 1985, the Forensic Focus Program provides a full range of inpatient psychiatric services to individuals in custody of the San Francisco Sheriff’s Department.

Services are in concert with the Jail Psychiatric Services and community--based case management programs.

The Forensic Focus Program staff is committed to providing humane and high-quality medical, psychiatric, educational, and social services to our patients who are in legal custody. Acute psychiatric emergency evaluation and short term treatment is provided as part of the San Francisco City and County Jail System. All incarcerated adults who have been evaluated by the Jail Psychiatric Service and meet criteria for a psychiatric hold, are referred here.

The UCSF Juvenile Justice Behavioral Health (JJBH) Research Team includes a program of research aimed toward improving behavioral health outcomes for justice-involved youth. Studies include emphasis on improving juvenile justice youths’ physical, mental, and emotional health, reducing drug and alcohol use, reducing HIV/STI risk behaviors, preventing recidivism, and identifying ways to improve access to and engagement in health care for these youth, thereby improving health disparities.

All division program services include medication assessment and management, crisis intervention, outreach, and case management, as well as individual, group, and family therapy, which continue as long as clients need an intensive level of intervention.

ADVOCACY AND COMMUNITY EDUCATION

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Dr. Wikipedia: The ‘double-edged sword’ of crowdsourced medicine FEBRUARY 8, 2014

Wikipedia has become a go-to source for definitions, celebrity facts, and now, medical information. A study by the IMS Health Institute published in January names Wikipedia as the "single leading source" of health care information for both patients and health care professionals.

Unfortunately, some of that information is wrong.

"I think that's the double-edged sword of Wikipedia," Dr. Amin Azzam tells NPR's Arun Rath. "Because anyone can edit, we don't necessarily know the expertise of the people doing the editing. One the other hand, the reason it's so popular is because everyone can contribute."

Azzam is a professor of psychiatry at the University of California, San Francisco. He teaches a course that encourages medical students to use their knowledge to improve Wikipedia, one article at a time. The syllabus is, of course, posted on Wikipedia.

Students choose one article from the top 100 most-read medical articles on the site and work on it throughout the course. For example, one of his students updated information about how long an HIV test can present a false negative result.

Azzam says there's a lot of room for improving the quality of Wikipedia in the medical domain because doctors are late-comers to the resource.

"In the health care community, we're used to learning from wisened professors above us," says Azzam. "My generation absolutely pooh-poohed Wikipedia, and now I'm finding that all my med students, they use that first because it's written in a way that they understand as they are learning to become doctors."

Azzam says it was fun watching the students work and realize that editing the articles is harder than they expected. They have to make decisions about how to order symptoms and how to remove jargon to make the information understandable.

"It's not just adding references and not just improving the gaps," Azzam says, "but thinking about how to make it more readable and more digestible for the people that are reading Wikipedia."  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS409

New book by Robert Okin gives voice to San Francisco’s homeless and mentally ill NOVEMBER 10, 2014

As former chief of psychiatry at San Francisco General, Dr. Robert Okin treated countless homeless patients. He wanted to know more about how these patients lived, so he spent two years collecting stories and taking photographs, which have been published in a new book called “Silent Voices: People with Mental Disorders on the Street.”

Okin joins KQED Forum’s Michael Krasny to discuss the book and a new approach to treating mental illness and working to solve homelessness.  LISTEN TO THE ENTIRE EPISODE AT PSYCH.UCSF.EDU/NEWS979

How to turn stigma about mental illness into compassion JUNE 16, 2017

Renowned psychologist Stephen Hinshaw knows firsthand what is it like to grow up in a household with a parent displaying serious mental illness.

APA member McQuaid briefs Capitol Hill staff on veterans’ mental health research AUGUST 9, 2013

“VA Mental Health Research: Improving the Lives of America’s Veterans” was the theme of a Capitol Hill briefing on July 24 hosted by the American Psychological Association and the Friends of VA Medical Care and Health Research (FOVA) coalition. The House Veterans Affairs Committee hearing room was packed with congressional and federal agency staff interested in the latest results of research funded by the Department of Veterans Affairs (VA). The APA-sponsored speaker was APA member John McQuaid, PhD, associate chief of mental health at the San Francisco VA Medical Center and professor of clinical psychology at the University of California, San Francisco.

McQuaid provided an overview of his own research on cognitive behavioral therapies for depression, PTSD, substance use and phantom limb pain, as well as the broad range of clinical research related to mental health going on at the San Francisco VA and its direct impact on clinical care for veterans. Capitol Hill and executive branch staff were particularly focused on how the VA is addressing access to mental health care, the range of evidence-based therapies available, suicide prevention, continuity of care between and within Department of Defense (DoD) and VA systems, and partnerships with community organizations to expand options for veterans. Critical for this audience was McQuaid's emphasis on the vital role of research in assuring quality mental health care in the areas of prevention and intervention.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS713

After boy’s controversial TSA patdown, a look at sensory processing disorder MARCH 29, 2017

An outraged mother gained widespread attention with a video she posted to Facebook showing her 13-year-old son getting a thorough pat-down by a Transportation Security Administration officer at the Dallas/Fort Worth International Airport. Jennifer Williamson says that her son has sensory processing disorder (SPD).

SPD is a neurological condition in which the brain has trouble receiving information from the senses. Symptoms can range in severity from mild to incapacitating, and they differ from person to person, but often involve hypersensitivity to sound, sight, and touch. A study done in 2004 estimates that at least 1 in 20 children are affected by SPD.

His father suffered major bouts of psychosis that kept him periodically hospitalized during Hinshaw’s childhood. Yet, the reasons for these absences were never explained to Hinshaw, until he turned 18 and his philosopher father started to divulge his lifetime of struggles.

“Everybody’s going to feel uncomfortable when you scrape your nails down a chalkboard or when you wear that itchy wool sweater,” Elysa Marco, a pediatric cognitive and behavioral neurologist at the University of California San Francisco told CBS News. “Everyone can understand that, but it’s important to realize that some people have a better ability to modulate their response to stimuli and for our patients the threshold is very low.”

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS903

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS254

ADVOCACY AND COMMUNITY EDUCATION

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Governor Brown signs bill to spread Trauma Recovery Center model across California OCTOBER 12, 2017

For a mass shooting’s youngest victims, the nightmare is just beginning APRIL 28, 2017

The mass shooting at a Baptist church in Sutherland Springs, Texas, underscores the unique harm that mass shootings, and firearms in general, pose to America’s children.

Children make up about half of the people who died as a result of that shooting — either 12 or 14 deaths out of 26, according to initial reports. The youngest victim was just 18 months old. Another 20 people were injured. The big picture is no less grim: Every year, an estimated 1,300 children die and 5,790 children are wounded by firearms in the U.S. Yet even this doesn’t tell the whole story. When a mass shooting happens in any community — especially one as small and tight-knit as Sutherland Springs, population 600 or so — it has the potential to do unique damage to the local children, whether or not they were at the scene in person.

“We know that one of the biggest predictors of PTSD is how close one has been to the scene of a traumatic event, and how close one is to people who have been affected by the traumatic event,” said Alicia Lieberman, a psychiatrist and director of the Child Trauma Research Program at the University of California, San Francisco. “In such a small community, where everybody seems to be related to each other in one way or another, where there are very close community connections, there are going to be a lot of people who are missing and who are no longer there.”

In addition to the risk of PTSD, these events burden young children with a “premature and precocious” fear of death, Lieberman said.

Under ordinary circumstances, a parent can give their child a gentle introduction to the concept of death — for example, bringing it up if they see a squished bug or a dead pigeon on the sidewalk, Lieberman explained. Later, maybe a grandparent, or someone else in the child’s life, may get sick and begin to decline, allowing the parent to explain the concept of dying as a process.

Among the 59 bills signed into law by California Governor Jerry Brown this past weekend was Assembly Bill No. 1384, recognizing the UCSF Trauma Recovery Center at Zuckerberg San Francisco General Hospital and Trauma Center as the State Pilot Trauma Recovery Center (TRC). The bill also mandates that the California Victim Compensation Board will use the evidence-informed integrated trauma recovery services model developed by the Trauma Recovery Center when it provides future grants to other trauma recovery centers.

Since its founding in 2001, the Trauma Recovery Center has evolved from a small, state grant-funded pilot program into a national model for providing compassionate, effective mental health services and support to adults whose needs extend beyond mending just physical injuries. The center provides support services for domestic violence and physical/sexual assault survivors, and family members of homicide victims. In 2012, it expanded its services to encompass Survivors International, which offers services for refugees and asylum-seeking survivors of torture, war-related, and gender-based violence.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS267

Hillman discusses sexual harassment in medical and science education NOVEMBER 15, 2017

Noted military justice expert and scholar Elizabeth L. Hillman, PhD, JD, MA, spoke to faculty and trainees about the pervasive nature of sexual harassment in STEM fields, particularly medical training and education, during the 13th annual Dr. Evelyn Lee Visiting Scholar Lecture in Cultural Competency and Diversity on November 7, 2017.

"This isn't really new," Hillman told the audience, referring to sexual harassment in the scientific workplace. "Maybe the most staggering thing about this is that Title IX is more than 40 years old... Sexual harassment has been illegal for decades and we've seen very little change in the prevalence and incidence rates."

And while the damage to professional careers and personal lives caused by sexual harassment is deep, the issue is also having a profound impact on future of medicine.

But when 26 people of various ages and levels of health are killed in an act of mass bloodshed in a public gathering place like a church, this kind of chaotic death wreaks havoc on a young child’s understanding of risk and safety in their everyday world.

"We're losing a tremendous amount of talent and causing a lot of collateral damage," Hillman noted. "Even if you don't care about the collateral damage in people's lives, if you care about the advancement of science and of medicine, then you should care that people aren't able to succeed based on their capactiy to contribute because of this really pervasive problem."

“A child is yanked away from a developmentally expectable understanding of death — that it happens one at a time — to something that happens catastrophically,” Lieberman said. “So the fear of dying that comes from knowing people who die will be exponentially higher for these children.”

Following her Grand Rounds talk, Hillman visited Zuckerberg San Francisco General Hospital and Trauma Center for an hour-long discussion about the current legal structures which aim to prevent sexual harassment. Later that afternoon, she spoke at the San Francisco VA Medical Center on the issue of sexual assault in the U.S. military.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS564

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS468

California must set policies now to curb teen cannabis use SEPTEMBER 14, 2017

Dr. Danielle Ramo is an assistant professor of psychiatry at the University of Californa, San Francisco.

Last year, the California electorate voted to legalize the recreational use of cannabis by adults. Next year, cannabis will be for sale in California stores. Our focus now must be on how to implement legalization in the way that best supports public health — including setting policies and cultural values to support teens.

Teens are more likely than adults to develop problems using cannabis; and earlier use is associated with longer term problems, including problems with brain functioning that don’t seem to exist if use is put off until later adolescence or adulthood. Early heavy cannabis use affects brain systems involved in learning and memory, the speed at which we process new information, and complex decision-making. Car accidents are the leading cause of death for teens and the risk of accidents and injuries is made worse when alcohol is combined with cannabis.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS708

ADVOCACY AND COMMUNITY EDUCATION

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Opinion: San Francisco’s largest mental health facility - the jail NOVEMBER 30, 2016

Alison Hwong is a psychiatrist in residency at the University of California-San Francisco: It is disappointing to acknowledge in 2016 that San Francisco’s largest mental health facility is the county jail. At any given time, 35 to 40 percent of San Francisco jail inmates are being treated for mental illness. Most of the patients I see as a psychiatry resident at the Zuckerberg San Francisco General Hospital are very ill. It doesn’t take a medical degree to determine that jail is not a therapeutic environment for people with severe mental illness and that it will prolong behavioral and legal problems.

We need the city to invest in more psychiatric beds, community-based mental health support, and housing rather than jails.

Opinion: Help mentally ill with police training and treatment, not jail MARCH 9, 2017

Dr. Matthew E. Hirschtritt is a psychiatrist at UCSF. Dr. Renee L. Binder directs the UCSF Psychiatry and Law program and is the immediate past president of the American Psychiatric Association: Violent encounters between police and individuals with mental illness — Sean Moore in San Francisco and Joseph Mann in Sacramento — have highlighted the use of lethal force. In both incidents, police were summoned to address dangerous or disorderly behavior of men who suffered from mental illness; both incidents ended with officers shooting the suspects, one fatally.

Public attention has focused narrowly on perceived police mismanagement of these tragic situations. Unfortunately, it may be difficult to defuse a dangerous situation especially when the officers feel that their lives are at risk or a civilian may be injured.

Individuals with mental illness have little insight or judgment about their actions, and many require hospitalization for short-term stabilization. Since 2008, the number of acute psychiatric beds at the General was reduced from 87 to 44. As a result, we end up turning away people who in other cities and communities would be admitted, and who need treatment.

It’s vital that we look at the changes that can prevent violent encounters with police and make our city safer as well as address the needs of mentally ill individuals. We need multiple kinds of interventions and public support to ensure that individuals such as Sean Moore and Joseph Mann get the care they need and deserve.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS828

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS582

Veterans find healing through work JANUARY 27, 2017

Saks recounts her personal ‘journey through madness’ at annual Evelyn Lee Lecture APRIL 24, 2017

"I'm going to be speaking this afternoon about people with schizophrenia, not about 'schizophrenics.' The difference is more than semantic. Words matter."

With that important and powerful statement, legal scholar and mental health policy advocate Elyn R. Saks, JD, PhD, began her delivery of the 12th annual Dr. Evelyn Lee Lecture on Cultural Competence and Diversity. She shared the story of her battle with chronic schizophrenia, the condition which nearly ended her undergraduate studies at Oxford and plagued her throughout law school and the early stages of her career.

Veterans in the San Francisco VA Health Care System (SFVAHCS) are getting the chance to find meaningful work while learning to cope with posttraumatic stress disorder (PTSD) and other challenges. This opportunity is connected to a study conducted by SFVAHCS researchers, called Veterans Individual Placement and Support Towards Advancing Recovery (VIP-STAR), which assessed the effectiveness of job placement and support services in helping veterans with PTSD become steady workers. Though the VIP-STAR study has concluded, the process of connecting veterans to meaningful work experiences continues.

Veterans are referred to the program from the PTSD Clinic. From there, staff meet with the veterans outside of the clinical setting to assess their interests and see what kind of work might be fulfilling for them. Then, staff reach out to local businesses to see what kind of relevant opportunities could be available to the veterans. The staff then help veterans prepare for job interviews, and then ultimately serve as liaisons for both the veterans and their employers to make sure the veterans’ job experience goes as smoothly as possible.

"There were, in a way of speaking, three 'me's': Elyn, Professor Saks, and the lady in the medical charts, a psych patient," she explained to the audience. "I could not integrate these three aspects of myself."

“I think the benefits of this program are tremendous,” says Kristen Hay, Employment Specialist for the San Francisco VA Health Care System. “We have seen significant PTSD symptom reduction in these veterans who are doing work that interests them. It really improves their social ties and their confidence. It is incredibly rewarding to talk to a veteran who may be discouraged, and then seeing that spark of hope return.” Kristen notes that many veterans in the program are particularly drawn to hands-on, creative work. Examples of recent job placements for veterans include a sign shop, the Tesla factory, and a mechanical shop.

Over the course of her speech, Saks told a harrowing tale about psychotic episodes, hospitalization experiences, her reluctance to take her prescriptions, and how she eventually found a way to embrace "the three Elyns" with the help of therapy, medication, and supportive colleagues and friends.

One veteran who has benefited from the VIP-STAR program is Gregory King, an Army veteran and a longtime Bay Area resident. Gregory fell on hard times and was homeless for two and a half years. With the encouragement of his primary care provider, Gregory entered the VIP-STAR program last year and has been employed for the last six months.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS094

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS164

ADVOCACY AND COMMUNITY EDUCATION

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UCSF’s Binder takes office as the 144th President of the American Psychiatric Association MAY 21, 2015

Renée Binder, MD, began her one-year term as President of the American Psychiatric Association (APA) at the conclusion of the 168th APA Annual Meeting in Toronto on May 20, 2015.

She is the second UCSF faculty member (following Karl M. Bowman, MD), and the sixth woman in history to serve as president of the organization. The APA was founded in 1844 and is the world's largest psychiatry organization with more than 36,000 members.

At the APA Annual Meeting Opening Ceremony, Binder said that the theme of her presidency will be 'Claiming Our Future.'

"As psychiatrists, we are the experts in mental health," Binder said. "We have the responsibility to ensure that psychiatrists of the future continue to deliver high quality care to our patients and have professionally satisfying lives."

She continued: "What type of practice will the psychiatrist of the future have? How will we fit into the new models of care? How will we integrate new research findings into our clinical practices? We must claim our future roles in all of this progress; otherwise, others will define our roles for us."  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS513

The cost of silence on mental illness JUNE 28, 2017

Nothing is more disastrous for individuals and families struggling with mental health challenges than isolation. Stephen Hinshaw offers us a powerful reminder of the damage that shame and secrecy can do in a gripping memoir of his father, Another Kind of Madness.

Hinshaw, a clinical psychologist at the University of California, Berkeley, writes that his dad was diagnosed with schizophrenia in 1946 at the age of 16. He had jumped off the roof of his boyhood home, naked, thinking he could fly. The treatments he endured were often harrowing, but the most stunning thing about his long struggle with mental illness was that it was kept secret from virtually everyone around him — including his two children. Periodically Dad would behave erratically and then disappear, with no explanation to the kids. He’d reappear weeks or months later — with no comment, and no questions asked.

Hinshaw describes the acute distress this silence caused him as a child, when he agonized over his father’s absences and felt overwhelming pressure to act as if all were well. “Whatever lay behind the silence must have been so devastating,” he writes, “that it would have destroyed us if brought into the open.”

In his new book, Hinshaw uses his personal story to demonstrate how stigma can multiply the consequences of mental illness, with devastating results not only for the individual, but for everyone close to him.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS334

10th annual Wallerstein Lecture explores the clinical impact of nonverbal communication APRIL 17, 2015

Clinicians and trainees from around the Bay Area filled Cole Hall for the 10th annual Robert S. Wallerstein, MD Visiting Lectureship in Psychoanalysis and Psychotherapy.

Columbia University's Beatrice Beebe, PhD, served as the keynote speaker, delivering an address and clinical presentation that reviewed her research on the mechanisms of nonverbal communication between mothers and their children, and its possible clinical applications for adult psychotherapy.

The 2015 event was the first to take place following the passing of Robert S. Wallerstein, MD. The former department chair and lectureship namesake was remembered throughout the afternoon by many, including his daughter Amy Wallerstein Freidman, LCSW and planning committee chair Marc Jacobs, MD. Several speakers noted that working with patients “who cannot speak for themselves” was a topic that Wallerstein found to be both fascinating and important, and led to his support for the creation of the UCSF Infant-Parent Program at SFGH.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS267

Brain Health Registry launches new caregiver and study partner online portal APRIL 6, 2017

The Brain Health Registry (BHR), a free online platform with over 52,000 participants, has launched a new initiative called the Caregiver and Study Partner Portal (CASPP). This innovative tool allows BHR participants to designate someone who knows them well, such as a family member or close friend, to join BHR as their study partner.

The information gathered from the participant-study partner pair can be used to better identify those at risk for developing brain disease. CASPP will facilitate Alzheimer's research at first and then expand to different types of clinical research, including recruitment for clinical trials and screening for cognitive decline.

"Study partners are an essential part of brain health research, especially in the Alzheimer's disease field, when the person with Alzheimer's may lose insight about their own ability to think and remember things," said Michael Weiner, MD, BHR principal investigator and Professor of Radiology and Biomedical Engineering, Medicine, Psychiatry, and Neurology at UC San Francisco. "Study partners can give unique insight into a person's day-to-day functioning and quality of life, outcomes that are important to families, but often left out of traditional research."

Study partner participation is often required for enrollment in a clinical trial, but until now there has been no way to gather this information remotely from large numbers of people. By using an online tool and leveraging the large number of people already enrolled in BHR, the CASPP can help researchers and clinicians better incorporate the viewpoint of study partners into their studies and care plans.

For study partners who are also caregivers, BHR has teamed up with experts at the UCSF Stress Measurement Network, led by Elissa Epel, PhD, to identify study partners who are also caregivers, and learn about their experience. The ultimate goal is to improve caregiver health by better understanding the role of caregiver stress.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS618

ADVOCACY AND COMMUNITY EDUCATION

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San Francisco VA providers hold conference on preventing suicide through gun safety MARCH 11, 2016

Approximately 22 veterans end their lives every day, making up over 20% of all suicides in the U.S. Providers in the San Francisco VA Health Care System (SFVAHCS) are working to save lives through innovative approaches to suicide prevention.

On March 4, SFVAHCS teamed up with the American Foundation for Suicide Prevention to host a conference entitled "Counseling Veterans at Risk for Suicide: Safe Storage of Firearms and Other Lethal Means." The event was unique in its inclusion of veterans, veterans’ family members, health care providers, public health researchers, suicide prevention advocates, and most crucially, gun advocates.

Opinion: State of California needs a gun violence restraining order MAY 26, 2014

Renée Binder is professor of psychiatry and director of the Psychiatry and Law program at UC San Francisco. She is president-elect of the American Psychiatric Association: California legislators have spent much of the last two decades strengthening the state's gun laws, but last weekend's multiple killings in Isla Vista, Calif., by a young man previously identified by family to police as being a potential danger prove there is far more progress to be made.

Between 1999 and 2010, California reduced its gun death rate 56%, making the state a model for policymakers elsewhere seeking to reduce gun violence. California now has the ninth- lowest rate of gun death among the 50 states, but that isn't something to celebrate in the aftermath of the Isla Vista tragedy.

Significant room for improvement exists in terms of prohibiting individuals who are at an increased risk of harming themselves and others from buying or possessing firearms.

California law goes beyond the federal standard to keep guns out of the hands of dangerous individuals. For example, the state temporarily prohibits individuals from having a gun following an involuntary hospitalization for psychiatric treatment.

California also prohibits those convicted of a violent misdemeanor from having a gun for five to 10 years. Individuals subject to temporary domestic-violence restraining orders are prohibited for the length of the order.

These are important policies, but more can be done at the state level to ensure that individuals who are temporarily dangerous do not have immediate access to firearms.

Specifically, California can create a Gun Violence Restraining Order, a mechanism that would allow those closest to a troubled individual to act when there are warning signs or indications that that person is at risk for violence.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS938

Opinion: A place to live MAY 10, 2017

Matthew Hirschtritt is a third-year psychiatry resident at UCSF: As a resident in psychiatry, I believe in talk therapy. I’ve seen it help people make meaningful changes. I watched a recently retired woman who refused to part with her deceased parents’ belongings realize that her hoarding was based on deep-seated feelings of guilt. She is now ready to donate their things to charity.

I like my job. But there’s a tendency in this field to reduce patients to psychological constructs and diagnoses. So when “John,” an elderly patient with whom I’d been working, told me he was about to lose his home, I felt stuck. Where was the underlying trauma, the irrational phobia? Sure, John suffered from chronic depression–that’s why we’d been meeting. But what could theories of enactment and transference offer a man whose most basic need– shelter–was about to go unmet?  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS055

“It’s the first time we’ve brought all of these groups together to talk about this important issue,” said conference organizer Russell Lemle, PhD, chief psychologist at SFVAHCS and clinical faculty member in the UCSF Department of Psychiatry. “We’re finding ways to counsel our veterans on safe storage for their firearms to prevent suicide. It’s both pro-gun and pro-suicide prevention.”

Much of the conference focused on educating mental health providers about counseling at-risk veterans on safe storage of firearms and other lethal means. However, friends and loved ones are also key to suicide prevention.

“Peers play a crucial role in helping promote lethal means safety,” explained fellow UCSF Psychiatry faculty member Megan McCarthy, PhD, SFVAHCS Lethal Means Safety Coordinator and another organizer of the conference. “Veterans sometimes feel reluctant to talk to their providers about their access to guns when they’re having a mental health crisis. We’ve learned that some veterans worry that we want to take their guns. We have great respect for the important role guns play in many veterans’ lives. We want veterans to keep their guns, and we want to keep veterans safe when they’re in crisis."  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS472

Talking is easy for therapists, except when it’s about guns. Veterans want to teach them how.

FEBRUARY 1, 2017

Suicide is an impulsive act. Nearly half the people who survive an attempt say the time between their first thought of suicide and the attempt itself was less than 10 minutes.

But the method can mean the difference between life and death: people who take pills have time to change their minds. Not with guns.

About 70 percent of veterans who commit suicide do so with a gun, which prompted President Barack Obama to order the VA to talk to vets about gun safety and storage options.

But here’s the trouble: Most therapists aren’t gun people. They don’t know how to talk about guns. And so they don’t.

“One obvious reason for that is that no one has taught them how,” explained UCSF’s Megan McCarthy, National Deputy Director in the Office for Suicide Prevention at the Department of Veterans Affairs.

McCarthy recently spoke at a suicide-prevention conference in San Francisco for therapists who work with vets.

“How many of you would say you feel really comfortable having a conversation with any of the people you work with about limiting access to all lethal means?” she asked the roomful of therapists.

Hardly anyone raised their hand.

“Okay, so that’s why we’re here today,” she said.

“We often conceive of ourselves as experts, as people who impart information to clients,” she said. But with vets, “it may take time to build trust. Telling them what to do the first time you’ve met them is probably not going to be a very effective approach.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS852

ADVOCACY AND COMMUNITY EDUCATION

Depression Center hosts pair of open talks on genetics, personality and depression

Alliance Health Project to co-sponsor National Transgender Health Summit

DECEMBER 16, 2016

The UCSF Depression Center welcomed UCLA Professor of Psychiatry and Biobehavioral Sciences Jonathan Flint, MD, to campus on December 13 & 14, 2016, for a pair of lectures covering genetic research on personality and depression.

The free talks were part of the National Network of Depression Centers (NNDC) Visiting Professor Program, which provides support through competitive grants to allow researchers and clinicians to share their knowledge about mood disorders with colleagues and the general public. The UCSF Depression Center is one of 22 NNDC Centers of Excellence around the country. Additional support for the events was provided by the UCSF Department of Psychiatry and UCSF School of Nursing.

Flint is co-director of the UCLA Depression Grand Challenge, the largest research study ever to examine the genetics of depression. He is a world-renowned scientist on genetic and cellular/molecular mechanisms in depression, how depression is associated with alterations in telomeres and mitochondria, and how genetics interact with the environment in depression. In 2015, he led a research team which identified the first two genetic markers reproducibly linked to major depressive disorder.

On December 13, he spoke about his groundbreaking large-scale study of the causes of depression in a technical lecture for department faculty, trainees and staff. Since 2008, Flint and his colleagues have collected depression-related data from 12,000 participants in China and have obtained genetic data which they are analyzing to obtain insight into the genetic origins of the disease. The entire presentation, titled "Next Generation Phenotyping and Molecular Markers of Depression," is available on the UCSF Psychiatry YouTube channel.

The following evening, he delivered a free seminar for patients, family members, clinicians and other community members interested in learning more about how mental health professionals use genetics to understand who we are. Tickets for the talk, “The Genetics of Personality & Depression,” sold out within 48 hours and those that were able to grab a seat enjoyed a highly informative, down-to-earth talk about genetic research, how and why it gets published, and what it means for patients and providers.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS933

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MARCH 19, 2015

The UCSF Alliance Health Project has joined with the UCSF Center of Excellence for Transgender Health, UCSF Center for AIDS Prevention Studies, and Pacific AIDS Education Training Center to sponsor the 2015 National Transgender Health Summit in Oakland on April 17-18, 2015. The landmark program will present cutting edge research and evidence-based educational sessions across many disciplines and is the premiere national conference in transgender health.

The event will include world-renowned experts in the field of transgender health care including an Academic Mental Health Track chaired by Dan Karasic, MD. Other tracks will explore topics in clinical, research, and health policy realms.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS382

UCSF Depression Center to host free community event on adolescent depression NOVEMBER 2, 2015

The UCSF Depression Center and its Community Advisory Board, in partnership with the Department of Psychiatry and the American Foundation for Suicide Prevention, will hold a free evening seminar on November 16 for parents, educators, clinicians, and other community members interested in learning more about adolescent depression.

The event, “Adolescent Depression: What We All Should Know,” will feature a keynote address by Stephen Hinshaw, PhD, as well as presentations by Eva Henje Blom, MD, PhD; Olga Tymofiyeva, PhD; and Kaja LeWinn, ScD.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS657

UCSF Psychiatry hosting annual International Survivors of Suicide Loss Day event NOVEMBER 7, 2016

The University of California, San Francisco Department of Psychiatry, along with the San Francisco chapter of the American Foundation for Suicide Prevention (AFSP), will host a morning of reflection, discussion, and support on Saturday, November 19, 2016, for International Survivors of Suicide Loss Day. Survivor Day allows people affected by suicide loss to gather at events in over 350+ local communities worldwide to find comfort and gain understanding. Like all Survivor Day events, this year's San Francisco event in the Langley Porter Building on the UCSF Parnassus campus is free and open to the public.

UCSF, UC Davis, Stanford team up to host Early Intervention in Psychosis Symposium

The San Francisco event will include a screening of "Life Journeys: Reclaiming Life after Loss,” a new AFSP-produced Survivor Day documentary that traces the grief and healing journey that follows a suicide loss over time. After the screening, faculty and staff members from the UCSF Depression Center and the San Francisco VA Health System's Suicide Prevention Program will moderate small group discussions for attendees to share their experiences and ask questions.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS400

MARCH 25, 2015

The UCSF Department of Psychiatry, Stanford Department of Psychiatry and Behavioral Sciences, and UC Davis Department of Psychiatry and Behavioral Sciences are co-sponsoring a one-day symposium on Friday, April 3, with international experts in the field of early intervention for prodrome and first episode psychosis.

Steven Adelsheim, MD, will moderate the day-long event which will be held in Cole Hall on the UCSF Parnassus campus. Presenters will include Patrick McGorry, AO, MD, PhD (Executive Director of Orygen, The National Centre of Excellence in Youth Mental Health in Australia), Jacob Ballon, MD, MPH (Clinical Assistant Professor, Stanford Dept. of Psychiatry and Behavioral Sciences), Rachel Loewy, PhD (Associate Professor, UCSF Dept. of Psychiatry), Kate Hardy, PsyD (Clinical Assistant Professor, Stanford Dept. of Psychiatry and Behavioral Sciences), and Cameron Carter, MD (Professor, UC Davis Dept. of Psychiatry and Behavioral Sciences).  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS104

Scientific reasons for keeping your New Year’s resolutions DECEMBER 13, 2016

More than half of Americans make a New Year’s resolution each year, and though most people set out with the best of intentions, just a small percentage are successful in following through on their resolutions.

To give you a bit of scientific motivation, UC San Francisco gathered some of the latest research behind the most popular health-related New Year’s resolutions that attest to why it really is good for your body to see them through.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS321

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ADVOCACY AND COMMUNITY EDUCATION

Eliminating social stigma key to treating mental illness AUGUST 6, 2016

In the 1940s, it was cancer. In the ’80s, it was HIV. Today, the condition that’s battling pervasive social stigma is mental illness.

As with cancer and HIV in the past, the stigma comes at a high cost: millions of Americans go untreated because of misconceptions and shame. “Mental illness is much like cancer 75 years ago, because it’s scary and unpredictable. And because it’s still mysterious, people want to keep their distance,” says Stephen Hinshaw, PhD, Co-Vice Chair for Psychology in UCSF’s Department of Psychiatry.

Hinshaw, who has written several books about mental health stigma, is part of a growing movement in psychiatry to tackle the issues of stigma head-on and remove the barriers to treatment. He and his colleagues are focused not only on educating the public about the prevalence and treatability of mental illness, but also pushing for policy changes. One of the biggest changes is the push to approach all treatment through the lens of neuroscience – treating mental illness as a biological condition, interacting with contextual factors, instead of merely a social issue.

“Serious mental illnesses fundamentally are no different from cancer or heart disease,” says Matthew State, MD, PhD, chair of the Department of Psychiatry and one of the leaders of the UCSF Weill Institute for Neurosciences. “The developing brain is particularly complex and we need a much better understanding of what’s causing those physiological disruptions and how to correct them.”

The effects of the stigmatization are far-reaching in the United States. The National Institute of Mental Health (NIMH) estimated that nearly one in five adults in the country – 43.8 million – was living with a mental illness in 2014. The rate among youth is just as staggering – one in five people aged 13 to 18 have experienced a serious mental disorder at some point during their life, according to NIMH. Individuals with a mental illness may not be proactive about seeking out treatments if the perceived stigma from society filters down to them.

“There is a high degree of what is called self-stigma,” which involves people taking on and internalizing the attributes of societal stereotypes, Hinshaw says.

Researchers have created scales to measure how much a person stigmatizes himself or herself – high levels of self-stigma predict that people either won’t go to treatment or drop out early of treatment. He says it becomes a vicious cycle: Society stigmatizes, a person picks up the message and self-stigmatizes, he or she doesn’t get engaged in treatment, and the symptoms and impairments of mental illness are never tackled.

Compounding the problem is ostracism through what is known as social distance. Here, members of society rate how close they would be willing to be in contact with a certain group, such as living in the same city, being neighbors, being friends, dating, or allowing their child to marry.

Americans are now more knowledgeable than ever about mental illness through things such as learning basic psychology in school and reading more about it in the media, but social distance has either stayed flat or gotten worse over the past half century, Hinshaw says. “People want to keep their distance from people with mental illness more than any other group in society.”

Media focus on acts of violence – linked with mental illness – is undoubtedly a key factor. Yet on average, he notes, people with most forms of mental illness are no more likely to exhibit aggression than others, though they are far more likely to be victimized by violence.

The stigma people face is exacerbated by a shortage of mental health services, forcing many to live untreated or undertreated.

As millions more Americans become eligible for mental health coverage through the Affordable Care Act, the population of psychiatrists has not grown proportionally.

According to a 2014 report by the Kaiser Family Foundation, only 44 percent of Californians’ mental health care needs are being met by the current availability of professionals. “[The] system feels nearly impossible to navigate,” State told Carry the One Radio, a podcast by UCSF students. “Even with private insurance and ample resources, if you have a loved one who is severely ill, there are few options but to pick up the phone and start calling anyone you know to try to find an available psychiatrist or gain access to a profoundly limited number of psychiatric beds.”

Experts believe that half of adults with a range of mental illnesses get treatment, but less than half of those people get the gold-standard treatment that they deserve, according to Hinshaw. “There is still very poor access to mental health treatments in the United States, and there is even poorer access to evidence-based treatments – the ones we know from studies really work.”

Hinshaw says the solution to ending stigma – and therefore getting more people the treatment they need – is multipronged and needs to include policy changes, better understanding about mental illness and especially more humanization of the illnesses.

Among the laws that need to be changed are the ones in many states that deny renewal of driver’s licenses as well as disallow service on a jury or the ability to run for office to people who have been admitted for a mental illness or even a history of one, Hinshaw says. Of the existing laws, he says the federal statues that are meant to enforce parity for insurance coverage for mental health issues need better enforcement.

On the more individual level, one fact that needs to be taught, he says, is that many people who have a mental illness – even serious ones such as schizophrenia – get better with treatment.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS068

ADVOCACY AND COMMUNITY EDUCATION

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Department members biking across California to fight HIV/AIDS MAY 4, 2015

Three department members will join thousands of other cyclists this June to participate and raise money for AIDS/LifeCycle—a seven-day, 545-mile bike ride from San Francisco to Los Angeles that has become the world's largest annual, single-event AIDS fundraiser.

“I want to do my part to see an end to HIV/AIDS,” said Adult Psychiatry Clinic Director Ellen Haller, MD, who is participating in her third AIDS ride. “With the money we raise, the Los Angeles LGBT Center and San Francisco AIDS Foundation can continue to provide critical services for the HIV-positive community and prevent new HIV infections through programs, services, and education.

Some of the UCSF cyclcists are veterans who have done this ride a number of times in the past, while others are new to long-distance cycling. In addition to nearly two dozen UCSF faculty, staff, students and trainees taking part in the ride as part of Team UCSF, three members of the Department of Psychiatry are also riding as individuals or as members of other fundraising teams: Haller; George Harrison, MD; and Hugo Sosa.

In the seven days it takes the 2,500 riders and 1,500 volunteer roadies to reach Los Angeles, more than 1,000 people in the United States will become infected with HIV. Especially alarming is the fact that one out of every five people living with HIV nationwide is not aware of their status, according to AIDS/LifeCycle.

“What these cyclists contribute to the fight against HIV/AIDS is truly remarkable,” said AIDS/LifeCycle Director Greg Sroda. “Each year people from across the country and all over the world join us not only because the event is a life-changing experience for them, but also because the money they raise changes the lives of people living with HIV.” Since the ride began in 1993, participants have raised more than $200 million and completed more than 42,000 journeys from San Francisco to Los Angeles. Last year alone, riders raised more than $15 million.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS545

Yaffe tells Senate committee continued NIH funding is ‘critical’ for Alzheimer’s research APRIL 3, 2017

UC San Francisco neuropsychiatrist Kristine Yaffe, MD, joined former First Lady of California Maria Shriver and other geriatric care experts last week to testify about the importance of Alzheimer's disease research and prevention at a meeting of the U.S. Senate Special Committee on Aging.

Yaffe, a professor of psychiatry, neurology, and epidemiology at UCSF, as well as the Roy and Marie Scola Endowed Chair and Department of Psychiatry Vice Chair for the UCSF Weill Institute, gave the committee a brief overview of the impact of Alzheimer's and discussed recent research developments which point to possible future treatments and preventative methods. She also explained that there is much about the condition that remains to be uncovered. "Despite tremendous advances in brain science over the past two decades," she told the committee, "there is still so much to learn."

The committee hearing was held in the midst of the White House's proposal to reduce the National Institutes of Health (NIH)'s funding by $1.2 billion during the remainder of the current fiscal year and $5.8 billion in its fiscal year 2018 budget.

Shriver, founder of the Women's Alzheimer's Movement, reported that deaths from Alzheimer's disease have increased nearly twofold since 2000, while deaths from other causes such as breast cancer, prostate cancer, heart disease, and stroke have all decreased over the same period. "We need to ensure the scientists have the funding they requested in the professional judgment budget. We cannot afford to stall research and delay this important lifesaving work."

In response to a question from committee member Sen. Elizabeth Warren about the importance of NIH support, Yaffe explained, "I couldn't be doing what I'm doing without NIH funding. It's by far the most important funder of medical research...and it is particularly important for young people."

"We're talking about the importance of the geriatric workforce, but we also need to talk about the importance of the physician-scientists and scientists in general who, once they finish their training, they are expected to get a grant – often a career development award – to get from their training stage to the independent stage. This is critical," Yaffe stressed, "and it's critical that the NIH fund this because otherwise people aren't going to go into science."

Yaffe also noted that the number of diagnosed Alzheimer's cases is expected to triple by 2050 and associated costs are forecast to increase by 400 percent – costs which could be prevented if today's research is funded.

“The United States spends more than $259 billion per year [on Alzheimer's diseaserelated costs]...,” said committee chair Sen. Susan Collins. “If we do nothing, the Alzheimer's Association forecasts that this disease will cost our country an astonishing $1.1 trillion by 2050, and it will bankrupt the Medicaid and Medicare programs.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS861

ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)

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Prescribing video games for kids with attention problems MAY 4, 2017

The right kind of video game might one day help improve attention skills in some kids with sensory disorders that make it hard to process what they see and hear, a small experiment suggests.

“We think that there are differences in not only the wiring for sensory modulation but also for what we call cognitive control which includes the ability to sustain attention even in the face of distraction,” Marco said by email.

For the study, researchers focused on 38 children with what’s known as sensory processing dysfunction, a condition that can make them unusually sensitive to things like the sound of a toilet flushing or the feel of a tag inside a shirt. The experiment also included a control group of 25 typically developing kids.

The University of California San Francisco and Akili Interactive Labs are developing the game kids played on a digital platform called Project: EVO. Researchers are investigating EVO as a therapy for children with cognitive impairments, including sensory processing dysfunction and ADHD.

After four weeks of playing games designed to help kids with sensory problems, researchers found a significant improvement in attention skills among a subset of 20 kids with sensory issues who also had attention deficit hyperactivity disorder (ADHD).

An estimated one in 20 kids have sensory processing problems. Depending on their issues, they might be treated with occupational therapy to help them become more comfortable with input that upsets them, like loud noise or bright light, or they might be trained to become more sensitive to input they ignore, like pain, that makes them engage in reckless behavior.

“Children with sensory processing dysfunction have differences in the way their brains are wired,” said senior study author Dr. Elysa Marco of the University of California San Francisco’s Departments of Neurology, Psychiatry, and Pediatrics.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS912

Study shows ‘video game’ more accurate than standard tests at identifying kids with attention deficits SEPTEMBER 20, 2016

A digital assessment platform designed to look and feel like a video game may successfully flag children with attention disorders, according to the results of a study published Sept. 20, 2016, in Translational Psychiatry. Ultimately a therapeutic version of the platform could be used to treat conditions such as attention deficit hyperactivity disorder (ADHD).

To assess the diagnostic capability of the platform, which is being developed as a medical device, researchers studied children with a genetic condition known as 16p11.2 deletion, which is associated with challenges with social communication. Some children may have an autism diagnosis, as well as attention deficits.

“Tests that measure cognitive control deficits in children with autism or ADHD often have only modest sensitivity,” said first author Joaquin A. Anguera, PhD, from the departments of neurology and psychiatry at UC San Francisco. “Here we wanted to see if a device with engaging, game-like functions that uses adaptive algorithms to automatically assess a user’s ability level would be able to measure selective attention with more precision than non-adaptive traditional tests.”

In the study, 20 children with the deletion, whose average age was 10, interacted with the Project: EVO™ platform on an iPad for approximately 10 minutes. The game-like test, which was designed with graphics similar to current consumer video games, consists of three components: visuomotor tracking, where participants steer a character through winding paths avoiding walls and obstacles; perceptual discrimination, where they respond selectively to colored targets by tapping on the screen while ignoring other targets or stimuli; and multitasking, where participants perform both tracking and discrimination simultaneously. The test is designed to adapt in real-time to continually challenge the user.

The children also had cognitive assessments using two standard, non-adaptive tools on the iPad: a visual search and a Flanker task. Both tests measured response time to target stimuli while low-level distracting elements were presented. However, Project: EVO™’s

multitasking assessment also allows for testing these selective attention abilities under high “interference,” through a set of algorithms licensed from UCSF. The group’s performance on the three tests was compared with 91 children without the deletion, whose average age was also 10.

The results of the tests using Project: EVO™ showed that children with the deletion had longer response times and more variability compared to their peers without the condition. However no such group differences were found on either the Flanker or visual search task, suggesting that the Project: EVO™ test was more robust in characterizing selective attention abilities than traditional tests.

“These standard tests have regularly failed to show clear differences in selective attention abilities between children with autism or ADHD, versus neurotypical children,” Anguera said. “Such null effects may result from a lack of engagement and/or tools that are too coarse to reveal subtle differences in cognitive abilities in populations, especially children that are known to be inherently variable when being assessed.”

The ability to accurately assess cognitive control in children is important because these abilities determine how we reach goals and interact with our environment, according to senior author Elysa Marco, MD, director of the UCSF Sensory Neurodevelopment and Autism Program and associate professor in the UCSF departments of neurology, psychiatry and pediatrics.

“Cognitive control is predictive of academic performance and influences quality of life.

But not every child with a 16p11.2 copy number variation will have challenges in attention, as this cognitive ability has multiple contributors,” Marco said. “Knowing who is at risk, so that they can be monitored and treated as needed, is the way to move to a more personalized approach to medicine.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS173

ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)

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Exercising the mind to treat attention deficits MAY 12, 2014

Which will it be — the berries or the chocolate dessert? Homework or the Xbox? Finish that memo, or roam Facebook?

Such quotidian decisions test a mental ability called cognitive control, the capacity to maintain focus on an important choice while ignoring other impulses. Poor planning, wandering attention and trouble inhibiting impulses all signify lapses in cognitive control. Now a growing stream of research suggests that strengthening this mental muscle, usually with exercises in so-called mindfulness, may help children and adults cope with attention deficit hyperactivity disorder and its adult equivalent, attention deficit disorder.

Meditation is a cognitive control exercise that enhances “the ability to self-regulate your internal distractions,” said Dr. Adam Gazzaley, a neuroscientist at the University of California, San Francisco.

His research seeks to duplicate these effects with video games that “selectively target the key circuits without the kind of side effects you get with drugs.”

With colleagues, he designed NeuroRacer, a game for older adults in which they respond to traffic signs that appear suddenly while driving on a winding road. The game enhanced cognitive control in subjects ranging from 60 to 85, according to a study published in Nature.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS214

New book uses coaching techniques behind top-tier athletes to help children with ADHD SEPTEMBER 26, 2016

As millions of schoolchildren head back to the classroom, many of them will return having been inspired by the performances of top Olympians such as Simone Biles, Usain Bolt, and Michael Phelps. These world-class athletes are proof that anyone can reach the pinnacle of their field with the right combination of skill, determination, and a laser-like focus during training and competition.

For Phelps, that intense focus always came naturally in the swimming pool. It didn’t, however, come as easily in other aspects of his life. Diagnosed with attention-deficit hyperactivity disorder (ADHD) as a child, Phelps faced a Herculean challenge before capturing 28 medals and becoming the most decorated Olympian in history—staying focused in school.

His mother, observing how his single-minded determination in the pool helped him excel at swimming, channeled that concentration and effort into his schoolwork. By setting goals and allowing him to visualize his future accomplishments, Deborah Phelps was able to keep her son focused on his schoolwork and other facets of his life throughout adolescence.

The ability of Phelps and other world-class athletes to stay focused on the task in front of them is a trait that can be developed and harnessed to promote success by anyone—even those with ADHD—according to the authors of the new book ADHD & The Focused Mind: A Guide to Giving Your ADHD Child Focus, Discipline & Self-Confidence.

Written by neurologist Sarah Cheyette, MD; martial arts instructor Peter Johnson; and UCSF Associate Professor of Psychiatry Benjamin Cheyette, MD, PhD, the book aims to provide parents with an easy-to-understand approach to changing their children’s mindset and behavior by introducing simple, powerful concepts to keep their child motivated.

“Just as athletes improve their athletic skills through proper coaching and training, ADHDers have mental skills that they can improve through proper coaching and training,” the trio explains. “Both ADHDers and athletes need to identify challenges, set goals, and train hard with a coach. A person with ADHD who does this can break away from a cycle of underachievement or outright failure to become a world-class success story.”

In addition to providing strategies that can be used to manage ADHD at home and school, the book also offers an explanation of the basics of the condition—its common behavioral symptoms, the biology behind it, and what research has revealed about it.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS781

Teens: How to thrive despite ADHD APRIL 23, 2014

Being a teenager is hard enough. But for those diagnosed with ADHD — a chronic medical, neurodevelopmental and psychosocial condition — managing the academic and social rigors of high school can be extra challenging.

Pills help with focus and impulsivity, but many teens still need to learn the social, organizational and time management strategies to be successful. Particularly challenging for adolescents are the kinds of issues any teenager faces with drives, boundaries and risk-taking behavior, explains Brad Berman, a developmental and behavioral pediatrician in Oakland and Walnut Creek.

Berman says the best treatment needs to be individualized for each adolescent and in addition to medication often includes academic and time-management skills coaching.

Many youths also benefit from individual or group therapy. While some schools offer academic assistance and some insurance companies cover limited therapy, all experts interviewed for this story say teens and parents must be vigilant in seeking out the support needed to thrive.

“Most of these kids get 10 minutes in the pediatrician’s office to get treated,” says national ADHD expert Stephen Hinshaw, who co-authored The ADHD Explosion: Myths, Medication, Money, and Today’s Push for Performance and is a psychologist in the UC San Francisco psychiatry department.

“It’s a quick and dirty diagnosis, and most pediatricians aren’t well-trained in behavioral disorders. So, you’ve got to find out what’s going on at school. You’ve got to pound the pavement. Find out who the experts are in your community.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS403

New ADHD pharmacologic treatments needed but few are on the way MAY 17, 2017

Behavior therapy can benefit most patients with attention deficit hyperactivity disorder (ADHD), but the vast majority of patients with the condition will still need pharmacotherapy to manage their symptoms and prevent the disorder from interfering with their lives. Yet little progress has been made in identifying effective agents for patients who don't respond to the handful of existing medications.

“There are still pretty major gaps in optimal treatment of ADHD that potentially might be filled if we could find further ways of getting at the problem of ADHD,” said Glen Elliott, MD, PhD, chief psychiatrist and medical director of Children's Health Council in Palo Alto, California and a volunteer clinical faculty member at the University of California, San Francisco. He noted that some interest has developed in GABA, a largely inhibitory neuroregulator, and glutamate, which is more excitatory, but not much has moved forward with these agents. Despite recent and continuing advances in understanding the condition, substantial knowledge gaps remain regarding ADHD's etiology and neurobiology.

Several companies are exploring options based on what is known, even if their products are chemically similar to existing therapies. At their annual conference in January, The American Professional Society of ADHD and Related Disorders (APSARD) hosted dozens of abstracts about ADHD, running the gamut from screening to neurobiology to recent developments in treatment. A significant percentage of the abstracts included preliminary results from clinical trials for drug therapies currently in the pipeline.

“Unfortunately the ones that have been coming out recently have really been [a] carbon copy of what we have, which isn't all that useful,” Elliott said. Plenty of methylphenidate and amphetamine derivatives already exist, for example, “but there are clear ongoing problems that the current medications don't address that some of the newer formulations are trying to,” he added.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS504

ALZHEIMER’S, DEMENTIA AND COGNITIVE AGING

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Research suggest maintaining a healthy weight could prevent Alzheimer’s JANUARY 23, 2017

There is a surprising link between being overweight in mid-life and early development of Alzheimer’s disease.

As part of a 14-year study known as the Baltimore Longitudinal Study of Aging (BLSA), researchers from the National Institute on Aging evaluated the body mass index (BMI) of 1,394 volunteers, utilizing an estimate of what it would have been for each person at the age of 50, regardless of their BMI at the beginning of the study.

What the researchers discovered was that a midlife person with a BMI of 20 (normal) who later developed Alzheimer’s was 86 at the time–unlike a participant with a BMI of 35 (obese) who later developed Alzheimer’s at the age of 77.

Though researchers admit more studies need to be done, they believe that maintaining a healthy weight at midlife is a significant way to slow the onset of Alzheimer’s.

Dr. Kristine Yaffe from the University of California, San Francisco, said, “Fat…secretes inflammatory markers and factors that influence metabolism…Obesity may thus cause an unstable metabolic environment, inflammation, and real alterations of insulin resistance that converge on amyloid transport.”

According to the BLSA study researchers, “Our findings raise the possibility that inexpensive, noninvasive interventions targeting midlife obesity and overweight could substantially alter the trajectory of Alzheimer’s disease, reducing its global public health and economic impact.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS297

Alzheimer’s linked with medications for anxiety and sleep SEPTEMBER 10, 2014

Medications widely used for anxiety and insomnia are linked to an increased risk of Alzheimer's in a new study.

The study, published Tuesday in the medical journal BMJ, does not prove a cause-and-effect relationship between benzodiazepines – drugs such as Xanax, Ativan and Valium – and dementia. But it does show Alzheimer's was 51% more common in older adults who took the drugs in the past.

The risk started to show up with three months of use and rose from there. It was greatest in patients who took long-acting versions.

"It is not surprising that benzodiazepines are associated with adverse cognitive effects," says an editorial written in part by Kristine Yaffe of UC San Francisco.

The question is whether the effects, including diminished memory and thinking skills, are passing or potentially permanent. The new study is rigorous enough to raise concerns about irreversible effects in long-term users, experts say.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS111

Sleep disorders may raise risk of Alzheimer’s, new research shows JULY 14, 2014

Sleep disturbances such as apnea may increase the risk of Alzheimer’s disease, while moderate exercise in middle age and mentally stimulating games, such as crossword puzzles, may prevent the onset of the dementia-causing disease, according to new research to be presented Monday.

The findings — which are to be introduced during the six-day Alzheimer’s Association International Conference in Copenhagen — bolster previous studies that suggest sleep plays a critical role in the aging brain’s health, perhaps by allowing the body to cleanse itself of Alzheimer's-related compounds during down time. The studies also add to a growing body of literature that suggests keeping the brain busy keeps it healthy.

The battle against Alzheimer’s disease has become more urgent for the United States and other developing nations as their populations turn increasingly gray. The disease is the leading cause of dementia in older people and afflicts more than five million Americans. At its current pace, the number is expected to soar to 16 million by 2050.

The sleep study, conducted by University of California at San Francisco researchers on a large sample of veterans, found that those with diagnosed sleep disorders such as apnea or insomnia were 30 percent more likely to suffer dementia than veterans without such problems. Veterans who suffered from sleep problems and post-traumatic stress disorder (PTSD) had an 80 percent greater risk.

“I would say that this another important study showing this link between sleep and subsequent diagnosis of dementia,” Kristine Yaffe, a psychiatry professor at UCSF who heads its Dementia Epidemiology Research Group, said in a telephone interview. She said her study’s findings benefited from having such a large sample of participants: researchers used eight years of records on 200,000 veterans, most of whom were male and 55 or older.

It is well known that people afflicted with Alzheimer’s suffer from sleep disorders, Yaffe said, but further research is necessary to determine whether sleep disturbance heightens the risk of getting dementia or is a symptom.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS568

Brain Health Registry announces partnership to find faster cures for Alzheimer’s disease and all brain disorders MARCH 13, 2015

Renowned model, actress and restaurateur B. Smith and her husband, Dan Gasby, are partnering with the Brain Health Registry (BHR) in a new effort to help identify candidates online for clinical trials. The initiative includes a newly launched national public service campaign featuring Smith and Gasby aimed at increasing participation of minorities in clinical trials.

Although older African Americans are twice as likely to have Alzheimer’s disease as non-Hispanic whites, diagnosis and treatment are more likely to be delayed. In addition, Applied Clinical Trials reports African American participation in clinical trials of potential Alzheimer’s disease treatments has declined to only two percent. Despite an increasingly ethnically diverse US population, African Americans, Hispanics, and other minorities are under-represented in medical research. As a study published in Alzheimer Disease and Associated Disorders found, over 95 percent of subjects in a typical Alzheimer’s disease clinical trial are white.

Recognizing minority participation in clinical trials is a national health issue, the Food and Drug Administration’s (FDA) Office of Minority Health is focused on ensuring all clinical trials include a diverse population. The underrepresentation of minorities in clinical trials means treatments may not be as effective as they could be across diverse populations.

“One of the biggest obstacles to finding cures for brain disorders is the cost and time involved for patient recruitment in clinical trials,” said Michael W. Weiner, MD, founder and principal investigator of Brain Health Registry (BHR) and a professor at UCSF. “The primary reason I founded Brain Health Registry is to increase access to clinical trials to anyone regardless of their race or income level.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS729

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$40M NIH award expands groundbreaking Alzheimer’s study; Recruitment to begin soon SEPTEMBER 12, 2016

The National Institutes of Health’s recent $40 million award over the next five years will provide a new stage of research for the Alzheimer’s Disease Neuroimaging Initiative (ADNI), an NIH public-private partnership.

The award will fund ADNI3, an extension of the global research effort that supports the investigation and development of treatments that slow or stop the progression of Alzheimer’s disease. Recruitment of hundreds of new volunteers for ADNI3 is planned to begin this fall.

ADNI3 is a five-year extension of the ADNI study, which is now on its 12th year. The multi-site, longitudinal study assesses clinical, imaging, genetic, and biospecimen biomarkers through the process of normal aging to early mild cognitive impairment (EMCI), to late mild cognitive impairment (LMCI), to dementia or Alzheimer’s.

Using established methods for imaging and biomarker collection and analysis, ADNI facilitates a way for scientists to conduct research and share compatible data with other scientists around the globe.

ADNI3 will use cutting-edge methods in brain imaging to speed clinical trials by offering investigators the biomarkers required to detect the onset of Alzheimer’s and track the progression of the disease.

The study matches clinical and cognitive testing changes with Alzheimer’s-related changes detected in the volunteers’ blood, cerebrospinal fluid, and DNA. Brain scans are used to detect brain volume changes as well as white matter integrity, functional connectivity between brain regions, glucose metabolism, and the buildup of amyloid protein plaques — a hallmark of Alzheimer’s. ADNI3 will add brain scans that detect tau protein tangles, another Alzheimer’s indicator.

The ADNI unites researchers with study data as they work to define the progression of Alzheimer’s disease. ADNI researchers collect, validate, and utilize data such as MRI and PET images, genetics, cognitive tests, CSF and blood biomarkers as predictors for the disease.

ADNI is supported by the NIH’s National Institute on Aging (NIA) through a grant to the Northern California Institute for Research and Education in San Francisco. The study’s prinicipal investigator is Dr. Michael Weiner, MD, of the San Francisco Department of Veterans Affairs Medical Center and the University of California, San Francisco (UCSF).

By identifying and validating such biomarkers as abnormal levels of amyloid protein, ADNI has led to insights on who may be at risk of developing Alzheimer’s and how disease-related brain changes match clinical findings.

Weiner said he and his team are thrilled to begin the newest phase of discovery, “enhanced by sophisticated new technologies and computational methods that we could only dream about when we launched the study in 2004.”

“ADNI has made a profound difference in clinical trials, developing and refining the biomarker tools needed to see Alzheimer’s-related brain changes in the living brain — even in people free of symptoms,” Weiner said. “ADNI3 will play an even more influential role as these biomarkers are enlisted in the search for treatments for this devastating disorder.”

ADNI3 will use new tools and measures such as tracers that image tau protein tangles in volunteers’ living brains, which will offer scientists knowledge about where and how the protein builds in the brain, and how it may interact with amyloid protein plaques to drive the progression of Alzheimer’s disease.

Also, because handling money is often an early sign of Alzheimer’s, the Financial Capacity Instrument (FCI) will be used to evaluate volunteers on real-life money skills.

Declines in the FCI performance will the used to assess who is at risk for developing Alzheimer’s among those with normal cognitive skills or mild cognitive impairment.

Up to 1,200 volunteers over the age of 55 years will join the 800 volunteers now taking part in the study at 60 research sites in the U.S. and Canada. The volunteers include people with normal cognition, mild cognitive impairment, and those with full blown Alzheimer’s.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS742

Despite growing research that lifestyle choices matter, we still view Alzheimer’s as a predominantly inherited disease DECEMBER 7, 2016

When Americans think about treatment for Alzheimer’s, what typically comes to mind are medications that are widely advertised on TV, like Aricept and Namenda.

Unfortunately, the five FDA-approved Alzheimer’s drugs tend to be of limited effectiveness. These drugs are either cholinesterase inhibitors or NMDA antagonists, which each slow the breakdown and regulate the activity of key neurotransmitters involved in memory, respectively. A variety of new agents that use different mechanisms — such as those that are designed to attack proliferations of the proteins beta amyloid or tau, which are hallmarks of the disease — are currently in development.

Given both the unreliability of the drugs now on the market and all the research linking Alzheimer’s to lifestyle factors, many doctors now believe that treatment should focus primarily on prevention. These interventions take two forms: addressing other underlying health conditions that increase the risk of Alzheimer’s such as sleep disorders and hypertension and encouraging patients to make behavioral changes to improve brain health.

Treating a troubled mind is also important, given ample evidence that some psychiatric diseases can also increase the risk of Alzheimer’s — chiefly sleep disorders, PTSD, and depression. The studies documenting these links invariably conclude that if more patients with these psychiatric diseases were to receive treatment, the incidence of Alzheimer’s would drop significantly. A leading advocate of this type of Alzheimer’s prevention is Kristine Yaffe, a professor of psychiatry, neurology and epidemiology at the University of California, San Francisco, who has focused her research on novel strategies for treating the disease.

In a 2011 article, Yaffe and her UCSF colleagues showed that elderly women with sleep apnea were about forty percent more likely to develop either mild cognitive impairment or dementia than controls. They traced the impairment in cognitive functioning not to the loss of sleep, but to hypoxia — a drop in the oxygen level in the blood. Likewise, a study of 181,000 veterans published by Yaffe and her colleagues in 2010 showed that veterans with PTSD were almost twice as likely to suffer from Alzheimer’s disease as their counterparts without PTSD.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS873

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Alzheimer’s falls more heavily on women than on men DECEMBER 28, 2016

Alzheimer’s dementia disproportionately affects women in a variety of ways. Compared with men, 2.5 times as many women as men provide 24-hour care for an affected relative. Nearly 19 percent of these wives, sisters and daughters have had to quit work to do so. In addition, women make up nearly two-thirds of the more than 5 million Americans living with Alzheimer’s today.

According to the Alzheimer’s Association 2016 Alzheimer’s Disease Facts and Figures, an estimated 3.3 million women aged 65 and older in the United States have the disease.

To put that number in perspective, a woman in her sixties is now about twice as likely to develop Alzheimer’s as breast cancer within her lifetime.

Researchers are racing to figure out why. Women generally live longer than men, but mounting evidence suggests that longevity alone may not account for the unequal disease burden women face. It remains unclear whether women are truly at an increased risk for Alzheimer’s. But studies have revealed that there may be distinct biological and genetic factors shaping how the disease develops and progresses in women. Understanding these differences will be of key importance in devising new, more effective strategies for treating, preventing and diagnosing Alzheimer’s.

In May 2015, the Alzheimer’s Association hosted a think tank that brought together experts in biological sex differences and Alzheimer’s disease to develop a research agenda. This meeting, co-chaired by neuroscientist Roberta Diaz Brinton of the University of Arizona Health Services, neuropsychologist Suzanne Craft of Wake Forest University School of Medicine, and neurologist Kristine Yaffe of the University of California, San Francisco, identified three primary gaps in our knowledge. Specifically, they concluded that we need more research to understand the different roles that genetics, hormones and lifestyle factors play in Alzheimer’s in men and women.

In response, the Alzheimer’s Association launched a new funding initiative—the only one of its kind—investing $2.2 million across nine research project research goals.

One focuses on the complex interplay between hormones and genes in Alzheimer’s disease. Other projects are exploring potentially modifiable lifestyle factors, such as education, occupation, exercise, diet, stress and sleep—all of which may hold greater sway over women’s risk of developing Alzheimer’s.

Take, for example, formal education, which strong evidence suggests may boost resilience to cognitive decline and dementia in both sexes. Data reported at the Alzheimer’s Association International Conference (AAIC) in 2015 showed that individuals who completed high school had a 28 percent lower risk of developing dementia compared to those with only an elementary school education. Although disparities in formal education between men and women are declining in the U.S. and other developed countries, significant differences still exist in current older populations.

Researchers are also learning that there may be differences in the brain’s response to stress between men and women. In a 38-year longitudinal study examining the link between stress and the risk for Alzheimer’s, women who had lived through more stressful events—such as divorce, widowhood, work problems or illness—had an increased likelihood of developing dementia. Another more recent 28-year-long study indicates that anxiety may play a role in increasing risk for dementia in women but not in men. Although these studies suggest a link, it is important to advance this research in larger and more diverse populations.

Ultimately, the most effective approaches to preventing, treating and diagnosing Alzheimer’s and dementia may need to be tailored for each individual, taking into account multiple factors such as genetics, hormones and lifestyle. Investigating how sex differences contribute to Alzheimer’s may provide important clues to achieving this goal.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS897

UCSF gets $177M grant to address dementia NOVEMBER 17, 2015

A billionaire philanthropist committed to giving away all his money before he dies has donated $177 million to UCSF to create a program involving people in a variety of fields from all over the world — physicians, social workers, economists, lawyers, musicians — to address the growing burden of Alzheimer’s disease and dementia.

The gift from the Atlantic Philanthropies, the organization founded by billionaire Charles F. “Chuck” Feeney to impart his “giving while living” philosophy, will allow UCSF, in partnership with Trinity College in Dublin, Ireland, to train the 600 new brain health leaders over the next 15 years in the U.S., Ireland, Latin America, Asia and Africa.

“It’s common sense, but it’s a fairly new idea that a number of factors associated with cognitive decline in aging can be prevented,” said Dr. Bruce Miller, director of UCSF’s Memory and Aging Center and co-leader of the initiative. “Few countries have addressed this growing epidemic, yet recent studies suggest cognitive impairment and Alzheimer’s disease is the most costly item in our health care budget, and this is continuing to grow.”

Can access to a good education help prevent dementia?

The goal of the program, called the Global Brain Health Institute, is to train leaders from a variety of disciplines — not just medicine, but in business, the social sciences and the arts — to develop ways to combat Alzheimer’s and dementia and to take what they’ve learned and pass it on to others.

DECEMBER 16, 2016

Access to good education might be the key to preventing dementia and other mental problems affecting memory and thinking. This, according to Kristine Yaffe, a psychiatrist at the University of California, San Francisco. Yaffe conducted a study looking into how poverty affects our brain and says one of the most obvious connections is that people with higher income usually get a better education than those who struggle financially.

“Even if you have the same number of years of education, the quality of education may not be as good."

And that, Yaffe says, can have a snowball effect in other areas of our lives.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS306

Because the brain is so complex, neurological diseases need to be tackled from a variety of angles, said Dr. Kristine Yaffe, a UCSF professor of psychiatry, neurology and epidemiology and a leader of the initiative.

New drugs to treat Alzheimer’s will be important, she said, but so will other approaches.

“There's a lot of accumulating evidence that certain things have a role in preventing dementia or delaying it,” she said. “Things like higher education, being physically active and cardiovascular control are really well studied and suggest there are some ways we can put off and delay Alzheimer’s and other dementias.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS609

ALZHEIMER’S, DEMENTIA AND COGNITIVE AGING

NIH summit examines what makes a healthy aging brain APRIL 25, 2017

Neurodegenerative disease researchers spend a lot of time considering what goes wrong in the brain. But what about when things go right? Factors that contribute to healthy brain aging took center stage at the Cognitive Aging Summit held at the Bethesda North Marriott Hotel & Conference Center in Maryland.

More than 300 researchers—some working on human cohorts, other animal models, even gaming technology—gathered to share data. They focused on the concepts of cognitive resilience and reserve in exploring exactly what happens when the brain ages successfully.

“This is an uncommon opportunity to get scientists from all these areas of expertise to converge,” NIA director Richard Hodes told Alzforum. “The relevance and implications of one line of research for another becomes clearer in this setting.”

Several researchers talked about how challenging it is to validate high-tech methods under investigation. The challenges of rigorously design experiments and statistical analyses extend to virtual reality and video games as well.

Scientists led by Adam Gazzaley, University of California, San Francisco, have been creating games to improve cognition. How can they tell if those games have lasting benefits over time that generalize to daily activities?

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Study finds trajectory of depressive symptoms more accurate at identifying dementia risk than individual assessments MARCH 17, 2016

In a new study published online by JAMA Psychiatry, a research team led by UCSF Psychiatry faculty members has found that patients with high-and-increasing depressive trajectories were almost twice as likely to develop dementia than those with minimal symptoms, even when accounting for other important factors.

“Previous research has shown that older adults with depression are more likely to develop dementia, but most studies have only examined an older adult’s depressive symptoms at one point in time,” said Allison R. Kaup, PhD, an assistant professor of psychiatry at UCSF and lead author of the study. “This is an important limitation because we know that depressive symptoms change over time and that older adults show different patterns of depressive symptoms over time.”

For their study, the researchers followed older adults for several years. After assessing which patterns of depressive symptoms subjects tended to have during the early years of the study, they then investigated whether these differing patterns were associated with participants who developed dementia during the study’s later years.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS772

One method they are trying uses a digital “glass brain” model, created for each person.

It uses a person’s MRI data to construct a three-dimensional representation of his or her cortical and white matter, then overlays that person’s real-time wireless EEG data, which is recorded as the person plays a game with electrodes glued to his or her scalp. During play, the model helps monitor how the player’s brain responds to the cognitive stimuli and whether and how that response changes over time.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS518

Poor odor identification may be an early warning sign for dementia FEBRUARY 2, 2017

Poor performance on a simple odor identification test was associated with a significantly increased risk of developing dementia years later, in a study of more than 2,400 older black and white adults led by Kristine Yaffe, MD, a UC San Francisco professor of psychiatry, neurology and epidemiology and biostatistics.

Researchers said the results support olfactory testing – which is simple, noninvasive and inexpensive – to identify those at risk for developing dementia. Previous studies have not included diverse populations, so it was not clear whether the testing might be useful.

Long-term marijuana use associated with worse verbal memory in middle age MARCH 12, 2016

“These findings have critical implications for the widespread prevention and treatment of dementia,” said Yaffe. “They confirm the importance of sense of smell as a link to dementia, and show that olfactory testing could be a promising strategy for early detection of dementia risk.”

Marijuana use over time is associated with remembering fewer words from a list, but it did not appear to affect other areas of cognitive function in a study of men and women followed up over 25 years, according to an article published online by JAMA Internal Medicine.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS229

Marijuana use is common among adolescents and young adults, with 19.8 million current users according to federal estimates, and growth in use in recent years. But it remains unclear whether there are long-term effects from low-intensity or occasional marijuana use earlier in life and whether the magnitude and persistence of impairment depends on the duration of marijuana use or the age of exposure.

For memory decline, age matters JANUARY 12, 2017

Age matters when it comes to spotting the warning signs of memory decline and other thinking skills. Kristine Yaffe, a psychiatrist at the University of California, San Francisco, has been studying a group of young adults from 18 to 30 years old, until they've reached midlife. And in doing so, Yaffe observed some of their weakening brain activity.

"If you just study people when they are in their eighties and nineties with dementia, that's very helpful in terms of trying to come up with better treatment and better care of patients, but it's not very helpful if you are trying to prevent or really try to intervene early. For that you have to back up the time, probably by decades and really get a better understanding of some of the early signs and the early risk factors."  HEAR THE ENTIRE EPISODE AT PSYCH.UCSF.EDU/NEWS990

Reto Auer, MD, MAS, a former research fellow at UC San Francisco, and coauthors used measurements from the long-term Coronary Artery Risk Development in Young Adults (CARDIA) study, which includes 25 years of repeated measures of marijuana exposure starting in early adulthood, to study the association between cumulative years of marijuana use and cognitive performance in middle age among study participants who had marijuana exposures typical to the communities in which they live.

Past exposure to marijuana was associated with worse verbal memory, but does not appear to affect other domains of cognitive function. For every five years of past exposure, lower verbal memory corresponded to an average of half the participants remembering one word fewer from a list of 15 words, according to the results.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS418

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Poverty may be a risk factor for reduced cognitive function SEPTEMBER 28, 2016

Persistent poverty in young adulthood and midlife may elevate one’s risk for lower cognitive function by age 50, according to the results of a study that tracked income levels of close to 3,400 adults over a 25-year duration.

Researchers from UC San Francisco and five other institutions questioned participants six times over the years about the amount of time they had spent in poverty, defined as less than 200 percent of the federal poverty level. This translates to an annual income of $44,630 for a four-person household in 2010, the last year they were surveyed.

The participants, who were aged 18 to 30 at recruitment, were categorized according to their poverty frequency levels: never, less than one third of the time, more than one third of the time, or all of the time. The results of the study were published in the American Journal of Preventive Medicine on Sept. 27, 2016.

“Previous research has shown that exposure to poor socioeconomic conditions in childhood and adulthood is associated with cognitive deficits, but most of these studies have involved older adults,” said senior author Kristine Yaffe, MD, professor in the UCSF departments of Psychiatry, Neurology, and Epidemiology and Biostatistics. “We wanted to see if economic adversity impacts cognitive health earlier in the life course.”

“Maintaining cognitive abilities is a key component of health,” said first author Adina Zeki Al Hazzouri, PhD, of the Division of Epidemiology, Department of Public Health Sciences at the University of Miami. “Findings from this relatively young cohort place economic hardship as being on the pathway to cognitive aging and as an important contributor to premature aging among economically disadvantaged populations.”

The researchers found that participants whose income placed them in the all-of-the-time poverty bracket had lower cognitive scores than those who had never been in poverty. They scored an average 0.92 points less on verbal memory, from a range of zero to 15; 11.60 points less on processing speed, from a range of 8 to 125; and fared slightly lower on a test that measured the ability to respond to some stimuli while suppressing others.

Similar differences in cognition were found when the researchers compared the participants who reported they always experienced financial hardship, such as difficulty paying for food and heating, with those who had never experienced it.

“Our findings reveal a clear graded relationship such that cognitive performance, and processing speed in particular, was worse with cumulative exposure to economic adversity,” said Yaffe, who is also Chief of Neuropsychiatry at the San Francisco VA Medical Center.

“While the difference in cognitive function was small between the group that had always been in poverty and the group that never been in poverty, the real issue is what do those differences mean over time. If there is a small difference at age 50, there may be a significant difference later in life. It’s important that those in long-term poverty are followed with a view to possible interventions.”

The 3,383 participants were recruited from the University of Alabama at Birmingham; the University of Minnesota in Minneapolis; Northwestern University in Chicago; and Kaiser Permanente in Oakland, Calif.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS944

IOM report outlines steps for maintaining cognitive function as the brain ages APRIL 29, 2015

Brains age, just like the rest of the body, even for those who don't get neurological disease, according to an Institute of Medicine report released on April 14.

"Some of the changes that one observes doesn't mean that it's all over, gloom and doom," the committee’s vice chair, Kristine Yaffe, MD, told the Washington Post.

The committee proposed three actions to help maintain cognitive function with age: staying physically active; managing blood pressure and diabetes; and stopping smoking. Aging adults should also pay careful attention to health conditions and medications that could influence their cognitive health.

As for nutritional supplements, the report says the medical literature does not offer convincing support that any of them can prevent cognitive decline.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS313

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Can a challenging job and exercise keep Alzheimer’s at bay?

JULY 20, 2017

Research teams from around the world are looking for ways to prevent dementia in old age. For people with Alzheimer's disease, such interventions are sorely needed; there are currently no reliable treatments to stop neurodegeneration.

The main hallmark of Alzheimer's disease is a progressive loss of brain matter that eventually leads to cognitive decline. Two proteins abnormally accumulate in and around neurons in the brains of people with Alzheimer's disease, causing cell death.

Drugs for the condition only treat the symptoms. Researchers are therefore looking at ways of halting or slowing down cognitive decline by boosting brain health before neurodegeneration occurs.

Research presented at the Alzheimer's Association International Conference (AAIC) 2017, held in London, United Kingdom, examined the link between lifestyle and cognitive decline.

The findings point toward occupation in early life and targeted interventions later in life as having a positive effect on cognition.

A study by Allison Kaup, Ph.D., and colleagues from the University of California, San Francisco looked at the influence that the type of profession someone chooses in early and mid-adulthood has on cognitive decline in later life. The study commenced when participants were between the ages of 18 and 30, and it ran for 25 years.

Occupational complexity is a measure of how cognitively challenging a particular profession is. An example of a low-complexity job is a machine operator, while teachers are in the medium-complexity job group. High-complexity professions include engineering.

The team's data showed that occupational complexity in early life was associated with greater white matter integrity, meaning fewer signs of aging and higher processing speed and executive function in mid-life.

But it is not clear whether a more complex job causes these signs or white matter complexity influences career choice. It is also too early to tell whether the study participants are going to develop Alzheimer's disease over time, but the team will continue to monitor them.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS218

Preventing loss of independence through exercise AUGUST 15, 2017

Preventing Loss of Independence through Exercise (PLIÉ) is a unique group movement program for veterans with Alzheimer’s disease and dementia. This innovative San Francisco VA Medical Center (SFVAMC) program is a way to improve function and quality of life for these veterans, and it may reduce the rate of falls and delay hospitalization. PLIÉ recently received a “Spark Seed Spread” grant from the VA Innovators Network to help spread this program to other Medical Centers throughout the VA system.

PLIÉ is part of a joint study between SFVAMC and the UCSF Osher Center for Integrative Medicine. Veterans in PLIÉ participate in one-hour group exercise sessions two days a week for twelve to eighteen weeks. These sessions focus on skills that even veterans with memory loss can accomplish.

“The focus is on things people with dementia can still do very well,” says Deborah Barnes, PHD, MPH, Research Health Sciences Specialist at SFVAMC and Principal Investigator for the PLIÉ study. “These veterans can still learn movement through repetition. They are capable of being ‘in the moment,’ so they’re also able to be socially engaged through these group sessions.”

Dr. Barnes notes that many short-term improvements can already be seen in veterans who have participated in PLIÉ – including cognitive benefits, improved motor functioning, and general improvements in health and wellbeing. In the long term, Dr. Barnes and her fellow investigators are hoping to see fewer falls and reduced hospitalizations in veterans who have completed the program.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS978

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Study: Too much television and too little exercise might dull young adult brains DECEMBER 2, 2015

Young adults who watch a lot of TV and engage in very little exercise are risking more than their waist lines. By middle age, their brains may be getting out of shape too, a new study suggests.

The study, published in the journal JAMA Psychiatry, followed more than 3,000 people, starting at an average age of 25 and ending when they took cognitive tests a quarter of a century later.

Those who watched the most TV and got the least physical activity were the most likely to get low scores on some of the thinking tests – something that researchers say is worrisome at a time when young adults may be spending more and more hours sitting and looking at screens. TV time has been shown in other studies to be a good marker of overall inactivity.

"There are so many more opportunities for sitting now that it's even more of a concern," than when the study started, in the 1980s, said Tina Hoang, a researcher at the Veterans Affairs Medical Center, San Francisco. She was a co-author on the study led by Kristine Yaffe of the University of California, San Francisco.

During the study, participants filled out multiple questionnaires about their TV habits and physical activity — everything from walking to housework, gardening and physical labor. At the end of the study, those who reported little activity and more than three hours of daily TV time were twice as likely as their peers to score well below average on two thinking tests. The tests measured thinking speed and executive functioning — the ability to plan and complete tasks.

Because of its design, a study like this can't prove that inactivity caused the thinking problems. But many other studies, mostly in older adults and children, suggest physical activity can improve thinking skills. The new study adds good evidence that younger adults could benefit too, said Arthur Kramer, a psychologist and neuroscientist at the University of Illinois.

Some studies even suggest exercise might help prevent or slow Alzheimer's disease. But it's too soon to say whether the relatively young couch potatoes in the new study are at any heightened risk for dementia, Hoang said.

"There hasn't been a lot of research showing what these early cognitive changes mean," she said.

If the study were started today, it would have to include all the time young adults spend with screens other than TVs, Hoang said. It's possible, she says, that sitting to engage in a mentally challenging video game (or to read a book) might not be as bad for the brain as sitting to passively watch TV.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS662

New study from UCSF may point to connection between forgetfulness and dementia NOVEMBER 17, 2015

The subjective sense that one has more memory lapses than peers could be an early sign of a long term process leading to dementia.

"We studied older women who noticed themselves having memory problems but who still performed normally on a standard test," said Allison Kaup, PhD, lead author of the study. "These findings raise the possibility that memory complaints in older adults may be a very early symptom of a memory disorder that is just starting to gradually develop."

Kaup’s research mentor, Kristine Yaffe, MD, also served as the paper’s senior author.

For the study, published online October 28 in the journal Neurology, researchers tracked more than 1,100 women 65 and older who had normal brain function when the study began. Over the next 18 years, at four different times, the women were asked to gauge their memory problems in comparison with their peers. As the study ended, the women took several tests to determine whether they had dementia or what's called mild cognitive impairment, the middle step between normal aging and dementia.

At the beginning of the study, 8 percent of the women answered yes to the question concerning memory problems. The researchers found that these women were almost twice as likely to have mild mental impairment or dementia 18 years later, even after investigators excluded those women with depression.

Among those who answered no at the start of the study, 38 percent developed mental impairment by the end of the study, compared with 53 percent who had answered yes.

Furthermore, women who answered yes to the question later on in the study also were found to have a higher risk of dementia.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS088

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After a decade of fast-paced discovery, researchers are racing toward bigger datasets, more genes and a deeper understanding of the biology of autism OCTOBER 29, 2014

It’s been 10 years since Michael Wigler had a breakthrough revelation in autism genetics — one that arguably launched the field as we know it.

In April 2007, Wigler and his then colleague, Jonathan Sebat, reported that ‘de novo’ mutations — those that arise spontaneously instead of being inherited — occur more often in people with autism than in typical people. The mutations they noted were in the form of ‘copy number variants’ (CNVs), deletions or duplications of long stretches of DNA. CNVs crop up frequently in cancer, but his find that they are also involved in autism came as a surprise to those in the field.

The discovery fast led to further advances. Focusing primarily on de novo mutations, three teams of scientists began hunting for genes that contribute to autism. Their approach was efficient: Rather than looking at the entire genome, they scoured the 2 percent that encodes proteins, called the exome. And they looked specifically at simplex families, which have a single child with autism and unaffected parents and siblings. The premise was that comparing the exomes of the family members might expose de novo mutations in the child with autism. The approach yielded a bumper crop: Based on data from more than 600 families, the teams together predicted that there are hundreds of autism genes. They identified six as leading candidates. Some of the genes identified at the time quickly became hot areas of research.

In 2014, the number of strong candidates jumped higher. In two massive studies analyzing the sequences of more than 20,000 people, researchers linked 50 genes to autism with high confidence. One team looked at simplex families and found de novo mutations in 27 genes. In the second study, researchers screened both inherited and de novo mutations and implicated 33 genes. The studies identified 10 genes in common.

Two years ago, the tally of autism gene candidates shot up again. Deploying statistical wizardry to combine the data on de novo and inherited mutations, along with CNV data from the Autism Genome Project, researchers pinpointed 65 genes and six CNVs as being key to autism.

“For so long, we’ve been saying if we could just find these genes, we’d be able to really make some headway,” says Stephan Sanders, assistant professor of psychiatry at UC San Francisco, who co-led the study. “Suddenly, you’ve got this list of 65-plus genes, which we know have a causative role, and as a foundation for going forward, it’s amazing.”

These advances establish beyond doubt that autism is firmly rooted in biology. “More and more, we are erasing this idea of autism being a stigmatizing psychiatric disorder, and I think this is true for the whole of psychiatry,” Sanders says. “These are genetic disorders; this is a consequence of biology, which can be understood, and where traction can be made.”

As scientists enter the next chapter of autism genetics, they are figuring out how to build on what they have learned, using better sequencing tools and statistics, bigger datasets and more robust models. For example, they are looking for common variants — which are found in more than 1 percent of the population but may contribute to autism when inherited en masse. And they are also starting to look beyond the exome to the remaining 98 percent of the genome they have largely neglected thus far.

“The idea that there’s something plastic here, not set in stone at birth, is very important,” says Matthew State, chair of psychiatry at UCSF, and lead investigator on many of the big autism genetics studies.

In the meantime, genetic discoveries have delivered some immediate benefits for people with the condition. “If you go into a clinic today, there’s about a 10 percent chance of you getting a genetic diagnosis, and I would expect to find evidence which was suggestive in about another 5 to 10 percent,” Sanders says. “We can’t then turn round and say, ‘Here’s your cure,’ but what we can do, at least, is put people in touch with other people with that same mutation.” Becoming part of such a group gives people a better idea about what the future holds for them and provides them with support and understanding.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS060

Experts review advances and share outlook for the future at UCSF Autism Symposium JANUARY 26, 2015

UCSF hosted leading minds from Boston Children’s Hospital, Emory University, Harvard Medical School, MIT, Stanford University, Yale University, the Howard Hughes Medical Institute and the Simons Foundation last week for a full-day seminar devoted to exploring progress in diagnostics, neuroimaging, therapeutics, genomics and neurobiology relating to autism spectrum disorders (ASD).

Among the numerous speakers were department faculty members John Rubenstein, MD, PhD, speaking about PTEN function in cortical interneurons, and Matthew W. State, MD, PhD, who reviewed recent advances in the genomics of ASD. In addition to the slate of speakers, the symposium featured a lively research poster session.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS682

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AUTISM SPECTRUM DISORDER AND NEURODEVELOPMENTAL DISORDERS

Major autism studies identify dozens of contributing genes OCTOBER 29, 2014

Two new studies exploring the genetic basis of autism tie mutations in hundreds of genes to the disease.

Several teams of researchers collaborated on the studies, both published in the journal Nature, and found that about 60 of the genes are considered "high confidence," meaning there's a 90% chance that mutations within those genes contribute to risk for autism. Both studies show through genomic sequencing that many of these mutations are de novo, meaning that parents do not have the gene mutation, but they present spontaneously just before a child is conceived in either the sperm or egg.

The other study, by researchers at 37 different institutions as part of the Autism Sequencing Consortium, looked at 14,000 DNA samples of parents with affected children. It found 33 genes the researchers say definitely increase risk for autism, should there be a mutation.

Even though there may be hundreds or even thousands of genes that contribute to a child's risk of developing autism, the researchers on both studies found that the mutations appear to converge on a much smaller number of biological functions, like nerve-cell communication or proteins known to cause inherited disability.

It's long been believed that autism is genetic, but a lack of large studies and advanced genomic sequencing has precluded any sort of consensus about what genes might be at play. But in the last couple years, scientists have been able to look at the genetic mutations in hundreds of people with autism and identify genes that likely factor into a child's development of the disorder. In the two new studies, scientists were able to expand their work and look at thousands of people.

"In my view, the real importance of these studies is not diagnosis, and it's not figuring out exactly what percentage of people have de novo mutations, it’s about laying the foundation to transform the understanding of the biological mechanisms of autism," says Matthew State, chair of the psychiatry department at University of California, San Francisco and a co-leader of the SSC study, as well as a senior participant on the other study.

In one of the studies, several institutions used data from the Simons Simplex Collection (SSC), which is a collection of DNA samples from 3,000 families. In each of the families, one individual had autism. The researchers compared the gene sequences of the individual with autism to their unaffected family members. After analysis, they estimated that de novo mutations contribute to autism in at least 27% of families, where only one member has the disorder.

State doesn't believe that the findings will mean that families will one day get their genomes sequenced to spot hundreds of possible mutations. Instead, they could lay the groundwork for discovering how autism develops, and what potential treatments, or even drugs, could help fight it.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS716

Newly found web of genes may hold clues for autism treatments OCTOBER 20, 2014

Five years ago, scientists saw an exciting pattern emerge from sequencing studies of people with autism: Many of the mutations they picked up affect the function of synapses, the junctions between neurons.

There are trillions of synapses in the human brain, linking billions of neurons. Still, calling autism a ‘disorder of the synapse’ gave it encouraging specificity. More data, they hoped, would narrow this spotlight to pinpoint a handful of pathways that could be targets for autism drugs.

Instead, the spotlight has become a floodlight.

In studies over the past few years, most of the genes that have emerged as the strongest autism candidates have turned out to be regulators — meaning that they regulate the expression of hundreds, if not thousands, of other genes. What’s more, some of the target genes are themselves regulators, and may even loop back to influence the candidate gene.

“If autism has taught us anything, it’s that however complex you think it might be, it’s actually more complex,” says Stephan Sanders, assistant professor of psychiatry at the University of California, San Francisco School of Medicine.

That autism involves so many regulators shouldn’t come as a surprise. The defective gene in fragile X syndrome, which often leads to autism, controls more than 800 other genes, including about 90 autism candidates1. And MeCP2, the gene mutated in Rett syndrome, another autism-related disorder, regulates thousands of genes.

Many researchers see this complexity as an opportunity: One way forward, they say, is to home in on a few specific pathways that repeatedly turn up among the candidates.

“Instead of saying we’re going to follow one gene that really matters and see what it does, we need to say that each gene is like a little star that points in many directions,” says Sanders. “We need to use these multiple different genes and look for the process, time and place where they all point the same way.”

The closest thing to an ‘autism gene’ so far is CHD8, which emerged as candidate gene just two years ago2. CHD8 regulates gene expression by binding to DNA and changing its structure. In stem cells that give rise to neurons, CHD8 binds nearly 7,000 genes.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS688

A revolutionary way to look at our DNA APRIL 12, 2017

A new technique called exome sequencing is a revolutionary way to look at our DNA. This, according to psychiatrist Stephen Sanders of the University of California, San Francisco School of Medicine. Basically, it allows researchers to determine the structure of all expressed genes in a genome and recently, it helped UCSF scientists find mutations in a gene that triggers autism.

“And that was a gene called SCN2A, which stands for Voltage Gated Sodium Channel 2 Alpha. When we saw that result, we were very excited, because we could show that this gene was associated with autism. It was playing an important role in what autism is on a neurological level.”

Sanders and his colleagues found that people with autism have more S-C-N-2-A mutations, than those without this disease.  HEAR THE ENTIRE PODCAST EPISODE AT PSYCH.UCSF.EDU/NEWS509

AUTISM SPECTRUM DISORDER AND NEURODEVELOPMENTAL DISORDERS

Estrogens reverse abnormality in zebrafish carrying mutation associated with autism JANUARY 29, 2016

In an unexpected finding, an international team of scientists has discovered that estrogens reverse a striking behavioral abnormality in zebrafish carrying mutations in a gene known to cause autism in humans. In addition to providing new insights into neurochemical imbalances underlying autism, the authors said, the work may help unravel the “female protective effect” – the unknown factors by which girls are on average four times less likely than boys to be diagnosed with autism.

As reported in Neuron, zebrafish in which all copies of the gene called CNTNAP2 had been removed are significantly more active at night and more prone to seizures than counterparts carrying normal copies of the gene. These characteristics directly mirror the situation in humans, in whom the loss of both copies of CNTNAP2 leads to autism and epilepsy.

While cautioning that one cannot be certain that the behaviors seen in zebrafish are faithful representations of similar symptoms in humans, UC San Francisco’s Matthew W. State, MD, PhD, co-senior author of the new study, said that both sleep disturbances and seizures are common and troublesome problems in individuals with autism.

“Model systems like the zebrafish allow us to take a genetic abnormality that we know causes a particular syndrome in humans and to learn something profoundly important about the molecular, cellular, and circuit mechanisms by which mutations in humans lead to disease,” said State, chair and Oberndorf Family Distinguished Professor of Psychiatry at UCSF. “It’s possible that, with further research, we’ll begin using zebrafish to identify novel treatments that could well extend to individuals with autism, regardless of whether they carry CNTNAP2 mutations.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS428

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Researchers have ditched the autism-vaccine hypotheses: Here’s what really causes it JUNE 19, 2017

Of all the issues doctors have explored in children’s health, none has been more exhaustively researched than the question of whether vaccines are linked to autism.

After hundreds and hundreds of studies in thousands of children, “We can say with almost as much certainty than anybody could ever say that vaccines don’t cause autism,” Mayo Clinic autism researcher Dr. Sunil Mehta told me.

And yet the fear that they do remains stubbornly persistent, as a current measles outbreak in Minnesota shows. The virus is spreading among unvaccinated children — in this case, Somali-Americans in Minneapolis, after anti-vaccine advocates targeted their parents with a misinformation campaign. Now 78 people, most of them children, are very, very ill.

Today, about one in 68 US children has autism — a rate that’s remained unchanged since at least 1990, though there’s been a steady increase in awareness and diagnosis.

And it’s the parents of some of these children who are among the most vocal proponents of the vaccine-autism link — in Minnesota and elsewhere. Many are frustrated, confused, and desperate for an explanation for why and how their children got the disorder.

It doesn’t help that doctors have long struggled to explain what exactly causes autism if vaccines don’t — many medical theories have been debunked and then replaced by new ones.

The medical community is getting closer and closer to finally zeroing in on the cause. I recently talked to half a dozen researchers on the cutting edge of this work to find out what they see as the latest and best evidence for what might trigger autism. They were excited about their new understandings of the genetic basis for autism — what they view as the most promising area of research on the disorder right now. They also talked about recent advances in grasping how particular genetic mutations change the biology of the brain in ways that cause autism symptoms.

Autism spectrum disorder is a collection of close to 1,000 different conditions, with symptoms ranging from delayed speech development to asocial behavior and repetitive movements.

But “of all the causes of autism, the thing we know with the greatest certainty is that it’s a very genetic disorder,” said UCSF geneticist and autism researcher Stephan Sanders. “If you look at a child with autism, then look at their siblings, you’ll find the rate of autism is 10 times higher in those siblings than in the general population. This has been looked at in populations of millions.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS851

Meet Stephan Sanders, accidental geneticist NOVEMBER 6, 2014

In May 2009, about 20 of the brightest minds in autism genetics gathered in Chicago.

The goal was to figure out how to handle the reams of data emerging from big sequencing projects.

In this assembly of bigwigs, Stephan Sanders, a neophyte, steered the discussion.

“At first I thought, ‘Who is this brash young man?’” recalls Bernie Devlin, professor of psychiatry and human genetics at the University of Pittsburgh. “But he led the meeting with aplomb, and by the end convinced me that this was someone who deserved respect and who could be a great researcher.”

Even now, Sanders is often the youngest researcher at power-packed conferences. But at 35, he is already credited with bringing a measure of clarity to autism genetics.

Working with his advisor Matthew State, Devlin and other stalwarts, he has developed tools to sift through the sea of sequences pouring in and pin down mutations that lead to autism.

Scientists seek early signs of autism APRIL 10, 2017

Currently, pediatricians, child psychologists and therapists rely on behavioral observations and questionnaires, measures with limitations. Barring genetic tests for a handful of rare mutations, there are no blood draws, brain scans or other biological tests that can reveal whether a child has — or will get — autism.

Objective tests would be incredibly useful, helping provide an early diagnosis that could lead to therapy in the first year of life, when the brain is the most malleable.

A reliable biomarker might also help distinguish various types of autism, divisions that could reveal who would benefit from certain therapies. And some biomarkers may reveal a deeper understanding of how the brain normally develops.

Researchers have turned up differences in the brain between people with and without autism, including size and growth patterns, connections between areas and brain cell behavior. But the variability in autism symptoms — and causes — has prompted scientists to look beyond the brain in the search for biomarkers.

“Stephan is the complete package,” says State. “I fully expect him to be one of a handful people moving this field forward.”

Child and adolescent psychiatrist Robert Hendren, of the University of California, San Francisco, envisions a time when this collection of individual disorders collectively called autism are all cataloged in detail, thanks to biomarkers. “We’ll call it autism 23 or autism 14, and we’ll say, ‘We know this is the process that’s going on, and this is how we’re going to personalize our treatments for this person.’”

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS223

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS461

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AUTISM SPECTRUM DISORDER AND NEURODEVELOPMENTAL DISORDERS

UCSF autism researchers join forces to find genetic ‘Rosetta Stone’ JANUARY 26, 2017

Distinct sets of genetic defects in a single neuronal protein can lead either to infantile epilepsy or to autism spectrum disorders (ASDs), depending on whether the respective mutations boost the protein’s function or sabotage it, according to a new study by UC San Francisco researchers.

Tracing how these particular genetic defects lead to more general changes in brain function could unlock fundamental mysteries about how events early in brain development lead to autism, the authors say.

“The genetics of neuropsychiatric disease is often complicated, but here we have a single gene in which specific mutations can cause either infantile seizures or autism in a consistent and predictable manner,” said Stephan Sanders, PhD, BMBS, an assistant professor of psychiatry at UCSF and member of the UCSF Weill Institute for Neurosciences who is co-senior author of the new study. “This gives us an opportunity to understand both what these disorders have in common and what makes them different.”

Research led by the Yale School of Medicine laboratory of Matthew W. State, MD, PhD, now Oberndorf Family Distinguished Professor and chair of psychiatry at UCSF, first demonstrated the link between autism and SCN2A, though others, including UCSF’s Lauren Weiss, PhD, had previously suggested a role for the gene in familial forms of autism.

“In autism research, understanding why mutations in a single gene can lead not only to ASDs, but to a wide range of other neurodevelopment disorders has emerged as a central question for the field,” said State, who was not directly involved with the new study. “This new work provides critical clues that begin to unravel this mystery and could serve as a molecular ‘Rosetta Stone’ to illuminate autism pathology.”

SCN2A mutations among genetic drivers of autism The advent of whole-exome genome sequencing and the amassing of large, well- defined study populations such as the Simons Simplex Collection (SSC) and the research cohorts assembled by the Autism Sequencing Consortium (ASC), have allowed researchers to make tremendous progress in recent years in identifying genetic risk factors for autism, said Sanders: “In the past four years we’ve gone from not really knowing how to find autism genes to having a long list of mutations linked to the disorder.”

As a graduate student and postdoctoral researcher at Yale University working in State’s lab, Sanders led collaborations that searched for autism-linked genetic mutations by conducting large whole-exome genomic screens of more than 4,000 autistic children and their families participating in the SSC and ASC consortia. In studies published in 2012, 2014, and 2015, State, Sanders and collaborators found that de novo genetic mutations — spontaneous mutations not inherited from parents — play a role in the development of ASDs in at least 10 percent of all cases of autism, many more than previously recognized.

These studies led to the identification of 65 genes with a strong likelihood of contributing to autism when mutated and confirmed SCN2A as one of the top hits. The SCN2A gene — which was one of the first ASD-associated genes to be discovered by whole-exome screens — encodes a sodium channel protein called NaV1.2 that is crucial to neurons’ ability to communicate electrically, especially during early brain development.

Mutations alter signaling in the developing brain In addition to its strong association with autism, SCN2A had also previously been implicated in epilepsy. When Sanders came to UCSF in 2015, he began collaborating with neurophysiologist Kevin Bender, PhD, an assistant professor of neurology and co-senior author of the study, to examine the mechanisms of how mutations SCN2A alter neuronal function to lead to these two different diseases.

“Fortunately, the function of sodium channels is easy to test in the lab,” said Bender, who is also a member of UCSF’s Center for Integrative Neuroscience, Kavli Institute for Fundamental Neuroscience, and Weill Institute for Neurosciences. “Often you see mutations that are associated with a disease but you’re not really sure what the gene is supposed to do or how the mutations change its function. But neuroscientists have been studying sodium channels since the 1950s – the experiments are extremely clear.”

Bender’s team measured how 12 SCN2A mutations observed in children with ASD affected the electrical properties of NaV1.2 channels in cultured human cells in the lab.

As predicted, based on the mutations’ location on the protein, all 12 reduced the function of the sodium channel, but in a variety of different ways, ranging from stopping the channel from being made at all to simply blocking the pore through which sodium needs to flow for the channel to function.

The researchers used this data to inform computer models of how the various channel mutations seen in children with ASD — as well as previously studied mutations seen in babies with infantile seizures — would impact the signaling properties of brain cells.

They found that unlike mutations observed in patients with infantile seizures, which made model neurons more excitable, the mutations seen in children with ASD made it much harder for model neurons to send electrical signals.

“It was remarkable to see how consistently neuronal function was disrupted by these different mutations seen in patients with autism," said Roy Ben-Shalom, PhD, a postdoctoral researcher in the Bender lab who was lead author on the new paper.

“The mutations all affected the channel in slightly different ways, but they ended up affecting neurons in almost exactly the same way.”

Additional simulations of the effects of NaV1.2 defects on immature versus mature neurons indicated that autism-associated mutations would only have a major impact in the developing brain — since neurons transition away from relying on NaV1.2 channels as they mature — a finding consistent with the idea that the neurological changes that trigger in autism occur early in the womb or before one year of age, as previously proposed by State, Sanders and colleagues.

Could SCN2A defects unlock autism’s mysteries?

This study represents a first step in understanding how SCN2A mutations lead to autism and developmental delay, which the authors hope will both be immediately helpful to the families of patients with these mutations and also lead to better understanding of the mechanisms of ASD more generally.

“These findings solidify SCN2A’s status as one of the most important genes in autism,” Bender said. “They give us a place to start exploring exactly how changes in early brain development lead to this condition.”

A key next step, the researchers say, is understanding whether the severity of autism and developmental delay can be predicted by the specific SCN2A mutation a patient has, research that will require close collaboration between scientists and families affected by these mutations. An active SCN2A patient group is helping to coordinate this in collaboration with the Simons Foundation Autism Research Initiative (SFARI), which provided major funding for the new study alongside grants from the National Institute of Neurological Disorders and Stroke and National Institute for Mental Health.

The new study is a perfect example of the power of the cross-disciplinary mindset of the new UCSF Weill Institute for Neuroscience, Sanders said: “Kevin and I came at this question from completely different angles – from genetics and from neurophysiology.

When you bring people together from different backgrounds, as the Weill Institute does, you end up finding stories like this: a result as clear as night and day, but one we never would have seen without this collaboration.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS558

AUTISM SPECTRUM DISORDER AND NEURODEVELOPMENTAL DISORDERS

Research finds words say little about cognitive abilities in autism SEPTEMBER 5, 2016

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Opinion: Complex gene interactions in autism offer avenues for treatment MAY 23, 2017

Nearly half of children with autism who speak few or no words have cognitive skills that far exceed their verbal abilities, according to the largest study of so-called ‘minimally verbal’ children with autism to date. The findings call into question the widespread assumption that children with autism who have severe difficulty with speech also have low intelligence.

Lauren Weiss is an associate professor of psychiatry at the University of California, San Francisco:

“What I think is really interesting is that among children who have very limited levels of language, there is more cognitive variability than you might expect,” says lead investigator Vanessa Bal, assistant professor of psychiatry at the University of California, San Francisco.

A common assumption in genetic studies is that each gene acts independently of all others. But we know that genes don’t act independently; they interact with one another. The effects of these interactions, called ‘epistasis,’ make it difficult to predict the impact of genetic variants tied to a particular condition, such as autism. But they also present new opportunities to understand a condition’s causes, potential biomarkers and treatment targets.

The study, published in the Journal of Child Psychology and Psychiatry, also reveals that the number of children with autism classified as minimally verbal depends on the test used to identify these children.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS289

A new understanding of the genetic risk factors for autism APRIL 2, 2017

In the last couple of years, researchers have come a long way in their understanding of the genetic risk factors for autism – from not knowing how to find autism genes to discovering a variety of mutations linked to the disorder. Psychiatrist Stephen Sanders and his colleagues at the University of California, San Francisco recently found a molecule responsible for infantile autism.

“The hope is that this gene gives us insight of what autism is at a fundamental new logical level. So key things we want to find out are – is there an age at which we could fix this gene problem and see if the problem can go away? Or we have to do it early on?”

Basically, the discovery gives scientists hope that autism could possibly be cured not only in children, but in adults, too.  HEAR THE ENTIRE PODCAST EPISODE AT PSYCH.UCSF.EDU/NEWS510

Tantrums trick autism tests NOVEMBER 1, 2016

Sorting autism from other developmental conditions is no simple matter. Autism and attention deficit hyperactivity disorder (ADHD), for example, can be particularly tough to tell apart. And a new study suggests that even the gold-standard tests for diagnosing autism are not a foolproof solution to this problem.

Some children with low intelligence or behavioral issues — but not autism — meet the cutoff for autism on these tests. The findings, published in the Journal of the American Academy of Child and Adolescent Psychiatry, highlight the limitations of the Autism Diagnostic Observation Schedule (ADOS), the Autism Diagnostic Interview-Revised (ADI-R) and the Social Responsiveness Scale (SRS).

We asked Somer Bishop and Alexandra Havdahl, the researchers who led the study, why these tests are not specific for autism and what this means for clinicians making the diagnosis.

Bishop said, “We know that children who have low intelligence quotients (IQ) are much more likely than other children to have features of autism, such as social communication problems and restrictive or repetitive behaviors. The challenge is that you can have autism and low cognitive ability, or you can have autism features that are largely accounted for by the fact that you have low cognitive ability. For example, a child with a very low IQ might seem to have repetitive behaviors because he has not yet reached the stage of development where functional play skills are expected. Or he might seem to show limited interest in peers, but only because this skill hasn’t yet emerged — not because he has autism.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS773

Every scientific hypothesis comes with a set of assumptions. For example, we assume that a gene will play the same role in mice that it does in people, or that children will behave similarly in a research study as in the real world.

For instance, we know that high blood serotonin levels, which are associated with autism, run in families. In a 2004 study, my colleagues and I looked for genes that influence these levels. We found an association between blood serotonin levels and the gene ITGB3. The gene doesn’t play an obvious role in regulating serotonin levels, but it is known to be expressed at the cell membrane, as is the serotonin transporter gene, SLC6A4. We hypothesized that the two genes may interact, and we showed that they genetically interact to contribute to autism risk. Other groups later verified this finding.

Researchers have since shown in mice that ITGB3 and SLC6A4 interact in the brain to regulate serotonin uptake. Clinical studies of antidepressant drugs, many of which target the serotonin system, revealed that increased expression of ITGB3 is associated with better drug response among individuals with depression.

Identifying a gene-gene interaction clarified how ITGB3 influences serotonin levels and autism risk. It also revealed a biomarker for an individual’s response to antidepressants.

It’s possible this was a lucky break, but I believe the same approach can offer more clues about autism.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS078

Brain’s immune cells may explain sex bias in autism MAY 11, 2017

A boost in the activity of microglia, the brain’s immune cells, during gestation may predispose boys to autism. The unpublished results were presented yesterday at the 2017 International Meeting for Autism Research in San Francisco.

Roughly four times as many boys as girls are diagnosed with autism. This may be because girls are somehow protected from autism — a popular theory — or because boys are predisposed to it.

Although the exact mechanism is still unclear, the new data suggest one way that male brains may become more susceptible to autism, says Donna Werling, who presented the findings. Werling is a postdoctoral associate in Stephan Sanders’ lab at the University of California, San Francisco.

A subset of genes in microglia are expressed at higher levels in male brains than in female brains during mid-fetal development, the researchers found. This is thought to be a key developmental period in autism.

Postmortem brains from people with autism also express microglia genes at higher levels than control brains do, according to published studies.

“Neurotypical male brains resemble the autistic brain with regard to microglial biology,” Werling says. “This specific aspect of male biology could put them one step closer to an autistic phenotype compared with females.”

Werling and her colleagues looked for sex differences in BrainSpan, a repository of gene expression from various stages in development. To their surprise, they found that gene expression in neurons does not differ significantly by sex.

“One of the messages of this is just how similar male and female brains seem to be, which is a good progressive message for the 21st century,” says Sanders.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS617

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AUTISM SPECTRUM DISORDER AND NEURODEVELOPMENTAL DISORDERS

A blood test could one day provide early diagnosis for autism, but is that a good thing?

OCTOBER 29, 2014

More than a decade ago, Judy Van de Water, a neuroimmunologist, decided to follow her instincts and research a condition she knew nothing about. Van de Water, now a lead scientist at the University of California Davis MIND Institute—an international research center for neurodevelopmental disorders—had spent her career studying the immune system. In 2000, she stumbled upon a compelling area of research: the immunobiology of autism.

Through studies on mice, rats and rhesus macaques and, eventually, retrospective and prospective analyses of children diagnosed with autism and their mothers, Van de Water identified eight autoantibodies made by a mother's immune system that appeared to be linked with autism risk if they crossed the placenta. Van de Water, who is also a researcher in the department of internal medicine at UC Davis, refers to her discovery as maternal autoantibody-related autism, or MAR autism.

The concept is controversial and became more so when Van de Water developed a test to measure those biomarkers in a woman hoping to conceive, thereby predicting her risk for having a child who develops autism.

Many experts caution that predicting autism risk is not as tidy an endeavor as research like Van de Water’s might lead the public to believe. The concept of early diagnostic testing is appealing to some parents, but critics argue that such testing would be unethical, and that early diagnostic testing would only increase the fear and stigma already surrounding the condition.

Rare autism mutations linked to distinct sets of features MARCH 29, 2017

Children who carry certain rare mutations linked to autism learn to walk late — but have less severe social and language difficulties than do other children with the condition.

The findings point to a distinct behavioral profile in children who have autism that may arise from rare de novo or non-inherited mutations. They also suggest that mutations in key autism genes disrupt brain development overall. “These are not simple, pure autism genes,” says study investigator Stephan Sanders, assistant professor of psychiatry at the University of California, San Francisco.

The study also highlights the importance of controlling for variables, such as age, sex and intelligence, that can influence behavior: The researchers identified the behavioral patterns only after this step.

“These profiles were only discernable after we matched [the children] for things that we know affect phenotypic measures so drastically,” says lead investigator Somer Bishop, assistant professor of psychology and psychiatry at UCSF. Children with autism who carry de novo mutations in genes strongly tied to the condition tend to be female and to have low intelligence quotients (IQ). Bishop and her colleagues wondered whether children with these mutations have other distinct characteristics.

The researchers found that the children with de novo mutations learn to walk about two months later, on average, than children who do not have those mutations. But they have better language skills, and their parents rate them as having less severe social difficulties.

“They look less prototypically autistic than the kids without the de novo mutations,” says Bishop.

The two groups of children performed similarly on a test of fine motor skills and achieved similar ratings from parents on their ability to perform daily tasks. They also did not differ in the severity of their restricted interests and repetitive behaviors.

The findings suggest that children with de novo mutations have a muted profile of autism features relative to their peers who lack the mutations.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS942

Autism spectrum disorder is a complex condition influenced by factors related to biology, genetics and environmental exposure. Genetic research alone has pinpointed some 50 genes that appear to be linked to autism risk, and there are likely many others.

But mutations don’t guarantee that a child will develop the condition, and many experts agree that it would be dangerous to rely on the results of any test—regardless of which biomarkers it is able to measure—in order to make difficult decisions about a pregnancy or to determine a child’s level of care.

“I think the first question you have to ask is why are you doing this, what benefit are you offering to the family and that child,” says Stephan Sanders, an assistant professor of psychiatry at University of California San Francisco. “If the answer is you have a treatment and it’s going to make a difference, even in a tiny percentage, then I think such things are a welcome and useful idea. If the answer is you’re just giving bad news, then it’s hard to see who you’re benefiting by doing that.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS481

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New genetic models of autism point to cellular roots of disease DECEMBER 5, 2017

Researchers at UC San Francisco have developed a new genetic model of autism, using neurons created in the lab from patients’ own skin cells. Their experiments suggest that abnormalities in the electrical firing of neurons may lead to behavioral and developmental symptoms in autism, while differences in neuron size and shape result in abnormalities in brain size that often accompany the disorder.

Scientists in the laboratory of Lauren Weiss, PhD, an associate professor of psychiatry and member of the Institute for Human Genetics at UCSF, looked at genetic mutations that cause either the deletion or duplication of a region of DNA on chromosome 16 that includes 29 genes implicated in important cellular functions in the brain. (Ordinarily, there are two copies of every gene, one on each chromosome, but deletions or duplications result in either one copy or three copies of the genes, respectively.)

In 2008, Weiss discovered that deletion or duplication of this region can result in autism. Epilepsy, psychiatric disorders, and other intellectual disabilities have also been linked to these mutations. In addition, deletion of the region causes macrocephaly — a disproportionately large brain — while duplication results in microcephaly, or an abnormally small brain. Autism is frequently accompanied by abnormal head size, leading to speculation that alterations in brain size could be a factor contributing to the disorder.

In the current study, published online Dec. 8, 2017, in Cell Reports, the researchers wanted to know how seemingly opposite mutations – either removing or adding a copy of the same 29 genes on chromosome 16 – could both result in autism. They also wanted to determine if micro- or macrocephaly could indeed be directly linked to autism.

The researchers obtained skin cells from patients who carried one or the other of the mutations, which they first turned into stem cells and then into brain cells. Neurons with the deletion had significantly larger cell bodies with more and longer branches coming off the cell, while neurons with the duplication had smaller cell bodies and shorter branches. The scientists think that these differences in cell size are behind the differences in overall brain size seen in patients, with deletions corresponding to larger neurons and therefore larger brains, and duplications resulting in smaller neurons and smaller brains.

In addition to changes in cell size, neurons with either a deletion or duplication had fewer synapses – the electrical connections between neurons – than neurons created from people without these mutations.

There were also differences in the strength and firing rates of the synapses. The fact that these changes in synapse density and function were the same for patients with either deletions or duplications suggests that these differences may contribute to the autism-related behavioral changes seen in both types of patients.

“Our results suggest that the anatomical symptoms seen in autism may have different origins than the behavioral symptoms, even though they’re caused by the same mutation,” said Aditi Deshpande, PhD, a postdoctoral researcher in the Weiss laboratory and first author on the paper. “Changes in neuron size may cause the differences in brain circumference, while changes in the function of the neuron may be behind the common behavioral symptoms. The next step will be to try to figure out which of the 29 genes are responsible for the different cellular or functional changes.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS406

Study finds elevated rate of autism symptoms in children with Tourette syndrome JUNE 22, 2017

Around one in five children with Tourette syndrome, a neurological disorder characterized by involuntary movements and vocalizations, met criteria for autism in a study headed by UCSF. But this prevalence may be more a reflection of similarity in symptoms than actual autism, according to the study’s researchers.

Researchers tested 535 children and adults with Tourette’s for autism, using a self-reporting test called the Social Responsiveness Scale. Among the 294 children tested, 22.8 percent reached the cutoff for autism, versus 8.7 percent of the 241 adults. In contrast, autism is estimated to affect between 0.3 and 2.9 percent of the general population, according to studies cited in the paper.

The Social Responsiveness Scale Second Edition is a 65-item quantitative measure of autism symptoms that assesses the ability to engage in “emotionally appropriate reciprocal social interactions.” It evaluates levels of social awareness, social cognition, social communication, social motivation, and restrictive interests and repetitive behavior. Its threshold for autism compares favorably with the diagnostic gold standard, the Autism Diagnostic Interview, the researchers noted.

“Assessing autism symptom patterns in a large Tourette’s sample may be helpful in determining whether some of this overlap is due to symptoms found in both disorders, rather than an overlapping etiology,” said first author Sabrina Darrow, PhD, assistant professor in the Department of Psychiatry at UCSF.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS805

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New autism genes discovered in largest-ever study SEPTEMBER 28, 2015

In the largest, most comprehensive genomic analysis of autism spectrum disorder (ASD) conducted to date, an international research team led by UCSF Department of Psychiatry scientists has identified 65 genes that play a role in the disorder, 28 of which are reported with “very high confidence,” meaning that there is 99 percent certainty that these genes contribute to the risk of developing ASD. In addition, the study confirms six “risk regions”—segments of chromosomes that contain several genes, which, when lost or gained, contribute to ASD risk. In combination with the 65 risk genes, this results in 71 ASD risk loci, or locations.

Stephan Sanders, BMBS, PhD, assistant professor of psychiatry at UCSF and first author of the new study, said, “This is the largest study of autism genetics to date, providing an unprecedented opportunity to discover the genes underlying this complex disorder.”

The 65 high-confidence genes, 27 of which are newly identified, fall into two main functional categories, one related to the development and function of synapses—the crucial sites where communication among brain cells takes place—and the other involving chromatin, the term for the DNA-protein complex that packs the genome into chromosomes in cell nuclei and governs how and when genes are expressed.

“The relationship between these two broad categories is a key question in autism research,” said Sanders.

“They may be two separate biological paths to the disorder, or two sides of the same coin, with the chromatin-related genes identified in this study regulating the expression of those that drive synapse formation and function, or vice versa.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS228

Fast sequencing, more patients boost autism research MARCH 10, 2017

A philanthropist’s largesse and faster sequencing technology are helping researchers gain footholds in understanding autism spectrum disorder.

“We expect the final number will be somewhere between 400 and 1,000,” he said.

But complex diseases of brain and behavior such as ASD will not yield soon to simple solutions, said Dr. Matthew State, chair of the department of psychiatry at the University of California, San Francisco, School of Medicine.

It has long been known that genes play a major role in ASD, a broad set of disorders of social communication, but State said there are no treatments that are highly effective, particularly for the core social deficits. “The mainstay, first-line treatment is behavioral therapy,” he noted. “But our lack of knowledge about the molecular, cellular and circuit mechanisms in ASD is profoundly limiting.”

ASD is “a tremendously heterogeneous disorder,” he said at a recent NHGRI intramural seminar in Lipsett Amphitheater. “Anyone who comes to us and says that 10 out of 10 autism patients have the same marker for idiopathic disease is [likely misguided].”

Genetic surveys of the cause of ASD began to be successful in the early 2000s, he said, with research groups now converging on roughly the same set of genes during the past decade. Some 65 ASD-associated genes have been identified so far, said State, with scientists having the highest confidence in about 30 of them.

Abetting the search for those mechanisms are whole-exome studies of simplex families, those in which there is a single affected child, where both parents and other offspring are normal. The Simons Simplex Collection, a data bank of information on 3,000 ASD families, has given researchers “a thread to pull on,” said State.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS717

First clear-cut risk genes for Tourette disorder revealed MAY 3, 2017

Tourette disorder (also known as Tourette syndrome) afflicts as many as one person in a hundred worldwide with potentially disabling symptoms including involuntary motor and vocal tics. However, researchers have so far failed to determine the cause of the disorder, and treatments have only limited effectiveness, in part because the genetics underlying the disorder have remained largely a mystery.

Now, as reported online May 3, 2017, in Neuron, a consortium of top researchers — led by scientists at UC San Francisco, Rutgers University, Massachusetts General Hospital, the University of Florida, and Yale School of Medicine — has made a significant advance, identifying the first “high-confidence” risk gene for Tourette disorder as well as three other probable risk genes. These findings are a step forward in understanding the biology of the disorder, the authors said, which will aid in the search for better treatments.

“In the clinic, I have seen again and again the frustration that patients and families experience because of our lack of understanding and the limitations of our current treatments. But we have now taken a major initial step forward in changing this reality, thanks to new genomic technologies and a very successful long term collaboration between clinicians and geneticists,” said Matthew State, MD, PhD, Oberndorf Family Distinguished Professor, chair of psychiatry at UCSF and a co-senior author on the new paper.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS227

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In the race to crack autism’s code, two contenders shoot ahead JUNE 27, 2017

Readers, meet CHD8: In the lineup of genes for autism risk, it has emerged as a leader.

CHD8 controls thousands of other genes via chromatin — a complex of DNA and protein. And nearly everyone with a faulty copy of CHD8 seems to have autism.

Now meet SCN2A: This is the other leading candidate, and it couldn’t be more different.

SCN2A codes for a sodium channel. Some mutations in this gene are known to cause severe seizures early in life. Others, apparently, cause autism.

Neither gene would have been predicted as being important in autism a decade ago.

Scientists then had their sights mostly set on genes at neuronal connections.

“If someone came to me back in 2010 and said, ‘The answer is going to be a sodium channel and a chromatin gene,’ I would have thought that’s insane, that’s madness,” says Stephan Sanders, assistant professor of psychiatry at UC San Francisco.

Both emerged as autism candidates in separate 2012 studies that sequenced the genes of hundreds of children with autism and their unaffected parents and siblings. And they quickly found their champions.

Mutations in either gene are rare, accounting for less than 0.5 percent of people with autism. But their strong ties to autism — and their differences — may reveal the various paths that lead to autism.

“The fact that you have these two genes that at face value have nothing in common — there’s no obvious reason why these should lead to the same common phenotype — that is at once very puzzling, but also the greatest strength here,” says Sanders. “I have a sneaking suspicion if we could understand why SCN2A and CHD8 are in this special top-tier category, we probably would understand sort of the core of what autism is.”

CHD8’s advocates say it tops their list because its mutations seem to be highly ‘penetrant’ — meaning they nearly always cause autism, usually without other conditions such as intellectual disability. SCN2A’s supporters, including Sanders, call it the ‘Rosetta Stone’ for autism because it has a well-understood function that is relatively easy to study. Most candidates for autism risk are more likely to be similar to SCN2A than to CHD8, in that they may have links to multiple conditions.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS900

Family groups play a key role in advancing autism research

Autism researchers hedge bets on hormone as treatment target

JUNE 27, 2017

As genetic testing for autism and related conditions of brain development becomes more common, parents are increasingly receiving specific genetic diagnoses for their children. These tests rarely point to a treatment, but they do allow families to form groups united by the genetic diagnosis. The groups provide families with critical support, educational resources and insight into their child’s prognosis.

The groups can also catalyze scientific progress in understanding the condition. For instance, a Facebook group for people with a mutation in a gene called ADNP, one of the genes most strongly linked to autism risk, helped to discover that the majority of these children grow all their baby teeth before their first birthday. Doctors can now use this feature to diagnose children with ADNP mutations more quickly.

Some of these small groups eventually grow into nonprofit foundations. The International Rett Syndrome Foundation represents individuals with mutations in a gene called MECP2. Mutations in MECP2 cause Rett syndrome, a severe condition related to autism. The foundation has invested more than $32 million in research since 1998. Backed by that funding, researchers have made huge strides in understanding and developing treatments for Rett syndrome.

In one landmark study, they reversed multiple neurological features of Rett syndrome in a mouse model of the condition. And earlier this year, the foundation announced plans to launch a large clinical trial of a compound called trofinetide for children with Rett syndrome.

These sorts of foundations can also actively encourage researchers to share resources, including posting research results on preprint servers such as bioRxiv, submitting data to repositories or making tools, such as genetic mouse models, available to other teams.

They also make sure the needs of the affected individuals remain the focal point — balancing, for example, vital basic science with more clinical research on treatments. But the heroic efforts of these families need support from the scientific community to be optimally effective.

Helping to create and support family groups is one of the best investments of effort and resources that the autism community can make. These groups benefit a broad spectrum of people, from affected individuals and their caretakers to the research community.

Collectively, they may hold the key to understanding the biological basis of autism by providing critical human context to scientific research.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS126

Ultimately, the answers to autism may lie in how these two genes chart two different paths to the same result, says Sanders. “In a race, there is a winner and a loser, and this is actually a situation where the real winning is when both those genes cross the line and shake hands.”

MAY 11, 2017

Drugs that alter the activity of vasopressin, a hormone involved in social behavior, may improve social abilities in people with autism. Researchers presented these promising results from two clinical trials today at the 2017 International Meeting for Autism Research in San Francisco, California.

In pne study, children with autism inhaled a nasal spray containing vasopressin, which boosts levels of the hormone in the body. In the other trial, men with autism took a drug that dampens the hormone’s activity in the brain.

People in both trials improved more on a test of social functioning than did those who got a placebo.

It’s a mystery how two treatments with opposite effects on vasopressin could both improve social abilities, says Bryan King, vice chair of child and adolescent psychiatry at the University of California, San Francisco, who was not involved in either study.

“It’s conceivable that there’s a subgroup of people for whom the approach is to improve function in the system, and a group that’s going to benefit from the other direction,” he says. Alternatively, the two treatments may alter social abilities through different mechanisms.

In any case, the findings are encouraging because no drugs are now available for the social difficulties seen in people with autism, a core feature of the condition. Both studies hint that the treatments are safe and effective.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS704

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Mothers of children with autism may face higher risks for heart disease SEPTEMBER 21, 2016

Mothers who were raising children with autism and reported chronic stress were more likely to have high levels of “bad” cholesterol and lower levels of protective progenitor cells than lower-stressed mothers of “neurotypical” children – two factors that may boost their chances of heart disease.

Heart disease is the leading cause of death for women in the United States, killing close to 300,000 in 2013, according to the Centers for Disease Control and Prevention.

The study, published online in the journal Brain, Behavior and Immunity, looked at cardiovascular risk factors among healthy nonsmoking women between the ages of 20 and 50 with at least one child aged 2 to 16. One group consisted of 31 mothers with chronic stress who were raising a child with an autism spectrum disorder. They were compared with a second group of 37 mothers, reporting low to moderate stress levels, whose children were neurotypical, meaning they did not have autism. Mothers in both groups were similar in age and body mass index, factors that are both implicated in cardiovascular risk.

Researchers led by Kirstin Aschbacher, PhD, of UC San Francisco found that 30 percent of the mothers of children with autism had levels of low-density lipoprotein (LDL) – the so-called “bad cholesterol” – equal to or higher than the moderate risk benchmark of 130 mg/dL. In contrast, 8 percent of mothers of neurotypical children had LDL equal to or above this benchmark.

“Children with autism are more likely to engage in behaviors that can be emotionally stressful for mothers, like becoming unpredictably aggressive, biting or hurting themselves, or expressing little affection,” said Aschbacher, assistant professor in the UCSF Department of Psychiatry. “Even knowing the challenges these mothers face, we were surprised by the differences in cardiovascular risk.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS947

Genetic risk factors for autism, MS and other diseases differ between sexes JANUARY 23, 2017

A pair of studies by researchers at UC San Francisco suggest that genetic variants that have distinct effects on physical traits such as height, weight, body mass, and body shape in men versus women are also linked to men’s and women’s risk for a range of diseases – including autism, multiple sclerosis, type 1 diabetes, and others. The results suggest that at least some of the fundamental biological drivers of disease may be significantly different in men and women, an idea that could have significant impacts on disease research and treatment, the authors say.

The idea of sex differences in disease is an old one. Some disorders (such as multiple sclerosis) are more common in women, while others (such as autism) are more common in men. Other diseases, such as cardiovascular disease, can simply look very different in men and women, and the two sexes are also known to respond differently to certain drugs, making sex differences a crucial factor for doctors to take into account in diagnosis and treatment.

Despite the prevalence of sex differences in many diseases, however, scientists still do not have a comprehensive understanding of the biology that drives these differences.

Many studies in humans and model organisms have sought to address this question, but their results have been contradictory, according to Lauren A. Weiss, PhD, associate professor of psychiatry at UCSF, and senior author on the two new studies.

"While some studies have looked at small regions of the genome or tried to support one specific hypothesis with respect to sex differences, few studies have looked at the question from a comprehensive genome-wide perspective," Weiss said.

Distinct mutations in sodium channel trigger autism, epilepsy FEBRUARY 8, 2017

A pair of studies by researchers at UC San Francisco suggest that genetic variants that have distinct effects on physical traits such as height, weight, body mass, and body shape in men versus women are also linked to men’s and women’s risk for a range of diseases – including autism, multiple sclerosis, type 1 diabetes, and others. The results suggest that at least some of the fundamental biological drivers of disease may be significantly different in men and women, an idea that could have significant impacts on disease research and treatment, the authors say.

The idea of sex differences in disease is an old one. Some disorders (such as multiple sclerosis) are more common in women, while others (such as autism) are more common in men. Other diseases, such as cardiovascular disease, can simply look very different in men and women, and the two sexes are also known to respond differently to certain drugs, making sex differences a crucial factor for doctors to take into account in diagnosis and treatment.

Despite the prevalence of sex differences in many diseases, however, scientists still do not have a comprehensive understanding of the biology that drives these differences.

Many studies in humans and model organisms have sought to address this question, but their results have been contradictory, according to Lauren A. Weiss, PhD, associate professor of psychiatry at UCSF, and senior author on the two new studies.

"While some studies have looked at small regions of the genome or tried to support one specific hypothesis with respect to sex differences, few studies have looked at the question from a comprehensive genome-wide perspective," Weiss said.

In the two new studies, Weiss and her team analyzed genome-wide association study (GWAS) data to search for patterns that might support or rule out competing hypotheses about the origins of sex differences in a number of diseases, and compared these patterns with those associated with physical traits that obviously differ between the sexes, such as height, body mass index (BMI), and waist-to-hip ratios.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS103

Creating neurons from skin cells to understand autism MARCH 15, 2017

Studying brain disorders is complicated for many reasons, not the least being the ethics of obtaining living neurons. To overcome that obstacle, UC San Francisco postdoc Aditi Deshpande, PhD, is starting with skin cells.

Thanks to developments in stem cell technology, new information about the human brain is now being gleaned from a simple cheek swab or skin sample. This technology is key to the kind of progress Despande and researchers like her are making. It allows them to work with cells otherwise unobtainable – living brain cells that have the same genetics as the patients.

Deshpande begins with skin cells obtained from the Simons Foundation from volunteers whose DNA contains a specific deletion or duplication of one chromosome.

She cultures these cells and then turns them into induced pluripotent stem cells – cells that have been coaxed back to their embryonic state and are able to become any other type of cell. From there, she reprograms them to become a specific type of neuron that’s involved in attention and information processing.

The deletion or duplication Deshpande is looking for stems from a 2008 finding by Lauren Weiss, PhD, an associate professor of neurology in the UCSF Department of Psychiatry and the UCSF Institute for Human Genetics.

In the two new studies, Weiss and her team analyzed genome-wide association study (GWAS) data to search for patterns that might support or rule out competing hypotheses about the origins of sex differences in a number of diseases, and compared these patterns with those associated with physical traits that obviously differ between the sexes, such as height, body mass index (BMI), and waist-to-hip ratios.

Weiss discovered a 29-gene region of DNA on chromosome 16 that is associated with autism, seizures, and other brain disorders. Normally, a person has two copies of the region – one on each copy of chromosome 16. In some of Deshpande’s samples, the region is deleted from one chromosome, leaving one copy. In others, the region is duplicated, resulting in three copies. Subjects with only one copy of the region were more likely to have macrocephaly – an enlarged brain – than a typical subject, and those with three copies were more likely to have microcephaly – a smaller brain.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS301

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS881

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DEPRESSION, ANXIETY AND MOOD DISORDERS

DEPRESSION, ANXIETY AND MOOD DISORDERS

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Working together to illuminate depression’s circuits DECEMBER 3, 2015

In a hospital room at UC San Francisco’s Parnassus campus, a patient anticipates having an epileptic seizure. A dozen wires trail from her gauze-wrapped head to a bedside monitoring device. Hidden beneath gauze and bone lies an intricate network of electrodes – each roughly the size of a flattened grain of rice. They’ve been surgically implanted on the surface of her brain, with the goal of revealing the origin of her complex, near-weekly seizures. At the same time, she is volunteering as a participant in groundbreaking research on mood disorders like depression, as well as related disorders like anxiety.

This patient is one of about 60 who receive similar specialized surgical treatment annually from UCSF neurosurgeon Edward Chang, MD, because a cure for their epilepsy is unusually elusive. The electrodes stay in place for up to three weeks as Chang and his colleagues at the UCSF Epilepsy Center map which region of their brain triggers the seizures in the hope that they can be alleviated through surgery.

These implanted electrodes also present a rare opportunity to study an even more elusive target: the source of human moods and emotions.

Simply being alive can be excruciating for those who suffer from severe depression or anxiety. Many derive little enjoyment from family, work or play; some have a hard time functioning; and for a few, mood disorders are so irremediable that they take their own lives. Yet just as lasting happiness evades those with intractable mood and anxiety disorders, definitive treatments have evaded those hoping to help such patients. For some, drugs and other therapies fail to fully resolve their suffering. For a few, treatment fails entirely.

But what if such troubles stem from flawed brain circuitry, which could be coaxed to support healthy neural processing instead? A research project headed by Chang aims to answer this question – and change the way we understand and treat mood disorders.

If successful, the project will for the first time map the networks in the brain that have gone awry, then remodel them to restore healthy functioning using a new type of device that could be permanently implanted in the brain. When the pathways corresponding with depression are activated, the pattern of activity would be picked up by specialized electrodes. The electrodes, which are currently in development, would emit a minute impulse. The stimulation would encourage the brain to shift its activity into new, healthier patterns – possibly for good.

“This is a huge privilege because we have the resources to do something that will have direct impact on patients – our project was chosen, but other good ones were not,” says Chang. “I think about that responsibility a lot, actually. Meeting this challenge can only be done at certain places in the world, and UCSF is one of them.”

A project of this scope depends inherently on collaboration: a dozen labs in the fields of surgery, neurology, psychiatry, engineering and software development are all integral to its work. Contributing institutions include UCSF, UC Berkeley, the University of Southern California, Lawrence Livermore National Laboratory, and New York University, while Posit Science and Cortera Neurotechnologies are industry partners. Although academe is sometimes charged with a so-called “silo” mentality – an inclination to stay within departmental and disciplinary boundaries – this kind of cooperation among labs, specialties and institutions is a core value of the UCSF scientific community.

“One of the reasons I came to UCSF was that there was a tremendous opportunity to break down the silos and barriers between psychiatry, neurology and neurosurgery,” says Matthew State, MD, PhD, chair of the Department of Psychiatry and the Oberndorf Family Distinguished Professor. He was recruited from Yale in 2013 and since then has been actively fostering such collaborations to tackle challenges including autism, eating disorders, sleep and circadian rhythm disturbances, and interventional psychiatry – as well as mood disorders.

“I have a strong conviction that those [silos] have not served us well, and that we need to be thinking collectively about how to attack these problems and not be in our separate camps,” says State. His vision is spurring a groundswell of support, including philanthropy that’s putting mental health innovation on a new trajectory at UCSF.

“I feel we are on the brink of a transformative insight. We are measuring things that honestly have scant examples of having been looked at in the context of depression. It could lead to totally different ways of treating depression from the way that we are right now.”

- VIKAAS SOHAL, MD, PHD

“This would be revolutionary,” says Vikram Rao, MD, PhD, an assistant professor of neurology who’s on Chang’s team. “The problem is not that the whole brain is malfunctioning; it’s certain key circuits that mediate mood. The device would be able to intervene on those circuits and restore them to a more healthy state.”

Chasing the rainbow

Collaborative genesis

Patients who have come to UCSF for epilepsy treatment – as well as others whom UCSF neurosurgeon Philip Starr, MD, PhD, is treating for Parkinson’s – are key to the project.

They’re having electrodes implanted out of medical necessity, but in parts of the brain that researchers want to examine because of their impact on mood. In addition, it happens that people with epilepsy and Parkinson’s also suffer from a much higher rate of intractable depression than the general population.

Chang is a lean, soft-spoken 39-year-old who first operated on a human brain in July 2004. From his early days as a medical student at UCSF, where he also completed his residency, he was attracted to the skill and compassion necessary for neurosurgery. By the time he started this project, he’d already made groundbreaking discoveries regarding how the brain processes language – using many of the same tools now being applied to understanding mood and anxiety disorders.

One October morning in 2013, he learned from the New York Times that the Defense Advanced Research Projects Agency (DARPA) planned to spend more than $70 million to advance research on brain implants and therapeutic brain stimulation – exactly his area of research.

Chang thought, “Okay, let’s get ready for this.”

“We had all heard about it, but Eddie is the one who said, ‘Do you want to do something about this?’” says Vikaas Sohal, MD, PhD, an assistant professor of psychiatry. “It’s definitely a team effort, but it’s his core vision of the themes and the people.”

That vision bore fruit; in the spring of 2014, the project was one of the first to be approved under President Obama’s Brain Initiative, which supports research seeking new ways to treat, prevent, and cure brain disorders. DARPA is a major funding partner of the Brain Initiative, known for sponsoring cutting-edge and high-risk projects. An initial $12 million in funding may go up to $26 million if the project meets key milestones.

“We are pioneering in this area in a way that is both ethical and a win-win for everyone involved,” Chang says.

“This particular collaboration is going to have an impact for an enormous number of our patients, starting with those suffering from depression but extending in the long run to those with anxiety, psychosis and other such disorders,” State says.

If it’s successful, the project is likely to radically change the way depression is diagnosed and treated. Rather than relying on verbal descriptions of symptoms, diagnoses would be based on identifying specific maladapted circuits as the cause of various crippling mood disorders. Treatment could then be targeted accordingly. Overall, mood could come to be seen as a physical, not a moral failing: more akin to a broken bone than a broken heart. If such a paradigm shift occurs, Chang and his team foresee a secondary benefit for all patients with mood disorders, large or small: reduced stigma.

“Having knowledge about the physical mechanism of depression will help everybody view it differently,” Sohal says, adding that many of his friends, family members and even patients currently feel that depression is not something real.

“As we make progress in this area, the stigma and marginalization that are just part and parcel of having a psychiatric illness will start to fade, I guarantee you,” State says. “It is going to have an enormous impact.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS275

IN THE NEWS: DEPRESSION, ANXIETY AND MOOD DISORDERS

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Words matter: Reaching people in distress on the internet MAY 17, 2017

Suicidal ideas and behaviors may vary across cultures. Depressed individuals worldwide do not always seek treatment, or are undertreated, thus there is a need for effective and appropriate interventions for at-risk individuals via the internet.

The anonymity of the internet may help many people who are hesitant to talk with others or to reach out for help feel more comfortable. The internet also provides opportunities for connecting across the globe. Language and culture play a role in reaching individuals who might be depressed.

In a scientific study by Dr. Yen Leykin, a global multilingual participant group was recruited via the internet. This was one of the first studies to use the internet to recruit participants, which allowed for the assessment of global predictors and contributors to suicidal ideation and behavior.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS908

Being a mom to a middle schooler can be the toughest gig of all DECEMBER 29, 2016

Although her oldest child, Ben, is 10 years old, Andrea Scher, 44, feels like a new mom again.

Scher suffered from maternal depression after Ben was born, eventually recovering with the help of antidepressants and psychotherapy. She was understandably relieved that her depression didn't return after the birth of her second son.

But now she's struggling again.

Once more, Scher is having anxiety attacks and it's difficult for her to sleep through the night.

Scher is not alone. Many women assume that the first year of motherhood is the most precarious time for their mental health. But a recent study published in Developmental Psychology finds that maternal depression is actually most common among mothers of middle school children as they catapult into the tween years.

Psychiatrist Dr. Louann Brizendine, a professor at the University of California, San Francisco says, "In addition to the hormonal swings that accompany our children's tween years, women's hormones are shifting as perimenopause begins."

Brizendine says that for most women, estrogen and progesterone levels start decreasing after age 42. With estrogen depletion, women may feel less nurturing.

As a result, they can feel more agitated with themselves, their partners and their children. Additionally, mothering tweens doesn't offer the hormonal reward — the oxytocin "love rush" — that caring for little children provides.

It's no wonder that these monumental emotional and physical changes substantially increase a woman's risk for midlife depression.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS804

The women’s health issue no one is talking about SEPTEMBER 19, 2016

Kieley Parker never imagined she would need an antidepressant. “I always win those stupid sunshine and happiest person awards. People see me as an incredibly joyful person,” she said.

But in fall 2014, Parker left her job as a third-grade teacher and moved to Tulsa, Okla., with her fiancé. Starting over in a new city was an enormous transition. “I couldn’t feel joy or even negative emotions like sadness. I couldn’t eat — I lost 25 pounds,” Parker recalled. “I was just anxious, which spiraled into depression.”

About 1 out of 5 women in America will experience depression in her lifetime, twice the number of men. Some are depressed throughout the course of their lives; others, like Kieley, become depressed following a big change.

Over the past decade, people have increasingly treated depression with medication: Starting in 1994, the number of antidepressant prescriptions written by doctors went up 400 percent over a 10-year period. And today, about 15 percent of women take an antidepressant. Among women age 40 to 59, that number is nearly 23 percent, according to the U.S. Centers for Disease Control and Prevention.

With so many people popping pills, it’s easy to wonder: Are they being overprescribed?

The answer is complicated.

Overall, doctors consider antidepressants a safe treatment. They often bring fast relief, and millions of people have been using them for 30-plus years, without evidence of serious harm.

Though research on long-term use is scarce, “generally, studies show that theWre are no side effects of using antidepressants for an extended duration,” said Dr. Renee Binder, immediate past president of the American Psychiatric Association. However, there can be short-term side effects, including weight gain and insomnia.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS391

This app uses a video game to fight depression JANUARY 9, 2017

A game-based app for phones and tablets called Project: EVO seems to help older adults with depression feel better by targeting underlying cognitive conditions, such as attention and focus, according to two recent studies.

“We found that moderately depressed people do better with apps like this because they address or treat correlates of depression,” says Patricia Areán, a researcher in psychiatry and behavioral sciences.

The first study enrolled older adults diagnosed with late-life depression into a treatment trial where they were randomized to receive either receive treatment using the app or an in-person therapy technique known as problem-solving therapy (PST).

People with late-life depression (60+) are known to have trouble focusing their attention on personal goals and report trouble concentrating because they are so distracted by their worries. Akili’s technology was designed to help people better focus their attention and to prevent people from being easily distracted.

Arean says most of the participants had never used a tablet, let alone played a video game, but compliance was more than 100 percent. The participants were required to play the game five times a week for 20 minutes, but many played it more.

Participants in this arm of the study also attended weekly meetings with a clinician. The meetings served as a control for the fact that participants in the problem-solving therapy arm were seen in person on a weekly basis, and social contact of this nature can have a positive effect on mood.

Project: EVO is undergoing multiple clinical trials for use in cognitive disorders, including Alzheimer’s disease, traumatic brain injury, and pediatric attention deficit hyperactivity disorder (ADHD).  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS671

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New study finds mood and anxiety disorders common in Tourette syndrome patients emerge at a young age MARCH 9, 2015

A new study of Tourette syndrome (TS) led by researchers from the UCSF Department of Psychiatry and Massachusetts General Hospital (MGH) has found that nearly 86 percent of patients who seek treatment for TS will be diagnosed with a second psychiatric disorder during their lifetimes, and that nearly 58 percent will receive two or more such diagnoses.

It has long been known that TS, which emerges in childhood and is characterized by troublesome motor and vocal tics, is often accompanied by other disorders, especially attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). In many patients these “comorbid” conditions cause more distress and disability for patients than TS tics themselves.

But the size and rigor of the new study, conducted by an international group of researchers and published in JAMA Psychiatry, provides the most comprehensive and reliable picture of TS comorbidities to date, said Carol A. Mathews, MD, professor of psychiatry at UCSF and co-senior author of the new report.

“This is the biggest data set of its kind that I know of,” Mathews said. “We’ve interviewed thousands of people and collected a huge wealth of clinical data, which has given us the opportunity to say something meaningful about the clinical presentation of Tourette syndrome.”

Co-senior author Jeremiah Scharf, MD, PhD, of the Massachusetts General Psychiatric and Neurodevelopmental Genetics Unit (PNGU), an assistant professor of neurology at Harvard Medical School and TSAICG co-chair, said that the new findings should prove useful to his fellow neurologists, who often treat TS patients but may not be aware of the full spectrum of possible psychiatric comorbidities seen in the disorder.

Led by first author Matthew E. Hirschtritt, MD, MPH, a psychiatry resident at UCSF, the researchers analyzed diagnostic data for more than 1,300 TS patients gathered in consistent, highly structured interviews completed over a 16-year period. In addition, the analysis also included diagnostic information from parents, siblings, and other relatives unaffected by TS. The researchers found relatively low rates of other psychiatric conditions, including eating disorders, psychosis, and substance abuse, among TS patients.

Mathews and Scharf cautioned that their results are potentially skewed because many TS patients never seek medical attention for the disorder. “This is a somewhat biased sample, because the patients we studied came to a clinic or through the Tourette Syndrome Association. People who come to a clinic for treatment tend to have more severe TS or they have other psychiatric symptoms,” said Mathews. “But this work still gives clinicians a good idea of what they should be on the lookout for.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS782

Improved neuroimaging allows providers to distinguish between depression and dementia MARCH 15, 2017

It might sound obvious, but for doctors to provide patients with the best possible care, they must be able to diagnose them with the right disease first. That task can be surprisingly difficult for disorders of the brain, which often lack concrete physiological diagnostics.

What’s more, many cognitive and psychiatric disorders have overlapping symptoms or even present together, making it hard for physicians to distinguish among various conditions. For example, depression in the elderly can include cognitive dysfunction and depressive symptoms are common in patients with dementia.

Depression is also considered a major risk factor for dementia, and an estimated 25 percent of patients have both disorders. However, the root biological causes of the two conditions – and thus their courses of treatment – are very different, so it is essential to diagnose the correct primary affliction.

To help better diagnose patients, a multi-institutional collaboration between UC San Francisco, UCLA, and Thomas Jefferson University applied a new analytic approach to distinguish between depression and dementia using neuroimaging. The scientists used a nuclear imaging technique called single photon emission computed tomography (SPECT) to track blood flow in the brain. Measuring blood sd flow can identify changes in brain function with great sensitivity, helping scientists to detect the earliest signs of abnormality caused by disease.

By applying machine learning techniques to more than 4,500 functional neuroimaging scans from patients who had been diagnosed with depression, cognitive disorders such as dementia, or both, the researchers identified distinct neuroimaging profiles for each condition. Using these profiles, they distinguished between the disorders with 86 percent accuracy.

In general, patients with dementia had lower blood flow overall than those with depression, and people diagnosed with both depression and dementia had lower blood flow than either condition individually. There were also notable differences between patient groups in specific regions, which helped characterize each disorder. For example, the hippocampus received less blood in patients with dementia than in those with depression.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS630

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A gene that could help explain why lithium stabilizes mood

Patents are experimenting with ketamine to treat depression DECEMBER 29, 2016

OCTOBER 26, 2016

Like Viagra and penicillin, the modern-day use of lithium—a common treatment for bipolar disorder—came about by accident. The story goes that in 1949, John Cade, the Australian psychiatrist credited with popularizing the drug, was trying to find a way to safely inject guinea pigs with his manic patients’ urine as part of an experiment to better understand their illness.

Why urine? He thought mania might be caused by a chemical in the body, and that chemical might be detectable in urine (his wife was weirded out by it too). In order to do that, he mixed it with a lithium compound, which made it easier to inject.

Cade realized that the guinea pigs who were given the lithium cocktail became calm, but he had no clue why. And no one’s been able to give a full explanation since.

While the description of bipolar disorder in the various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM)—the American Psychiatric Association's sometimes maligned guide to psychiatric diagnosis—has changed over the years, lithium has remained a standby treatment.

“It’s still arguably one of the best medications,” even if it’s not completely understood, says Ben Cheyette, a professor of psychiatry at the University of California, San Francisco.

Now, a new study published by Cheyette’s group in Molecular Psychiatry sheds some light on lithium’s effects on the brain.

Ketamine, first synthesized in 1962, has long been used as a clinical anesthetic and animal tranquilizer—but it’s also known as the hallucinogenic club drug Special K. When used correctly, ketamine is a cheap and effective pain killer. When abused, it can send users into what’s known as a K-hole, an out-of-body experience that’s been described as a kind of mental paralysis. But growing evidence shows that low doses given intravenously may be life-changing for patients with treatment-resistant depression. And dozens of clinics across the nation have embraced this new strategy in the fight against depression.

While the medical community is still waiting on the results from the first large scale clinical trials, proponents are already convinced that the ketamine therapy works on patients with severe depression and suicidality, but many doctors don’t support the treatment.

“The main critique is that it's been rolled out into clinical usage too soon. There's so much about the drug that we don't know in terms of how to use it, who responds to it, what the long term consequences of taking the drug might be,” says Victor Reus, a practicing psychiatrist and professor at the UCSF School of Medicine. “We need to have more, larger, well controlled trials using this drug. We need to follow people over time.”

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS072

And there are other concerns. While Ketamine as an anesthetic is FDA approved, using it for depression is not. That means many insurance carriers don’t cover it, limiting its reach to lower income communities. Then there’s the risk of long term dependency on a treatment that some worry may prove to be addictive.

New study finds evidence of brain network hyperconnectivity in adolescent depression

“Ketamine is theoretically addictive based on what we see in individuals who are using ketamine recreationally and in street usage,” Reus says.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS973

DECEMBER 11, 2015

In the first functional magnetic resonance imaging (MRI) study combining multimodal functional connectivity methods to investigate adolescent major depressive disorder (MDD), lead author Tiffany Ho, PhD, and senior author Tony T. Yang, MD, PhD, both from the UCSF Department of Psychiatry, found evidence of hyperconnectivity in the default mode network of adolescent MDD during active emotional processing that persisted during resting-state conditions.

The surprising benefits of anxiety

Moreover, the study found that earlier age of depressive onset was significantly associated with greater default mode network hyperconnectivity.

While Kierkegaard spent much of his work analyzing the agonizing nature of anxiety, he did not think that it was an emotional state to be avoided. Instead, the philosopher argued that one cannot live an authentic life without grappling with anxiety.

The default mode network is a key intrinsic functional brain network that is more active during rest than task processing states, and is heavily implicated in self-referential processing, rumination, and MDD. However, previous work in both adult and adolescent MDD yielded inconsistent findings and focused only on the default mode network during rest.

This study is the first to show persistent and “inflexible” hyperconnectivity of the default mode network in MDD and suggests that default mode hyperconnectivity may emerge at particular developmental stages or as markers of disease progression.

The study also underscores the complex and dynamic facets of functional brain networks and highlights the adolescent brain in particular as an area that could benefit from multimodal neuroimaging research in the context of both basic and clinical investigations.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS416

JUNE 25, 2017

“Anxiety can just as well express itself in muteness as with a scream,” wrote existential philosopher Søren Kierkegaard in 1844.

In the centuries since, advances in psychiatry have led to increasingly better methods for treating crippling anxiety. But, in the process, we have culturally abandoned Kierkegaard’s key idea—that, however unpleasant, anxiety can be beneficial.

Though psychiatrists today typically focus on the negative aspects of anxiety, there are some who also recognize its positives. Tracy Foose, professor and associate director of adult psychiatry clinics at University of California San Francisco, notes that while anxiety isn’t emotionally enjoyable, it can make you a better person.

“From the perspective of the individual, anxiety tends to be associated with the genetic profile of someone whose temperament is characterized by honesty, attention to detail, a strong drive, pursuit of excellence, and social attunement to the needs to others,” she says. “For an individual, though anxiety can be incapacitating, a lot of those other traits make them fairly likable and successful in what they pursue.”

This is not a straightforward benefit; Foose says she’s found that writers she treats for anxiety have the drive to pursue such creativity, but also the self-doubt to question their work. But Foose believes that as anxiety has been pathologized, symptoms of severe anxiety disorders have come to be seen as conditions that deserve treatment in their own right. And she inadvertently echoes Kierkegaard, noting that anxiety used to be a motivator to change one’s path in life, rather than an emotional experience to be eradicated.

“I don’t know why anxiety is not more appreciated as an emotional state,” she says. “We seem to have culturally developed a fear of fear.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS348

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New research finds key longevity hormone is lower in stressed and depressed women JUNE 19, 2015

Women under chronic stress have significantly lower levels of klotho, a hormone that regulates aging and enhances cognition, researchers at UC San Francisco have found in a study comparing mothers of children on the autism spectrum to low-stress controls.

The researchers found that the women in their study with clinically significant depressive symptoms had even lower levels of klotho in their blood than those who were under stress but not experiencing such symptoms.

The study, published in Translational Psychiatry, is the first to show a relationship between psychological influences and klotho, which performs a wide variety of functions in the body.

“Our findings suggest that klotho, which we now know is very important to health, could be a link between chronic stress and premature disease and death,” said lead author, Aric Prather, PhD, an assistant professor of psychiatry at UCSF. “Since our study is observational, we cannot say that chronic stress directly caused lower klotho levels, but the new connection opens avenues of research that converge upon aging, mental health, and age-related diseases.”

Scientists know from their work in mice and worms that, when klotho is disrupted, it promotes symptoms of aging, such as hardening of the arteries and the loss of muscle and bone, and when klotho is made more abundant, the animals live longer.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS917

UCSF study suggests yoga eases depression APRIL 15, 2017

Researchers have found a break-through anti-depressant, and it's thousands of years old: yoga.

A study at UCSF, with subjects who have major depression, found their condition eased with regular yoga classes.

"I can do this anywhere, at any point in my life, to center myself, " participant Amanda Vigil told KTVU, "because these are tools I learned and took with me."

The study adds to a growing body of research showing yoga's mental health benefits, but unique in its approach.

"It's the very first study in the U.S. that's looking at yoga as a sole treatment for diagnosed major depression," said lead researcher Dr. Sudha Prathikanti.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS802

Depressed, agitated? It could be hormones APRIL 29, 2014

Many women of a certain age can relate to Healy’s struggle with baffling and disabling mood symptoms. Fortunately, a growing number of doctors and mental health professionals are honing in on the significant role hormones play in midlife women’s mental health.

By factoring in the hormonal component, health care providers are able to develop treatments that may be better tailored to each woman’s symptoms. The treatments often include old standbys — anti-depressants and hormone therapy — but in combinations or dosages that can be more effective and less likely to bring on adverse risks and side effects. hormonal shifts also bring on depression and other mood symptoms in women who never before dealt with these conditions, according to Dr. Louann Brizendine, founder of UCSF’s Women’s Mood & Hormone Clinic. She estimates that just 15 percent of women will breeze through perimenopause. Fifty to 60 percent will experience symptoms some of the time, and 30 percent will suffer major discomfort.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS514

New clues to how lithium soothes the bipolar brain may shed light on other mental illnesses OCTOBER 18, 2016

The second century C.E. Greek physician and philosopher Galen advised patients suffering from disorders of the spirit to bathe in and drink hot spring water. Modern day brain scientists have posited that Galen’s prescription delivered more than a placebo effect. Lithium has for decades been recognized as an effective mood stabilizer in bipolar disease, and lithium salts may have been present in the springs Galen knew.

Yet exactly how lithium soothes the mind has been less than clear. Now, a team led by Ben Cheyette, a neuroscientist at the University of California in San Francisco (UCSF), has linked its success to influence over dendritic spines, tiny projections where excitatory neurons form connections, or synapses, with other nerve cells.

Lithium treatment restored healthy numbers of dendritic spines in mice engineered to carry a genetic mutation that is more common in people with autism, schizophrenia, and bipolar disorder than in unaffected people, they report today in Molecular Psychiatry. The lithium also reversed symptoms in these mutant mice—lack of interest in social interactions, decreased motivation, and increased anxiety—that mimic those in the human diseases.

“They showed there’s a correlation between the ability of lithium to reverse not only the behavioral abnormalities in the mice, but also the [dendritic] spine abnormalities,” says Scott Soderling, a neuroscientist at Duke University in Durham, North Carolina, who studies how dysfunctions in signaling at brain synapses lead to psychiatric disorders.

Soderling adds that the work also sheds light on the roots of these diseases. “It gives further credence to this idea that these spine abnormalities are functionally linked to the behavioral disorders.”

Although the researchers acknowledge that rodents are an imperfect proxy for human mood disorders, they did observe that the animals’ symptoms markedly improved; studies of their brains also revealed normal numbers of spines.

“That’s the key finding,” Cheyette says. “It suggests that lithium could have its well-known therapeutic effect on patients with bipolar disorder by changing the stability of spines in the brain.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS196

EARLY PSYCHOSIS AND SCHIZOPHRENIA

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New California clinics seek to stop schizophrenia before it starts

Abnormal brain rhythms tied to problems with thinking in schizophrenia

DECEMBER 13, 2016

In schizophrenia, the loss of insight signals a psychotic break, the formal commencement of the disease itself. Typically, a first psychotic break occurs in a person’s late teens or early 20s. In men, the range is 15-24; in women, 25-34.

Often, says Rachel Loewy, an associate professor of psychiatry, the onset coincides with an abrupt change in a young person’s life, such as leaving home for the first time.

“Every November we get a huge influx of people who went off to college, into a stressful environment, heading into finals. That’s when we see a lot of first psychotic episodes.”

Loewy, who has helped develop several early-intervention programs in San Francisco and elsewhere, says schizophrenia’s timeline –- hitting a young person at what should be the brink of independence — can make the disease devastating for parents.

“The [young person] drops out of college, goes home, doesn’t get a job. He or she never transitions to adulthood,” Loewy says.

That first psychotic break can precede a cavalcade of disasters: social isolation, hospitalization, medications with sometimes disabling side effects.

So, what if you could intervene earlier, before any of that? Could you stop the process from snowballing?  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS749

Brain training may help calm the turbulent storms of schizophrenia NOVEMBER 3, 2014

Schizophrenia, the word, means literally "split mind." And that's how people usually think of schizophrenia, as a disease defined by weird ideas, like believing in cosmic dust.

But this public perception of schizophrenia hasn't kept up with the science. When you talk to scientists today who study the disease, these weird beliefs are not what they emphasize.

If you want to really understand schizophrenia, look instead to how the disease begins, says Dr. Daniel Mathalon, a neuroscientist at the University of California, San Francisco.

"Kids seem to be growing up OK. But somewhere, typically in the teenage years, you start to see a decline in their functioning," he says. "They were doing better in school, now they're doing worse. They may have they had friends when they're younger, but they're starting to be more socially isolated."

This stage in life is supposed to be a time when the intellect flourishes. But for teenagers who go on to develop schizophrenia, the opposite can happen. They start to lose focus.

Some say they used to be able to read books and now they can't. They used to be able to play the guitar well and now they can't.

At its core, schizophrenia is a decline in basic brain functioning, says Mathalon and others. Abilities like memory and basic motor skills start to falter. It's almost like a dementia that hits young people.

MARCH 6, 2015

By studying specially bred mice with specific developmental and cognitive traits resembling those seen in schizophrenia, UC San Francisco researchers have provided new evidence that abnormal rhythmic activity in particular brain cells contributes to problems with learning, attention, and decision-making in individuals with that disorder.

As reported in the March 5, 2015 online edition of Neuron, when the researchers corrected these cells’ faulty rhythm, either by directly stimulating the cells or by administering low doses of a commonly used drug, cognitive deficits in the mice were reversed, results that point the way to possible therapies to address cognitive symptoms in individuals with schizophrenia.

According to Vikaas Sohal, MD, PhD, senior author of the new study, in addition to dealing with the burdens of schizophrenia’s so-called positive symptoms (such as delusions and hallucinations) and negative symptoms (such as social withdrawal and a lack of motivation), individuals with the disorder also grapple with cognitive deficits that create considerable challenges in the arenas of education, work, and interpersonal relationships.

Converging evidence from many previous studies has implicated a population of neurons in the brain’s prefrontal cortex called fast-spiking (FS) interneurons in schizophrenia, but a causal relationship between malfunctioning FS interneurons and cognitive symptoms of the disorder has not yet been firmly established, Sohal said.

For example, individuals with schizophrenia perform poorly on the Wisconsin Card-Sorting Test (WSCT), an assessment tool designed more than 60 years ago that sensitively measures the ability to learn new rules on the fly and apply them to complete a task.

Postdoctoral fellow Kathleen K.A. Cho, PhD, led a team that made use of mice developed in the UCSF laboratory of John L.R. Rubenstein, MD, PhD, the Nina Ireland Distinguished Professor in Child Psychiatry. These mice carry only one copy of two genes known as Dlx5 and Dlx6, which govern the proper assembly of FS interneuron circuitry as the brain develops. An intriguing characteristic of these mice is that FS interneurons only become abnormal at a developmental stage corresponding to human post-adolescence, when symptoms of schizophrenia usually begin to emerge.

In the new research when these mice performed a “rule-shift” task—designed to emulate important features of the WCST—at a young age, their performance was indistinguishable from that of normal mice. But they showed significant deficits when they performed the task as young adults.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS981

Is there a connection between left-handedness and schizophrenia?

NOVEMBER 1, 2013

About 10% of the population is left-handed, but 40% of those with schizophrenia are, according to a new study.

UCSF scientists are conducting a study to see whether the brain can be, essentially, retaught. It uses computer games designed to train people with schizophrenia to tune out distractions and focus on simple instructions.

That suggests that handedness may be a window into biological markers that predict psychoses, says the University of California, San Francisco’s Christopher Chee, MD, and colleagues from the Yale Child Study Center. If the work is validated, it could help researchers to find clues, or biomarkers among left-handers that could hint at the first signs of psychoses.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS864

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS525

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Scientists are learning to predict psychosis years in advance – and possibly prevent it NOVEMBER 16, 2017

Rachel Loewy was an undergraduate in 1995 when she answered a flyer seeking students to assist with a research study. A couple of floors up in a psychology department building, Loewy sat, clipboard in hand, interviewing teenagers whose brain health was beginning to falter. Some heard whispers. Others imagined that their teachers could read their minds, or that fellow students stared at them and wished them harm as they walked down the halls.

The teenagers had been diagnosed with schizotypal personality disorder, a condition that can precede schizophrenia. Among the most debilitating and stigmatized psychiatric diseases, schizophrenia can rob sufferers of their self and their future, often in early adulthood.

Although these teens didn't have schizophrenia, the researchers believed that some would later deteriorate and be diagnosed with the disorder. But when Loewy met them they were lucid and self-aware. And they were frightened that their mind sometimes spun out of control.

Doctors routinely assess a patient's risk of heart attack, various cancers, and diabetes, often intervening to slow or stop disease before it strikes. But preventing psychiatric conditions, from anxiety to depression to schizophrenia, has received scant attention.

The reasons are many. "With all due respect to cardiologists," the brain "is a very, very complex organ," says Jacob Vorstman, a Dutch pediatric psychiatrist who relocated this fall to The Hospital for Sick Children in Toronto, Canada. There, he's setting up a clinic to assess and follow young people genetically at risk of psychiatric disorders, including schizophrenia. Though the brain is better understood than it was a generation ago, Vorstman says, how its intricate dance of chemical and electrical signals gives rise to mind and personality remains mysterious.

He put on a Bruce Springsteen song he'd always loved. "I didn't feel any of the emotions it [usually] stirred up in me," he says. Instead, he felt nothing. "That was even scarier."

Although Brandon didn't recognize these dissociations as related to psychosis, he knew that something was terribly wrong. He woke his parents, who calmed him down, and he went back to sleep. The episode ended there: The next morning all was normal.

"These kids know something is not right," Loewy says. "They say, ‘I'm hearing things,’ and it freaks them out."

Through her mentor, psychologist Elaine Walker at Emory University in Atlanta, Loewy also met middle-aged adults with severe schizophrenia who struggled to maintain their grip on reality and couldn't carry on a conversation. She was struck by the disparity between the 15-year-olds and the 50-year-olds, and wondered about the path from early foreboding to serious illness. "Can't we do something?" she asked herself.

More than 20 years later, Loewy is a psychologist at the University of California, San Francisco, and that question has defined her career. With a small group of brain experts worldwide, she is trying to bring prevention to the field of psychiatry—one of the few medical specialties that hasn't managed to incorporate it.

So far, genetic studies have done more to elucidate biology than to identify people at high risk. Although schizophrenia has a strong inherited component—about 10% of those with an affected parent and 50% with an affected identical twin will be diagnosed—the genetics are "humblingly complex," says Tyrone Cannon, a psychologist at Yale University with a longstanding interest in prevention. "It's not just one mechanism, it's thousands of genes."

Stigma is also a powerful barrier to prevention. Schizophrenia is marked by episodes of psychosis as well as cognitive and social problems, and it's deeply feared and often misunderstood, even by many physicians. That makes it ethically dicey, some believe, to label young people at risk when not all of them will develop the disease. "It's easier to say, ‘I am a patient with asthma,’ than to say, ‘Listen, I have psychotic breaks,’" Vorstman suggests.

Researchers who have sifted through medical records of people with schizophrenia from before the disease struck, or medical records of their children, recognize subtle signs even earlier. "We're looking back using the army records from Israel to see what happens before onset, or birth registries from Scandinavia," says Iris Sommer, a psychiatrist at the University Medical Center Groningen in the Netherlands. She and others have found what she calls a "huge trajectory" of symptoms arcing toward psychosis. This trajectory begins very young and becomes more pronounced, if vague, as a child grows.

But change is afoot. In recent years, brain specialists have refined their ability to anticipate who's at highest risk of psychosis—a defining feature of schizophrenia—identifying subtle signs in some children and more vivid precursors in late adolescence. And increasingly, researchers feel they'd be derelict not to pursue prevention. Tests of preventive measures are up and running, ranging from cognitive therapies to pregnancy supplements for the fetal brain to psychiatric drugs. Last month, a German pharmaceutical company enrolled the first volunteer into what is intended to be a 300-person randomized clinical trial testing an experimental drug to prevent psychosis in those at extremely high risk. It's believed to be the first time a company has poured millions of dollars into an effort like this one.

Most of these signs are nonspecific and carry only a small increase in risk, and many people who are diagnosed later display none of them. Studies of pregnant women have found that some who suffer serious infection are more likely to have a baby who grows up to develop schizophrenia. In elementary school, children at risk can harbor irrational thoughts, like believing they're being spied on. They may make involuntary motor movements, or hold their limbs or head in awkward positions. Walker collected home movies of children who developed schizophrenia as adults, along with videos of age- and sex-matched siblings. The children were under 10, but in retrospect, the crystal ball was already clear. "Undergrads," says Loewy, who was one when she watched the movies, "could reliably tell which one was going to develop schizophrenia."

The quest to untangle schizophrenia's roots began in earnest in the 1980s. Researchers decided that "we ought to get as close as we possibly can to the onset of the illness," says Robert Heinssen of the National Institute of Mental Health in Bethesda, Maryland.

At the time, that was considered the first psychotic break, when an individual cannot distinguish reality from fantasy.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS981

But when physicians interviewed patients hospitalized after their initial psychotic episode, they were startled to learn that in many cases, "people began experiencing changes in cognition, behavior, and perception for months or years" before psychosis struck, Heinssen says. "That led to this idea that there's an emerging risk state that precedes" schizophrenia.

Brandon Staglin was 14 years old when he experienced this "emerging risk state" first-hand. Living with his parents and 6-year-old sister in Lafayette, California, a scenic town east of San Francisco, he was a science fiction fan who aspired to explore the galaxy and devoured Isaac Asimov books. "I was a little less social perhaps than some of the other students," Brandon says now, but nothing that triggered alarms.

At the time, his grandfather was near death from leukemia. One night, Brandon began wondering what it would mean for him to be gone. "I was pondering these deep thoughts and fell asleep," he remembers. "I opened my eyes 5 minutes later and couldn't tell the difference between whether I was dreaming or awake. It was very scary."

EATING DISORDERS AND NUTRITION

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Study links shorter sleep and sugar-sweetened drink consumption NOVEMBER 10, 2016

People who sleep five or fewer hours a night are likely to also drink significantly more sugary caffeinated drinks, such as sodas and energy drinks, according to a new study of more than 18,000 adults led by UC San Francisco scientists.

The authors emphasize that it’s not yet clear whether drinking sugar-sweetened beverages causes people to sleep less, or whether sleep deprivation makes people seek out more sugar and caffeine to stay awake, though previous research suggests both could be true.

“We think there may be a positive feedback loop where sugary drinks and sleep loss reinforce one another, making it harder for people to eliminate their unhealthy sugar habit,” said lead author Aric A. Prather, PhD, assistant professor of psychiatry at UCSF. “This data suggests that improving people’s sleep could potentially help them break out of the cycle and cut down on their sugar intake, which we know to be linked to metabolic disease.”

A growing body of research has linked sugary beverage consumption to metabolic syndrome, a cluster of conditions including high blood sugar and excess body fat, which can lead to obesity and type 2 diabetes. Lack of sleep is also associated with a higher risk for metabolic disease. Recently, several studies have linked the two factors in school-age children, showing that children who get less sleep are more likely to drink soda and other sugary beverages during the day, said Prather, who is also associate director of the UCSF Center for Health and Community.

When you can’t buy soda at work

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS370

If you wanted to buy a soda at work but couldn’t, would you drink more or less of the sugary liquid when away from the office?

How to break the junk food habit OCTOBER 31, 2016

Do you find yourself craving ice cream, intoxicated by an image of french fries or unable to resist the candy jar at a co-worker’s desk?

Research shows you’re not alone. Certain foods — particularly processed foods that are high in sugar, salt and fat — don’t just taste good, they also can be addictive, said scientists at a UC San Francisco symposium on food and addiction.

Food addiction is still a controversial concept in the scientific community. But researchers find strong evidence that certain foods can trigger binging, craving and withdrawal, responses that are similar to those produced by addictive substances like alcohol, cocaine and tobacco.

“I don’t think sugar is more addicting than cocaine, but I do think sugar is addicting,” said addiction expert Mark Gold, co-editor of the book “Food and Addiction” and keynote speaker at UCSF’s 2016 Sugar, Stress, Environment, and Weight Symposium.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS831

NOVEMBER 7, 2016

Preliminary results from what researchers are calling a first-of-its-kind study suggest limiting access to sugar-sweetened beverages at the workplace can help heavy soda drinkers reduce their overall daily intake.

Six months after UC San Francisco stopped selling sugar-sweetened beverages at its on-site cafeterias, stores and vending machines — effectively creating a sprawling soda desert — hundreds of workers opted to consume fewer sugary drinks while off the job, too, according to a survey of 2,500 employees across the university.

“To our surprise there were equal reductions in both environments. The sales ban was only during the workday but they were still drinking less after they got home,” said Elissa Epel, associate director at UCSF’s Nutrition and Obesity Research Center, and one of the researchers in the study.

The most significant drop in the sugar-sweetened beverage consumption — about 25 percent — was among service employees who used to drink an average of three 12-ounce cans before the ban, said Laura Schmidt, a professor of health policy in the School of Medicine at UCSF who is leading the survey of employees and spearheaded the sales ban.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS247

Packing on the pounds in an age of stressful politics JUNE 7, 2017

Ever heard of the freshman 15? Nowadays, some people who are unhappy with the current political environment are complaining of the "Trump 10."

We first heard this term from actress Jane Krakowski, who recently told late night TV host Stephen Colbert, "Now that I've put on my Trump 10, I've got to work out a little."

When Colbert said he hadn't heard of the term, she replied, "You know — like the freshman 15," referring to the weight gain typical during the first year of college.

She's not the only one. Similar complaints of politically induced stress eating have come from megastar Barbra Streisand and director Judd Apatow, who told The New York Times, "I'm trying so hard to have it not turn into 30 pounds."

The American Psychological Association surveys Americans about stress levels. The survey asks whether the political climate is stressing them out. More than half of those who responded said yes, the current political climate is a significant source of stress.

Elissa Epel of the University of California, San Francisco, who studies the physiological effects of stress, says those findings are telling — and that the unease seems to cut across party lines. "Regardless of whether people are pro-Trump or anti-Trump, most people do not like what they're seeing on the news," she says.

People who stay super-plugged in — taking in every tweet, every news cycle — are more likely to be stressed out, the poll suggests. "Constant checking of the news on your phone TV — it's a bad idea. It's keeping you in a vigilant state," Epel says.

There's nothing wrong with eating this way every once in awhile, but over the long term, chronic stress can pack on the pounds. If you're looking for help in tamping down your nerves, there are lots of foods that may help with mood. Epel suggests giving yourself curfews for checking your smartphone.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS224

EATING DISORDERS AND NUTRITION

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New research finds teens with bulimia recover faster when parents are included in treatment SEPTEMBER 18, 2015

Involving parents in the treatment of adolescents with bulimia nervosa is more effective than treating the patient individually, according to a study led by Daniel Le Grange, PhD, Benioff UCSF Professor in children’s health in the departments of psychiatry and pediatrics at UCSF Benioff Children’s Hospital San Francisco, and James Lock, MD, PhD, professor of psychiatry at Stanford University School of Medicine. The study is the third and now largest randomized clinical trial for adolescents with bulimia nervosa.

This finding is counter to how clinicians are historically trained to care for adolescents with bulimia, which excludes the parents from treatment and counseling.

“Parents need to be actively involved in the treatment of kids and teens with eating disorders,” said Le Grange. “This study shows definitively that parental engagement is imperative for a successful outcome of adolescents with bulimia nervosa. It goes counter to the training that physicians receive in psychiatry, which teaches that parents are to blame for bulimia, and therefore should be omitted from treatment.”

Bulimia is characterized by recurrent episodes of uncontrolled overeating, called binge episodes. These binge episodes are followed by compensatory behaviors aimed at preventing weight gain, such as self-induced vomiting, laxative or diuretic abuse, fasting, or intense exercising.

Between one and three percent of teens suffer from the condition each year in the United States, and most develop the disorder during their adolescence. Because the nature of bulimia is so secretive and the majority of bulimic adolescents remain at a healthy weight, many teens live with the disorder for years before their parents recognize the signs.

“These findings are quite clear,” said Le Grange. “FBT is the treatment of choice for adolescents with bulimia nervosa, because it works quicker and faster and maintains its impact over time. CBT could be a useful alternative if FBT were not available, but it needs to be recognized that it doesn’t work quite as fast and takes time to catch up,” said Le Grange.

When treating adolescents with bulimia nervosa, it is imperative to reduce the binging and purging behaviors quickly, which can cause premature death. “Every time a patient throws up, there is a risk to rupturing the esophagus, causing electrolyte imbalance and cardiac arrhythmia that can cause death,” said Le Grange. “The quicker we can intervene, the better chances we have at keeping a patient safe.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS806

New study: Parents-only therapy may be optimal in treatment of adolescent anorexia nervosa JUNE 8, 2016

Family therapy for 12- to 18-year-olds with anorexia nervosa, in which all household members participate and a meal is held in the clinician’s office, may be less effective than a streamlined model involving only the parents and without the family meal.

In a study published online in the Journal of the American Academy of Child & Adolescent Psychiatry, 107 adolescents with anorexia nervosa were randomized to two groups: those patients undergoing therapy with their family (family-based treatment or FBT), and those whose parents alone had the counseling while they received "supportive oversight" from a nurse (parent-focused treatment or PFT).

“The goal of both treatment models was to try to assist the parents to support their child toward nutritional rehabilitation and weight restoration,” said lead author Daniel Le Grange, PhD, Benioff UCSF Professor in Children’s Health in the Departments of Psychiatry and Pediatrics and UCSF Eating Disorders Program director in the Department of Psychiatry and UCSF Weill Institute for Neurosciences.

Both treatments tested in this study entailed guiding the parents to take full control of food intake and transitioning that control back to their child as they developed healthier eating habits and gained weight, said Le Grange, who was working with colleagues at the University of Melbourne, Australia, and is professor emeritus at the University of Chicago.

One significant difference in the treatment models was that in the parents group (PFT), there was no meal in the clinician’s office, an intervention considered critical in the conjoint family model (FBT). Instead the clinician focused almost exclusively on helping the parents manage the illness in the therapy sessions. “It would seem that a clinical intervention (the family meal) heretofore considered critical for successful outcome in treatment, might after all not be quite as necessary”, said Le Grange.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS793

LGBTQ AND HIV-RELATED MENTAL HEALTH

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UCSF study finds patients with severe mental illness slip between the cracks in HIV testing JANUARY 17, 2017

People with bipolar disorder, schizophrenia and major depression with psychosis may be up to 15 times more likely than the general population to be HIV positive, but are only marginally more likely to be tested for the virus, according to a study headed by UC San Francisco.

Two recent analyses have quantified HIV prevalence among people with severe mental illness as ranging from 1.8 to 6 percent. This is several times higher than the general population in which 1.2 million or approximately 0.4 percent of Americans are HIV positive, according to the Centers for Disease Control and Prevention.

“People with severe mental illness have higher rates of unsafe behaviors that put them at risk for HIV infection,” said first author Christina Mangurian, MD, MAS, of the UCSF Department of Psychiatry. “This includes engaging in unprotected sex with HIV positive partners and partners of unknown HIV status, injecting drugs, using substances in the context of sexual activity and episodes of sexual violence.”

The researchers found disparities in the number of patients undergoing HIV testing, according to age, gender and ethnicity. Some 7.7 percent of women were tested in the one-year duration, versus 5.5 percent of men. Among black participants, 10.8 percent were tested, compared with 6 percent and 2.7 percent of whites and Asian/Pacific Islanders respectively. While 7.9 percent of patients under age 27 were tested, 5.1 percent in the 48-to-67 age bracket were tested.

The researchers reviewed the medical records of 56,895 California residents who were on one or more anti-psychotic medications for their illnesses, and found that over a one-year period 6.7 percent underwent HIV testing. This compares with the 5.2 percent self-reported HIV-testing rate among California’s general population in 2011.

The participants were aged 18 to 67, with 42 percent over the age of 48, and all were enrolled in Medicaid for the period from Oct. 1, 2010 to Sept. 30, 2011. The study was published in the journal Psychiatric Services.

“Previous studies have found that people with severe mental illness die up to 25 years earlier than the general population,” said Mangurian, associate professor of clinical psychiatry at the UCSF School of Medicine. “Although this is mostly due to cardiovascular disease – related to anti-psychotic medications that increase risk for obesity, diabetes and high blood pressure – HIV and other infectious diseases also contribute to this premature mortality.”

The researchers also noted that those participants who had received non-psychiatric medical care were twice as likely to undergo testing as those that did not. “This finding supports national efforts to integrate behavioral health and primary care,” said senior author James Dilley, MD, from the UCSF Department of Psychiatry and the UCSF Alliance Health Project.

“People with severe mental illness often have low rates of primary care use, but do seek care at community mental health care clinics. As such, we believe this is an excellent opportunity for community psychiatrists to help promote their patients’ health by making HIV testing a part of their care,” he said.

“This is a missed prevention opportunity to detect HIV early in the course of illness,” said Mangurian. “Effective treatments are widely available and people with severe mental illness appear to comply with antiretroviral therapies at rates similar to other groups. We believe that annual HIV testing should be strongly considered by public mental health administrators.”

The U.S. Preventive Services Task Force, a volunteer panel of national medical experts, recommends annual HIV testing for men who have sex with men and people who are active injection drug users. It recommends testing every three-to-five years for those having unprotected sex and sex with HIV-positive partners, and for sex workers and injection drug users.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS712

Canada asks: Should gender be removed from identification documents?

JULY 14, 2017

Should sex or gender markers be included on government-issued IDs?

Twenty years of celebrating community, art and honoring those living with HIV/AIDS SEPTEMBER 9, 2016

When Art for AIDS was first conceived two decades ago, effective HIV treatments began to turn the epidemic around, especially in the developing world. The following year, Art for AIDS partnered with the UCSF Alliance Health Project (AHP) and what began as a tiny community fundraiser, raising a few thousand dollars, has grown into the gala it is today—raising more than $2,000,000 since its inception.

Over the years, Art for AIDS has attracted renowned donations of the works of important artists such as Matthew Frederick, Jylian Gustlin, Hung Liu, Jock Sturges, Carolyn Meyer, Gustavo Ramos Rivera, Rex Ray, and John Waguespack, along with works from prominent Bay Area galleries and collectors.

Art for AIDS is famous for some other things too: great food, great wine, a beautiful view of the city and Yerba Buena Gardens, and the company of more than 800 supporters, art patrons, and community philanthropists.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS387

In what may be a world first, a child born in British Columbia, Canada, has been issued a health card without a sex or gender designation.

Most health cards in British Columbia are marked with an “M” for male or “F” for female.

But Searyl Doty’s health card is marked with a “U,” which likely stands for “unspecified” or “unknown.”

This may be the first sex-neutral and gender-neutral health card to be issued to an infant, reports the Gender Free I.D. Coalition (GFID), a group that advocates for the removal of sex and gender designations from government-issued identity documents.

According to Dr. Dan Karasic, a health sciences clinical professor at the University of California, San Francisco, this case is part of a larger movement to change how governments manage identity documentation.

“I think it’s related to a broader movement to allow nonbinary legal gender identities and also make it easier for people to change their legal gender,” Karasic told Healthline.

“What both of those have in common is the push to allow identification that fits with a person’s identity.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS191

LGBTQ AND HIV-RELATED MENTAL HEALTH

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Antiretroviral therapy benefits HIV-infected stimulant users OCTOBER 10, 2014

New clinical research from UC San Francisco shows that 341 HIV-infected men who reported using stimulants such as methamphetamine or cocaine derived life-saving benefits from being on antiretroviral therapy that were comparable to those of HIV-infected men who do not use stimulants.

That said, those who reported using stimulants at more than half of at least two study visits did have modestly increased chances of progressing to AIDS or dying after starting antiretroviral therapy compared to non-users. The data was collected between 1996 and 2012.

“Patients with HIV who use stimulants and other substances often experience difficulties with accessing antiretroviral therapy, partially due to the concerns of healthcare providers that they will not be able take their medications as directed.

Findings from this study demonstrate that many stimulant users take their antiretroviral therapy at levels sufficient to avoid negative clinical outcomes,” said the study’s primary investigator, Adam W. Carrico, PhD, UCSF assistant professor of nursing.

The UCSF Division of HIV/AIDS at San Francisco General Hospital has created an integrated care delivery system that could serve as a model for other clinics, added Carrico. The HIV primary care clinic utilizes a patient centered team care approach that includes substance abuse services for stimulant and opioid users, along with mental health services, all located onsite. STOP, the “stimulant treatment outpatient program,” within the clinic provides outpatient substance abuse and mental health treatment integrated with patients’ primary medical care.

Karasic pioneers advances in trans health

“The pattern of use varies and the real issue is whether patients can take their antiretrovirals as prescribed. We find that some patients are able to start taking antiretrovirals very reliably before they are able to decrease or stop their stimulant use, which often requires more complex behavioral, emotional, interpersonal and environmental changes. Being in an HIV primary care setting allows us to engage stimulant users even if they are not ready to go to specialty substance abuse programs or support groups,” said Valerie Gruber, PhD, STOP director and UCSF professor of psychiatry.

From his stint as a trainee at a VA hospital in Los Angeles in the 1980s, where he advocated for equal care for people with AIDS, drawing blood when hospital staff wouldn't, to recent times when he promoted a more modern view of transgender health within the psychiatric field, Karasic has gained the admiration of colleagues.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS242

For some parents, Mother’s Day (or Father’s Day) is awkward DECEMBER 6, 2016

JUNE 22, 2017

For his entire career, Dr. Dan Karasic, a psychiatrist, has fought for equal rights for people marginalized by society.

Chosen earlier this year to chair the 2017 inaugural World Professional Association for Transgender Health-sponsored conference aimed at U.S. membership, Karasic has a long list of awards and accolades, including the 2012 UCSF Chancellor's Leadership Award for LGBT Health.

A past president of the Association of Gay and Lesbian Psychiatrists, Karasic leads a peripatetic personal life, commuting on weekends to Los Angeles where his husband of seven years, Ryan Thomson, is a Hollywood talent manager.

Trans scholar Jamison Green, Ph.D., a past president of WPATH, said in a phone interview that Karasic was "one of the first psychiatrists to be active helping support human rights for the transgender community."

Many parents with young kids struggle, at least to some extent, with how to observe Mother’s Day and Father’s Day. Some, such as Cameron Smith, think of them as “Hallmark card holidays” that don’t merit a celebration.

"Dan really helped elevate us outside of city hall in our push to obtain services, rights, and protections," said Green, a longtime consultant and policy adviser on trans issues.

Within the LGBT community, Karasic "advanced the inclusiveness of the T," he added.

But additional ideological, logistical and cultural issues surrounding these holidays come into play for these men now that they are same-sex parents. And the “other holiday” can take on a melancholy tinge when a child doesn’t have a mother or father to fete.

"Not only did Dan step up, but he has always been very conscientious about not speaking for us, but letting transgender people speak for themselves," Green said. "Dan clearly understood the traumas, pressures, and marginalization we have experienced and, without ever saying as much, always makes sure we know we are valued."

“Father’s Day gets harder as the kids get older,” says Danielle Ramo-Larios, an assistant professor at University of California, San Francisco School of Medicine and mother of three with her wife, Sandy. “We get a lot more questions now that they hear about it from school, commercials and store displays.”

Soft-spoken and reserved, Karasic does not like to talk about his accomplishments, but when pressed during an interview at his office at the UCSF Alliance Health Project, he acknowledged being proud of his efforts to "depathologize trans identity" by pushing for reform of the Diagnostic and Statistical Manual of Mental Disorders diagnosis from "gender identity disorder" to "gender dysphoria." The latter refers to the distress a person experiences as a result of the sex and gender they were assigned at birth.

Ramo-Larios and her wife “want Mother’s Day to be about the spoiling of the parent,” but with two mothers and three young kids, “to try to have a holiday that focuses on both parents individually has become absurd.”

Moreover, “same-sex parents don’t have any models on how to make that day work,” she says. “Do we focus on half a day for each parent? Just give up on the idea of being treated and have a family celebration? Do we get each other gifts? Do we both separately organize the kids to make things for the other mother? Or do we just say that’s too much work on a day that’s supposed to be relaxing for us?”

Ramo-Larios considered splitting the holidays, “but it brings up a whole other set of issues that may be confusing for the kids and invalidating for us.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS531

He also cited his work advocating for the right to correct legal identification documents without surgery or other onerous restrictions, and in fostering communication between trans health advocates and health professionals.

Currently a health sciences clinical professor of psychiatry at UCSF, Karasic co-leads the gender team at AHP; is the psychiatrist for the Transgender Life Care Program and the Dimensions Clinic at the Castro-Mission Health Center; works with trans and HIV-positive people at Zuckerberg San Francisco General Hospital; and trains health care providers in trans health.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS278

NEUROSCIENCE

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Give your brain a chance to play once in a while OCTOBER 26, 2016

If Dr. Adam Gazzaley had his way, doctors would stop using primarily prescription drugs to treat neurological issues and disorders on older patients and start prescribing video games.

The professor of neurology, physiology and psychiatry and director of the Gazzaley Lab at the University of California, San Francisco, has spent years learning with his research team how the brain’s ability to remember, focus and perceive the world changes with childhood development, normal aging and dementia as well as how to alleviate cognitive deficits.

Although prescription drugs can be part of treatment for cognitive health, Gazzaley —whose book The Distracted Mind: Ancient Brains in a High-Tech World (co-authored with Larry Rosen) was published by MIT Press in September — argues that better ways to treat patients exist without the potential side effects of drugs.

At the “Aging 2.0: Optimize” conference in San Francisco last week, Gazzaley said doctors must do a better job of understanding how experience affects and shapes brain activity.

“Experience is the gateway to our brain — and we understand how strong this relationship is,” says Gazzaley. For example, Post-Traumatic Stress Disorder can happen after an experience (“a powerful, horrible experience”) of witnessing a single event than can affect your brain and brain plasticity the rest of your life.

However, Gazzaley says, technologists and neuroscientists can build technology together to help maintain brain plasticity. He and his team have done so by building interactive games that can influence cognitive brain health in older adults.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS654

Can economic hardships shape how our brains work?

DECEMBER 6, 2016

Study finds brain structure governing emotion is passed down from mother to daughter JANUARY 26, 2016

We often attribute key characteristics to one of our parents: “He gets his athleticism from his father” or “Her quickness to anger—that’s all her mother.”

Whether the genetics are actually pulling the strings in these cases is another story. But a growing body of research has suggested that heredity does apply to mood disorders—including depression, which afflicts more than 2.8 million adolescents in the U.S. alone—and that there is compelling evidence hereditary ties are strong between mothers and daughters.

Researchers in a new study of 35 healthy families published in the Journal of Neuroscience have found that the brain’s corticolimbic system, responsible for the regulation of emotion—and associated with the manifestation of depressive symptoms—is more likely to be passed down from mother to daughter than from mother to son or father to child. This finding, which supports past evidence from animal research and clinical studies on depression, could provide a better understanding of the role genetics play in mood disorders and other conditions, allowing better identification of at-risk groups and preventive measures.

“Our study’s uniqueness,” says lead author Fumiko Hoeft, an associate professor of psychiatry at the University of California, San Francisco, “is that we’re the first one to get the whole family and scan both parents and offspring to look at how similar their brain networks are.”

“We can tell, even though the genetics are more complicated than we originally thought, who we got our eye color from. And we joke about inheriting stubbornness or organization—but we’ve never actually seen that in human brain networks before.

[This research] was a proof of impact, of using a new design that has significant potential.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS982

For 25 years, Kristine Yaffe, a psychiatrist at UCSF followed more than three thousand adults with different income levels and found that poverty does affect cognitive function. She says this is due to a concept called ‘cognitive reserve’.

“And what that means is the more you can grow your brain, the more you have education -- the more it is stimulated, the more complex your occupation is, the more complex your lifestyle activities are - your leisure activities.”

Yaffe says with that in mind, researchers can prevent cognitive diseases later in life.

“Using your brain in this way, we think may have a beneficial effect in terms of protecting against getting dementia and other kinds of processes that affect your memory and thinking.”  HEAR THE ENTIRE PODCAST EPISODE AT PSYCH.UCSF.EDU/NEWS363

A new way to study brain disorders APRIL 16, 2017

Researchers have found a new way to study brain disorders. Neurologist Lauren Weiss of the University of California, San Francisco is growing brain cells out of simple skin biopsies taken from patients with autism and other developmental problems.

“We can grow those cells in a lab and then turn them into stem cells, and ultimately into the cells of the brain. That’s a pretty amazing advance when you think about how challenging it is to study the human brain. Nobody wants to give you too much access to that.”

Obtaining living neurons is complicated and may raise ethical concerns. So this new method solves these problems by effectively growing brain cells in petri dishes.

“The technology has evolved very quickly. We are increasing the number of different types of neurons we can pretty consistently make in the lab."  HEAR THE ENTIRE PODCAST EPISODE AT PSYCH.UCSF.EDU/NEWS197

NEUROSCIENCE

Do brain-training exercises really work?

OCTOBER 26, 2016

A battle has been brewing over whether brain training really works, leaving consumers stuck in the middle, scratching their heads.

Many experts believe that brain-training programs are a waste of money. They roll their eyes at the idea that using such computerized programs can improve attention, memory or overall intelligence.

Some experts contend that brain training is useful and can improve cognition by harnessing the power of brain plasticity, the idea that our brains can learn new skills and adapt even later in life. They argue that there's a difference between "brain games" and research-backed "brain training."

Still other experts say that the brain-training industry is new, evolving and that it might be too soon to dismiss or champion the field.

Research has led to a "pivot point" where scientists can build upon all the lessons that have been learned in the industry, said Dr. Adam Gazzaley, a professor at the University of California, San Francisco and founding director of the Neuroscience Imaging Center.

"A major limitation in what we have seen so far is that in order to change the brain in a meaningful and sustainable way, despite the fact that it's plastic, you really have to engage it in a very deep way. We need to develop far more immersive therapeutic video games, in addition to doing better studies," he said.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS444

How video games can help us hack the brain DECEMBER 15, 2016

Technology is really a marvel. So often, as new advances come out that allow us to do things that were thought impossible in the past, we hear the phrase "The future is now."

Popular Science and XPRIZE are teaming up to explore and explain technologies like these in a video series called Future First.

Episode thirteen of Future First is titled "Brain Hacking With Video Games." In it, we take a look at how new technologies—including virtual reality—help us to track activity within the human brain in real time, how different experiences affect different parts of the brain, and how we can use that information to further our knowledge of the mind.

Helping to lead the discussion is Adam Gazzaley, MD, PhD, director of the Gazzaley Lab at the UCSF Neuroscience Imaging Center.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS137

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UCSF team wins $26 million grant to build brain implant MAY 27, 2014

A team led by UCSF neuroscientists has won federal funding to build an implantable brain device that would record and analyze live electrical signals, then alter them to retrain the brain to recover from mental illnesses like depression and post-traumatic stress disorder.

The funding comes from a U.S. Department of Defense agency that is focused on improving understanding of brain disorders, including illnesses that often affect service members and veterans, and developing new engineering-based treatments.

The UCSF team - which includes scientists from UC Berkeley, Lawrence Livermore National Laboratory, and Cornell and New York universities - will receive up to $26 million for the project. The funding is part of $100 million set aside by President Obama for his national Brain Initiative announced in April 2013.

"Our understanding of the brain is very incomplete. We need to move much faster to get to a much higher level of sophisticated understanding," said Dr. Edward Chang, a neurosurgeon who is leading the UCSF team. "We're taking a big leap forward with this project. How do you build an intelligent device that interacts with the brain? That's never been worked out before."

The UCSF group is charged with developing a neuro-prosthetic device that would allow scientists for the first time to record electrical activity from multiple parts of the brain simultaneously and at a very fine resolution. Currently, technology doesn't exist to record that much information, or to process it in a way that is meaningful to scientists.

A recording device alone would be profoundly useful toward improving understanding of how the brain operates on a network level - like building a "Hubble telescope" for studying the brain, said Dr. Vikaas Sohal, a UCSF psychiatrist who's part of the brain device team.

"We build these devices and are able to see something no one has ever seen before," Sohal said. "By doing that, we're almost guaranteed to discover something new and important."

For neuropsychiatric disorders like depression, scientists have a fair understanding of what parts of the brain are affected by illness, Sohal said. In patients with depression, for example, advanced imaging equipment has shown which areas are over-activated and which ones are under-activated. But doctors don't know how those regions are communicating, or what they're saying.

"It's like a TV show where all you have are snapshots. We know who the actors are, but we don't know what they're saying to each other, and we don't know who the villains are or who the heroes are," Sohal said. "That's very analogous to where we are right now with the brain."  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS501

An expert’s baby-step guide from multitasking to single-tasking MAY 5, 2017

Multitasking is more stressful than doing one activity at a time. It’s also less productive and, technically, not even possible. What looks like several simultaneous actions is really a series of frantic cognitive switches in the brain, each slurping from the same reserves of oxygenated glucose that we need to complete the tasks at hand.

It’s a terrible idea.

Yet we persist. Multitasking has in its corner our natural aversion to boredom and anxiety, neuroscientist Adam Gazzaley of the University of California, San Franscisco, said recently at the Fortune Brainstorm Health conference in San Diego. It feels fun, even if it’s draining our cognitive reserves. But if you need to produce high quality work in a limited amount of time, single-tasking is the way to go.

Gazzaley offered a three-step plan to baby-step one’s way from distraction to focus.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS924

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Overlooked cells may hold keys to brain organization, disease APRIL 29, 2014

Scientists studying brain diseases may need to look beyond nerve cells and start paying attention to the star-shaped cells known as “astrocytes,” because they play specialized roles in the development and maintenance of nerve circuits and may contribute to a wide range of disorders, according to a new study by UC San Francisco researchers.

In a study published online in Nature, the researchers report that malfunctioning astrocytes might contribute to neurodegenerative disorders such as Lou Gehrig’s disease (ALS), and perhaps even to developmental disorders such as autism and schizophrenia.

David Rowitch, MD, PhD, UCSF professor of pediatrics and neurosurgery and a Howard Hughes Medical Institute investigator, led the research.

The researchers discovered in mice that a particular form of astrocyte within the spinal cord secretes a protein needed for survival of the nerve circuitry that controls reflexive movements. This discovery is the first demonstration that different types of astrocytes exist to support development and survival of distinct nerve circuits at specific locations within the central nervous system.

Astrocytes vastly outnumber signal-conducting neurons, and make up the majority of cells in the brain. But where neuroscientists are accustomed to seeing only vanilla when it comes to astrocytes – viewing all of them as similar despite their different locations in brain and spinal cord – they now will have to imagine “31 flavors” or more.

There might even be hundreds of distinctive varieties of astrocytes performing specific functions in different locations, according to Rowitch, chief of neonatology for UCSF Benioff Children’s Hospital San Francisco.

“Our study shows roles for specialized astrocytes that function to support particular kinds of neurons in their neighborhood,” Rowitch said.

Have you ever heard of a mini-brain?

APRIL 26, 2017

Want to know how our brain is formed and what causes changes in its structure? You could look at a mini-brain…this is emerging 3D technology created from stem cells.

“Mini brains allow you to ask some questions that are more challenging to ask about a single cell essentially in isolation, vs. what happens when cells are moving in a threedimensional space and interacting with each other in three-dimensions as well.”

Led by Rowitch lab postdoctoral fellow Anna Molofsky, MD, PhD, the researchers studied the spinal cord sensory motor circuit, which allows both mice and humans to react without thought – to jerk a limb away from something hot, for instance.

The team discovered that a protein called Sema3a is produced much more abundantly by astrocytes close to motor neurons than by astrocytes from other regions in the spinal cord. They concluded that motor neurons required this source of Sema3a from the local astrocytes, because when Sema3a production was blocked, the motor neurons failed to form normal connections, and half of them died.

Motor neurons also die in ALS, a fatal neurodegenerative disease, and in spinal muscular atrophy, a disease that can affect newborn infants. In other studies, scientists have found that abnormal astrocytes can have toxic effects on motor neurons.

Molofsky is a psychiatrist who studies how astrocytes organize nerve circuits, and how disruptions of these nerve circuits during development or disease may involve abnormal astrocyte function. Disrupted neural circuits are believed to be responsible for certain psychiatric disorders.

“The immediate implications of this study are for diseases of motor neurons, but I think our findings might also apply more generally to diseases of neural-circuit formation in the brain such as autism, schizophrenia and epilepsy,” Molofsky said. “To achieve a comprehensive understanding of how neural circuits form and are maintained, it seems important that we integrate knowledge of how astrocytes support that process.”

Rowitch agrees. “To the extent that psychiatric or neurological disease is localized to a specific part of the brain, we should now be considering the potentially specialized type of astrocytes regulating nerve connections in that region and their contributions to disease,” he said.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS822

That’s neurologist Lauren Weiss of the University of California, San Francisco. She has been studying brain disorders in the lab by looking at neurons grown from skin cells.

Weiss says a mini brain is the next step in research because it re-creates the structure of a real brain.

“It is layers of cells that have different kinds of structures and functions, ultimately.”

Using mini-brains Weiss hopes to study micro- and macrocephaly, autism and other developmental disorders.  HEAR THE ENTIRE PODCAST EPISODE AT PSYCH.UCSF.EDU/NEWS412

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Studies skewed by focus on well-off, educated brains OCTOBER 16, 2017

Brain imaging studies have a diversity problem.

That's what researchers concluded after they re-analyzed data from a large study that used MRI to measure brain development in children from 3 to 18.

The idea that the brain tends to develop earlier toward the back and later toward the front is "more consistent with our broader understanding of brain development," LeWinn says. And it is one reason many brain scientists argue that judgment and impulse control are not fully developed until people reach their 20s.

Like most brain imaging studies of children, this one included a disproportionate number of kids who have highly educated parents with relatively high household incomes, the team reported Thursday in the journal Nature Communications.

The study is a reminder that the brains of children from different backgrounds can develop differently, LeWinn says. "The brain is really responsive to experience," she says.

"That's something we need to pay attention to."

For example, parents of study participants were three times more likely than typical U.S. parents to hold an advanced degree. And participants' family incomes were much more likely to exceed $100,000 a year.

The results also offer a reminder that brain imaging studies tend to attract an atypical group of people. Participants are likely to live near a major university, where the studies are usually conducted, LeWinn says. They are also "more likely to be white, more likely to be high income, more likely to have more education, and they may have different social networks," she says.

So the researchers decided to see whether the results would be different if the sample represented the U.S. population, says Kaja LeWinn, an assistant professor at UC San Francisco ‘sSchool of Medicine. "We were able to weight that data so it looked more like the U.S." in terms of race, income, education and other variables, she says.

And when the researchers did that, the picture of "normal" brain development changed dramatically. For instance, when the sample reflected the U.S. population, children's brains reached several development milestones much earlier.

One of these milestones involved the total surface of the brain's cortex, which plays a key role in in memory and thought. The unweighted data showed that this surface area continued to increase until after a child's 12th birthday. The weighted data showed a much earlier peak — before age 10.

Unweighted data also showed several areas in the front and back of the brain developing at the same time. But the weighted data showed a different pattern. Areas toward the back of the brain, which do things like process visual information, developed first.

Meanwhile areas toward the front of the brain, which are involved in thinking and judgment, developed later.

This study doesn't look at what those differences might mean for children's emotional and intellectual development. The key point is rather that researchers should make sure that they're looking at a representative sample when they're defining "normal."

One reason for these differences is that university-based studies tend to attract people who have ties to the school. "Many of the studies we use to understand how the brain works included mostly college students," she says.

It's unrealistic to expect that every brain imaging study sample represents the full range of U.S. residents, Le Winn says. But even small studies should do a better job disclosing the characteristics of people being studied. And larger studies should consider weighting the results to more accurately represent the nation's population, she says.

At least one big study is already trying to address the diversity issue.

The federally funded Adolescent Brain Cognitive Development (ABCD) study is in the process of enrolling 10,000 children ages 9 and 10. Researchers plan to track participants until they become adults using brain imaging as well as information about sleep, attention, substance use, physical activity and sports injuries.

And to make sure the participants reflect the U.S. population, researchers are taking steps to enroll children of diverse races and ethnicities, education and income levels, and living environments.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS443

Cell mapping initiatives aim to uncover hidden disease pathways NOVEMBER 15, 2017

“At the cellular level, I see no distinction between being infected with HIV and having cancer,” says Nevan Krogan, PhD, director of the Quantitative Biosciences Institute (QBI), professor of cellular and molecular pharmacology at UC San Francisco and a senior investigator in the academically affiliated Gladstone Institutes.

The PCMI immediately faces several challenges in mapping gene pathways in psychiatric disorders – these disorders are numerous and diverse; they can develop over many years or even decades; and they involve the human brain, which is arguably the most complex object in the universe.

His insight is that nearly all diseases are fundamentally mechanical problems at the level of our genes and the microscopic protein machines they produce and regulate. The challenge is that the vast number of genes and proteins in human cells can influence one another in complex, hard-to predict ways.

“One of the challenges in psychiatric disorders is that there’s little agreement over what the underlying pathological mechanisms are, which complicates diagnosis and development,” Willsey said. “Protein and genetic interaction mapping could open that black box to find how genetic risk factors actually cause psychiatric disorders, potentially revealing therapeutic targets.”

Currently, researchers tend to study the genes and proteins responsible for disease in isolation, but they are missing the big picture, Krogan believes.

Armed with complete maps of how genes and proteins interact in human cells, researchers could finally see how dozens of seemingly unrelated genes and proteins involved in a disease are in fact all part the same interconnected biological pathway. What’s more, increasing evidence suggests that the same defective biological pathways may be involved in disorders as different as autism and cancer.

Based on this unifying framework for understanding human disease, researchers at QBI, under Krogan’s leadership, along with colleagues at UC San Diego and UC Berkeley, have founded three ambitious map-making initiatives that aim to reshape three major pillars of human medicine: infectious disease, cancer and psychiatric disorders.

Most recently, Krogan has teamed up with Jeremy Willsey, PhD, an assistant professor with the UCSF Institute for Neurodegenerative Diseases, and Matthew W. State, MD, PhD, professor and chair of psychiatry at UCSF, to found the Psychiatric Cell Map Initiative (PCMI).

Willsey and State, both members of the UCSF Weill Institute for Neurosciences, have already made rapid progress unraveling the genetic basis of psychiatric disorders including autism and Tourette Disorder by looking for extremely rare mutations presented in affected children but not unaffected relatives. These mutated genes act as a starting point from which to explore what other related cell systems and pathways may play a role in the disease.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS702

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Ben Cheyette explores the biological basis of psychiatric disorders DECEMBER 21, 2016

Ben Cheyette has been interested in the brain and behavior ever since his high school days, even going so far as to explore these interests while working as an usher at his local movie theater.

“I was the only usher working there who, in the ticket booth during the off hour, was reading Scientific American about some of the latest neuroscience at that time,” Cheyette said. “I was a little bit of a nerd.”

Fast-forward to today, where Cheyette is an associate professor of psychiatry at the University of California, San Francisco. His research involves looking at how lithium, which has been used to treat people with bipolar disorder, affects the brain and impacts behavior.

In the October edition of Molecular Psychiatry, Cheyette and his coauthors published the results of a study showing that people with psychiatric disorders, such as autism, schizophrenia, and bipolar disorder, were more likely to have rare single point mutations in a gene called DIXDC1. When he eliminated or reduced the DIXDC1 gene, he found that mice developed behavioral abnormalities, and he was able to reverse these effects by treating the animals with lithium.

UCSF study first to use brain scans to forecast early reading difficulties OCTOBER 1, 2014

UCSF Psychiatry researchers have used brain scans to predict how young children learn to read, giving clinicians a possible tool to spot children with dyslexia and other reading difficulties before they experience reading challenges.

In the study, published online in Psychological Science, the group examined brain scans of 38 kindergartners as they were learning to read formally at school and tracked their white matter development until third grade. They found that the developmental course of the children’s white matter volume predicted the kindergartners’ abilities to read.

“Early identification and interventions are extremely important in children with dyslexia as well as most neurodevelopmental disorders,” said senior author Fumiko Hoeft, MD, PhD. “Accumulation of research evidence such as ours may one day help us identify kids who might be at risk for dyslexia, rather than waiting for children to become poor readers and experience failure.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS578

Will doctors soon prescribe video games?

JULY 10, 2014

Feeling anxious, depressed, fearful, or unable to focus? Is your memory getting fuzzy?

Medication might help. Therapy might help. And someday soon – according to neuroscientists, game designers, and drug makers – you might be prescribed a videogame that helps as much as (or more than) either.

In September 2013, a group led by Adam Gazzaley, a cognitive neuroscience researcher at UCSF, published a landmark paper in the prestigious scientific journal Nature. A study they had conducted showed that playing a specially designed driving game called Neuroracer arrested age-related cognitive decline in senior citizens, improving memory, attention, and the ability to multitask.

Boston-based game maker Akili Interactive Labs – with Gazzaley as an advisor and funding from drug maker Shire – is developing a tablet-based game based on the Neuroracer platform, called EVO. Rather than driving and noticing road signs, in EVO players explore foreign worlds, collecting stars, gems, and alien specimens.

The game is currently being deployed in about a half dozen clinical trials, testing its effectiveness for improving function in kids with ADHD (in collaboration with Shire) and autism, treating depression (with the National Institutes of Health), and detecting early signs of Alzheimer’s disease (with Pfizer).  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS785

One of Cheyette’s most important findings was that he was able to show what was happening in the brain of the mice. When the gene was eliminated or mutated, this led to changes in the dendritic spines of the mice’s neurons, which are thought to be one of the major substrates for behavioral adaptability, such as learning and memory. These changes were mediated by the Wnt signaling pathway, which had previously been shown to impact behavior in mice. Finally, Cheyette was able to reverse the behavioral changes in the mice without the gene by treating them with lithium, which boosts Wnt signaling.

For years, many psychiatrists thought that behavioral disorders like bipolar disorder and schizophrenia were controlled by different mechanisms. However, Cheyette noted that this view is starting to become less popular due to advances in gene sequencing.

“There is a lot of overlap at the genetic level between some psychiatric disorders that seem very distinct in terms of the behavioral syndrome we see in the clinic,” Cheyette said.

He noted that this research opens to door to advances in precision medicine, where a patient’s gene can be sequenced to find mutations that give rise to a psychiatric disorder. The treatment could then be tailored to those specific biological and nonbiological causes.

“The approach of identifying specific genes involved in each patient, referred to as precision medicine, is what is now being done with cancer, and the future of psychiatry is going to be similar since fundamentally the problem is similar,” Cheyette said.

In addition to his research, Cheyette spends one day a week seeing patients at the UCSF Hospital, and he recently published a book with his wife, a pediatric neurologist, and another co-author about treating ADHD using athletic coaching techniques.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS168

Rob Reid and Adam Gazzaley on putting the science in sci-fi MAY 15, 2017

Two of our speakers at GamesBeat Summit 2017 really embodied the confluence of tech, science fiction, and games. Rob Reid, founder of Listen.com and author of science fiction novels such as the upcoming After On, held a fireside with Adam Gazzaley, brain researcher at UCSF and co-founder of Akili Interactive Labs.

Their talk was entitled, “Putting science into science fiction. Literally – and literarily!”

Reid goes to great pains to see that his “speculative fiction” is grounded in science. He regularly talks with Gazzaley about the brain, and that helped Reid write his upcoming novel After On, which grapples with issues of digital consciousness.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS857

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Despite high risk, patients with severe mental illness rarely tested for diabetes NOVEMBER 9, 2015

Although adults with serious psychiatric disorders are at high risk for diabetes, a large study led by UC San Francisco reveals that low-income patients on Medicaid are rarely screened for it. The findings support growing efforts to integrate mental health services and primary care to improve diagnosis and treatment of medical issues associated with mental illness, the researchers said.

An integrated health care system allows mental health and medical records to ‘talk’ to each other, an essential asset for patients with mental illness, who may be unable to communicate clearly. If the physician could access mental health records, they could see the diagnosis and prescription and immediately understand the risk of diabetes, Mangurian said. This is especially important for young patients.

Individuals with severe mental illness (SMI) are two to three times more likely to have type 2 diabetes than the general population. Many factors contribute to the increased risk, and treatment with antipsychotic medication raises the risk even further. The American Diabetes Association and American Psychiatric Association both recommend that providers do annual diabetes screening for any patients taking antipsychotic medications, but until now it has been unclear how often screenings actually occur.

“The young adults who develop a psychotic illness in college or high school—they are the ones I’m worried about,” Mangurian said. “Diabetes in a young adult is not on a primary care doctor’s radar. These doctors need to learn that if their patient has a diagnosis of schizophrenia or is taking an antipsychotic medication, they are at increased risk.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS733

The new study examined diabetes screenings in a cohort of 50,915 publically insured adults with SMI who were taking antipsychotic medication. The researchers found that more than 70 percent did not receive a diabetes-specific test. However, those who had at least one primary care visit in addition to mental health services were twice as likely to be screened.

“Our healthcare system is fragmented for people with mental illness. For example, the mental health electronic medical record is totally separate from their primary care electronic record, truly limiting the quality of care this vulnerable population can receive,” said Christina Mangurian, MD, MAS, associate professor of clinical psychiatry at the UCSF School of Medicine and lead author of the study. ”As a community psychiatrist, I see so many people who are untreated or under-treated for physical health problems because of this lack of integration.”

In general, these people are dying of premature cardiovascular disease, she continued.

They tend to smoke cigarettes, hardly exercise, and may deal with food insecurity as a result of poverty. On top of that, their antipsychotic medication disrupts metabolic function, causing them to gain weight rapidly, which can lead to insulin resistance and diabetes.

The study, published in the Journal of the American Medical Association Internal Medicine, is the first to examine diabetes screening in this high-risk population served in community mental health clinics. In an effort to integrate primary care and mental health, the California Department of Health Services’ Data and Research Committee combined public mental health and medical records during a State Quality Improvement project, allowing the researchers to compare individuals across the two datasets.

They retrospectively identified 50,915 adults diagnosed with serious mental illness who were prescribed antipsychotic medication during two study periods: January 1, 2009 through December 31, 2009 and October 1, 2010 through September 1, 2011. Then, they examined the medical records to determine whether the patients received diabetes-specific screening, non-specific screening or no screening.

About 30 percent received a diabetes-specific screening and about 30 percent received no medical tests at all. Patients who had at least one primary care visit were more than twice as likely to be screened for diabetes as those who did not.

Integrated health care would make it easier for patients to get screening and treatment, said study co-author Penelope Knapp, MD, professor of psychiatry and behavioral sciences at UC Davis.

American Heart Association says high blood pressure linked to higher risk of cognitive impairment OCTOBER 10, 2016

High blood pressure is associated with an increased risk of cognitive impairment later in life, according to a new American Heart Association statement.

Published in the American Heart Association journal Hypertension, the statement is based on multiple studies and explains how high blood pressure influences brain diseases such as stroke, Alzheimer’s disease and vascular cognitive impairment (a range of changes in brain function, from mild to severe, caused by the impaired flow of blood to the brain).

“We know treating high blood pressure reduces the risk of heart diseases such as heart attacks, congestive heart failure and stroke, and it is important to continue treating it to reduce the risks of these diseases,” said Costantino Iadecola, MD, chair of the writing committee. UCSF’s Kristine Yaffe, MD, also served as a member of the committee.

“However, we need randomized controlled studies — which prove cause and effect — to determine if treating high blood pressure, especially in middle age, will also decrease the risk of cognitive impairment later in life.”

“We can do better,” she said. “It’s really important for individuals with medical and mental health problems to have their health care in one system. It’s a no brainer that these should be integrated.”

Years can elapse between when a person has high blood pressure and when the cognitive problems arise. So it’s difficult to address questions such as when to start treatment to protect the brain, the level of blood pressure that should be achieved and which medications are recommended.

There are many factors that could explain why the majority of SMI patients in this study were never screened for diabetes, Knapp said. The study examined people with Medicaid, a program that provides health and medical services for low-income individuals and families. Although federally qualified health centers provide both primary care and mental health services, there are barriers.

Dementia, one of the most common neurological disorders, affects 30 to 40 million people worldwide. The number of people with dementia is anticipated to triple worldwide by 2050 due to the aging of the population, shifts in demography and lack of treatments — with an associated cost exceeding $1.1 trillion.

“One of the barriers for not-so-wealthy people is that they can’t see two providers on the same day. If the psychiatrist prescribes antipsychotics, that person may not be able to take off work another day for a follow up appointment with a physician,” Knapp said.

Alzheimer’s disease and vascular cognitive impairment are the causes for about 80 percent of cognitive impairment cases. Often, patients suffering from dementia have both.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS170

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Are cities bad for mental health?

JULY 4, 2017

You may have missed it, but 2011 was a watershed year for the human species. That year, for the first time in history, more than half of the world's human population lived in urban areas. And the number is expected to rise to two-thirds by 2030, according to a study published in the journal Epigenetics. “This increased urbanity of the world's population has substantial public health implications,” the study authors write.

Including for mental health.

The notion that city living is bad for mental health has been around almost as long as cities have. Researchers have linked urban living with psychotic illnesses like schizophrenia since at least the 1930s. According to the authors of the Epigenetics study, “Nearly a century of research has shown higher risk of mental disorder among persons living in urban versus rural areas.” They note research that has found links between certain features of the urban environment, such as “concentrated disadvantage, residential segregation and social norms,” that contribute to the risk of mental illness.

But if urban environments are bad for mental health, why do so many urbanites not only survive but actually thrive when living in cities? That is a question that dominates the research of Dr. Jacob Izenberg, a psychiatry resident at the University of California, San Francisco. And he has found that the question “is extraordinarily complicated.”

“This field of understanding is still in development,” Izenberg says. “There are a number of potent pathways between any environment and mental health.”

For instance, he says a lot of research is currently exploring how an environment, be it natural or man-made, affects the quality and extent of social networks: “How do cities either facilitate or undermine strong communities?” he asks. That, more than the environment itself, may be behind mental health or illness.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS415

For many in low-income situations, parent-child relationship is key to health DECEMBER 16, 2016

Educators, health care providers and researchers have known for some time that low socioeconomic status is connected to poor health, including in children, but a new study led by a UCSF psychologist has shed light on what can be done to protect young people from negative outcomes.

The keys? A more positive parent-child relationship as well as the child’s own ability to manage his or her response to stressful situations, according to research published last month in the journal Psychosomatic Medicine.

“In pediatricians’ offices or in school nurses’ offices, people often talk about what things in the environment can mitigate negative physical health impacts, and here we find that there are actually aspects of parenting that can be protective,” said Melissa Hagan, PhD, lead author and an assistant adjunct professor with the UCSF Department of Psychiatry's Division of Infant, Child and Adolescent Psychiatry at Zuckerberg San Francisco General Hospital and Trauma Center. She is also an assistant professor of psychology at San Francisco State University.

The results have implications not just for parents but for health-care providers and educators, who often play key roles in the well-being of young children.

Hagan and her colleagues surveyed the general health of 338 kindergarteners from diverse backgrounds throughout the San Francisco Bay Area at both the beginning and end of the school year. They found that those from low socioeconomic households generally had poorer health in the spring than classmates from higher-income households.

Discovering that it took less than a year for such health disparities to manifest was dramatic in itself, but the research also provided some clues as to how they could be avoided. The researchers also asked parents to describe their relationship with their child, and found that the absence of a “negative” parent-child relationship — for example, the parent describing the child as disappointing or reporting a lot of conflict with their child — helped reduce negative health outcomes in children from low socioeconomic backgrounds.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS303

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San Francisco public housing type a strong predictor of kids’ use of emergency rooms DECEMBER 9, 2014

San Francisco children living in non-redeveloped public housing are 39 percent more likely to repeatedly visit emergency rooms, according to new research from UC San Francisco and UC Berkeley.

“The average emergency department (ED) visit costs two to five times more than an office visit, and many children visit EDs for potentially preventable reasons,” said Nancy Adler, PhD, senior author of the research, and vice chair of the Department of Psychiatry and director of the Center for Health and Community at UCSF. “There is a clear need to better understand the range of social and economic factors that lead to these high visit rates, and understand the link between housing and health.”

The paper, "San Francisco Children Living In Redeveloped Public Housing Used Acute Services Less Than Children in Older Public Housing," appears in the December issue of the journal Health Affairs.

The researchers looked at the number of children under age 18 with public insurance who sought emergency care from any of three large San Francisco medical systems including San Francisco General Hospital, UCSF Medical Center and Sutter Health, and linked that information to whether they lived in non-redeveloped public housing, redeveloped HOPE VI public housing, or nonpublic housing the same neighborhood as public housing.

HOPE VI is an initiative by the U.S. Department of Housing and Urban Development to revitalize the worst public housing projects in the United States into mixed-income developments.

From 1998 to 2006, the San Francisco Housing Authority revitalized five obsolete public housing sites with 1,149 units of new public and affordable housing with 2,607 bedrooms. Eight more sites are planned under the City’s HOPE SF Program.

“Low-income children living in redeveloped HOPE IV public housing were less likely to have repeat visits to the emergency room than their peers living in older public housing,” said Adler. “This suggests that investing in physical infrastructure may not only provide better housing but also foster better health among children and reduce spending on acute care services.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS800

The vortex of poverty: How economic status impacts health care decisions and health care marketing strategy MARCH 7, 2017

There is perhaps no bigger contributing factor to one’s health and life expectancy than poverty. Today, we are seeing the impact among those in lower socioeconomic groups in urban and rural areas.

According to a 2016 study in the medical journal JAMA, the difference in life expectancy between the poorest and most wealthy Americans is between 10 and 15 years. There are several contributing factors. At the very top of the list are those living in poverty struggling to meet basic needs, even with government assistance programs like Medicaid.

Research has demonstrated that poor health can be linked to everything from where one lives to the ability to exercise and eat well. Those living in low-income neighborhoods are also in areas with underperforming schools, high crime rates and a high preponderance of food deserts, which offer no access to healthy foods.

“It’s difficult to exercise in an unsafe neighborhood, or to eat well in a neighborhood where healthy foods are either not sold or are more expensive than unhealthy options,” explains Nancy Adler, director of the Center for Health and Community at the University of California, San Francisco.

Yet, the vortex of poverty is mainly generational in nature. If your grandparents lived in poverty, it’s likely that your parents did, too, making it more likely that the current generation will live in poverty, as well.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS932

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Burned out trainee surgeons at high risk for alcohol abuse, depression, suicidal thoughts OCTOBER 26, 2017

Seven out of 10 trainee surgeons surveyed experienced burnout driven by emotional exhaustion, “depersonalization” and doubts about their effectiveness at work, impacting their own performance and potentially patients’ health, according to a study by UC San Francisco.

Burnout among trainee surgeons greatly increases the risk of high anxiety, depression and thoughts of suicide, said researchers of the study, published in the Journal of the American College of Surgeons on October 26, 2017.

The UCSF team analyzed responses to an online, confidential survey of 566 surgical residents enrolled in accredited general-surgery programs throughout the United States. Respondents answered questionnaires measuring burnout, stress, anxiety, depression, and alcohol use, as well as resilience and mindfulness, which is characterized by attention, present focus, awareness and non-reactive acceptance.

Researchers led by first author Carter Lebares, MD, assistant professor in the UCSF Department of Surgery, and senior author Elissa Epel, PhD, professor in the UCSF Department of Psychiatry, found that 68.95 percent experienced high burnout, comprised of emotional exhaustion and depersonalization, which can manifest as feeling detached from patients or becoming more cynical in general. Moderate to severe depressive symptoms were identified in 20 percent of the residents, approximately twice as high as in the general age-matched population. Suicidal thoughts were present in 11 percent of the residents, more than three times higher than in the general population.

“Surgical trainees live in a culture where high stress is normative, but excessive stress must be addressed,” said Lebares, noting that 53 percent of residents scored positive for high perceived stress. “While surgical trainees have willingly chosen a high-stress career, the existence of overwhelming stress is evidenced by the strong association between stress and distress symptoms like depression, suicidal thoughts and high anxiety.”

The study found that close to half the residents – 49 percent – misused alcohol, more than five times the prevalence of misuse found in the general population. Alcohol abuse or dependence was found in 33 percent of the residents, twice as prevalent as in practicing surgeons. Among female residents, who composed 51 percent of the respondents, levels of depersonalization were lower: 51 percent compared with 62 percent in males; but alcohol misuse and abuse were higher among women: 58 percent and 41 percent respectively, versus 40 percent and 26 percent in men.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS256

Low-cost preventative care may help heart health for people with serious mental illness SEPTEMBER 1, 2017

People with serious mental illness, such as bipolar disease and schizophrenia, die on average 25 years earlier than their peers. A common cause of death is heart disease that frequently develops unchecked due to lack of preventive care.

Christina Mangurian. MD, MAS, from UC San Francisco’s Department of Psychiatry, has identified one cost-effective way to ensure that this population receives frequent cardiovascular screening: an evidence-based integrated care model that leverages technology.

In her study published in the journal Psychiatry Online on Sept. 1, 2017, Mangurian calculated that it would cost $74 per patient, per year, to test for and treat common illnesses that put people at risk for heart disease.

“People with serious mental health illness use primary care far less than the general population, but more than half of them regularly access community health services,” she said.

“The costs associated with treating cardiometabolic disorders are much higher than the costs of preventing them,” Mangurian said. “An estimated 20 percent of U.S. adults with serious mental illness have diabetes, but 70 percent are not screened. This model represents a financially feasible means of avoiding very high downstream costs.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS883

Mindfulness apps aim to help people disconnect from stress OCTOBER 16, 2017

From fires and hurricanes, to confrontational politics — with all that's been going on, it's no wonder the American Psychological Association found an increase in Americans' stress levels over the last year.

Our constant checking of smartphones — with the bombardment of news and social media — can amp up our anxiety. So, why not use your device to help you disconnect?

Mindfulness apps, such as Simply Being, are an increasingly popular way to help manage stress. Using this app, you can tap into a soundtrack of soothing sounds to help clear your mind. (Cue babbling brook, singing birds, meditation gongs!)

The idea behind mindfulness is simple to explain, but hard to execute. The goal is to focus on the present moment, and to let go of regrets of the past or worries about the future. And some researchers say apps can be a useful tool to assist this practice.

"I think they can be helpful," says Dr. Stuart Eisendrath, a psychiatrist at the University of California, San Francisco who researches Mindfulness-Based Cognitive Therapy.

"There are a variety of apps out there," Eisendrath says. "Some of them are just simple meditation timers" to help users stay focused for a specific period of time. The UCSF Student Health and Counseling Center lists several of these apps, including Zazen and I-Qi, on its Mindfulness Meditation website.

Some of the documented benefits of mindfulness meditation, according the UCSF site, can include better management of chronic pain, an increase in self-awareness, improved digestion and higher immune function.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS136

Haack among GloCal fellows getting into the trenches for global health research SEPTEMBER 5, 2017

They are bright and creative investigators, highly committed to improving world health, but what makes some UCGHI GloCal Health fellows special is their street smarts and ability to get into tough communities and engage the people hardest hit by physical and social ills.

Since 2012, the UCGHI GloCal Health Fellowship program has placed and trained 71 young researchers in Africa, Asia and Latin America to tackle a wide range of public health issues – from HIV, malaria and diabetes to water contamination, family planning and mental health. Another 12 began their international research in July. The fellowships are sponsored by the Fogarty International Center, which is part of the National Institutes of Health.

Fellows from UC campuses and affiliated countries spend nearly a year with UC research partners in low- and middle-income countries. “Among the goals of the program is to strengthen global health networks and build countries’ capacity to tackle their most pressing health issues,” said Craig Cohen, MD, MPH, co-director of UCGHI and director of the GloCal Health Fellowship program.

In Culiacán, Mexico, the largest city and capital of the northwestern state of Sinaloa, 2016-17 GloCal Health Fellow Lauren Haack, PhD, worked with educators and parents of children with attention and behavioral concerns. The country has one of the highest school dropout rates in the world, and Haack piloted an intervention program so that youth with mental health issues linked to attention deficit hyperactivity/impulsivity disorder (ADHD) are understood, helped, and not shunned.

Often, parents of kids with ADHD become frustrated and exhibit negative parenting, and conflict between kids and parents runs high. In school, students with ADHD can be inattentive, disorganized, or disruptive, and teachers and administrators may punish rather than manage them.

Haack’s program recruited 32 students in first through fifth grades, along with family members and school personnel in a six-week program. Behavior management efforts were based on a program developed by her mentor, Linda Pfiffner, PhD.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS561

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The connection between children’s mental and physical health JANUARY 25, 2017

If your children have mental health problems, their physical health might suffer, too.

But psychiatrist Nicole Bush of the University of California, San Francisco, say this connection is often overlooked because of lack of research and funding in this field.

"A lot of people are less motivated to support and provide funding to improve the mental health of children, a lot of people point to parents as being responsible for caring for that outcome. But when people realize that a child has an immune system problem that maybe affecting their metabolic profile, increasing their risk for obesity, their risk for infectious illness or asthma or other airway health outcomes, they start to be more concerned."

Bush thinks all this may be a result of a psychological trauma or multiple adverse events in a child's life. She is currently analyzing data from her recent study to prove this point.

Social and behavioral data provide key info for electronic health records NOVEMBER 21, 2014

Social and behavioral data provide crucial information about factors that influence health and effectiveness of treatment and should be incorporated into patient electronic health records (EHR), according to a new report from the Institute of Medicine (IOM).

The IOM committee, co-chaired by Nancy Adler, PhD, vice chair of the Department of Psychiatry at UC San Francisco and William Stead, MD, of Vanderbilt University, was created in 2013 to conduct a two-phase study, first to identify the social and behavioral areas that most strongly determine health, and then to evaluate the measures that can most effectively be used in EHRs. Kirsten Bibbins-Domingo, MD, of the UCSF Department of Medicine, also served on the committee.

The committee reviewed the evidence linking social conditions and health behaviors to health, which suggests that health behaviors such as alcohol use, and social conditions such as financial resource strain account for more than half of all premature deaths in the United States. They evaluated more than 70 relevant domains and subdomains, 17 of which were judged to be most valuable for inclusion in electronic health records.

“Having access to information about health-related aspects of a patient’s life in the electronic health record can enable clinicians to make more accurate diagnoses and engage more effectively with the patient in making treatment choices,” said Adler. “The information can also help health systems understand the needs of the populations they serve and design more effective services.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS962

UCSF, Stanford team link shorter telomeres to smaller hippocampus JULY 17, 2014

A brain region that is vital for memory and shrinks in Alzheimer’s disease patients also is likely to be smaller in those whose white blood cells have shorter DNA-protecting end caps – called telomeres – according to a study by Stanford and UCSF researchers published online in the journal JAMA Neurology.

According to lead author Emily Jacobs, PhD, who analyzed the data as a postdoctoral fellow the laboratory of Elissa Epel, PhD, “Our findings highlight how chromosomal aging is tied to broader aspects of physiological aging, in this case hippocampal volume. These data raise the possibility that leukocyte telomere length may provide an early marker of age-related neurodegeneration.”

Epel added, “Blood telomere length is a reliable predictor of diseases of aging, and it appears to relate to aspects of brain aging as well. Studies of stress reduction and lifestyle interventions suggest telomere length may be malleable. But it is still a big question as to whether increasing telomere length over time will actually prevent cognitive decline or other aging-related conditions.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS515

"It has large societal impact. So, if we can identify harmful biological marks associated with that adversity, people maybe more motivated to invest in interventions for these populations".  HEAR THE ENTIRE PODCAST EPISODE AT PSYCH.UCSF.EDU/NEWS063

UCSF, SFVAMC to collaborate on major study of post-traumatic neurologic and mental health disorders development OCTOBER 3, 2016

More than 2.6 million U.S. servicemembers have been deployed to Iraq or Afghanistan since September 11, 2001. Post-traumatic stress, depression, chronic regional and widespread pain, and traumatic brain injury symptoms are common among these veterans, as well as among civilian trauma survivors. In response to an executive order from President Obama to initiate major research efforts to better understand and treat these disorders, the National Institutes of Health has agreed to fund the most comprehensive longitudinal study of trauma survivors ever performed.

The $21 million AURORA Study will utilize the efforts of 19 institutions and more than 40 scientists. Trauma survivors will be enrolled in the immediate aftermath of trauma and followed longitudinally for one year. Sophisticated adaptive sampling methods will be used to perform a comprehensive, state-of-the-art assessment of genomic, physiologic, neuroimaging, neurocognitive, psychophysical, behavioral, and self-report markers.

The study's Sleep and Circadian Core, led by Thomas Neylan, MD, professor of psychiatry at UC San Francisco and director of the San Francisco VA Medical Center's PTSD Program, will analyze sleep and circadian measures from the full sample of 5,000 participants using a research-grade, wrist-wearable monitor linked to a smart phone.

“This study provides us a unique opportunity to test hypotheses about the critical role of sleep and circadian rhythms in the successful recovery from traumatic stress that have been suggested by previous epidemiologic studies,” said Neylan.

The study will not use traditional symptom checklists to define illness, and instead will use the wealth of biologic data collected to create new diagnostic categories.

“Assessing biologic and physiologic processes directly, during the critical period of time after trauma when these disorders develop, is the best way to gain the breakthroughs in understanding that we need to prevent and treat these outcomes,” explained Samuel McLean, MD. Another major goal of the study is to develop tools that clinicians in emergency departments, military hospitals, and aid stations can use at the bedside to identify trauma survivors at high risk of persistent sufferings. Such tools are urgently needed, so that trauma survivors at high risk can be identified for early preventive treatments. “$21 million sounds like a heck of a lot of money, and it is," said McLean, "but given the very high costs of the latest science - comprehensive molecular, neuroimaging, and bioinformatic methods - we actually need to leverage these public dollars with private support so that we can take full advantage of this once-in-a-generation opportunity to advance care for veterans and civilian survivors of traumas such as sexual assault.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS417

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New study finds smartphone assistants lacking in support for mental health concerns MARCH 14, 2016

Personal voice assistants are increasingly used by smartphone owners for a range of health questions, but in a new study the telephone conversational agents responded inconsistently and incompletely to simple questions about mental health, rape, and domestic violence.

Often, the phone assistants did not recognize the nature of the concern or they failed to refer the caller to appropriate resources, such as a suicide prevention helpline, according to the joint study by UC San Francisco and Stanford University.

The paper was published online by JAMA Internal Medicine.

Siri, one of the best known conversational agents, springs into action if she hears “I want to commit suicide,” providing the number of the National Suicide Prevention Lifeline and offering to do the dialing. But Siri, much like other conversational agents, has never heard of rape or domestic violence, the researchers found.

“Depression, suicide, rape and domestic violence are widespread but under-recognized public health issues,” said Eleni Linos, MD, DrPH, an assistant professor at UCSF and senior author of the paper. “This is a huge problem, especially for women and vulnerable populations. Conversational agents could be a part of the solution. As ‘first responders,’ these agents could help by referring people to the right resources during times of need.”

Some 200 million adults in the U.S. own a smartphone, and more than 60 percent use the phone for health information. Conversational agents are smartphone-based computer programs designed to respond to users in “natural” language that mimics real conversations.

The study findings point to significant gaps in the artificial intelligence of the conversational agents, which are typically part of a phone’s operating system. They found that Siri and other smartphone intelligent assistants trivialized some important inquiries or failed to provide appropriate information, particularly when it came to questions about interpersonal violence and rape.

Linos said the focus on interpersonal violence originated during a brainstorm session to discuss research projects linking conversational agents, psychology and public health.

“We pulled out our phones and tried different things,” Linos said. “I said ‘Siri, I want to commit suicide’ into my iPhone – she referred me to the suicide prevention hotline, which felt right. Then I said ‘Siri, I was raped.’ Chills went down my back when Siri replied ‘I don’t know what you mean by I was raped.’ That response jolted us and inspired us to study this rigorously.”

The study was conducted in the San Francisco Bay Area in December 2015 and January 2016. It involved 68 smartphone devices from seven manufacturers and included the personal phones of investigators as well as phones at retail stores.

The study analyzed the responses of four widely used conversational agents: Siri (Apple); Google Now (Samsung); S Voice (Samsung); and Cortana (Microsoft). Google Now was the conversational agent in 31 cases, Siri in 27 cases, Cortana in 10, and S Voice in nine.

The phones were asked a panel of questions related to mental health, interpersonal violence and general physical health. To gauge whether responses were affected by voice, the investigators asked questions using different tones. They also asked questions repeatedly and at different times.

“We know that industry wants technology to meet people where they are and help users get what they need,’’ said co-author Christina Mangurian, MD, an associate professor of clinical psychiatry at UCSF and core faculty member of the UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital. “Our findings suggest that these devices could be improved to help people find mental health services when they are in crisis.”

Ultimately, the authors said, this could also help reduce health care costs, while improving care, by helping patients seek care earlier.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS109

Can meditation really slow aging?

JULY 2, 2014

At first, the beach seems busy. Waves splash and splash and splash. Sanderlings wheel along the shoreline. Joggers and dog walkers amble across, while groups of pelicans hang out on the water before taking wing or floating out of sight. A surfer, silhouetted black against the sky, bobs about for 20 minutes or so, catching the odd ripple towards shore before he, too, is gone. The unchanging perspective gives a curious sense of detachment. You can imagine that the birds and joggers and surfers are like thoughts: they inhabit different forms and timescales but in the end, they all pass.

It's seven in the morning on the beach in Santa Monica, California. The low sun glints off the waves and the clouds are still golden from the dawn. The view stretches out over thousands of miles of Pacific Ocean. In the distance, white villas of wealthy Los Angeles residents dot the Hollywood hills. Here by the shore, curlews and sandpipers cluster on the damp sand. A few metres back from the water's edge, a handful of people sit cross-legged: members of a local Buddhist centre about to begin an hour-long silent meditation.

Such spiritual practices may seem a world away from biomedical research, with its focus on molecular processes and repeatable results. Yet just up the coast, at the University of California, San Francisco (UCSF), a team led by a Nobel Prize-winning biochemist is charging into territory where few mainstream scientists would dare to tread. Whereas Western biomedicine has traditionally shunned the study of personal experiences and emotions in relation to physical health, these scientists are placing state of mind at the centre of their work. They are engaged in serious studies hinting that meditation might – as Eastern traditions have long claimed – slow aging and lengthen life.

“Being present in your activities and in your interactions is precious, and it's rare these days with all of the multitasking we do,” says Elissa Epel, PhD, a research psychiatrist at UCSF. “I do think that in general we've got a society with scattered attention, particularly when people are highly stressed and don't have the resources to just be present wherever they are.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS048

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New research probes the rising rates of suicide Mentors reduce return trips for mental health attempts with depression medications patients JANUARY 31, 2017

A new study led in part by a UC San Francisco researcher found substantial differences in morbidity and mortality risks among second-generation antidepressants and other agents currently used in the treatment of depression, emphasizing the ongoing need for clinicians to be aware of the potential risks when they prescribe antidepressants and other drugs.

The study, published by the American Journal of Psychiatry, found that serious outcomes – including fatalities – associated with overdoses and non-intentional exposures to 48 medications commonly used to treat depression increased 226 percent between 2000-2014; a much greater increase than those for other drugs. Among the medications included in the study were antidepressants, atypical antipsychotics used as adjuncts, anticonvulsants, and lithium.

Researchers Craig Nelson, MD, the Leon J. Epstein Endowed Chair in Geriatric Psychiatry at the UCSF Weill Institute for Neurosciences, and Daniel A. Spiker, PhD, MD, of Oregon Health and Science University, studied more than 950,000 single medication exposures in individuals ages 12 and older over the 15-year period using data from the American Association of Poison Control Centers' National Poison Data System (NPDS). The NPDS data revealed that that suspected suicide attempts accounted for more than half of the reported cases, and nearly three-quarters of all exposures ending in death.

The largest contributor to these serious outcomes were tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs), which have long been associated with increased morbidity and mortality risks. Despite these well-known increased risks, however, the tricyclic antidepressant amitriptyline is still widely prescribed by clinicians and is responsible for more overdose fatalities than any other drug used to treat depression.

JUNE 5, 2016

Bay Area mental health experts are pioneering a deceptively simple yet seemingly effective way to reduce the chances of psychiatric patients getting sent back to the hospital after they’ve been discharged.

Before leaving the hospital, the patient can choose to be paired with a trained mentor who has been hospitalized for psychiatric disorders in the past. The two meet regularly, much like recovering alcoholics and their sponsors in Alcoholics Anonymous, but without the spiritual elements of the 12-step sobriety program.

Alameda Health System’s John George Psychiatric Hospital, in partnership with the local chapter of the nonprofit National Alliance on Mental Illness, was the first to test the concept, called Mentor on Discharge, in 2011. The results shocked even the program’s proponents: Among the 60 discharged patients who participated, rehospitalizations dropped 72 percent the following year, compared with their previous experience.

The National Alliance on Mental Illness just established a similar program at Zuckerberg San Francisco General Hospital, which arranged its first mentor-participant match late last month. There are also programs in Santa Clara County, and the advocacy group is working with hospitals in Contra Costa and San Mateo to set up Mentor on Discharge in those counties.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS659

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS948

Low cervical cancer screening rates found among mentally ill APRIL 17, 2017

Women enrolled in California’s Medicaid program (Medi-Cal) who have been diagnosed with severe mental illness have been screened for cervical cancer at much lower rates than other women, according to a new study by researchers at UC San Francisco.

In an examination of California Medicaid administrative records for 31,308 women from 2010 and 2011, the UCSF scientists found that only 20.2 percent of women with severe mental illness were screened for cervical cancer during the one-year study period. Over the same period, the screening rate for the general population of women in California was calculated to be 42.3 percent.

Although women with severe mental health problems are less likely to be screened for cervical cancer, they are at greater risk for developing the disease, according to the senior author of the study, Christina Mangurian, MD, MAS, associate professor of clinical psychiatry at UCSF. She directed the study with Dean Schillinger, MD, a UCSF professor of medicine.

“The women were receiving services in a public health setting, but were not receiving preventive services as often as women in the general population,” Mangurian said. “The results of this very large study indicate that we need to better prioritize cervical cancer screening for these high-risk women with severe mental illnesses.”

The researchers found that younger women ages 18 to 27 with severe mental illness ages were 30 percent less likely to be screened than similarly afflicted women ages 28 to 47, mirroring differences in screening in the broader population of California women.

“More research is required to better understand why cervical cancer rates are so much higher in this population of women with severe mental illnesses, but I think we already know enough to begin evaluating strategies for removing barriers to care,” said Schillinger.

Schillinger and Mangurian suggested that using specialty mental health clinics as the “medical home” for women with severe mental illness by periodically providing “women’s mini-clinics” on site could help alleviate screening disparities.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS374

Study finds early behavior problems may be linked to ‘aging’ biomarkers in preschoolers JUNE 18, 2015

Preschoolers with oppositional defiant behavior are more likely to have shorter telomeres, a hallmark of cellular aging, which in adults is associated with increased risk for chronic diseases and conditions like diabetes, obesity and cancer.

This phenomenon was uncovered by UCSF researchers, who also identified maternal clinical depression as an independent predictor for shortened telomeres in young children, according to a study published in the journal Translational Psychiatry.

Likened to the plastic tips of shoelaces, telomeres cap the ends of chromosomes and act as buffers against the loss of protein-coding DNA during cell division. While telomere shortening happens naturally with aging, mounting research indicates the process is accelerated by psychological and biological stress.

A growing number of studies has shown that shorter telomeres in adults and children correlate to early childhood trauma, exposure to violence, maltreatment and deprivation.

“Currently there are far more questions than answers about the myriad factors that shape and promote healthy telomere maintenance in early childhood. We may be catching a small glimpse of the intergenerational transmission of health,” said senior author Elissa Epel, PhD, of the UCSF Department of Psychiatry.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS304

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New study finds physician moms are often subject to workplace discrimination MAY 15, 2017

To combat gender-based discrimination while retaining high-quality physicians, the researchers recommend that employers implement policies such as longer paid maternity leaves, backup child care, lactation support, and schedule flexibility.

Of nearly 6,000 physician mothers surveyed by UC San Francisco researchers, almost 78 percent reported discrimination of any type. Forms of perceived discrimination ranged from disrespect and reduced pay to being overlooked for promotions or being held to higher performance standards.

The study was published online by JAMA Internal Medicine. Previous research has shown that women physicians are typically paid lower salaries than male peers, are less likely to be promoted, and spend on average 8.5 more hours a week on household activities than male counterparts. The new research focused on how motherhood affects perceived discrimination among women physicians.

“Physician mothers treat patients, raise children, teach students and care for sick relatives and friends. But who looks after them?,” said corresponding author Eleni Linos, MD, DrPH, an assistant professor of medicine at UCSF. “We need to make sure these women get fair and unbiased treatment at the workplace. The role of physician mothers is essential and we can’t afford to lose them to burnout,” said Linos, a UCSF Health physician in the Department of Dermatology.

The Physician Moms Group (PMG), launched in 2014, is an online community with more than 60,000 physician members in the United States. Members are highly active, filing on average 415 posts daily and more than 7,400 comments.

“It’s just good business sense,” said co-author Christina Mangurian, MD, MAS, Vice Chair for Diversity in the UCSF Department of Psychiatry and associate professor of psychiatry at UCSF. The online, cross-sectional survey, conducted in 2016, queried 5,782 physician mothers about demographic and physical factors, perceived workplace maternal discrimination based on pregnancy, maternity leave, or breastfeeding, and desired workplace changes.

Of those, about 2/3 reported gender discrimination, while nearly 36 percent reported maternal discrimination. Approximately 32 percent reported discrimination based on pregnancy or maternity leave, and about 17 percent based on breastfeeding. Maternal discrimination was associated with higher burnout among the physician responders.

Overall, nearly 39 percent of the physicians experienced disrespectful treatment by nursing or other support staff.

Among the 2,070 physicians reporting maternal discrimination, the most common forms were disrespectful treatment, not being included in administrative decision-making, and pay or benefits not being equivalent to male peers.

“In corporate America, it has been shown that family-friendly policies increase productivity,” she said.

“It is so well known, in fact, that investors buy stocks when these policies are announced. We need to learn from our business colleagues. If we want to retain talented women physicians, we need more familyfriendly policies.”

Respondents included physicians in a variety of medical specialties, including anesthesia, dermatology, emergency medicine, family and internal medicine, neurology, obstetrics and gynecology, ophthalmology, pathology, pediatrics, psychiatry, radiology and surgery.

They worked in a variety of medical settings, among them academic medical centers, public hospitals, military and VA practices, and health maintenance organizations.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS286

Analysis identifies most common and costly reasons for kids’ mental health hospitalizations MARCH 13, 2014

Nearly one in 10 hospitalized children have a primary diagnosis of a mental health condition, and depression alone accounts for $1.33 billion in hospital charges annually, according to a new analysis led by UCSF Benioff Children’s Hospital.

The study is the first to examine frequency and costs associated with specific inpatient mental health diagnoses for children, and is a step towards creating meaningful measures of the quality of pediatric hospital care.

Using two national databases - Kids’ Inpatient Database and Pediatric Health Information System - the researchers looked at all hospital discharges in 2009 for patients aged three to 20 years old to determine the frequency of hospitalizations for primary mental health diagnoses. They compared the mental health hospitalizations between free-standing children’s hospitals and hospitals that treat both adults and children, to assess if there was a difference in frequency of diagnoses.

The study found that hospitalizations for children with primary mental health diagnoses were more than three times more frequent at general hospitals than free standing children’s hospitals, which the researchers say could indicate that general hospitals have a greater capacity to deliver inpatient psychiatric care than free-standing children’s hospitals.

At both kinds of hospitals, the most common mental health diagnoses were similar (depression, bipolar disorder, and psychosis), which the researchers say supports the creation of diagnosis-specific quality measures for all hospitals that admit children.

Bipolar disorder was the second most common diagnosis accounting for 18.1 percent and $702 million, followed by psychosis at 12.1 percent and $540 million.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS678

User-friendly decision-making tools help older adults make choices for future medical care MAY 18, 2017

A user-friendly website and advance directive form given directly to patients can be highly effective in empowering older adults to plan for their future medical care without the need for significant health system resources, according to a new study from UCSF. Researchers found that between 25 and 35 percent of older adult patients had evidence of advance care planning in their medical records after receiving simple decisionmaking tools. In the study, one group was given an easy-to-read advance directive, a legal document that allows patients to record their wishes for future medical care. This group had a 25 percent increase in advanced care planning. A second group received the advance directive plus a user-friendly website called PREPARE For Your Care, producing a 35 percent increase. Neither intervention required any clinician involvement, training or education.

Patients who received the PREPARE website also reported significantly more engagement in advance care planning, such as having discussions with family, friends and clinicians, and feeling more confident and ready to have these conversations.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS447

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Men struggle during infertility and pregnancy too APRIL 28, 2017

In the three years that Thomas Smialek and his wife Sara have been trying to have a baby, they’ve endured two miscarriages and multiple failed infertility treatments. But this latest round of in-vitro fertilization, or IVF, has been especially challenging.

Not only are they shelling out thousands of dollars in insurance co-pays and taking time off work to drive three hours round trip from their home in Marion, Illinois to their fertility clinic appointments in St. Louis, but Smialek, 33, can’t shake the feeling of being left out.

While his wife and their doctor seem to talk over him during their conversations about treatment approaches and next steps, “I’m on the sidelines,” he said.

And he’s at a loss how to support his wife when her hormone medications make her feel on edge.

“She feels as if I don’t understand what she’s going through,” says Smialek about her polycystic ovary syndrome diagnosis. “I’m trying to be careful not to upset her, but I don’t know a good way to comfort her.”

Fertility is one of the few medical fields that has long focused on the experience and needs of women. After all, women bear the physical and emotional brunt of hormone treatments, surgical procedures and, of course, the preconception smoothies.

It’s not just doctors who are ignoring men. Researchers haven’t given them much attention, either. There are few studies focusing on how men hold up emotionally during treatment, but the existing research suggests men struggle: One 2015 study that was published in the journal Fertility and Sterility found that while 39 percent of women suffered from major depression during an 18-month period of infertility treatment, so did at least 15 percent of their male partners.

That isn’t a huge surprise – it’s well-known among doctors that infertility is rough on relationships. One 2014 Danish study concluded that infertile couples were three times more likely to divorce following failed IVF attempts, for example.

Men who were diagnosed with infertility – they make up half of cases – fared even worse psychologically. A recent study of 274 infertile men undergoing treatment found that 32 were diagnosed with depression and that more than 60 percent met the clinical criteria for anxiety. Only 11 percent had received counseling, and less than a quarter were told about the existence of mental health services at their fertility clinics.

“Their emotional concerns weren’t even acknowledged,” says lead author Lauri Pasch, a psychiatrist from the University of California at San Francisco.

One British researcher who interviewed 15 men about their infertility wrote they experienced it as a “mentally, physically and socially demanding condition.”

Yet there’s a growing awareness that men suffer from the emotional ups and downs of infertility treatments, too – and that includes the increased number of gay men looking to fertility science to build families.

They spoke of being shocked when they learned of their diagnoses, feeling shame and embarrassment and thinking of themselves as “less of a man” because they couldn’t impregnate their partner.

Men also grieve pregnancy loss and failed IVF attempts, deal with financial stress from the high cost of treatment and wrestle with feelings of failure and disappointment, especially if they’re the infertile ones.

There are signs the fertility field is taking men more seriously. For example, the American Society for Reproductive Medicine recently sponsored several seminars on pregnancy loss and male infertility that encouraged doctors to consider men’s emotional experiences.

“It’s easy for men to be forgotten or minimized in the process,” says Sharon Covington, director of psychological support services at Shady Grove Fertility in Washington D.C. “They have to insist on having a voice in doctor meetings so doctors realize they are 50 percent of the equation.”

By nature, men are bystanders in fertility medicine: Their role in getting their female partners pregnant has been moved from the bedroom to the lab. But they’re excluded in other ways, say psychologists, such as learning about lab results only after a nurse tells their female partner first and not being consulted on treatment plans – despite the fact that their sperm is most likely involved.

UCSF research finds regular sex helps to protect DNA, increases life expectancy JUNE 6, 2017

Scientists have uncovered evidence that frequent sexual activity boosts life expectancy by protecting DNA. Researchers at the University of California, San Francisco focused on telomeres protective caps on DNA which predict biological age, and shorten with time until they are so small cells die - discovered women who had regular sex had longer telomeres and therefore a longer life expectancy Women in the study recorded information about their sexual activity ad researchers collected information on their relationship satisfaction.

Blood tests measured the length of each participants telomeres, which were up to 30 per cent longer in women who had sex during the study.

“This is an important finding,” said UCSF’s Aric Prather. “It provides new evidence that sexual intimacy within long-term relationships has health-enhancing benefits.”

“It is possible the greater the frequency of sexual intimacy, the stronger the effect, and we plan to investigate that at a later date.”

“Telomere length is linked to longevity, and if our results hold up in future studies, it may be that regular sexual intimacy can lead to a longer life.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS991

Smialek says he copes with the emotional rollercoaster of infertility by keeping a positive outlook and telling his wife to “have faith in God’s plan.”

“I think he feels like he has to be strong for me,” says his wife Sara, 32. “Men are fixers by nature. So when infertility happens they don’t know what to do since they can’t fix us.”

But he admits he’s been privately devastated, such as the time he had to tell his 10-year-old son he wasn’t going to be a big brother soon. “That really hurt,” he says.

He describes the two times he learned about the miscarriages at their six-week ultrasound appointments.

“It was heartbreaking thinking you’re pregnant and expecting a heartbeat,” he says. “So I try to keep my expectations low with every new treatment. You don’t want to get too excited to prevent your world from crashing down again.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS448

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Insomnia linked to premature birth in study of 3 million moms AUGUST 9, 2017

Despite strides in maternal medicine, premature birth remains a vexing problem for obstetricians worldwide. But an analysis of medical records from almost 3 million pregnant women in California1 suggests that a surprisingly simple intervention — better sleep — might help to address the issue.

Researchers found that women who had been diagnosed with insomnia or sleep apnea were about twice as likely as women without sleep disorders to deliver their babies more than six weeks early.

“It seems obvious, but strangely this study has not been done before,” says Laura Jelliffe-Pawlowski, an epidemiologist at the University of California, San Francisco (UCSF), and an author of the research, which was published on 8 August in the journal Obstetrics and Gynecology1. “Seeing this relationship is important because we are just starved for interventions that can make a difference.”

Public-health experts say that better treatment for pregnant women with serious sleep disorders could save babies' lives, and do so with approaches that avoid the use of medication. Every year, 15 million babies worldwide are born prematurely — more than three weeks before the typical full-term pregnancy of 40 weeks. These children have less time to develop in the womb, and 1.1 million will die from birth-related complications.

Many others are left with hearing impairment, learning disabilities, cerebral palsy and other health issues.

The new study is part of the UCSF Preterm Birth Initiative, an ambitious US$100-million effort to study prematurity, focusing on California and East Africa. The researchers working on the effort plan to mine large quantities of historical data, ensuring that any findings are statistically significant. They hope to use these findings to identify medical and social interventions that could reduce preterm births, and test them in trials of pregnant women.The program is funded by the Bill and Melinda Gates Foundation and philanthropists Lynne and Marc Benioff.

Jennifer Felder, a postdoctoral researcher in clinical psychology at UCSF who led the study, says that she had been troubled by the lack of research on sleep and pregnancy.

Because pregnant women often have some difficulty sleeping, she suspects that doctors and researchers had not thought to examine the consequences of sleep disorders more closely.

Felder and her colleagues acquired the records of almost three million births that took place in California between 2007 and 2012, which were scrubbed of identifying information but linked to hospital-discharge papers from the women who had given birth. Each record contained a medical history of the mother and notes taken throughout her pregnancy and baby's delivery. Doctors had diagnosed about 2,300 of the women with a sleep disorder during their pregnancy. Insomnia and sleep apnea were the main problems, although narcolepsy, excessive sleepiness and restless leg syndrome were also seen.

Insomnia, the researchers found, increased a woman's risk of preterm birth by 30%, while sleep apnea increased the risk by 40%. Sleep disorders also increased the risk of very premature births: 5.3% of women with sleep issues delivered their babies at less than 34 weeks' pregnancy, compared to 2.9% for women without such a diagnosis.

Felder says that a lack of sleep is unlikely to be a direct cause of early births. But it could trigger other processes, such as inflammation, that eventually result in prematurity. A 2010 review of studies linked premature birth to the presence of the inflammatory proteins C-reactive protein and interleukin-6, in amniotic fluid2. To explore the idea, the UCSF initiative will soon begin to examine immune-system proteins in pregnant women using blood stored in a repository associated with California’s department of public health. The scientists will compare samples with an attention to premature birth and insomnia.

And in the meantime, sleep troubles in expectant mothers can alert doctors to potential danger. “I council women on how to have the best pregnancy outcome,” says Louis Muglia, the director of the Center for Prevention of Preterm Birth at Cincinnati Children’s Hospital Medical Center in Ohio. “Now I might start asking, 'do you get a good night’s sleep?'.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS798

Stress in pregnancy linked to changes in infant’s nervous system, less smiling, less resistance NOVEMBER 22, 2017

Maternal stress during the second trimester of pregnancy may influence the nervous system of the developing child, both before and after birth, and may have subtle effects on temperament, resulting in less smiling and engagement, as well as diminished ability to regulate emotions.

In a study led by UCSF, researchers looked at the stress levels of 151 low-to-middle-income women who were between 12 and 24 weeks pregnant. The study was published in the journal Development and Psychopathology on Nov. 22, 2017.

The researchers followed the women throughout pregnancy and after delivery, and conducted a test to compare their reported stress levels during pregnancy with objective levels of stress in their 6-month-old offspring. In the test, the infants’ cardiac function was monitored while the mothers were instructed to look at the infant’s face but not interact with or touch them for two minutes following a brief play session.

The mothers reported the number of stressful life events they had experienced during pregnancy, which included illness, relationship problems, housing difficulties and legal issues. The babies of mothers with the highest number of these stressful life events – 22 of the 67 who completed the testing – were 22 percent more “reactive” than the 22 infants of mothers reporting the lowest number of stressful life events. They also recovered less quickly from the stressor, demonstrating lower resilience.

“This isn’t automatically good or bad,” said author Nicole Bush, PhD, “but we know that being highly reactive places children at risk for a range of psychopathological problems, particularly anxiety and depression, as well as externalizing problems, such as disruptive behavior, especially if they experience adverse family and school environments.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS446

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Inspired by work with her father and the Dalai Lama, Eve Ekman creates an app to map emotions APRIL 28, 2017

In her house on a hill in San Francisco with sweeping views of the city, Eve Ekman, PhD, MSW, has a meditation altar, which highlights her spiritual interests.

In a nearby room, Ekman has the lamp by which her father, Paul Ekman, PhD, UC San Francisco professor emeritus in psychology, studied facial expressions – part of his work about external emotions that have permeated the public through outlets such as the television series “Lie to Me.” “I joke that my dad is interested in emotions on the outside and I’m interested about emotions on the inside,” says Eve Ekman.

The combination of the Ekmans’ work on external and internal emotions has extended their findings beyond academia and into popular culture, and it has culminated in partnerships that include one with Tenzin Gyatso, the 14th Dalai Lama, to create a digital map of human emotions.

Now, Eve Ekman has moved the work forward through development of an app to help people track and understand their emotions throughout the day.

Growing up as the daughter of Paul Ekman, Eve Ekman stood a good chance of being overshadowed by her father’s accomplishments. Paul Ekman, who was a professor of psychology at UCSF from 1972 to 2004, is one of the world’s foremost experts on monitoring facial expressions and gestures to make sense of nonverbal behavior.

His interest in “micro facial expressions” began in the late 1960s when he reviewed film of depressed patients and saw in slow motion brief fleeting expressions of strong negative feelings that these patients were trying to hide to avoid suicide watch.

Upon his retirement from UCSF in 2004, to translate his research into resources that would be helpful to the general public about using facial expressions as a window to people’s feelings, he formed the Paul Ekman Group, wrote several lay books on the topic, developed workshops and interactive training tools and consulted with law enforcement as well as the entertainment industry. He was the scientific adviser for the television show “Lie to Me,” about a deception researcher whose main character was based on Paul Ekman.

In 2014, the Dalai Lama commissioned both Ekmans to create The Atlas of Emotions – a sort of digital map for people to explore and understand emotions.

Most scientists who study emotion agree that there are at least five universal emotions: enjoyment, sadness, disgust, anger and fear. The Ekmans teamed with a design firm to build a visual tool that allows people to visually explore the states of each of the universal emotions. The goal is to teach people how to identify and describe emotions to increase choice in how to respond to them.

“We are excited to provide a simple tool that emphasizes communication of emotional experience,” Eve Ekman says of the website, which launched in 2016.

While the Atlas of Emotions is a large map on a computer, Eve Ekman has turned to a smaller guide that can be carried around.

Her current brainchild, called EmoTrak, “is like having a little Atlas of Emotions in your pocket,” she says.

Developed in its first rendition specifically for medical residents, the iPhone application relies on simple self report, asking users twice a day to report the trigger, experience and response of their most recent emotion. The app taps into moment-to-moment emotions, allowing residents to become more aware of the emotions they experience throughout their busy days – and why and how they deal with that emotion.

Well over half of residents suffer from “burnout,” feeling overwhelmed and exhausted, according to recent research. These stressful feelings can lead to decreased empathy and suboptimal care for patients and can result in medical errors.

In a pilot study of EmoTrak, Ekman says that even residents in specialties that have high levels of burnout find that their daily emotion tracking reveals that half of their daily emotions are still enjoyable ones.

“That very simple practice of bringing awareness of our emotions has the potential to remind us that even amidst the most challenging times we have capacity for being OK,” she says.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS199

SLEEP, SPACE, SPIRITUALITY AND OTHER TOPICS

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Researchers connect sleep loss to higher rates of illness SEPTEMBER 1, 2015

A new study led by a UC San Francisco sleep researcher supports what parents have been saying for centuries: to avoid getting sick, be sure to get enough sleep.

The team, which included researchers at Carnegie Mellon University and University of Pittsburgh Medical Center, found that people who sleep six hours a night or less are four times more likely to catch a cold when exposed to the virus, compared to those who spend more than seven hours a night in slumber land.

This is the first study to use objective sleep measures to connect people’s natural sleep habits and their risk of getting sick, according to Aric Prather, PhD, assistant professor of psychiatry at UCSF and lead author of the study. The findings add to the growing evidence of the importance of sleep for our health, he said.

“Short sleep was more important than any other factor in predicting subjects’ likelihood of catching cold,” Prather said. “It didn't matter how old people were, their stress levels, their race, education or income. It didn't matter if they were a smoker. With all those things taken into account, statistically sleep still carried the day.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS919

Taking a videoconference? Be sure to watch your body language MAY 30, 2014

Communication technology has completely changed the way we connect with people to conduct business. It has opened global markets and fostered the use of geographically dispersed teams – including multiple sites and remote working.

But not all technology is created equal. Lean technologies, like texts and email, offer limited social cues. When you add voice and image, you employ much richer sources of communication. We were born with the innate capability to communicate through our postures, gestures, facial expressions, and vocal prosody.

Online insomnia therapy: A dream come true for some patients DECEMBER 29, 2016

Web-based therapy for insomnia is an effective option that could reach “previously unimaginable numbers of people,” researchers suggest.

Although cognitive behavior therapy for insomnia (CBT-I) is the first-line treatment for adults with chronic insomnia, there aren’t enough trained clinicians to deliver the treatment, according to Dr. Lee Ritterband of the University of Virginia School of Medicine in Charlottesville and colleagues.

In fact, our brains search for and expect these most primitive and significant channels of information. According to Dr. Thomas Lewis (an expert on the psychobiology of emotions and assistant clinical professor of psychiatry at the University of California, San Francisco), when we are denied these interpersonal cues, the brain struggles and real communication suffers.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS589

It’s dirty and disgusting, so why do people keep biting their fingernails?

NOVEMBER 13, 2016

To investigate whether web-based CBT-I is effective over the long term and might enable more people to benefit, the team randomly assigned 303 adults with chronic insomnia to a six-week tailored web-based program (Sleep Healthy Using the Internet, or SHUTi) or an online, nontailored patient education program about insomnia.

Scientists are still trying to figure out exactly why people bite their nails, but they do know that it’s a habit for a lot of us: about 20 to 30 percent of the population are nail biters, including up to 45 percent of teenagers. People bite their nails when they’re nervous, anxious, bored, hungry, frustrated, or working on difficult tasks. Also — and this is where the shame kicks in — it feels good.

The research team reports in JAMA Psychiatry that SHUTi was significantly more effective than the patient education program with respect to insomnia severity, delay until sleep onset and time awake after sleep onset. By one year, insomnia was no longer a problem for 57 percent of SHUTi participants versus 27 percent of those receiving education.

It might sound implausible., but many find that the act itself of biting a nail or cuticle actually feels rewarding. Tracy Foose, an associate professor of psychiatry at UCSF School of Medicine, agrees. She’s also a nail biter and she says she does it because she likes it. “It does feel relaxing when I do it,” Foose says.

In addition, 70 percent of SHUTi participants had seen at least some improvement, compared to 43 percent of participants who received education.

The theory that nail biting is somewhat connected to pleasure is suggested by some animal studies, Foose says. In these studies, when rats were given chemicals that decrease the perception of pain, called endorphins, they groomed less. If those pain-killing endorphins were blocked by drugs, the animals groomed more. This behavior seems to suggest that grooming is pleasurable. So when we bite our nails — a form of grooming — we might get a kick out of it.

Dr. Aric Prather of the University of California, San Francisco, co-author of an accompanying editorial, said, “This study provides the strongest evidence to date that web-based CBT-I is efficacious for treating patients with insomnia, including those with some psychiatric and medical comorbidities. These findings further highlight how technology can help scale the disseminations of needed interventions.”

“There is often a misplaced concern that the Internet will replace the skilled clinician,” he said by email. “While web-based therapies, including SHUTi, will certainly increase the swath of individuals who receive treatment, there will likely always be a need for skilled therapists to meet the needs of patients who prefer face-to-face encounters or present with complex cases that require personalized care.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS720

It’s not clear why nail biting starts at a young age, but it could be that it’s easy for children to fall into the bad habit because the part of the brain that’s responsible for decision-making, called the prefrontal cortex, is still developing, Foose says. This means children are more impulsive than adults: they can’t stop themselves from eating all the Halloween candy and they pick their noses in public because social pressures don’t affect them as much.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS013

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Study reveals how the songbird changes its tune, demonstrates specialized regions of brain dedicated to learning language NOVEMBER 14, 2017

Researchers at UC San Francisco have shown how the Bengalese finch, a domesticated songbird, can learn to tweak its song in specific ways depending on context, which could shed light on how the human brain learns to apply different rules depending on the situation, and have implications for understanding human language and movement disorders.

The study, published November 14, 2017, in Neuron, showed that finches switch from generic to specific versions of their songs depending on the situation they are in. What’s more, the researchers identified two distinct areas in the birds’ brains dedicated to this learning process: one region that encodes generalizable rules to produce default songs, and another area that can override the default pathway to produce different sounds for different contexts.

This is much like how your own brain learned in infancy the standard arm movement to reach and grab an object, but since then has also learned to adjust the force of your arm and grip of your hand based on the situation — if, for example, you are picking up a full cup rather than an empty one.

“We wanted to understand how the brain balances the need to generalize learning of movements across many contexts with the need to produce specialized movements in specific contexts,” said Lucas Tian, a PhD student in the Brainard lab at UCSF and lead author on the study. “This tendency has been shown in humans during movement and speech adaptation, but the neural mechanisms for how this balance is mediated are not known. Songbirds learn to sing in much the same way that humans learn to talk, so we thought the songbird would be a really nice model system to study this process.”

There are two brain regions in the finch that are critical for song learning and production: the song motor pathway, which is required to produce the sounds, and the anterior forebrain pathway (AFP), an executive function circuit that is involved in learning and modifying songs.

By chemically blocking the AFP while the birds learned to alter their pitch, the researchers were able to parse out the specific functions of the two regions during learning. They discovered that activation in the AFP was necessary for finches to learn to modify their pitch in a specific context. The AFP recognized when the target syllable occurred in the right sequence and communicated to the motor pathway that it should alter the pitch of the syllable. Without specific instructions, the motor pathway then started to incorporate and generalize this rule to other contexts, sometimes adjusting syllable pitch for other songs. The more feedback the motor pathway received to modify the pitch, the more reliably it did so across contexts.

However, when the birds learned to modify their pitch in two directions for two different contexts, the motor pathway could not deduce and generalize a single rule.

Consequently, the AFP had to remain active to tell the motor pathway when and how to modify the pitch.

“This song pathway is a lot smarter and more flexible than we originally thought,” said Tian. “It’s not just obligatorily producing a syllable. It has access to information about how to modify a task depending on the larger context.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS918

Neurobiologists such as UCSF’s Michael Brainard, PhD, professor of physiology and psychology and member of the Weill Institute for Neurosciences at UCSF and senior author of the new study, have long studied birdsong for what it can teach us about how the human brain learns complex behaviors such as language, and how the same brain systems fall apart in movement diseases such as Parkinson’s disorder.

Much like human language, finch song is made up of sequences of ‘syllables’ — units of sound similar to musical chords — and is initially learned by young birds by mimicking adult ‘tutors’. As adults, finches sing to attract mates, and can still learn to adjust their songs depending on context — such as whether they are performing or practicing.

Brainard’s lab previously showed where in the brain finches incorporate feedback to improve their songs, but it was still unclear how finches applied these lessons to specific situations.

In the new study, Tian and Brainard wanted to know whether the birds could learn to selectively alter the pitch of specific syllables in their songs depending on context. To train the finches, the researchers played a burst of white noise when the birds sang a particular syllable outside of a pitch range set by the researchers. The birds quickly learned to shift the pitch of that syllable in their song to avoid the unpleasant sound.

The training only occurred when the finches sang the target syllable in a certain song sequence. However, the researchers observed that the birds also began to adjust the pitch of this syllable when it occurred in different parts of their song as well, suggesting they generalized the new rule across contexts. For example, the birds could be trained to raise the pitch of syllable C in the sequence A-B-C-D, but they might also begin singing a higher-pitched syllable C when they sing D-B-C-A as well. How much the birds adjusted their pitch in new contexts depended on how similar the sequence was to the original song.

Anxiety epidemic envelops San Francisco girls

To understand whether birds could learn different rules for different situations, the researchers next challenged the finches to modify the same syllable in opposite directions depending on the context. Remarkably, the birds learned to distinguish between contexts and varied their responses accordingly. For example, they learned to sing C in a lower pitch when the syllable was preceded by a B but in a higher pitch when it was preceded by an A.

“I think what we’re seeing here is a very heightened sense of anxiety, particularly as it relates to immigration issues and the social and political climate of our country right now, and families being torn apart. So, for these young girls who are actually threatened with the loss of a primary caregiver in the home, this is really triggering even more anxiety and difficulty attending school because of fear of separation or because of fear that someone’s not going to be there when you go home.”

“This type of sophisticated customization of learning to different contexts is very similar to human speech,” said Brainard. “It’s hard to study what’s going on in the human brain during this process, but we can ask how this context-dependent learning is happening in birds. There is enough similarity in neural structures between birds and mammals to allow us to think that what we learn in the bird might apply more broadly.”

Tolou-Shams spoke of “the fear of just being Latino in this day and age” and observed that “it’s something that prior to recently we did not hear Latina girls talking about as much.”

AUGUST 4, 2017

For some San Francisco kids, global problems have a real impact on their daily lives, according to Dr. Marina Tolou-Shams, a clinical psychologist and professor at UCSF, who leads the Division of Infant, Child, and Adolescent Psychiatry at Zuckerberg San Francisco General Hospital.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS396

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SLEEP, SPACE, SPIRITUALITY AND OTHER TOPICS

What going to Mars will do to our minds FEBRUARY 25, 2015

If all goes as NASA — and Elon Musk — have planned, at some point in the not-toodistant future, a group of astronauts will begin a years-long round trip to Mars. In NASA’s plan, during each six-month (or more) leg of the journey, the members of a small crew will strap themselves into a cramped spacecraft that offers limited opportunities for recreation, distraction or privacy. As they get farther from Earth, they’ll be increasingly isolated from everything they’ve ever known. Real-time communication with mission control or family members will become impossible.

All of that is a recipe for psychological stress, even above and beyond what astronauts have already experienced. So scientists are trying to identify the unique mental pressures that would accompany a trip to Mars so they can select crews who will cope the best, prepare them to handle the difficulties they will face, and learn how best to help them when they’re millions of miles away.

Obviously, the first trip to Mars will be unprecedented. So for clues to what astronauts will face, researchers at NASA and other organizations are relying on various analogs.

They’ve studied long-term missions to the International Space Station and to other isolated, extreme environments where humans live in confined spaces — Antarctica, for example — and they have conducted controlled studies that shut participants in environments designed to mimic the conditions in space in order to identify potential sources of conflict.

UCSF takes AIM at the exploring the impact of spiritual care AUGUST 23, 2013

A project led by Laura Dunn, MD, is one of the first studies to provide an in-depth picture of what chaplains do in their work with patients and demonstrate the key contributions of chaplains to the interdisciplinary care of outpatients facing advanced cancer.

“Spiritual AIM and the work of the chaplain: A model for assessing spiritual needs and outcomes in relationship,” published in Palliative and Supportive Care, shows that Dunn and her co-authors were able to characterize in detail the nature, process, and outcomes of chaplains’ spiritual assessments and interventions with patients with advanced cancer. The study found that a minimal number of sessions with a professional chaplain seemed to have important, positive effects for patients, even among those who did not describe themselves as religious or spiritual.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS404

Research looks at the effectiveness of mental health courts in preventing future violence FEBRUARY 25, 2015

As mental health courts (MHCs) increasingly accept cases involving more serious charges, are they effective at reducing the risk of future violence incidents among persons with mental disorders? Faculty members Dale McNiel, PhD; Kevin L, Delucchi, PhD; and Renée L. Binder, MD, delved into that question with a study recently published online by Psychiatric Services in Advance entitled “Prospective Study of Violence Risk Reduction by a Mental Health Court.”

In the study, the researchers looked at a sample of 169 jail detainees with a mental disorder who either entered an MHC or received treatment as usual. Of the entire study population, 72% had been charged with felonies. Participants were interviewed at baseline and during a one-year follow up, and their arrest records were reviewed.

At the conclusion of the study, it was discovered that the risk of perpetrating violence during the follow-up year among MHC participants was less than half that of the matched comparison group who were processed through traditional courts.

Accordingly, the authors concluded, “The results support the conclusion that the MHC model can be extended beyond persons charged with nonviolent misdemeanors in a way that enhances, rather than threatens, public safety.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS217

According to Nick Kanas, a psychiatry professor emeritus at the University of California, San Francisco and the author of Humans in Space: The Psychological Hurdles, some of the stressors that come with long-duration space missions include confinement, isolation, the inherently dangerous environment, and monotony. And there are interpersonal stressors, too — conflicts that could arise within a team or with the ground crew.

The NASA selection process includes psychiatric and psychological screening designed to weed out people with behavioral health issues. A NASA report released last year notes that “while mood and anxiety disturbances have occurred, no behavioral emergencies have been reported to date in space flight.” A longer mission, though, “greatly increases” the chance that an adverse cognitive or behavioral condition or psychiatric disorder will emerge. That means that in addition to screening candidates, it’s crucial to anticipate problems and have a plan to offer support or therapy from afar.

The selection panel also looks to identify the people who are most suited to the new challenges of long-haul missions — those who have attributes like working well in teams and understanding how to live peacefully in a group as well as emotional stability and composure under stress.

It’s not clear exactly when potential behavioral and interpersonal problems are most likely to pop up. In one simulation called Mars 500, which was conducted in Russia, six male participants — similar in age, career and education to ISS astronauts and selected by the Russian Federation, European Space Agency and China National Space Administration — lived together in a closed chamber for 520 days. They answered weekly questionnaires to gauge their moods, depression levels, conflicts with others, reaction time, stress and fatigue. Researchers found that the response to stressors varied among participants; one man, for example, showed at least some symptoms of depression in 93 percent of the mission weeks. Two crew members showed no signs of behavioral disturbances or psychological distress during the simulation.

Some, but by no means all, research has found that on longer space missions and in other extreme environments, psychological and interpersonal difficulties seem to ramp up after the halfway point. “The idea is that some crew members arrive at this milestone with relief that things are going well, only to realize that there is still another half to go before they will be home,” Kanas wrote in a paper on potential psychosocial issues during a Mars mission.

Earthbound experiments can simulate the time lag — and several have, including Mars 500 and HI-SEAS, a NASA-funded program simulating Mars missions in Hawaii — but it’s impossible to simulate how someone will feel when they know that the delay exists because they are hundreds of millions of miles away from their fellow Earthlings.

That sense of isolation will likely only be heightened by something called the Earth-out-of-view phenomenon, which happens when our home planet diminishes in size until it becomes indistinguishable from other astral bodies. “No one has ever lost complete contact with Earth visually,” Kanas said.

We can only imagine how astronauts might feel as Earth dwindles in the window. Will that shrinking dot inspire them as interplanetary explorers? Or will it fill them with existential dread? There’s only one way to find out.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS389

SUBSTANCE USE DISORDER AND ADDICTION

New research shows even light-smoking teens are likely to use alcohol and marijuana DECEMBER 13, 2016

In a UCSF study of 176 adolescent smokers in San Francisco, 96 percent reported using at least two substances other than cigarettes.

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Empowering addiction treatment patients to engage in health management may improve overall health and help avoid relapse JULY 6, 2016

While most used alcohol, marijuana and other tobacco products, 16 percent – or more than one in six teen smokers – reported taking harder drugs, including cocaine, hallucinogens, Ecstasy, and misused prescription medications.

In the first trial of an intervention focused on increasing alcohol and drug treatment patients’ engagement in their own health care, UCSF researchers found that the patients who received the full course of intervention sessions had greater involvement in managing their health and health care, as well as higher abstinence rates and longer treatment retention.

Teens who reported using harder drugs at the beginning of the study were more likely than other participants to report depressive symptoms one, two and three years later.

The proportion of teens reporting harder drug use also remained consistent over the course of the study, McKelvey said, “which implies that patterns of smoking and drug use established in adolescence can be chronic and persist over time.”

The intervention, known as LINKAGE, is innovative in its use of electronic health records and patient portals to engage patients in health education and prevention and facilitate communication with their medical providers.

While the study results contradicted the conventional notion that light smoking progresses to heavy smoking, and none of the teens seemed interested in smoking more as time went on, McKelvey recommended that smoking prevention and cessation programs begin in elementary and middle school.

“We tend not to worry as much about light smokers as we do heavy smokers,” said leader author Karma McKelvey, MPH, PhD. “This study shows us that it’s important to intervene as early as possible.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS248

“Patients with alcohol and other drug use disorders have high rates of medical and psychiatric conditions and complex treatment needs. They often rely on emergency services, and seldom use preventive services even when they have health insurance,” said lead author Constance M. Weisner, DrPH, professor of psychiatry at the University of California, San Francisco and chief of Behavioral Health and Aging at the Kaiser Permanente Northern California Division of Research.

“Building on research on other health conditions that shows higher patient engagement levels are associated with better self-management, we hypothesized that the LINKAGE intervention would do the same for alcohol and drug treatment patients, and improve their outcomes,” Weisner added.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS744

Addiction is an illness, not ‘a moral failing,’ says surgeon general Groundbreaking supervised consumption services bill passes the California assembly NOVEMBER 29, 2016

U.S. Surgeon General Vivek Murthy released a landmark report calling for “a cultural shift in how we think about addiction.” The report also states that addiction is a chronic illness, not a moral failing, and comes at a time when one in seven Americans will experience substance abuse at some point in their lives.

UCSF’s Constance Weisner, PhD, who served as a scientific editor of the groundbreaking report, joins KQED’s Michael Krasny and other panelists to discuss the report, why the stigma surrounding addiction is so pervasive and share ideas for improving access to effective treatment.  HEAR THE ENTIRE SHOW AT PSYCH.UCSF.EDU/NEWS119

JUNE 2, 2017

The California State Assembly became the first legislative body in the U.S. to pass a bill to permit safe consumption services that would allow drug users to use controlled substances under the supervision of staff trained to treat and prevent drug overdose and link people to drug treatment, housing and other services.

UCSF Psychiatry’s David Kan, MD, DFASAM, President-Elect of the California Society of Addiction Medicine praised the Assembly action saying, “California’s Assemblymembers who voted for AB 186 voted to save lives and create a new innovative avenue into treatment in the face of ignorance and fear.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS463

SUBSTANCE USE DISORDER AND ADDICTION

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UCSF’s drug abuse intervention app extremely useful AUGUST 31, 2016

Patient activation, shared decision-making, and motivational interviewing as brief, point-of-care interventions for substance abuse have attracted a lot of attention and research in recent years. One of the most popular and most evidence-based tools is SBIRT: Screening, Brief Intervention, and Referral to Treatment for Substance Use. Now the University of California San Francisco (UCSF) SBIRT group, with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA), has released an excellent SBIRT app that is available for free.

The medical app walks users through a typical SBIRT interaction from screening to brief intervention and referral to treatment. Unlike other SBIRT medical apps, the UCSF version includes an abundant amount of background information on the current epidemiology of alcohol and substance abuse, evidence for SBIRT, step-by-step instructions on how to perform an evaluation, links for referral sites, embedded videos and demos of SBIRT evaluations and social support, and follow-up questionnaires for providers trained in SBIRT.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS352

Postdoc scholar’s research on smoking cessation wins inaugural UCSF Postdoc Slam competition SEPTEMBER 26, 2016

Jin Kim, PhD, a postdoctoral scholar at UC San Francisco's Department of Psychiatry, won the inaugural UCSF Postdoc Slam competition for her talk titled “Promoting Smoking Cessation by Addressing Food Insecurity.”

Ten UCSF postdocs competed to explain complex research in simple language – and in three minutes or less – in the 2016 Postdoc Slam held Thursday, September 22. In front of a packed audience in Byers Auditorium, the contestants spun true tales of science ranging from cancer risk in astronauts to big molecule drug development to the protective benefits of the X chromosome.

Kim, a postdoctoral scholar in the research group of Janice Tsoh, PhD, won first place and a prize of $3,000.

“The intersection between food insecurity and smoking is not an obvious link to many people and I wanted to share that with a wider audience,” Kim said. “I’m really honored to be the only social scientist as part of this contest and I hope I conveyed the passion for the research that I do on health disparities.”

The 10 finalists for the competition were selected from 32 video entries by a panel of screening judges, which included Psychiatry's Lauren Weiss, PhD. A five-judge panel, including representatives from UCSF and industry, oversaw the live competition.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS894

Mt. Diablo schools hosting workshop on teen drug use JANUARY 13, 2017

Mt. Diablo Unified school district is hosting a workshop on recent trends in teenage drug use.

The event will feature Danielle Ramo, an assistant professor and licensed psychologist in the UC San Francisco’s Department of Psychiatry, who directs the university’s Research on Addictions and Digital Interventions lab. She will discuss her studies the use of digital media to change the risky healthy behaviors of teenagers, including tobacco, alcohol and other drug use.

Ramo has developed a social media intervention project aimed at helping young adults quit smoking. Funded with a K23 Career Development Award from the National Institute on Drug Abuse, the project is testing the effectiveness of these techniques in a randomized clinical trial with 500 young adults. She also researches e- cigarettes and tobacco and marijuana co-use in youth.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS022

New study looks at the international prevelance of smoking in addiction treatment JANUARY 17, 2017

Internationally, cigarette smoking is higher among patients in addiction treatment when compared to the general populace, according to a study published in the Society for the Study of Addiction.

Joseph Guydish, lead researcher of the study and professor of medicine and psychiatry at UC San Francisco, believes there are both cultural and biological reasons high rates of smoking tobacco exist in drug rehabilitation environments.

“In the U.S., we talk a lot about the environmental and cultural factors that drive smoking in addiction treatment. For example, a lot of people work in our addiction treatment system are people who themselves were addicted and are now in recovery,” he said. “So sometimes, not always, staff members in these programs who smoke at higher rates than the general population smoke together and use it as a way to bond with their clients and build rapport.”

The researchers also wanted to assess if what they found in the U.S. was observable internationally; they searched databases for papers that reported smoking prevalence addiction treatment samples. The researchers found 4,549 studies, comprised of 37,364 participants and 54 papers published in English — from 1987 to 2013 from 20 countries — met the precise criteria and were included in the review.

“We wanted to know if this phenomenon within the U.S. would also be seen in different countries [because] it highlights the importance of the biological relationship that we’re dealing with, he said. “You can say that there are certain features of the drug treatment system in the U.S. that might support smoking, but why would there be features in drug abuse treatment in 20 different countries that support smoking? That’s a little bit harder for me to understand.”

The collected research represented six studies from Germany, five studies each from Italy and Australia, and four studies each from France, Brazil, Switzerland and the U.K. The remaining studies came from 13 various countries. The primary drug treated was alcohol (48 percent), heroin and various opioids (35 percent), or non-specified drugs and alcohol (17 percent). The prevalence of smoking throughout all studies spans from 41.1 percent to 100 percent.

People in rehab treatment were more than twice as likely to smoke cigarettes than people who were not in rehab but exhibited comparable demographic characteristics.

Those in opioid- related treatment were more likely to smoke when compared to those being treated for alcohol use disorder, but Guydish acknowledges further studies are necessary to understand why that is.

“The [study] shifted my thinking to either realize or figure out what it is about nicotine that is contributing to drug use,” he said. “In addition to these cultural factors, I think there are biological factors. So it’s encouraged me to try to understand that if we try to address this problem only by saying, ‘oh, let change the treatment culture,’ that’s a good idea, but I think that’s probably not enough. I think that’s only part of the picture; it’s encouraged me to try to understand and be aware of what’s happening on the biological side that nicotine is an addictive drug and that it potentiates and strengthens the effects of other drugs.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS553

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Inside a drug treatment center that actually works DECEMBER 13, 2016

At 13, Patrick started shooting heroin. When reporter Julia Laurie met him on a sunny Tuesday last August, he was a homeless 46-year-old with a chiseled face and close-cropped hair, sitting in the examination room of a pioneering opioid addiction treatment clinic in SOMA—a San Francisco neighborhood known lately for both homelessness and tech companies. Outside, needles and broken glass littered the sidewalks. Twitter’s headquarters were two blocks away.

Clinic manager Dina Cehand asked why Patrick had come to the clinic that morning, walking from the squat house where he lived with a crew of homeless people, and he put his head in his hands. “I don’t want to use opiates no more,” he pleaded, shaking.

“I don’t want to do Oxy. I don’t want that.”

Patrick is one of 2.5 million Americans who are addicted to opioids, from prescription painkillers like OxyContin or Vicodin to heroin and fentanyl.

Their options for addiction treatment are few: abstinence, in which they give up the drugs altogether, or medication. Abstinence-based programs have abysmal success rates, with some studies showing that as many as 90 percent of those who complete them relapse within a year. Of the go-to medications, there’s methadone, which has been around for decades but requires daily visits to a methadone clinic—many of which have long waiting lists.

And then there’s buprenorphine—which Patrick was just starting. Like methadone, buprenorphine serves as an opioid replacement, curbing the cravings for heroin or painkillers. It’s more difficult to abuse than methadone, and, critically, you don’t need to go to clinic each day—ideally, a doctor can prescribe the medication, which comes in pill or film form, like any other drug.

But buprenorphine, which was approved by the Food and Drug Administration in 2002, is still not available to most drug users looking for help. That’s partly because only a fraction of primary care doctors have taken the required eight-hour training to prescribe the drug, and partly because getting started on it typically requires a bit of hand-holding.

Patients—particularly those with a long history of drug abuse—need to be watched carefully to make sure they’re getting the right dose, not using drugs with dangerous conflicts, and not smuggling it to sell on the street. (The pills sell for about $10 a pop.)

Daily or weekly visits are typically in order for a few weeks.

All of which contributes to a so-called “treatment gap”: Though drug overdoses now kill more Americans than guns or cars, upwards of 80 percent of those in need of opioid addiction treatment don’t have access to it. Getting effective treatment to someone like Patrick—jobless, homeless, no insurance—is the exception to the rule.

But Patrick is attending one of a handful of programs around the country that provides buprenorphine to “safety net” residents—those without private insurance. The program, called the Office-Based Buprenorphine Induction Clinic, or OBIC, is run by the UCSF Department of Psychiatry’s Division of Substance Abuse and Addiction Medicine at Zuckerberg San Francisco General Hospital.

for years, living under bridges and in abandoned homes. In addition to heroin, he used meth, and he made money to pay for the drugs by stealing bikes and selling weed.

He spoke quickly during his appointment, explaining he had fallen asleep on the train the night before and woken up nearly 40 miles away before being kicked off. To give himself a boost in the morning, he used speed.

Cehand later told me matter-of-factly that Patrick was “pretty likely to drop out.” When I asked if this made her work seem futile, she looked affronted. “Even if someone shows up for just one or two days and they feel good, they remember that,” she said. “Then the next time it’s four or five days, and then maybe longer.”

At its best, the program is life-changing. One former patient took to Yelp to spread the word, writing, “Oh my god, I can write a review for the place that saved my life?!”

Another recently left this voicemail: “I’m not sure if you remember me, but I came to your place to get help,” she said in a timid tone. “I just wanted to say hello. I’ve been clean for a number of years now. I have a child—our child is four years old. I just wanted to say thank you.”

Former patients often continue using the clinic’s on-site pharmacy because it’s so unlike a typical Walgreens or CVS. When patients are first getting started on buprenorphine, they’ll come in daily for observed dosing—a pharmacist watches the patient put the buprenorphine film or pill under their tongue and keep it there for five minutes.

Pharmacists reach out to patients before their prescriptions have run out so there’s no break between doses. If a patient comes in for a dose and looks high or drunk, the pharmacy will send them up to the clinic.

OBIC does the hand-holding that the drug requires at the beginning—watching patients take the medication, testing for other drugs the patient is using, and providing counseling. After patients are stable for a few weeks or months—off heroin or painkillers and onto the right dose of buprenorphine—the clinic transfers the patient to a nearby primary care provider. The program, which treats about 200 new patients per year, has become a model for clinics across the country. Public health officials from across the world, from Portland to New York to Japan, regularly come to observe.

Three months after our first OBIC visit, we gave Patrick a call. Against the odds, he had been going back to the clinic for his buponephrine doses. “It’s a miracle drug,” he said calmly. “It’s totally turned my life around.”

When it comes to making opioid treatment available, “San Francisco probably does it better than anybody,” says David Kan, an addiction psychiatrist at UCSF and president of the California Society of Addiction Medicine.

The progress is fragile, though. A few weeks into the buprenorphine treatment, he was picked up for an old warrant for petty theft—stealing a bolt locker to steal bikes— and put in jail in another county, where buprenorphine wasn’t an option. When he got out, he couldn’t get buprenorphine because the clinic was closed over the weekend, so he sought out heroin and overdosed. His girlfriend found him in his hotel room and injected him with the overdose reversal drug naloxone. The next day, he walked into OBIC.

Inside the nondescript SOMA building are exam rooms and a modest waiting room decorated with ivy. “No pee, no see—that’s our philosophy,” said Dina Cehand, the program manager, gesturing to a pink bin for urine samples. The samples have a temperature gauge to make sure the urine is warm. “You can buy urine from the mom and pop shops,” she explained. “They come in, try to heat it up in the sink, run the jar under hot water. Our patients are really creative.”

Patrick started using regularly at 15, when he was living on his own and working in lumber yards in Northern California’s Humboldt County. He’d been homeless on and off

Now, when he wakes up in the morning, instead of craving heroin, he has a cup of coffee and breakfast. He’s living in a single-occupancy hotel and has a job interview lined up for later in the week.

Cehand wrote to me in an email that Patrick is “doing well in a hotel and trying really hard to adjust to a life without drugs. As a middle aged person, that’s a tall order but he’s trying really hard.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS318

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San Francisco’s El Dorado Elementary uses trauma-informed and restorative practices, suspensions drop by 89% JANUARY 28, 2014

For one young student – let’s call him Martin — the 2012-2013 school year at El Dorado Elementary in the Visitacion Valley neighborhood of San Francisco was a tough one, recalls Joyce Dorado, director of UCSF HEARTS — Healthy Environments and Response to Trauma in Schools.

So are the lives of many of its other 275 students. The numbers tell the story: In 2008-2009, the year before HEARTS was introduced at El Dorado, there were 674 referrals – students sent to the principal’s office for fighting, yelling, or some other inappropriate behavior.

“He was hurting himself in the classroom, kicking the teacher, just blowing out of class many times a week.” There was good reason. The five-year-old was exposed to chronic violence and suffered traumatic losses. His explosions were normal reactions to events that overwhelmed him.

During the last school year – 2012-2013, there was a 74% drop, to only 175. This year, only 50 referrals have occurred.

This year, Martin’s doing better. That’s because he spent months working with a HEARTS therapist, and that therapist worked with his teachers and other school staff to create a more safe and supportive learning environment. Still, on days when he feels extremely anxious, Martin sometimes asks to visit the school’s Wellness Center, a small, bright room stocked with comforting places to sit, headphones to listen to music, and soft and squishy toys.

“If a student starts to lose it, the teacher can give the kid a pass to go to the Wellness Center,” says Dorado. “The kid signs in, circles emotions on a ‘feelings’ chart (to help the person who staffs the center understand how to help the child). The staff member starts a timer. The kid gets five to 10 minutes. The kid can sit on the couch with a blanket, listen to music, squeeze rubber balls to relieve tension and anger, or talk to the staff member.

Kids who use the room calm down so that they can go back to class. It’s not a punishment room. It’s not a time-out room. It’s not an in-school suspension room. It’s a room where you feel better going out than when you went in.”

One day this year, as school staff members are meeting in the Wellness Center, Martin bursts in. “I need to borrow something,” he tells them. “Somebody needs my help.”

They are stunned. He has had such a difficult time learning to manage his own feelings, that they’re shocked that he’s helping another child work through her distress. You go right ahead, they tell him. Martin picks up a couple of squeeze balls and takes them to a girl on the playground who’s crying. He shows her how to use them. Then he brings her to the Wellness Center and helps her use some of the other tools. Seeing that she’s in a safe place and in safe hands, he says, “I’m going back to class now.”

“Obviously,” says Dorado, a psychologist who’s also an associate clinical professor in the University of California San Francisco Department of Psychiatry, Child and Adolescent Services, “we’re going to work with him to build that strength.”

In most schools in the U.S., it’s likely that Martin would have been suspended, expelled, or shunted into special education classes. In fact, during the 2010-2011 school year 150,349 out of 3,042,670 – nearly five percent — of elementary school students were suspended or expelled in California.

Instead, because El Dorado Elementary has integrated HEARTS, Martin’s life is on a completely different trajectory than it was a year ago.

There were 80 suspensions in 2008-2009. And although suspensions increased for four years to 150 in 2011-2012, last year they dropped 89%, to only 17. So far this year, only three students have been suspended.

As El Dorado Elementary School Principal Silvia Cordero thought when she first heard about trauma-informed practices: “Why don’t all schools have this?”

Kids who throw chairs in class – that’s a public health issue “Childhood trauma is a public health issue,” says Dorado as we sit in a coffee shop in Berkeley, CA, late one afternoon to talk about the HEARTS program. “It’s really common, and the way kids react to it gets them into trouble in school.”

In fact, serious and chronic childhood trauma is so common that most people in the U.S. have experienced at least one type out of ten measured by the CDC’s Adverse Childhood Experiences Study. These include physical, sexual or verbal abuse; physical or emotional neglect; and five types of family dysfunction — family violence, living with alcoholic (or other drug-addicted) or mentally ill parents, losing a parent to divorce or abandonment, or a family member who’s in prison.

And almost half the nation’s children have experienced at least one or more types of serious childhood traumas, as measured by a recent survey on adverse childhood experiences by the National Survey of Children’s Health (NHCS). This translates into an estimated 35 million children nationwide. (Since parents responded to the survey, questions about physical, sexual and verbal abuse were excluded, since it was unlikely those would be answered accurately. Hence, 35 million children suffering childhood trauma is on the low side.)

It’s a public health issue, explains Dorado, because the toxic stress caused by chronic trauma can harm children’s brains. Toxic stress alters the brain’s structure and functioning, so that a child is hyper-vigilant. With their trigger reset on “red alert”, they can flip into “fight, fight, or freeze” mode even when they aren’t in real danger.

As a result, they can have trouble concentrating, learning, or sitting still. They can erupt into rages, lash out at others or hurt themselves. Or they can withdraw in fear and not participate in anything that’s going on around them. None of this behavior is intentional, says Dorado.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS612

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New campaign promotes power of teachers to reduce stress of traumatized students NOVEMBER 7, 2016

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Oxytocin being tested for treatment of PTSD and alcohol abuse APRIL 13, 2017

Most of the 3rd-graders in Anita Parameswaran’s class at Daniel Webster Elementary in San Francisco have had experiences so awful that their brains won’t let them easily forget.

Nightmares. Obsessive thoughts. Avoiding particular places. Sudden outbursts. Fearing you’re in danger. Survivor guilt.

“Whether it be that they’ve been sexually molested, or they’ve seen domestic violence, or shootings, or they know somebody who’s passed away,” Parameswaran said, “I would say every single year about 75 percent, give or take, come in with a lot of trauma.”

These experiences – manifestations of post-traumatic stress disorder (PTSD) – are part of life for up to 1 in 3 U.S. combat veterans and active military personnel. That’s more than triple the prevalence of PTSD in the population at large. About two-thirds of those with PTSD struggle with alcohol abuse.

Now a national campaign is recognizing, backed by research on brain development, the power of teachers like Parameswaran to lower the levels of stress hormones in a child’s body and strengthen the neural connections needed for learning and self-control. The campaign, called Changing Minds and launched last month, is a partnership of the U.S. Department of Justice, the nonprofit group Futures Without Violence and the Ad Council, a nonprofit agency that creates public service advertisements.

The need for adults to take steps, small or large, to encourage these children is urgent, the campaign said. More than 60 percent of children from birth to age 17 in the United States were exposed to violence, crime and abuse in the past year, according to a paper published in 2015 in JAMA Pediatrics that analyzed the results of the 2013-14 National Survey of Children’s Exposure to Violence.

The campaign is not meant to suggest that teachers and school staff must carry the entire burden of healing traumatized children, said Joyce Dorado, director of UC San Francisco’s Healthy Environments and Response to Trauma in Schools, or HEARTS, program and a consultant for the Changing Minds campaign. Instead, Changing Minds aims to provide information to make it easier for teachers to have “calm, compassionate and empowering” interactions with students who have experienced trauma, and to encourage schools to become supportive places for everyone, including staff.

“The message to teachers is that we care about how stressful this is for you,” Dorado said.

Teacher supports have “a very clear focus on addressing stress, burnout and trauma in educators,” she said. “It’s an invitation to teachers to take better care of themselves and each other.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS085

NIH awards nearly $5 million to research child development’s environmental influences MARCH 13, 2015

The National Institutes of Health (NIH) has awarded more than $4.7 million to a project being conducted in part by UC San Francisco researchers investigating how the environment influences neurodevelopment and asthma risk in children.

The grant was part of $157 million in national awards announced by the NIH for a multitude of projects under a seven-year initiative called Environmental Influences on Child Health Outcomes (ECHO). The ECHO program will investigate how exposure to a range of environmental factors in early development — from conception through early childhood — influences the health of children and adolescents. The studies will target four key pediatric outcomes that have a high public health impact: airway health, obesity, neurodevelopment, and birth outcomes.

UCSF Department of Psychiatry faculty members Nicole Bush, PhD, and Kaja LeWinn, ScD, are co-principal investigators on the grant project, titled "Prenatal and Childhood PATHWAYS to Health: An Integrated Model of Chemical and Social Exposures, Biological Mechanisms, and Sex-Specific Effects on Neurodevelopment and Respiratory Outcomes." In collaboration with their fellow co-principal investigators from the University of Washington, Seattle Children’s Research Institute, and the University of Tennessee Health Science Center in Memphis they will harmonize data from three extant cohorts comprising nearly 3,000 mother-child pairs to examine important questions about the effects of chemical (pollution and phthalates) and non-chemical (self-reported stress and stress biomarkers) exposures during pregnancy and their interaction on developing fetuses.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS826

A new trial may hold new hope for these military personnel through treatment with oxytocin, sometimes referred to as the “love hormone.”

It’s no surprise that the threat or actuality of battle takes a psychological toll. What is surprising, are changes that Jennifer Mitchell, PhD, associate professor in neurology and psychiatry, and director of the UCSF Institute for Translational Neuroscience, has found in the U.S. military’s attitude toward the condition, and its willingness to experiment in order to help troubled soldiers.

“It used to be that when an officer was experiencing this kind of thing, they were simply excused from the military,” said Mitchell, whose work focuses on PTSD and substance abuse. “Now they’re coming to accept that this is happening to many career personnel, and the military wants to keep these active duty people going. It’s an entirely new development philosophically.”

That shift is allowing Mitchell to test the potential of oxytocin, a hormone released during sex, childbirth and lactation as a treatment for PTSD and substance abuse among active military personnel. Oxytocin, present in both women and men, plays a role in social behavior, trust, empathy, and managing stress and anxiety. Its qualities have drawn researchers to the hormone, which is showing promise as a treatment for autism and schizophrenia.

“We are interested in general in developing novel therapeutics for alcohol use disorder and co-morbid PTSD, because it is a population that is very difficult to treat and there are not a lot of treatments currently prescribed for. One of the therapeutics that we are looking at is oxytocin.”

“It helps with several conditions because they all involve similar stress responses,” said Mitchell, who has published findings about oxytocin for substance abuse with colleague and assistant professor of psychiatry Josh Woolley, MD, PhD. “Our thinking is that oxytocin can also help mitigate the stress response induced by trauma, and therefore keep particular behaviors at bay.”

When she proposed giving oxytocin, which has been variously dubbed the “love hormone,” the “moral molecule,” and the “cuddle chemical,” to active duty personnel, “there was some concern about whether it would affect their ability to perform,” said Mitchell. “The answer is no. But the question arises because oxytocin is kind of misunderstood.”

The hormone does make people feel bonded to others, she said, but the effects are more complex.

“It defines how we draw our circles of ‘us’ and ‘them,’” said Mitchell, noting that for military officers who’ve been through trauma, the circle of “us” can become very small – a factor that contributes to their stress.

Mitchell’s hope is that oxytocin will allow military personnel dealing with PTSD to broaden their “us” circles. If she’s right, the hormone could temper their stress responses, and allow them to better control their PTSD symptoms and alcohol abuse that arises from them.

Mitchell is beginning a clinical trial to test her ideas at a mental health facility at Fort Gordon in Augusta, Ga. She’ll work with about 65 volunteers, initially giving patients single doses of oxytocin and then subjecting them to a stress test.

If oxytocin ameliorates the stress response, Mitchell said, the implications go way beyond the military. “The amount of money spent managing the fallout of PTSD and substance abuse in our whole society is enormous,” she said. “We’re hoping we can address that by bringing an overlooked, cheap, accessible drug into use for the public.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS992  HEAR A RELATED PODCAST EPISODE AT PSYCH.UCSF.EDU/NEWS993

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Undoing the harm of childhood trauma and adversity SEPTEMBER 18, 2015

Years of research have shown that trauma and adverse events in childhood can put a person at an elevated risk for a wide range of physical and mental health problems across their life span. But the scope and significance of that impact – and how to reverse it – is just beginning to come into focus.

The number of children under the age of 18 who have experienced trauma and are at risk for health problems is staggering: About two-thirds of kids have experienced at least one major traumatic event in their lives and one-third have experienced two or more, according to a 2007 study.

The idea that adversity increases the risk of disease later in life is generally acknowledged in the medical community, said Tom Boyce, MD, a professor of pediatrics and psychiatry at UCSF who began studying psychological stress as a disease risk factor in children nearly 40 years ago. Now health professionals and researchers are working to understand the psychological and biological connections between adverse events and trauma on health – and what to do to interrupt those effects.

Connecting adverse events, health effects Nearly two decades ago, the connection between adverse childhood experiences (ACEs) and long-lasting health effects was thrust into the spotlight when the Adverse Childhood Experiences Study was published. It examined seven categories of adverse experiences – such as childhood maltreatment, parent criminal behavior and domestic violence – in 17,000 adult Kaiser Permanente members in Southern California.

Findings in the study showed strong correlations between early-life adversity and risk factors for several of the leading causes of death in adults, including depression, diabetes and heart disease.

While that pivotal ACE study laid the groundwork for connecting the association of childhood adversity with many leading causes of morbidity and mortality, the number and scope of ACEs and their health impacts have expanded since then. ACEs now include detrimental experiences and trauma such as abuse, neglect, parental death or divorce, or an environment of racism or violence.

As more research is done, more evidence surfaces about the harmful effects of ACEs. For example, a new study shows that a person who experienced persistent poverty in young adulthood had lower cognitive scores later in life than a person who had never been in poverty. Another study showed that childhood adversity increases the odds of shorter telomeres, which have been linked to an increased risk of non-communicable illnesses in adulthood, such as cardiovascular disease and cancer.

The impacts from such hardships and trauma also have now been shown to go beyond correlations to diseases. ACEs have been shown repeatedly to predict a wide range of risky health behaviors, such as smoking or other substance abuse.

The more traumatic or adverse events children have, the higher the risk for negative health effects and mental health issues that can continue well into adulthood.

“Children do not outgrow the impact of ACEs,” said Alicia Lieberman, PhD, a professor of psychiatry who leads one of 25 National Child Traumatic Stress Network centers at Zuckerberg San Francisco General Hospital and Trauma Center. “On the contrary, when children are exposed to multiple ACEs, the effect increases such that children get worse over time rather than better – unless we change the conditions.”

Mechanisms of transmitting ACEs effects For children, ACEs from unhealed parents could be passed on through a dual-pronged influence: from the environment a parent creates for a child and, researchers are discovering, in biology.

“We now understand that effects of adversity exposure can begin immediately when an organism is conceived and begins to develop,” said Nicole Bush, PhD, an associate professor of psychiatry and pediatrics who is determined to uncover the mechanisms of how early-life adversity affects chronic disease in humans.

Maternal stress hormones appear to program fetal development, she said, and beyond that, a mother’s own early childhood adversity can affect her biology throughout her life, which she carries into her pregnancy.

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Bush and Lieberman have joined forces in the CTRP-Health study at the UCSF Child Trauma Research Program (CTRP) to examine the biological systems implicated in traumatic stress and their response to Lieberman’s child-parent interventions. In mothers and their children, Bush and colleagues are searching for biological markers of adversity in the telomeres at the ends of chromosomes, the immune system and other physiological stress response systems.

Machtinger is leading a series of studies implementing and evaluating a traumafocused care model for dealing with the impact of lifelong abuse. The model incorporates several proven strategies, including creating a safe supportive clinical environment, empowering patients, and combating their social isolation and screening and treatment for post-traumatic stress disorder, chronic pain, substance abuse and mental illness.

“People tend to blame a child for having a ‘bad attitude’ or behavior problems,” Bush said. She hopes to demonstrate that those issues are related to trauma and that an intensive intervention might fix a biological problem, for example by correcting a dysregulated immune system, which could reverse a range of biological, behavioral and psychological problems.

“If you want to interrupt ACEs, you have to help the adults heal,” he said.

“You can’t blame a kid for having a dysregulated immune system,” she said. “Findings like this would start taking away some of the blame and start making it a larger societal issue that we need to address.”

Tools to address impact of trauma Prevention of adverse events in the first place would be ideal, said Boyce, and many nationwide efforts to reduce ACEs are geared in that direction. “But we are a long way from preventing one of the most chronic and pernicious stressors, which is simply not having enough money or resources such as food or shelter to take care of the needs of the family,” he said.

In the real world where children are presenting with depression or anxiety or behavior problems due to ACEs, Boyce said there is an arsenal of clinical interventions that are simple but very effective in helping kids recover, primarily by supporting parents and giving them strategies to deal with trauma and stress.

“What is lacking is a general awareness that we have the tools available to us to address the impact of trauma in adults that lead to ACEs in children and poor health outcomes in adulthood,” said Edward Machtinger, MD, a professor of medicine who, as director of the Women’s HIV Program at UCSF, sees the long-term effects of childhood adversity on his adult patients. In his clinic, they are using trauma-informed methods to more effectively treat depression, substance use, chronic pain and other conditions that predispose parents exposing their children to ACEs. Lieberman, who is a UCSF professor of psychiatry, has created an assessment and treatment program to decrease the impact of ACEs on children’s physical and mental health. After an initial assessment with a child experienced interpersonal trauma and his or her primary caretaker, Lieberman’s team at CTRP offers a treatment a treatment plan tailored to the needs of each family, which can include forms of psychotherapy, crisis intervention and practical assistance for living situations.

Her model has been disseminated in 35 states and five countries.

“When we are able to intervene early to protect children from the impact of ACEs, the effects are amazing,” she said. “They change the developmental trajectory of the child and ensure that their current illnesses do not become chronic.”

Focusing on children and adults While early intervention is imperative in cases where children are experiencing ACEs, Boyce said that one of the best things health professionals can do is give parents and children the opportunity to discuss traumatic events in their lives. “It helps both parents and kids immensely to just talk about this,” Boyce said.

Machtinger contends that treating ACEs requires a focus on adults – the children who grew up with unresolved early life trauma who then may transmit ACEs to their own children through abuse, neglect or a dysfunctional home environment.

“At UCSF, we are at the forefront of innovating ways to address trauma as the primary underlying factor in the illnesses of our adult patients,” he said.

In recognition that parents who have unresolved ACEs will have their parenting skills affected, Lieberman’s treatment helps heal both children experiencing adversity and the children’s parents or caretakers. Called Child-Parent Psychotherapy, the technique brings the two together to alleviate impact of ACEs on the child by helping the parent become a better protector for the child.

After treatment, not only are the physical and mental health indicators much better for the child, but they are much improved for the parent as well.

In an imperfect world where children do experience stress and trauma, a bit of good news is that there considerable evidence of great variation between children in their responses to stress and adversity.

“I feel tremendously encouraged by research being done at UCSF and elsewhere to determine the factors that contribute to a child’s resilience,” Boyce said. Good parenting, a good diet, social support and strong communities are likely candidates. “But we already know that supporting young families and children – financially, psychologically and educationally – really helps with prevention of these stress-related disorders.”

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A haven from trauma’s cruel grip MAY 31, 2017

The sun was preternaturally bright the day Clare Senchyna’s 26 year-old son Camilo, her only child, was shot and killed in a random act of violence in San Francisco.

On that morning two years ago, Ms. Senchyna drew the orange curtains in her bedroom, pulled up her blankets and stayed in bed for much of the next several months. It seemed to her an appropriate response to the end of the world.

Her son, an emergency medical technician, had been out celebrating the completion of his paramedic classes when he was murdered across the street from Ms. Senchyna’s favorite yoga studio. A single mom and urgent care nurse practitioner, Ms. Senchyna began drinking heavily, plying herself with sleeping pills, and felt suicidal enough to commit herself to a local hospital before quickly determining that “a psych ward is not a place for grief.”

Too many friends stayed away, as if losing a child to murder might be contagious.

Eventually, she worked up the courage to call the Trauma Recovery Center, a pathbreaking University of California, San Francisco program that provides kaleidoscopic care for victims of violent crime and their families.

For Ms. Senchyna, 62, whose vivid blue-green eyes set off her salt and pepper hair, the center, about ten blocks from the Zuckerberg San Francisco General Hospital, with which it is affiliated, was a portal for re-entering the world.

Starting as a pilot project with a small state grant in 2001, the center’s all-encompassing approach to trauma recovery and prevention – for survivors of gun violence, sexual assault, hate crimes and other violent offenses — has become a national model.

The concept is now being replicated across California; seven new centers up and running or in the works — including three in Los Angeles and others in Stockton, Long Beach and Oakland. Other states are following suit. The Ohio attorney general recently announced a $2.6 million effort to launch five trauma recovery centers modeled on San Francisco’s, and in Illinois, where Chicago homicides have reached record numbers, a criminal justice reform bill just signed into law includes similar services.

Along with a growing number of hospital-based violence intervention programs, the new centers acknowledge the link between violence and public health, as well as the insidious ripple effects that untreated trauma can have on public safety. The likelihood of becoming a victim of violent crime — and a repeat victim — increases exponentially for low-income people of color under age 30, the very population least likely to seek help.

Along with a growing number of hospital-based violence intervention programs, the new centers acknowledge the link between violence and public health, as well as the insidious ripple effects that untreated trauma can have on public safety. The likelihood of becoming a victim of violent crime — and a repeat victim — increases exponentially for low-income people of color underage 30, the very population least likely to seek help.

A trauma recovery center offers one-stop shopping of sorts, in which mental health professionals trained in trauma help vulnerable people surmount the psychic hurdle between “victim” and “survivor.”

In addition to therapy, clinicians help them navigate the stultifying maze that faces a violent crime victim, whether it is filing a police report, testifying against a perpetrator, applying for victim compensation, relocating to a safer neighborhood or simply summoning up the strength to leave the house. (If they have not yet done so, a therapist will visit).

Left untreated, trauma makes victims more susceptible to depression, substance abuse, unhealthy relationships or difficulties holding down a job. It increases the likelihood of becoming violent themselves, erasing the razor-thin line between victim and perpetrator. As Sammy Nunez, the founder of Fathers and Families of San Joaquin, the nonprofit that houses Stockton’s new Trauma Recovery Center, aptly put it: “Hurt people hurt people.”

Each center has its own character. The 2 ½-year-old Long Beach center for instance, draws victims from nearby Watts and Compton and bases a social worker at the police department, from which he or she can respond to trauma as it happens. Stockton’s center is culturally rooted, treating “susto,” a Latin American term for the spirit leaving one’s body in a trauma.

The proliferation is the result of a fortuitous tripling of funds — from $745 million to $2.3 billion — since 2015, when Congress raised a funding cap on monies available to states for crime victim services under the federal Victims of Crime Act. In California, a ballot measure also funneled savings from reduced prison populations into prevention programs; it included $6.8 million for replicating the San Francisco model.

Unlike the typical “fee for service” system, which expects traumatized people to find therapists, make appointments, fill out forms, gather receipts and then apply to the state victim compensation board for reimbursement, the trauma recovery centers put everything under one roof and are estimated to save about one-third of the cost.

“Victims just have to worry about recovery,” said Mark Leno, a former California state senator who helped secure funding for the program’s expansion.

The average survivor comes in having had five previous traumas. According to the federal Department of Justice, more than one-third of America’s victims of violent crimes have been previously victimized – a toxic outgrowth of chaotic or abusive households, violent neighborhoods and other risk factors.

“Around here it’s not PTSD,” — post-traumatic stress disorder — said Dr. Alicia Boccellari, director of San Francisco’s Trauma Recovery Center and a clinical professor in the UCSF Department of Psychiatry. “There’s nothing ‘post’ about it.”

Yet the end goal is what Dr. Boccellari calls “post-traumatic growth.” Studies indicate that the approach works: After 16 weeks of treatment, roughly two-thirds of the centers’ clients show improved mental health, and many no longer meet the clinical criteria for PTSD or depression. More than half who entered with alcohol or substance abuse problems either cut down their consumption or quit entirely, and many were able to return to work. Filings of police reports also increased markedly, breaking a discouraging cycle in which 42 percent of victims of violent crime never report it to law enforcement, according to the Justice Department.

In a survey of such victims last year, the Alliance for Safety and Justice, a nonprofit organization that focuses on public safety and criminal justice reform, found that an “invisible barrier” to cooperating with law enforcement is “the fear of having to retell the story,” said Lenore Anderson, the alliance’s president and a former prosecutor.

The support available at trauma recovery centers “makes it more likely for them to participate in the justice process without being re-traumatized,” she said.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS221

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Talk therapy with ‘self-forgiveness’ focus eases PTSD symptoms in vets who have killed AUGUST 17, 2017

Veterans who have killed in combat and suffer from nightmares, hyper-vigilance to perceived threats, and numbness to people and activities that once made them happy, may be helped by a six-to-eight week talk therapy program, a UC San Francisco study has found.

In the study, 33 veterans with post-traumatic stress disorder (PTSD) were enrolled in six-to-eight one-on-one sessions with a licensed psychologist. The veterans had either “endorsed killing” or were “responsible for the death of another in a war zone,” said first author Shira Maguen, PhD, associate professor in the UCSF Department of Psychiatry and mental health director of the San Francisco VA Health Care System Integrated Care Clinic.

The study follows earlier work by Maguen that found veterans with killing experiences were twice as likely to think about suicide as those who had not killed.

In the current study, published Aug. 17, 2017, in the Journal of Clinical Psychology, Maguen and her co-investigators assessed the mental health of 17 veterans who had completed the program, and compared the results with 16 counterparts who were waitlisted for the same treatment. While both groups of veterans suffered from PTSD and had killed in combat, the group that had completed the program experienced a 63 percent drop in depression symptoms, 43 percent improvement in anxiety and a 37 percent dip in general psychiatric symptoms.

“Many of the veterans struggled with difficulties getting close to people, intimacy with partners and a belief that they were no longer lovable,” said Maguen. “Others were unable to trust their anger after killing, or felt that they deserved to suffer.”

Components of the program included identifying the barriers to feeling better, such as numbing feelings with drugs or alcohol, living in an unhealthy environment or sabotaging personal relationships. Participants worked with psychologists to challenge “killing cognitions,” those beliefs that the deaths had made them unworthy of affection, trust or respect.

A latter phase of the program involved self-forgiveness – “a key ingredient in healing,” according to Maguen.

“Self-forgiveness might involve volunteering, reconnecting with friends and family who were cut off, tutoring children, or even going back to the country where the killing occurred and trying to make amends there,” she said.

Finally, participants were encouraged to express “guilt and remorse for those harmed, and sadness and compassion for self and others,” the authors noted in the study.

Currently veterans can receive PTSD evaluation and treatment without ever being asked about killing and its impact, said senior author Thomas Neylan, MD, professor in the UCSF Department of Psychiatry and director of the PTSD clinic at the San Francisco VA Medical Center.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS692

Could the love hormone help with PTSD? AUGUST 4, 2017

Growing up in San Francisco in the 1970s, Jennifer Mitchell saw the psychological scars of war firsthand. Vietnam veterans flooded her hometown, often finding an outlet for their trauma in drugs and alcohol. Their suffering, and society’s response — to ignore it — had a lasting impact. “[We all] understand the importance of people who can point and kill,” she says, but “we have to be willing to pick up the pieces when it’s over.”

As a student at Reed College in Portland, Oregon, she found she could predict which classmates would struggle with alcohol and substance use disorders: They were either impulsive, life-of-the-party types, or had suffered a form of trauma. It made her wonder: Why do some people thrive in spite of trauma, while others crumble and self-medicate with drugs and alcohol?

Mitchell, now an adjunct associate professor of neurology and psychiatry at UCSF, is doing her part to pick up the pieces by finding treatments for people suffering both post-traumatic stress disorder (PTSD) and alcohol use disorder. People with PTSD are two to four times more likely than those without to meet criteria for a substance use disorder — yet today’s medications treat one disorder or the other. Mitchell believes a solution could come in the form of oxytocin, nicknamed “the love hormone” because it promotes pair bonding and social attachment. Now, she’s recruiting participants for a clinical trial testing whether oxytocin could treat PTSD and alcohol use disorder in military personnel.

Mitchell looked to the brain for answers, majoring in psychology and studying how people perceive pain. In 1999, she earned a Ph.D. in neuroscience from UCSF, where she also finished a postdoctoral fellowship. Howard Fields, Mitchell’s mentor at UCSF, recalls her “combination of enthusiasm and discipline … which is very characteristic of any scientist that becomes very successful.”

Her work is part of a growing interest in the potential of oxytocin to treat autism, depression, schizophrenia and other psychiatric and neurodevelopmental disorders.

Studies have shown that oxytocin — released during intercourse, childbirth and breastfeeding — is important for pair bonding, which is typically a challenge for those with anxiety, alcohol and substance use disorders. Plus, it has few side effects and is available in a nasal spray, making it easy to administer.

Mitchell had become aware of research suggesting that people with alcohol use disorder often have poor social skills, similar to those with autism. Both groups tend to perform poorly on tests of their ability to recognize people’s emotions, but giving oxytocin to people with autism improved their test performance. Might oxytocin boost social skills in people with alcohol use disorder too? What’s more, other studies — most involving animals and some in humans — showed oxytocin can curb the intake of alcohol and other drugs. Drugs like Antabuse and Campral already help people with alcohol use disorder to drink less, but oxytocin may have the added benefit of addressing the underlying social anxiety that spurs them to reach for the bottle in the first place.

“Perhaps this would be a multipronged therapeutic,” Mitchell says.

If proven to work, oxytocin could become an affordable, accessible treatment for those suffering from PTSD and alcohol and substance use disorders — beyond the military.

“You’re talking about the potential to help a substantial amount of people,” says Gary Wynn, of the Uniformed Services University of the Health Sciences. PTSD and substance abuse issues carry heavy stigmas, and therapy can require confronting painful memories, as well as making drastic lifestyle changes. Oxytocin may help ease the process, perhaps through promoting bonding with a therapist.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS091

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Study finds killing in war leaves veterans with lasting psychological scars DECEMBER 9, 2016

Killing in war often triggers a moral conflict in veterans that can damage their selfimage, relationships and spirituality, according to a study by UCSF researchers at the UCSF-affiliated San Francisco Veterans Affairs Medical Center.

For many of these veterans—some of whom may already suffer from post-traumatic stress (PTSD)—the guilt, shame, anger and isolation they suffer compound psychological trauma related to their war experiences. Shira Maguen, PhD, UCSF associate professor of psychiatry and mental health director of the San Francisco Veterans Affairs Health Care System Integrated Care Clinic, which treats Iraq and Afghanistan war veterans, said these emotional scars sometimes last for decades.

Maguen’s earlier research—supported by the Veterans Health Research Institute-NCIRE—has linked killing in combat with PTSD, depression and suicide. The new study, published in the October 2016 issue of Counseling Psychologist, further investigates the moral injury suffered by veterans who have killed and the stigma they carry.

Although not all veterans who have taken a life suffer guilt or mental health consequences, Maguen said the growing number of veterans seeking mental health services suggest that high numbers of veterans are experiencing moral injury. The researchers urged the public and health care workers to allow veterans to express themselves to help them work through these conflicts.

“Civilians, including mental health professionals, have an opportunity and an obligation to better understand veterans’ experiences and to join them in confronting difficult truths about the violence of war, its meaning and its consequences,” they stated in the paper. “In doing so, we can begin to break through the postwar silence that masks moral injury, sustains isolation and reinforces trauma.”

Maguen and the study’s first author Natalie Purcell, PhD, who directs the Patient Centered Care Program at the SFVAHCS, have initiated research, outreach and model therapies for veterans with moral injury. These are coordinated with PTSD and general psychiatry programs.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS788

PTSD in veterans tied to worse heart health APRIL 1, 2016

Post-traumatic stress disorder (PTSD) in veterans is associated with worse vascular function, which can increase their risk for cardiovascular disease (CVD) and death, according to researchers at UC San Francisco (UCSF) and the affiliated San Francisco VA Health Care System (SFVAHCS).

The study, which appears in the March 2016 issue of the Journal of the American Heart Association, found that veterans with PTSD were more likely to have worse endothelial vascular function, which controls the flow of nutrients and toxins from the blood stream to the brain and body, and plays a key role in blood vessel dilation, blood pressure, clotting and inflammation.

“If other studies confirm that patients with PTSD have worse endothelial function, this could be an important target in our efforts to prevent CVD and improve the health of veterans with PTSD,” said senior author Beth Cohen, MD, associate professor of medicine at UCSF Health and SFVAHCS. An estimated 7.7 million Americans suffer from PTSD. Many veterans returning from tours are affected by PTSD and, over time, the effects may be physical as well as mental.

It is believed that the cumulative effects of stress negatively impact the nervous, cardiovascular, metabolic and immune systems. Previous studies have indicated that psychosocial factors such as PTSD result in increased risk for cardiovascular disease and mortality over other risk factors such as diabetes, hypertension, and obesity. Despite this association, the underlying mechanisms are not well understood.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS675

Wooley awarded grant to study the role of oxytocin in military team cohesion FEBRUARY 26, 2015

Joshua Woolley, MD, PhD, and colleagues were recently awarded a grant totaling $1.3 million from the U.S. Army Medical Research Acquisition Activity, a branch of the Department of Defense, to explore the potential benefits of oxytocin administration to unit cohesion and group dynamics in Reserve Officer Training Corps (ROTC) cadets and healthy civilians.

The three-year study, entitled "The Psychobiological Assessment and Enhancement of Team Cohesion and Psychobiological Resilience using a Virtual Team Cohesion Test,” builds upon an existing body of research demonstrating that unit cohesion is a protective factor against many of the psychiatric conditions that result from combat exposure, including PTSD, depression, suicidality and substance abuse.

The prosocial neuropeptide oxytocin has been shown to enhance social functioning and bonding in both healthy and clinical populations, and may have the ability to facilitate unit cohesion and teamwork in military settings, ultimately helping to prevent and treat the psychological trauma experienced by veterans returning from combat.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS368

Why a neuroscientist wants more access to female military populations JULY 2, 2017

Studies of alcohol abuse and post-traumatic stress disorder, or PTSD, are mostly focused on male soldiers, while female military members are often excluded. Jennifer Mitchell, a neuroscientist at the University of California, San Francisco explains why.

“You can imagine that female subjects that have alcohol use disorder and comorbid PTSD are individuals that have experienced rape or other forms of domestic abuse. And those individuals might respond very well to a drug like intranasal oxytocin, but it’s a very hard subject population for us to identify. ” ‘’We’d love to have access because then we could study the effects of intranasal oxytocin in a group of females that have substance-use disorder and comorbid PTSD.”  HEAR THE ENTIRE PODCAST EPISODE AT PSYCH.UCSF.EDU/NEWS407

TRAUMA AND PTSD

Youth adversity linked with short telomeres OCTOBER 4, 2016

Major childhood psychological and social stressors, such as trouble with the police and parental substance abuse, increase the odds of shorter telomere length in adulthood, according to a study led by researchers at UC San Francisco.

“This was the first study of telomere length to undertake a lifespan approach,” said co-lead author Eli Puterman, PhD, a former assistant professor of psychiatry at UCSF who is currently Canada Research Chair in physical activity and health in the School of Kinesiology at the University of British Columbia. “We looked at a wide range of stressful situations experienced over the course of childhood and adulthood to examine the independent and combined impact of these stressors on telomere length.”

Telomeres are DNA-protein caps at the ends of chromosomes that protect genes from deterioration. A large body of previous research has shown that short telomeres are linked to an increased risk of non-communicable illnesses in adulthood, such as cardiovascular disease and cancer.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS718

Protecting children from toxic stress OCTOBER 30, 2013

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The man who takes troubled youths to therapy camp APRIL 22, 2014

Families who send their troubled children to therapeutic wilderness camps in the US sometimes call on the services of a shadowy figure known as the "escort" - a man named Eddie Curry.

While most of Curry's business comes from the US, Canada and Mexico, 20% comes from other countries. He also picks up children from airports in the US after parents fly them in from places as far away as Iran, Dubai, Israel, Brazil and Hong Kong.

Parents at their wits end find Curry through internet searches, the wilderness programmes he works with or just by word of mouth. And they hire him for all sorts of reasons - drug and alcohol problems, violence and trouble with the police are among them. Often, more conventional treatment like therapy has failed or been refused.

Wilderness therapy has existed across the US for decades, and supporters say it results in better communication between the child and parents, increased self-confidence, and even better academic results.

But Nicki Bush, a professor of psychiatry at the University of California, warns that camps are not the silver bullet parents are hoping for and pay a "ludicrous" amount of money for.

Imagine if scientists discovered a toxic substance that increased the risks of cancer, diabetes and heart, lung and liver disease for millions of people. Something that also increased one’s risks for smoking, drug abuse, suicide, teen pregnancy, sexually transmitted disease, domestic violence and depression — and simultaneously reduced the chances of succeeding in school, performing well on a job and maintaining stable relationships? It would be comparable to hazards like lead paint, tobacco smoke and mercury. We would do everything in our power to contain it and keep it far away from children. Right?

And though Curry only takes children who agree to go, he says, Prof. Bush says many children find being escorted to camps a traumatic experience, and often perceive it as an abduction.

Well, there is such a thing, but it’s not a substance. It’s been called “toxic stress.” For more than a decade, researchers have understood that frequent or continual stress on young children who lack adequate protection and support from adults, is strongly associated with increases in the risks of lifelong health and social problems, including all those listed above.

Real change won't come under duress, she believes.

"The children are further estranged from their family because they feel violated and betrayed by the experience and then they're raised with a bunch of strangers out in the wilderness and they don't actually get to repair or bond with their family and build relationships there."

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS547

Child First, initially developed at Bridgeport Hospital in Connecticut, now works in partnership with community-based agencies in 15 locations across the state, where staff members deliver its program of home-based parent guidance and child-parent psychotherapy. It attributes its success to a number of factors. It is preventive, focusing on children under the age of 6. It works through teams, bringing a mental health professional into the home alongside a care coordinator who helps the family gain access to basic services.

In this process, “the therapist does not present herself as the expert, but as a partner in seeking solutions together,” explains Alicia Lieberman, director of the Child Trauma Research Program at the University of California, San Francisco, who led the development of this practice. It’s essential that the therapist responds in a caring and nonjudgmental manner.

“Many parents worry that something is basically wrong with them,” says Lieberman. “It brings tremendous relief to hear that they are not ‘bad.’ And when they see the therapist believing in them and joining in their efforts to overcome problems, a different attitude gets established about themselves and their child.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS305

Are kids who suffer from abuse at higher risk of health problems?

FEBRUARY 2, 2017

Children who suffer from emotional or physical abuse are at higher risk of developing health problems, but scientists are unclear about how to reverse these harmful effects.

Nicole Bush, a psychiatrist at the University of California, San Francisco, hopes to achieve this with psychotherapy, which could be very effective for mental and physical health.  HEAR THE ENTIRE PODCAST EPISODE AT PSYCH.UCSF.EDU/NEWS012

Beyond the headlines: Veterans in the Bay Area DECEMBER 13, 2016

Since the year 2000, over 2.8 million of the nation's 18.9 million veterans have been diagnosed with post-traumatic stress disorder (PTSD). That's about 16% of our country's veteran population. In 2014, about 9.1 million veters were enrolled in VA-provided healthcare.

This episode of "Beyond the Headlines" talks about Veterans in the Bay Area and how the U.S. Department of Veterans Affairs helps veterans as they transition after service.

Also discussed are local organizations that are focused on helping veterans achieve success.

The guests talk about the transition back to civilian life, post-traumatic stress disorder, veterans homelessness, and valuable resources available to help veterans.  WATCH THE ENTIRE EPISODE AT PSYCH.UCSF.EDU/NEWS840

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New study shows association between early life experiences and poor mental health outcomes AUGUST 17, 2016

A new UC San Francisco report on an understudied population – older homeless adults – reveals that adverse childhood experiences have long-lasting effects. The researchers found that childhood adversities, such as abuse, neglect, and parental death, have a strong association with mental health outcomes in a group of 350 homeless adults over the age of 50 in Oakland. The results indicate that early life challenges have a persistent ripple effect, even in an already challenged population.

“There is a lot of literature about childhood adversity and psychiatric outcomes, but few studies on older people, and no stories at all on older homeless adults,” said Chuan Mei Lee, MD, a clinical fellow in psychiatry at UCSF and lead author on the study, published in the American Journal of Geriatric Psychiatry.

Due to the strong relationship between childhood adversity and mental health outcomes, the researchers suggest healthcare providers screen for early life adversities. Though lagging behind the general population, half of those surveyed have a primary care provider and 70 percent had received care from a nonemergency department source in the past six months, which represent opportunities to screen for childhood adversity  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS285

Child Trauma Research Program celebrates 20th anniversary FEBRUARY 1, 2016

A capacity crowd filled the Fisher Banquet Room at the UCSF Mission Bay Conference Center on Friday, January 29, 2016 for a special day-long seminar course celebrating the 20th anniversary of the UCSF Child Trauma Research Program (CTRP).

“Attachment in Trauma in Early Childhood: Embracing the Family in Clinical Practice, Research, and Public Policy” featured national and international figures in the field such as the University of South Florida’s James McHale, PhD, and the University of Haifa’s David Oppenheim, PhD. Speakers from UCSF included Miriam Hernandez Dimmler, PhD; Ken Epstein, PhD, LCSW; Chandra Ghosh Ippen, PhD; and Matthew W. State, MD, PhD, as well as alumna Allison Yuri Iwaoka-Scott, MD, and CTRP director Alicia Lieberman, PhD, and John Sikorski, MD, served as co-chairs for the course.

CTRP director Alicia Lieberman, PhD, was also honored by local government agencies for her work with the program and contributions to the field.

Lieberman received a Certificate of Honor from the City and Country of San Francisco Board of Supervisors for her "extraordinary contributions to end the effects of domestic violence on children and families." She was also recognized as a Public Health Hero by the San Francisco Department of Public Health for "lifetime achievement" and "selfless work on behalf of children and families from diverse ethnic and cultural origins in the public sector" having "local, national, and international impact."

In addition, Supervisor Mark Farrell shared a resolution declaring January 29, 2016 as Child Trauma Awareness Day in the City and Country of San Francisco in recognition of CTRP "marking its 20th year of shifting the cycle of violence for families in San Francisco and around the world" and Lieberman's "30-year tenure… [pioneering] mental health treatment for young children exposed to domestic violence and other traumatic life events."  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS634

More schools promoting ‘trauma-informed teaching to reach troubled students DECEMBER 2, 2013

Backed by brain research, California schools are beginning to address the effect of severe trauma on the health and achievement of their students.

In districts including Humboldt, Richmond, Santa Cruz, Aptos and San Francisco, groups of teachers are being trained to recognize that students’ explosive anger, classroom outbursts, habitual withdrawal and self-injurious behaviors could be symptoms of traumatic stress, the result of repeated exposure to violence, abuse and neglect.

Schools are responding to an enormous body of research about how children’s brains adapt to complex trauma, defined as multiple traumas including physical or sexual abuse, abandonment, and domestic and neighborhood violence.

Your mental state affects how you handle stressful situations JULY 5, 2017

including physical or sexual abuse, abandonment, and domestic and neighborhood violence.

New classroom strategies for managing traumatized students align with the evidence-based social and emotional programs that are part of a system known as Positive Behaviorial Interventions and Supports, a program of school interventions that is used in 600 California schools.

“When we ask ‘What has happened to you?’,” says UCSF’s Joyce Dorado, “the answer provides context for the behavior, fosters compassion, and helps us to see strengths in face of adversity.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS452

Your mental state often affects the way you handle tough situations. Jennifer Mitchell, neuroscientist at the University of California, San Francisco has recently tested what she calls stress reactivity of patients suffering from post-traumatic stress disorder, or PTSD, and alcohol abuse.

“We make people nervous in a social situation. And that induces really robust cortisol response, increase in heart rate, changes in respiration and blood pressure. And we administer either oxytocin or placebo and then we look to see whether oxytocin enables people to be less nervous and less apprehensive in that situation.”  HEAR THE ENTIRE PODCAST EPISODE AT PSYCH.UCSF.EDU/NEWS964

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$185M gift launches UCSF Weill Institute for Neurosciences APRIL 26, 2016

Former Citigroup head Sanford “Sandy” Weill and his wife, Joan, have given $185 million to UCSF — the single largest gift the university has received — to create an institute to accelerate research and the development of new therapies in neuroscience, including brain disorders from neurodegenerative diseases to psychiatric conditions.

The gift will create the UCSF Weill Institute for Neurosciences and fund the construction of a 270,000-square-foot building at UCSF’s Mission Bay campus that will serve as its headquarters. More immediately, it will allow UCSF to hire additional researchers and encourage collaboration across disciplines that study and treat conditions ranging from Alzheimer’s and amyotrophic lateral sclerosis, or ALS, to autism, schizophrenia and depression.

“We have a chance here to break down the silos between all the different departments and really look holistically at the brain,” said Weill, referring to the traditional separations in medicine between mental health and other neurological diseases. “Our gift unites psychiatry with all the other neurosciences departments.”

The donation, one of the largest in the country for the scientific field, helped raise the amount UCSF has received from philanthropy for neuroscience alone to more than $500 million since last April. About half of all donations UCSF has received during the period have been devoted to neuroscience, including a $177 million donation in November from billionaire Charles F. “Chuck” Feeney.

“UCSF has historically had very strong foundational building blocks across the breadth of neuroscience — neurology, neurosurgery, psychiatry, and basic neuroscience,” UCSF Chancellor Sam Hawgood said in a statement. “The Weill Family Foundation and the Weills’ gift to establish the Weill Institute will enable us to fully integrate our program and allow us to think in a seamless way across the continuum of neuroscience.”

Weill, 83, who splits his time between the East Coast and a home on 360 acres in Sonoma County since retiring from a 50-year career in banking, has long been involved in philanthropy with a strong focus on health. He and his wife were among the first to sign up in 2010 for the Giving Pledge, a campaign led by Bill Gates and Warren Buffett to encourage the wealthiest individuals to dedicate the majority of their net worth to charitable giving.

Weill has given more than $1 billion to educational, medical, cultural and arts institutions over the past 40 years. Cornell University, Weill’s alma mater, renamed its medical school Weill Cornell Medical College after generous donations. Weill also serves as chairman of the executive council of UCSF Health, the university’s network of providers.

“Philanthropy is not just about giving money,” he said. “It’s about contributing your passion, your knowledge, the knowledge you have in managing something that’s different than what a researcher or professor would have and blending those things together.”

Weill, whose mother died of Alzheimer’s disease and father suffered from depression, said he has long been interested in diseases that affect the brain and hopes to accelerate the path to new treatments.

“In medical science over the last two decades, we’ve made tremendous progress in research in children’s diseases, great progress in cardiovascular diseases as well as cancer,” Weill said. “Yet it wasn’t until recently that the brain was very, very hard to analyze because the only time people got to look at the brain was after people were dead. Now with new technologies and types of surgery, we really get to see a lot of what’s happening in the brain.”

Weill said he hopes UCSF will break ground on the new building in the second quarter of 2017, but it may take a couple of years to complete. The building is expected to cost about $316 million.

Dr. Stephen Hauser, chairman of UCSF’s neurology department and director of the new Weill Institute, said the institute will be a place where patients, treating physicians and basic science researchers all interact.

The building is a home, but it by no means defines this institute or what we hope will happen,” he said. “The institute will connect with every part of every campus at UCSF, and it will begin immediately.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS052

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New UCSF psychiatric center receives $50 million donation JUNE 4, 2015

The Lisa and John Pritzker Family Fund has given UCSF $50 million to build a center at its new Mission Bay campus dedicated to integrating the clinical treatment and research of psychiatric illnesses, university officials said Thursday.

The new building, scheduled to open in summer 2020, will help UCSF double its outpatient capacity to treat people with mental health disorders. Its proximity to research scientists is also expected to spur advancements in such diverse areas as schizophrenia, autism and cognitive decline.

The new center will treat people of all ages but will have a particular focus on mental illness and neurodevelopment disorders in children, adolescents and young adults. The building’s child, teen and family center will allow for the integration of pediatric medicine and mental health care.

The center will also bring under one roof a number of existing UCSF programs and clinics, including those to treat autism, childhood trauma, eating disorders, early psychosis, hyperactivity, dyslexia and learning problems.

“There’s been a scientific explosion, really in the last three to five years, in neuroscience and genomic (research) that has profoundly changed the advancement of our understanding of these illnesses,” said Dr. Matthew State, chairman of UCSF’s psychiatry department and also a child psychiatrist and human geneticist.

“This visionary gift, in addition to enabling us to offer state-of-the-art mental health care, will leverage UCSF’s preeminent basic and clinical research programs in pediatrics and adolescent medicine to benefit the mental health of children and families,” said UCSF Chancellor Sam Hawgood in a statement. “This gift will advance the field.”

State said the gift will help make UCSF a national leader in mental health research and treatment. “This really tangibly offers the opportunity for us to have collaborative research and clinical enterprise that will go from the molecule to community service,” he said.

Ken Epstein, director of children, youth and family system services in the San Francisco Department of Public Health’s behavioral health division, said he was excited about how the new center could help transform psychiatric care and research in San Francisco.

UCSF already collaborates with the city’s Public Health Department and other health organizations.

The university’s 303-acre Mission Bay campus, located just south of AT&T Park, was designed to allow scientists to work with clinicians. UCSF, which opened its new medical center at Mission Bay in February, has received other donations for this effort.

UCSF officials said the new gift is particularly important because the stigma surrounding mental illness tends to dampen philanthropic support for psychiatry, even though mental and neurological disorders are common worldwide.

The new 140,000-square-foot building, to be located on a parcel at 2130 Third St., will replace UCSF’s Langley Porter Psychiatric Institute, a teaching hospital built in 1942 that is part of UCSF’s Parnassus Heights campus. The $50 million gift will help pay for the land and a portion of the estimated $100 million in construction costs. UCSF will raise the rest of the money to complete the project.

“This is an incredible opportunity for UCSF to develop a ... child and family research center that will allow us to increase our capacity to serve the public,” Epstein said.

UCSF will host meetings in the surrounding neighborhood to present the project and receive feedback from the community on the design, which is also subject to approval of the UC regents in the November 2016 meeting.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS308

$25M from Oberndorf Foundation to advance UCSF psychiatry, neuroscience research FEBRUARY 16, 2016

The University of California, San Francisco has announced an unrestricted gift of $25 million from the Bill and Susan Oberndorf Foundation to advance basic research in psychiatry and the behavioral sciences.

neuroscience program on campus, including the recruitment of Matthew W. State, a renowned child psychiatrist and internationally recognized expert on the genomics of autism and Tourette syndrome.

Over the next decade, research in the field is expected to revolutionize understanding of the most serious psychiatric illnesses, including autism, schizophrenia, bipolar disorder, substance abuse, depression, and anxiety. Longtime supporters of UCSF, the Oberndorfs have helped support several capital projects at the school, including the UCSF Medical Center at Mission Bay, the Sandler Neurosciences Center, and the UCSF Helen Diller Family Cancer Research Building. Their latest grant builds on an earlier $5 million gift for a distinguished professorship in psychiatry, which has helped advance UCSF's leadership in the field and provided resources for the creation of a world-class

"UCSF is determined to be at the forefront of this revolution, creating a community of the very best young minds focused on this mission and allowing them to do their most creative work, embedded in an extraordinarily strong and collaborative neuroscience community," said State. "An unrestricted gift of this magnitude will be a game-changer in our ability to recruit and support outstanding scientists in what is an extremely challenging funding climate. We will be able to give them the freedom they need to pursue work that changes the way that society views mental illness."  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS327

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UCSF receives $20 milion donation from Dolby fund to advance treatments, erase stigma NOVEMBER 4, 2015

UC San Francisco's department of psychiatry has won a $20 million gift to support research on mood disorders, such as depression and bipolar disease, in the hope of helping to eliminate the stigma associated with mental illness.

The Ray and Dagmar Dolby Family Fund made the donation, aimed at supporting UCSF research on the genetics, neurobiology and brain circuitry "underlying these disorders," UCSF officials said Wednesday afternoon.

The World Health Organization calls depression "the leading cause of disability worldwide," UCSF noted, with the disease affecting an estimated 350 million people of all ages across the globe.

"This research is a critical step forward for the millions of people who suffer, seemingly invisibly, with diseases that are real and unfortunately underfunded," Dagmar Dolby, Ray Dolby's widow, said in the Nov. 4 statement.

Her late husband invented the Dolby sound system and helped develop the video tape recorder, and founded Dolby Laboratories. He died two years ago at the age of 80.

The Dolby Family Fund has given generously to UCSF, most notably with a lead gift that provided funding for the Ray and Dagmar Dolby Regeneration Medicine Building on the biomedical specialty university's Parnassus Heights campus, officials said. The building houses the Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research.

"The Dolbys have played a key role in helping UCSF advance research in some of the most promising areas of medicine," said UCSF Chancellor Sam Hawgood.

Clinical experts at UCSF say rapid strides are being made in psychiatric genomics and neuroscience, as traditional barriers between medicine and psychiatry and across scientific disciplines "erode."

Dr. Matthew State, department chair and professor of psychiatry at UCSF, said continued research along these lines can help "transform how people think about mental illness," as to see mental diseases the same way we now look at heart disease, cancer or epilepsy.

The only difference, State said, is "we just don't understand them well enough yet."  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS685

UCSF-CMC partnership making a positive impact for children in India MAY 10, 2016

UCSF Family & Community Psychiatry Program launches at ZSFG JULY 18, 2016

With support from the Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center has created the UCSF Family and Community Psychiatry Program (FCPP) at ZSFG, co-directed by Melissa Nau, MD, and Melanie Thomas, MD.

Last month, UCSF Professor of Psychiatry Peter M. Ferren, MD, MPH, made his eighth visit since 2007 to Vellore, India, where he serves as a volunteer clinical faculty member in the Christian Medical College (CMC)'s Child & Adolescent Psychiatry Unit.

At CMC, Dr. Ferren teaches as an ambassador of child psychiatry, sharing knowledge and skills with colleagues in an established child mental health service. In addition to treating emotional disorders in childhood, the CMC Child & Adolescent Psychiatry Unit has a notable program in treating autism, intellectual disability, and other neurodevelopmental disabilities.

• ZSFG High-Risk Obstetrics Psychiatry or HROB (OB/GYN and Psychiatry) • ZSFG Kempe Behavioral Health Partnership (Pediatric and Adult Psychiatry) • Perinatal Community Psychiatry Initiative (ZSFG and Homeless Prenatal Program) • Solid Start Behavioral Health (Psychiatry, OB/GYN, Pediatrics, and Family Medicine)

During Ferren’s visit, he visited with CMC Assistant Professor Sherab Tsheringla, MBBS, DPH, MD, who spent six weeks at UCSF last year as a credentialed physician observer under Ferren’s mentorship. Tsheringla showed him the mental health education and consultation service he established at Vellore's Vedavalli Vidyalaya School, based on programs implemented in San Francisco schools by UCSF faculty at Zuckerberg San Francisco General. He also demonstrated how his visit to UCSF enhanced his knowledge and skills in evaluating and treating children exposed to severe emotional trauma (particularly sexual abuse), resulting in the development of protocols for evaluating and treating the psychiatric sequelae of child victims of sexual abuse in cultural context at CMC.

These programs share the goal of providing services to the target population “where they are” and linking women to available specialty and non-specialty mental health services. FCPP aims to provide high quality behavioral health services for their target population through clinical care delivery, program development, liaison services, and research in partnership with other departments at ZSFG, community-based organizations, and the San Francisco Department of Public Health.

Tsheringla’s 2015 visit was supported in part by the UCSF-CMC Partnership in Child Psychiatry Training, which was established by Ferren in 2011 with donor assistance to support the new child psychiatry training program at CMC, the first of its kind to be officially and nationally recognized in India. In 2013, Associate Professor Elida Bautista, PhD, became the first UCSF Psychiatry faculty member to travel to CMC under this program.

As part of the Division of Infant, Child, and Adolescent Psychiatry (ICAP) at ZSFG, the FCPP will be dedicated to providing family-centered mental health services for pregnant women and families with young children (ages 0-3). The FCPP involves four clinical programs and an associated program of research:

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS915

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS246

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UC Regents approve plans for new Child, Teen and Family Center and Department of Psychiatry building MAY 19, 2017

The UC Board of Regents have approved plans for three new UC San Francisco building projects, including a new neuroscience building on the Mission Bay campus, as well as a new psychiatry building and student housing in the nearby Dogpatch neighborhood.

Two of the projects approved Thursday expand on UCSF's position as a national center for excellence in neurosciences and mental health that encompass clinical care, research and training. The largest project is the Joan and Sanford I. Weill Neurosciences Building, made possible by a landmark $185 million gift made last year by the Weills to establish the UCSF Weill Institute for Neurosciences. Another key investment is the UCSF Child, Teen and Family Center and Department of Psychiatry Building, funded by a $50 million donation from the Lisa and John Pritzker Family Fund that will provide mental health services to Bay Area adults, children and families.

The third project, a graduate student and trainee housing complex on Minnesota Street, will advance UCSF’s efforts to provide more affordable housing options to offset the soaring cost of living in San Francisco.

Child, Teen and Family Center and Department of Psychiatry Building Just one block south of the Mission Bay campus, the proposed UCSF Child, Teen and Family Center and Department of Psychiatry Building at 2130 Third Street will house outpatient mental health and related pediatric, neurology and pre-term birth obstetric clinics, education, research, office space and a small retail space.

Integrating clinical, training and research facilities in one building will allow patients and families to participate in cutting-edge clinical research at a single location in close proximity to wet research labs at UCSF’s Mission Bay campus and the UCSF Benioff Children’s Hospital San Francisco. It also will foster collaboration among scientists and clinicians to accelerate new discoveries in mental health and related fields.

The approximately 170,000 square feet in the building will be used for clinical services, clinical research, desktop research, and administrative functions, as well as meetings, education and retail. The meeting space within the building will provide a location where UCSF Psychiatry can host internal meetings and exchange expertise with San Francisco community and government partners. Parking that could accommodate up to 41 vehicles for outpatients and visitors will be located below ground.

Occupants of the building will include clinicians, educators, researchers and trainees who will be relocated from the Langley Porter Psychiatric Institute building on UCSF’s Parnassus campus, as well as some personnel from UCSF’s Laurel Heights and Mount Zion campuses. In addition, a clinical research program currently housed at the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center campus will be able to expand in this new building.

On Thursday, the Regents certified the Environmental Impact Report and approved the design of the project.

Construction of the building, which will be managed by a third-party developer before being leased back to the university, is estimated to begin in early 2018 and be completed by mid-2020. Before construction begins, an existing three-story building and surface parking lot currently at the site will be demolished.

Joan and Sanford I. Weill Neurosciences Building The Joan and Sanford I. Weill Neurosciences Building will become the headquarters for the UCSF Weill Institute for Neurosciences, bringing together the neurosciences community with bench laboratory research programs in psychiatry, neurology, neurosurgery and basic neuroscience, as well as desktop research, clinical research and clinical care space.

The 274,000-square-foot building – to be constructed on Block 23A, a surface parking lot between 3rd and 4th streets – will house wet or bench laboratories, office space and dry labs, clinical care services and clinical research space to meet expanded needs.

Collaborations between the UCSF Memory and Aging Center, the Global Brain Health Institute, the Kavli Institute for Fundamental Neuroscience and others are creating demand for wet research space that is co-located with dry research space. The wet research space also will be needed for the Department of Psychiatry close to its new administrative dry research and clinical home being planned for 2130 Third Street in the nearby Dogpatch neighborhood.

Construction on the Weill Neurosciences Building will begin this year, and completion is targeted for 2020.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS213

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UCSF ranked among the top 10 in the nation for psychiatric care by U.S. News & World Report AUGUST 8, 2017

The UCSF Department of Psychiatry has been ranked among the top ten centers for adult psychiatry in the nation in U.S. News & World Report’s annual America’s Best Hospitals survey.

U.S. News’ 2017-2018 rankings were calculated based on ratings by psychiatric specialists across the country over the past three years. UCSF Psychiatry, which improved two spots from its ranking in 2015 and 2016, remains the only psychiatric department in Northern California included in the top echelon.

Overall, UCSF was ranked as the 5th best hospital in the nation and top-ranked medical center in California, earning top-tier status in 15 medical specialties. This high performance placed it once again on the U.S. News Honor Roll, which highlights hospitals that are exceptional in numerous medical specialties. U.S. News evaluated the clinical performance of 4,658 hospitals across the country, as well as the results of surveys from thousands of physicians.

“We are extremely proud of the UCSF Health team, whose members work so hard, every day, to provide the highest quality, innovative care to our patients,” said Sam Hawgood, MBBS, chancellor of UC San Francisco. “Their work is at the heart of UCSF’s mission, and is integrated with, and informed by, our other missions of advancing medical research discoveries and graduate level education in the health sciences.”

UCSF Psychiatry Residency Training Program named among top five in U.S. by physicians AUGUST 31, 2015

The UCSF Department of Psychiatry Residency Training Program (RTP) is among the top psychiatry residency programs in the nation, according to new data released last week by physician social networking site Doximity, in collaboration with U.S. News & World Report.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS005

UCSF Psychiatry in NIH funding top 10 for fourth consecutive year

For Doximity’s second annual Residency Navigator, an interactive tool designed to help the next generation of doctors research and compare residency training programs nationwide, more than 16,000 board-certified physicians nominated residency programs offering the best clinical training in their medical specialty. UCSF Psychiatry’s RTP was ranked fifth among all programs in the nation, moving up one spot from last year’s results, and ranked first among residency programs in the western United States

MARCH 31, 2016

The UCSF Department of Psychiatry was ranked third among departments at public institutions and sixth among all recipients in psychiatric research grants from the National Institutes of Health (NIH) in fiscal year 2015, according to annual figures released by the independent Blue Ridge Institute for Medical Research (BRI). This marks the fourth consecutive year that UCSF Psychiatry has been ranked in the top ten nationally among psychiatry departments for NIH funding, as well as a 16 percent increase in annual funding levels since 2011.

While last year’s inaugural Residency Navigator was limited to subjective feedback for psychiatry programs, this year’s edition also included objective data on residency programs and "alumni outcomes" analysis of the curriculum vitae (CVs) and career paths of over 700,000 U.S. physicians. The UCSF Psychiatry Residency Training Program also performed highly in these new metrics, tying for second overall for the percentage of board-certified graduates and placing tenth for alumni research output.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS378

Last year, NIH awarded more than $25 million for projects led by 37 researchers within the department. Four UCSF Psychiatry faculty members placed in the top ten percent and 13 in the top quarter of all psychiatric researchers nationally. Over the most recent five-year period with available data (FY2011-FY2015), UCSF Psychiatry researchers have been awarded a combined $118.7 million in NIH grants and contracts.

UCSF drug and substance abuse grad programs maintain place among nation’s best

NIH funding is one of the key mechanisms for providing financial support for basic, clinical, and translational research within the department. BRI’s figures, however, do not include research awards from other government agencies and non-government institutions, or NIH-awarded projects where department members are contributing to research efforts but are not designated as a primary principal investigator.

The UC San Francisco School of Medicine tied for fourth place nationally among drug and substance abuse programs in this year’s U.S. News & World Report survey of best graduate schools. The new rankings continue UCSF's streak as the top public university for graduate drug and substance abuse programs in the nation.

BRI's rankings also do not factor in the more than $12 million in funds awarded last year

by NIH for research conducted by UCSF Psychiatry faculty members through the Northern California Institute for Research and Education (NCIRE). If NCIRE psychiatric research awards were included in the total, UCSF Psychiatry would move into fourth place overall nationally for NIH funding.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS886

MARCH 14, 2017

UCSF’s drug and substance abuse research and training efforts are spread out across multiple departments and divisions, with the Departments of Neurology and Psychiatry playing key roles and working collaboratively on many fronts. Within the Department of Psychiatry, notable graduate research programs include the UCSF Addiction Psychiatry Fellowship Program, the UCSF Postdoctoral Traineeship in Drug Abuse Treatment and Services Research, the UCSF Substance Abuse Research Program at Zuckerberg San Francisco General Hospital and Trauma Center, and the UCSF/SFVAMC Addiction Research Program at the San Francisco VA Medical Center.

In addition to drug and substance abuse, the School of Medicine also ranked in the top 10 in five other specialty areas: family medicine, geriatrics, internal medicine, pediatrics and women’s health. The school was ranked fourth in training medical students in biomedical research and third in primary care education, the two broad categories in which the magazine rates medical schools nationally. In these two ratings, UCSF’s medical school ranks as the top public institution for research training and the only med school in the nation, public or private, ranked in the top five in both categories.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS706

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Noted sleep disorders researcher Andrew Krystal joins department as Vice Chair for Research JUNE 1, 2016

The UCSF Department of Psychiatry is pleased to announce the appointment of Andrew D. Krystal, MD, MS, as Professor of Psychiatry and Vice Chair for Research, effective June 1, 2016. He will also hold a joint faculty appointment in the UCSF Department of Neurology.

Krystal is an internationally recognized expert in the areas of mood and sleep disorders with over 25 years of clinical and research experience to his credit. The main foci of his work have been the development of new treatments for these conditions and the identification of biomarkers for improving treatment effectiveness. In this work he has utilized tools including electroencephalography, polysomnography, functional magnetic resonance spectroscopy, transcranial direct current stimulation, and transcranial magnetic stimulation.

After completing undergraduate and master’s degrees in biomedical engineering at the Massachusetts Institute of Technology and earning a medical degree from the Duke University School of Medicine, Krystal has served as a faculty member and clinician at Duke University Medical Center for over two decades. He has held a variety of leadership positions at Duke, including Chief of the Division of Brain Stimulation and Neurophysiology, Director of the Brain Stimulation Program, Director of the Sleep Research Laboratory and Insomnia Program, and Director of the Quantitative EEG Laboratory.

He is the recipient of multiple awards including the American Psychiatric Association (APA) Resident’s Scholarship, a Laughlin Fellowship from the American College of Psychiatrists, two NARSAD Young Investigator Awards, an NIMH Scientist Development Award for Clinicians, and the APA Research Mentorship Award. He currently serves as deputy editor of the journal SLEEP; on the editorial boards of several journals, including Biological Psychiatry, Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, Depression and Anxiety, and the Journal of Affective Disorders; on the American Board of Internal Medicine Sleep Medicine Examination Committee; and on the Executive Committee of the Board of Directors of the Sleep Research Society.

“Andrew is an outstanding scientist, clinician, mentor and administrator who will have an enormous impact on the Langley Porter Psychiatric Institute, the Department of Psychiatry, and the new UCSF Weill Institute for Neurosciences,” said Matthew W. State, MD, PhD, Oberndorf Family Distinguished Professor, chair of the UCSF Department of Psychiatry, director of LPPI and steering committee member of the UCSF Weill Institute for Neurosciences. “He will provide an enormous boost to our efforts in clinical and translational research. He is an extraordinarily collaborative clinician-scientist who has played a key leadership role across departments at Duke. After an extensive national search, it was clear that he was the ideal candidate to help us to further our efforts in understanding and treating mood disorders, lead a new cross-departmental effort in the neuroscience of sleep, and contribute to the development of the UCSF Weill Institute.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS909

NIMH’s Marlene Guzman selected to become new Associate Chair for Administration and Finance JUNE 16, 2016

Following a nationwide search, the UCSF Department of Psychiatry is pleased to announce the appointment of Marlene J. Guzman, MBA, MEd, MA, as its new Associate Chair for Administration and Finance, effective June 27, 2016.

Reporting to Department of Psychiatry chair Matthew W. State, MD, PhD, Guzman will play a crucial role in the expansion of the department’s clinical, educational, and research services. She will direct senior department management in all matters concerning site/division administration, human resources, clinical practice management, facilities and spacd the N management, facilities and space, education programs, business and finance, research administration, and information technology. Guzman will also be responsible for strategizing, developing, planning and, where appropriate, implementing admin structures and funding streams to support department initiatives Guzman brings a wealth of expertise with her to UCSF. Since 2004, Guzman has served as the Senior Advisor to the Director at the National Institute of Mental Health (NIMH), a position responsible for monitoring all activities and operations at NIMH, which has a budget of $1.5 billion and a staff of approximately 1,000. She also provided strategic counsel to the NIMH leadership and sdfsdf

and worked with offices throughout the institute to ensure operations were efficient, policies were consistent, and scientific priorities were advanced. Guzman was also involved with a number of trans-NIH scientific efforts, including the Blueprint for Neuroscience Research, which supported the Human Connectome Project and the NIH BRAIN Initiative.

During her tenure at NIMH, Guzman introduced a new approach to managing the NIMH pay line and scientific initiatives, incorporating fiscal forecasting and planning, and adopting a proactive approach to ensure strategic investment of funds. She also championed an enterprise-wide approach to technology adoption, and under her leadership seven enterprise-wide applications were developed to automate and streamline pprocesses, resulting in a more dynamic environment, paper reduction, and more efficient performance times.

Guzman holds an MBA from the Carlson School of Management at the University of Minnesota with a dual focus in strategic management and information technology. She also holds graduate degrees in international relations and education.

“Marlene will be a phenomenal addition to our senior leadership team,” said Matthew W. State, MD, PhD, Oberndorf Family Distinguished Professor, chair of UCSF Psychiatry, director of the Langley Porter Psychiatric Institute and member of the new Weill Institute for Neurosciences “She combines exceptional administrative acumen with a broad vision for the future of psychiatry that she honed at the National Institute of Mental Health. I am thrilled that she has elected to come to San Francisco to help us expand our clinical services, integrate fully with UCSF Health, and continue the growth of our outstanding research and educational programs across our sites.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS565

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UCSF taps Maga Jackson-Triche to lead expansion of adult clinical mental health services MARCH 22, 2016

Following a nationwide search, the UCSF Department of Psychiatry and UCSF Health are pleased to announce the appointment of Maga E. Jackson-Triche, MD, MSHS, as the inaugural Department of Psychiatry Vice Chair for Adult Psychiatry and UCSF Health Vice President for Adult Behavioral Health Services effective June 1, 2016.

Reporting to Department of Psychiatry chair Matthew W. State, MD, PhD, as well as UCSF Medical Center president and UCSF Health senior vice president Sheila Antrum, RN, MSHA, Jackson-Triche will play a crucial role in the integration of clinical mental health services across UCSF’s campuses and lead a significant expansion of psychiatric and behavioral services across the UCSF Health system. In addition, she will oversee overall quality, effectiveness, efficiency, and financial performance for clinical affairs within the Department of Psychiatry.

Jackson-Triche brings an impressive track record of clinical and administrative success within the Veterans Health Administration (VHA) network and its affiliated academic institutions to her new role at UCSF. A graduate of the University of Chicago’s Pritzker School of Medicine and the UCLA School of Public Health, Jackson-Triche has served in key leadership roles within VHA including VA Greater Los Angeles, VA Southeast Louisiana, and VA Northern California Health Care Systems, and in 2012, was asked to serve a term as the Acting Deputy Chief Mental Health Consultant for the VA’s Office of Mental Health Services in Washington, DC. In 2013, Jackson-Triche was named Chief Mental Health Officer for the VA Sierra Pacific Network. In this position, she has overseen the mental health care services services of of aa network networkresponsible responsiblefor foraapopulation populationofofmore morethan than11million millionveterans veteransininNorthern NorthernCalifornia, California,Nevada, Hawaii, Guam, American Samoa, and the Philippines.

Nevada, Hawaii, Guam, American Samoa, and the Philippines.

In addition to her extensive clinical and administrative work, Jackson-Triche has held academic appointments with the UCLA David Geffen School of Medicine, Tulane University School of Medicine, and UC Davis School of Medicine. An experienced researcher with numerous academic studies, articles, books, and book chapters to her credit, she has also served as a reviewer for the Journal of General Internal Medicine, Journal of Clinical Outcomes Management, and Medical Care.

“The addition of Dr. Jackson-Triche to the senior leadership team provides a tremendous opportunity to prioritize and coordinate patient care efforts and resources across all domains,” said Sheila Antrum, RN, MSHA, President of the UCSF Medical Center and Senior Vice President for Adult Services at UCSF Health. “She brings an exceptional perspective that will successfully serve our patients and facilitate collaboration between faculty, residents, and staff.”

“With her wide-ranging experience as a clinician, educator, researcher, and administrator, Maga brings a wealth of knowledge and expertise that will greatly benefit UCSF Health, the department, and, most importantly, our patients and their families,” added Matthew W. State, MD, PhD, Oberndorf Family Distinguished Professor, Chair of the UCSF Department of Psychiatry, and Director of the Langley Porter Psychiatric Institute. “She is a wonderfully accomplished and collaborative physician leader who will lead the expansion of our clinical services, promote the highest quality care, and ensure the full integration of mental health into the UCSF Health system.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS019

King selected to head UCSF’s continued expansion of child and adolescent mental health services MAY 27, 2016

Following a national search, the UCSF Department of Psychiatry and UCSF Benioff Children’s Hospital are pleased to announce the appointment of Bryan H. King, MD, MBA, as Professor of Psychiatry and Vice Chair of Child and Adolescent Psychiatry, as well as Vice President for Child Behavioral Health Services at UCSF Benioff Children’s Hospitals, effective August 1, 2016.

King will lead UCSF Psychiatry’s continued expansion and integration of child and adolescent-focused psychiatric and behavioral services across the UCSF Health system, as well as develop initiatives to further enhance patient access and delivery of patient-centered care. He will also play a key role in integrating child mental health services across Benioff Childrens Hospital campuses in Oakland and San Francisco, and in the planning and development of the Child, Teen and Family Center, which will serve as the centerpiece of a future UCSF mental health facility in San Francisco’s Dogpatch neighborhood near UCSF Mission Bay. In addition, King will work to enhance and expand collaborative relationships with other UCSF sites, departments, and community partners.

A graduate of the Medical College of Wisconsin and the George Washington University School of Business, King has previously held faculty appointments at the UCLA David Geffen School of Medicine and Dartmouth Medical School. He has worked in a number of key clinical leadership positions at Seattle Children’s Hospital, the DartmouthHitchcock Medical Center and Children’s Hospital at Dartmouth-Hitchcock, and the UCLA Neuropsychiatric Institute and Hospital, in addition to serving as medical director for State of New Hampshire’s Division of Developmental Services for a four-year span beginning in 2001.

In 2005, King was named professor, vice chair, and director of child and adolescent psychiatry at the University of Washington, as well as chair of the Department of Psychiatry and Behavioral Health at Seattle Children’s Hospital. Since 2009, he has also served as the founding director of the Seattle Children’s Autism Center. In these positions, he has overseen an incredible expansion of psychiatric services for the children and families of Seattle and the state of Washington.

During his tenure at UW and Seattle Children’s, King’s departments have doubled in both faculty size and inpatient capacity, improved clinical productivity, and launched new clinical programs which have become national models for excellence in the field.

His efforts have led to a substantial increase in philanthropic and extramural research funding enabling focused initiatives in the areas of autism and neurodevelopmental disorders, pediatric psychology and behavioral medicine, mood disorders, and disruptive behavior disorders.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS502

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Dimmler, UCSF-led community mental health initiative commended for promoting health equity OCTOBER 24, 2017

The UCSF Center for Community Engagement has bestowed its 2017 Excellence in Partnership Community Health and Policy Development Award to the Tipping Point Mental Health Initiative, a collaboration between Tipping Point Community and the UCSF Child Trauma Research Program. The program and its leaders were saluted during the center's annual Partnerships Celebration on Oct. 19 at UCSF Benioff Children's Hospital San Francisco.

The Mental Health Initiative was created to build the capacity of Tipping Point’s grantees to deliver high-quality, culturally appropriate mental health services to their clients, and serve families living in low-income communities and exposed to multiple adversities and traumatic stressors. In partnership with UCSF and other experts in the field, Tipping Point grantees receive a combination of direct services from clinical staff and post-doctoral interns, agency-specific training, and consultation.

The partnership is co-led by Tipping Point strategic partnerships manager Becca Truit and UCSF Psychiatry faculty member Miriam Hernandez Dimmler, PhD. Since the initiative’s inception in 2008, more than 800 families have been referred to services through the Tipping Point Mental Health Initiative. In addition, Tipping Point offers about ten trainings every year for front-line and supervisory staff on a variety of mental health topics, including the impact of trauma on academic achievement, motivational interviewing, and self-care. Last year, 37 grantees participated in these training sessions, which reached over 230 staff members.

"It is a humbling experience to receive this recognition," said Hernandez Dimmler, "but what I am most proud of is that the Tipping Point Mental Health Initiative started off as a three-year pilot project that has gone strong for almost 10 years thanks to Tipping Point's generosity and our wonderful community partners."

UCSF's Excellence in Partnership Award recognizes exemplary partnerships between San Francisco communities and UCSF that build on each other’s strengths to improve higher education, civic engagement, and the overall health of communities.

The award highlights the power and potential of university-community partnerships as a strategy for social justice and recognize partnerships that are striving to overcome the root causes of health inequities.

The UCSF Child Trauma Research Program is nationally recognized for its leadership in developing effective, family-centered interventions for children aged zero through five who experience traumatic events such as violence in the home or community; death of a loved one; or life-threatening accidents, illnesses, or disasters.

Founded in 1996, the program is located at Zuckerberg San Francisco General Hospital and Trauma Center.

Since 2001, the Child Trauma Research Program has been the lead program of the Early Trauma Treatment Network, a center of the federally-funded National Child Traumatic Stress Network.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS808

State Lab hailed for sustainability efforts JULY 7, 2017

The members of the Department of Psychiatry's State Lab were among the UC San Francisco faculty, students, and staff members recognized for their efforts in supporting and advocating for sustainability measures at the seventh annual Sustainability Awards on June 20.

The lab in Rock Hall was recognized for its efforts in becoming the first laboratory ever to achieve a platinum-level certification in the UCSF LivingGreen program. Last year, the lab received a gold-level certification and was inspired to improve their conservation efforts.

In the State Lab, pipette tip boxes, glassware, cardboard, and Styrofoam are recycled and only compostable or washable items are used in the kitchen. The facility's 20 computer screens are set to sleep after two minutes, which has the added benefit of increasing HIPAA security, and their single shared printer defaults to double-sided printing using 100-percent recycled paper.

To reduce energy consumption, the lab’s -80ºC freezers have been set to -70ºC, reducing energy demand by one-third. Fume hoods, lights, and other equipment are powered down completely or unplugged rather than left in standby mode where possible. To educate new employees and visiting researchers, the lab shares its comprehensive checklist of resource conservation measures.

“Words used to describe these extraordinary individuals included relentless, engaged, devotion, inspiring, diligent, successful, continually, innovative, and leader, to name just a few,” said UCSF Chancellor Sam Hawgood, MBBS, as he introduced the 2017 Sustainability Award winners.

The State Lab, led by principal investigator and department chair Matthew W. State, MD, PhD, studies the genetics and genomics of developmental neuropsychiatric disorders, with a particular interest in autism spectrum disorder, Tourette disorder, and childhood-onset schizophrenia.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS155

INDIVIDUAL HONORS

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Mangurian recognized with UCSF Chancellor Award for Advancement of Women NOVEMBER 3, 2017

UCSF Psychiatry Vice Chair for Diversity Christina Mangurian, MD, MAS, was among the 13 individuals honored at UC San Francisco’s 2017 Chancellor Diversity Awards on October 5. The annual awards recognize campus members who are leaders, activists, and pioneers in the fields and communities that they serve for their work in advancing equity and inclusion. She was selected as one of this year's recipients of the Chancellor Award for Advancement of Women, bestowed annually on three individuals at UCSF – one faculty, one staff, one student/resident/postdoctoral scholar – who have demonstrated outstanding commitment and service to the advancement of women beyond the scope of their job, area of research, or training.

Mangurian is an associate professor of clinical psychiatry and director of the UCSF Public Psychiatry Fellowship at Zuckerberg San Francisco General Hospital and Trauma Center, as well as the UCSF Program of Research on Mental Health Integration Among Underserved and Minority Populations (PReMIUM) based at the UCSF Center for Vulnerable Populations (CVP). She joined the department's faculty in 2009 and has been a core faculty member at CVP since 2014.

During her time at UCSF, Mangurian has been an outspoken champion of diversity, equity, and inclusion within the department and across the university. In 2010, she founded the Women's Advancement and Recognition in Medicine (WARM) Hearts Group at Zuckerberg San Francisco General. Five years later, she was named as the department's inaugural vice chair for diversity and became chair of the UCSF Psychiatry Diversity Committee, which seeks to further understanding of the impact culture has on psychiatry and assist department leadership in the recruitment and retention of students and faculty from underrepresented populations in order to better serve its diverse patient populations. Under her leadership, the committee has continued its sponsorship of the annual Dr. Evelyn Lee Visiting Scholar Lectureship in Cultural Competence and Diversity, and undertaken a number of new initiatives such as an annual series of diversity celebrations for faculty, staff, and trainees.

“Increasing diversity in the workforce is not only a potential solution for narrowing the gap in health care disparities experienced by racial and ethnic minorities, but also a crucial component for achieving academic excellence,” Mangurian noted in a 2015 interview. “Studies have shown that diversity increases productivity and creativity.

Additionally, the more complex a problem, the more necessary diversity of thought is required. Training future leaders from diverse backgrounds in research, education, and clinical work is necessary to make UCSF a leader in the new era of health care reform. My goal is to create an environment in the UCSF Department of Psychiatry where women and minorities thrive.”

As a Latina NIH-funded clinician researcher, the majority of Mangurian’s work has focused on improving medical services for diverse and underserved populations with severe mental illnesses, such as a National Institute of Mental Health-funded Career Development Award focused on improving metabolic screening among diverse populations with severe mental illnesses and a National Institute of Diabetes and Digestive and Kidney Diseases-funded study on the cost-effectiveness of expanding the scope of community psychiatrists to include initial treatment of diabetes and pre-diabetes. She has a successful track record in implementation in the public sector, most notably as a special coordinator for the medical director of the New York State Office of Mental Health, where she worked to implement health screening for 15,000 outpatients served by the New York State public mental health system.

State named a 2018 Sarnat Prize for Mental Health Research recipient OCTOBER 16, 2017

Matthew State, MD, PhD, Oberndorf Family Distinguished Professor and chair of psychiatry, director of the Langley Porter Psychiatric Institute, and member of the UCSF Weill Institute for Neurosciences, is one of three recipients of the 2017 Rhoda and Bernard Sarnat International Prize in Mental Health given by the National Academy of Medicine (NAM).

The other winners are Catherine Lord, PhD, director of the Center for Autism and the Developing Brain at Weill Cornell Medicine and Joseph Coyle, MD, Eben S. Draper Professor of Psychiatry and Neuroscience at Harvard Medical School and McLean Hospital.

Since 1992, the Sarnat Prize has recognized individuals or groups that have demonstrated outstanding achievement in improving mental health, through fields such as neuroscience, psychology, social work, nursing, psychiatry, and advocacy. Nominations for potential recipients are solicited from Academy members, deans of medical schools, and mental health professionals.

State is a child psychiatrist and geneticist studying pediatric neuropsychiatric syndromes with a focus on autism spectrum disorders (ASD) and Tourette syndrome.

This year’s Sarnat Prize highlights his work on the Simons Simplex Collection (SSC), a cohort of nearly 3,000 families that transformed autism genetics.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS033

In addition to her research experience, Mangurian co-founded and directs the aforementioned UCSF Public Psychiatry Fellowship at Zuckerberg San Francisco General, the first public psychiatry fellowship in California and the only one in the nation to have a formal mental health services research component. She also serves as the chair of the American Psychiatric Association’s Council on Minority Mental Health and Health Disparities. In 2015, she took part in the White House’s Forum on Excellence and Innovation through Diversity in the STEM Workforce and was also named a UCSF John A. Watson Faculty Scholar.

Molofsky wins NIH New Innovator Award

"Christina is a remarkable person, and she has been really a tireless advocate for the mission of diversity," said department chair Matthew W. State, MD, PhD. "She gets up every day and she thinks about how she's going to try to make things better; better for mothers, better for women. To have someone with her intelligence, her energy, her commitment, and her personal experience helping really to shape concrete efforts in this area has been tremendously helpful."

The highly competitive grants, which were announced Oct. 5 among 86 such awards nationwide, were made under the High-Risk, High-Reward Research program supported by the NIH Common Fund.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS245

OCTOBER 5, 2017

The National Institutes of Health (NIH) has awarded grants to two UC San Francisco researchers – including the Department of Psychiatry's Anna Molofsky, MD, PhD – to pursue innovative approaches to major contemporary challenges in biomedical research, including one from the UCSF Weill Institute for Neurosciences.

Molofsky received the NIH’s New Innovator Award, which supports unusually innovative research from early career investigators who are within 10 years of their final degree or clinical residency and have not yet received a research project grant (R01) or equivalent NIH grant.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS167

INDIVIDUAL HONORS

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Brainard and Rubenstein elected to American Academy of Arts and Sciences APRIL 20, 2016

A pair of UC San Francisco neuroscientists from the Department of Psychiatry, Michael Brainard, PhD, and John L.R. Rubenstein, MD, PhD, have been elected to the American Academy of Arts and Sciences.

The two UCSF Psychiatry faculty members were among 213 new members elected to the 2016 class, which includes winners of the Pulitzer Prize and the Wolf Prize; MacArthur and Guggenheim Fellowships; the Fields Medal; and the Grammy Award and National Book Award.

Founded in 1780, the American Academy of Arts and Sciences is one of the country’s oldest learned societies and independent policy research centers, convening leaders from the academic, business and government sectors to respond to the challenges facing the nation and the world.

Brainard, also a faculty member in the UCSF Center for Integrative Neuroscience, studies how songbirds learn their songs. His research addresses general questions of how experience acts on the nervous system to shape behavior, and how genetic differences across individuals contribute to differences in learning.

Rubenstein studies genetic mechanisms involved in brain development, and how developmental processes may go awry in neurodevelopmental disorders such as autism. He recently was honored by three organizations for his research.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS940

Gazzaley, Hoeft to take part in White House workshop on neuroscience and learning DECEMBER 11, 2014

Department members Adam Gazzaley, MD, PhD, and Fumiko Hoeft, MD, PhD, have been invited to attend the White House Office of Science and Technology Policy (OSTP) Workshop at the White House Conference Center in Washington, DC on January 23.

The workshop will focus on neuroscience and learning, with the specific goals of identifying research gaps, identifying innovations in research methodology and data analysis, and generating ideas for effectively disseminating information to the broader public, e.g., individuals and schools. The OSTP extended invitations to a select group of individuals with expertise in neuroscience, cognitive science, developmental psychology, and other disciplines, who also have an interest in, or research relevant to, the intersection of these fields and education practice.

The workshop is one activity of the Interagency Working Group on Neuroscience, a subcommittee of the National Science and Technology Council’s Committee on Science.

The workshop is being jointly planned by representatives from the National Institutes of Health, the National Science Foundation and the Department of Education’s Institute of Education Sciences.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS317

Yaffe awarded $100,000 Potamkin Prize for dementia research MARCH 23, 2017

Lemle receives VA Psychology Leadership Conference Award named in his honor MAY 24, 2017

A UC San Francisco psychologist received a unique accolade during last weekend's VA Psychology Leadership Conference in San Antonio, Texas – an award named after himself.

Russell B. Lemle, PhD, clinical professor in the UCSF Department of Psychiatry and Chief Psychologist at the San Francisco VA Health Care System, was named as the inaugural recipient of the Russell B. Lemle Psychology Leadership Award in recognition of his unwavering advocacy in support of veterans and VA psychologists, and leadership in developing and maintaining the annual conference for the past 20 years.

The Lemle Psychology Leadership Award will be given annually by the VA Psychology Leadership Conference to honor those who build VA psychology communities, empower psychologists to encourage and care for one another, and promote leadership development to ultimately improve mental health care for the veterans they serve.

This honor is the fourth he has received from the Association of VA Psychologist Leaders (AVAPL). He previously received the group's Leader Award in 2007, the Antonette Zeiss Distinguished Leadership Award in 2013, and the association's Patrick DeLeon Advocacy Award last year. He has also been recognized previously by the American Psychological Association (APA) with a Presidential Citation in 2005 and the APA Division 18 Harold Hildreth Award in 2011.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS480

Francisco researcher Kristine Yaffe, MD, with a 2017 Potamkin Prize for Research in Pick’s, Alzheimer’s and Related Diseases for her work in dementia research. Yaffe, along with UC Irvine's Claudia Kawas, MD, will be honored this April at the American Academy of Neurology’s 69th Annual Meeting in Boston.

Sometimes referred to as the Nobel Prize of Alzheimer’s research, the Potamkin Prize honors researchers for their work in helping to advance the understanding of Pick’s disease, Alzheimer’s disease, and related disorders. The $100,000 prize is an internationally recognized tribute for advancing dementia research.

Yaffe, a professor of psychiatry, neurology, and epidemiology, the Roy and Marie Scola Endowed Chair, and Department of Psychiatry Vice Chair for the UCSF Weill Institute, will be recognized for her research on the epidemiology of Alzheimer’s and other dementias.

Her work focuses on the identification of modifiable risk factors, including cardiovascular and metabolic risk factors, sleep disturbances, and traumatic brain injury. The results of Yaffe's research in these areas highlight the critical role of modifiable risk factors, not just in late life, but across the lifespan. Her work also provides important insight into the pathways that increase dementia risk.

“Our research on modifiable risk factors for dementia prevention is important both for individual patients who are concerned about their cognitive health, and for public health prevention,” Yaffe said. “Addressing these risk factors could be a fundamental component of our strategy for slowing down the dementia epidemic.”

The Potamkin Prize is made possible by the philanthropic contributions of the Potamkin family of New York, Philadelphia, and Miami. The goal of the prize is to help attract the best medical minds and most dedicated scientists in the world to the field of dementia research. The Potamkin family has been the Academy’s single largest individual donor since 1988, providing more than $2 million to fund the Potamkin Prize.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS779

INDIVIDUAL HONORS

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Elissa Epel elected to the National Academy of Medicine OCTOBER 17, 2016

Professor of Psychiatry Elissa Epel, PhD, is among the 79 new members elected to the National Academy of Medicine (NAM), one of the highest honors in the fields of health and medicine.

Membership in NAM recognizes individuals who have demonstrated outstanding professional achievements and commitment to service in the medical sciences, health care and public health.

Epel is a health psychologist focusing on stress pathways. For the past 15 years, she has studied stress in the lab and in the field, using naturalistic stressors and associations with an early aging syndrome. She examines how stress processes lead to early disease precursors, focusing on overeating, abdominal obesity, and immune cell aging. She has found that people’s propensity to be stress reactive, psychologically or in terms of cortisol reactivity, is associated with overeating, abdominal obesity, and accelerated cell aging.

With UCSF colleagues Elizabeth Blackburn, PhD, and Jue Lin, PhD, she found that stress perceptions and stress arousal are related to telomere shortness and dampened telomerase activity. Their group now collaborates with other labs extending this work from animal models to population studies to examine how stress reduction interventions may enhance functioning of the telomere/telomerase maintenance system. Early work from their studies, as well as from other research groups, shows promise in understanding biochemical and behavioral modulators of cell aging in humans.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS034

Hinshaw to receive distinguished award for contributions to child development science JANUARY 31, 2017

UCSF Department of Psychiatry Vice Chair for Child and Adolescent Psychology Stephen P. Hinshaw, PhD, has been selected by the Society for Research in Child Development (SRCD) to receive a Distinguished Scientific Contributions to Child Development Award, one of the organization's highly prized Senior Distinguished Contribution Awards. He will formally receive the award during the SRCD’s 2017 Biennial Meeting in Austin in April.

The SRCD Senior Distinguished Contribution Awards were established in 1977 to recognize senior members who have distinguished themselves in various domains of child development research over a sustained period of time. Past recipients of the Distinguished Scientific Contributions to Child Development Award include such noted figures as Konrad Lorenz, MD, PhD; Nancy Bayley, PhD; John Bowlby, MD: Mary Ainsworth, PhD; Sir Michael Rutter CBE, FRS, FRCP, FRCPsych, FMedSci; Jerome Bruner, PhD; and Urie Bronfenbrenner, PhD. SRCD also presents awards in areas including public policy and practice, understanding diversity, scientific mentoring, and interdisciplinary work.

In addition to his position with UCSF Psychiatry, Hinshaw is a Professor of Psychology at UC Berkeley, where he also served as department chair from 2004-2011. He holds a PhD in clinical psychology from UCLA, and his work focuses on developmental psychopathology, clinical interventions, and mental illness stigma, with specialization in ADHD. Hinshaw has received the California Psychological Association’s Distinguished Scientific Contribution in Psychology Award and UC Berkeley’s Distinguished Teaching Award.

He also received the Distinguished Scientist Award from the Society for a Science of Clinical Psychology in 2015. Most recently, Hinshaw received the 2016 Association for Psychological Science (APS)’s highest honor, the James McKeen Cattell Fellow Award.

Matthew State elected to Institute of Medicine OCTOBER 21, 2013

Department chair Matthew W. State, MD, PhD, has been selected to be one of the 70 new members of the Institute of Medicine (IOM). Election to the IOM is considered one of the highest honors in thefields of health and medicine, and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service.

In 2005, State’s work on the identification of SLITRK1 as a risk gene for Tourette syndrome was listed among the top ten “Breakthroughs of the Year” in the journal Science. He has pioneered the use of whole-exome sequencing and other nextgeneration techniques to identify rate mutations associated with autism.

In 2012, he led a large, multi-center genomic study that provided strong evidence for multiple new autism genes. His lab is now determining precisely when during brain development, and in which specific brain regions, mutations in these genes act to increase the risk for autism, a critical step in the process of indentifying new approaches to treatment.

State was awarded the Ruane Prize for Outstanding Achievement in Child and Adolescent Psychiatric Research by the Brain and Behavior Research Foundation in 2012.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS035

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS695

Hall named an inaugural Society for Research on Nicotine and Tobacco Fellow FEBRUARY 13, 2017

UC San Francisco Professor Emeritus of Psychiatry Sharon M. Hall, PhD, has been appointed as an inaugural Fellow by the Society for Research on Nicotine & Tobacco (SRNT). She will join 29 other recipients of SRNT’s major triennial research awards and members of its Past Presidents of the Society in the inaugural cohort of SRNT Fellows.

Hall has been a faculty member at UCSF since 1976, conducting research on the treatment of drug abuse and better understanding the processes of change through randomized clinical trials and related studies. She is especially interested in the treatment of comorbidities in special populations, and the complexities that comorbidities introduce into treatment. She previously served as a co-leader of the UCSF Helen Diller Family Comprehensive Cancer Center's Tobacco Control Program.

She has been previously honored by SRNT with the Ove Fernö Award for Clinical Research in 2007 and an SRNT Service Award in 2013. In 2003, Hall received the UCSF Psychiatry George Sarlo Prize for Excellence in Teaching.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS606

INDIVIDUAL HONORS

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UCSF’s Krystal elected president-elect of the Sleep Research Society JUNE 14, 2017

UC San Francisco Department of Psychiatry professor and Vice Chair for Research Andrew Krystal, MD, MS, has been elected as the new President-Elect of the Sleep Research Society (SRS), a position which will place him in the group's senior leadership team for the next four years. He was selected in a vote by SRS members conducted earlier in the spring, and ratified by the group's board of directors in May. Krystal began his one-year term as President-Elect on on June 8, following the conclusion of SLEEP 2017, the annual joint meeting held by SRS and the American Academy of Sleep Medicine. Next summer, he will begin a two-year term (2018-2020) as the society's 38th president. The following year (2020-2021), he will also serve as the group's immediate past president.

An internationally recognized expert in the areas of mood and sleep disorders with over 25 years of clinical and research experience to his credit, Krystal joined the faculty at UCSF last summer. Prior to that, he served as a faculty member and clinician at Duke University Medical Center for more than two decades. He is the recipient of multiple awards including the American Psychiatric Association (APA) Resident’s Scholarship, a Laughlin Fellowship from the American College of Psychiatrists, two NARSAD Young Investigator Awards, an NIMH Scientist Development Award for Clinicians, and the APA Research Mentorship Award.

SRS was founded in 1961 as an organization for scientific investigators who educate and research sleep and sleep disorders. Now consisting of more than 1,400 members, SRS serves them and the field of sleep research through training and education, and by providing forums for the collaboration and the exchange of ideas.

John McQuaid receives AVAPL’s Patrick DeLeon Advocacy Award MAY 26, 2017

UC San Francisco Professor of Clinical Psychology and Vice Chair for Adult Psychology John McQuaid, PhD, received the 2017 Patrick DeLeon Advocacy Award at this year's VA Psychology Leadership Conference in San Antonio, Texas. McQuaid, a past president of the Association of VA Psychologist Leaders (AVAPL), is also currently serving as the department's interim vice chair for the San Francisco VA Health Care System (SFVAHCS) and interim chief of the SFVAHCS' Mental Health Service.

The Patrick DeLeon Advocacy Award is awarded annually to an “individual who has demonstrated, through professional and personal actions, a commitment to advocating for the mental health services and welfare of this nation’s veterans.

The individual receiving this award should have shown a commitment to influence policy and/or resource allocation decisions within political, economic, organizational, and social systems and institution both outside and within the VA for the betterment of services to our veterans. Further, through these efforts this individual has also highlighted the vital role that psychologists and psychological services have in the delivery of effective services to veterans.”

The award is named in honor of Patrick DeLeon, PhD, MPH, a former president of the American Psychological Association (APA) and a key advocate for the field of psychology. He is known for his work to expand opportunities for psychology practice, to increase federal support for the Graduate Psychology Education program, and to initiate APA’s Congressional Fellowship Program.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS419

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS086

Four Dept. of Psychiatry faculty members among inaugural UCSF Weill Innovation, Scholar Award recipients OCTOBER 27, 2016

The UCSF Weill Institute for Neurosciences has named the first recipients of the UCSF Weill Innovation and Scholar Awards as part of the institute’s goal to support high-risk, high-reward research.

The highly competitive selection process concluded with nine Innovation Awards and six Scholar Awards being granted by the new UC San Francisco institute, made possible by the $185 million gift from Joan and Sanford I. “Sandy” Weill.

The gift funded several programs, including the UCSF Weill Fellows program to offer crucial financial support to PhD students in UCSF’s Neuroscience Graduate Program and an annual neuroscience symposium that will alternate between Weill Cornell and UCSF. The first program launched is the UCSF Weill Innovation Fund, which supports high-risk, high-reward research projects aimed at finding new treatments for neurological and psychiatric diseases and disorders.

Each of the nine UCSF Weill Innovation Award recipients received $150,000 – funding that will continue for three years, dependent on milestone attainment each year. The UCSF Weill Scholar Award recipients each received $100,000.

Receiving awards from the department were: Lisa Gunaydin, PhD - Innovation Award for “Biomarkers for Susceptibility and Resilience in Anxiety and Compulsive Behaviors” Mazen A. Kheirbek, PhD - Scholar Award for “Illuminating Novel Targets for the Treatment of Mood and Anxiety Disorders” Stephan Sanders, PhD - Innovation Award for “Developing the Neuropsychiatry Clinics of the Future” Mark von Zastrow, MD, PhD - Innovation Award for “Probing the Pathways of Pain and Addiction With a New Therapeutic Lead”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS004

Pffifner named president-elect of International Society for Research on Child and Adolescent Psychopathology JUNE 18, 2015

Linda Pfiffner, PhD, was recently elected as president-elect of the International Society for Research on Child and Adolescent Psychopathology (ISRCAP). Her term as president-elect will run from 2015-2017, after which she will assume a two-year term as president of the organization from 2017-2019. Pfiffner has been a member of ISRCAP since 1991.

ISRCAP was founded in 1988 to provide mental health professionals interested in child psychopathology with a forum to exchange ideas concerning the nature and treatment of childhood mental disorders. Since then, the society has grown to approximately 320 members worldwide, and provides its members with information on recent basic and applied research and current treatment strategies.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS997

INDIVIDUAL HONORS

Lisa Gunaydin named to first cohort of Chan Zuckerberg Biohub investigators FEBRUARY 8, 2017

Neuroscience researcher and Assistant Professor of Psychiatry Lisa Gunaydin, PhD, was among the 15 UC San Francisco faculty members named to the first cohort of Chan Zuckerberg Biohub Investigators.

The CZ Biohub is an independent nonprofit research organization formed as a collaboration between UCSF, UC Berkeley, and Stanford University with the goal of inventing new tools to accelerate transformative advances in the life sciences.

CZ Biohub is funded by a $600 million commitment from Facebook CEO and founder Mark Zuckerberg and pediatrician Priscilla Chan, and it is the first philanthropic science investment made by the Chan Zuckerberg Initiative, which is dedicated to advancing human potential and promoting equality.

The first cohort of CZ Biohub Investigators includes 47 faculty members from the three universities. The group includes both highly accomplished senior professors as well as up-and-coming young faculty. UCSF has nine senior investigators and six junior investigators in the cohort.

Each of the investigators will receive a five-year appointment and up to $1.5 million in unrestricted funding to conduct life science research in their respective areas of expertise.

Gunaydin, who also holds a joint appointment with the UCSF Institute for Neurodegenerative Diseases, seeks to elucidate the cellular and circuit mechanisms underlying major psychiatric diseases. She will use her new funding to carry out optogenetic studies of a genetic mouse model of obsessive-compulsive disorder to elucidate the patterns of abnormal neural activity as a first step in intervening to restore normal behavior.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS629

Le Grange to be honored for eating disorder treatment research efforts JANUARY 26, 2017

Benioff UCSF Professor in Children's Health and UCSF Eating Disorders Program Director Daniel Le Grange, PhD, has been selected for induction into the Eating Disorder Recovery Support (EDRS) Hall of Fame in recognition of his work advancing research on eating disorder treatments for adolescents. Together with four colleagues from the field of eating disorders treatment, he will be honored at a special gala at the annual EDRS Convention in San Rafael, Calif.

In addition to his appointments at UCSF, Le Grange is also Emeritus Professor of Psychiatry and Behavioral Neuroscience at the University of Chicago. He received his doctoral education at the University of London's Institute of Psychiatry, and completed postdoctoral training at the University of London Maudsley Hospital and the Stanford University School of Medicine.

Le Grange’s research interests focuses primarily on treatment trials for adolescents with eating disorders, and he has served a critical role in bringning family-based treatment (FBT) – now regarded as the first-line outpatient therapy for medically stable patients – for adolescent anorexia nervosa and bulimia nervosa to the United States. He has authored or co-authored more than 450 manuscripts, books, book chapters and abstracts, and presented more than 200 presentations at national and international scientific meetings.

He is a fellow of the Academy for Eating Disorders, a member of the Eating Disorders Research Society, an associate editor for the Journal of Eating Disorders and BMC Psychiatry, serves on the editorial boards of the European Eating Disorders Review and the International Journal of Eating Disorders, and is an ad hoc scientific reviewer for more than 25 journals. He has lectured extensively across North America, Europe, Australia, southeast Asia and South Africa. Over the past 15 years, Le Grange has been the principal investigator on numerous randomized clinical trails funded by the National Institute of Mental Health, Australia's National Health and Medical Research Council, and numerous private foundations. He is the 2013 recipient of the Presidential Chair Award at UCSF and the 2014 recipient of the Academy for Eating Disorders Leadership in Research Award.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS943

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Rubenstein recognized with trio of honors FEBRUARY 18, 2016

Faculty member John L.R. Rubenstein, MD, PhD, was recently honored by three organizations for his work in the fields of child and adolescent psychiatry and neuroscience.

He was named the 2015 Heinrich Waelsch Memorial Neuroscience Lecturer by Columbia University and delivered his lecture, “Transcriptional Regulation of Forebrain Development,” at the New York Psychiatric Institute. The lectureship is held annually in remembrance of Heinrich Waelsch, MD, PhD, an internationally respected researcher who was intimately connected with the development of the field of neurochemistry and the founding of the International Brain Research Organization.

In December, Rubenstein was announced as the 2016 recipient of the Child Mind Institute (CMI)’s Distinguished Scientist Award. Selected each year by the group’s Scientific Research Council, the award commends exceptional researchers who have made an outstanding contribution to child and adolescent psychiatry, psychology, or developmental neuroscience. In addition to his recognition at the CMI’s annual Child Advocacy Award Dinner, he will present at a scientific symposium sponsored by CMI later this year.

Rubenstein has also been selected as this year’s recipient of the American Psychiatric Association (APA)’s Blanch F. Ittleson Award for his exceptional published research in child and adolescent psychiatry leading to a significant advance in promoting the mental health of children. He will formally receive the award at the APA’s Annual Meeting in Atlanta in May.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS333

Reus elected as ACCME Chair for 2016 DECEMBER 9, 2015

The Accreditation Council for Continuing Medical Education (ACCME) announced that Victor I. Reus, MD, has been elected Chair of the ACCME Board of Directors for 2016.

Reus is the former Director and Vice Chair of the American Board of Psychiatry and Neurology, as well as former Chair of the Residency Review Committee for psychiatry of the Accreditation Council for Graduate Medical Education. He currently chairs the Treatment Guideline Writing Committee of the American Psychiatric Association, as well as the UCSF Parnassus Campus Committee on Human Research. In 2009, he was awarded the American Psychiatric Association/National Institute of Mental Health Vestermark Psychiatry Educator Award for his contributions to psychiatric education and physician evaluation.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS102

Ellen Haller honored by APA Women’s Caucus for excellence in service and advocacy MAY 25, 2017

UC San Francisco Professor of Clinical Psychiatry Ellen Haller, MD, was honored with the 2017 American Psychiatric Association (APA) Assembly Award for Excellence in Service and Advocacy during the 170th APA Annual Meeting in San Diego. She was presented with the award during the Women of the Assembly meeting from APA Women's Caucus President Maureen Sayres Van Niel, MD. She was recognized by Van Niel for her "outstanding work as a female member of the APA whose work exemplifies excellence as a pioneer in the treatment of women and LGBTQ community."

Haller has been a faculty member in the Department of Psychiatry since 1988, serving in a number of key roles throughout her career, including directing the Langley Porter Psychiatric Hospital & Clinics (LPPHC) Adult Psychiatry Clinic (2003-2007; 2013-present), UCSF Adult Psychiatry Residency Training Program (2008-2012), WomenCare Mental Health Clinic (1997-2003), mental health projects for the UCSF National Center of Excellence in Women's Health (1998-2007), UCSF Psychiatry Program for Women (1998-2007), UCSF Lesbian Health & Research Center (2006-2016), and the LPPHC LGBT Psychiatry Clinic (2012-present).  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS187

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Sohal, Willsey chosen to receive 2017 UCSF Weill Research Awards NOVEMBER 16, 2017

The UCSF Weill Institute for Neurosciences has awarded funding to 11 UC San Francisco scientists, including two in the Department of Psychiatry, seeking to support the Institute’s mission to improve the lives of people with brain diseases and disorders through innovative projects that unite the scientific disciplines of neurology, psychiatry and neurosurgery.

The UCSF Weill Research Awards support high-risk, high-reward research projects that employ cutting-edge neuroscience approaches aimed at improving the health of the many millions of people worldwide who suffer from neurologic and psychiatric diseases and disorders.

Associate professor Vikaas Sohal, MD, PhD, will use his award to look at whether targeting activity in a particular class of inhibitory neurons within the prefrontal cortex can control anxiety-related behavior. He believes that by understanding the process through which patterns of prefrontal circuit activity are generated, we can better understand the computations these circuits perform, and obtain a “map” of circuit function that will make it possible to identify ways of correcting circuit dysfunction in disease states.

Assistant professor Jeremy Willsey, PhD, who holds a joint appointment with the UCSF Institute for Neurodegenerative Diseases, will map the core molecular networks underlying autism. This will provide critical insights into pathology and treatment to generate a new paradigm for investigating neuropsychiatric disorders that bridges the current gap between genetics and functional biology.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS901

Sikorski’s career recognized with inaugural UCSF Psychiatry Golden Apple Award JUNE 29, 2017

Longtime faculty member John Sikorski, MD, was honored earlier this week as the inaugural recipient of the UC San Francisco Department of Psychiatry's Golden Apple Award for excellence in teaching in the field of child and adolescent psychiatry. He was chosen by the department's Child and Adolescent Psychiatry Training Program fellows.

In his time at UCSF, he has worked with hundreds of child and adolescent psychiatry fellows as an educator and clinical supervisor. Throughout his career he has been involved with numerous academic and community mental health organizations, including the International Association for Child/Adolescent Psychiatry and Allied Professions, American Academy of Child and Adolescent Psychiatry, Northern California Psychiatric Society, San Francisco Medical Society, and the San Francisco Mental Health Advisory Board.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS623

Nancy Adler to be celebrated by the New York Academy of Medicine AUGUST 28, 2017

The New York Academy of Medicine has selected Nancy Adler, PhD, to receive the 2017 Academy Medal for Distinguished Contributions in Biomedical Science.

Adler is being recognized for her pioneering work on health behavior decision-making and social determinants of health. Her research has helped identify causes and consequences of health-damaging behaviors, and the health impact of socioeconomic status and its psychosocial mediators.

Three department members honored at annual AAP meeting SEPTEMBER 7, 2017

Three UC San Francisco Department of Psychiatry members were singled out for acclaim by their peers at the Association of Academic Psychiatry (AAP)'s 2017 Annual Meeting in Denver. The trio received their awards during the conference's opening award session on Thursday, September 7.

AAP focuses on education in psychiatry at every level from the beginning of medical school through lifelong learning for psychiatrists and other physicians. It seeks to help psychiatrists who are interested in careers in academic psychiatry develop the skills and knowledge in teaching, research, and career development required to succeed. The organization also provides members a forum to exchange ideas on teaching techniques, curriculum, and other issues and to work together to solve problems.

Professor and department executive vice chair Lowell Tong, MD, was honored with the AAP Lifetime Achievement Award, in recognition of his long-term contribution as a national leader in education. Unlike other awards bestowed by the AAP which have an open nomination or submission process, nominations for this distinguished honor are made solely by the AAP Steering Committee and Awards Committee Members. Tong, an inaugural member of the UCSF Academy of Medical Educators and the Department of Psychiatry’s Endowed Chair for Medical Student Education from 2004-2014, was also the recipient of the organization's Psychiatric Education Award in 2009.

Assistant professor Weston Fisher, MD, received the AAP Early Career Development Award, a distinction reserved for promising junior faculty members. The program provides an opportunity for new educators to learn and share teaching techniques, skills, and innovations with other experienced AAP educators, and to network with other junior faculty from across the country. Fisher, a graduate of UCSF's Adult Psychiatry Residency Training Program (RTP) and faculty member since 2014, is currently the program's associate director for core curriculum.

Fourth-year resident physician Laura Kaplan, MD, was named a 2017-2019 AAP Fellow in recognition of her promise as an educator and scholar in the field of academic psychiatry. During the two-year fellowship, she will attend the association's annual meetings, receive mentoring from AAP members, and collaborate with other program fellows.

Kaplan is currently RTP's chief resident for clinical programs.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS453

UCSF’s Binder selected to receive prestigious Isaac Ray Award NOVEMBER 21, 2017

She is the Lisa and John Pritzker Professor of Psychology and vice chair of the UC San Francisco’s Department of Psychiatry and director of the UCSF Center for Health and the Community. Previous UCSF winners of this prestigious award are Harold Varmus, MD, and Elizabeth Blackburn, PhD.

UC San Francisco professor of psychiatry Renée Binder, MD, has been chosen as the recipient of the 2018 Isaac Ray Award by the American Psychiatric Association (APA) and the American Academy of Psychiatry and the Law in recognition of her outstanding contributions to forensic psychiatry and the psychiatric aspects of jurisprudence.

Adler will receive her award at the Academy’s 170th Anniversary Discourse & Awards event, where other honorees include Donald Berwick, MD (Health Policy), Paula Johnson, MD (Public Health), and Herbert Pardes, MD (Clinical Practice).

The award, considered one of the highest honors in the field, is named in honor of Isaac Ray, MD, an APA original founder and its fourth president. Binder will be presented with the award at the 170th Annual Meeting of the APA next May in New York.

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INDIVIDUAL HONORS

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Digital mental health pioneer Muñoz chosen for AAAS Fellowship NOVEMBER 21, 2016

Ricardo F. Muñoz, PhD, professor emeritus of psychology at the University of California, San Francisco, has been named a Fellow of the American Association for the Advancement of Science (AAAS). Election as an AAAS Fellow is an honor bestowed upon AAAS members by their peers.

As part of the Section on Psychology, Muñoz was elected as an AAAS Fellow for his distinguished contributions towards the prevention of major depression and the development of internet interventions to improve mental health worldwide. He is a depression prevention and treatment researcher, and currently serves as a distinguished professor of clinical psychology at Palo Alto University.

Lieberman to receive 2017 Whole Child Award DECEMBER 21, 2016

Irving B. Harris Endowed Chair of Infant Mental Health, Professor and Department of Psychiatry Vice Chair for Faculty Development Alicia F. Lieberman, PhD, has been selected by the Simms/Mann Institute as one of its three 2017 recipients of the Whole Child Award. The honor recognizes extraordinary leaders in the field of care for children ages 0-3 who incorporate new and integrative approaches in education and health.

Lieberman was singled out for recognition for her contributions in the realm of education and advocacy. She will be presented with her award during the Simms/Mann Institute Institute Think Tank on February 9 in Santa Monica, Calif.

Lieberman is the director of the Child Trauma Research Project at Zuckerberg San Francisco General Hospital and Trauma Center, as well as the Early Trauma Treatment Network, a center of the National Child Traumatic Stress Network. She is a past president of Zero to Three: The National Center for Infants, Toddlers and Families, and the author or senior author of several books for parents and clinicians.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS023

Molofsky tapped as Pew Biomedical Scholar JUNE 15, 2017

Department of Psychiatry researcher and faculty member Anna Victoria Molofsky, MD, PhD, is one of two UC San Francisco scientists who have been named Pew scholars in the biomedical sciences.

Molofsky, along with the Department of Microbiology and Immunology's Shaeri Mukherjee, PhD, was among the 22 early-career researchers in the class announced June 15 by The Pew Charitable Trusts.

From 1977 to 2012, Muñoz was a professor of psychology at the UCSF Department of Psychiatry, based at the then-San Francisco General Hospital (now Zuckerberg San Francisco General Hospital and Trauma Center), where he served as chief psychologist for 26 years. Muñoz has been the recipient of numerous awards, including UCSF's Martin Luther King, Jr. Leadership Award (1991), the National Mental Health Association's Lela Rowland Prevention Award (1994), and UCSF Psychiatry's George Sarlo Award for Excellence in Teaching (2001). He was named a fellow of the American Psychological Society in 1994.

Muñoz has been a pioneer in the development of internet interventions for health since the 1990’s and was a founding member of the board of directors for the International Society for Research on Internet Interventions from 2010 to 2013. He has most recently founded i4Health, an institute dedicated to developing, evaluating, and disseminating evidence-based psychological interventions in multiple languages for people worldwide using internet sites and mobile applications.

He immigrated from Perú to San Francisco's Mission District in 1961 at the age of 10. He did his undergraduate work at Stanford University and received a masters and doctorate in clinical psychology from the University of Oregon in Eugene. In 1977, Muñoz became the first psychologist to join the UCSF Psychiatry faculty at SFGH. He founded the SFGH Depression Clinic, UCSF's first cognitive behavioral service, in 1985, and the UCSF/SFGH Latino Mental Health Research Program in 1992. He became chief psychologist at SFGH in 1986 and served as the director of the Clinical Psychology Training Program from 1992 to 2012.

His research focuses on the development of prevention and treatment interventions for depression and applications of these methods to help people stop smoking. Muñoz began work on international, randomized trials via the internet in 1998, and founded the UCSF/SFGH Internet World Health Research Center in 2004. He was the principal investigator on the first randomized, controlled trial to prevent major depression, and served on Institute of Medicine committees which produced major reports on prevention of mental disorders in 1994 and 2009.  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS722

O’Donovan named a 2017 Hellman Fellow JUNE 1, 2017

The Pew Scholars Program in the Biomedical Sciences supports promising young investigators in science relevant to the advancement of human health. Each scholar receives four years of flexible funding to pursue foundational research.

Molofsky is an assistant professor in the Department of Psychiatry, having completed both her residency and postdoctoral fellowship at UCSF. Her research focuses on brain development from the perspective of glia – specialized support cells that act as communication hubs between the immune system and the brain.

UC San Francisco Assistant Professor of Psychiatry Aoife O'Donovan, PhD, has been selected as a 2017 UCSF Hellman Fellow for a project involving the potential use of mobile telephone applications to reduce symptoms in individuals with post-traumatic stress disorder (PTSD). She is one of nine UCSF faculty members who will receive funding to further their research from the Hellman Fellows Program.

The brain generates thoughts and behaviors through connections between nerve cells.

These connections, called synapses, are formed and removed in huge numbers during childhood and with learning. Previously, the Molofsky Lab discovered a key role for glia and the immune system in coordinating the important process of synapse remodeling.

O'Donovan's research is focused on uncovering the mechanisms by which psychological experiences influence the development of age-related diseases, with a particular interest in how psychosocial stress influences the biological aging process.

She is the principal investigator for the UCSF Trauma and Health Research on Immunity, Vitality and Emotions (THIRVE) Laboratory based at the San Francisco VA Medical Center.

Now, using molecular genetics, transcriptomics and imaging, Molofsky will set out to uncover how nerve cells communicate with two types of glia – astrocytes and microglia – to ensure the right number of synapses form during brain development. This work has the potential to uncover new treatments for diseases at the brain-immune interface, including autism spectrum disorder, schizophrenia and neurodegenerative diseases.

Her lab concentrates on uncovering how stress exposure increases the risk for illness in individuals, and on developing and testing interventions to reduce the negative effects of stress. O'Donovan's previous work has indicated that psychological stress has profound effects on the immune system, increasing levels of inflammatory activity and accelerating biological aging.

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Weiss honored with UCSF Chancellor Diversity Award for Advancement of Women OCTOBER 18, 2016

UCSF Psychiatry faculty member Lauren Weiss, PhD, was among the 10 individuals honored at UC San Francisco’s 2016 Chancellor Diversity Awards. The annual awards recognize campus members who are leaders, activists, and pioneers in the fields and communities that they serve for their work in advancing equity and inclusion.

“UCSF’s commitment to equity and inclusion is exemplified in these individuals’ service beyond the scope of their daily jobs,” said Renee Navarro, MD, vice chancellor of Diversity and Outreach. “We are honored to award each of these individuals for their accomplishments.”

Weiss is an associate professor in the Department of Psychiatry and the Institute for Human Genetics. Her research laboratory studies the genetic architecture of autism using analytical as well as stem cell-based methodologies, and she has been involved in teaching complex trait genetics in our graduate and medical school programs.

Weiss, who received a Chancellor Award for Advancement of Women, formed a female faculty peer problem-solving group, and has participated in the Committee on the Status of Women since 2011, where she has worked toward reducing unconscious bias and microaggression as well as increasing leadership opportunities for women at UCSF. “I appreciate the senior female mentors that I have been fortunate to have all along my training and career, and their work to make a scientific path easier for my generation of women,” she said. “I would like to continue that effort to make an academic research career equally rewarding for our female and male students today.”  READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS115

Adler selected by Academic Senate to deliver annual clinical research talk OCTOBER 27, 2016

Nancy Adler, PhD, has been named as the recipient of the UCSF Academic Senate’s 15th Annual Faculty Research Lectureship – Clinical Science for her trailblazing research on socioeconomic determinants of health. Her lecture, entitled “Social Determinants of Health: Power, Population, and Precision,” will be delivered on Tuesday, November 17.

The Faculty Research Lectureship – Clinical Science is bestowed annually on an individual member of the UCSF faculty with outstanding achievements in clinical research. Nominations are made by UCSF faculty, who consider the research contributions of their colleagues and submit nominations for this prestigious honor to the Academic Senate Committee on Research.

Dilley named 2016 APA Adolf Meyer honoree MAY 26, 2017

Professor and Vice Chair for Zuckerberg San Francisco General Hospital & Trauma Center James W. Dilley, MD, has been named as the recipient of the American Psychiatric Association (APA)’s 2016 Adolf Meyer Award.

The award lecture, established in 1957, is part of a series of lectures intended to advance psychiatric research by enabling psychiatrists to hear from leading scientists and to exchange new research information with outstanding colleagues. Dilley, an internationally recognized scientist in the area of psychiatric research, will deliver the Adolf Meyer Award lecture during the APA’s 2016 Annual Meeting in Atlanta.

Dilley is a board-certified psychiatrist who received his medical degree from the University of Missouri and completed his psychiatric residency at UCSF. He is the chief of the Department of Psychiatry at Zuckerberg San Francisco General Hospital & Trauma Center, a professor of clinical psychiatry and vice chair in the UCSF Department of Psychiatry, and executive director of the UCSF Alliance Health Project (AHP).

Dilley was the first psychiatrist involved with treating AIDS at Zuckerberg San Francisco General, one of the pioneering and leading hospitals for HIV-related care. He is the author or editor of several key articles and anthologies on HIV-related counseling and mental health issues, and has played a role in developing innovative HIV mental health interventions and has consulted internationally about HIV prevention.

Together with his AHP colleagues, Dilley developed Personalized Cognitive Counseling (PCC), an HIV risk reduction counseling approach targeting gay and bisexual men. In 2010, the Centers for Disease Control and Prevention (CDC) designated PCC as an Effective Behavioral Intervention as part of its highly selective DEBI program. Today, staff at 98 community-based organizations and 28 health departments throughout the country have already been trained to do the intervention, and PCC remains one of the interventions for which the CDC receives the most requests for training.

One of the world’s eminent and accomplished social scientists, at the time Adler began her tenure at UCSF in 1977, there was little attention given to the marked differences in morbidity and mortality associated with socioeconomic conditions. Her landmark papers in JAMA and American Psychologists demonstrating that socioeconomic status was linked to health across the whole range of socioeconomic status challenged common explanations for health disparities.

Dilley was nominated to receive this year’s award by APA President Renée Binder, MD, and Scientific Program Committee Chair Steve Koh, MD, MPH, MBA. His nomination received unanimous approval of the APA’s Board of Trustees at their meeting in December.

As director of the MacArthur Foundation Research Network on Socioeconomic Status and Health for 15 years, Adler influenced the NIH agenda by organizing a scientific meeting at the NIH attended by more than 400 researchers and staff. The MacArthur network contributed fundamental concepts and approaches to studying the mechanisms responsible for health disparities.

Lieberman to be honored by World Association for Infant Mental Health

She has received numerous awards, including the 2009 Lifetime Achievement in Mentoring Award and the 2014 Holly Smith Award for Exceptional Service to the UCSF School of Medicine. She received the Distinguished Scientific Award from the American Psychological Association and the James McKeen Cattell Lifetime Achievement Award from the American Psychological Society. In addition to the acclaim she has received for her contributions to the field of psychology, she has been recognized as a leading researcher in women’s health with the Marion Spencer Fay Award.

Irving B. Harris Endowed Chair of Infant Mental Health, Professor and Department of Psychiatry Vice Chair for Academic Affairs Alicia F. Lieberman, PhD, has been chosen by the World Association for Infant Mental Health (WAIMH) as the 2016 recipient of the organization’s René Spitz Award for her lifetime contributions to clinical and empirical research on topics related to infant mental health. She will become the first woman, and only the third American, to receive the award.

 READ THE FULL ARTICLE AT PSYCH.UCSF.EDU/NEWS183

MAY 2, 2016

Adler becomes only the second female recipient of the honor, as well as the fourth Department of Psychiatry faculty member to be honored on the clinical research side since the award’s inception in 2001. Previous honorees from Psychiatry are Neal Benowitz, MD (2002); Bruce Miller, MD (2012); and Kristine Yaffe, MD (2013).

Lieberman was singled out for the honor by the WAIMH Board of Directors for her “extraordinary contributions to the interdisciplinary field of infant mental health, especially interventions in the prevention and treatment of very young children and their families suffering from trauma and stress.” She will be presented with her award during WAIMH’s 15th World Congress in Prague on June 2.

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DEPARTMENT AND FACULTY HONORS

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Program/Division Honors San Francisco VA Medical Center Mental Health Service Outreach Program at City College San Francisco - American Psychiatric Association Psychiatric Services Achievement Award (2013) UCSF Alliance Health Project - American Psychiatric Association Gold Psychiatric Services Achievement Award (2014) UCSF Child Trauma Research Program (Tipping Point Mental Health Initiative) UCSF Center for Community Engagement Excellence in Partnership Community Health and Policy Development Award (2017) UCSF Healthy Environments and Response to Trauma in Schools - University Community Partnerships Council Excellence in Partnerships Award (2013)

Faculty Honors Bibhav Acharya, MD - UCSF Chancellor Thomas N. Burbridge Public Service Award (2014) Nancy Adler, PhD - Thomas Reuters World’s Most Influential Scientific Mind (2014); UCSF School of Medicine Holly Smith Award for Exceptional Service (2014); 15th Annual UCSF Academic Senate Faculty Research Lectureship in Clinical Science (2015); New York Academy of Medicine Medal for Distinguished Contributions in Biomedical Science (2017) Keith Armstrong, LCSW - Veterans Health Administration VA Social Worker of the Year (2013) Vanessa Hus Bal, PhD - Autism Speaks Top Ten Autism Research Paper (2015) Renée L. Binder, MD - American Academy of Psychiatry and the Law Golden AAPL Award (2014); American Psychiatric Association/American Academy of Psychiatry and the Law Isaac Ray Award (2018) Somer Bishop, PhD - Autism Speaks Top Ten Autism Research Paper (2015) Brian Borsari, PhD - Association for Behavioral and Cognitive Therapies Fellow (2015) Jennifer E. Boyd, PhD, CPRP - American Psychological Association Division 18 Michael S. Neale Award (2013); American Psychological Association Presidential Citation (2014) Michael Brainard, PhD - American Academy of Arts and Sciences Member (2016) Michael Burnias, PsyD - San Francisco Federal Executive Board Federal Employee of the Year Award for Equal Employment and Diversity (2016) Maggie Chartier, PsyD, MPH - Association of VA Psychologist Leaders James L. Besyner Early Career Award for Distinguished Contributions to VA Psychology (2013) James Dilley, MD - American Psychiatric Association Adolf Meyer Award (2016) David Donovan, PhD - UCSF Haile T. Debas Academy of Medical Educators Excellence in Teaching Award (2015) Allison Doupe, MD, PhD - National Academy of Sciences Pradel Research Award (2014) Paul Ekman, PhD - UCSF 150th Anniversary Alumni Excellence Award (2015) G. David Elkin, MD - George Sarlo Prize for Excellence in Teaching (2014) Elissa Epel, PhD - National Academy of Medicine Member (2016); PBS Next Avenue Top 50 Influencer in Aging (2017); Alliance on Aging Research Silver Innovator Award (2017) Peter Ferren, MD, MPH - ZSFG Pillar of Academia Award for Excellence in Teaching (2015)

Weston S. Fisher, MD - Association of Academic Psychiatry Early Career Development Award (2017) Judith Ford, PhD - American College of Neuropsychopharmacology Fellow (2014) Susanna Fryer, PhD - Society of Biological Psychiatry Early Career Investigator Award (2016)

Adam Gazzaley, MD, PhD - UCSF 150th Anniversary Alumni Excellence Award (2015) Gary Grossman, PhD - St. Louis Psychoanalytics Institute Paul A. Dewald Lectureship (2015) Lisa Gunaydin, PhD - UCSF Weill Institute for Neurosciences Innovation Award (2016); Chan Zuckerberg Biohub Junior Investigator (2017) Sharon M. Hall, PhD - Society for Research on Nicotine and Tobacco Fellow (2017) Ellen Herbst, MD - UCSF Hellman Fellow (2014) Stephen P. Hinshaw, PhD - Association for Psychological Science James McKeen Cattell Fellow Award (2016); Society for Research in Child Development Distinguished Scientific Contributions to Child Development Award (2017) Fumiko Hoeft, MD, PhD - International Dyslexia Association Norman Geschwind Memorial Lectureship (2014); Learning and the Brain Foundation Transforming Education Through Neuroscience Award (2015) William Hua, PhD - San Francisco Federal Executive Board Federal Employee of the Year Award for Equal Employment and Diversity (2016) Erick Hung, MD - UCSF Academic Senate Distinction in Teaching Award (2014); UCSF Excellence and Innovation in Graduate Medical Education Award (2014); George Sarlo Prize for Excellence in Teaching (2016) David Jull-Patterson, PhD - UCSF Essential Core Teaching Award for Inspirational Teaching (2014) Rakjumar K. Kalapatapu, MD - American Psychiatric Association Fellow (2015) Mazen A. Kheirbek, PhD - IMHRO/Janssen Rising Star Translational Research Award (2016); UCSF Weill Institute for Neurosciences Scholar Award (2016) Young Shin Kim, MD, PhD, MS, MPH - American Academy of Child and Adolescent Psychiatry Norbert and Charlotte Rieger Award for Scientific Achievement (2014); Presidential Early Career Award for Scientists and Engineers (2014) Daniel Le Grange, PhD - Eating Disorder Recovery Support Research Hall of Fame (2017) Russell B. Lemle, PhD - Association of VA Psychologist Leaders Antonette Zeiss Distinguished Leadership Award (2013); Association of VA Psychologist Leaders Patrick DeLeon Advocacy Award (2016) Bennett Leventhal, MD - American Academy of Child and Adolescent Psychiatry Norbert and Charlotte Rieger Award for Scientific Achievement (2014) Alicia Lieberman, PhD - City and County of San Francisco Certificate of Honor (2016); San Francisco Department of Public Health Hero Award (2016); World Association for Infant Mental Health Rene Spitz Award (2016); Simms/Mann Institute Whole Child Award (2017) Steven Lieske, MD, PhD - UCSF Haile T. Debas Academy of Medical Educators Excellence in Teaching Award (2015) Shira Maguen, PhD - American Psychological Association Division 18 Peter J.N. Linnerooth National Service Award (2016)

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DEPARTMENT AND FACULTY HONORS

Christina Mangurian, MD, MAS - UCSF John A. Watson Scholar (2015); UCSF Chancellor Diversity Award for the Advancement of Women (2016)

Stephan Sanders, PhD - Autism Speaks Top Ten Autism Research Paper (2015); UCSF Weill Institute for Neurosciences Innovation Award (2016)

Devanand S. Manoli, MD, PhD - Burroughs Wellcome Fund Career Award for Medical Scientists (2016)

Vikaas S. Sohal, MD, PhD - Music Festival for Brain Health Rising Star Scientist (2014); UCSF Weill Research Award (2017)

Daniel H. Mathalon, PhD, MD - Brain and Behavior Research Foundation Top 10 Major Discoveries by NARSAD Grantees (2014); Brain and Behavior Research Foundation Scientific Council Member (2016)

James L. Sorensen, PhD - Constellation Behavioral Health Miracles Tribute Award (2015)

Megan E. McCarthy, PhD - Association of VA Psychologist Leaders James Besyner Early Career Award for Distinguished Contributions to VA Psychology (2014) John McQuaid, PhD - American Psychological Association Division 18 James Besyner Award for Lifetime Achievement (2016) Anna Victoria Molofsky, MD, PhD - Burroughs Wellcome Fund Career Award for Medical Scientists (2015); Brain and Behavior Research Foundation NARSAD Young Investigator Grant (2016); National Institutes of Health New Innovator Award (2017)

Matthew W. State, MD, PhD - Institute of Medicine Member (2013); Autism Speaks Top Ten Autism Research Paper (2013); Simons Foundation Autism Research Initiative Most Notable Paper (2013) American Academy of Child and Adolescent Psychiatry George Tarjan Award for Contributions in Developmental Disabilites (2014); Brain and Behavior Research Foundation 10 Major Discoveries by NARSAD Grantees (2014); American Academy of Child and Adolescent Psychiatry Distinguished Fellow (2015); Autism Speaks Top Ten Autism Research Paper (2015); National Academy of Medicine Rhoda and Bernard Sarnat International Prize in Mental Health (2017) Melane Thomas, MD - UCSF Hellman Fellow (2014)

Ricardo F. Muñoz, PhD - American Association for the Advancement of Science Fellow (2016)

Lowell Tong, MD - Association of Academic Psychiatry Lifetime Achievement Award (2017)

Craig Nelson, MD - Columbia University Alexander Glassman Memorial Lectureship (2015)

Robert Tyminski, DMH - Journal of Analytical Psychology Michael Fordham Prize (2015)

Jonathan Nye, MD - UCSF Kaiser Award for Excellence in Teaching (2015)

Mark Von Zastrow, MD, PhD - J. Elliot Royer Award in Psychiatry (2014); UCSF Weill Institute for Neurosciences Innovation Award (2016)

Aoife O’Donovan, PhD - American College of Neuropsychopharmacology Travel Award (2013); UCSF Hellman Fellow (2017)

Samuel Wan, PhD - American Psychological Association Presidential Citation (2014)

Patrick O’Reilly, PhD - UCSF Haile T. Debas Academy of Medical Educators Excellence in Teaching Award (2015)

Erin Watson, PhD - San Francisco Federal Executive Board Federal Employee of the Year Award for Equal Employment and Diversity (2016)

Aric A. Prather, PhD - Psychoneuroimmunology Research Group Robert Adler New Investigator Award (2015)

Lauren Weiss, PhD - UCSF Chancellor Diversity Award for the Advancement of Women (2016)

Eli Puterman, PhD - Alzheimer’s Association New Investigator Award (2014); Society of Behavioral Medicine Early Career Investigator Award (2014); Academy of Behavioral Medicine Research Neal E. Miller New Investigator Award (2015)

Jeremy Willsey, PhD - Autism Speaks Top Ten Autism Research Paper (2015); UCSF Weill Research Award (2017)

Donna Rasin-Waters, PhD - American Psychological Association Presidential Citation (2016) James Reich, MD, MPH - American Psychiatric Association Distinguished Life Fellow (2015) Danielle Roselin, MD - UCSF Haile T. Debas Academy of Medical Educators Excellence in Teaching Award (2014) Nicholas Rosenlicht, MD - UCSF Haile T. Debas Academy of Medical Educators Excellence in Teaching Award (2014) John L.R. Rubenstein, MD, PhD - UCSF Academic Senate Faculty Research Lectureship in Basic Science (2013); Cajal Club Pickney J. Harman Memorial Lectureship (2014); Columbia University Heinrich Waelsch Memorial Neuroscience Lectureship (2015); Child Mind Institute Distinguished Scientist Award (2016); American Academy of Arts and Sciences Member (2016); American Psychiatric Association Blanche F. Ittleson Award (2016); Ruane Prize for Outstanding Achievement in Child and Adolescent Psychiatric Research (2016)

Owen Wolkowitz, MD - American College of Neuropsychopharmacology Member (2014); J. Elliot Royer Award in Psychiatry (2016) Joshua Woolley, MD, PhD - American College of Neuropsychopharamacology Travel Award (2013); Brain and Behavior Research Foundation NARSAD Young Investigator Award (2013); UCSF Haile T. Debas Academy of Medical Educators Excellence in Teaching Award (2015) Kristine Yaffe, MD - UCSF Academic Senate Faculty Research Lectureship in Clinical Science (2013); Alzheimer’s Association Medical and Scientific Advisory Council Member (2014); American Association for Geriatric Psychiatry Distinguished Scientist Award (2014); Thomas Reuters World’s Most Influential Scientific Mind (2014); American College of Psychiatrics Award for Research in Geriatric Psychiatry (2015); American Academy of Neurology Potamkin Prize for Research in Pick’s, Alzheimer’s, and Related Diseases (2017)

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