As the sponsor of a dedicated research track at this year's annual meeting,
the National Institute of Mental Health (NIMH) will showcase the yield of its
hefty investment over the past decade and more in disparate fields of basic,
preclinical, and clinical science that today has increasingly immediate
relevance to understanding and treating mental disorders.
Under the theme "From the Science of Mental Illness to Clinical
Care," the series will encompass plenary lectures by Nobel Laureate Eric
Kandel, M.D., Bruce McEwen, Ph.D., Robert Freedman, M.D., Daniel R.
Weinberger, M.D., and NIMH Director Thomas R. Insel, M.D. In addition, the
track features symposia, workshops, and other sessions focused on the
translation of information gleaned from research into tools and strategies for
practicing clinicians.
"One of the fundamental recommendations that emerges repeatedly from
our Advisory Council work groups as well as from public comments concerns the
need to translate basic-science discoveries into biomarkers, diagnostic tests,
and new treatments for patients with mental disorders," said Insel.
"The challenge is for those of us who are immersed in research to
hand off to busy clinicians information in a form that they can carry forward
and use in daily practice."
Taking that advice to heart, NIMH staff, under the lead of Wayne Fenton,
M.D., Mayada Akil, M.D., and Catherine Roca, M.D., designed a special track
that underscores the priority that NIMH attaches to translational research at
multiple levels— that is, moving new insights about basic mechanisms of
illness into focused clinical research questions and designing clinical
studies that are responsive to clinicians' interests and needs. In one
symposium, for example, the lead investigators on four of NIMH's multisite,
clinical-effectiveness trials will summarize key findings to date in studies
involving patients with schizophrenia, bipolar disorder, childhood and
adolescent depression, and depression resistant to standard interventions.
Some of the topics included tend to be off the radar in day-to-day
practice. For example, "Neuroscience for the Clinician," will
comprise two symposia—both of which were organized and will be chaired
by Akil—that will familiarize clinicians with the latest advances in
genetics and functional neuroimaging with potential relevance to clinical
practice.
"Mainstream psychiatric journals are filled with scientific papers
invoking genes in psychiatric disorders in one way or another. This symposium
is a primer for the clinician interested in critically following these
developments without necessarily becoming a geneticist," said Akil."
We know that the genetics of psychiatric disorders are complex,
involving many genes, each contributing a small percentage of the risk, as is
the case in diabetes and cancer. Given their small effects, what strategies
exist or are being developed to identify risk genes? How do we go from
identifying a susceptibility gene to prevention, diagnosis, and
treatment?"
To answer these questions, the session will include presentations that
describe the use of genetic studies of complex disorders, highlight genomic
approaches to screen tens of thousands of genes and their expression levels,
review strategies for understanding genetic findings in the context of neurons
and neural circuitry, and discuss ways to integrate this information to
enhance understanding of the pathophysiology of mental disorders.
The second "Neuroscience for the Clinician" symposium will
review the explosive growth of functional neuroimaging. "Appreciating
the implications of functional neuroimaging for psychiatry requires awareness
of, but not expertise in, the technology, methodology, interpretation, and
applications of imaging technologies," said Akil.
Of particular interest to clinicians, and among the research to be
presented, are studies that are tracking susceptibility genes from brain
activation during cognitive tasks and studies demonstrating how different
types of treatment can affect activation and predict treatment response. The
two "Neuroscience for the Clinician" symposia will be scheduled so
that attendees may attend both.
"Each case, each doctor-patient interaction in any psychiatric
practice, whether it be general psychiatry or in a specialty area such as
child/adolescent, geriatric, addiction, forensic, consultation-liaison, or any
other area, is unique," said Insel. "In that sense, clinical
practice and the questions that emerge from it are enormously important in
developing the research agenda for understanding of mental disorders. We
intend for the NIMH track this year to provide the clinical community a forum
in which to learn about the way questions in their work are inspiring exciting
lines of research that move us closer to answering the challenges faced in
clinical care."
Indeed, the vast range of patient populations and settings in which
psychiatrists work is well reflected in the research track. Symposia will
present new findings on targeted, early interventions for autism, an update on
pediatric bipolar disorder, and both psychopharmacologic and psychosocial
approaches to the treatment of eating disorders. The focus on child and
adolescent disorders will be counterbalanced by a review of research advances
in late-life disorders.
Sessions also will review new research concerned with the delivery of
mental health care in correctional settings and in the context of the general
health care system.
Evident, too, in the NIMH program are symposia and workshops that
illustrate the barrage of new challenges constantly confronting clinicians:
one session, for example, will consider strategies that research now suggests
can be useful in managing distress and psychiatric disorders in the wake of
terrorist attacks, and another will present new information on the appropriate
use of antidepressant medications in treating child and adolescent
patients.
The emphasis on new linkages between psychiatric and clinical science and
clinical care, Insel said, testifies to a significant realignment of NIMH's
core scientific priorities under his tenure as director. "We have
shifted several areas of basic science, such as studies of emotional
regulation or cognitive development, to new translational divisions to
accelerate the development of tools to help patients."
When NIMH last sponsored the research track at APA's annual meeting, the
research community was realizing the culmination of the Decade of the Brain.
As the remarkable output of that national and international effort comes more
clearly into focus, and as the scientific return mounts from the recent
doubling of the NIMH budget, Insel believes that NIMH and the field are poised
for a Decade of Translation.
"We view our research track at the APA meeting as an extraordinary
opportunity to call the attention of the profession and the larger field to
our commitment at NIMH to work toward a long-term goal of personalized care
for every individual who lives with a mental disorder," Insel said.▪