Notes on NIMH Alliance for Research Progress Summer Meeting

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Representatives of SARDAA attended a day long presentation of the latest
research recently conducted or sponsored by the National Institute of Mental
Health (“NIMH”) in Bethesda, Maryland on July 12, 2013. The NIMH is the
component of the NIH that is the world’s largest funded of research on
mental disorders.

The group invited to hear these presentations is called the “Alliance for
Research Progress” and consists of representatives of all of the major
organizations in the U.S. advocating for people with mental illness and
related research, treatment and policy needs such as SARDAA, the Brain and
Behavior Research Foundation and the National Alliance on Mental Illness.

Thomas R. Insel, M.D., the Director of the NIMH, led the meeting with
initial remarks about mental disorders, explaining that while some are
“highly heritable”, such as autism, bipolar and schizophrenia, some of the
genetic markers also occur “de novo,” for the first time. The research
challenge is that there are not too few genes involved, but that, especially
in schizophrenia, that there are too many genes.

Dr. Insel also commented on the flurry of controversy that arose with the
recent issuance of the fifth edition of the new DSM–the diagnostic and
statistical manual of mental disorders–used by mental health professionals
in providing treatment treatment. He stated his belief that the DSM
classifications & criteria are, for now, where they needed to be, but
that with the NIMH’s more neuroscience-oriented research approach to mental
disorders (example: the BRAIN initiative) the DSM is likely to evolve as
well.

Dr. Insel gave the representatives of the Alliance for Research Progress
an update on the NIH’s vision for its BRAIN initiative (Brain Research
through Advancing Innovative Neurotechnologies). The goal of the BRAIN
initiative is to create and apply new tools for the understanding of brain
activity. Dr. Insel pointed out that we know more about the biology of
cancer than the biology of mental illness and that this needs to change. The
BRAIN initiative will be launched with a proposal for federal funding,
endorsed by President Obama, of just over $100 million in the next fiscal
year, led by NIH & other govt and private partners. Dr. Insel predicts that
the BRAIN initiative will produce insights into brain disorders that will
lead to better diagnostics, prevention and treatment for schizophrenia and
other brain disorders.

With the promise of the BRAIN initiative in the future, Dr. Insel then
introduced the first of four presenters doing research in the present. Dr.
Gail L. Daumit, an internist and professor at Johns Hopkins gave the results
of her 2012 NIMH-funded behavioral weight loss trial including people with
serious mental illness. She noted that many people w/ serious mental illness
take a variety of psychotropic medications that cause weight gain through
increased appetite and other mechanisms (and that this weight gain can have
a significant impact on a person’s cardiovascular health risk, among
others). Recruiting overweight or obese adults from community psych rehab
outpatient programs in the Baltimore area, the participates in the
intervention group received weight management sessions, nutrition guidance
and group exercise sessions over a period of 18 months. Of 291 participants,
58% had schizophrenia or schizo-affective disorder. The study concluded that
with this kind of guidance, people w/ serious mental illness can achieve
significant weight loss, physical health change and a better overall
self-perception.

The next speaker was Scott Santarella, the president and C.E.O. of the
Bonnie J. Addario Lung Cancer Foundation, an organization founded by Ms.
Addario, a lung-cancer survivor and set up to advocate to give a voice to
people w/ lung cancer. While 80% of people who get lung cancer are
non-smokers, stigma still attaches to the disease–something that people w/
mental disorders understand all too well. He spoke about the importance of
empowering people w/ illness to unite to advocate for themselves, something
that SARDAA does for people w/ schizophenia & related diseases.

The Alliance for Research Progress was particularly excited to hear next
from Helen S. Mayberg, M.D., a highly regarded professor of psychiatry,
neurology and radiology at Emory University who heads up a
multi-disciplinary depression research program that studies the brain
circuits in depression in an effort to learn which treatment, for example,
an antidepressant or cognitive behavioral therapy (or both) will be most
effective bars on the structure and imaging of a person’s brain. The goal of
her team’s research (reported in JAMA psychiatry, June 12, 2013) is to
develop reliable bio-marchers that match an individual patient to the most
optimal treatment option (and avoid the trial & error approach of using
unsuccessful options).

In an NIH-funded study, Dr. Helen S. Mayberg of Emory university, was
able, through pre-treatment imaging using a PET scan on persons w/
depression, to locate parts of the brain which predicted a person’s
response to Cognitive Behavioral Therapy or to a specific SSRI
antidepressant. She learned that if a patient’s pre-treatment resting brain
activity was low on the front of an area called the “insula” on the right
side of the brain, then there was a significant likelihood of a good
response/higher rate of remission with CBT and a poorer rate of response to
the antidepressant med. Conversely, if the insula showed pre-treatment
hyper-activity, the person was more likely to have a good response/remission
with a treatment of the antidepressant med – and a poor response to CBT. If
these findings can be reproduced in a larger study, Dr. Mayberg foresees
their use in personalized predictions in a clinical setting as to evict
treatments will work the best for patients w/ major depression.

Dr. Helen Mayberg also told the Alliance for Research Progress group of
an ongoing trial (200 patients) at Emory University involving persons w/
treatment-resistant depression who over years had no improvement from
multiple meds, therapies and treatments. Her team studied an area of the
brain known as “area 25″ which was hyperactive w/ sadness. Using “deep brain
stimulation” (DBS), Dr. Robert Gross, an Emory surgeon, was able to implant
a battery-operated electrode in the brain to essentially switch-off the
hyperactive mechanism. 64% of the patients undergoing this surgery have
responded well over 6 years. When asked why the procedure was not effective
on all patients, she referred to the micro-anatomy of the brain’s circuits
and the growing understanding of the need to precisely place the implant for
the greatest impact. She explained to the group that to extend the potential
of this treatment strategy would not be to conduct invasive brain surgery on
a wide-scale but to develop bio-markers that could lead to targeted meds.

The last speaker at NIMH’s “Alliance for Progress” meeting on 7/12/13 was
clearly a “rising star”, being only 34 years-old yet conducting major
research at Duke. Kafui Dzirasa, M.D., with a Ph.D. in neurobiology, spoke
about the “new frontier of neuropsychiatric diagnostics and therapeutics.”
Dr. Dzirasa and his team studied the brains of mice to demonstrate the
involvement of certain brain circuits in major depressive disorder. He, like
Dr. Mayberg at Emory, is studying the brain to find bio-markers to help
pinpoint treatments for mental disorders.

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