Updated on Jun 30, 2022 | Psychiatry
Marianne Goodman, MD, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, with her patient, Wilfredo Santos. Photo courtesy of Medical Media, JJP (Bronx) VA Medical Center.
On June 1, Marianne Goodman, MD, Associate Director of the U.S Department of Veterans Affairs’ New York Mental Illness Research Education Clinical Center of Excellence (MIRECC) and Director of the MIRECC’s Suicide Prevention and Treatment Research Program, was honored by Congressman Jose E. Serrano (D-NY) with a flag flown over the U.S. Capitol.
This was requested by one of her patients, Wilfredo Santos, who had written to Congressman Serrano to ask how to honor Dr. Goodman and the VA team for their dedication to preventing suicide in veterans via the Project Life Force (PLF) program. Congressman Serrano suggested the June 1 flag ceremony, and on August 16, the patient presented her with the flag that was flown and the accompanying dedication letter. “You often hear negative news being published about the VA, specifically related to suicide,” Mr. Santos said. “But we don’t recognize the hard work and achievements of our providers, which is why I wanted to honor Dr. Goodman. Sometimes we need to recognize good work in the news.”
PLF is one of several suicide prevention projects at the New York MIRECC. It brings veterans with recent histories of suicidal thinking and completed suicide plans together in groups for safety planning and skills training. The program incorporates elements from dialectical behavior therapy, and emphasizes building interpersonal relationships with friends, family, and the treatment team. It also includes gun safety education and recommends a mobile app to help them stay on track with their safety plans.
As they move through the program, veterans update their safety plans with the new skills they learn in therapy. While group therapy is common for treating PTSD and anger, it is typically not used for suicidal patients because the prevailing belief has been that suicidal patients mixing and discussing their thoughts could actually increase risk. However, Dr. Goodman’s group has found that at least with veterans, the effect is the opposite. “Veterans no longer feel alone,” she said. “They feel someone understands their impulses and urges.”
Dr. Goodman has worked with Mr. Santos for the last 10 years, and he believes that she saved his life through PLF. “With PLF, we communicate with other veterans in the room to offer support and generate ideas on how to distract yourself so that you don’t hurt yourself,” he said. “We truly use our suicide safety plans and make them part of our everyday lives.”
“The flag and the dedication on Capitol Hill are an incredible honor,” said Dr. Goodman. “It’s a great feeling to know that our work is helping veterans find meaning and purpose in their lives.”
Updated on Jun 30, 2022 | Psychiatry
The 2019 Computational Psychiatry Course speakers.
On July 29-30, the Department of Psychiatry hosted the 2019 Computational Psychiatry Course at The Metropolitan Museum of Art with support from the Icahn School of Medicine at Mount Sinai and IBM Research. The first day opened with a speech from René Kahn, MD, PhD, Chair of Psychiatry and Behavioral Health at the Icahn School of Medicine at Mount Sinai. He addressed the promise of computational models in psychiatry: we understand psychiatric disease more than ever, but we have no cures, and to create cures we need new ideas, large samples, and new techniques—enter computational psychiatry. He emphasized the predictive clinical utility of these models, such as predicting onset of psychosis in high-risk subjects, predicting treatment response, and predicting course of illness. The keynote addressed was given at the end of the second day by Matthew Botvinick, MD, PhD, Director of Neuroscience Research at DeepMind, on deep reinforcement learning. “Deep reinforcement learning is not an architecture or even really an algorithm, ” he said. “It’s a framework, and a huge amount of variability and diversity can be explored within it.”
The rest of the course lectures are listed below.
Day 1: Theory
Theoretical Approaches to Function and Dysfunction
Peter Dayan, PhD, Max Planck Institute for Biological Cybernetics
Computational and Algorithmic Accounts of Inference and Choice—Inference About States
Chris Mathys, MSc, MSc, PhD, Scuola Internazionale Superiore di Studi Avanzati
Model-Free and Model-Based Learning
Nathanial Daw, PhD, Princeton University
Social Exchange Games to Study Human Behavior
Read Montague, PhD, Virginia Tech
Trial-by-Trial Model Fitting
Yael Niv, PhD, Princeton University
Modelling Example: A Line by Line Lesson
Yael Niv, PhD, Princeton University
Natural Language Processing for Brain Disorders
Guillermo Cecchi, PhD, IBM Research
Computationally-Relevant NIH Funding Opportunities
Michele Ferrante, PhD, National Institute of Mental Health
Panel Discussion
Jean Zarate, PhD, Nature Neuroscience
Participants:
Daniela Schiller, PhD, Icahn School of Medicine at Mount Sinai
Yael Niv, PhD, Princeton University
Sonia Bishop, PhD, University of California, Berkeley
Rick Adams, PhD, University College London
Matthew Botvinick, MD, PhD, DeepMind
Day 2: Application
Brain Computations in Schizophrenia
Rick Adams, PhD, University College London
Autism Spectrum Disorder
Becky Lawson, PhD, University of Cambridge
Depression
Robb Rutledge, PhD, University College London
Anxiety and Decision-Making Under Uncertainty
Sonia Bishop, PhD, University of California, Berkeley
Neural Computations in the Aftermath of Trauma
Daniela Schiller, PhD, Icahn School of Medicine at Mount Sinai
Addiction
Xiaosi Gu, PhD, Icahn School of Medicine at Mount Sinai
Deep Phenotyping
Read Montague, PhD, Virginia Tech
Updated on Jun 30, 2022 | Psychiatry
Timothy Brennan, MD, Director of the Addiction Institute at Mount Sinai West and Mount Sinai St. Luke’s, spoke about the opioid crisis at the White House.
On June 25, Timothy Brennan, MD, Director of the Addiction Institute at Mount Sinai West and Mount Sinai St. Luke’s, gave a speech at the White House. During the event, entitled “Building the Addiction Medicine Workforce: Giving Americans Access to the Care They Need,” he discussed the role of addiction medicine in addressing America’s opioid crisis. In particular, he emphasized the rise of addiction medicine as a medical specialty, and spoke about the importance of addiction medicine fellowships in educating the next generation of addiction change-agents.
The other speakers included James Carroll, Director of the U.S. Office of National Drug Control Policy; Admiral Brett Giroir, MD, Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS); George Sigounas, MD, PhD, Administrator for the HHS’s Health Resources and Services Administration; Nora Volkow, MD, Director of the National Institute on Drug Abuse; and George Koob, PhD, Director of the National Institute on Alcohol Abuse and Alcoholism.
Dr. Brennan is the Director of the Fellowship in Addiction Medicine Program at the Icahn School of Medicine at Mount Sinai. He has spoken at local, state, national, and international levels about addiction policy issues, particularly involving young adults. He was appointed by New York Governor Andrew Cuomo to serve on the Medical Review Board at the New York State Justice Center. He also volunteers as a member of the Adolescent Advisory Panel at the New York State Office of Alcoholism and Substance Abuse Services.
Updated on Jun 30, 2022 | Psychiatry
The Psychiatry Department faculty presented on their current research at The Metropolitan Museum of Art in Manhattan. Image courtesy of The Met.
On Thursday, June 20, the Department of Psychiatry’s third annual faculty retreat took place at the Metropolitan Museum of Art. The morning began with opening remarks from Rene Kahn, MD, PhD, Professor of Psychiatry and Chair of Psychiatry and Behavioral Health, followed by the keynote talk by Joel Dudley, PhD, Director of the Institute for Next Generation Healthcare and Executive Vice President for Precision Health, on moving from precision medicine to next generation healthcare. Over the course of the day, faculty presented on “What’s New in Psychiatry?” followed by a cocktail reception.
Schahram Akbarian, MD, PhD, Professor of Psychiatric Epigenomics, covered how the chromosomal contact map of adult dopaminergic neurons shows convergence of psychiatric and metabolic risk variants.
Nelly Alia-Klein, PhD, Associate Professor of Psychiatry and Neuroscience and Co-Chief of the Neuropsychoimaging of Addiction and Related Conditions Research Program, discussed targeting the prefrontal cortex for intervention in human drug addiction.
Michal Beeri, PhD, Professor of Psychiatry, presented on the effects of advanced glycation end products on the brain and cognition.
Lotje D. De Witte, MD, PhD, Assistant Professor of Psychiatry, discussed the role of microglia in schizophrenia and depression.
Erin A. Hazlett, PhD, Professor of Psychiatry and James J. Peters VA Medical Center (JJPVA) research career scientist, discussed clinical research at the JJPVA, from suicide to schizophrenia and bench to bedside.
Muhammad A. Parvaz, PhD, Assistant Professor of Psychiatry and Neuroscience, discussed phenotyping adolescents with elevated risk for developing substance use disorders.
Mercedes Perez-Rodriguez, MD, PhD, Assistant Professor of Psychiatry and Assistant Training Director for Research, covered challenges and strategies for recruiting, training, and retaining physician-scientists in psychiatry.
Avi Reichenberg, PhD, Professor of Psychiatry and Environmental Medicine, discussed cognitive decline in schizophrenia and bipolar disorder.
Nikolaos K. Robakis, PhD, Professor of Psychiatry, Neuroscience, and Experimental Therapeutics, discussed clinical trials and the etiology of Alzheimer’s disease.
Mary Sano, PhD, Professor of Psychiatry and Director of the Alzheimer Disease Research Center, covered prevention research for cognitive loss and Alzheimer’s disease.
Updated on Jun 13, 2019 | Psychiatry
Psychiatry residents at the Icahn School of Medicine at Mount Sinai have been awarded several prestigious national prizes and fellowships this year in recognition of their exceptional patient care, outstanding leadership, and remarkable research prowess.
Psychiatry residents and training directors at the Icahn School of Medicine at Mount Sinai.
Jessica Ables, MD, PhD, was selected as one of 12 Laughlin Fellows by the American College of Psychiatrists. She was also selected for membership in Alpha Omega Alpha, the national medical honor society, in recognition for her service as an outstanding clinician, scholar, mentor, teacher, and role model. Finally, she was selected as one of 20 residents for the Career Development Institute for Psychiatry, a highly competitive national training program funded by the National Institute of Mental Health. “I am extremely honored to be selected,” she said. “I’m thankful for the wonderful mentorship at Mount Sinai that has enabled me to be competitive for these awards.”
Youngjung Kim, MD, PhD, was one of 10 psychiatry trainees nationwide awarded the APA/APAF Leadership Fellowship. The award fosters leadership development by connecting trainees with thought leaders, peers, and mentors in order to grow their networks and learn about governance in organizational psychiatry. “It is an honor to be selected to be an APA/APAF Leadership Fellow,” said Dr. Kim. “I hope to learn from the leaders and colleagues in psychiatry to bring about a positive change in my community. I am very lucky and grateful to have amazing mentors in our Mount Sinai program who will challenge, encourage, and support me to apply for this incredible opportunity.”
Adjoa Smalls-Mantey, MD, DPhil, received the Resident Recognition Award from the American Psychiatric Association (APA). This award is given to outstanding residents who exhibit one or more of the following: compassion, leadership, community service, political action, and clinical excellence. “It is an honor to be recognized by the APA,” said Dr. Smalls-Mantey. “I hope that more trainees and faculty become involved in the APA because it is a great organization through which to effect change for patients and the field of psychiatry.”
May 30, 2019 | Psychiatry
On May 19, James Murrough, MD, PhD, director of Mount Sinai’s Depression and Anxiety Center for Discovery and Treatment, and Martijn Figee, MD, director of Mount Sinai’s Interventional Psychiatry Program, chaired a session on next-generation solutions for treatment resistant depression (TRD). The speakers covered ketamine, inflammation, deep brain stimulation (DBS), and electroconvulsive therapy (ECT).
Ketamine: Then, now, and looking ahead
Dr. Murrough discussed how the road to discovering new treatments for TRD has been paved with medications that have almost identical biological mechanisms, and that a new pathway—like targeting the glutamate system via ketamine—has been an inevitable next step. The first iteration of this, Janssen’s newly approved SPRAVATO (esketamine) CIII Nasal spray, could bring relief to millions of patients. Dr. Murrough discussed the first multi-site clinical trial of ketamine in TRD, studies on repeated dosing of ketamine for TRD, and the first study of intranasal ketamine in TRD—all conducted at Mount Sinai. He also covered the rapid antidepressant effects of the novel GABA-A modulator brexanolone, which the FDA recently approved for the treatment of postpartum depression. He concluded that the long-term efficacy and effects of ketamine remain to be seen, but based on preliminary rodent studies he believes the treatments will need to be regular and conducted indefinitely in order to maintain efficacy in patients.
Dr. Murrough discussing ketamine at the APA Annual meeting in San Francisco.
A subgroup: Patients with inflammation
Andrew Miller, MD, professor of psychiatry and behavioral sciences at Emory University, showed that as many as 25-30 percent of depressed patients exhibit the primary features of chronic inflammation. He covered how administration of inflammatory stimuli causes depressive symptoms, and how inhibition of inflammation reduces depressive symptoms. In addition to targeting the inflammation directly, he recommends targeting the “downstream effects” of inflammation on the brain, such as dopamine and glutamate systems. Dopaminergic medications these patients may respond to include bupropion, stimulants, monoamine oxidase inhibitors, and dopamine agonists. This targeted treatment, available by way of the red flag of inflammation, means precision medicine is possible for these patients.
Deep brain stimulation
Dr. Figee brought the backstory on DBS, a treatment that uses implanted electrical impulses to control symptoms for a range of psychiatric and neurologic diseases. In patients with TRD, DBS targets are part of a larger ventral corticostriatal network involved in the regulation of negative and positive mood. Although DBS is effective in approximately 50 percent of patients with TRD, it is still experimental and can only be received as part of a clinical trial. Before taking this step, however, Dr. Figee emphasizes that patients need to have gone through a variety of attempts at treatment including psychotherapy, a variety of antidepressants, at least six sessions of ECT, and possibly repetitive transcranial magnetic stimulation and ketamine. In order to be considered for DBS, the patient must have suffered from TRD for less than two years, and exhibit no schizophrenia/non-affective psychosis, no primary Axis II personality disorder, and no cerebrovascular risk factors. They must also have no other implanted devices, no drug abuse in the past six months, and no cognitive impairment or mental retardation. For more information, check out the Nash Family Center for Advanced Circuit Therapeutics.
A slide from Dr. Figee’s talk on deep brain stimulation.
Ketamine and ECT for apathy, anhedonia, and suicidal ideation
Katherine Narr, PhD, professor of neurology, psychiatry, and biobehavioral sciences at The University of California, Los Angeles, discussed how ECT and ketamine are highly effective at reducing symptoms of apathy, anhedonia (reduced ability to feel pleasure), and suicidal ideation in patients with TRD. ECT has its advantages in that about 70 percent respond and about 50 percent achieve remission, and it’s fast-acting (within 2-4 weeks), it has no systemic effects (unlike medications). Its disadvantages, on the other hand, include stigma, anesthetic effects, cost, cognitive side effects, and the fact that approximately 50 percent relapse within six months. As for ketamine, the pros include that 50-70 percent respond positively, it’s fast-acting (within hours), and has been used safely as an anesthetic since the 1960s. The disadvantages, however, are durability (approximately one week), potential psychotic and dissociative effects, it’s an easy drug to abuse, and the high cost. She concluded that over the short term, ketamine may be as effective as clinically prescribed ECT for reducing depression, apathy, anhedonia, and suicidal ideation.
