Psychiatry | Mount Sinai Today

Faculty Retreat at The Met

Sep 5, 2018 | Psychiatry

New and veteran faculty mingled over cocktails at the Met’s Great Hall Balcony Bar.

On Thursday, July 28, the second annual Faculty Retreat took place at the Metropolitan Museum of Art. Over the course of the day, 17 new faculty members introduced themselves to the department and presented their current research, followed by a cocktail reception.

Keren Bachi, PhD, LCSW, Assistant Professor of Psychiatry, Assistant Professor of Department of Environmental Medicine and Public Health, presented “Neuroimmune and Psychosocial Pathways to Disease and Recovery in Drug Addiction.” Dr. Bachi received her PhD in Social Welfare from the City University of New York, and completed her postdoctoral fellowship training with the Neuroimaging of Addiction and Related Conditions Research Program.

Veerle Bergink, MD, PhD, Professor of Psychiatry, Professor of Obstetrics, Gynecology and Reproductive Science, Director of Women’s Mental Health Program, presented “Perinatal Psychiatry Research: Between a Rock and a Hard Place.” Dr. Bergink received her MD from the University Groningen, trained at OLVG West and University Hospital Utrecht, and completed her PhD at Erasmus University Rotterdam (all in the Netherlands).

Alexander Charney, MD, PhD, Assistant Professor of Psychiatry, Assistant Professor of Genetics, Assistant Professor of Neurosurgery, presented “Advancing the Treatment of Mental Illness Through Multiscale Neuroscience.” Dr. Charney received his MD, PhD and residency in psychiatry at the Icahn School of Medicine at Mount Sinai.

Cheryl Corcoran, MD, Associate Professor of Psychiatry, Program Leader in Psychosis Risk, Staff Physician, The James J. Peters VA Medical Center (Bronx VA), presented “Language and Psychosis Risk.” Dr. Corcoran received her MD from Harvard University, trained at Cambridge Hospital, and completed a fellowship at NewYork-Presbyterian Hospital/Columbia University Medical Center.

Silvia De Rubeis, PhD, Assistant Professor of Psychiatry, presented “A Translational Approach to DDX3X Syndrome: From Basic Science to Clinical Studies.” Dr. De Rubeis received her PhD in cellular and molecular biology from the University of Rome “Tor Vergata” (Italy), and completed postdoctoral fellowships at the VIB Center for Human Genetics (Belgium), and the Seaver Autism Center at the Icahn School of Medicine at Mount Sinai.

Gaelle Doucet, PhD, Assistant Professor of Psychiatry, presented “Role of Resting-State FMRI in Vulnerability and Resilience to Psychotic Disorders.” Dr. Doucet completed a PhD in cognitive neuroscience from the University of Caen (France), a postdoctoral fellowship at Thomas Jefferson University, and postdoctoral fellowship at the Icahn School of Medicine at Mount Sinai.

Elodie Drapeau, PhD, Assistant Professor of Psychiatry, presented “iPSC Modeling of Rare Neurodevelopmental Disorders.” Dr. Drapeau received her PhD in neurosciences and neuropharmacology at the University of Bordeaux (France) and completed her first postdoctoral training at Columbia University and completed her second postdoctoral training at the Seaver Autism Center at the Icahn School of Medicine at Mount Sinai.

Martijn Figee, MD, PhD, Associate Professor of Psychiatry, Director of Interventional Psychiatry Program, presented “Optimizing Neuromodulation of Circuits for Mood, Motivation, and Motor Control.” Dr. Figee received his MD and PhD, and completed his residency at the University of Amsterdam (Netherlands).

Xiaosi GU, PhD, Assistant Professor of Psychiatry, presented “Computational Psychiatry: Promises and Challenges.” Dr. Gu completed her PhD in neuroscience at the Icahn School of Medicine at Mount Sinai, and completed her postdoctoral training in computational psychiatry at Virginia Tech and the University College London.

Hala Harony-Nicolas, PhD, Assistant Professor of Psychiatry and Neuroscience, presented “Neural Circuits and Brain System Alterations Underlying Social Deficits.” Dr. Harony-Nicolas received her PhD in molecular biology at the Technion Institute (Israel), completed her first postdoctoral training in molecular neurobiology at University of Haifa (Israel), and completed her second postdoctoral training at the Seaver Autism Center at the Icahn School of Medicine at Mount Sinai.

David Kimhy, PhD, Associate Professor of Psychiatry, Program Leader in New Interventions in Schizophrenia, Director of Experimental Psychopathology Lab, presented “Novel Cognitive and Behavioral Interventions for People with Psychosis and At-Risk States.” Dr. Kimhy received his PhD from Long Island University, trained at Long Island Jewish Medical Center, and was a postdoctoral fellow in schizophrenia research at Columbia University.

Dolores Malaspina, MD, MS, MSPH, Professor of Psychiatry, Professor of Neuroscience, Professor of Genetics, Director of the Psychosis Program, presented “A Behavioral Ecology Approach to Schizophrenia.” Dr. Malaspina completed her residency and fellowship training at the New York State Psychiatric Institute and Columbia University; she also completed an MPH in epidemiology. She joined the Icahn School of Medicine at Mount Sinai from New York University, where she had served as the Chair of Psychiatry.

Helen S. Mayberg, MD, Professor of Neurology, Professor of Neuroscience, Professor of Neurosurgery, Professor of Neurotherapeutics, Professor of Psychiatry, Director of Center for Advanced Circuit Therapeutics, presented “Evolution of the Center for Advanced Circuit Therapeutics.” Dr. Mayberg received her MD from the University of Southern California, trained at the Neurological Institute of New York at Columbia University, and was a postdoctoral fellow in nuclear medicine at Johns Hopkins Medicine.

Julie Spicer, PhD, Assistant Professor of Psychiatry, presented “The Role of Maternal Prenatal Stress in Mother-Infant Outcomes: A Health Neuroscience Approach.” Dr. Spicer completed her PhD in psychology with a specialization in cognitive affective neuroscience from Columbia University, and postdoctoral training in behavioral medicine at Columbia University Medical Center.

An-li Wang, PhD, Assistant Professor of Psychiatry, presented “Neuroimaging of the Public Health and Clinical Interventions in Opioid Addiction.” Dr. Wang completed her PhD in human electrophysiology and pain at the University of Oxford, and her postdoctoral training in neuroimaging and addiction at the University of Pennsylvania.

Anna Zilverstand, PhD, Assistant Professor of Psychiatry, presented “Neuroscience-Based Personalized Interventions for Human Drug Addiction.” Dr. Zilverstand completed her PhD in cognitive neuroscience at Maastricht University (Netherlands), and was a postdoctoral fellow at the Neuropsychoimaging of Addiction and Related Conditions Research Program at the Icahn School of Medicine at Mount Sinai.

Eliminating Physical Restraints in the Psychiatric Emergency Department

Sep 4, 2018 | Psychiatry

Some of the key players in this project, from left to right: Gail Perry-Estime, clinical nurse; Francesca Jean, clinical nurse; Robin Kahn, clinical nurse; MaryJoy Adverderada, MSN, RN-C, nurse manager (now retired); and Kenneth Larock, nurse practitioner.

“Vision Zero” is New York City Mayor Bill de Blasio’s campaign to reduce pedestrian deaths to zero by improving traffic safety. Kenneth Hung, MD, Assistant Clinical Professor and Director of the Psychiatric Emergency Department at Mount Sinai Hospital, decided to create his own vision zero based on the mayor’s model. The goal? To completely eliminate the use of four-point restraints in the Psychiatric Emergency Department.

Background

As the hospital’s main access point for patients with psychiatric emergencies, the Psychiatric Emergency Department team treats a disproportionate number of our most highly agitated or violent patients. For the patient’s safety and the safety of hospital staff, four point restraints (securing wrists and ankles to the bedframe) have historically been used to manage very agitated patients. This is extremely traumatizing for both the hospital staff and the patient and can also lead to injury due to thrashing.

Leaders of the New Standard

To mitigate this situation, regulatory bodies such as the Joint Commission are pushing for a drastic decrease in the use of these restraints—and Mount Sinai Hospital has met these goals before any other psychiatric emergency departments in New York City. The department went from an average of 22 restraints per year between 2006 and 2012 to 7 in 2013, and an average of 1 per year thereafter (with zero in 2016). At the American Psychiatric Association’s annual meeting in May, Dr. Hung presented the multi-year process his department underwent to achieve this.

Data presented at the American Psychiatric Association’s annual meeting in May.

Transforming the Culture

To incorporate a culture of safety, four main changes were implemented:

Regular Crisis Prevention Institute training for all staff.
Modifying the clinical environment; specifically, redesigning the room to a layout conducive to walking off anger.
Constructing a padded seclusion room for extreme cases so the patients can’t hurt themselves.
Emphasizing early intervention including verbal de-escalation techniques and medication.

“The few cases of restraint use in the past five years have been for truly extreme circumstances and only as a last resort,” said Dr. Hung. “The success of this new ‘vision zero’ goal has really improved team morale, and we are continually looking for new ways to improve our processes.”

Melinda Lantz, MD, Assumes Leadership Role

Updated on Jun 30, 2022 | Featured, MSBI, Psychiatry

Melinda Lantz, MD

Members of the American Association of Geriatric Psychiatry (AAGP) have elected Mount Sinai Beth Israel physician Melinda Lantz, MD, to become the organization’s President. Dr. Lantz, Vice Chair, Chief of Geriatric Psychiatry, and Associate Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, assumes her new role at a pivotal time.

Founded in 1978 to promote the well-being of older people through education, advocacy, and career development of psychiatrists, AAGP has embraced change. Its growing ranks now include nurses, physician assistants, and mental health professionals coping with a growing geriatric population.

Every day, an estimated 10,000 people reach age 65. Behavioral health problems affect 15 percent of older adults and up to 5 percent have serious mental illnesses, according to the federal Substance Abuse and Mental Health Services Administration. In 2013, more than 7,000 people age 65 or older died by suicide. Additionally, experts say direct health care costs associated with dementia in the elderly often equal or exceed the costs for heart disease and cancer.

In her role as President of AAGP, Dr. Lantz—a specialist in dementia care and geriatric mental illness—plans to address the need for additional recruitment and training by increasing interest in and availability of subspecialty fellowships in geriatric psychiatry. Boosting physician compensation for providing care to older adults with complex needs would also revitalize career opportunities.

Dr. Lantz would like to see an emphasis placed on empathy during training, a critical element for older patients who often cannot advocate for themselves. Elderly patients as a whole, she says, tend to like and respect doctors and welcome human contact.

Encouraging empathy in the treatment of patients “inspired me to be in the organization,” she says.

Too often, physicians lose empathy when they are stressed and have heavy workloads. “Everybody does better when they perceive empathy from physicians. One of the things that fellowships can do is help them get it back.”

After robust lobbying by the AAGP, the Centers for Medicare and Medicaid Services recently agreed to assign an insurance code to monitor the impact of geriatric psychiatry. “Getting that code suffix added was a major win,” says Dr. Lantz, who anticipates a favorable outcome once all of the factors are weighed. Tracking patients will show how geriatric psychiatry affects medical costs and resources.

Having spent billions of dollars researching dementia drugs with little success, many drugmakers have pulled back, according to Dr. Lantz. Today, she adds, “There are limited drug options for dementia in the pipeline. We need to focus on care and quality of life for those with dementia.”

An area that does show promise for helping in the treatment of geriatric psychiatry is technology. For elderly patients who are less mobile, telemedicine via videoconferencing can ease loneliness and increase access to care. Dr. Lantz says technology will also expand the scope of support to other health care providers who are located in communities where there are no specialists in geriatric psychiatry.

Celebrating Trailblazer Pamela Sklar, MD, PhD

Updated on Jun 30, 2022 | Community, Featured, Psychiatry

Luminaries in the study of psychiatric genomics joined the Mount Sinai community in celebrating the work of the late Pamela Sklar, MD, PhD, a groundbreaking psychiatrist and neuroscientist who made major discoveries that established the genetic roots of mental illness.

In her honor, the Icahn School of Medicine at Mount Sinai launched the annual “Advances in Psychiatric Genomics” lecture, held on Monday, April 16, in Goldwurm Auditorium, and renamed the division she created—now one of the best in the nation—the Pamela Sklar Division of Psychiatric Genomics. Dr. Sklar was Chair of the Department of Genetics and Genomic Sciences.

Celebrating her trailblazing research—and presenting their own—were scientists from the National Institute of Mental Health, Harvard University, the University of Pennsylvania Perelman School of Medicine, and the Icahn School of Medicine, among others. Attendees also included Dr. Sklar’s husband, Andrew Chess, MD, Professor of Genetics and Genomic Sciences; Cell, Developmental and Regenerative Biology; and Neuroscience; and their children, Michael and Isabel. The day after the event, the inaugural “Get Psyched” 5k Run/ Walk was held in Central Park to benefit the newly named division.

“Pamela was perhaps one of the bravest people I’ve ever met,” said Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System. “She led a revolution in the study of the genetic basis of mental illness, showing that hundreds of genes are implicated, not just a handful as was previously believed. It took courage to challenge the prevailing point of view.”

“With a keen intellect and an unusual force of personality, Dr. Sklar was both an outstanding scientist who changed the field of psychiatric disease and a beloved mentor to students and young scientists,” said Eric J. Nestler, MD, PhD, Nash Family Professor of Neuroscience; Director of The Friedman Brain Institute; and Dean for Academic and Scientific Affairs.

Kristen Brennand, PhD, Associate Professor, Genetics and Genomics, Neuroscience and Psychiatry, added: “In memory of Pamela Sklar, it was incredibly meaningful to spend a day surrounded by her closest friends and collaborators, hearing stories of the psychiatric genetics of lore as well as the newest insights from cutting-edge genetic research.”

At the inaugural “Advances in Psychiatric Genomics” lecture in honor of Pamela Sklar, MD, PhD, were, from left: Dennis S. Charney, MD; Isabel Sklar Chess; Andrew Chess, MD; Michael Sklar Chess; and Eric J. Nestler, MD, PhD.

Participants in the “Get Psyched” 5k Run/Walk.

Five Specialists in the Field of Psychotic Illnesses Join Mount Sinai’s Department of Psychiatry

Updated on Jun 30, 2022 | Featured, Psychiatry, Research

From left: Judith Weissman, PhD, JD, MPH; Dolores Malaspina, MD, MSPH, MS; David Kimhy, PhD; Lotje de Witte, MD, PhD; and Cheryl Corcoran, MD

The recent recruitment of five specialists to the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai has revitalized research, treatment, and prevention efforts in the field of psychotic illnesses and has led to the creation of the Critical Connections Program, which will help advance these endeavors.

Critical Connections will incorporate the collaborative efforts of multiple specialties within the Mount Sinai Health System—including neuroimaging, psychophysiology, genetics, neural stem cells, immunology, and epidemiology—with the goal of using the latest technologies and developments to find personalized interventions and treatments for psychosis. Clinical sites across the Health System also will contribute to a shared biorepository of samples collected from people with these illnesses.

Dolores Malaspina, MD, MSPH, MS, a leader in the field of psychosis, and Director of the new Critical Connections Program, says, “The most fundamental human quality is the ability to connect with others. Severe mental illness, particularly psychosis in schizophrenia, bipolar disorder, depression, and other conditions, disrupts this capacity and has an enormous impact on individuals, families, communities, and the general population.” The costs of social services, hospitals, courts, and prisons have an economic impact, as well. “In spite of significant scientific advances, we still know little about how to prevent and treat most psychotic illnesses. Breakthrough discoveries require innovative designs,” she adds.

Resilience, genetic susceptibility, family characteristics, environmental exposures, and other factors that account for the influences of nature and nurture will be studied by the program’s researchers. Pivotal changes occur in the brain throughout young adulthood that can be directed toward recovery and resilience. Plans call for educational training of medical students, residents, and fellows to translate new findings into evidence-based treatments.

Prior to her recruitment to Mount Sinai, Dr. Malaspina established successful clinical research programs in psychosis at the New York State Psychiatric Institute and at Bellevue Hospital Center. One of her currently funded National Institutes of Health studies that uses the Genomic Psychiatry Cohort examines the gut microbiome-brain axis, with respect to brain inflammation.

The following renowned recruits to the Icahn School of Medicine will be working with Dr. Malaspina to create a robust center of psychosis at the Mount Sinai Health System:

Cheryl Corcoran, MD, Senior Faculty, and Program Leader in Psychosis Risk at the Mount Sinai Health System, plans to launch two programs: a clinical risk and resilience research program for teens and young adults who have unusual thoughts, perceptual disturbances, and suspiciousness, and a familial-risk program for young relatives of patients with psychosis. Dr. Corcoran also plans to partner with community clinicians and experts in adolescent medicine to implement early identification and intervention programs for at-risk youth, and collaborate with basic and translational neuroscientists to study the pathophysiology underlying illness risk.

Currently, her main focus is natural language in neuropsychiatric disorders. Working with computational neuroscientists, Dr. Corcoran has identified language features that predict psychosis onset in at-risk youths. This includes subtle decreases in semantic coherence and complexity of speech (such as using shorter sentences and eliminating the words “which” and “that”). Funding from the National Institute of Mental Health has enabled Dr. Corcoran to study the neural correlates of these language abnormalities in a larger international cohort that will determine replicability and develop targets for preventive intervention.

David Kimhy, PhD, Senior Faculty, also serves as Director of the Experimental Psychopathology Laboratory, and Leader in New Interventions in Schizophrenia at the Icahn School of Medicine at Mount Sinai. Dr. Kimhy will focus on the development of novel interventions for schizophrenia and investigate the pathophysiology and phenomenology of cognitive, affective, and social functioning in individuals with schizophrenia.

Over the past decade, Dr. Kimhy has pioneered the use of mobile phone technologies in the study of psychotic symptoms and functioning, and the use of active-play video games as part of aerobic exercise training aimed at improving neurocognition in people with schizophrenia.

Preliminary work from his laboratory indicates that aerobic exercise training is effective in improving cognitive functioning in this population, with improvements linked to exercise-related upregulation of Brain-Derived Neurotrophic Factor (BDNF), a biomarker of neuroplasticity. His current funding includes an award from the National Institute of Mental Health supporting a multisite, single-blind, randomized clinical trial examining the impact of aerobic exercise on neurocognition and biomarkers of neuroplasticity in individuals with schizophrenia.

As Director of Education at The Mental Illness Research, Education and Clinical Center at the James J. Peters VA Medical Center in the Bronx, Dr. Kimhy will continue his longstanding commitment to training future researchers and clinicians.

Lotje de Witte, MD, PhD, Assistant Professor of Psychiatry, combines clinical work and scientific exploration in immunology in pursuit of treatments and interventions for psychiatric diseases. Her laboratory investigates the connection between the immune system and the pathogenesis of psychiatric disorders, such as schizophrenia, mood disorders, and autism.

Recently, Dr. de Witte set up a novel stem-cell derived brain organoid model to study microglia, and established the methodology to isolate microglia from postmortem brain tissue. Microglia cells are part of the immune system and involved in both inflammation and reconstruction in the brain, processes thought to be involved in schizophrenia.

After studying the cell biological mechanisms of HIV-1 transmission, Dr. de Witte used this experience to start a distinctive research line at the Brain Center Rudolf Magnus in Utrecht, the Netherlands. She received her MD and PhD at the VU University Medical Centre, Amsterdam. Her research has been published in Nature Medicine, the Journal of Clinical Investigation, PLOS Pathogens, and Proceedings of the National Academy of Sciences.

Judith Weissman, PhD, JD, MPH, Assistant Professor of Psychiatry, serves as a Research Health Specialist at the James J. Peters VA Medical Center. Her expertise is in using national data sets to examine health care patterns in the mentally ill.

At the VA Medical Center, she will collaborate with other researchers to investigate the incidence and risk factors of suicide, along with the access and utilization of mental health care services among vulnerable populations, particularly military veterans with mental illness. Dr. Weissman will also research possible interventions. Suicide by veterans remains a critical problem, and few empirically based treatment strategies for suicide prevention among post-deployed military personnel currently exist.

Serving as a Senior Service Fellow at the U.S. Centers for Disease Control and Prevention earlier in her career helped hone Dr. Weissman’s skill in analyzing large data sets. She has also investigated topics such as polypharmacy in the nation’s elderly and disparities in antidepressant prescribing practices.

Addiction Institute to Explore Effective Therapies

Updated on Jun 30, 2022 | Featured, Psychiatry, Research, Your Health

The Icahn School of Medicine at Mount Sinai recently opened a new Addiction Institute that will address one of the nation’s greatest health concerns by exploring effective treatments for patients with substance abuse problems.

“Bringing science to bear on the development of new therapies has reached the top of the national agenda, and that is where Mount Sinai excels,” says Yasmin Hurd, PhD, the Ward-Coleman Chair in Translational Neuroscience and Director of the Addiction Institute at Mount Sinai.

The Institute will manage therapies for all types of substance abuse. By removing the traditional silos that separate research and clinical care, and unifying all areas of addiction under one umbrella, Dr. Hurd says the Institute is “well positioned to meet the challenges of New York City and the nation.” The Institute will leverage Mount Sinai’s considerable body of research and clinical expertise in neuroscience and behavioral health in order to move the field forward.

According to the 2016 U.S. Surgeon General’s Report on Alcohol, Drugs, and Health, more than 20 million Americans have substance abuse disorders and 12.5 million reported misusing prescription painkillers. Despite decades of expense and effort focused on a criminal justice-based model for addressing substance-related problems, the report acknowledged that addiction remains a public health crisis with economic consequences in crime, health, and lost productivity totaling more than $400 billion annually. Dr. Hurd says the Institute’s collaboration with Mount Sinai’s other specialties such as precision medicine, population health, infectious disease, epidemiology, and genomics will help advance treatments and novel discoveries.

“The Institute’s modernized structure across a large, integrated health system will enable us to approach addiction in a cohesive way,” says Dr. Hurd. “In addition to prioritizing our research based on clinical needs, we want to understand the populations at risk and their patterns of behavior. Addiction is complex and one group cannot do it alone.”

Yasmin Hurd, PhD

An important aspect of the Institute’s work will be dispelling the stigma associated with addiction through greater understanding of the biological and behavioral complexities of substance use disorders. Another goal will be encouraging young clinicians to enter residencies and fellowships in the fields of addiction psychiatry and addiction medicine.

“We want to train the best and the brightest through enhanced clinical and research rigor to elevate the field,” says Dr. Hurd. “Clinical treatments for some addictions have not advanced in 50 years. This and other stigmas can deter young physicians from going into this field. Unless we improve the clinical toolkit available for clinicians we will not be able to change the trajectory of care.”

Decades of scientific studies have established that chronic substance misuse leads to profound disruptions of brain circuits involved in pleasure, reward, habit formation, stress, and decision-making. Repeated drug use alters the expression of genes to ultimately increase or decrease their production of proteins, leading to long-term changes in cellular function and even reshaping of the physical structure of neurons.

“Drugs can change the morphology of cells and induce a cascade of adverse events in the brain,” says Dr. Hurd. The Institute plans to move forward with multiple clinical trials that seek to reverse those disruptions. “Most addicts do not want to be addicted,” she adds. “Addiction can be treated. We need medical therapies that partner with behavioral therapies, and we need to be diverse in our treatment portfolio.”

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