Tips for Coping With Child Anxieties: For Back-to-School and Beyond

Updated on Oct 24, 2024 | Psychiatry, Your Health

For many kids, the back-to-school season stirs up nervous feelings.

“It’s normal for anxiety to gear up before kids go back to school. Some are able to adapt, and that anxiety soon fades away. But others continue to experience heightened stress and worry,” says Saniya Tabani, PhD, Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai and a licensed clinical psychologist at The Mount Sinai Hospital.

Whether a child is experiencing short-term back-to-school jitters or something more long lasting, parents and caregivers can do a lot to support them.

“It’s common for kids and teens to experience anxiety. But we’ve also seen great strides in our understanding of anxiety, and there are resources in place to help them,” Dr. Tabani says.

Some nerves are normal when kids are starting a new school year, taking a big test, or trying out for a sports team. But anxiety can show up in different ways.

“There’s a spectrum of typical responses,” Dr. Tabani says. Those can range from healthier coping strategies—like eagerly laying out back-to-school outfit days in advance—to less-healthy strategies, like procrastinating on a summer reading assignment that’s due on the first day of school.

In general, there are two signs that suggest school-related anxiety might be cause for concern, Dr. Tabani says. The first is mood changes, such as increased worry, irritability, sadness, or withdrawing from social situations. The second is physical changes like headaches, upset stomach, or sleeping more or less than normal.

Saniya Tabani, PhD

“If you notice these types of symptoms, it’s a sign that the child’s anxiety is becoming more significant,” she says.

Anxiety can derail kids, interfering with their school success and social life. Yet anxiety is often predictable. By planning ahead, you can help your child work out what Dr. Tabani calls a “cope-ahead plan.”

The plan draws on a skill taught in dialectical behavior therapy, which teaches people how to increase their tolerance for distress. “It’s hard to think about how to react to a stressful situation when you’re in a tornado of emotions,” she explains.

By following these eight steps, caregivers can help kids and teens plan for the situations that make them worry.

Identify the challenge: What, specifically, is your child worried about? Are they concerned they won’t be liked by peers? Afraid they’ll get lost in their new school? Nervous about getting good grades in a tough course? “Have a conversation with your child or teen to better understand where their anxiety is coming from,” Dr. Tabani says.

Name emotions, thoughts, and actions: You’ve identified the challenging situation that makes your child feel anxious. Help them practice naming the specific emotions they may be feeling. Also guide them to identify worry thoughts connected to these feelings. Next, help them consider how their feelings about it and thoughts affect their behavior. If a child isn’t feeling smart enough for their honors class, what does that make them do? Do they not want to go to school? Avoid studying? Run to the bathroom if there’s a chance they might get called on?

Check facts: Nervous thoughts can quickly spiral. Stress about a test can turn into “I’m not smart enough for this class and if I don’t get an A I’ll never get into college.” Validate your child by acknowledging their fears, Dr. Tabani says. Then help them step back to consider whether the facts match their feelings, or if they might be falling into a “thinking trap” (a mistake in the way we think about things, such as assuming the worst-case scenario is also the most likely scenario). “Encourage them to look at whether their thoughts actually fit with the evidence,” she says. “Gently push back to help them see things rationally.”

Choose a coping strategy: “Different situations call for different ways of coping,” Dr. Tabani says. If a child gets anxious taking tests, for instance, they might try deep breathing exercises as the teacher hands out the exams. If a teen is worried about losing their temper or crying in public, they might work with a therapist to practice distress tolerance skills.

Imagine: The next step is to picture the stressful situation as vividly as possible. Help your child picture the situation in detail. Where are they sitting? Who is around them? How are they feeling? Then help them picture their coping strategy in action. If they’re concerned about getting teased by bullies, they can imagine how they’d look to a friend for support or turn to a trusted teacher. “Imagining a situation is a good way to work out the kinks,” she says.

Rehearse: Now it’s time to practice. Caregivers or friends can help a child act out the stressful situation and practice using their coping methods. Families can do this by helping the child visualize the situation or roleplaying at home. A parent can pretend to be a teacher or classmate, for example.

Envision coping with your biggest fear: While you don’t want to focus on the negative, it can be helpful to have a child rehearse how they might respond to their worst-case scenario. Chances are, their biggest fear won’t come to pass. And even if it does, they’ll feel more in control if they have imagined—and practiced—how they would respond.

Practice relaxation: Just imagining the things you’re afraid of can set your nerves on edge. As you work through these steps with your child, help them learn relaxation strategies like deep breathing, progressive muscle relaxation, or engaging in sensory exercises like smelling a calming scent or cuddling a pet or favorite plush. “When kids are feeling more relaxed about their fears and anxieties, these coping strategies feel more achievable,” Dr. Tabani says.

Parents and caregivers have an important role to play in helping kids learn to manage their anxiety. But you can’t solve all of their problems for them—nor should you try, Dr. Tabani says.

“It’s a delicate balance between providing structure and support, and not fragilizing children,” she says. That means you should help them develop a coping plan to manage their test anxiety—but you shouldn’t let them stay home from school on test day to avoid the stressful scenario altogether.

“Families may have the urge to treat kids as less capable of coping with these things than they actually are. Remember that kids today are incredibly smart and sophisticated—and resilient,” she says.

Still, many young people need support to put coping skills in place. If you notice that anxiety or depression is getting in the way of your child’s everyday activities, reach out to a mental health professional.

“They can tailor these coping strategies to a child’s individual needs,” Dr. Tabani says. “And if you notice any signs of self-harm or suicidal thoughts, or have any concerns about safety, refer to a mental health professional right away.”

Learn more about the Mount Sinai Child Behavioral Health and Science Center

Psychiatry Residents Provide Free Mental Health Services Through the HOPE Center in Harlem

Jul 24, 2024 | Psychiatry

Tina Kim, MD

As a psychiatry resident at the Icahn School of Medicine at Mount Sinai, Tina Kim, MD, had plenty of opportunities to treat patients in traditional clinical settings. But the Department of Psychiatry at Mount Sinai also offers a less conventional locale: The First Corinthian Baptist Church in Harlem. Since 2016, the church has partnered with Mount Sinai to provide free mental health services to the community through its novel Healing On Purpose and Evolving (HOPE) Center.

The HOPE Center was the brainchild of Senior Pastor Michael A. Walrond, who wanted to find a way to support the significant mental health needs of his congregation. He found an eager partner in Sidney Hankerson, MD, MBA, Associate Professor and Vice Chair for Community Engagement in the Department of Psychiatry at Icahn Mount Sinai. Dr. Hankerson is also Director of Mental Health Equity Research at Mount Sinai’s Institute for Health Equity Research and serves as Medical Director of the HOPE Center.

In 2023 and 2024, during her final year of residency, Dr. Kim joined the HOPE Center as one of the first psychiatry residents to participate in the program. “In the clinic, we often encounter folks who for a variety of reasons have a hard time accessing care,” she says. By offering free services, in a setting where community members already feel safe and supported, the HOPE Center tries to chip away at the twin challenges of cost and stigma. “I wanted to try practicing in a place that was addressing those barriers head on,” she says.

Fighting Stigma with Community-Based Mental Health Services

Overcoming stigma has been a driving force for the HOPE Center since its founding. “Pastor Mike would talk about therapy during his sermons, emphasizing that it is normal and healthy and should be talked about,” Dr. Kim says. In another effort to destigmatize treatment, HOPE Center health care professionals don’t refer to their clients as “patients,” but rather as “innovators.”

Many of those seeking services are living with depression, anxiety, or prolonged grief disorder. Others struggle with substance use or loneliness and isolation. “There is a lot of loss and trauma in this population, especially after COVID-19, but including childhood trauma as well,” she says.

People can come to the HOPE Center for up to 12 free sessions of evidence-based therapy. That therapy is mostly delivered by licensed clinical social workers and social work interns. Last year, Dr. Hankerson expanded the HOPE Center’s capabilities by adding psychiatry residents to the team. In addition to providing therapy, the psychiatrists can prescribe and manage psychiatric medications when appropriate.

The whole team meets regularly to discuss cases. While the social work interns offer a lot of knowledge about peoples’ lives, families, and communities, the psychiatric residents provide clinical input about things like their medical histories, diagnoses, and medication side effects. “It’s a great collaborative relationship,” Dr. Kim says.

The program has proved popular, with a waitlist that often contains dozens of names. To meet the demand, the canter also offers group programs such as grief support groups and men’s mindfulness sessions. In addition to providing one-on-one therapy and medication management, Dr. Kim also provided couples counseling and helped lead public conversations on topics such as holiday blues, stress management, and crisis and suicide.

Sidney Hankerson, MD, MBA, Associate Professor and Vice Chair for Community Engagement in the Department of Psychiatry, serves as Medical Director of the HOPE Center, and Lena L. Green, DSW, LCSW, is the Executive Director.

Dr. Hankerson and his colleagues hope to keep growing opportunities for psychiatry interns, offering more psychiatrist-led therapy and medication management to members of the church community. He also hopes to replicate the community-based model for training psychiatry residents in other community settings, such as barbershops and sports leagues. Through those types of engagement opportunities, people in low-income communities can access culturally sensitive care while psychiatry residents can train within a curriculum that addresses the impact of structural racism on psychiatric care.

Training Psychiatry’s Next Generation at Icahn Mount Sinai

Working at the HOPE Center was a great launching pad for her future psychiatry career, says Dr. Kim, who completed her residency in June and is now an outpatient attending psychiatrist at Maimonides Medical Center in Brooklyn. “In our work at the HOPE Center, we had a lot of autonomy to provide services and make decisions,” she says. Practicing within the small, independent team also helped Dr. Kim learn much of the behind-the-scenes administrative effort that goes into keeping a clinic running smoothly. “It was a really great learning experience and preparatory step toward becoming an attending,” she says.

Following her work at the HOPE Center, Dr. Kim was selected as a Community Diversity Fellow by the American Psychiatric Association, an opportunity for psychiatry residents committed to serving minority and vulnerable populations. Through that fellowship, she was able to attend many national meetings and conferences, and to collaborate as part of a national team working to increase leadership opportunities for psychiatry residents.

Dr. Kim says working at the HOPE Center is a rich opportunity for psychiatry trainees, and one that she encourages future residents to consider.

“The opportunity helped me learn to be confident in my own knowledge and experience. But I also recognize that a lot of it is in the hands of the innovator,” she says. “I can offer my knowledge and try to understand what’s going on for the other person in the room, but as much as possible we try to make decisions together. I want the innovator to choose the path that is right for them.”

For Transplant Patients and Donors, Mount Sinai’s Transplant Psychiatrists Offer Unique Assistance

Updated on May 23, 2024 | Featured, Psychiatry

For a patient and their loves ones, preparing for an organ transplant is never easy, and the same holds true for someone considering donating an organ. Mount Sinai’s transplant psychiatry program is one of many resources there to help with the process and, in the end, help save lives.

Mount Sinai Transplant is a premier program for organ transplantation, offering comprehensive treatment for patients who desperately need organs such as hearts, lungs, kidneys, and livers. Among the program’s renowned specialists are transplant psychiatrists who are specially trained to help both organ recipients and living donors.

Ambika Yadav, MBBS

“Across the United States, about 100,000 people require an organ transplant. There’s a huge need,” says Ambika Yadav, MBBS, Assistant Professor, Psychiatry, at the Icahn School of Medicine at Mount Sinai, who specializes in transplant psychiatry, focusing on liver and kidney donors and recipients.

“The goal of transplant psychiatry is to mitigate whatever psychosocial risks exist so we can help as many people as possible get the organs that will save their lives,” she says.

Transplant Psychiatry at Mount Sinai

Mount Sinai’s transplant psychiatrists are based at the Recanati/Miller Transplantation Institute, where they work closely with other members of the transplant team. They provide a range of services for organ recipients and for living donors who choose to donate a kidney or portion of a liver. Those services include:

  • Evaluating a patient’s suitability as a transplant donor or recipient
  • Establishing treatment plans for patients with preexisting psychiatric conditions
  • Helping patients develop coping skills and manage expectations around organ transplantation
  • Managing psychiatric symptoms that can arise as a result of surgery or medication side effects
  • Dealing with complicated emotions after transplant

 

Helping Organ Recipients Prepare for Transplant

All transplant recipients receive an extensive medical and psychosocial evaluation to determine their suitability for transplantation. Typically, a transplant social worker provides the initial psychosocial evaluation. But transplant psychiatrists often get involved to further assess patients and mitigate any risks.

The goal of that assessment isn’t to rule out whether a person is a suitable candidate for a new organ. Rather, the transplant psychiatrists focus on identifying factors that might cause setbacks and find ways to manage those factors.

“Our goal is always to optimize patients for organ transplant. By identifying risks, we can come up with a plan ahead of time so they can get the organ they need and continue to have a life,” Dr. Yadav says.

For example, when patients have diagnoses such as anxiety or depression, psychiatrists can work with them to develop a treatment plan to reduce the risk that symptoms will get in the way of their transplant recovery. Psychiatrists can also come up with plans to support patients with alcohol use disorder or other substance use disorders, a common history among patients with liver failure.

“In those cases, we’ll do a risk assessment of the severity of their substance use disorder and determine how we can best help prevent them from relapsing so they can be good stewards of their new organ,” Dr. Yadav says.

When possible, these meetings happen in an outpatient setting. But in many cases, patients are evaluated for transplant after they become critically ill and so are already in the hospital. “Because Mount Sinai is a major transplant center, many patients are transferred here because they are surgically complicated or otherwise high-risk,” Dr. Yadav says. She and her colleagues meet regularly with hospitalized patients to assess their needs and help them prepare for transplant.

Managing Life After Organ Transplant

Psychiatrists also help people manage issues that arise after an organ transplant. Agitation and delirium can be side effects of surgery, and immunosuppressant medications that prevent organ rejection can cause psychiatric side effects and may also interact with other psychiatric drugs in complicated ways, according to Dr. Yadav.

“Community psychiatrists may not have much experience managing those psychiatric side effects and interactions,” she says. “Once a patient is stabilized after transplant, we can refer them to a community psychiatrist and provide our recommendations for managing their treatment.”

Psychiatrists also help patients deal with complicated emotions following a transplant. Patients might feel guilty or unworthy after receiving an organ from a deceased donor. They may expect life to be completely different after a transplant and feel let down by ongoing medical challenges and other life stressors. “We can help people manage their expectations and find ways to cope,” Dr. Yadav says.

Supporting Living Organ Donors

On the other end, transplant psychiatrists play a key role in assessing living donors and helping them prepare for the procedure. Living organ donors can donate a kidney or a portion of their liver to recipients—including friends and family members, and in some cases, anonymous recipients. Psychiatrists screen patients for preexisting psychological conditions that could affect their decision and well-being, and ensure they understand the risks they’re taking.

Increasingly, living donors contribute kidneys in “paired exchanges”—for example, a donor who is not a match for his wife may donate to a stranger on the waiting list, while someone related to that stranger donates to the first man’s wife. Such paired exchanges can involve multiple steps of exchanges. “Given the intricacies and the many points at which things might not go as planned, we hold these patients to a higher standard and make sure they know what to expect,” Dr. Yadav says.

Donating an organ is a big decision. “These are people who are completely healthy, undertaking a surgical procedure with zero benefit to themselves,” Dr. Yadav says. Mount Sinai’s transplant programs go above and beyond to keep living donors’ well-being at the forefront. “Our living donor team is really special. They put the donor first, and always prioritize their needs separate from the needs of the organ recipient,” she adds.

Moving Transplant Psychiatry Forward

Dr. Yadav and her colleagues are also engaged in research to improve their approach to assessing patients and mitigating psychosocial risks.

“As a major transplant center, Mount Sinai has many complicated cases and we have a lot of data regarding our risk assessments and patients’ psychosocial outcomes,” she says. “We’re always trying to use data to come up with better assessment tools and ultimately improve outcomes for patients.”

Transplant psychiatry is a subspecialty of the Consultation Liaison Psychiatry services at the Icahn School of Medicine at Mount Sinai. Learn more about Mount Sinai Transplant and Living Donor Transplantation.

Can Exercise Improve My Mental Health?

Updated on May 2, 2024 | Mental Health, Psychiatry, Your Health

Exercise is great for your body—and your mind. When you engage in any physical activity, your brain releases “feel-good” chemicals (dopamine, serotonin, oxytocin, and endorphins) that boost your mood. In addition, forming long-term exercise habits can reduce your risk for neurological diseases, such as dementia.

Anna Hickner, PsyD

In this Q&A, Anna Hickner, PsyD, Supervising Psychologist and Assistant Professor, Icahn School of Medicine at Mount Sinai, and a trained yoga and meditation instructor, explains how increasing your activity can lead to a healthier, happier mind.

How does not getting enough exercise affect my mental health?

Leading a sedentary lifestyle can have many adverse effects on your physical, emotional, and mental well-being. Additionally, if you are not sleeping well and don’t move much during the day, this can have a compounding effect of worsening sleep and mood without inducing the benefits of the “feel-good” chemicals that exercise offers. As a result, you may find it harder to function or interact effectively with others.

Quick tips:

  • Creating an exercise routine can help you feel grounded and regulate stress
  • Achieving exercise goals boosts the brain’s reward center and builds self-esteem
  • Even small activities, such as walking during your lunch break, can make a big difference

How does exercise affect my mood?

There has been a lot written on the association between exercise and mental health, including how exercise induces the production of our natural “feel-good” chemicals. But exercise has additional benefits—for example, certain activities, like sports, are great outlets for socializing, and exercise, in moderation and well before bedtime, in general helps regulate sleep. Becoming more active may also motivate you to eat well in order to fuel your body, which can have a positive impact on mood. Some studies indicate people might demonstrate better memory and attention after a workout, which is most noticeable when exercise is consistent and the effects are studied over a longer period.

How can exercise improve my mental health in the long term?

Turning exercise into a routine that helps you achieve goals, such as losing weight or becoming fitter, can be gratifying and help build self-esteem, as long as you have reasonable expectations and stick to your goals. When you complete an activity, such as a race, or compete in a team sport, there can be an extra boost in your neurochemical rewards center, which offers a feedback loop for motivation to continue to engage in the activity. When you do this in moderation, exercise transforms into a habit that provides physical, emotional, and psychological benefits. It is important to find an activity that is enjoyable so you can easily stick with it. Another long-term benefit of exercise is that it is shown to reduce the risk of neurodegenerative diseases, such as Alzheimer’s disease and dementia, due to the stimulation of blood flow in the brain.

How much exercise do I need to get these benefits, and at what intensity?

It is usually better to be active than not. That said, some studies show walking is just as beneficial as running, whereas others find intensity matters. Regardless, a minimum of 150 minutes of moderate to vigorous movement each week is often cited as ideal, as well as the importance of elevating your heart rate.

While intensity can be beneficial, too much may stress your body or lead to injury, so consistency and moderation are important. Having a routine can keep you grounded and helps regulate stress. If intense exercise feels daunting, find an activity you enjoy that gets you moving, and that you can do regularly. You can also combine exercises, such as swimming, dancing, walking, or kick-boxing classes, mixing exercises that are leisurely on some days with more intense ones on others.

What are some simple ways to increase my activity to improve my mood?

Small activities can add up. If you have a desk job, get up and stretch or go for a mini walk every hour or so. Take the stairs instead of the elevator, bike instead of taking the bus or driving, park far away so you have to walk further. These are all examples of small, daily changes that can bring big benefits. You can also try fitness trends, such as “exercise snacks,” in which you do a vigorous activity for as little as two minutes. Whether you lack the time or a place to work out, finding small ways to increase exercise can improve both your health and mental well-being. Exercising outside on a regular basis can also improve your mood.

How does my gut health contribute to my mental well-being?

Gut health is also important for mental health—some research indicates that microbiome and inflammation can affect mood. Consuming food that offers adequate macronutrients (carbs, fats, proteins, water, and fiber) as well as micronutrients (vitamins and minerals) is imperative to feeling energized, meeting the day’s demands, and staying motivated. Increase your consumption of whole foods, limit processed foods, caffeine, alcohol, and sugar, and consult a dietician if you feel you need help.

Schedule an appointment with a mental health expert near you.

Clinical Neuroscience Fellow Looks Into the Brain to Improve OCD Treatments

Updated on Dec 18, 2023 | Featured, Psychiatry

Andrew H. Smith, MD, PhD

“What drives people to keep having certain thoughts and engaging in certain behaviors, well past the point when it is adaptive?”

That is the question underlying the research of Andrew H. Smith, MD, PhD, a clinical neuroscience fellow at the Icahn School of Medicine at Mount Sinai. He is studying the brain circuitry of obsessive-compulsive disorder (OCD) at the Nash Family Center for Advanced Circuit Therapeutics (C-ACT) at Mount Sinai West.

Dr. Smith has studied compulsive behavior—a feature of several psychiatric illnesses—from multiple angles. During his doctoral work at Yale University, he studied the genetics of compulsive behaviors, with a focus on compulsion in substance use. Now he is turning his attention from genetics to brain circuitry. His current work uses implantable devices to collect data about brain activity in people with OCD, with a long-term goal of improving treatments for this challenging disorder.

“Unfortunately, many patients with OCD are not where they want to be after treatment with psychotherapy and medication. What’s unique about this study is that it builds on clinical treatment. During the course of a patient’s treatment, we offer them the opportunity to partner with us on research that allows us to uncover what is happening in their brains.” –Andrew H. Smith, MD, PhD

Dr. Smith began working at the Center during his psychiatry residency in Mount Sinai’s physician-scientist program. After graduating in 2022, he stayed to expand his research experience through the T32 postdoctoral research fellowship in psychiatry. The competitive fellowship, funded by the National Institute of Mental Health, is designed to bridge the clinician-scientist gap to translate findings in neuroscience into better treatments for patients.

In his T32 project, Dr. Smith works with participants who come to Mount Sinai for deep brain stimulation (DBS) for obsessive-compulsive disorder.

“Unfortunately, many patients with OCD are not where they want to be after treatment with psychotherapy and medication,” Dr. Smith says. “What’s unique about this study is that it builds on clinical treatment. During the course of a patient’s treatment, we offer them the opportunity to partner with us on research that allows us to uncover what is happening in their brains.”

Deep Brain Stimulation for OCD

The Center focuses on innovative research to advance the use of neuromodulation for hard-to-treat neuropsychiatric disorders. Neuromodulation includes a range of interventions, from non-invasive techniques like transcranial magnetic stimulation (TMS) to deep brain stimulation (DBS), which involves surgically implanting electrodes into brain tissue.

Under the direction of Helen Mayberg, MD, Founding Director of C-ACT and Professor, Psychiatry, Neurology, Neuroscience, and Neurosurgery, Dr. Smith is collaborating with a multidisciplinary team of experts including Martijn Figee, MD, PhD, Associate Professor,  Psychiatry, Neurology, Neuroscience, and Neurosurgery; Ignacio Saez, PhD, Assistant Professor,  Neurology, Neuroscience, and Neurosurgery; and Xiaosi Gu, PhD, Associate Professor, Psychiatry, and Neuroscience and Director of Mount Sinai’s Center for Computational Psychiatry.

“In my previous research in computational genetics, I learned a lot about the genetic building blocks of compulsive thoughts and behaviors. This study allows me to pursue a line of research that directly involves working with patients who really need our help,” Dr. Smith says.

The first-line therapy for OCD involves medications and psychotherapy, followed by non-invasive neuromodulation tools like TMS. When patients don’t see significant improvements from those therapies, they may be candidates for treatment with DBS.

“With DBS, we can target the deep regions of the brain that we think are holding patients back and keeping them stuck in thought and behavioral loops,” Dr. Smith says.

Researchers at the Center were already studying DBS in patients with OCD, evaluating them over the course of treatment using a battery of cognitive tests. That study is allowing the researchers to better understand which cognitive processes—such as mental flexibility or sensitivity to environmental stimuli—are changing during treatment, as a person’s symptoms improve over time. In his fellowship research, Dr. Smith is adding to that work by exploring how brain activity changes as people’s cognitive processes and behaviors change during treatment.

Such research only became possible recently, when the U.S. Food and Drug Administration cleared the use of a new generation of DBS devices that record neural activity over time, in addition to providing brain stimulation.

“Once these devices are implanted, we can study people’s brain changes directly, in a way that has never been done in patients,” Dr. Smith says. “This device allows us to ask new scientific questions in a very direct way.”

DBS for OCD and Beyond

By connecting the dots between brain activity, cognitive processes, and behaviors, Dr. Smith hopes the research will paint a more detailed picture of OCD in the brain.

“Our goal is to more fully understand how brain stimulation is leading, bit by bit, to changes in what the brain does when faced with obstacles,” he says.

The research is also an opportunity to learn more about the underlying brain circuits involved in other illnesses, including the compulsive use of substances.

“If we can learn more about the neural circuits driving compulsive thinking and behavior, we can fine-tune non-invasive interventions such as medication or TMS. Ultimately, it may help us develop better treatments for more patients, so we don’t need to rely on surgery and DBS,” he says.

The T32 fellowship is a two-year program, so Dr. Smith considers this research a pilot study to demonstrate how the new implantable devices can be used to better understand compulsive behaviors. Those data will support his application for an NIH Career Development (K) Award, which he hopes will enable him to further this line of inquiry and launch his independent research career.

“The T32 fellowship program is designed to give candidates the time and space to define their intellectual contribution to the department. It has allowed me to build on the strength of the expertise at Mount Sinai without duplicating what anyone else is already doing,” Dr. Smith says. “I am thankful to be able to work with such an incredible interdisciplinary team of mentors, doing research that can optimize techniques for helping the patient sitting in front of me.”

 

 

Learn more about the Nash Family Center for Advanced Circuit Therapeutics
Read more stories about Psychiatry at Mount Sinai

Mount Sinai Researcher Launches Three Studies of Alzheimer’s Disease in Asian Americans

Oct 4, 2023 | Engagement, Featured, Psychiatry, Research

Clara Li, PhD, a clinical neuropsychologist and Associate Professor, Psychiatry, at the Icahn School of Medicine at Mount Sinai, has received new grants that will total more than $12 million from the National Institute on Aging (NIA), part of the National Institutes of Health (NIH). The funding will support three new projects that seek to improve the diagnosis and treatment of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) in Asian Americans.

Asian Americans are historically under-represented in clinical research on AD/ADRD. As a result, many older adults with Asian ancestry do not receive adequate diagnosis and treatment for mild cognitive impairment (MCI) or AD/ADRD.

Clara Li, PhD

“Chinese is the third-most-spoken language in the United States after English and Spanish, yet we don’t have many of these tools available,” Dr. Li explains. She’s hoping to change that, with three new studies launched in 2023.

Adapting Assessments for Alzheimer’s: Chinese Translation and Cultural Adaptation

In one of the studies, a five-year effort, Dr. Li will develop assessment tools that are linguistically and culturally adapted for older adults who speak Cantonese or Mandarin, with the hope to extend it to other Asian languages in the future.

Researchers rely on assessment tools from the National Alzheimer’s Coordinating Center Uniform Data Set (NACC UDS) to identify research participants with cognitive impairment or AD/ADRD. But those tests were developed for English speakers and Western cultures.

“I’ve seen many Asian American patients who try to take the English tests because a Chinese version isn’t available, and the language is a barrier,” Dr. Li says. “Sometimes a test would suggest cognitive impairment, but when I would translate the test myself into Chinese, the patient would score in the normal range.”

Language isn’t the only barrier. Cultural differences also make the test confusing for many Asian American patients. When asked to identify an image of a witch on the standard test, for instance, some of Dr. Li’s patients said “janitor” or “cleaner”—a common error because witches aren’t typically depicted with brooms in Chinese culture.

The lack of adequate tests hampers diagnosis and treatment, and also affects research seeking to better understand AD/ADRD in Asian Americans.

“Because we can’t enroll patients unless they can take the tests in English, many are excluded from studies. As a result, Asian Americans make up less than 2 percent of the participants in U.S. clinical trials,” Dr. Li explains. “If we want to increase diversity in research, we need to adapt these materials for Chinese speakers and eventually other Asian languages.”

A Research Infrastructure for Alzheimer’s Disease in Asian Americans

In the second study, Dr. Li will develop a research infrastructure and tools for studying AD/ADRD in older Asian Americans. She and her colleagues will develop questionnaires to fully characterize Asian American participants, including social determinants of health and any environmental or lifestyle factors that could increase or decrease their risk of developing AD/ADRD.

This five-year study will also investigate blood samples from Asian American participants to determine whether there may be novel biomarkers in this population, and whether known biomarkers are relevant to people from Asian backgrounds.

“Amyloid and tau are well known as biomarkers associated with Alzheimer’s disease, but those biomarkers were developed primarily from Caucasian samples. Therefore, the generalization of these findings in Asian Americans is not always clear, including criteria for amyloid and tau burden to establish AD/ADRD risk,” she says. “There may be different thresholds for those biomarkers in different populations.”

Support for Mild Cognitive Impairment

Dr. Li’s third newly funded project is a two-year pilot clinical trial. She and her colleagues will adapt the Memory Support System (MSS) for use in Chinese Americans who speak Cantonese or Mandarin. The MSS is a memory calendar training program to help older adults with MCI organize and remember their daily activities. The system is a component of the Healthy Action to Benefit Independence & ThinkingÒ (HABIT) Program, an evidence-based intervention that provides lifestyle and behavioral treatments for older adults with MCI.

“I see patients with MCI who want to do something to prevent the development of dementia, but if they can’t speak fluent English, they aren’t able to participate in clinical trials,” Dr. Li says. “We hope that by adapting this program, we can offer Chinese American older adults with MCI an opportunity to participate in a trial that seeks to improve memory and function, as well as their mood and quality of life.”

Alzheimer’s Disease Research at Mount Sinai

In addition to the three new studies Dr. Li has launched this year, she is leading two clinical trials at the Alzheimer’s Disease Research Center at Icahn Mount Sinai and is the site Principal Investigator for the Asian Cohort for Alzheimer’s Disease (ACAD) study, a multisite project to analyze genetic data to identify risk variants for Alzheimer’s disease in Asian Americans and Asian Canadians.

Through these projects, she hopes to improve research participation, diagnosis, and treatment related to patients of Asian ancestry—an effort that is long overdue, she says.

“There’s a lot of work that needs to be done. In addition to research inequities, there aren’t enough bilingual physicians outside the community, which often makes it difficult for Asian American older adults to receive integrated specialty care, leading to delayed diagnosis and treatment for AD/ADRD,” she adds.

Learn more about the Alzheimer’s Disease Research Center

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