behavioral health forum: integrating the science and the practice for the future university of texas...

Behavioral Health Forum:Integrating the Science and the Practice for the FutureUniversity of Texas MD Anderson Cancer CenterHouston, Texas – June 8, 2012

Stuart C. Yudofsky, M.D.D.C. and Irene Ellwood Professor and Chair;Distinguished Service Professor; andDrs. Beth K. and Stuart C. Yudofsky Presidential Chair of NeuropsychiatryMenninger Department of Psychiatry and Behavioral SciencesBaylor College of Medicine

1.1. A specialty of medicine…A specialty of medicine…

2.2. Dealing with dysfunctions and Dealing with dysfunctions and illness…illness…

3.3. That affect behavior, mood, thought That affect behavior, mood, thought and perception…and perception…

What is Psychiatry?What is Psychiatry?

What is the “organ” of What is the “organ” of Psychiatry?Psychiatry?

Houston…Houston…

1.1. We’re not urologistsWe’re not urologists

2. We’re not cardiologists2. We’re not cardiologists

The Human BrainThe Human Brain• 100 billion nerve cells-mostly neurons100 billion nerve cells-mostly neurons• Hundreds of trillions of synapsesHundreds of trillions of synapses• 60 known neurotransmitters60 known neurotransmitters• 300 putative neurotransmitters300 putative neurotransmitters• EnzymesEnzymes

– SynthesisSynthesis– DegradationDegradation

• Transport mechanisms, storage, and releaseTransport mechanisms, storage, and release• 2 to 10+ receptor subtypes2 to 10+ receptor subtypes• Second messenger systemsSecond messenger systems• Ion channels-binary action potentials of Ion channels-binary action potentials of

axonsaxons

THE DSM-IV-TRTHE DSM-IV-TR

1.1. Utilizes objectifiable clusters of signs Utilizes objectifiable clusters of signs and symptomsand symptoms

2.2. To define specifically over 300 To define specifically over 300 psychiatric illnessespsychiatric illnesses

3.3. Common diagnostic language worldwide Common diagnostic language worldwide among mental health professionalsamong mental health professionals

Biopsychosocial Biopsychosocial ApproachApproach

1.1. Biological featuresBiological features

a.a. Genetic predispositionsGenetic predispositions

b.b. Brain lesions and disordersBrain lesions and disorders

c.c. Endocrine dysfunctionsEndocrine dysfunctions

d.d. Toxins (e.g. alcohol)Toxins (e.g. alcohol)

e.e. Somatic disorders (e.g. diabetic Somatic disorders (e.g. diabetic Ketoacidosis)Ketoacidosis)

Biopsychosocial Biopsychosocial ApproachApproach

2. 2. Psychological featuresPsychological features

a. Life experiencea. Life experience

b. Memory storesb. Memory stores

c. Unconscious processesc. Unconscious processes

d. Thinking patternsd. Thinking patterns

Biopsychosocial Biopsychosocial ApproachApproach

3. 3. Social featuresSocial features

a. Cultural effectsa. Cultural effects

b. Family settingb. Family setting

c. Occupationc. Occupation

d.d. Interpersonal relationshipInterpersonal relationship

e. Spiritual lifee. Spiritual life

f. f. ValuesValues

The Human Costs of Mental The Human Costs of Mental Illness and Addictive Illness and Addictive Disorders -Stigma-Disorders -Stigma-

StigmaStigma

Stigma, fear, and embarrassment are Stigma, fear, and embarrassment are universally associated with mental universally associated with mental illness.illness.

Many Americans with treatable psychiatric Many Americans with treatable psychiatric disorders refuse to seek care.disorders refuse to seek care.

A survey conducted by the A survey conducted by the National Mental Health National Mental Health

Association (NHMA) Association (NHMA) of 1022 adults found:of 1022 adults found:

1.1. Half of American adults reported that they or a Half of American adults reported that they or a family member have suffered from depression.family member have suffered from depression.

2.2. Forty-three percent see depression as a Forty-three percent see depression as a “personal weakness,” with another 11% “personal weakness,” with another 11% uncertain whether it is a personal weakness or uncertain whether it is a personal weakness or a health problem.a health problem.

3.3. Two-thirds of those suffering from depression Two-thirds of those suffering from depression will not seek treatmentwill not seek treatment..

Due to Emotional Weakness

71%

Caused by Bad Parenting

65%

Victim’s Fault; Can will it Away

45%

Incurable

43%

35%

Has Biological Basis; Involves the Brain

10%

Consequence ofSinful Behavior

Public Perceptions of Mental Public Perceptions of Mental IllnessIllness

The Good News About Mental The Good News About Mental Illness and PsychiatryIllness and Psychiatry

• Through neuroscience discovery, important Through neuroscience discovery, important knowledge is being gained about the causes knowledge is being gained about the causes and effective treatments of psychiatric and effective treatments of psychiatric disorders.disorders.

• Examples: 70% of the people with manic Examples: 70% of the people with manic depression respond dramatically to lithium depression respond dramatically to lithium treatment.treatment.

• The use of lithium has been estimated to The use of lithium has been estimated to have saved $6.5 billion annually in have saved $6.5 billion annually in treatment costs alone.treatment costs alone.

The Good News About The Good News About Mental Illness and Mental Illness and

PsychiatryPsychiatry

• Between 80-90% of individuals Between 80-90% of individuals suffering from major depression suffering from major depression respond fully to psychiatric respond fully to psychiatric treatment that includes both treatment that includes both medications and counseling.medications and counseling.

The Good News About The Good News About Mental Illness and Mental Illness and

PsychiatryPsychiatry• Increasingly neuroscience research is Increasingly neuroscience research is

shedding light as to the causes of such shedding light as to the causes of such illnesses as Alzheimer’s disease, illnesses as Alzheimer’s disease, schizophrenia, and even alcoholism and schizophrenia, and even alcoholism and other substance use disorders.other substance use disorders.

• These discoveries open the way to These discoveries open the way to innovative pharmacologic and other innovative pharmacologic and other types of biological interventions.types of biological interventions.

The Promise of Biological The Promise of Biological ResearchResearch

1. Genetics1. Geneticsa.a. Localization on chromosomes of the Localization on chromosomes of the

genetic bases of specific psychiatric illnessgenetic bases of specific psychiatric illness

b.b. Unlock physiological processes by which Unlock physiological processes by which genes “trigger” psychiatric disordersgenes “trigger” psychiatric disorders

c.c. Development of tests to diagnose people Development of tests to diagnose people at risk of transmitting severe psychiatric at risk of transmitting severe psychiatric disordersdisorders

d.d. Development of more specific Development of more specific interventionsinterventions

The Promise of Biological The Promise of Biological ResearchResearch

2. Neuroscience Discovery2. Neuroscience Discoverya. Major technological advances in neuroscience a. Major technological advances in neuroscience

research will be applied to psychiatric research will be applied to psychiatric questions such as the development of questions such as the development of pharmacologic and electrophysiologic pharmacologic and electrophysiologic treatments.treatments.

b.b.Example-Deep Brain Stimulation for major Example-Deep Brain Stimulation for major depression and OCD.depression and OCD.

The Promise of Biological The Promise of Biological ResearchResearch

3. Brain Imaging3. Brain Imaginga.a.Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI)

b. Regional Cerebral Blood Flow (RCBF)b. Regional Cerebral Blood Flow (RCBF)

c. Positron Emission Tomography (PET)c. Positron Emission Tomography (PET)

d. Single Photon Emission Computer d. Single Photon Emission Computer Tomography (SPECT)Tomography (SPECT)

Views of the BrainViews of the Brain

Left Motor Cortex Left Motor Cortex ActivationActivation